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PubMedDate not supplied

The rationale of argon green laser photocoagulation for diabetic maculopathy.

Eighty-four patients of bilateral diabetic retinopathy were divided into 2 groups: Group I comprised of 60 patients (mean age 46 yrs) having non-proliferative diabetic retinopathy with maculopathy (total no. of eyes = 120). Group II consisted of 24 patients (mean age 49.1 yrs) with proliferative diabetic retinopathy with maculopathy (total no. of eyes under study = 48). One eye of each patient in group I was treated as a control and the other was subjected to focal laser therapy. While 48/60 control Group I eyes (80%) had 6/24 vision at the outset, at one year follow-up only 39/60 cases (65%) had 6/24 vision. Diabetic maculopathy persisted in all the 60 control eyes at one year. In contrast, 44/60 eyes (73%) subjected to focal laser therapy in Group I, had 6/24 vision at outset but one year later, 49/60 eyes (81%) had 6/24 vision. Maculopathy completely regressed in 48/60 eyes (80%). The 48 eyes of Group II patients were subjected to focal and scatter laser therapy. 20/48 eyes (41.6%) had 6/24 vision prior to treatment but one year after treatment, 25/48 eyes (52%) had 6/24 vision. Neovascularization and macular edema regressed after one year in 42/48 eyes (87.1%) and only 4/48 eyes (8.3%) developed localized vitreous hemorrhage. Laser therapy in Group I improved visual acuity by reducing macular edema. In Group II, it improved the vision and reduced the risk of vitreous hemorrhage, detachment and glaucoma.

Adult↗
PubMed1998

The risk of missing angle neovascularization by omitting screening gonioscopy in acute central retinal vein occlusion.

OBJECTIVE: The purpose of the study was to determine whether angle neovascularization can occur without pupillary margin neovascularization in central retinal vein occlusion (CRVO). DESIGN: The study design was a prospective study of the main question and a retrospective study of ancillary issues. PARTICIPANTS: The authors examined 105 eyes of 100 patients with CRVO having clinical evidence of ischemia between July 1, 1986, and March 18, 1996. INTERVENTION: The authors looked for iris and angle neovascularization with both undilated slit-lamp biomicroscopy and Zeiss four-mirror gonioscopy. MAIN OUTCOME MEASURES: The presence of anterior segment neovascularization was measured. RESULTS: Of 34 eyes developing anterior segment neovascularization, 4 (12%) developed angle neovascularization without pupillary margin neovascularization over a mean follow-up of 2.2 +/- 2.4 standard deviation years. CONCLUSIONS: Angle neovascularization can occur without pupillary margin involvement in CRVO, implying the necessity of screening gonioscopy and supporting the Central Vein Occlusion Study conclusion (based on a photographic technique not used clinically).

Acute Disease↗
PubMed2002

[Dynamic angiography in age related macular degeneration].

PURPOSE: To evaluate the utility of dynamic angiography with fluorescein and indocyanine green with scanning laser ophthalmoscope (SLO) in exudative age-related macular degeneration. METHOD: We retrospectively studied 95 patients with exudative age-related macular degeneration (ARMD) between April 98 and April 01. RESULTS: We studied 102 eyes of 95 patients with ARMD. Mean age was 75.3 years with a mean follow-up time of 16.8 months. We found an occult or mixed angiographic membrane pattern with fluorescein angiography in 85 eyes (83.3%). Angiography with indocyanine green showed choroidal neovascular membranes in 94 of 102 eyes (92.1%). The most frequent location found was sub-foveal (53.2%). Laser photocoagulation was used in 55 eyes and photodynamic therapy in 5 eyes. In 17 eyes laser treatment failed to close the membrane. CONCLUSION: Dynamic angiography with fluorescein or indocyanine green allowed neovascular membrane identification in more than 90% of the cases of ARMD. Successful treatment was achieved in 42% of cases.

Aged↗
PubMed1990

[Peripheral neovascularization of the retina in diabetic retinopathy: fluorescein angiography classification and results of panretinal laser treatment].

