Combining surgical ablation of retinal inflow and outflow vessels with photodynamic therapy for retinal angiomatous proliferation

PURPOSE: To evaluate short-term efficacy of combining surgical ablation of retinal inflow and outflow vessels and photodynamic therapy (PDT) for stage 3 retinal angiomatous proliferation (RAP). DESIGN: Prospective interventional case series. METHODS: Five eyes (five patients) underwent surgical ablation of inflow and outflow vessels and PDT for stage 3 RAP. RESULTS: Inflow and outflow vessels were ablated in four eyes, and only inflow was ablated in one eye. In four eyes starting PDT within six weeks of surgical ablation, choroidal neovascularization (CNV) disappeared or shrank after one PDT session (three months follow-up). However, CNV enlarged again in three of the four (final follow-up) because of reperfusion from newly formed inflow vessels. In one eye starting PDT seven months after ablation, a new retinal inflow vessel feeding the CNV appeared by the time of the first PDT session. The CNV continued to expand, despite two PDT sessions. CONCLUSIONS: Combining surgical ablation and PDT was not useful on account of a high frequency of reperfusion from retinal inflow vessels.     

Surgical excision of neovascularization in retinal angiomatous proliferation

Background We report the postoperative outcomes of surgical neovascularization excision in patients with retinal angiomatous proliferation (RAP).Methods Nine eyes of eight patients with RAP who underwent surgical excision of neovascularization were studied. Surgical indications were as follows: RAP diagnosed by fluorescein and indocyanine green angiography, foveal or perifoveal neovascularization, preoperative visual acuity of 0.1 or less, Yannuzzis stage II with detachment of retinal pigment epithelium (RPE) or stage III, and leakage on late-phase fluorescein angiography. After cataract surgery, vitreous surgery and neovascularization excision were conducted, followed by fluid–air or fluid–gas exchange.Results Visual acuity was 0.02–0.1 before surgery and 0.03–0.2 after surgery. Macular hole formation was seen in one eye but did not lead to retinal detachment. In two eyes, subretinal bleeding occurred during excision leading to vitreous bleeding after surgery. Although defects of the RPE and choriocapillaries were observed after surgery, the exudation and bleeding were absorbed.Conclusions In stage II RAP cases with RPE detachment, surgical excision maintains constant postoperative visual acuity but results in defects of RPE and choriocapillaris; therefore, other treatment options should be examined. Surgical excision of stage III RAP seems to be promising, as postoperative visual acuity remains stable after neovascularization removal in those advanced pathologic situations.     

Focal laser ablation of retinal angiomatous proliferation

PURPOSE: To evaluate the feasibility of focal laser ablation of retinal angiomatous proliferation (RAP) identified with clinical examination and high-speed indocyanine green (ICG) imaging in patients with age-related macular degeneration. METHODS: In this retrospective, interventional case series, 16 consecutive eyes of 15 patients with macular degeneration and leakage from a stage I or II RAP lesion were identified. RAP lesions were identified using clinical examination and high-speed ICG imaging. High-speed ICG imaging was used to identify the intraretinal component of the lesion. RAP lesions were treated with a 100- to 200-mum green or yellow wavelength laser spot that was applied to completely ablate the intraretinal component of the lesion. In eyes with stage II lesions, the subretinal component of the lesion was not treated. Early Treatment of Diabetic Retinopathy Study visual acuity, optical coherence tomography retinal thickness, angiographic leakage, and progression of the angiomatous process shown by ICG imaging were evaluated preoperatively and postoperatively. RESULTS: Sixteen eyes underwent successful ablation of the RAP lesions with an average of 1.9 treatment sessions. At a mean follow-up of 15.5 months, 94% of eyes had stable or improved visual acuity. Only 6% of eyes had a loss of >or=3 lines of visual acuity. The average visual acuity at the last follow-up was 20/45 in the stage I lesion group and 20/160 in the stage II lesion group. Of the patients, 87.5% had a reduction in retinal edema and subretinal fluid, with 69% of patients having complete resolution of retinal edema and subretinal fluid; 14% of patients had progression to retinal choroidal anastomoses. No treatment complications were encountered. CONCLUSION: Focal laser photocoagulation of RAP lesions appears to be feasible. This treatment appears to be a safe method of managing the leakage from RAP. Treatment of solely the intraretinal component of the lesion may be adequate to control leakage. Treatment may allow the angiomatous process to be arrested, resulting in stabilization of visual acuity. Visual acuity results appear to be better for patients with early stage lesions.     

