Recurrence after surgical ablation for retinal angiomatous proliferation

PURPOSE: To report the frequency of recurrence of retinal angiomatous proliferation (RAP) lesions after surgical ablation. METHODS: Seven eyes of seven consecutive patients with stage II RAP underwent surgical ablation of retinal feeder and draining vessels of RAP lesions. These eyes were examined with visual acuity testing, biomicroscopic slit-lamp fundus examination, fluorescein and indocyanine green angiographies, and optical coherence tomography before and after surgery. RESULTS: Between 2 months and 13 months after surgical ablation, all 7 eyes (100%) had lesion recurrence with exudative and/or hemorrhagic manifestations such as macular edema, serous detachment of the sensory retina, or pigment epithelial detachment. Retinal feeding and draining vessels were recanalized (six eyes) or newly developed (one eye) in communication with recurrent intraretinal neovascularization. CONCLUSIONS: After surgical ablation for stage II RAP, all seven eyes had recurrence of the RAP lesions. This treatment may be ineffective for RAP. Further study of this surgical technique is necessary before recommending it for the treatment of RAP.     

Preoperative factors influencing visual outcome following surgical excision of subfoveal choroidal

PURPOSE: To evaluate long-term visual acuity outcomes and the influences of various preoperative factors on visual outcome in patients undergoing surgical removal of choroidal neovascular neovascularization (CNV) caused by age-related macular degeneration (ARMD). METHODS: The authors studied 146 eyes of 146 patients who were followed for at least 1 year after surgical excision of CNV associated with ARMD. Surgical indications included subfoveal active CNV localized mainly above the retinal pigment epithelium (RPE) and a standard Japanese decimal visual acuity of 0.3 or worse. CNV above the RPE was diagnosed by fluorescein angiography, indocyanine green angiography, and optical coherence tomography. CNVs were divided into completely classic CNV or mainly classic CNV. The relationships of the post-operative logarithm of the minimum angle of resolution (logMAR) visual acuity with preoperative logMAR visual acuity, the shortest distance from the center of the foveal avascular zone to the CNV margin, CNV size, and age were analyzed. RESULTS: Final logMAR visual acuity was improved (defined as a logMAR visual acuity increase of 0.2 or more) in 78 eyes (54%), stable in 47 (32%), and worsened in 21 (14%). Stepwise regression identified CNV size as a significant factor influencing final logMAR visual acuity (R2 = 0.213, p<0.0001), while preoperative logMAR visual acuity, shortest distance from the center of the foveal avascular zone to the CNV margin, and age showed no significant correlation with final logMAR visual acuity. Surgical complications included retinal detachment in six eyes (4%), subretinal hematoma in four eyes (2%), macular hole in three (2%), and proliferative vitreoretinopathy in two (1%). CNV recurred postoperatively in 18 eyes (12%). In 92 eyes with completely classic CNV, visual acuity was improved in 57 (62%), stable in 27 (29%), and worsened in 8 (9%). In 54 eyes with mainly classic CNV, visual acuity was improved in 21(39%), stable in 20 (37%), and worsened in 13 (24%). CONCLUSIONS: Surgical excision of CNV for ARMD was effective for completely classic CNV, and better postoperative visual acuity was achieved in cases of small CNV. Given the fact that photodynamic therapy (PDT) has only been used in Japan since 2004, future study should compare PDT and surgical excision in Japanese subjects for relative merits against surgical risk and postoperative complications, to define indications for PDT and surgical excision.     

Adult retinal pigment epithelial transplantation in exudative age-related macular degeneration

PURPOSE: To improve visual function by retinal pigment epithelial (RPE) cell transplantation and systemic immunosuppression at the time of surgical removal of subfoveal choroidal neovascularization in exudative age-related macular degeneration (AMD). DESIGN: An interventional case series of RPE transplantation in exudative AMD. METHODS: Twelve patients (one eye only) underwent subfoveal membranectomy with transplantation of a sheet of adult human allogeneic RPE cells at a single institution and were followed for one year. Eligibility criteria included age >60, best-corrected acuity < or =20/63 and subfoveal neovascularization < or =9 disk areas on preoperative fluorescein angiography. All patients were started on triple immunosuppression postoperatively. The primary outcome measure was best-corrected vision, with contrast sensitivity and reading speed as secondary outcome measures. RESULTS: The best-corrected visual acuity (P = .085), contrast sensitivity (P = .204), and the reading speed (P = .077) did not change significantly at one year compared with preoperative values. Transplants showed no signs of rejection in patients who were able to continue the immunosuppressants for six months. Postoperative surgical complications included cataract progression requiring surgery (three of eight phakic eyes), retinal detachment (three eyes), intraoperative retinal breaks (two eyes), and macular pucker (two eyes). None of the patients developed cystoid macular edema on postoperative fluorescein angiography or postoperative inflammation. CONCLUSIONS: A sheet of adult human allogeneic RPE can be transplanted into the subretinal space in AMD patients at the time of subfoveal membranectomy. Systemic immune suppression appeared to prevent rejection of the transplanted tissue, but did not lead to an improvement in visual function.     

