光相干断层扫描血管成像观察新生血管性ARMD的临床研究

目的：利用光相干断层扫描血管成像(optical coherence tomography angiography,OCTA)观察新生血管性年龄相关性黄斑变性(neovascular age-related macular degeneration,nARMD)患者的脉络膜新生血管(choroidal neovascularization,CNV)及接受抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗前后的变化。

方法：本研究为病例系列分析研究。纳入2017-05/12就诊于我院眼科的nARMD患者29例37眼。所有患者玻璃体腔注射抗VEGF治疗前和治疗后1d,1wk,1mo及每月随访时均行OCTA检查,共随访3～6mo,观察抗VEGF治疗前后CNV病灶形态和大小、中心凹旁浅层视网膜血管密度和血流灌注的变化。

结果：nARMD患者CNV病灶的组织结构中不成熟的结构、小分支血管和毛细血管对抗VEGF的治疗应答反应较好; 术前基线病灶面积为1.27±1.88mm²,术后第1d病灶面积为1.13±1.79mm²,CNV病灶在抗VEGF治疗后1d即可缩小,最终病灶大小稳定在1mo时的病灶面积水平,与治疗前比较差异有统计学意义(P=0.001); 抗VEGF治疗后3mo,中心凹旁浅层视网膜血管密度和血流灌注明显降低,差异有统计学意义(P=0.003、0.015)。

结论：OCTA能够无创、清晰地显示nARMD患者CNV病灶的细微结构变化和定量分析CNV病灶面积的变化。OCTA还能够对视网膜血管进行分层显示,定量分析视网膜微循环的变化,在nARMD患者的病情监测和指导治疗方面有重要的临床应用价值。     

小鼠脉络膜血管新生模型中FLK-1的表达

目的:探讨小鼠脉络膜血管新生(choroidal neovascu larization, CNV)模型中FLK-1的表达.方法:采用激光击射的方法诱导成年C57BL/6小鼠CNV模型,术后行脉络膜灌流铺片及组织病理学检查观察CNV的发展.应用免疫组织化学染色探讨正常视网膜以及激光术后10d CNV模型中FLK-1的表达.结果:术后10d所有激光光斑均发展为实验性CNV,其中血管内皮细胞,类视网膜色素上皮细胞(retinal pigmented epithelium,RPE)及类成纤维细胞FLK-1表达强烈;在正常视网膜中,FLK-1仅在RPE、内核层及神经节细胞层有微弱的表达.结论:FLK-1参与了实验性CNV的发病过程,提示拮抗FLK-1可能成为防治CNV有效的生物学方法之一.     

信号转导与转录激活因子3在脉络膜新生血管发生中的可能作用

目的　观察磷酸化信号转导与转录激活因子3（STAT3）在激光诱导的大鼠脉络膜新生血管（CNV）中的表达,探讨STAT3在CNV中可能的作用。方法　建立激光诱导的大鼠CNV模型,免疫荧光法观察CNV生成早期磷酸化STAT3的表达。建立细胞缺氧模型,细胞培养液中加入Janus激酶2（JAK2）特异性阻断剂AG490后培养1、3、6、12、24 h。流式细胞仪检测视网膜色素上皮（RPE）细胞的增生指数,反转录聚合酶链反应（RT-PCR）检测缺氧诱导因子-1α（HIF-1α）和VEGF的mRNA表达,蛋白质免疫印迹法检测HIF-1α蛋白表达,酶联免疫吸附试验检测细胞培养液上清液中血管内皮生长因子（VEGF）的含量。结果　激光光凝后3 d,磷酸化STAT3高表达于大鼠CNV区域。阻断JAK2/STAT3信号转导通路后,缺氧条件下人RPE细胞随时间增生指数明显降低（t=1.472,3.566,2.391,6.420;P=0.054,0.038,0.042,0.016）。随缺氧时间增加,HIF-1α和VEGF mRNA表达逐渐增强。采用AG490阻断JAK2/STAT3信号转导通路后,缺氧条件下人RPE细胞HIF-1α mRNA和VEGF mRNA的表达、HIF-1α蛋白的活化均受明显抑制(t=0.07,0.02,0.01, P＜0.05);细胞培养上清液中VEGF含量显著降低（t=1.330,1.106,2.828,7.742,5.610,6.894,P=0.082,0.063,0.014,0.002,0.016,0.011）。结论　STAT3可能参与了CNV的发生,这一过程部分是通过JAK2/STAT3信号转导通路调控RPE细胞HIF-1α和VEGF表达而实现的。      