Photodynamic therapy for retinal angiomatous proliferations and pigment epithelium detachment

PURPOSE: To evaluate results of photodynamic therapy (PDT) with verteporfin for subfoveal neovascular age-related macular degeneration (ARMD) with retinal angiomatous proliferation (RAP) and pigment epithelial detachment (PED). DESIGN: Interventional case series. METHODS: Thirteen eyes (11 stage 2 and 2 stage 3 RAP) underwent PDT. Best-corrected visual acuity (BCVA), fluorescein and indocyanine-green angiography were performed to evaluate the outcome. RESULTS: After 13.5 +/- 2.5 months and 1.7 +/- 0.4 treatments, mean BCVA decreased from 20/73 to 20/174 (P = .04). Occlusion of RAP and flattening of PED was observed in three eyes, and persistence of PED in six. Two eyes deteriorated to disciform lesions, one developed hemorrhagic PED, and one evolved toward stage 3 RAP. Three eyes, with PED exceeding 50% of the entire lesion, developed retinal pigment epithelium tear. CONCLUSIONS: PDT might prove effective for neovascular ARMD with RAP and small PED, whereas it might cause acute retinal pigment epithelium tear for RAP with PED exceeding 50% of the lesion.     

Retinal angiomatous proliferation in age-related macular degeneration

BACKGROUND: Angiomatous proliferation in ARMD originates from the retina and extends into the subretinal space. Retinal angiomatous proliferation (RAP) is diagnosed with angiography. This study investigates the characteristics of RAP in optical coherence tomography (OCT) and correlates them with clinical and fluorescein angiographic findings. METHODS: 327 consecutive patients with age-related macular degeneration (ARMD) were retrospectively examined using a standardised protocol. The protocol included best corrected visual acuity (BCVA), binocular ophthalmoscopy, fundus photography, fluorescein angiography (FAG) and OCT. The OCT and angiographic findings were graded in 3 RAP stages. RESULTS: 32 of 327 (9.79 %) patients (45 eyes) had RAP. The age ranged from 56 to 90 years (median: 79 years). 9 eyes presented RAP stage I, 23 stage II and 13 stage III. BCVA ranged from 0.01 to 0.7 (median: 0.2). OCT foveal minimum was 136 to 722 microns (median: 327). 33 (73 %) eyes showed a detachment of retinal pigment epithelium (RPE). Macular oedema was found in 43 (96 %) eyes. Cystoid macular oedema was seen in 36 (80 %) eyes. In stage II, 22 eyes (96 %) showed an RPE detachment, in stage III 11 eyes (85 %). 11 (85 %) eyes in stage III showed retinal-choroidal anastomosis. CONCLUSIONS: RAP was found in 9.79 % of the patients with ARMD. The OCT is helpful in detection of RPE detachment, macular oedema and cystoid changes in RAP. RAP and retinal-choroidal anastomosis should be identified because of the possibly poor prognosis.     