Clinicopathological findings of retinal angiomatous proliferation

Background Neovascular membranes obtained from surgical excision of neovascularization for retinal angiomatous proliferation (RAP) were examined histopathologically in an attempt to elucidate the pathogenic mechanism of RAP. Methods Nine eyes of eight patients (mean age, 79±6 years) who underwent neovascularization excision were studied. Three eyes had stage II with RPE detachment, six had stage III. Immunohistochemical studies were performed to identify von Willebrand factor, vascular endothelial factor (VEGF), CD68 and hypoxia inducible factors (HIF-1 alpha and HIF-2 alpha). Results Multiple soft drusen were present in the macular area in all patients. In one stage II eye, we observed intraretinal neovascularization as a VEGF-positive mass, CD68-positive macrophage migration and HIF expression. In another stage II eye, neovascularization had extended above the RPE, while VEGF-positive fibroblasts were observed below the RPE. Therefore, in stage II, neither angiographic nor histopathological examinations identified choroidal neovascularization. In one phase III eye, angiography demonstrated choroidal neovascularization and chorioretinal anastomosis. Histopathologically, chorio-retinal communication was observed in the region where the RPE was destroyed, and VEGF-positive neovascularization was also seen below the RPE. Conclusions The findings of multiple drusen in elderly patients together with macrophage migration and HIF expression surrounding VEGF-positive retinal neovascularization suggest ischemic and inflammatory factors to be associated with the development and progression of RAP.     

Late complications in branch retinal vein occlusion

Neovascularization in branch retinal vein occlusion usually develops 6–12 months after the onset of the disease, although some cases have been reported in which neovascularization and subsequent vitreous haemorrhage developed 2–3 years later.This is a report of nine cases of late appearance of vitreous haemorrhage due to branch retinal vein occlusion, which occurred 3–6 years after the initial onset of the disease. In two of these nine cases the vitreous haemorrhage was very profound and had to be managed by vitrectomy. We have studied the remaining seven cases, which had retinal ischaemia and optic disc or retinal neovascularization documented by fluorescein angiographic examination. Laser coagulation was applied in these seven cases, which resulted in considerable regression of the neovascularization and absorption of the vitreous haemorrhage. In one out of the seven cases recurrent vitreous haemorrhages appeared and it was finally treated by vitrectomy. Visual acuity improved in six of the seven cases. The follow-up period ranged from 12 to 48 months.The late appearance of the ischaemic type of branch retinal vein occlusion with neovascularization can be attributed to the change in character of the initially mild oedematous form of the disease. Partial posterior vitreous detachment and traction exerted at some later stage upon the neovascularization could be additional factors of the late appearance of vitreous haemorrhage.Patients with branch retinal vein occlusion should be followed up regularly over a long period of time in order to avoid late complications of the disease, such as vitreous haemorrhage following optic disc or retinal neovascularization.     

Retinal Pigment Epithelium Tear after Vitrectomy for Vitreomacular Traction Syndrome in an Eye with Retinal Angiomatous Proliferation

