Submacular surgery to remove choroidal neovascularization associated with central serous chorioretinopathy

PURPOSE: To report the results of submacular surgery for removal of choroidal neovascularization associated with central serous chorioretinopathy. METHODS: Ten eyes of nine consecutive patients with central serous chorioretinopathy and subfoveal or juxtafoveal choroidal neovascularization underwent pars plana vitrectomy with removal of the choroidal neovascular membrane between January 1994 and January 1999.RESULTS: All 10 eyes (nine patients) were followed postoperatively for at least 6 months. The mean postoperative follow-up was 23 months (range, 6 to 56.5 months). The patients were followed for an average of 6.2 months from the time of symptoms to the removal of the choroidal neovascularization. Preoperative mean best-corrected visual acuity was 20/100 (range, 20/25 to 20/400), and postoperative best-corrected mean visual acuity was 20/60 + 2 (range, 20/20 to 20/400). Seven eyes had improved postoperative visual acuity, with an average of 3.4 lines gained. Of the three eyes that had worse acuity, an average of 1.3 lines of visual acuity was lost; final mean postoperative visual acuity was 20/80 + 1 (range, 20/25 to 20/400). Of the six eyes with symptoms of less than 3 months' duration, four had a final visual acuity of 20/50 or better. All three eyes with 20/300 or worse final visual acuity had loss of foveal retinal pigment epithelium after surgery; the remaining eyes had preserved retinal pigment epithelium with a visual acuity of 20/70 or better. Two eyes had intraoperative peripheral retinal tears, and two eyes had recurrence of the choroidal neovascular complex. CONCLUSIONS: The anatomic and visual results in eyes with choroidal neovascularization associated with central serous chorioretinopathy are modestly encouraging and suggest that submacular surgery for choroidal neovascularization in patients with central serous chorioretinopathy is a treatment option that may salvage good macular function in some eyes.     

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.     

Exudative idiopathic polypoidal choroidal vasculopathy and photodynamic therapy with verteporfin

PURPOSE: To report two cases of exudative idiopathic polypoidal choroidal vasculopathy treated by photodynamic therapy with verteporfin. DESIGN: Interventional case reports. METHODS: Two patients, a man aged 58 years and a woman aged 57 years, with recent visual impairment in the right eye (OD) (both eyes best-corrected visual acuity: 10/50 and Pelli-Robson contrast sensitivity 1.35 and 1.20) and angiographically proved subfoveal idiopathic polypoidal choroidal vasculopathy were treated with photodynamic therapy using verteporfin (Visudyne; Novartis SA, Rueil Malmaison, France). Functional and angiographic outcomes were assessed 6 weeks and 3, 6, and 12 months after treatment. RESULTS: In Patient 1, 3 months after treatment, best-corrected visual acuity and contrast sensitivity improved (10/16 and 1.50) and then remained stable throughout the 12 months after treatment. In Patient 2, 6 weeks after treatment, vision and contrast sensitivity were 10/20 and 1.35; and at 3 months, were improved and stabilized at 10/12.5 and 1.50. Angiographically, photodynamic therapy with verteporfin was associated with nonperfusion and occlusion of the exudative polypoidal dilations. No acute recurrence was noted during the follow-up period. CONCLUSION: In subfoveal exudative idiopathic polypoidal choroidal vasculopathy, photodynamic therapy with verteporfin may be associated with beneficial functional results.     

Optical coherence tomography of idiopathic polypoidal choroidal vasculopathy

PURPOSE: To document and study the cross-sectional structures of polypoidal elements using optical coherence tomography in eyes with idiopathic polypoidal choroidal vasculopathy. METHODS: Optical coherence tomography images of two eyes with idiopathic polypoidal choroidal vasculopathy were correlated with slit-lamp biomicroscopic findings, fundus photographs, fluorescein angiograms, and indocyanine green angiograms. RESULTS: Cross-sectional optical coherence tomographic images of retinochoroidal structures showed prominent anterior protrusion of the orange subretinal mass corresponding to the polypoidal structure in the indocyanine green angiogram. Hemorrhagic detachment of the retinal pigment epithelium was contiguous with the cone-shaped nodule beneath the retinal pigment epithelium in one eye, and an apparent discontinuity was observed in the highly reflective layer that delineates the polypoidal structure. CONCLUSIONS: Some of the polypoidal structures in eyes with idiopathic polypoidal choroidal vasculopathy are anteriorly protruding lesions in the inner choroid that may cause serosanguineous detachment of the retinal pigment epithelium through damage of the overlying Bruch membrane, retinal pigment epithelium, and the adhesion between them. Cross-sectional optical coherence tomographic images may increase understanding of the pathophysiology of idiopathic polypoidal choroidal vasculopathy.     

