Laser treatment of subretinal macular neovascularization in pathologic myopia

The authors evaluated retrospectively 100 eyes with pathological myopia and a macular subretinal neovascular membranes (SRNV) which was treated with direct laser photocoagulation. Argon green, krypton red and orange dye (590 nm) laser were used to treat, respectively, 19, 63 and 18 eyes. The follow-up period was of 12 months. Mean initial visual acuity was 0.33 and mean final visual acuity was 0.31, with no statistically significative difference between them. One or more recurrence was observed in 44% of the eyes. Recurrences could be treated in 80% of cases. At the end of the follow-up period SRNV had disappeared in 83 eyes and extended into the foveola in the remaining 17.     

Laser treatment of macular subretinal neovascularization in angioid streaks

The authors examined 17 eyes with macular subretinal neovascularization in angioid streaks treated by direct laser photocoagulation. Two eyes were treated with dye laser (590 nm), two with blue-green argon, three with green argon and ten with red krypton laser. At twelve-month follow-up, the visual acuity was of 0.21, a statistically significant decrease respect to the presenting vision. Poor functional results are due to the frequent recurrences of neovascularization.     

Recurrent subretinal neovascularization

A retrospective analysis of a consecutive series of patients treated with krypton red laser (KRL) photocoagulation for subretinal neovascularization (SRN) secondary to drusen-related macular degeneration (DMD) was carried out to investigate the frequency and nature of recurrent neovascularization (recurrence). A classification of various types of recurrences based on the clinical and fluorescein angiographic features and the onset of their appearance in the postoperative course was used in this study. Patient, fundus, and membrane variables were examined in search of relevant high risk factors predisposing to recurrences. The membrane's proximity to the fovea and its relative lack of pigmentation were individual factors which were associated with a high risk of recurrence (P less than 0.05 for distance and P = 0.005 for color). Multivariate analysis also indicated that a greater distance from the fovea (P less than 0.05) and a darker color (P = 0.002) were favorable features to the primary membrane, reducing the probability of a recurrence. Overall, 39% of the patients experienced recurrences (23% of the patients had treatable recurrences and 16% had non-treatable recurrences extending under the center of the fovea). The membranes recurred predominantly at the margin of the photocoagulation burn. The recurrences were also noted relatively early in the postoperative course, 65% within two months after photocoagulation of the primary membrane. The fluorescein angiographic and clinical nature of these membranes and the visual effect of retreatment are also discussed in the paper.     

Therapy of parapapillary subretinal neovascularization

A large variety of diseases may cause a subretinal neovascularization originating from choroidal vessels. Four cases of parapillary choroidal neovascularisation are described, including neovascularization caused by senile and myopic degeneration, by drusen of the optic nerve head, and by angioid streaks. Obliteration of the neovascular membrane with confluent argon laser coagulation reduced metamorphopsia and prevented a progredient loss of visual acuity in all four patients.     

Rubella retinopathy and subretinal neovascularization

Diseases that primarily affect the pigment epithelium, Bruch's membrane, or the choroid may lead to secondary subretinal neovascularization and its sequelae of hemorrhage and scarring. We studied three cases of presumed congenital rubella retinopathy with congenital deafness, which developed unilateral subretinal neovascularization, hemorrhage, and scarring.     

Sympathetic ophthalmia and subretinal neovascularization

We report a case of sympathetic ophthalmia with subretinal neovascularization of the macula. The subretinal neovascularization developed after penetrating trauma to the fellow eye. The occurrence of subretinal neovascularization in sympathetic ophthalmia is not surprising since disintegrative changes and breaks in Bruch's membrane have been reported in sympathetic ophthalmia. Subretinal neovascularization has also been reported in Vogt-Koyanagi-Harada syndrome, which is histopathologically similar to sympathetic ophthalmia.     

Retinochoroidal coloboma and subretinal neovascularization

Subretinal neovascularization associated with retinochoroidal coloboma is rare. To the authors' knowledge, only three cases have been reported. We report a new case of isolated subretinal neovascularization and coloboma in a 26-year-old woman without other causes of choroidal neovascularization. Only the disruption of the normal retinal anatomy could explain the development of this subretinal neovascularization.     

Rubella retinopathy and subretinal neovascularization

A case of rubella retinopathy associated with macular scarring from subretinal neovascularization is presented. Ophthalmoscopic findings included diffuse mottling of the retinal pigment epithelium throughout the macula and into the postequatorial areas, atrophic "rings" around both optic discs, and a solid white and slightly raised macular cicatrix in the right eye. The patient has been followed for three years; her visual acuity remains at 20/20 and there has been no change in the appearance of her retinae. Rubella retinopathy should be considered in the differential diagnosis of young patients with subretinal neovascularization.     