An 87-year-old Japanese man presented with retinal angiomatous proliferation (RAP) and a retinal pigment epithelium (RPE) detachment in his right eye. His decimal best-corrected visual acuity was 0.15 in the right eye, and optical coherence tomography (OCT) showed a vitreomacular adhesion in the right eye as well. After 3 monthly intravitreal injections of ranibizumab, the size and height of the RPE detachment was significantly reduced. The accumulated intra- and subretinal fluid also disappeared, but the vitreomacular traction remained. Pars plana vitrectomy was performed, and the posterior hyaloid was separated from the retina with a vitrectomy cutter without any intraoperative complications. Two months after the surgery, a large RPE tear was observed over the macular area. His visual acuity decreased to 0.06 and remained unchanged thereafter. We suggest that the small tear led to the larger RPE tear because vitreomacular traction was transmitted to the RPE through the fibrovascular tissue of the RAP during the creation of the hyaloid detachment. Because such an RPE tear has not been reported after vitrectomy for vitreomacular traction, surgeons need to pay special attention to this potential complication in eyes with vitreomacular traction and RAP.Key Words: Retinal angiomatous proliferation, Vitreomacular traction syndrome, Vitrectomy, Retinal pigment epithelium tear     

Different outcome among eyes with proliferative diabetic retinopathy indicated for vitrectomy

PURPOSE: The postoperative outcome was evaluated in each group of surgical indications of vitreous surgery for proliferative diabetic retinopathy (PDR), to investigate the factors responsible for postoperative visual prognosis. METHODS: Primary vitrectomy was performed in 119 eyes of 92 patients with PDR. Average postoperative follow-up period was 19 months. The indications for vitrectomy included vitrous hemorrhage in 58 eyes, macular tractional retinal detachment in 17 eyes, extramacular tractional retinal detachment in 10 eyes, macular heterotopia in 11 eyes, and progressive fibrovascular proliferation in the posterior fundus in 23 eyes. RESULTS: The visual acuity finally improved by 2 lines or more in 91 eyes (77%), remained unchanged in 10 eyes (8 %), and decreased by 2 lines or more in 18 eyes (15%). Final postoperative visual acuity was significantly better in cases of vitreous hemorrhage or progressive fibrovascular proliferation in the posterior fundus than in others. Preoperative rubeosis iridis and macular tractional retinal detachment were probably responsible for the final visual impairment, and intraocular tamponade affected the difference in visual prognosis between the groups of surgical indication. Multivariate analysis in all cases revealed that factors influencing visual outcome were preoperative rubeosis iridis and anemia. CONCLUSION: Rubeosis iridis and macular tractional retinal detachment were prognostic factors of the surgery. Vitrectomy for PDR may be effective in improving postoperative visual acuity if performed in the early stage of progressive fibrovascular proliferation in the posterior fundus after sufficient retinal photocoagulation.     

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.     

Management of branch retinal vein occlusion with vitrectomy and arteriovenous adventitial sheathotomy,the possible role of surgical posterior vitreous detachment

Background To analyze the results of vitrectomy and adventitial sheathotomy in the management of branch retinal vein occlusion (BRVO). This is a nonrandomized interventional case series.Methods Patients with BRVO with progressive decrease in visual acuity underwent surgery and were prospectively evaluated in two centers. Surgical procedure included a 3-port pars plana vitrectomy, removal of the internal limiting membrane and arteriovenous crossing sheathotomy. Clinical evaluation consisted of best-corrected visual acuity, fluorescein angiography and optical coherence tomography.Results Thirteen eyes were analyzed consecutively. An improvement in visual acuity of two ETDRS lines or more was observed in nine eyes (69%). The mean gain was 1.9 ETDRS lines. The absence of previous posterior vitreous detachment (PVD), poor initial visual acuity and the presence of retinal ischemia were correlated to the improvement in vision (P=0.014, P=0.002 and P=0.052, respectively). Eyes with initial PVD had a mean loss postoperatively of –5.7 lines, but eyes without PVD experienced a gain of 4.2 lines (P<0.001). Macular edema decreased significantly (preoperative thickness: 714 µm, postoperative thickness: 353 µm, P=0.04), whereas the aspect of the vein at the crossing and the non-perfused area remained unchanged.Conclusion Vitrectomy with sheathotomy seems to be of benefit in the management of BRVO, particularly in eyes with no previous PVD, and the main postoperative feature was the decrease in macular edema. The surgical detachment of posterior hyaloid could be as important (or more) as the sheathotomy itself. Further studies are needed to define the most efficient surgical management of BRVO.     

