Perifoveal laser treatment for subfoveal choroidal neovascularization in age-related macular degeneration

The management of subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration presents a major therapeutic dilemma. No treatment may lead to severe visual loss, and direct laser treatment to the entire subfoveal lesion results in acute loss of visual acuity. Encouraging results have been described with a foveal-sparing laser technique for subfoveal CNV. The authors performed perifoveal confluent laser treatment on a relatively well-defined occult CNV, sparing the foveal avascular zone. One month after treatment, the visual acuity had improved from 20/400 to 20/30. At 24 months, the visual acuity was 20/40 with no recurrence. Confluent perifoveal laser treatment for subfoveal CNV may be useful in preserving central visual acuity in selected patients.     

Indocyanine green angiographic features of idiopathic submacular choroidal neovascularization

A portable and closed-loop system is described for the paralysed hand using transcutaneous electrical stimulation. It is implemented using a modest microprocessor which receives data from force sensors mounted in a glove on the users hand. A display shows parameter values and a menu for the user to sequentially select controller states. For the grip state, the control loop is basically proportional plus a two stage integral response (gain adaptation). Eight channels can be accommodated in the stimulator. The system was evaluated with the help of a tetraplegic who managed to hold everyday objects in a stable grip.     

Digital subtraction indocyanine green angiography of occult choroidal neovascularization

OBJECTIVE: This study aimed to use a new technique for ocular imaging, digital subtraction indocyanine green angiography (DS-ICGA), to evaluate patients with occult choroidal neovascularization (CNV). DESIGN: The design was a cross-sectional study of patients with occult CNV. PARTICIPANTS: A total of 31 eyes of 31 patients were studied. INTERVENTION: Digital subtraction of sequentially acquired indocyanine green angiographic frames was used to image the progression of the dye front in eyes with occult CNV. A method of pseudocolor imaging of the choroid was developed that allows differentiation and identification of underlying choroidal arteries and veins. RESULTS: The DS-ICGA of occult CNV showed consistent findings. Occult CNV was imaged with greater detail and in a shorter period of time than with conventional indocyanine green angiography. The fundus landmarks were retained with DS-ICGA much better than with conventional indocyanine green angiography. CONCLUSIONS: The DS-ICGA uses time to dissect the choroidal circulation. With DS-ICGA, occult CNV could be imaged more quickly and in greater detail than with conventional imaging techniques. The DS-ICGA may improve the authors ability to image, and subsequently treat, occult CNV.     

Chorioretinal damage caused by the excision of choroidal neovascularization

BACKGROUND: In recent years many longitudinal studies have examined the predictors of smoking acquisition. However, only a few studies have focused on the precursors of smoking cessation. The current study is one of the first concentrating on longitudinal predictors of young people's smoking cessation. METHODS: Subjects were 215 smokers ages 14-15 years who were reinterviewed 3 years later. These smokers were allocated to four groups based on their motivation to quit and actual quitting behavior at the last wave. Independent variables were smoking-specific cognitions, social influences, and aspects of smoking habits. RESULTS: Univariate comparisons between the four groups showed that those with a positive attitude toward smoking and lower self-efficacy were less likely to be motivated to quit 3 years later. No long-term effects of environmental influences were found. Aspects of smoking habits, such as intensity and frequency of smoking, and the context of cigarette use affected the motivation to quit. Logistic regression analyses were conducted to examine differences in predictors between the groups in more detail. These analyses revealed that differences mainly in attitudes and self-efficacy affected whether subjects were absolutely not motivated to quit or had actually quit 3 years later. Differences in smoking behavior affected the allocation to the more closely related groups (e.g., preparing versus quitting). CONCLUSIONS: Adolescents' motivation to quit is affected by smoking-related cognitions and habitual factors. More research is needed to decide whether the relation between intensity and frequency of smoking and the likelihood to quit later on should be interpreted in terms of differences in smoking initiation or in terms of preparation to quit.     