病理性高度近视并发脉络膜新生血管行抗VEGF治疗后黄斑厚度的变化

目的：分析病理性高度近视并发脉络膜新生血管进行抗血管内皮细胞生长因子(vascular endothelial growth factor,VEGF)单独治疗与光动力疗法(photodynamic therapy,PDT)单独治疗后黄斑视网膜厚度的变化,探寻脉络膜新生血管的高效治疗方法。

方法：选取2014-11-1/2015-06-30于我院治疗的43例45眼病理性高度近视并发脉络膜新生血管患者,通过对不同治疗方法患者的病历资料回顾性分析进行疗效比较,采用抗VEGF单独治疗的20例22眼患者设为观察组,采用PDT治疗的23例23眼患者设为对照组。比较治疗后6mo两组患者患眼视力状况,并进行光学相干断层扫描(optical coherence tomography,OCT)检查比较黄斑区视网膜厚度、脉络膜新生血管(choroidal neovascularization,CNV)强反射区域变化和视网膜下液吸收情况,采用荧光素眼底血管造影术(fluorescein fundus angiography,FFA)、吲哚菁绿血管造影(indocyanine green angiography,ICGA)检查CNV渗漏情况,并比较两组患者治疗前后CNV突破视网膜色素上皮(retinal pigment epithelium,REP)的宽度、高度、离中心凹的距离和不良反应发生情况。

结果：观察组视力提高两行及以上眼数比例为82%,显著高于对照组(74%),差异有统计学意义(P<0.05); OCT检查两组患者治疗前黄斑区视网膜厚度,经比较差异无统计学意义(P>0.05),治疗后均显著降低,观察组显著低于对照组,差异有统计学意义(P<0.05); FFA、ICGA检查观察组CNV停止渗漏眼数比例为86%,渗漏减少14%,与对照组(74%,22%)比较,差异有统计学意义(P<0.05); 观察组不良反应发生率为14%,与对照组(17%)比较,差异无统计学意义(P>0.05); 治疗后两组患者CNV突破RPE的宽度、高度、离中心凹的距离均降低,且观察组显著低于对照组,差异有统计学意义(P<0.05)。

结论：相较于PDT治疗,抗VEGF单独治疗能显著提升病理性高度近视并发CNV患者的视力,降低黄斑区视网膜厚度,CNV停止渗漏效果更佳。     

骨髓来源细胞在脉络膜新生血管生成中的作用

目的 探讨骨髓来源细胞(BMCs)在脉络膜新生血管(CNV)生成中的作用。 方法 将绿色荧光蛋白(GFP)转基因小鼠骨髓细胞移植给野生型C57BL/6J小鼠建立嵌合体,应用532 nm倍频激光诱发嵌合体小鼠(处理组)和野生型小鼠(对照组)CNV。利用脉络膜铺片观察由GFP阳性细胞形成的新生血管;免疫荧光染色观察CNV中GFP 阳性细胞是否表达血管内皮生长因子(VEGF)和碱性成纤维细胞生长因子(bFGF)。结果 激光光凝后第29天,脉络膜铺片显示CNV中有大量绿色的骨髓来源细胞,由其组成的血管面积约占CNV表面积的16.22%;免疫荧光染色结果显示,CNV区域的一些BMCs表达VEGF和bFGF。结论 BMCs通过参与新生血管组成及分泌促血管生成因子的方式,可能在CNV发生过程中发挥着重要作用。     