Long-term results of vitreous surgery for proliferative diabetic retinopathy

In order to study long-term anatomical and functional results the authors evaluated the data from 260 patients who underwent pars plana vitrectomy for proliferative diabetic retinopathy. Indications for surgery were: vitreous hemorrhage, 68 eyes (26.2%); vitreous hemorrhage & tractional retinal detachment, 84 eyes (32.3%); tractional retinal detachment, 82 eyes (31.5%); and combined tractional-rhegmatogenous retinal detachment, 26 eyes (10%). In 118 eyes vitreoretinal surgery was combined with silicone-oil tamponade.The retina was completely attached posterior to a scleral buckle in 251 eyes (96%) at the time of the last examination. After a follow-up period of at least 12 months in a group of patients with vitreous hemorrhage, visual acuity improved in 88% of the eyes. Visual acuity was better than 0.5 in 31% of eyes. In group of eyes with nonresorbing vitreous hemorrhage & tractional retinal detachment visual acuity improved in 52% of eyes. Visual acuity improved in 76% of eyes with tractional retinal detachment and in 81% of eyes with combined tractional & rhegmatogenous retinal detachment. When comparing the latest postoperative visual acuity to visual acuity after three months postoperatively, visual acuity was unchanged in 88%, in 10% it became worse and in 3 cases (1%) became better. In the postoperative period, recurrent vitreous hemorrhage occurred in 33 (13%) eyes, reproliferation in 12 eyes.Cataract developed in 45 of 168 phakic eyes. If postoperative visual acuity before cataract formation was good, extracapsular cataract extraction with posterior chamber intraocular lens implantation was performed. Otherwise simple intra or extracapsular cataract extraction was performed. In 19 cases cataract operation was performed together with silicone oil extraction. Neovascular glaucoma developed postoperatively in 15 eyes (6%). Retinal detachment occurred postoperatively in 21 eyes (8%). In 15 eyes the retina was successfully reattached after additional operations.     

Vitrectomy in the management of peripheral uveitis

The natural history of peripheral uveitis may eventually lead to indications for vitreous surgery. Over a 7-year period, a consecutive series of 12 eyes in nine patients with peripheral uveitis underwent vitreous surgery. Indications for surgery included persistent dense vitreous inflammation, vitreous hemorrhage, traction retinal detachment (RD), and epiretinal membrane formation. Patients were followed for an average of 22 months. Six eyes (50%) required further surgery after the development of RD, recurrent vitreous hemorrhage, or cataract formation. The preoperative finding most frequently associated with postoperative complications was the presence of active neovascularization of the vitreous base. Final visual acuity ranged from 20/30 to 20/100 showing an average improvement of 5 Snellen lines. Persistent cystoid macular edema significantly limited visual improvement in five patients. Patients undergoing vitreous surgery for management of peripheral uveitis may show a significant degree of visual improvement though multiple operations may be required. Control of active neovascularization is an important factor in limiting postoperative complications and the need for further surgery.     

Retinal pigment epithelium translocation after choroidal neovascular membrane removal in age-related macular degeneration

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 on for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (ARMD). DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Nine patients with previously untreated exudative ARMD underwent surgical excision of the subfoveal CNV with RPE translocation and were observed for 12 to 32 months. METHODS: The surgery consisted of a standard three-port pars plana vitrectomy, excision of the CNV, and RPE translocation. Pre- and postoperative ocular examination included best-corrected visual acuity measurement, fundus color stereo photography, and fundus fluorescein angiography. Optical coherence tomography and confocal laser scanning ophthalmoscopy (cLSO) were performed after surgery. A crossfixation target and a single-point flashing light were projected on different areas of the posterior pole using a cLSO. Photopic 10 to 2 perimetry, photopic fine matrix mapping, and cLSO microperimetry were also performed after surgery in six patients. MAIN OUTCOME MEASURES: Optical coherence tomography cross-sectional scans and cLSO RPE autofluorescence were recorded to detect the presence of viable translocated RPE. Visual acuity, fixation, photopic 10 to 2 perimetry, photopic fine matrix mapping, and cLSO microperimetry were used to test central visual function. RESULTS: Retinal pigment epithelium was translocated successfully at the time of CNV removal from the edge of the RPE defect to a subfoveal location in seven of nine patients. One patient experienced proliferative vitreoretinopathy, but significant hemorrhage was not a feature. Optical coherence tomography showed the translocated RPE as an area of increased optical reflectivity with optical shadowing external to it. Confocal laser scanning ophthalmoscopy showed autofluorescence of the translocated RPE. The crossfixation target was seen when projected on the translocated RPE. During eccentric fixation, the patients could see a flashing point-target projected on the translocated RPE. Photopic 10 to 2 perimetry, photopic fine-matrix mapping, and cLSO microperimetry showed the presence of central visual function. CONCLUSIONS: The authors propose that translocation of 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 ARMD.     

