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PubMedDate not supplied

Optical coherence tomography (OCT) angiomatous prolifieration (RAP) in retinal.

PURPOSE: To verify the utility of optical coherence tomography (OCT) for diagnosing retinal angiomatous proliferations (RAP) in patients with exudative age-related macular degeneration (AMD). METHODS: Multiple cross-sections were taken with OCT from 41 eyes of 39 consecutive patients with AMD and RAP. The presence and the location of the angiomatous complexes had already been documented by fluorescein angiography (FA) and high-speed confocal indocyanine green videoangiography (ICGA). RESULTS: RAP was detectable by OCT scans in all 41 eyes, appearing as a focal hyper-reflecting area in the neuroretinal layers; it was frequently located close to the inner surface of the retinal pigment epithelium (29 eyes [70. 7%]). All eyes had either no or only a low-reflecting OCTsignal surrounding the RAP, caused by serous intraretinal edema. Only 13 eyes (31.7%), however, had large serous retinal detachment (SRD). OCT detected pigment epithelium detachment in 31 eyes (75.6%), but none had underlying choroidal neovascularization. CONCLUSIONS: OCT findings confirm the intraretinal localization of the RAP which are always associated with impressive exudative phenomena. OCT is therefore a useful diagnostic tool, adding information to FA and high-speed ICGA.

Aged↗
PubMed1986

Macular edema in association with severe carotid artery obstruction.

In seven eyes of six patients (four men and two women, 55 to 72 years old), with macular edema associated with severe carotid artery stenosis, the ipsilateral carotid obstruction was 90% or more. Concomitant fundus signs, such as midperipheral retinal hemorrhages, retinal arterial narrowing, and neovascularization of the optic disk, were observed. All eyes demonstrated leakage of fluorescein dye from the retinal vessels and optic disk.

Aged↗
PubMed1989

[Sorsby's pseudo-inflammatory macular dystrophy: laser treatment].

In 1949, Sorsby described a familial fundus disease with progressive visual loss and bilateral hemorrhages and exudates of the posterior pole. The dystrophy, whose inheritance was apparently autosomal dominant, was called pseudo-inflammatory macular dystrophy because of extensive macular lesions that could suggest a post-inflammatory change. The ophthalmoscopic signs include the presence of diffuse drusen-like deposits with extensive changes of retinal pigment epithelium and focal atrophy of the choriocapillaris, particularly in the posterior pole. Some eyes grow subretinal neovascularization, which appears associated to retinal edema, deep hemorrhages and hard exudates. These cases ultimately result in a disciform macular scar. Atrophy of peripheral fundus is typical of advanced stages. We present the case of three sisters whose fundus lesions resembled Sorsby's pseudo-inflammatory macular dystrophy. In two of them, where there was a great suspicion of macular subretinal neovascularization, the laser treatment seemed to positively condition the course of the disease. In our opinion, even though a generalized atrophy of the choroid and retina cannot probably be avoidable, laser treatment can delay the loss of central vision, by blocking the capillaries from leaking, thus preventing secondary destruction from bleeding and fibrosis.

Diagnosis, Differential↗
PubMed1987

Results and prognostic factors in vitrectomy for diabetic traction retinal detachment of the macula.

The level of final visual acuity results and the prognostic factors predictive of the level were analyzed in 360 eyes that had pars plana vitrectomy for diabetic traction retinal detachment of the macula. Fifty-nine percent of the eyes had improved visual acuity on final examination. The percentage of eyes that achieved a final visual acuity of 20/100 or better and the percentage that achieved 5/200 or better increased from 21% to 36% and from 57% to 72%, respectively, during the study. Preoperative factors associated with a favorable visual prognosis were a visual acuity of 5/200 or better, the absence of iris neovascularization, a clear crystalline lens or only minimal cataract formation, clear media or only mild vitreous hemorrhage, panretinal photocoagulation of at least one fourth of the retina, and the absence of severe preoperative retinal neovascularization. Intraoperative factors associated with a favorable visual prognosis include the avoidance of performing a lensectomy, the absence of iatrogenic retinal breaks, and the avoidance of using intraocular gas bubbles.

Adolescent↗
PubMed1986

Macular alterations secondary to intraocular inflammatory disease.