The prospective study reported here was based on 105 diabetic eyes with "new vessels elsewhere" (NVE), treated exclusively by panretinal laser application and followed up for 2.5 to 4 years. Fundus angiography was performed before treatment. The eyes were then classified in four categories according to the extent and location of capillary nonperfusion responsible for the NVE, namely 1) generalized ischemia (Type A); 2) extensive midperipheral ischemia (Type B); 3) moderate midperipheral ischemia (Type C); and 4) peripheral ischemia (Type D). Analysis of the neovascularization distribution pattern showed that NVE alone existed only in Type D, whereas in the other three types the neovascularization was present either only in the retina or in both the retina and the optic disk. This mixed vascularization was 100% in Type A, 71% in Type B, 31% in Type C, and nonexistent in Type D. Statistical analysis revealed a significant correlation between the type of ischemia and the location of the new vessels. The therapeutic results 3-4 months, 1 year, and 2.5-4 years after intervention showed a significant trend toward an increase in the number of eyes with recurrences when moving from Type D to Type A. This means that the prognosis of NVE after panretinal laser coagulation depends mainly on the type of retinal ischemia. The poorest prognosis is that for generalized ischemia (Type A), followed in descending order by Types B, C, and D. The critical period for increased recurrence in cases which initially responded positively to treatment is primarily in the first 3-4 months following the intervention.

Adult↗
PubMed2000

[Experimental model of subretinal neovascularization].

PURPOSE: To study the effect of transpupillary photocoagulation with a diode laser in the development of an experimental model of choroidal neovascularization (CNV) in the pigmented rat. METHODS: Diode laser was applied in Long-Evans rats using a setting of 75 microm spot size, 0.05 seconds durations and 200 mW intensity. Follow up was performed by fundus photography and fluorescein angiography that was performed weekly. The animals were sacrificed 7, 14, 21, 30, 45, 52, 60 and 75 days after photocoagulations, the eyes were enucleated and studied by light microscopy. RESULTS: Variation in burn intensity and diameter was common. During the experiment 42 of 93 burns (45%) showed fluorescein staining and late leakage. Neovascularization was confirmed with histopatology in all lesions that showed fluorescein leakage. CONCLUSIONS: Transpupillary diode laser may induce CNV in the pigmented rat. This model may be useful in the in vivo study of choroidal angiogenesis and its therapeutic modulation.

Animals↗
PubMedDate not supplied

[Treatment of choroidal neovascularization in degenerative myopia].

Choroidal neovascularization is quite frequent in degenerative myopia. If the neovascularization is near the center, a krypton laser photocoagulation can be effected. If they reach the center, no photocoagulation should be effected. We report here our results in the treatment by krypton laser and describe a simple technic for the determination of the exact position of the foveola, that can be displaced in degenerative myopia.

Adult↗
PubMed1989

[Multifocal choroiditis: diagnostic aspects and results of photocoagulation. Apropos of 25 cases].

A retrospective study was conducted on 25 patients who presented with both recurrent multifocal choroiditis and subretinal neovascularisation. As in other series, striking features were the young age of the patients (mean age 33 years), frequent recurrences of the macular lesions during a limited follow-up period, inflammation of the vitreous or the optic disk, and macular fibrosis. However, unlike previously reported data, refraction was more often in the emetropic range, there was no female predominance, and inflammatory signs were mild or limited to papillitis. Moreover serologic tests did not indicate an acute infection due to Epstein-Barr virus in any of the patients. This study also emphasized the results of Krypton laser treatment of the subretinal neovascularisation. Final visual acuity improved or remain the same in 26 eyes (72%) and worsened in 11 eyes (28%) during a mean follow-up period of 13 months (range 2-48 months). The best results were obtained in 15 eyes with neovascular membranes located more than 200 mu from the foveal avascular zone (mean final visual acuity: 20/40). However the mean final visual acuity of the nine eyes with neovascular membranes closer than 200 mu from the FAZ, was over 20/60. Recurrences of subretinal neovascularisation occurred in 7 out of 24 treated eyes and 3 were under the center of the FAZ. These results should be confirmed by a randomized prospective clinical trial in order to assess the benefits of laser treatment in recurrent multifocal choroiditis.

Adult↗
PubMed1998

[Senile macular degeneration].

The most frequent cause of severe visual deficiency in old age is degeneration-related neovascularization beneath the site of maximum visual discrimination. To date, the therapeutic possibilities are limited, but new methods of examination and treatment give reason for cautious optimism. In recent years, the condition has increased dramatically and, mild cases included, now affects some 20% of over-70-year-olds. A basic knowledge of this degeneration should therefore be required of every family doctor.

Aged↗
PubMed2001

Malattia leventinese presenting with subretinal neovascular membrane and hemorrhage.

