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At least 1,711 records · Page 95Linked to original sources
PubMed2005

[Radial neurotomy of the optic nerve in central retinal vein occlusion (case reports)].

The basic aim of this paper is to introduce the case reports of two patients with the ischaemic form of the central vein occlusion with very low preoperative best-corrected visual acuity (BCVA) and with very unfavorable prognosis, treated by means of radial neurotomy of the optic nerve disc (RNO) during the pars plana vitrectomy (PPV). Radial neurotomy of the optic nerve disc (RNO) was performed in two patients with ischaemic form of the central vein occlusion with very unfavorable prognosis during the pars plana vitrectomy in the nasal part of the rim of the optic nerve disc between nasal retinal vascular arcades with specially designed knife (Spaide CRVO knife), as described by Opremcak. The surgery was supplemented with the peeling of the epiretinal membranes and inner limiting membrane, using the Membrane blue. Both eyes were due to uncomplicated course of the operations left without the inner tamponade. RNO represents surgical treating method reserved for ischaemic CRVO with unfavorable prognosis. The key role in the pathological physiology of the RNO plays not only the breaking of the compartment system, but also acceleration of the collateral chorioretinal circulation, as we observed in both of our patients. The BCVA in the first patient improved from 1/50 (0.02 or 3/150) to 3/50 (0.06 or 20/333), and in the second one from 1/50 (0.02 or 3/150) to 5/30 (0,17 or 20/120). In both patients, the retinal hemorrhages and the edema markedly resorbed, the dilatation of the venous vessels disappeared as well as the edema of the optic nerve disc. The region of the scar after the neurotomy remained quiet without signs of retinal or choroidal neovascularizations. The authors demonstrate on their own case reports the efficacy of the RNO in two patients with prognosticaly unfavorable ischaemic form of the BRVO. The RNO seems to be a promising method suitable for the treatment in prognosticaly unfavorable ischaemic forms of the BRVO.

Aged↗
PubMed1999

Causes of severe visual loss in the early treatment diabetic retinopathy study: ETDRS report no. 24. Early Treatment Diabetic Retinopathy Study Research Group.

PURPOSE: To describe the causes of and risk factors for persistent severe visual loss occurring in the Early Treatment Diabetic Retinopathy Study (ETDRS). METHODS: The ETDRS was a randomized clinical trial investigating photocoagulation and aspirin in 3,711 persons with mild to severe nonproliferative or early proliferative diabetic retinopathy. Severe visual loss, defined as best-corrected visual acuity of less than 5/200 on at least two consecutive 4-month follow-up visits, developed in 257 eyes (219 persons). Of these 257 eyes, 149 (127 persons) did not recover to 5/200 or better at any visit (persistent severe visual loss). Ocular characteristics of these eyes were compared with those of eyes with severe visual loss that improved to 5/200 or better at any subsequent visit. Characteristics of patients with severe visual loss that did and did not improve and those without severe visual loss were also compared. RESULTS: Severe visual loss that persisted developed in 149 eyes of 127 persons. In order of decreasing frequency, reasons recorded for persistent visual loss included vitreous or preretinal hemorrhage, macular edema or macular pigmentary changes related to macular edema, macular or retinal detachment, and neovascular glaucoma. Compared with all patients without persistent severe visual loss, patients with persistent severe visual loss had higher mean levels of hemoglobin A1c (10.4% vs 9.7%; P = .001) and higher levels of cholesterol (244.1 vs 228.5 mg/dl; P = .0081) at baseline. Otherwise, patients with persistent severe visual loss were similar to patients with severe visual loss that improved and to those without severe visual loss. CONCLUSIONS: Persistent severe visual loss was an infrequent occurrence in the ETDRS. Its leading cause was vitreous or preretinal hemorrhage, followed by macular edema or macular pigmentary changes related to macular edema and retinal detachment. The low frequency of persistent severe visual loss in the ETDRS is most likely related to the nearly universal intervention with scatter photocoagulation (either before or soon after high-risk proliferative diabetic retinopathy developed) and the intervention with vitreous surgery when clinically indicated.

Aspirin↗
PubMed2004

massive peripapillary subretinal neovascularization: an indication for submacular surgery.