外源性VEGF及Ang-1对大鼠CNV的作用及机制探讨

目的:研究细胞因子VEGF,Ang-1对大鼠脉络膜新生血管的形成、分化以及成熟过程的影响及机制。方法:采用激光光凝诱导建立大鼠CNV动物模型后,分别在不同时期玻璃体腔注射VEGF,Ang-1,通过其眼底荧光造影与病理切片的变化观察上述因子的作用。结果:血管生成素-1组比对照组晚期渗漏明显减少,VEGF组较对照组晚期渗漏明显增加;组织病理切片显示实验组瘢痕形成,VEGF组和对照组可见肉芽组织。结论:血管生成素-1能有效抑制脉络膜新生血管的生成,促进新生的脉络膜新生血管成熟,促进瘢痕形成。     

激光诱导小鼠脉络膜新生血管模型中CD105的表达

目的通过激光诱导C57BL／6J小鼠CNV动物模型，观察CD105在新生血管组织中的表达。方法二极管激光诱导生成小鼠脉络膜新生血管，激光后1周和4周以免疫组化观察CD105的表达。结果激光后1周，视网膜下新生血管形成，CD105表达于CNV组织。激光后4周，当血管形成趋于静止时，CD105表达明显减弱。结论研究提示CD105在脉络膜新生血管形成过程中可能起重要作用。     

特发性脉络膜新生血管患者血清相关因子研究

目的　观察特发性脉络膜新生血管（CNV）患者血清相关因子水平的改变。方法　回顾分析临床确诊为特发性CNV的21例患者21只眼（CNV组）的临床资料。选取20名正常志愿者20只眼作为正常对照组。分别抽取两组受试者静脉血,采用酶联免疫吸附剂测定法和免疫散射比浊法测定血清的血管内皮生长因子（VEGF）,肿瘤坏死因子α（TNFα）,白介素1-β（IL1-β）,免疫球蛋白IgG、IgA、IgM、IgE,总补体CH₅₀、补体C₃、C₄,C反应蛋白（CRP）的浓度。结果　 CNV组血清VEGF浓度显著高于正常对照组(t=2.340,P=0.025),IgE浓度显著低于正常对照组(Z=-2.765,P=0.006);其余血清因子浓度与正常对照组相比,差异均无统计学意义（P＞0.05）。结论　VEGF和IgE可能参与了特发性CNV的形成。     

激光诱导小鼠脉络膜新生血管中膜攻击物与血管生长因子的表达

目的 观察激光诱导小鼠脉络膜新生血管(choroidal neovascularization,CNV)中膜攻击物与血管生长因子的表达.方法 雄性C57BL/6小鼠66只,随机分为对照组与眼镜蛇毒因子(cobra venom factor,cw)预处理组,每组各33只.用氪红激光诱导小鼠CNV动物模型;免疫组织化学检测激光诱导后24h视网膜色素上皮-脉络膜-巩膜复合体补体膜攻击复合物(membrane attack complex,MAC)的表达;RT-PCR分析激光诱导后1d、3d、5d、7d血管内皮生长因子(vascular endothelial growth factor,VEGF) mRNA表达;Western blot检测激光诱导后3 d VEGF蛋白的表达.结果 CVF预处理组:激光诱导后24 h,未见MAC阳性染色;激光诱导后3d、5d、7d与激光诱导后1d相比未见VEGF mRNA表达增加;激光7d未见CNV形成.对照组:激光诱导后24 h MAC呈阳性染色;激光诱导后3d、5d、7d与激光诱导后1d相比VEGF mRNA分别增加380％、276％、98％(均为P＜0.01);激光后3d,对照组较CVF预处理VEGF蛋白高表达.结论 CNV形成与补体MAC形成、VEGF表达上调相关联;MAC沉积导致VEGF表达增加;VEGF表达上调是CNV形成的主要原因.     