PURPOSE: To report a case of malattia leventinese involving subretinal hemorrhage. METHODS: Case report. RESULTS: Two weeks after initial presentation, the visual acuity of this 34-year-old man decreased to LE: 20/100. Funduscopic evaluation revealed a subretinal hemorrhage involving the center of the foveal in the left eye that was interpreted as secondary to a neovascular membrane on fluorescein angiography. The patient did well after the removal of the submacular material by pars plana vitrectomy. CONCLUSION: Patients with malattia leventinese may occasionally present with submacular hemorrhage. Prompt diagnosis and intervention may enhance the patient's chance for visual improvement.

Adult↗
PubMedDate not supplied

Subretinal neovascularization associated with retinochoroidal coloboma.

PURPOSE: To report a case of subretinal neovascularization associated with retinochoroidal coloboma. METHODS AND RESULTS: A 44-year-old female presented with metamorphopsia in her right eye for 4 weeks. Funduscopic examination revealed bilateral inferior retinochoroidal coloboma. Fluorescein angiography disclosed foci of subretinal neovascularization at the margin between the colobomatous defect and the normal-appearing retina. Five month later, multiple small areas of subretinal hemorrhages were noted. The hemorrhage was gradually absorbed. Six years after initial presentation, subretinal hemorrhage did not recur and her right VA was 0.2. CONCLUSIONS: Ophthalmologists should be aware of this rare but important complication of retinochoroidal coloboma.

Adult↗
PubMed1993

[The macula lutea in myopia].

High or degenerative myopia is associated to abnormalities of the posterior pole of the eye. Their expansion with time progresses to the occurrence of complications, especially neovascular ingrowth in the central macular area. The natural evolution of these new vessels results in loss of central vision at long term. Photocoagulation of the new vessels, sparing initially the center, has delayed the loss of central vision at 2 years in our randomized clinical trial. Only treated eyes retained useful acuity at 5 years. New therapeutic modalities will be possible when the mechanisms of occurrence of degenerative myopia are elucidated.

Humans↗
PubMed1996

[Surgical removal of submacular neovascularization membranes].

UNLABELLED: New techniques for vitreoretinal surgery enable the removal of submacular neovascular membranes inaccessible to laser coagulation. The present study describes the anatomical and functional results following membrane removal. PATIENTS: Between January 1994 and June 1995, submacular neovascular membranes were removed from 56 eyes with age-related exudative macular degeneration. Thirty-one eyes had classic subfoveal membranes; 19, occult membranes; and 6 eyes, disciform fibrotic changes that had already persisted for more than 6 months. RESULTS: Surgery led to improved vision in 20 of the 56 eyes (36%). In 26 of the 56 eyes (44%) vision at the last follow-up was no different from preoperative vision: in 10 eyes (17%) visual acuity declined. In the group of 6 eyes with a 6-month history of exudative maculopathy, surgery produced a slight improvement in vision in most patient. Complications arose in 8 of the 56 eyes (14%), namely choroidal hemorrhage (2 eyes), a macular hole (1 eye), and peripheral retinal detachment (5 eyes). Recurrence of the membrane was seen in 5 eyes (9%). CONCLUSION: Surgical removal of submacular membranes can often lead to stabilization or even improvement of vision. Owing to the relatively high rate of complications, however, the indications must be rigorously appraised on a case-by-case basis.

Aged↗
PubMed2002

Current treatment of retinoblastoma.

Chemotherapy has recently achieved a major role in the primary management of intraocular retinoblastoma. Tumor reduction by first-line chemotherapy (chemoreduction) followed by local treatments is now accepted as treatment strategy for intraocular retinoblastoma with the goal of avoiding external beam radiotherapy (EBRT) or enucleation. Although efficient in reducing tumor volume, chemotherapy cannot cure retinoblastoma. Different chemoreduction protocols are used to shrink the tumor, making it treatable with cryotherapy, laser photocoagulation, thermotherapy, and plaque radiotherapy. Systemic chemotherapy used with local ophthalmic therapies during or after the chemotherapy can eliminate the need for enucleation or external beam radiotherapy in Reese-Ellsworth group 1, 2, or 3 retinoblastoma. This combination is not sufficient to obtain tumor control in most eyes with large tumors and diffuse vitreous and subretinal seeds (Reese-Ellsworth group 4 and 5 tumors), and EBRT or enucleation is eventually required. The resultant visual acuity after globe-conserving therapies in those eyes with Reese-Ellsworth group 4 and 5 tumors is often poor. Preliminary results of a phase I/II study of subconjunctival carboplatin injection are encouraging. Enucleation is still recommended in situations such as eyes containing large tumors, long standing retinal detachment, neovascular glaucoma, pars plana tumor seeding, anterior chamber involvement or choroid, optic nerve or orbital tumor extension, and no expectation for useful vision. Chemoprophylaxis is necessary for patients with tumor extending to the surgical margin of the optic nerve and is likely beneficial in preventing metastases in patients with tumor extending beyond the lamina cribrosa. Intensified chemotherapy with autologous stem cell rescue appears effective for patients with metastatic retinoblastoma.