PURPOSE: To describe the course and outcome of three consecutive patients with massive peripapillary subretinal neovascularization secondary to ocular histoplasmosis syndrome managed with submacular surgery. METHODS: Three eyes of three consecutive patients with progressive and massive peripapillary subretinal neovascularization secondary to ocular histoplasmosis syndrome were treated with submacular surgery and followed up for a mean of 41 months (range, 11-59 months). The main outcomes were surgical complications, visual acuity, and subretinal membrane recurrence. RESULTS: Visual acuity improved in each patient from counting fingers, 20/25, and 20/400 preoperatively to 20/50, 20/20, and 20/20, respectively, at the last follow-up visit. With respect to complications, Patient 3 was found to have an operculated retinal tear approximately 1 month postoperatively, which was successfully treated with argon laser retinopexy. There were no cases of visually significant cataract, rhegmatogenous retinal detachment, or recurrent choroidal neovascularization in any of the operated eyes during the period of follow-up. CONCLUSIONS: Submacular surgery proved safe and beneficial in this small series of young patients with massive peripapillary subretinal neovascularization secondary to ocular histoplasmosis syndrome and should be considered in this relatively uncommon clinical presentation.

Adult↗
PubMed1985

Photofield mapping in the evaluation and management of subretinal neovascularization.

Photofield mapping is a useful method for classifying subretinal neovascularization based on its area and location. Careful central field mapping is performed to delineate scotomata during evaluation of patients with subretinal new vessels. A photofield map is then constructed by projecting 35 mm fundus photographs and angiograms onto an appropriately-oriented central visual field map. The composite map (photofield) documents the location and relationship of scotomata, subretinal neovascularization, foveal avascular zone, and retinal blood vessels. The areas of subretinal neovascularization and scotomata are measured in square millimeters with a planimeter. The distance between their closest edge and the center of the foveal avascular zone is measured in millimeters. This method permits quantitative comparison of results with different photocoagulation protocols and instrumentation. Such comparative analysis may help improve the technique and instrumentation used in laser photocoagulation of subretinal neovascularization.

Adult↗
PubMed1997

In vivo photoactivation of caged-thrombin.

Aberrant ocular neovascularization is a major cause of blindness in the world. Abnormal blood vessels in the eye may produce corneal opacification, corneal transplant rejection, neovascular glaucoma, vitreous hemorrhage, traction retinal detachment, and subretinal scars from choroidal neovascular membranes (1-5). Light-induced clotting of blood within these abnormal vessels could provide a novel method for the ablation of deleterious neovascularization. Thrombin is a serine proteinase that participates in the final stages of the coagulation cascade. An inhibitor of thrombin, p-Amidinophenyl-(E)-4-diethylamino-2-hydroxy-alpha-methylcinnamate hydrochloride, MeCINN (1), covalently attaches to the active site serine hydroxyl, inhibiting or caging, the enzyme. Photolysis of the caged-thrombin in vitro causes a trans-cis isomerization of MeCINN which leads to regeneration of active enzyme and cleaving of fibrinogen into fibrin (6). Using a rabbit model of corneal neovascularization, we found that light at 366 nm safely and effectively photoactivates intravenous caged-thrombin and produces localized thrombosis in vivo. These results suggest that intravascular photoactivation of caged-thrombin could be used to occlude abnormal blood vessels in the human eye.

Animals↗
PubMed1998

Rubeosis iridis after vitrectomy for diabetic retinopathy.

BACKGROUND: Iris rubeosis and neovascular glaucoma (NVG) are serious complications of vitrectomy for proliferative diabetic retinopathy. The present study analyzes incidence and risk factors of these complications. METHODS: Preoperative and postoperative iris rubeosis were compared in 389 diabetic eyes after vitrectomy. Minimum follow-up was 6 months (median 26 months). Risk factors were studied using multivariate logistic regression analysis. RESULTS: Following vitrectomy, in 8.5% of the eyes stromal iris rubeosis developed de novo; NVG occurred in 5%. Significant risk factors for postoperative rubeosis were preexisting iris neovascularizations and postoperative retinal detachment. Six months after surgery, regression of preexisting iris rubeosis was observed in 57% of the eyes. In eyes without preoperative iris rubeosis, progression was found in 13% of cases 6 months postoperatively. CONCLUSION: With current surgical techniques iris rubeosis is more commonly regressive than progressive after vitreous surgery in diabetic eyes.

