Submacular surgery for choroidal neovascularization secondary to optic nerve drusen

PURPOSE: To report a case of bilateral choroidal neovascularization (CNV) secondary to optic nerve drusen (OND). DESIGN: Interventional case report. METHODS: A 9-year-old girl presented with peripapillary CNV of the right eye and peripapillary and subfoveal CNV of the left eye secondary to OND. The CNV was excised with submacular surgery in the left eye. RESULTS: Visual acuity increased from 0.05 to 0.3 in the left eye after submacular surgery and did not change from 0.3 in the right eye during 6-month follow-up. Partial retinal pigment epithelial atrophy, but no recurrence of CNV, was observed after CNV excision. CONCLUSION: Subfoveal CNV is an uncommon complication of OND and surgical excision may be useful in selected cases.     

Photodynamic therapy-treated choroidal neovascular membrane secondary to toxoplasmic retinochoroiditis

Purpose To report the result of photodynamic therapy with Visudyne (PDT) on a child with choroidal neovascular membrane (CNV) secondary to toxoplasmic retinochoroiditis.Methods An 11-year-old child with a unilateral lowering of visual acuity secondary to an extrafoveal choroidal neovascular membrane was submitted to PDT.Results One week after PDT, the patients vision had improved from 10/160 to 20/70, with marked improvement in the angiographic findings. The CNV evolved with decreasing of leakage until 45 days after operation, when it regressed to a chorioretinal scar formation, with final vision of 20/25.Conclusion PDT promoted an early recovery of visual acuity in an eye with choroidal neovascularization secondary to toxoplasmic retinochoroiditis.     

Laser photocoagulation for choroidal neovascular membrane associated with optic disc drusen

PURPOSE: To report two cases of choroidal neovascular membrane associated with optic disc drusen which were successfully treated using argon laser photocoagulation. METHODS: Choroidal neovascular complications of optic disc drusen were diagnosed in two of our patients, a 36-year-old woman and a 14-year-old girl. In both cases visual acuity was 20/100 in the affected eye. Fundus examination and angiography revealed a choroidal neovascular membrane. Computer tomography identified bilateral calcified drusen of the optic discs. Photocoagulation of neovascular tissues was immediately performed. RESULTS: Visual acuity improved progressively, reaching 20/20 10 months after treatment in one case and 20/30 in the other. No recurrence was observed during follow-up. CONCLUSION: Early diagnosis and immediate laser photocoagulation of vision-threatening choroidal neovascular membranes associated with optic disc drusen helps stop progression towards the macula and improves longterm visual acuity.     

Photodynamic therapy of a posttraumatic choroidal neovascular membrane

The authors present a patient with posttraumatic choroidal neovascular membrane (CNVM) treated with PDT resulting in regression of the CNVM.     

Familial drusen of the optic nerve head associated with choroidal neovascular membranes

Drusen of the optic nerve head associated with a choroidal neovascular membrane have been reported, but, to the best of our knowledge this is the first report of such an occurrence in two members of the same family, a mother and son. Optic disc drusen should be included as a possible cause of choroidal neovascular membranes, especially in cases that are otherwise atypical. The author have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which include unlabeled, unapproved, or investigative products or devices. Meeting Presentation Presented by William Tasman, MD at the Macula Society Annual Meeting, Las Vegas, Nevada, February 27, 2004. Poster presented by Richard Scartozzi, MD at the Retina Society Annual Meeting, Baltimore, Maryland, October 2, 2004.     

Photodynamic therapy for choroidal neovascularization secondary to choroidal nevus

PURPOSE: To describe a patient treated with photodynamic therapy for subfoveal choroidal neovascularization secondary to choroidal nevus. DESIGN: Interventional case report. METHODS: A 61-year-old woman presented with subfoveal choroidal neovascularization secondary to choroidal nevus and best-corrected visual acuity of 20/50. The choroidal neovascularization was treated with two verteporfin photodynamic therapy sessions, separated by 3 months. RESULTS: The choroidal neovascularization was occluded after two sessions. Best-corrected visual acuity improved to 20/25 and remained stable throughout an 18-month follow-up. CONCLUSION: Photodynamic therapy seems to be an effective treatment for subfoveal choroidal neovascularization secondary to choroidal nevus.     

Submacular neovascular membrane and drusen of the optic disk

A case of unilateral serous hemorrhagic maculopathy with a very acute course is reported in an eight year old girl fluorescein angiography revealed the presence of a subretinal neovascular membrane extending from the inferotemporal part of the disc to the macula; CT scan identified calcified drusen of the optic disc. Ophthalmoscopy and angiography one year later showed a glial macular scar, absence of hemorrhage and serous detachment. Visual acuity was reduced to counting fingers. This unusual type of maculopathy combining optic disc drusen and a neovascular membrane contradicts the classically benign prognosis of optic disc drusen.     

Pseudopapilledema secondary to optic nerve drusen: ophthalmoscopic differentiation

Two cases of pseudopapilledema secondary to optic nerve drusen were presented. The first case demonstrated the difficulty of ophthalmoscopic differentiation in children and the possible misapplication of invasive neurologic procedures. The second case report demonstrated the relatively greater ease of ophthalmoscopic differentiation in adults and the familial and progressive nature of optic nerve drusen. Also presented were some of the possible sequelae of this condition.     