Retinal stimuli can be restored after autologous transplant of retinal pigment epithelium and choroid in pigment epithelium tears

Purpose: To evaluate the functional and anatomical outcome of patients undergoing autologous transplant of retinal pigment epithelium (RPE) and choroid after RPE tear secondary to age‐related macular degeneration (AMD). Methods: Data from nine eyes of nine patients were analysed retrospectively. Examinations included fluorescein and indocyanine green angiography, fundus autofluorescence imaging, optical coherence tomography, microperimetry and determination of visual acuity (far and reading ability). Data regarding intraoperative and postoperative complications were recorded. Mean follow‐up time was 18 months (range 4 months to 5 years). Results: After surgery, far visual acuity improved or remained stable (±3 lines) in three of nine eyes and for the near visual acuity in three of nine eyes. Visual acuity decreased postoperatively at the last follow‐up in four eyes mainly because of postoperative complications, i.e. retinal detachment due to proliferative vitreoretinopathy, retinal artery occlusion, pucker and fibrosis of the graft. In one case, retinal stimuli were restored over the scotoma as seen in microperimetry. Conclusion: Autologous transplant of RPE and choroid is a therapy option for RPE tears. Retinal stimuli can be restored in selected cases. Numerous intra‐ and postoperative complications compromise the functional prognosis and outcome.     

外伤性复发性视网膜脱离玻璃体手术的效果

目的评价玻璃体手术治疗外伤性复发性视网膜脱离的效果，分析其复发的原因。方法对56例（56眼）外伤性复发性视网膜脱离再次玻璃体手术的效果进行回顾性分析。对性别、年龄、眼外伤类型、术前有无眼内异物、有无硅油、手术距受伤的时间、两次手术的间隔时间、二次填充物的种类、术后眼压等进行Logistic回归分析。并总结外伤性视网膜脱离再修复的原因。结果再次手术原因：≥18岁组主要为增生性玻璃体视网膜病变（PVR）；〈18岁组主要为玻璃体残留和不完全玻璃体后脱离。56例视网膜复位率89．29％，以上各因素对复位率的影响差异无统计学意义（P〉0．1）。56例中视力提高者50例（89．29％），影响术后视力的主要因素是两次手术的间隔时间（P=0．05）。结论外伤性复发性视网膜脱离的主要原因在成人主要为PVR，在青少年主要为玻璃体残留和不完全玻璃体后脱离，把握再修复手术时机可获得较好的效果。     

玻璃体视网膜手术治疗Eales病的疗效及影响因素分析

目的 观察玻璃体视网膜手术治疗Eales病的效果以及影响视力预后和疾病转归的相关因素。 方法 回顾分析经玻璃体视网膜手术治疗的Eales病患者128例142只眼的临床及随访观察资料。应用SPSS(12.0) 软件，采用t检验、χ 2检验、秩和检验、Logistic回归分析等统计学方法，分析性别、年龄、眼别、手术前视力、疾病所处发展阶段、玻璃体积血至手术的时间、新生血管膜及玻璃体视网膜增生性改变、是否合并视网膜脱离及其它并发症等疾病自然因素与手术方式、手术技巧和方法、手术次数、手术后并发症等与手术预后和视力转归的相互关系。患者年龄18~45岁，平均年龄28.5岁，单纯玻璃体积血28只眼，伴有增生性改变者114只眼，其中合并视网膜脱离59只眼。手术后随访时间在3个月以上，平均随访时间35.8个月。以视网膜完全或部分复位视为手术成功；2次以上手术后视网膜未复位或眼球萎缩、甚至眼球摘除视为手术失败。 结果 手术成功129只眼，占90.8%；手术失败13只眼，占9.2%。疾病所处的不同发展阶段手术后视力差异有统计学意义（χ2=64.00，P<0.01）；玻璃体积血时间长短对视力预后有显著影响（OR=11.60，P<0.01）；合并视网膜脱离的程度、性质以及能否成功复位、视网膜脱离是否复发是影响手术后视力的关键因素；手术前视力、手术方式的选择、手术中操作的复杂程度及不同充填物对手术后视力均有影响；多次手术与一次手术对手术后视力的影响有统计学差异（χ2=66.84，P<0.01），手术复杂程度尤其是多次以上玻璃体视网膜手术明显影响手术预后及视力的恢复；有无手术后并发症者手术失败的危险性相差7倍(χ2=67.23，P<0.01),手术后并发症的发生与否对手术后视力预后的影响有显著性差异。 结论 玻璃体视网膜手术是治疗Eales病患者的有效手段。Eales病患眼所处疾病的发展阶段、玻璃体视网膜增生性病变的程度和范围及以及是否合并视网膜脱离、玻璃体积血至接受手术治疗的时间、手术操作的复杂程度、手术中及手术后并发症是决定患者手术后视力预后的重要因素。 （中华眼底病杂志，2006，22：291-294）      