Long-term visual outcome of choroidal neovascularization in pathologic myopia: natural history and laser treatment

Tumour-endothelial cell adhesion forms a key role in the establishment of distant metastases. This study examined the effect of gamma linolenic acid (GLA), an anti-cancer polyunsaturated fatty acid (PUFA), on both the gap junction communication of human vascular endothelial cells and tumour cell-endothelial interactions. By using scrape loading of Lucifer yellow dye, we showed that GLA at non-toxic levels increased Lucifer yellow transfer, indicating improved gap junction communication. The fatty acid also corrected the communication that was reduced by the mitogenic and motogenic factor HGF/SF. GLA inhibited the tyrosine phosphorylation of connexin-43, a protein that formed gap junction in this cell. When human tumour cells were added to quiescent or HGF/SF-activated endothelial cells, the presence of GLA reduced adhesion of tumour cells to the endothelium. It is concluded that GLA reduces tumour-endothelium adhesion, partly by improved gap junction communications of the endothelium.     

Comparison of indocyanine green and fluorescein angiography of choroidal neovascularization

We compared indocyanine green (ICG) and fluorescein angiography for evaluation of choroidal neovascularization (CNV). Cast preparations of CNV induced in monkey eyes by laser photocoagulation were correlated with ICG and fluorescein angiographies of the same CNV formations. Fluorescein angiography was more effective, in general, than ICG angiography in detecting CNV; however, CNVs with subretinal hemorrhage (2 of 35 sites) were visible only with ICG angiography. In early phase ICG angiography, CNV formations that casts showed to be dense or composed of thick vessels were seen, but less dense areas were not visible. Lesions that ICG angiography revealed as leaking were not differentiated morphologically from non-leaking areas by the CNV casts. This study confirms that only ICG angiography can identify CNV hidden by subretinal hemorrhage, although fluorescein angiography is otherwise superior. Indocyanine green angiography is indicated as a valuable complement to fluorescein angiography for evaluation of CNV.     

Evaluation of choroidal neovascularization in age-related macular degeneration with fluorescein and indocyanine green videoangiography

375 Individuals from 23 HBsAg positive families were investigated in the study. The results showed that HBsAg carrier rate among blood relatives was significantly higher than non-blood relatives (P < 0.01); HBsAg carrier rate decreased with the order of the first, second and third degree relatives (P < 0.01); and the rate in the individuals living together with the probands was higher than those living apart (P < 0.01). However, the other two markers of HBV infectivity, anti-HBs and anti-HBc, did not show any differences mentioned above. The results analysed by means of dichotomy and Logistic regression model, showed that blood relationship played an important role in HBsAg carrier state. In addition, the history of sharing living facilities was related to HBsAg carrier state. The average heritability in the first, second and third degree relatives was 79.68%. The analysis of genetic model showed that HBsAg carrier state was corresponded to the characteristic of multifactorial genetic disease, excluding the possibility of genetic disease due to single gene.     

Choroidal neovascularization not associated with age-related macular degeneration

Choroidal neovascularization (CNV) is an important clinical finding that is associated with many ocular conditions, including inflammatory, infectious, degenerative, hereditary, and congenital disorders, ocular tumors, trauma, and a few miscellaneous disorders. The growth of new choroidal vessels beneath the retinal pigment epithelium is associated with specific clinical signs. The clinical recognition of CNV plays a key role in the prognosis and management of these disorders. The clinical presentation of each disorder associated with CNV is reviewed in this paper, with comments on the location and the frequency of CNV occurrence.     

A long-term course of experimentally produced choroidal neovascularization in the rat

We studied morphologically a long-term course of experimental choroidal neovascularization (ChNV) induced by krypton laser photocoagulation in the rat retina. Fifty-two weeks after photocoagulation, ChNV was enveloped completely by the retinal pigment epithelium. Vascular endothelial cells of ChNV were thin, with many fenestrations and wide lumen. The ChNV maintained the morphological characteristics of mature leaky capillaries similar to choriocapillaris. The lumen of the neovascularizations tended to be compressed by massive collagen fibers produced by the retinal pigmented epithelium. We found that experimental ChNV in the rat retina retains the characteristics of leaky capillaries for a long time unlike that in the monkey ChNV.     