驻景方对病理性近视脉络膜新生血管VEGF表达的影响

目的: 观察中药驻景方对氪激光诱导的病理性近视脉络膜新生血管VEGF表达的影响,探讨中药驻景方对病理性近视脉络膜新生血管的干预作用。方法: 将3周龄雌性三色豚鼠45只随机选出15只为空白对照组,剩余豚鼠均带头套右眼形觉剥夺诱导病理性近视,A超检影(诱导失败者剔除出组)并随机分为模型组、中药组,双眼行氪激光光凝。中药组于光凝后第2d开始连续灌胃21d,3.285g/(kg·d),每次1.5mL,1次/d。21d后行脉络膜铺片、HE染色、免疫荧光、免疫组织化学观察。结果: 形觉剥夺4wk后右眼均诱导出高度近视,且眼轴较左眼增长;脉络膜铺片及免疫荧光示模型组右眼CNV面积及视网膜VEGF表达均明显高于左眼(P<0.01),中药组右眼CNV的面积及VEGF的表达较模型组右眼减少(P<0.01);免疫组织化学结果显示,中药组右眼VEGF的平均光密度值(0.0589±0.0146)较模型组右眼(0.0972±0.0507)减少(P<0.01)。结论: 中药驻景方可抑制氪激光诱导的病理性近视脉络膜新生血管的生长及VEGF的表达。     

Choroidal neovascularization in an adolescent with RDH12-associated retinal degeneration

ABSTRACT

Background: Leber congenital amaurosis (LCA) due to RDH12 mutations typically manifests with severe vision loss and panretinal dystrophy. We sought to describe a case of LCA with choroidal neovascularization (CNV) in a 17-year-old patient.

Materials and Methods: Case report of a 17-year old with LCA who presented with acute central vision loss of the right eye in the context of a chronic retinal dystrophy. Multimodal retinal imaging including spectral-domain optical coherence tomography and indocyanine green angiography revealed CNV.

Results: A 17-year-old boy with previously diagnosed LCA/early-onset retinal dystrophy (EOSRD), with subsequently identified biallelic mutations in RDH12 was found to have type 2 CNV. Patient was treated with intravitreal ranibizumab and exhibited improvement on follow-up exam.

Conclusions: Choroidal neovascularization may be a unique occurrence in RDH12-associated retinal dystrophy. Successful treatment of the neovascularization could be accomplished with intravitreal antivasogenic therapy.     

Optical coherence tomography (OCT) findings in normal retina and laser-induced choroidal neovascularization in rats

Background: To evaluate the optical coherence tomographic (OCT) features of the retina of rats, we compared the OCT images with the histological appearance of normal retinas and retinas with laser- induced choroidal neovascularization. Methods: Twelve eyes of 12 adult pigmented rats (Brown-Norway) were used. Color fundus photography, fluorescein angiography (FAG), and OCT images of normal retinas and retinas with laser photocoagulation-induced choroidal neovascularization were studied. Results: OCT showed a double-layered structure in the normal sensory retina with a highly reflective layer located in the inner retina and a low reflective layer located in the outer retina. The retinal pigment epithelium (RPE) and choriocapillaris were imaged as a layer with the highest reflection. On the first day after photocoagulation, OCT showed a disruption of the highly reflective layer corresponding to the RPE, and an enhanced reflectivity in the choroid under the lesion. Choroidal neovascularizations (CNVs) which appeared 2 weeks after photocoagulation was seen as a multi-layered, highly reflective area protruding from the RPE into the subretinal space A CNV beneath a subretinal hematoma was difficult to detect because of the low transmission of the scanning light through the hematoma. The histopathological appearance was well correlated with the OCT images. Conclusion: The two reflective bands in the OCT images were identified as coming from the inner layers of the retina and from the photoreceptors. The highest reflective band arose from the RPE and choriocapillaris. In the future, OCT combined with FAG or indo-cyanine-green angiography will be a useful tool for the evaluation of animal studies of choroidal neovascularization and other retinal diseases. Received: 18 April 2000 Revised: 30 June 2000 Accepted: 7 July 2000     

Mapping of the retinal pigment epithelium in exudative age related macular degeneration