Retinal angiomatous proliferation and intravitreal bevacizumab injection

PURPOSE: To evaluate the short-term efficacy and safety of intravitreal bevacizumab injection (IVBI) in patients with retinal angiomatous proliferation (RAP). METHODS: Seven eyes of 5 patients with RAP were included in this study. All of the eyes evidenced stage 2 RAP lesions, except for one eye with a stage 3 lesion. IVBI (1.25 mg/0.05 cc) were conducted at 4 or 6-week intervals. Complete ocular examinations, angiographic results and optical coherence tomographic findings before and after the IVBI were analyzed at baseline and upon the follow-up visits. RESULTS: Seven eyes were studied in 5 patients who had undergone IVBI. Partial (3 eyes) or complete (4 eyes) regression of RAP was noted after IVBI in all of the studied eyes. Visual acuity improved in 5 of the eyes, and was stable in 2 of the eyes. One eye evidenced severe intraocular inflammation after IVBI and a subsequent development of new RAP, which was controlled with vitrectomy and repeat IVBI. CONCLUSIONS: This treatment was effective over 6 months, stabilizing or improving visual acuity and reducing angiographic leakage. These short-term results suggest that IVBI may constitute a promising therapeutic option, particularly in the early stages of RAP.     

Features associated with surgical outcome in patients with stages 4 and 5 retinopathy of prematurity

PURPOSE: To present ocular features associated with surgical outcomes in infants with stages 4 and 5 retinopathy of prematurity (ROP). METHODS: Twenty-two infants (35 eyes) were referred for vitreoretinal surgery for stages 4 and 5 ROP. The following ocular features recorded before the development of retinal detachment requiring surgical intervention were analyzed: clock hour extent of ridge elevation, vitreous state, plus disease, prominent iris vessels, neovascularization, and the presence of exudates. Surgical procedures included scleral buckle, lensectomy-vitrectomy, and lens-sparing vitrectomy. Univariate and multivariate analyses were used to determine features associated with failure to achieve retinal reattachment as the main outcome variable. RESULTS: Of the 35 eyes that underwent at least one surgical procedure, nine had successful retinal reattachment after the first surgery, and 18 achieved it at the end of follow-up. After accounting for the correlation between the eyes, features significantly associated with surgical failure after the first surgery were vitreous haze, hemorrhage, or organization; plus disease; and neovascularization. The presence of exudates was significantly associated with a successful outcome. When eyes were analyzed by stage at the first procedure, vitreous organization and plus disease were associated with failed retinal reattachment in stage 4 eyes, whereas at least 6 clock hours of ridge elevation and plus disease were significant in stage 5 eyes. The need to perform a lensectomy-vitrectomy was associated with a poor surgical outcome. Neither stage nor number of procedures performed was associated with the development of phthisis. CONCLUSIONS: Vitreous haze, neovascularization, and plus disease are associated with a poor surgical outcome in eyes that progress after treatment for threshold ROP requiring surgical intervention for retinal detachment. When eyes were divided by stage of ROP at first surgery, plus disease remained a significant variable associated with failed retinal reattachment. Close observation of eyes after laser treatment for threshold ROP is necessary. If neovascularization and plus disease persist and progression of ROP is noted, additional laser should be considered before surgery for retinal detachment. Additional studies with a larger patient sample will be necessary to further define ocular features associated with surgical outcome for ROP.     

视网膜冷冻手术联合玻璃体注射曲安奈德治疗伴有渗出性视网膜脱离Coats病的初步观察

目的 观察视网膜冷冻手术联合玻璃体注射曲安奈德治疗伴有渗出性视网膜脱离Coats病的疗效.方法 前瞻性连续病例研究.21例伴有渗出性视网膜脱离的Coats病患者的21只眼纳入研究,其中,男性19例,女性2例,年龄2～18岁;部分视网膜脱离15只眼,属3A期,完全视网膜脱离6只眼,属3B期.所有患眼均接受视网膜冷冻手术联合玻璃体注射曲安奈德治疗,3只眼辅助巩膜切开引流视网膜下液.经视网膜冷冻手术联合玻璃体注射曲安奈德治疗后,4只眼针对残余异常血管再行视网膜光凝或冷冻手术.治疗后随访3～15个月,平均随访时间(7±3)个月.观察视力、眼压、眼位及眼球运动、裂隙灯、间接检眼镜及彩色眼底像,比较异常血管变化,视网膜下液及渗出的吸收情况等.以末次随访为疗效判定时间点.结果 治疗后眼压增高6只眼,均局部药物控制.随访结束时,视网膜复位19只眼,局限视网膜脱离1只眼,视网膜全脱离1只眼.视力提高3只眼,不变14只眼,下降2只眼.新发生斜视1只眼.新发生白内障或白内障加重4只眼.结论 视网膜冷冻手术联合玻璃体注射曲安奈德治疗伴有渗出性视网膜脱离Coats病,可使大部分患者视网膜复位,视功能可以有效保存.     