Thalassemia and macular subretinal neovascularization

A 12 year old boy who suffered from homozygous beta-thalassemia came to our clinic complaining of progressive deterioration of the visual acuity of the left eye. His visual acuity at this eye was finger counting at a distance of 50 cm. Fundus examination revealed a tortuous course of the fundus vessels, angioid streaks radiating from the region of the disk and a greyish elevated circular lesion measuring about half a disk diameter in the macular area. Fluorescein angiography showed the existence of a subretinal new vascular membrane. The possibility of the development of severe fundus complications in patients with thalassemia syndromes is discussed.     

Peripapillary subretinal neovascularization in retinoblastoma

Background Peripapillary subretinal neovascularization (PSRNV) is a rare type of choroidal neovascularization. Herein we report a case of retinoblastoma complicating PSRNV, and discuss the histopathological findings. Methods A 1-year-old male underwent enucleation of his right eyeball based on the clinical diagnosis of bilateral retinoblastoma after chemotherapy. Results There was a mass arising from the retina showing highly calcified and necrotic retinoblastoma. The peripapillary region revealed neovascular membrane extending from the optic nerve head to the subretinal space. The membrane included retinal pigment epithelial (RPE) cells and glial cells, as well as endothelial cells. Immunohistochemistry revealed cytokeratin 18-positive RPE cells situated beneath glial fibrillary acidic protein-positive glial cells and their processes. The neovascular membrane did not have a connection with vessels arising from the optic nerve head. There were multiple mound foci made up of proliferated RPE cells in the globe. Conclusion These results suggest that migration of RPE cells and glial cells plays a crucial role in the pathogenesis of PSRNV, which might be directly or indirectly mediated by retinoblastoma.     

Idiopathic focal subretinal neovascularization.

In 20 patients idiopathic focal subretinal neovascularization was characterized by a solitary focus of subretinal neovascularization at or near the fovea, associated with serous or hemorrhagic detachment of the overlying and adjacent sensory retina, or both. Although the lesions resembled the neovascular membrane seen in the presumed ocular histoplasmosis syndrome, none of the other associated characteristic ophthalmoscopic findings, considered essential to make the latter diagnosis, were apparent. In this group of patients, the incidence of positive histoplasmin skin tests was no greater than in the general population. Of the 20 patients, two had bilateral disease. In no case were there any other lesions of any kind in the afflicted or the opposite eye. The disease is self-limited over a variable period of time, but may result in extensive scarring with loss of central vision.     

Enzymatic and mechanically induced subretinal neovascularization

Mechanical and enzymatic disruption of Bruch's membrane and induction of subretinal neovascularization in an experimental primate model have produced limited success. The methods and results are reported here to identify some problems encountered in methodology and to detail the results of this approach to subretinal neovascularization.

---

Zusammenfassung Mechanische und enzymatische Kontinuitätsunterbrechungen der Bruch'schen Membran führen nur in wenigen Fällen zur Entwicklung subretinaler Gefäßproliferationen. Methode und Befunde werden beschrieben, um einige Probleme der Methodologie darzustellen und die Einzelheiten der Befunde bei diesem experimentellen Modell aufzuzeigen.

---

---

Presented at the Macula Society meeting. Miami, Florida, January 17–20, 1980

---

Dr. Ryan was a recipient of the Louis B. Mayer Scholar Award from Research to Prevent Blindness, Inc., New York, New York, during the period of this work

---

This work was funded in part by two grant awards from the National Institutes of Health, National Eye Institute, EY-00944 and EY-01545     

Peripapillary subretinal neovascularization in peripheral uveitis

A 29-year-old white female with peripheral uveitis developed bilateral disc edema and unilateral peripapillary subretinal neovascularization which was successfully treated with argon laser photocoagulation. To our knowledge, this is the first reported case of peripapillary subretinal neovascularization complicating the course of peripheral uveitis.     

Bilateral choroidal osteoma with subretinal neovascularization

Choroidal osteoma is a rare entity, reported previously mainly in females. We report a case of bilateral choroidal osteoma in a 15-year-old boy. Ultrasonography and computerized tomography findings were key to establishing the diagnosis. During two years' follow-up, there was observable growth in the tumor size. Leakage from subretinal neovascular tufts covering the tumor caused visual deterioration. Photocoagulation of the subretinal new vessels was performed twice, with limited success, but the value of this treatment in choroidal osteomas needs further study.