Transplantation of autologous retinal pigment epithelium in eyes with foveal neovascularization resulting from age-related macular degeneration: a pilot study.

PURPOSE: To describe the indications, surgical technique, and clinical results of 14 eyes in 13 patients with age-related macular degeneration and foveal choroidal neovascularization, in which subretinal surgery was combined with simultaneous transplantation of autologous retinal pigment epithelial cells. METHODS: Between March 1999 and February 2000, in a prospective study, 14 eyes (13 patients) with age-related macular degeneration underwent subretinal surgery because of foveal choroidal neovascularization with simultaneous transplantation of retinal pigment epithelium harvested from the nasal subretinal area of the same eye. Preoperatively, 1 month postoperatively, 3 months postoperatively and at 3-month intervals thereafter, examinations were performed including best-corrected visual acuity, visual field, biomicroscopy of anterior and posterior segment, tonometry, fluorescein and indocyanine angiographies, autofluorescence, scotometry, and fixation tests. RESULTS: Postoperatively, after median observation of 17 months (range, 12 to 24 months) best-corrected visual acuity was improved 2 or more lines in eight eyes (57.1%), remained the same (+/- 1 line) in five eyes (35%), and decreased by more than 2 lines in one eye (7.1%). Pairwise t test showed significant improvement after 1 month (P = .0031, P = .0062) as well as 1 year (P = .0066, P = .0105). Satisfactory reading vision between Jaeger 1 and 4 was achieved in three eyes (21.2%). No significant intraoperative or postoperative complications occurred in any eye. No recurrence of choroidal neovascularization was observed during the observation period. CONCLUSIONS: In eyes with age-related macular degeneration and foveal choroidal neovascularization, autotransplantation of retinal pigment epithelium was performed in addition to conventional removal of the choroidal neovascularization without significant intraoperative or postoperative complications. Visual acuity improvement of 2 or more lines in 57% of the eyes was achieved. No recurrent choroidal neovascularization formation was observed during the observation period. The results of this pilot study suggest that autologous transplantation of retinal pigment epithelium combined with submacular surgery might be a reasonable treatment option for patients with foveal choroidal neovascularization secondary to age-related macular degeneration.     

Optical coherence tomography of orange-red subretinal lesions in eyes with idiopathic polypoidal choroidal vasculopathy

PURPOSE: To study the cross-section images of orange-red lesions in eyes with idiopathic polypoidal choroidal vasculopathy and compare their protrusions quantitatively with those of serous retinal pigment epithelium detachment. METHODS: Optical coherent tomography images scanning remarkable orange-red lesions in eyes with idiopathic polypoidal choroidal vasculopathy and serous retinal pigment epithelium detachment in age-related macular degeneration or central serous chorioretinopathy were prospectively recorded. The correlation between the base diameter and the height of the lesions was analyzed. RESULTS: Optical coherence tomography images show prominent anterior protrusion of the orange-red lesions. The ratio of the height to the base diameter of the orange-red lesions in eyes with idiopathic polypoidal choroidal vasculopathy is 0.32+/-0.05, and it is significantly larger than lesions in eyes with serous retinal pigment epithelium detachment (0.18+/-0.05, P< .001). CONCLUSION: The orange-red lesions in eyes with idiopathic polypoidal choroidal vasculopathy have a more sharply peaked shape than serous retinal pigment epithelium detachment as a subretinal structure, suggesting polypoidal vascular lesions in eyes with idiopathic polypoidal choroidal vasculopathy are situated beneath the Bruch membrane and covered anteriorly with both the retinal pigment epithelium and the Bruch membrane.     