Adult↗
PubMed1999

Eales' disease: increased oxidation and peroxidation products of membrane constituents chiefly lipids and decreased antioxidant enzymes and reduced glutathione in vitreous.

PURPOSE: To measure the levels of oxidation and peroxidation products of membrane constituents chiefly lipids produced by oxygen and lipid free radicals as thiobarbituric acid reacting substances (TBARS), reduced glutathione (GSH) and the antioxidant enzymes, superoxide dismutase (SOD) and glutathione peroxidase (GP) in vitreous samples from patients with Eales' disease and estimate GSH, SOD, GP in the erythrocytes of patients with Eales' disease with active perivasculitis and healed perivasculitis. METHODS: Vitreous samples on vitrectomy from 11 patients with Eales' disease and 11 patients with diabetic vitreous hemorrhage were used for comparison. For study on erythrocytes, 30 patients of Eales' disease at the active vasculitis stage (group-I), 33 of healed vasculitis stage (group-II) and 25 controls (group-III) were used. The male female ratio was kept the same among the patients and the controls. Oxidation and peroxidation products of membrane constituents chiefly lipids were estimated as TBARS, SOD by its activity to inhibit auto-oxidation of epinephrine, GP by estimating the reduction in the level of GSH and GSH by its colour reaction with 5,5'-dithio bis (2-nitro) benzoic acid (DTNB). RESULTS: TBARS were increased 6 fold in the vitreous of Eales' patients compared to the samples from those with diabetic vitreous hemorrhage while there was a reduction of 95.9% of SOD and 84.2% of GSH. Activity of SOD, GP and the levels of GSH in the erythrocytes were reduced (%) by 81.6, 65 and 56.5 respectively in group I and 22,46.4 and 29.2% respectively in group II. The values are statistically significant. CONCLUSIONS: Increased levels of TBARS and decreased levels of SOD and GSH in the vitreous could explain inflammation, retinal damage and neovascularization in patients with Eales' disease. Decrease of SOD, GP and GSH is found in erythrocytes both in the active perivasculitis stage and the healed perivasculitis stage. Treatment of Eales' disease with antioxidants vitamin E, C as also vitamin A may have a beneficial effect.

Adult↗
PubMed2000

Corticosteroid therapy for optic disc neovascularization secondary to chronic uveitis.

PURPOSE: To report successful corticosteroid treatment of optic disc neovascularization associated with uveitis. METHODS: Retrospective review of medical records. RESULTS: Nine patients were identified with chronic uveitis and optic disc neovascularization without clinical or angiographic evidence of retinal ischemia. Ages ranged from 14 to 37 years (median age, 27). All patients were treated with either oral and/or subtenon's corticosteroids. Partial regression of the neovascularization was observed in all patients within 2 to 6 weeks (median, 5 weeks) after initiating treatment. Eight of nine patients had complete resolution of disc neovascularization at a median of 3 months (range, 2 to 42 months) after initiation of treatment and a median follow-up of 24 months (range, 7 to 144 months). Recurrence of disc neovascularization occurred in two patients, but it regressed again after further corticosteroid therapy. CONCLUSIONS: Optic disc neovascularization may occur in patients with chronic uveitis in the absence of retinal ischemia. This neovascularization can be successfully treated with corticosteroids.

Administration, Oral↗
PubMed1989

Long-term visual results of vitreous surgery in diabetic eye disease.

Long-term visual results in the first 124 consecutively vitrectomized eyes of 105 diabetic patients in our department were evaluated. The indications for vitrectomy were unresorbable vitreous haemorrhage (77 eyes, 62%) (group A), central traction retinal detachment (21 eyes, 17%) (group B), and a combination of both (26 eyes, 21%) (group C). Initially visual acuity (VA) improved at least by one category in 83 eyes (67%). The latest postoperative VA after the mean follow-up of 3.7 +/- 0.2 years was greater than = 0.3 in 36 eyes (29%), 0.1-0.25 in 15 eyes (12%), 0.05-0.08 in 9 eyes (7%), counting fingers (CF) 1-less than 3 m in 13 eyes (11%), and less than CF 1 m in 51 eyes (41%). The latest VA of 0.3 or better was significantly more common in group A (40%) than in group B (10%) or group C (12%) (P = 0.0087 and 0.0076, respectively). The most common causes of visual failure (VA less than C F 1m) were neovascular glaucoma and/or retinal detachment. At the latest follow-up visit 50% of the patients had VA of 0.3 or better, 16% were in the low-vision category, and 34% were blind (VA less than 0.05).