Photodynamic therapy for choroidal neovascular disease: photosensitizers and clinical trials

Photodynamic therapy with visudyne for choroidal neovascular disease (CNV) has proved effective at preventing moderate to severe visual loss in eyes with subfoveal predominantly classic CNV or occult-only CNV caused by age-related macular degeneration (AMD) and in eyes with subfoveal CNV caused by pathologic myopia. PDT is not meant to improve visual acuity. It should, therefore, be used in eyes with potentially useful macular vision. Clinical trials are under way to evaluate the usefulness of early retreatment with PDT and visudyne at 6 weeks for reducing the risk for moderate visual loss in eyes with predominantly classic CNV, the efficacy of PDT with visudyne for the treatment of AMD in eyes with minimally classic CNV, and the efficacy of PDT for use with SnET2, lutetium texaphyrin, and Npe6.     

Intravitreal bevacizumab in the management of choroidal neovascular membrane secondary to choroidal osteoma

PURPOSE. To describe a patient with choroidal neovascular membrane (CNVM) secondary to choroidal osteoma treated successfully with intravitreal bevacizumab. METHODS. Case report. A 25-year-old healthy woman presented with complaints of sudden painless decrease in vision in the left eye (OS) of 1 month duration. On examination, visual acuity was 20/20 in the right eye (OD) and counting fingers at 1.5 meters OS. Slit lamp examination was unremarkable. Fundus examination OD was normal; OS demonstrated a flat, opaque, yellowish parapapillary choroidal lesion with adjacent subfoveal grayish membrane associated with minimal subretinal fluid suggestive of a CNVM. B-scan ultrasonography revealed findings consistent with a choroidal osteoma. Fundus fluorescein angiography (FFA) of the left eye revealed a relatively well-defined area of hyperfluorescence that increased in size and intensity in the later phases suggestive of active subfoveal CNVM. Optical coherence tomography (OCT) confirmed the subfoveal CNVM with altered foveal contour and distortion of foveal architecture. A diagnosis of subfoveal CNVM associated with choroidal osteoma was made. The patient was treated with intravitreal bevacizumab 1.25 mg in 0.05 mL OS and repeated 6 weeks later. RESULTS. At the 4-month visit, vision OS improved to 20/125. The FFA and OCT revealed a resolved CNVM. CONCLUSIONS. Intravitreal bevacizumab may be an effective alternative in the management of CNVM secondary to choroidal osteoma. Larger series of such cases need to be studied to further validate our findings.     

Surgical removal of peripapillary choroidal neovascularization associated with optic nerve drusen

PURPOSE: To assess the anatomical and functional results after surgical removal of peripapillary choroidal neovascularization (CNV) associated with optic nerve head drusen. METHODS: A retrospective study was carried out on four eyes (four patients) undergoing vitrectomy, retinotomy, and removal of CNV associated with optic disk drusen. CNV was preoperatively demonstrated by fluorescein angiography in all cases. In three cases, the CNV had a subfoveal extension, and a serous-hemorrhagic retinal detachment was the cause of the central vision disturbance in the remaining one. Optic nerve head drusen were bilateral and were confirmed with computed tomography scan. RESULTS: Visual acuity (VA) improved in all cases after a follow-up ranging from 12 to 42 months. Preoperative VA was 20/200, 20/200, 20/50, and count fingers and final VA was 20/50, 20/25, 20/25, and 20/30, respectively. There was no evidence of CNV recurrence during the follow-up period. CONCLUSION: The results of surgical removal of peripapillary CNV with macular involvement associated with optic nerve head drusen are very encouraging, especially if we consider the variable outcome of the natural course in these cases.     

Photodynamic therapy for the treatment of choroidal neovascularization secondary to rubella retinopathy

PURPOSE: To describe a patient for whom photodynamic therapy was used to treat subfoveal choroidal neovascularization secondary to rubella retinopathy. DESIGN: Interventional case report.METHODS: A 36-year-old man with subfoveal choroidal neovascularization secondary to rubella retinopathy was treated with photodynamic therapy using verteporfin. Outcome was followed up with subsequent fundus examinations, fluorescein angiography, and evaluations of best-corrected visual acuity. RESULTS: Two treatments of photodynamic therapy using verteporfin resulted in involution of the neovascular membrane, resolution of subretinal hemorrhage, and improvement in best-corrected visual acuity from 20/200 to 20/60 2 months after the second treatment. Owing to recurrence of active choroidal neovascularization, the patient required two more treatments of photodynamic therapy in the next 6 months, after which his best-corrected visual acuity was restored to 20/60. CONCLUSION: Photodynamic therapy may be an effective treatment for subfoveal choroidal neovascularization secondary to rubella retinopathy.     

Transpupillary thermotherapy in subfoveal choroidal neovascular membrane secondary to age-related macular degeneration

PURPOSE: To report our initial experience in the treatment of subfoveal choroidal neovascular membrane, secondary to age-related macular degeneration (AMD) by transpupillary thermotherapy (TTT). METHODS: Fifty consecutive patients with subfoveal choroidal neovascularisation (CNV) secondary to AMD, were included in the study. The parameters assessed before the TTT were visual acuity by ETDRS chart, scotoma score by Amsler grid chart, reading speed, fundus examination by direct and indirect ophthalmoscope as well as +90 Diopter lens followed by digital fundus photography and fluorescein angiography (FA). RESULTS: The letter visual acuity improved or stabilized in 72% cases up to 12 weeks after TTT. Mean scotoma score decreased from a mean of 47.56, to 43.56 at 6 weeks and to 37 at 12 weeks. Mean reading speed increased from 27.04 words/minute at pretreatment to 34.52 words/minute at 6 weeks and 37.33 words/minute 12 weeks after TTT. CONCLUSION: TTT is not only a cheaper alternative to photodynamic therapy (PDT), but also is an efficacious tool in stabilisation or improvement of visual acuity in the management of subfoveal choroidal neovascular membrane due to AMD.