Idiopathic polypoidal choroidal vasculopathy and sickle cell retinopathy

PURPOSE: To report a patient who had concomitant idiopathic polypoidal choroidal vasculopathy and sickle cell retinopathy. METHOD: Case report. A 46-year-old black woman presented with sudden onset of "blurring" in the left eye. Her ocular history was unremarkable, and her medical history was relevant for sickle cell disease with yearly episodes of sickle cell crises. RESULTS: Both eyes had evidence of idiopathic polypoidal choroidal vasculopathy and peripheral retinal neovascularization secondary to sickle cell disease. The left eye had hemorrhagic retinal pigment epithelial detachments secondary to idiopathic polypoidal choroidal vasculopathy. CONCLUSION: We present this case as an example of concomitant sickle cell retinopathy and idiopathic polypoidal choroidal vasculopathy. We are unaware of previous reports with these findings.     

玻璃体切除联合Conbercept玻璃体腔注射治疗PCV并发玻璃体积血

目的:探讨息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)并发玻璃体积血的患者行玻璃体切除术联合康柏西普(Conbercept)玻璃体腔注射的临床疗效.方法:回顾性筛选2014-02/2015-07我院收治的11例11眼首诊为玻璃体积血的患者,其中男7例,女4例;年龄65 ～ 79(平均69.5 ±9.0)岁,术前视力:光感者1眼,手动者7眼,眼前/指数者3眼,11眼均给予玻璃体切除术及C3F8填充并联合超声乳化白内障摘除及人工晶状体(IOL)植入术.术前有3例患者行FFA及ICGA造影检查确诊为PCV,其余8例患者于玻璃体切除术后1mo时行FFA及ICGA造影检查确诊为PCV.于玻璃体切除术后1mo对11例患者明确诊断后,即行首次康柏西普玻璃体腔注射,注射剂量为0.5 mmg(0.05 mL),连续3次,间隔1 mo,此后根据随访情况,当病情加重或复发时追加一次注射治疗.所有患者于首次康柏西普玻璃体腔注射后随访12 mo.本研究观察玻璃体切除术前、术后1 mo,和首次康柏西普注射后l、2、3、4、5、6、9、12mo的眼底、B超、最佳矫正视力(best corrected visual acuity,BCVA)、光学相干断层扫描(optical coherence tomography,OCT)等情况,对此四项指标进行临床疗效观察.结果:随访至康柏西普注射后12mo时,眼底检查显示11眼患者视网膜深层及浅层出血完全吸收,其中5眼患者仍可见视网膜下橘红色病灶;B超显示11眼患者视网膜下积血完全吸收;11眼患者的BCVA均较术前明显提高,其中有3眼患者诉存在不同程度的视物变形等情况;OCT显示黄斑中心视网膜厚度明显下降,其中有6眼患者仍存在浆液性视网膜色素上皮脱离.结论:玻璃体切除术为PCV并发玻璃体积血患者的明确诊断及后续治疗创造了条件;玻璃体切除术后联合康柏西普玻璃体腔注射治疗,能快速促进视网膜出血及渗出的吸收,减轻视网膜的水肿,促使息肉状病灶的消退,有效地提高患者的预后视力.     

Visual prognosis of eyes with submacular hemorrhage associated with exudative age-related macular degeneration

Purpose

To study the retinal structural changes associated with submacular hemorrhage due to exudative age-related macular degeneration (AMD) and their relationships with visual prognosis.

Methods

We retrospectively reviewed the medical records of 31 consecutive patients (31 eyes) with visual impairment due to an acute submacular hemorrhage associated with typical AMD (10 eyes) or polypoidal choroidal vasculopathy (21 eyes).

Results

Optical coherence tomography (OCT) revealed that submacular hemorrhage exhibited intense hyperreflectivity beneath the neurosensory retina and often seemed to infiltrate it. In the OCT sections, mild to moderate amorphous hyperreflectivity and/or hyperreflective dots were observed within the neurosensory retina, resulting in the loss of the junctions between the inner (IS) and outer (OS) segments of the photoreceptors. Of the 31 eyes, the foveal IS/OS line could be seen incompletely in 12 eyes and was totally absent in 16 eyes. The initial integrity of the foveal photoreceptor layer was correlated with the final visual acuity; the initial detection of the IS/OS just beneath the fovea was correlated with good final visual acuity (r?=?0.375, p?=?0.038).

Conclusion

As a hallmark of integrity of the foveal photoreceptor layer, the initial detection of the IS/OS just beneath the fovea may predict good visual outcomes.     