Adolescent↗
PubMed1988

Photocoagulation of raised new vessels by long-duration low-energy argon laser photocoagulation--a preliminary study.

Direct laser treatment of retinal neovascularisation is indicated when regression has not been brought about by retinal photocoagulation. Current treatment regimens involve multiple laser applications to the neovascular complex. Long-duration low-energy burns have the advantage of slowly heating the tissue without engendering disruption. We report the use of this treatment as a means of occluding the feeder vessels to a neovascular network. The application of argon blue-green laser treatment at 0.1 watt for 60 seconds at two adjacent points on a feeder vessel was found to give rise to permanent vascular occlusion without causing complications.

Adult↗
PubMed2003

[Surgical arteriovenous decompression (sheathotomy) in branch retinal vein occlusion: retrospective study].

PURPOSE: To evaluate best-corrected visual acuity (BCVA), incidence of neovascularization and angiographic changes in patients with branch retinal vein occlusion (BRVO) treated with surgical decompression by sheathotomy. METHODS: Retrospective study including 17 cases of temporal BRVO with macular edema treated with surgical decompression. Results of BCVA, incidence of neovascularization and vitreous hemorrhage 6 months following surgery are included. Angiographic changes in the first 8 cases a month after decompression are also evaluated. RESULTS: The mean postoperatory BCVA was 0.40 with a mean improvement of 0.26. Seventy one percent of patients (12/17) improved 2 or more visual acuity lines and 53% of patients (9/17) improved 4 or more lines. Only in one case the vision worsened. There was no evidence of retinal neovascularization or rubeosis iridis six months after surgery. CONCLUSIONS: Surgical decompression is a therapeutical option for those patients suffering BRVO with macular edema. Our initial results are encouraging, not only regarding visual acuity improvement, but also because of a decreased risk of neovascularization. No patient included in our study developed neovascularization.

Decompression, Surgical↗
PubMedDate not supplied

Intravitreal triamcinolone acetonide for acute radiation papillopathy.

OBJECTIVE: To evaluate intravitreal triamcinolone acetonide for patients with visually symptomatic acute radiation-induced papillopathy. METHODS: In a prospective, nonrandomized, single-center case series, intravitreal triamcinolone acetonide (4 mg/0.1 mL) was injected through the pars plana using sterile technique in 9 patients with radiation papillopathy after plaque radiotherapy for choroidal melanoma. Status of radiation papillopathy and final visual acuity were the main outcome measures. RESULTS: At the time of diagnosis of the choroidal melanoma, visual acuity was 20/20 to 20/40 (n = 6), 20/60 (n = 2), and 20/100 (n = 1). The mean radiation dose to the optic disk was 6,175 cGy (median, 5,994 cGy; range, 3,571-12,760 cGy). Radiation papillopathy developed a mean of 18 months (median, 17 months; range, 6-33 months) after plaque radiotherapy. In all cases, the choroidal melanoma was regressed, and there was no retinal detachment or neovascularization of the retina, optic disk, or iris. Concomitant radiation maculopathy was found in 8 eyes manifesting as macular edema (n = 8), intraretinal dot hemorrhages (n = 6), intraretinal exudation (n = 6), or nerve fiber layer infarction (n = 3). The radiation papillopathy findings included optic disk hyperemia (n = 9), edema (n = 9), and circumpapillary hemorrhage (n = 8). At the time of diagnosis of radiation papillopathy, visual acuity was 20/70 (n = 1), 20/100 (n = 4), 20/200 (n = 1), and counting fingers (n = 3). At 1 week after injection of triamcinolone acetonide, visual acuity improvement was found in seven patients, and resolution of optic disk hyperemia and edema was noted for four and three patients, respectively. At a mean follow-up of 11 months (median, 9 months; range, 6-19 months), visual acuity was stable or improved in 7 patients, and resolution of optic disk hyperemia and edema was found in all 9 patients. The mean time to improvement in visual acuity by > or =2 lines was 3 weeks (median, 1 week; range, 1-12 weeks). The mean time to complete resolution of radiation papillopathy was 4 months. The two patients with worse final visual acuity also had macular hole and central retinal vein obstruction. The only complication of this therapy was possibly related cataract in three patients. CONCLUSION: During short-term follow-up, acute radiation-induced papillopathy appears to respond rapidly to intravitreal triamcinolone acetonide injection with resolution of optic disk hyperemia and edema and modest return of visual acuity. The long-term effects remain unknown.