One case of Harada disease complicated by acute posterior multifocal placoid pigment epitheliopathy-like recurrence in both eyes

BACKGROUND: We encountered a patient who developed serous retinal detachment in one eye first, subsequently showed multiple small subretinal punctuated opacity looking like acute posterior multifocal placoid pigment epitheliopathy (APMPPE) in both eyes, and had repeated recurrence. CASE: A 28-year-old female presented with serous retinal detachment accompanied by multifocal small subretinal white punctuated opacity at the posterior pole of the fundus in the left eye. Fluorescein angiography (FAG) revealed many small punctuated hypofluorescent lesions scattered all over the eye in the early stage and multiple subretinal spotty leakage of fluorescein, subretinal accumulation of dye, and leakage of fluorescein from the optic disc in the late stage. Indocyanine green angiography (ICG) revealed small punctuated hypofluorescent lesions from the early to late stage in both eyes. The disease recurred five and a half months after, and there appeared many yellowish white round opaque parts and serous retinal detachment at the posterior pole in both eyes. FAG showed a reversal phenomenon of fluorescein in both eyes. On ICG many small punctuated hypofluorescent lesions were noted and in the late stage insular faint hypofluorescence consistent with serous retinal detachment, light tissue stain and fluorescent leakage in the center of the hypofluorescent lesion were also found. The disease recurred three times thereafter. At present, about two years after the first medical examination, the fundus does not show any sunset glow-like fundus, and vision of 1.2 is maintained on the right and left. CONCLUSION: A rare case of Harada disease complicated with APMPPE-like recurrence is presented.     

One Case of Harada Disease Complicated by Acute Posterior Multifocal Placoid Pigment Epitheliopathy-like Recurrence in Both Eyes

Background: We encountered a patient who developed serous retinal detachment in one eye first, subsequently showed multiple small subretinal punctated opacity looking like acute posterior multifocal placoid pigment epitheliopathy (APMPPE) in both eyes, and had repeated recurrence.Case: A 28-year-old female presented with serous retinal detachment accompanied by multifocal small subretinal white punctated opacity at the posterior pole of the fundus in the left eye. Fluorescein angiography (FAG) revealed many small punctated hypofluorescent lesions scattered all over the eye in the early stage and multiple subretinal spotty leakage of fluorescein, subretinal accumulation of dye, and leakage of fluorescein from the optic disc in the late stage. Indocyanine green angiography (ICG) revealed small punctated hypofluorescent lesions from the early to late stage in both eyes. The disease recurred five and a half months after, and there appeared many yellowish white round opaque parts and serous retinal detachment at the posterior pole in both eyes. FAG showed a reversal phenomenon of fluorescein in both eyes. On ICG many small punctated hypofluorescent lesions were noted and in the late stage insular faint hypofluorescence consistent with serous retinal detachment, light tissue stain and fluorescent leakage in the center of the hypofluorescent lesion were also found. The disease recurred three times thereafter. At present, about two years after the first medical examination, the fundus does not show any sunset glow-like fundus, and vision of 1.2 is maintained on the right and left.Conclusion: A rare case of Harada disease complicated with APMPPE-like recurrence is presented.     