Schisis-like rhegmatogenous retinal detachment associated with choroidal colobomas

BACKGROUND: The breaks that cause retinal detachments in colobomatous eyes are often hidden within the lesion and difficult to find. METHOD: To elucidate the pathoanatomy and possible pathomechanism of such detachments, histological sections of eight choroidal colobomas were reviewed. RESULTS: Sections of the margin showed central continuation of the inner neuroblastic layer (the intercalary membrane) and eversion and separation of the outer neuroblastic layer. The opposite direction of continuity of the neuroblastic layers created a schisis-like configuration between the intercalary membrane and the everted outer retina. The zone of duplication was a point of retinal adhesion, but also a locus minoris resistentiae due to vitreous attachments and variable glial support at the margin. CONCLUSION: The subset of coloboma-associated retinal detachments requires both a central break in the inner layer and a break in the outer layer at the margin of the coloboma. The inner layer break may be precipitated by retinovascular ischemia or scleral stretching; that in the outer layer may be caused by vitreous traction on the margin of the coloboma or extension of the formerly isolated detachment through the outer marginal zone of decreased glial support.     

Photocoagulation of well-defined choroidal neovascularization in age-related macular degeneration: clinicopathologic correlation

PURPOSE: To present the clinicopathologic features of the eyes of a patient with age-related macular degeneration (ARMD): the right eye was treated for well-defined extrafoveal choroidal neovascularization (CNV), and the left eye had an untreated disciform scar. METHODS: The patient was studied ophthalmoscopically and by fluorescein angiography at the time of presentation and on follow-up examinations up to 54 days after laser treatment, when he died. The posterior portions of both eyes (obtained postmortem), including the macula and optic nerve head, were sectioned serially for light microscopy. Tissue sections from both eyes were removed from glass slides and studied by transmission electron microscopy. RESULTS: Histopathologic study of the right eye disclosed a thin layer of basal laminar deposit throughout the posterior pole. Two defects in Bruch's membrane without CNV were present within the area of laser photocoagulation located superior to the fovea. No CNV was present in the scar. Eleven areas of early CNV were present in the posterior pole. Histopathologic study of the left eye showed a prominent basal laminar deposit throughout the posterior pole. A 2.6 x 2.7 mm disciform scar was present that was located mostly in the subretinal space. Four sources of CNV were present. CONCLUSIONS: The clinicopathologic features of a treated eye with well-defined extrafoveal CNV, and the fellow eye with a disciform scar, both associated with ARMD, are presented. Although laser treatment obliterated a choroidal neovascular membrane, 11 additional areas of early, subclinical CNV were present.     

Outcomes in anterior uveitis associated with the HLA-B27 haplotype

OBJECTIVE: This study aimed to test the hypothesis that patients presenting with anterior uveitis who are HLA-B27 positive, either with or without associated systemic disease, have a less-favorable outcome than do patients with idiopathic anterior uveitis who are HLA-B27 negative. DESIGN: Retrospective case-controlled series. PARTICIPANTS: Ninety-seven patients who were HLA-B27 positive with no systemic disease, 94 patients who were HLA-B27 positive with systemic disease, and 72 patients who were HLA-B27 negative who presented with anterior uveitis were studied. MAIN OUTCOME MEASURES: Ocular complications (e.g., secondary glaucoma, cataract formation, pupillary synechiae, vitritis, cystoid macular edema, and optic disc edema), medical and surgical treatment, number of recurrent attacks, and final visual acuity were recorded for all patients. RESULTS: The patients who were HLA-B27 positive, either with or without systemic disease, experienced a greater number of complications than did the patients who were HLA-B27 negative. Periocular corticosteroids, systemic corticosteroids, and systemic immunosuppressive chemotherapy were required in a far greater number of HLA-B27-positive patients than in HLA-B27-negative patients (60% vs. 11%, 53% vs. 7%, and 18% vs. 1%, respectively; P < 0.001). The percentage of legally blind eyes was significantly greater in the HLA-B27-positive group, both with and without systemic disease, when compared with the HLA-B27-negative group (11% vs. 2%; P < 0.005). CONCLUSIONS: The prognosis of anterior uveitis associated with the HLA-B27 haplotype, either with or without associated systemic disease, is less favorable when compared with that of HLA-B27-negative patients with idiopathic anterior uveitis.     

Focal myoclonus associated with posterior thalamic hematoma

PURPOSE: We report a new incision for repair of penile fracture. MATERIALS AND METHODS: We describe 2 cases in which the inguinal scrotal incision was used for repair of penile fracture. The preoperative evaluation as well as the technical case and rationale for use of this incision are discussed. RESULTS: Preoperative cavernosogram delineated the site of the fracture. Immediate repair of the fracture using the inguinal scrotal incision was successful. CONCLUSIONS: The inguinal scrotal incision should be entertained for cases of penile fracture. It avoids incision into markedly edematous penile skin and allows for excellent visualization of the fracture site.     