Limited macular translocation for the management of subfoveal retinal pigment epithelial loss after submacular surgery

PURPOSE: To report a case of subfoveal retinal pigment epithelial (retinal pigment epithelium) loss after submacular surgery managed successfully by limited macular translocation. METHODS: Case report. RESULTS: A 28-year-old woman presented with a visual acuity of 20/100 caused by subfoveal choroidal neovas-cularization secondary to ocular histoplasmosis syndrome. Submacular resection of the choroidal neovascularization was complicated by inadvertent retinal pigment epithelium loss from beneath the foveal center. She underwent limited macular translocation 5 days after the initial surgery and had successful displacement of the fovea to an area inferior to the retinal pigment epithelium defect. Her visual acuity was 20/60 4 months postoperatively. CONCLUSION: This report demonstrates the feasibility of using limited macular translocation for the management of eyes with central retinal pigment epithelium defect after submacular surgery and extends the clinical indications for limited macular translocation.     

Six-month visual prognosis in eyes with submacular hemorrhage secondary to age-related macular degeneration or polypoidal choroidal vasculopathy

Background

To determine clinical or imaging prognostic features for visual outcome in eyes with submacular hemorrhage secondary to age-related macular degeneration (AMD) or polypoidal choroidal vasculopathy (PCV).

Methods

A prospective case series of 11 eyes from 11 patients with submacular hemorrhage secondary to AMD or PCV. All participants had measurement of clinical characteristics, fundus angiogram, and indocyanine green angiography, spectral domain optical coherence tomography (OCT, Cirrus, Zeiss) at baseline and 6 months.

Results

Median visual acuity improved from 20/132 to 20/63 at month 6. The median improvement in vision was 0.20 LogMAR units. Proportion of eyes with best-corrected visual acuity (BCVA) ≥1.0 increased from 6/11 (54.5 %) at baseline to 8/11 (72.7 %) at month 6. Eyes with BCVA?>?1.0 were more likely to have larger area of hemorrhage and thinner subfoveal neurosensory retinal thickness at baseline and at month 6.

Conclusions

Thinner neurosensory retina demonstrated on OCT at baseline may be a useful prognostic sign for limited visual recovery.     

Morphologic and angiographic assessment of the macula after macular translocation surgery with 360 degrees retinotomy

PURPOSE: To compare the optical coherence tomographic assessment of retinal thickness and the fluorescein angiographic appearance after macular translocation surgery for subfoveal choroidal neovascularization. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twenty-three consecutive eyes. INTERVENTION AND TESTING: Optical coherence tomography and fluorescein angiography were performed before and 6 to 15 months (mean +/- standard error [SE], 10.4+/-0.7) after macular translocation surgery with a 360 degrees retinotomy in 23 patients, ages 48 to 79 years, with age-related macular degeneration (12 eyes), polypoidal choroidal vasculopathy (2 eyes), and high myopia (9 eyes). The diameter of the choroidal neovascularizations ranged from 0.3 to 2.6 disc diameters (mean +/- SE, 1.2+/-0.2), and the angle of rotation of the retina ranged from 11 degrees to 45 degrees (mean +/- SE, 29.1+/-2.1 degrees ). RESULTS: The preoperative best-corrected visual acuity ranged from hand motions to 20/100, and the postoperative best-corrected visual acuity ranged from 20/667 to 20/25. Optical coherence tomography demonstrated a concave foveal configuration after surgery in all 23 eyes, with a mean foveal thickness of 150+/-11 micro m (mean +/- SE). Fluorescein angiography showed various degrees of fluorescein leakage with a pattern similar to cystoid macular edema in 16 of 23 eyes (70%). CONCLUSIONS: The newly located macula after macular translocation surgery with a 360 degrees retinotomy had cystoid macular edema on fluorescein angiography and normal macular configuration with normal thickness in optical coherence tomography.     

Idiopathic polypoidal choroidal vasculopathy: its extreme aspects in one patient--case report

To describe a case of idiopathic polypoidal choroidal vasculopathy and the role of indocyanine green angiography findings in the differential diagnosis of exudative maculopathies, particularly with age-related macular degeneration, and the extreme evolution of idiopathic polypoidal choroidal vasculopathy in one patient. A patient with vitreous hemorrhage was examined and evaluated by fluorescein and indocyanine green angiographies in the right eye and with hemorrhagic detachment of the retinal pigment epithelium in the left eye. The patient was treated by pars plana vitrectomy in the right eye which was followed by retinal detachment and vision loss. In the left eye an involution of the hemorrhagic detachment of the retinal pigment epithelium with preservation of the vision was seen. The idiopathic polypoidal choroidal vasculopathy seems to be a distinct clinical entity that can and should be differentiated from age-related macular degeneration and the fluorescein and indocyanine green angiographies should be performed to evaluate the choroidal vasculature in an attempt to establish a more definitive diagnosis. Particularly in this case the entity had an extreme clinical course in the patient.     