Retinal detachment in myopic eyes after laser in situ keratomileusis

PURPOSE: To report the characteristics and surgical outcomes of rhegmatogenous retinal detachments in myopic eyes after laser in situ keratomileusis (LASIK). METHODS: Clinical charts of patients that developed rhegmatogenous retinal detachment after LASIK were reviewed. Surgery to repair rhegmatogenous retinal detachment was performed in 31 eyes (mean follow-up of 14 months after vitreoretinal surgery). RESULTS: A total of 38,823 eyes underwent surgical correction of myopia from -0.75 to -29.00 D (mean -6.00 D). Thirty-three eyes (27 patients; frequency .08%) developed rhegmatogenous retinal detachment after LASIK; detachments occurred between 12 days and 60 months (mean 16.3 mo) after LASIK. Eyes that developed a rhegmatogenous retinal detachment had a mean -8.75 D before LASIK. Most rhegmatogenous retinal detachment and retinal breaks occurred in the temporal quadrants (71.1%). Final best spectacle-corrected visual acuity (BSCVA) of 20/40 or better was obtained in 38.7% of the 31 eyes (two patients refused surgery). Poor final visual acuity (20/200 or worse) occurred in 22.6% of eyes. Information regarding visual acuity after LASIK and before the development of rhegmatogenous retinal detachment was available in 24 eyes; 45.8% (11/24 eyes) lost two or more lines of visual acuity after vitreo-retinal surgery. Reasons for poor visual acuity included the development of proliferative vitreo-retinopathy (n=5), epiretinal membrane (n=1), chronicity of rhegmatogenous retinal detachment (n=1), new breaks (n=1), displaced corneal flap (n=1), and cataract. CONCLUSIONS: Rhegmatogenous retinal detachment after LASIK for myopia is a serious complication. Final visual acuity may be limited by myopic degeneration, amblyopia, or delayed surgical repair.     

LASIK术后视网膜脱离的临床观察

目的: 探讨准分子激光原位角膜磨镶术( LASIK) 后视网膜脱离的临床特点及其手术治疗效果。方法: 回顾性分析我院行 LASIK手术的 18 342 眼 (9598 例)中发生视网膜脱离的患者的临床资料。所有近视患者在 LASIK手术前均无角膜病等疾患, 术前进行详细的眼底检查。术后平均随诊 20mo, 对 LASIK术后发生的视网膜脱离的临床特点及治疗进行考察。结果: 一共有 6 例患者( 6 眼) 发生了视网膜脱离, 包括 2男 4 女, LASIK术后的视网膜脱离发生率为 0.33‰。这些患者在 LASIK手术前的平均近视度数为 - 9.33D, 6 眼都没有进行手术前预防性光凝治疗。脱离发生与 LASIK手术的平均间隔时间为 9.2mo, 所有视网膜脱离发生没有其他诱因。治疗采用玻璃体切割术联合其他视网膜复位手术方法, 复位手术后平均随诊 9.3mo, 6 例视网膜脱离均一次复位成功(100%)。结论: LASIK术后的视网膜脱离发生率不高。近视眼中视网膜脱离的发生与其行 LASIK手术间没有确定的相关关系, 但医生仍应警惕 LASIK术前可能引起脱离的视网膜病变并予以处理。     

在显微镜下联合间接眼底镜行视网膜脱离非凝固手术

目的:探讨显微镜联合间接眼底镜行外路视网膜脱离非凝固手术的可行性及效果。方法:2007-01/08对50例50眼孔源性视网膜脱离患者,在显微镜下行球结膜环形剪开、四直肌预置牵引线、巩膜外放液或不放液、放置或不放置环扎条带、巩膜缝线固定硅胶(或硅海绵)外加压块、缝合球结膜,在间接眼底镜下行视网膜裂孔定位及术毕眼底检查,术中对裂孔未作凝固处理。术后裂孔周围行激光光凝。手术后随访3~9mo。结果:所有患者手术过程顺利,平均手术时间缩短。手术中并发症:1例术中视网膜下出血;手术后随访3~9mo,视网膜完全复位47眼,1眼出血性视网膜脱离经保守治疗后视网膜复位,1眼手术后视网膜脱离复发经玻璃体手术后视网膜复位,1眼手术后视网膜脱离未复位经二次环扎带调位术后视网膜复位;手术后视力提高43眼,不变5眼,下降2眼。结论:显微镜下联合间接眼底镜操作巩膜扣带术及对裂孔未作凝固处理,使手术创伤小、时间缩短、术中及术后并发症少、手术效果好,患者满意度高。     