It is often the sequelae of intraocular inflammation that is most damaging to the patient's vision. Macular alterations are frequently seen and include neovascularization, both subretinal and retinal; pre-retinal membranes, particularly in young patients with recurrent vitreal hemorrhages; macular holes; and cystoid macular edema, by far the most common alteration. The goal in assessing the maculae of these patients is to determine if and what type of therapy might be applicable. In addition to fluorescein angiography, we have found that laser interferometry is a useful tool in predicting the visual outcome of patients with uveitis. Therapeutic modalities center around corticosteroids, while cyclosporine also has been found to be effective in treating cystoid edema. Vitrectomy has been suggested as a therapeutic approach to both the uveitis and cystoid edema, but this approach still needs to be more scientifically evaluated. A well-defined therapeutic approach to uveitis-induced macular changes is lacking, with well-designed clinical trials sorely needed.

Fluorescein Angiography↗
PubMed2002

A new real-time retinal tracking system for image-guided laser treatment.

A new system is proposed for tracking sensitive areas in the retina for computer-assisted laser treatment of choroidal neovascularization (CNV). The system consists of a fundus camera using red-free illumination mode interfaced to a computer that allows real-time capturing of video input. The first image acquired is used as the reference image and utilized by the treatment physician for treatment planning. A grid of seed contours over the whole image is initiated and allowed to deform by splitting and/or merging according to preset criteria until the whole vessel tree is demarcated. Then, the image is filtered using a one-dimensional Gaussian filter in two perpendicular directions to extract the core areas of such vessels. Faster segmentation can be obtained for subsequent images by automatic registration to compensate for eye movement and saccades. An efficient registration technique is developed whereby some landmarks are detected in the reference frame then tracked in the subsequent frames. Using the relation between these two sets of corresponding points, an optimal transformation can be obtained. The implementation details of proposed strategy are presented and the obtained results indicate that it is suitable for real-time location determination and tracking of treatment positions.

Algorithms↗
PubMed2002

Differential retinal angiogenic response to sustained intravitreal release of VEGF and bFGF in different pigmented rabbit breeds.

PURPOSE: To determine if two different breeds of pigmented rabbits can demonstrate differences in the degree of inducible angiogenesis within the retina. METHODS: Non-biodegradable Hydron pellets approximately 1.5 mm in diameter containing both vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) were implanted intravitreally over the optic disk of either Dutch belt rabbits or New Zealand White/Black satin cross rabbits. Control animals from both groups were implanted with blank Hydron pellets. Animals were examined periodically over a 30-day period following implantation. Results were documented by fundus photography and flourescein angiography. Stages of neovascularization (NV) were graded between +1 (preproliferative) and +4 (total NV) with +5 for NV complicated by hemorrhage and/or retinal detachment. RESULTS: The angiogenic response in the retinas of pigmented NZW/Black satin cross rabbits (N = 5) following implantation of VEGF/bFGF-containing pellets varied extensively from the Dutch belt animals (N = 7). In the Dutch belt rabbits, grading of the angiogenic response demonstrated either +4 or +5 between day 20 and day 30 after implantation. In contrast, the NZW/Black satin cross animals gave a more muted response with a maximum grade of +2 following exposure to the same amount of VEGF and bFGF. Control eyes that received only blank pellets showed no evidence of retinal NV in either the Dutch belts (N = 5) or the NZW/Black satin cross rabbits (N = 5). Statistical analysis showed a significant interaction effect for breed and pellet type (F = 44.85 with 1 df, p < 0.00005), indicating a difference between the breeds in the angiogenic response to the pellet. Moreover, both the NZW/BSC and Dutch belt rabbits displayed a significant increase in angiogenesis with the VEGF/bFGF pellet in comparison to the blank pellet (p = 0.037 and p < 0.00005, respectively). CONCLUSIONS: These studies indicate that two different breeds of pigmented rabbits exhibit different angiogenic responses to the same amount of both VEGF and bFGF. Florid retinal NV leading to hemorrhage, fibrovascular membrane formation, and traction retinal detachment occurred in the Dutch belt rabbits while tortuosity and dilatation of existing blood vessels with subsequent regression occurred in the NZW/Black satin cross animals. Such differences in the angio-genic response may be due to differences in the genetic background of these animals. If genetic heteriogeneity exists for angiogenic responses, then understanding the genetic role in the regulation of angiogenesis will lead to the design of more effective anti-angiogenic agents and can provide predictive outcomes of individual responses to therapy.

Animals↗
PubMed1995

[Confocal scanning laser indocyanine green angiography with the Heidelberg retinal angiograph].