Chorioretinal anastomosis after photodynamic therapy for polypoidal choroidal vasculopathy

An 80-year-old woman was treated with photodynamic therapy (PDT) to the left eye for polypoidal choroidal vasculopathy (PCV). About 3 months after PDT, her left eye developed a chorioretinal anastomosis with severe atrophy of the retinal pigment epithelium in the macula; visual acuity in this eye was 20/1000. She received a second session of PDT, plus an intravitreal injection of triamcinolone acetonide. About 3 months after the second treatment, the chorioretinal anastomosis was enlarged and the retinal vessels involved in the anastomosis were more dilated. About 1 year after the first PDT, visual acuity in the left eye had stabilized at 20/400. Development of a chorioretinal anastomosis is a distinct possibility following PDT in eyes with PCV, and can lead to poor visual recovery.     

Macular translocation for subfoveal choroidal neovascularization in age-related macular degeneration: a prospective study.

PURPOSE: To conduct a prospective study of macular translocation in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration. METHODS: In 10 eyes of 10 patients with subfoveal choroidal neovascularization and best-corrected visual acuity ranging from 20/50 to 20/800 (median, 20/111), the fovea was relocated by means of scleral imbrication, intentional retinal detachment with small posterior retinotomies, and partial fluid-air exchange. In two eyes, the choroidal neovascular membranes were removed at the time of macular translocation; in seven eyes they were photocoagulated in the postoperative period; and in one eye the membrane was removed during reoperation to unfold a macular fold. RESULTS: All 10 eyes were followed up for 6 months. The median postoperative foveal displacement was 1286 microm (range, 114 to 1,919 microm). In three eyes (30%), a foveal fold formed postoperatively requiring reoperation, with one of these eyes requiring a second reoperation for a rhegmatogenous retinal detachment. Best-corrected visual acuity improved in four eyes (median, 10.5 letters) and decreased in six eyes (median, 14.5 letters). The median change in visual acuity was a decrease of 5 letters. The final best-corrected visual acuity was 20/80 in two eyes, 20/126 in one eye, 20/160 in four eyes, 20/200 in one eye, 20/250 in one eye, and 20/640 in one eye. CONCLUSIONS: Our initial experience with limited macular translocation suggests that this surgical technique is unpredictable. However, in patients with subfoveal choroidal neovascularization from age-related macular degeneration, it offers the potential for improving visual function and may be associated with less loss of vision than the disease itself, if allowed to progress. Further refinements in surgical indications and technique are needed to make this procedure safer, more predictable, and more beneficial.     

Treatment of massive subretinal hematoma associated with age-related macular degeneration using vitrectomy with intentional giant tear

The purpose of this study was to report the surgical outcomes after creating a 120° intentional giant retinal tear for use in removing hemorrhage and subretinal proliferative tissue in patients with polypoidal choroidal vasculopathy (PCV) or age-related macular degeneration (ARMD). This study involved 12 eyes of 12 patients (10 eyes: PCV, 2 eyes: ARMD). After removal of the lens in phakic eyes, we performed a vitrectomy with artificial posterior vitreous detachment. Subsequently, a 120° intentional giant retinal tear was created in the temporal periphery, the retina was then turned, and the subretinal hemorrhage and proliferative tissue were removed. In order to preserve as much of the retinal pigment epithelium (RPE) as possible, we used a bimanual technique under direct visualization. After stretching the retina by use of perfluorocarbon liquid (PFCL), we performed endophotocoagulation around the tear followed by PFCL/silicone oil exchange. Except for 1 eye in which extensive loss of the RPE occurred, the fundus findings and the visual acuity (VA) improved in all patients. In addition, postoperative VA improved to ≥20/50 in 3 eyes in which the macular RPE was preserved. This surgical procedure is an effective treatment for PCV or ARMD patients with extensive subretinal hemorrhage and proliferative tissue.     