New micro vertical scissors for the surgical ablation of retinal angiomatous proliferation

PURPOSE: To develop new micro vertical scissors for the ablation of retinal angiomatous proliferation (RAP) to minimize possible retinal damage. DESIGN: Interventional case report. METHODS: New micro vertical scissors were developed and used for the ablation of RAP vessels. RESULTS: The length of the inner side of the tip is 180 microm, which is approximately one seventh that of regular vertical scissors. The scissors handled easily and the RAP vessels were ablated with less retinal damage compared with that associated with use of standard vertical scissors. Postoperatively, intraretinal hemorrhage was reduced and hyperfluorescence seen on indocyanine green angiography resolved. CONCLUSIONS: The new micro vertical scissors developed for the ablation of RAP vessels can be used safely and effectively during this surgical procedure.     

Laser photocoagulation of indocyanine green angiographically identified feeder vessels to idiopathic polypoidal choroidal vasculopathy

PURPOSE: To evaluate the efficacy of laser photocoagulation of indocyanine green angiographically identified feeder vessels to idiopathic polypoidal choroidal vasculopathic lesions. DESIGN: Interventional case series. METHODS: Fifteen eyes of 14 consecutive patients with idiopathic polypoidal choroidal vasculopathy lesions treated by laser photocoagulation of indocyanine green angiographically identified feeder vessels were investigated. RESULTS: In 10 of the 15 eyes, serous retinal detachment of sensory retina in the macula disappeared after photocoagulation of the feeder vessels. The best-corrected visual acuity improved by 2 or more lines in eight of the 15 eyes and worsened in two eyes during the mean follow-up period of 13.6 months. CONCLUSIONS: Laser photocoagulation targeted exclusively to the feeder vessels supplying the idiopathic polypoidal choroidal vasculopathy lesions is a safe and effective method and can improve vision in eyes in which a serous retinal detachment is present in the macula. Indocyanine green angiography-guided laser photocoagulation should be considered as an optional treatment for idiopathic polypoidal choroidal vasculopathy.     

Retinal detachment of regressed retinopathy of prematurity in children aged 2 to 15 years

PURPOSE: To reveal the clinical features and surgical results of retinal detachment of regressed retinopathy of prematurity (ROP) that occur in the children aged 2 to 15 years. PATIENTS AND METHODS: The records of patient who had a retinal detachment of a regressed ROP were retrospectively reviewed. Sixteen eyes from 15 patients that required surgical treatments due to retinal detachment of a regressed ROP were included. RESULTS: After treatment of acute phase of ROP, eight eyes showed grade II of cicatricial change and eight eyes showed grade III. We did not find any evidence that the acute stages of ROP and its treatment affect the degree of the cicatricial changes. All eight eyes with grade III of cicatricial ROP showed tractional retinal detachment (TRD) and five of eight eyes (62.5%) with grade II showed rhegmatogenous retinal detachment (RRD). The mean interval between regressed ROP and development of late retinal detachment was 20.7 months (range, 12-61 months) in the TRD group and 85.8 months (range, 33-148) in the RRD group. The mean age at onset of late detachment was 34.1 months (range, 26-73 months) in the TRD group and 98.6 months (range, 45-162) in the RRD group. Anatomical success was achieved at one of five eyes (20%) with RRD and six of 11 eyes (54.5%) with TRD. Compared with the preoperative visual acuity, visual improvement, no change, and decreased visual acuity were achieved, respectively, in two eyes, three eyes, and no eyes in the RRD group and three eyes, six eyes, and two eyes in the TRD group. However, only two of 16 eyes with late retinal detachment achieved a visual acuity of 20/200 or better. CONCLUSION: Late retinal detachment is the main vision-threatening condition in patients with regressed ROP during childhood. The visual prognoses of these patients are poorer than those with late retinal detachments that occur in adult ROP patients. Therefore, a periodic fundus examination should be performed more frequently during childhood than in adulthood, particularly in nonverbal children.     