PURPOSE: Indocyanine-green angiography (ICG) has been shown to be a valuable adjunctive technique to fluorescein angiography including further delineation of choroidal neovascularization in age-related macular degeneration. We report on initial clinical experiences with a newly developed infrared confocal scanning laser ophthalmoscope. MATERIALS AND METHODS: Fundus and fluorescein angiography photographs were obtained in 20 patients with various fundus changes. Confocal laser scanning ICG-angiography using the Heidelberg Retina Angiograph (Heidelberg Engineering GmbH, Germany) was performed after injection of 25 mg ICG. The confocal principle ensures that only light reflected from a defined focal plane is detected by the integrated photomultiplier. Excitation wave-length was 795 nm, and emission was recorded above 810 nm. About 60% of the emission is detected. An additional built-in diode laser (830 nm) allowed fundus visualization prior to dye injection. RESULTS: ICG angiography using the scanning laser angiograph showed typical findings as previously reported with other systems. The images were characterized by high contrast. In addition, the retinal vessels were readily visualized in the late phase. By means of the confocal mode different layers of the circulation could be visualized. CONCLUSIONS: The findings indicate that the confocal scanning angiograph is a useful alternative tool for ICG angiography and that it offers similar information obtained by other imaging systems. Advantages compared with previous techniques may include high image contrast, visualization of retinal vessels in the late phase, lower amount of light exposure, direct digital image acquisition and easy practical operation.

Adult↗
PubMed1996

Localization of vascular endothelial growth factor in human retina and choroid.

OBJECTIVE: To examine the distribution and relative levels of vascular endothelial growth factor (VEGF) in the nondiabetic and preproliferative diabetic human retina and choroid. METHODS: Immunohistochemical localization was performed on frozen sections from cryopreserved postmortem human tissue using a polyclonal antibody against VEGF and a streptavidin peroxidase system. Eyes from 5 subjects without diabetes and 8 subjects with diabetes were examined and analyzed using a 7-point immunohistochemical grading system. RESULTS: In subjects without diabetes, weak or no VEGF immunoreactivity was associated with retinal blood vessels. In subjects with diabetes, we found significantly increased immunoreactivity in the retinal vascular endothelium and blood vessel walls. Vascular endothelial growth factor immunoreactivity was also associated with intravascular leukocytes in subjects with and without diabetes. In the choroid of subjects without diabetes, immunoreactivity was almost exclusively associated with intravascular leukocytes, whereas in diabetic subjects, immunoreactivity was localized within choriocapillaris endothelium, choroidal neovascular endothelium, and migrating retinal pigment epithelium cells. CONCLUSIONS: The observed increase in VEGF immunoreactivity in the diabetic retina and choroid suggests that VEGF may contribute to 2 well-documented events during retinopathy: increased vascular permeability and angiogenesis.

Adult↗
PubMedDate not supplied

Management of central retinal vein occlusion.

The management of central retinal vein occlusion (CRVO) is discussed briefly. Since the prognosis, complications, visual outcome and management of nonischemic and ischemic CRVO are very different, the first essential step in the management of CRVO is to determine which type of CRVO one is dealing with. The various parameters which help to differentiate the two types reliably are described briefly. In this connection, the most important thing to remember is that the conventional, very prevalent use of a 10-disc area of retinal capillary obliteration is an invalid parameter to differentiate ischemic from nonischemic CRVO, or to predict ocular neovascularization (NV). Ocular NV is a complication of ischemic CRVO only. Relevant issues about the natural history of CRVO are summarized; the natural history of the disease must not be mistaken for a beneficial effect of treatment. Various advocated modes of treatment of CRVO and their relative merits are discussed, particularly photocoagulation, which is widely advocated. Controversies with regard to various aspects of CRVO management are examined. Finally, it is noted that apart from routine systemic and hematologic evaluations, the vast majority of patients with CRVO do not need an extensive and expensive workup. In conclusion, in spite of enthusiastic claims of success for various therapies, the reality is that we currently have practically no proven safe and effective treatment for CRVO.

Diagnosis, Differential↗
PubMed1990

Re-operation following pars plana vitrectomy for the sequelae of proliferative diabetic retinopathy.

A review of 306 eyes undergoing pars plana vitrectomy for the complications of proliferative diabetic retinopathy revealed that 26 (8.5%) required a second vitrectomy operation. Among the eyes that required repeat vitrectomy, the eventual visual acuity ranged from 20/20 to 20/400 in 35% and was no light perception in 31%. Reasons for subsequent surgery included recurrent vitreous hemorrhage in 54% of eyes, retinal detachment in 42% and neovascular glaucoma in 4%. Twelve eyes (46%) remained with a permanent retinal detachment despite attempts at surgical repair, and eleven of these twelve eyes subsequently developed rubeosis iridis.

Adult↗