Purpose To evaluate a novel technique for three-dimensional mapping of the retinal pigment epithelium (RPE) layer in patients with subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration. Methods Scanning with a recent generation retinal thickness analyzer (RTA) was performed in consecutive patients undergoing fluorescein angiography. From a 3×3mm area centered on the fovea, three-dimensional area maps of the RPE level were calculated by external spreadsheet software. Included were 18 eyes with classic CNV, 18 eyes with occult CNV and 18 eyes from age-matched normal subjects. Repeatability was assessed by measuring 17 eyes with CNV 3 times. In ten additional patients, RTA imaging results were compared with cross-sections obtained by optical coherence tomography. Results By both methods, distinctive changes in RPE level maps were observed in classic and occult CNV. In classic CNV with the lesion extending over the RPE, only focal irregularities in the anteriorly displaced RPE surface were observed. In contrast, mapping of occult CNV showed a more irregular displacement of the RPE layer. The RPE map standard deviation indicating surface irregularity differed statistically significantly between the groups, with coefficients of variance of 5.9% for controls, 6.1% for classic and 8.8% for occult CNV (P<0.001). Regarding repeatability, RPE level maps showed 1.2% coefficient of variance and an intra-class correlation coefficient of 0.87 for triplicate measurements in CNV patients. Conclusions Topographic mapping of CNV lesions offers a fast, reproducible method for obtaining three-dimensional morphometric information on the RPE level and to quantify changes.     

高度近视致单纯黄斑出血与继发CNV的黄斑出血之OCT图像鉴别

目的 观察高度近视所致单纯黄斑出血与继发脉络膜新生血管形成（CNV）的黄斑出血在相干光断层扫描（OCT）上的图像特征。设计 回顾性病例系列。研究对象  47例（47眼）高度近视黄斑出血的患者。方法 回顾性研究2009年7月-2013年5月就诊,并行最佳矫正视力、眼底彩照、荧光素眼底血管造影（FFA）、眼底自发荧光（FAF）、相干光断层扫描（OCT）检查的47例高度近视黄斑出血患者的47眼,对其视力及光学影像图像特征进行分析。主要指标  OCT,自发荧光结果及视力。结果  47眼高度近视黄斑出血中,通过FFA及吲哚青绿血管造影（ICGA）明确诊断继发于CNV的黄斑出血27眼,单纯的黄斑区出血20眼。继发于CNV的黄斑出血OCT图像特征为黄斑中心凹下较高反射信号的团块状影位于视网膜色素上皮（RPE）层之下,RPE层结构破坏、隆起,及RPE层上的中高反射信号影;单纯黄斑出血,其OCT图像特征为黄斑中心凹隆起,神经上皮层下三角形稍高反射信号影,其后信号略减弱,RPE层反射条带完整。继发于CNV的黄斑出血组,24/27眼IS/OS破坏,3/27眼IS/OS完整,仅表现IS/OS的隆起;而单纯黄斑出血组,7/20眼IS/OS破坏,13/20眼IS/OS完整（χ2=14.86,P=0.000）。FAF检查在继发于CNV的黄斑出血组可呈小片状中央弱自发荧光,周围环以强自发荧光或正常荧光;而在单纯黄斑出血组,自发荧光可呈正常或片状弱自发荧光。结论 OCT和眼底自发荧光检查可明确分辨高度近视黄斑出血是继发于CNV还是单纯黄斑出血。（眼科,2014, 23： 103-106）     

Changes in fluorescein angiogram early after surgical removal of choroidal neovascularization in age-related macular degeneration

BACKGROUND: Retinal pigment epithelial (RPE) defects inevitably occur in surgical removal of choroidal neovascularization (CNV) in age-related macular degeneration (AMD). RPE can proliferate and cover the denuded area, but the healing process has not been investigated in humans. To understand the RPE wound-healing process, we estimated the changes in fluorescein angiograms early after CNV removal. METHODS: Ten consecutive patients with exudative AMD underwent CNV removal without gas tamponade. Fluorescein angiography was performed within 4 days of surgery and again 1 or 2 weeks postoperatively. Areas of leakage were measured using a computer-assisted image analyser. The decreasing rate of leakage was calculated as the change in disc areas of leakage per day (DA/day). RESULTS: The rates of decreasing leakage ranged from 0 to 0.42 DA/day (mean, 0.24 +/- 0.15 DA/day; median, 0.26 DA/day). The rate of decreasing leakage correlated with changes in visual acuity (r = 0.642, P = 0.0456). CONCLUSION: The retinal pigment epithelial wound after surgical removal of choroidal neovascularization may heal at the rate of 0.24 disc areas/day based on the blood retinal barrier function in patients with age-related macular degeneration. A faster rate of decreasing leakage may be associated with better visual prognosis.     