Recurrent retinal detachment more than 1 year after reattachment

PURPOSE: Little information exists regarding recurrent retinal detachment after 1 or more years of complete retinal reattachment. To better understand this uncommon problem, we evaluated late recurrent retinal detachments in relation to the contemporary classification of proliferative vitreoretinopathy (PVR). DESIGN: Retrospective consecutive noncomparative case series. PARTICIPANTS: Nine patients (10 eyes) with late recurrent retinal detachment after 1 or more years of complete reattachment. METHODS: We retrospectively analyzed the clinical and operative records of one surgeon over a 9-year period to identify late recurrent retinal detachments that occurred 1 or more years after complete retinal reattachment. The study group was derived from a total of 453 consecutive cases of rhegmatogenous retinal detachment repair not associated with proliferative diabetic retinopathy, uveitis, or penetrating ocular trauma. MAIN OUTCOME MEASURES: Late recurrent retinal detachments after 1 or more years of complete retinal reattachment. RESULTS: The study group consisted of 10 eyes (2.2% of total) in nine patients. Redetachment occurred from 12 to 126 months (average, 46.8 months) after the initial detachment surgery. Late recurrent retinal detachments were associated with new retinal breaks (five eyes), reopening of old breaks (three eyes), or both (two eyes). In all, 13 open breaks were identified, nine of which were on or anterior to the scleral buckle. Eight eyes had grade C PVR, including four eyes with anterior PVR, three eyes with posterior PVR, and one eye with both anterior and posterior PVR. The retina was reattached after additional vitreoretinal surgery in eight eyes of seven patients; two patients (two eyes) declined reoperation. Visual acuity improved in seven of eight eyes after repair of the late recurrent retinal detachment. Postoperative follow-up after late recurrent detachment repair ranged from 69 to 140 months (average, 101.7 months, or 8.5 years). CONCLUSIONS: Vitreous base traction seems to be an important factor in late recurrent retinal detachments occurring 1 or more years after complete retinal reattachment, and the associated PVR was probably a secondary phenomenon and not a causative factor in most cases. Reoperation for such late recurrent retinal detachments can successfully reattach the retina and improve visual acuity in most cases.     

Retinal detachment in phakic eyes with anterior chamber intraocular lenses to correct severe myopia

PURPOSE: To analyze the incidence and characteristics of retinal detachment in patients with severe myopia corrected by implantation of phakic anterior chamber intraocular lenses. METHODS: We studied retinal detachments in 166 consecutive eyes (98 patients) that underwent implantation of angle-supported phakic anterior chamber intraocular lenses (models ZB5M and ZB5MF; Domilens; Lyon, France) for the correction of severe myopia (follow-up +/- SD, 45.26 +/- 14.65 months; range, 20 to 84 months). RESULTS: Retinal detachment occurred in eight eyes (4.8%); four eyes belonged to men and four to women. The time between implanting surgery and retinal detachment was 17.43 +/- 16.4 months (range, 1 to 44 months). In all cases, retinal detachment was spontaneous. In seven eyes, the retina was reattached successfully during the first retinal detachment surgery. Mean best-corrected visual acuity after phakic anterior chamber intraocular lens implantation and before retinal detachment development was 20/50 (range, 20/100 to 20/25). After retinal detachment repair, best-corrected visual acuity was 20/73 (range, 20/2000 to 20/33). In these seven eyes, differences between best-corrected visual acuity before and after reattachment were not statistically significant (P = .898, paired Student t test). In one eye, a proliferative vitreoretinopathy was observed, which required additional treatment by vitrectomy and explantation of the phakic anterior chamber intraocular lens. A refractive change was observed after retinal detachment repair, from -1.1 +/- 0.7 diopters (range, 0.00 to -2.50 diopters) before retinal detachment and -2.8 +/- 1.1 diopters (range, -1.00 to -4.50 diopters) after retinal detachment surgery (P = .03, paired Student t test). CONCLUSIONS: The implantation of a phakic anterior chamber intraocular lens as a correcting procedure for severe myopia was followed by a 4.8% incidence of retinal detachment. Conventional scleral surgery was successful in most cases, without causing significant changes in the final best-corrected visual acuity. A significant increase in the myopic spherical equivalent was observed after retinal detachment repair in these patients.     