Macular polypoidal choroidal vasculopathy with a remote lesion

Purpose: To report cases of the macular type of polypoidal choroidal vasculopathy with a remote lesion. Methods: We report six patients (seven eyes) with polypoidal choroidal vasculopathy who had macular and remote lesions. These eyes were examined with angiography and tomography. Results: All seven eyes showed an exudative macular lesion beneath the fovea. In addition, all eyes showed remote polypoidal lesions that were not connected to the macular lesions; the remote lesion was detected outside of the vascular arcade in five eyes, superotemporally beside the optic disc in one eye and on the nasal side of the optic disc in one eye. Indocyanine green angiography, fluorescein angiography and optical coherence tomography failed to reveal any sign of a branching vascular network or choroidal neovascularization that connected the macular lesion with the more remote lesion. At the initial visit, visual acuity in the seven eyes ranged from 6/150 to 6/9 (median, 6/15). Four eyes underwent photodynamic therapy to the exudative macular lesion. During 27.6 ± 14.3 months of follow up, no worsening was detected in any of the remote lesions. Median visual acuity was 6/60 at the final visit. Conclusions: Some patients with macular polypoidal choroidal vasculopathy also have a remote lesion, although the remote lesion seems to have only a minor effect on visual outcome.     

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）     

Foveal translocation with scleral imbrication in patients with myopic neovascular maculopathy

PURPOSE: To report our surgical results of foveal translocation with scleral imbrication in patients with myopic neovascular maculopathy. DESIGN: Noncomparative, interventional, consecutive case series. METHODS: Ten eyes of 10 myopic patients with subfoveal neovascular membranes that had undergone foveal translocation with scleral imbrication were recruited for this retrospective study. Inclusion criteria were myopia 6.0 diopters or greater in refractive error (or axial length 26.5 mm or longer), subfoveal choroidal neovascularization, and preoperative best-corrected visual acuity of 20/100 or worse. None of these eyes had undergone prior laser photocoagulation or submacular surgery. The main outcome measures were surgical complications and postoperative visual function. RESULTS: Postoperatively, visual acuity had improved more than 3 lines in the logarithm of minimum angle of resolution (logMAR) measurement in all eyes. The mean preoperative, postoperative best, and final visual acuity were 0.12, 0.59, and 0.51, respectively. Of the 10 eyes, six achieved a postoperative final visual acuity of 20/40 or better. The mean postoperative foveal displacement was 0.78 disk diameter (range, 0.3--1.3 disk diameter). Two patients underwent a reoperation because of insufficient foveal displacement. Furthermore, one of these two patients required a third operation to reduce an excessive retinal fold involving the fovea induced by the second surgery. Of the 10 patients, two noted transient diplopia. This complaint, however, resolved over time as suppression developed. Although unintentional iatrogenic retinal tears formed intraoperatively in two eyes, these were successfully treated without serious complications. Postoperatively, mild retinal pigment epithelial changes were observed in all cases, but none led to significant deterioration of visual acuity during the follow-up period. All patients but one were followed for a minimum of 6 months. CONCLUSIONS: In eyes with myopic neovascular maculopathy, foveal translocation with scleral imbrication may be useful in improving visual acuity. Further refinements in surgical technique and assessment of the long-term complications will be needed to make this procedure safer and more useful.     

Retinal pigment epithelial tear in polypoidal choroidal vasculopathy

PURPOSE: To study the clinical characteristics of tears of the retinal pigment epithelium (RPE) in eyes with polypoidal choroidal vasculopathy (PCV). METHODS: The authors report eight eyes of eight patients with PCV that had tears of the RPE. These were examined with angiography and tomography. RESULTS: Eight eyes of eight patients (seven men and one woman) had RPE tears at the margin of a serosanguineous pigment epithelial detachment (PED) associated with PCV. Tears of the RPE were detected at the initial visit in one eye and during follow-up without any treatment in five eyes. In two eyes, the RPE tears were detected 3 months and 6 months, respectively, after photodynamic therapy. In all eyes, the RPE tears were detected at the side opposite to the polypoidal lesions of the PEDs, and the fovea was not involved in the RPE tear. Visual acuity in the seven eyes without RPE tears on presentation ranged from 20/100 to 20/16 (median, 20/32). During follow-up, three of these eyes lost three or more lines of vision. At the final examination, while three of these eyes had visual acuity of 20/25 or better, the other four had visual acuity of 20/200 or worse. CONCLUSION: In eyes with PCV, RPE tears can occur at the margin of serosanguineous PEDs-either spontaneously or after photodynamic therapy.