Retinal pigment epithelium translocation and central visual function in age related macular degeneration: preliminary results

Purpose: To test the feasibility of a new surgical technique, and to assess visual function over the translocated retinal pigment epithelium (RPE) cells in patients operated upon for subfoveal choroidal neovascularization (CNV) secondary to age-related maculardegeneration (AMD).Materials and methods: Six patients presenting previouslyuntreated exudative AMD underwent surgical excision of the subfoveal CNV with RPE translocation and were followed from 1 to 10.5 months. The surgery consisted of a standard three port pars plana vitrectomy (TPPPV), excision of the CNV and RPE translocation. Pre and post-operative ocular examination included best-corrected visual acuity measurement, fundus color stereo photography and fundus fluoresceinangiography. Optical coherence tomography (OCT) and confocal laser scanning ophthalmoscopy (cLSO) were performed post-operatively. A cross fixation target and a single-point flashing light were projected on different areas of the posterior pole using a cLSO. Photopic 10-2 perimetry, photopic fine matrix mapping, cLSO microperimetry were also performed pre and post-operatively in four patients. OCTcross-sectional scans and cLSO RPE autofluorescence were recorded to detect the presence of viable translocated RPE. Visual acuity, fixation, photopic 10-2 perimetry, photopic fine matrix mapping and cLSO microperimetry were tested for the presence of central visual function. Results: RPE could be effectively translocated at thetime of CNV removal from the edge of the RPE defect to a subfoveal location. OCT showed the translocated RPE as an area of increased optical reflectivity with optical shadowing external to it. cLSO showed autofluorescence of the translocated RPE. The cross fixation target was seen when projected on the translocated RPE. During eccentricfixation, the patients could see a flashing point-target projected on the translocated RPE. Photopic 10-2 perimetry, photopic fine matrix mapping and cLSO microperimetry showed presence of central visual function.Conclusions: The authors propose that translocationof RPE at the time of CNV removal, from the edge of the RPE defect to a subfoveal location, may have a role in the surgical management of AMD.     

Bilateral midperipheral large drusen and retinal pigment epithelial detachments associated with multifocal areas of choroidal neovascularization: a histopathologic study

PURPOSE: The ocular histopathologic features of a patient with bilateral multiple midperipheral areas of choroidal vascularization, large drusen, and detachments of the retinal pigment epithelium (RPE) are presented. METHODS: The eyes were obtained at autopsy and fixed in 4% buffered formaldehyde. Serial sections through the macula area and inferior segments were prepared. Light as well as electron microscopy was performed. RESULTS: Microscopic examination disclosed numerous large drusen measuring up to 200 micro m in height and 280 micro m in diameter and areas of serous RPE detachments in the midperiphery of both eyes. Some of the large drusen had choroidal vascularization. Areas of sub-RPE neovascularization that measured up to 6.5 mm in diameter were present in the midperiphery of both eyes. The choroidal origin for neovascularization was evident in 10 areas. A 1-mm area of hemorrhagic detachment of the RPE contiguous with choroidal neovascularization (CNV) was present in the immediate postequatorial area temporally in the left eye. No drusen, basal deposit, or CNV was present in the macular area. CONCLUSION: Multifocal midperipheral RPE detachments and CNV can occur in the absence of significant age-related macular disease.     