Long-term results after surgical extraction of subfoveal choroidal neovascular membranes with and without haemorrhage in age-related macular degeneration

Background Surgical extraction has been suggested as a treatment of choroidal neovascular membranes. We demonstrate the long-term results of our patients regarding complications, risk of recurrence and development of visual acuity.Methods We have retrospectively evaluated the charts and re-examined the patients who underwent surgical extraction of choroidal neovascular membranes (CNV) because of age-related macular degeneration (AMD) between March 1994 and December 2000 in the Department of Ophthalmology of the Benjamin Franklin Clinic, Berlin. Fifty-two eyes of 49 patients with a minimum follow-up of 12 months after pars plana vitrectomy with CNV extraction and SF6-endotamponade were included. Initially, in 15% of all eyes the lesions were obscured by intravitreal haemorrhage. All visible lesions were located subfoveally. In 40% of all eyes the lesion was predominantly classic; 21% of the lesions were predominantly occult and 23% of the lesions were comprised of more than 50% haemorrhage. The maximum follow-up was 80 months, the mean 46 months.Results The median initial visual acuity was 0.08 (range: hand movements to 0.4) and the median final visual acuity was not significantly different at 0.067 (range: non lux to 0.4). A loss of less than three lines of visual acuity occurred in 65.4% of our patients. During follow-up, 25% of eyes developed a rhegmatogenous retinal detachment and 19.2% of all eyes suffered from recurrence of CNV. At the end of the follow-up, three eyes (5.8%) suffered from non-treated retinal detachment and three eyes (5.8%) had recurrent CNV lesions. All eyes showed a retinal pigment epithelium defect at the site of former CNV.Conclusion A stabilisation of visual acuity in individual patients with CNV because of AMD can be achieved by surgical extraction, yet the defect of the RPE and the risk of complications limit the benefit. We consider the surgical extraction of CNV from AMD in patients with low initial visual acuity who are not amenable to PDT.This paper was presented at the 100th DOG Congress, September 2002     

Laser photocoagulation and photodynamic therapy (PDT) with verteporfin for retinal angiomatous proliferation (RAP) in age-related macular degeneration (AMD)

BACKGROUND: Retinal angiomatous proliferation (RAP) is a subtype of neovascular age-related macular degeneration (AMD) with particularly bad prognosis. Diverse treatment modalities are performed. PATIENTS AND METHODS: This is a retrospective review on the treatment results of 41 consecutive patients from 1/2003 to 12/2005 with RAP stage 1-3 (Yannuzzi classification), who were treated with laser photocoagulation, photodynamic therapy (PDT) and intravitreal injection of triamcinolone acetonide (IVT). Follow-up was 12 months minimally. RESULTS: In RAP stage I complete closure of the vascular lesion in 14 / 22 eyes was achieved by 1.2 +/- 0.5 sessions of laser photocoagulation (4 x combined with IVT) and in 3/14 eyes with photodynamic therapy (2 +/- 0.5 sessions). In RAP stage II closure of the lesion was achieved by 3.2 +/- 0.6 sessions of photodynamic therapy in 6/14 eyes (4 x combined with IVT). In RAP stage III closure of the lesion was achieved by 3.2 +/- 0.4 sessions of photodynamic therapy in 0 / 5 eyes (3 x combined with IVT). A rip of the retinal pigment epithelium was observed in 2/14 eyes of RAP stage II and 2/5 eyes of RAP stage III. Visual acuity improved in 9/17 eyes with occlusion of RAP stage I. Without closure of the vascular lesion all eyes got legally blind (visual acuity 1/50 or less). CONCLUSIONS: Early detection and subsequent direct treatment of RAP stage I in AMD is recommended. In advanced stages anatomical closure of the vascular complex is rarely achieved and the risk is improved for development of tears in the retinal pigment epithelium and getting legally blind.