Acute Disease↗
PubMed1991

[Analysis of 52 cases of retinal vein occlusion treated with laser photocoagulation].

41 of 52 cases of retinal vein occlusion (RVO) treated with laser photocoagulation were followed up for 3-30 months. Visual prognosis was good for patients of branch RVO, while visual improvement was not much for central RVO; however, the treatment could prevent or combat neovascularization and in turn neovascular glaucoma. Laser photocoagulation therapy of RVO was effective and few complications occurred if performed at an opportune time with an optimal wavelength or combination of wavelengths, and periodical follow-up and fluorescein angiography were useful in promoting the rate of successful operations.

Adult↗
PubMedDate not supplied

Intravitreal triamcinolone acetonide for radiation maculopathy after plaque radiotherapy for choroidal melanoma.

OBJECTIVE: To evaluate the effect of intravitreal triamcinolone acetonide on patients with visually symptomatic radiation-induced maculopathy after plaque radiotherapy for choroidal melanoma. DESIGN: In this prospective, nonrandomized, single-center case series of 31 patients with visually symptomatic radiation-induced maculopathy after plaque radiotherapy for choroidal melanoma at the Ocular Oncology Service at Wills Eye Hospital of Thomas Jefferson University, triamcinolone acetonide (4 mg/1 mL) was injected through the pars plana into the vitreous cavity using sterile technique. Status of radiation maculopathy and final visual acuity were the main outcome measures. RESULTS: At the time of diagnosis of choroidal melanoma, visual acuity was 20/20 to 20/50 in 90% (n = 28), 20/60 to 20/200 in 10% (n = 3), and 20/400 or worse in none of the patients. The mean radiation dose to the foveola was 5,122 cGy (median, 3,280 cGy; range, 1,000-16,100 cGy). Radiation maculopathy developed at a mean of 22 months (median, 16 months; range, 6-96 months) after plaque radiotherapy. In all cases, the choroidal melanoma was regressed, and there was no retinal detachment or neovascularization of the retina, optic disk, or iris. At the time of diagnosis of radiation maculopathy, visual acuity was 20/20 to 20/50 in 19% (6/31), 20/60 to 20/200 in 58% (18/31), and 20/400 or worse in 23% (7/31) of patients. After intravitreal injection of triamcinolone acetonide, visual acuity was stable or improved in 91% (20/22) of patients by 1 month and 45% (14/31) by 6 months. Mean foveal thickness by optical coherence tomography was 417 microm at injection and 207 microm at 1 month and 292 microm at 6 months after injection. CONCLUSIONS: Intravitreal triamcinolone acetonide can stabilize or improve visual acuity in some patients with radiation-induced maculopathy, but its effect might not be lasting.

Adult↗
PubMed2005

[cSLO digital fundus autofluorescence imaging].

BACKGROUND: Fundus autofluorescence (FAF) originates from age- and disease-dependent accumulation of lipofuscin in the lysosomal compartment of the retinal pigment epithelium (RPE). FAF imaging is a noninvasive method to detect intrinsic RPE fluorescence in vivo. We describe features of a novel confocal scanning laser ophthalmoscope (cSLO) for FAF imaging and compare images to the previous cSLO system. METHODS: FAF images were obtained with a cSLO using an optically pumped solid state laser (OPSL) instead of an argon laser for generation of excitation light at 488 nm. For detection of emitted FAF signals >500 nm a barrier filter was used. RESULTS: The novel cSLO allows FAF imaging with a resolution of up to 5 microm/pixel to delineate normal and pathological features in various retinal pathologies including early-stage and advanced atrophic or neovascular age-related macular degeneration, macular edema, and retinal dystrophies. Further technical improvements include an internal fixation target and an enlarged optical focus adaption range. CONCLUSIONS: Improved image quality using the novel cSLO for FAF imaging is of clinical relevance for diagnosis and precise phenotyping of retinal diseases. This method may also be useful to monitor therapeutic effects targeting RPE lipofuscin accumulation as a common pathogenetic pathway in various degenerative and hereditary retinal diseases.

Aged↗