Systemic Inflammation by Collagen-Induced Arthritis Affects the Progression of Age-Related Macular Degeneration Differently in Two Mouse Models of the Disease

PurposeAge-related macular degeneration (AMD) shares similar risk factors and inflammatory responses with rheumatoid arthritis (RA). Previously, we identified increased risk for dry AMD among patients with RA compared to control subjects, using retrospective data analysis. In this current study, we investigate the role of systemic inflammation triggered in a murine model of arthritis on choroidal neovascularization and retinal pigment epithelium (RPE) degeneration mouse models.MethodsCollagen-induced arthritis (CIA) was induced in C57BL/6J mice prior to laser-induced choroidal neovascularization (CNV; wet AMD model) or sodium iodate–induced retinal degeneration (NaIO₃; dry AMD model). CNV lesion size and retinal thickness were quantified by optical coherence photography (OCT), visual function was analyzed using optokinetic response and electroretinography, RPE morphology was examined by immunohistochemistry, and inflammatory gene expression was analyzed by quantitative PCR.ResultsCIA mice demonstrated decreased spatial acuity and contrast sensitivity, whereas no difference was observed in the RPE-generated c-wave. CNV lesion size was decreased in CIA mice. NaIO₃ decreased c-wave amplitude, as well as retinal thickness, which was augmented by CIA. NaIO₃ treatment resulted in loss of normal RPE hexagonal shape, which was further aggravated by CIA. Increased Cxcl9 expression was observed in the presence of CIA and CIA combined with AMD. Disease severity differences were observed between sexes.ConclusionsOur data suggest systemic inflammation by CIA results in increased pathology in a dry AMD model, whereas it reduces lesions in a wet AMD model. These findings highlight the need for additional investigation into the role of secondary inflammation and sex-based differences on AMD.     

Intravitreal bevacizumab injection in patients with choroidal neovascularization due to choroid rupture after blunt-head trauma

Purpose To describe and report the effect of intravitreal bevacizumab (Avastin) as primary treatment for secondary choroidal neovascularization (CNV) after choroidal rupture due to blunt-head trauma. Design Interventional case report. Methods The study was of the left eye of a patient who presented with choroidal neovascularization secondary to choroidal rupture due to blunt-head trauma. The patient received single intravitreal injection of 1.25 mg (0.05 ml) bevacizumab as treatment for CNV after informed consent was signed. The patient underwent fundus fluorescein angiography (FA) and optic coherence tomography (OCT) before the bevacizumab injection and then again three months after. Visual acuity was also measured before and after treatment. The patient was re-examined on the first day, and monthly thereafter. After intravitreal injection of bevacizumab the visual and anatomic responses were observed. Results The patient showed regression of the neovascularization three months after injection of bevacizumab. There was no loss of vision in the immediate postoperative period and at the 3rd month vision improved from 20/60 to 20/20. Central retinal thickness decreased. No cataract progression, endophthalmitis, or injection-related complications were observed. Conclusions Our study shows that intravitreal 1.25 mg bevacizumab can be an effective alternative treatment for choroidal neovascularization (CNV) due to choroidal rupture. The authors have no proprietary interest in the material used in this study.     

Correlation Between Indocyanine Green Angiographic Findings and Histopathology of Polypoidal Choroidal Vasculopathy

Purpose To analyze the histopathology of polypoidal choroidal vasculopathy (PCV) and choroidal neovascularization (CNV) developing from PCV, the authors evaluated correlations between pathological findings and the findings of preoperative indocyanine green angiography (IA).Methods Two specimens were obtained during CNV excision associated with PCV. PCV tissue was excised with the CNV. The specimens were examined by light microscopy.Results In one case, IA revealed polypoidal lesions exhibiting hyperfluorescence in both the early and the late phase, and in the affected area, abnormally dilated vessels were identified histologically underneath relatively healthy retinal pigment epithelium (RPE). In the other case, the polypoidal lesions seen on IA showed early hyperfluorescence and late isofluorescence, and dilated vessels were observed under the RPE; perivascular amorphous material was present. The RPE adhered to the side of the choroid, and there was CNV under the neurosensory retina in both cases. The CNV had numerous vascular lumens, was not surrounded by the RPE, and exhibited few fibrous components.Conclusions IA findings vary depending on the condition of the RPE located above the PCV and the extent of amorphous material around the PCV. Jpn J Ophthalmol 2004;48:249–255 © Japanese Ophthalmological Society 2004