Primary vitrectomy for rhegmatogenous retinal detachment associated with choroidal detachment

OBJECTIVE: This study aimed to report the success rate of primary vitrectomy, scleral buckling, and oral steroids in eyes with combined rhegmatogenous retinal detachment (RRD) and choroidal detachment (CD) and to compare these results with those reported in the literature for similar cases managed by scleral buckling alone. DESIGN: Consecutive case series. PARTICIPANTS: Twenty-one eyes of 21 consecutive patients with primary RRD associated with CD were examined. INTERVENTION: All patients were treated with systemic corticosteroids before surgery. Pars plana vitrectomy with scleral buckling or encircling or both were performed. MAIN OUTCOME MEASURES: Retinal reattachment rate and resolution of choroidal detachment were measured. RESULTS: At mean follow-up of 11.4 months, retinal reattachment was attained in 19 eyes (90.5%) compared to less than 53% reported in the literature for scleral buckling alone. With preoperative oral steroids, choroidal detachment regressed completely in 13 eyes (61.9%). In the remaining eyes with persistent choroidal detachment, suprachoroidal fluid was drained during vitrectomy. CONCLUSION: Aggressive treatment with oral steroids followed by pars plana vitrectomy and scleral buckling or encircling is recommended instead of scleral buckling alone in the management of combined primary rhegmatogenous retinal detachment and choroidal detachment.     

Immunosuppressive treatment in haemophiliacs with inhibitors to factor VIII and factor IX

9 patients with severe haemophilia A and inhibitors (inhibitor levels between 0.1 to 5.8 U/ml) and 3 patients with severe haemophilia B and inhibitors (inhibitor levels between 0.1 to 11 U/ml) were treated on a total of 16 and 13 occasions, respectively, with a large dose of antigen (factor VIII or factor IX) and cyclophosphamide (10-15 mg/kg b.w. i.v. initially and then 2-3 mg/kg b.w. orally for 7-10 days) in connection with severe bleeding and surgery. All the patients had proved not to respond to treatment with factor VIII or factor IX concentrate alone, and all except one had shown strong secondary antibody increases. In 6 of the patients with haemophilia A the treatment (11 occasions) had a satisfactory haemostatic effect and even permitted neurosurgery without bleeding complications. The inhibitor level remained at zero for 5-10 days, after which it gradually began to return towards its original level. In these cases it was possible to give factor VIII in amounts which neutralised the inhibitor and afterwards raised the factor VIII initially to at least 50%. In the 3 patients with haemophilia B treatment (13 occasions) was successful except on one occasion, and surgery was performed without abnormal bleeding. The factor IX level was initially raised to at least 50% except in the one failure. The inhibitor level remained at zero for 12 days to 3 months, after which it gradually rose towards its original level. One patient was treated on 8 occasions.     

Efficacy of proton therapy in circumscribed choroidal hemangiomas associated with serious retinal detachment

OBJECTIVE: The purpose of the study is to evaluate the efficacy and safety of proton therapy in complicated circumscribed choroidal hemangiomas. DESIGN: The study design was a retrospective review. PARTICIPANTS: Studied were 13 patients (13 eyes) who had circumscribed choroidal hemangioma associated with serous retinal detachment. Of these, four eyes previously underwent laser unsuccessfully. INTERVENTION: Proton therapy including a total dose of 30 Cobalt-Gray-Equivalent was administered to each eye. MAIN OUTCOME MEASURES: Patients were controlled for initial and final best-corrected visual acuity, slit-lamp examination, intraocular pressure, fundus examination, fluorescein angiography, and tumor thickness on B-scan ultrasonography. RESULTS: The mean follow-up period was 26 months (range, 9-48 months). Retinal reattachment was obtained in all cases after a mean period of 52 days. The tumor height decreased in all cases. Visual acuity improved to two lines or more in eight eyes (62%) and reached 20/200 or more in nine eyes (69%). No radiation complication was detected during follow-up. CONCLUSIONS: Proton radiation seems to be effective and safe in the management of choroidal hemangioma associated with serous retinal detachment. It may be useful when photocoagulation can not be performed.