Brachytherapy↗
PubMed1999

Angiogenic factors in human proliferative sickle cell retinopathy.

BACKGROUND/AIMS: Preretinal neovascular formations called sea fans develop at the border of non-perfused peripheral retina in sickle cell retinopathy. Angiogenic factors which could contribute to their development, however, have not been examined previously. The objective of this study was to determine immunohistochemically if vascular endothelial growth factor (VEGF) or basic fibroblast growth factor (bFGF) were associated with sea fan formations. METHODS: Immunohistochemistry on cryosections was used to localise bFGF, VEGF, heparan sulphate proteoglycan, human serum albumin, collagens IV and II, and von Willebrand factor in tissue from five sickle cell and one control subject. RESULTS: The greatest immunoreactivity for VEGF and bFGF was in the feeder and preretinal vessels of sea fans (p<0.01). The most prominent reaction product was localised to vascular endothelial cells. In retinal vessels, VEGF and bFGF immunoreactivities were greater in sickle cell subjects (both proliferative and non-proliferative) than in the control subject (p<0.01 and p<0.02 respectively). In the sickle cell retina, no angiogenic factor immunoreactivity was detected in non-perfused periphery and there was no significant difference in bFGF or VEGF immunoreactivity between perfused retina and the border of perfused and non-perfused areas. CONCLUSION: Our results demonstrate for the first time that VEGF and bFGF are associated with sea fan formations in sickle cell retinopathy. Both factors may function in an autocrine manner because immunoreactivity for these factors was greater within the neovascularisation than in adjacent retina.

Adolescent↗
PubMed1992

[The operation treatment for the age-related macular degeneration wet-type eyes and its complications].

Age-related macular degeneration (AMD) is one of the important causes for blindness in elderly population. The effect of the treatments by laser and vitrectomy in AMD wet-type eyes, which subretinal neovascularization is existed in or have vitreous hemorrhage, is reported and discussed. Using laser photocoagulation, 65% of the affected eyes had marked cicatrization and 31% were partially improved. Among the 4 AMD eyes with vitreous hemorrhage, three cases were successful after vitrectomy. It has a certain significance for rescuing the vision and controlling the development in AMD wet-type eyes.

Aged↗
PubMedDate not supplied

Increased interleukin-18 content and angiogenic activity of sera from diabetic (Type 2) patients with background retinopathy.

Hyperglycaemia increases inflammatory cytokine concentration in the blood. Elevated levels of interleukin-18 (IL-18), a cytokine belonging to the interleukin-1 (IL-1) family, were recently reported in patients with Type 2 diabetes mellitus (DM2) and nephropathy. The aim of the present work was an examination of IL-18 concentration in the sera of elderly DM2 patients with nonproliferative retinopathy and age-matched control people and an estimation whether this cytokine plays pro- or anti-angiogenic role in in vivo angiogenic activity of their sera in mice cutaneous angiogenesis test. Recombinant human IL-18 injected intradermally to murine skin induced significant neovascular reaction. DM2 patients sera contained higher concentration of IL-18 and induced stronger neovascular reaction in mice skin than did the sera of corresponding control people. Sera from both groups of people after neutralization with antihuman IL-18 antibodies lost substantial part of their angiogenic activity.

Aged↗
PubMed1999

Intravitreal triamcinolone and elevated intraocular pressure.

PURPOSE: To ascertain whether intravitreal triamcinolone given for subretinal neovascularization is associated with an ocular pressure rise. METHODS: A total of 113 patients with angiographically proven subretinal neovascularization were enrolled into a prospective study of the effects of intravitrea triamcinolone. Intraocular pressure was one of the parameters studied. RESULTS: Approximately 30% of the study group developed a significant rise (> or =5 mm Hg) in intraocular pressure above baseline during the first 3 months. CONCLUSIONS: Patients considering this form of treatment should be fully informed of the known risks of intraocular injections of steroids.

Fluorescein Angiography↗