Clinicopathological correlation of an excised choroidal neovascular membrane in pseudotumour cerebri

AIMS/BACKGROUND—To correlate the histopathology of an excised choroidal neovascular membrane (CNV) with the clinical and angiographic findings in a 32-year-old woman with pseudotumour cerebri and a peripapillary CNV with subfoveal extension.
METHODS—The patient's visual acuity was assessed by individuals experienced in low vision refraction and who were not members of the surgical team. The CNV was excised via a conventional three port vitrectomy with subretinal dissection. The excised tissue was studied with light and electron microscopy. Preoperative and serial postoperative fluorescein angiograms (FAs) and fundus photographs were obtained to study the dissection bed.
RESULTS—One week after surgery, the FA showed mottled subfoveal choriocapillaris perfusion. Three weeks after surgery, this area showed retinal pigment epithelium (RPE) atrophy clinically, and the FA showed choriocapillaris non-perfusion. Six months after surgery, the area of RPE atrophy and the corresponding area of choriocapillaris non-perfusion had expanded. Histologically, the excised CNV disclosed hyperplastic RPE, fibrovascular tissue, and no choriocapillaris. Fragments of RPE basement were present along the external edge of the specimen. The patient's visual acuity did not improve significantly after surgery.
CONCLUSIONS—Choriocapillaris non-perfusion can develop even in young patients following CNV excision. In this particular case, it is believed that choriocapillaris atrophy was caused by incomplete ingrowth of RPE into the dissection bed following RPE removal with CNV excision. As far as is known, this is the first report describing the results of surgery for CNV secondary to papilloedema associated with pseudotumour cerebri.

     

Surgical Excision of Type 2 Choroidal Neovascularization in Age-Related Macular Degeneration

Purpose To evaluate the visual acuity outcome and the influence of various factors on visual outcome in patients undergoing surgical removal of type 2 choroidal neovascular neovascularization (CNV) caused by age-related macular degeneration (AMD).Methods We studied the records of 92 patients (92 eyes) who were followed for at least 1 year after surgical excision of CNV associated with AMD.Results The final visual acuity was 0.4 or better in 21%, 0.1 to 0.3 in 66%, and worse than 0.1 in 13% of the patients. Final visual acuity was improved in 62%, stable in 29%, and worse in 9%. Stepwise regression identified CNV size as a significant factor influencing final visual acuity (R = 0.287, P = 0.0045).Conclusions Surgical excision of CNV for AMD is indicated for patients with subfoveal active type 2 CNV with a visual acuity of 0.3 or worse. To achieve better postoperative visual acuity it is important to operate on AMD patients in the early stage of CNV. Jpn J Ophthalmol 2005;49:321–323 © Japanese Ophthalmological Society 2005     

视网膜脱离晶状体切除术中保留前囊膜的临床观察

目的观察视网膜脱离晶状体切除术中保留前囊膜的疗效。方法视网膜脱离34例(34眼)患者行视网膜脱离晶状体切除术,术中切除晶状体及玻璃体,保留前囊膜,同时行硅油填充。术后随访6～24个月,平均18.5个月,观察患者随访末期视网膜复位、视力及并发症情况。结果术后视网膜裂孔封闭、视网膜复位21例,复位率61.8%。术后视力高于术前,差异有统计学意义(P<0.05)。术后并发症有角膜水肿伴硅油继发性青光眼、前房纤维素性渗出、玻璃体再次积血、黄斑区及周围视网膜点状出血、渗出等。结论视网膜脱离晶状体切除术中保留前囊膜可减少并发症的发生,有利于视力提高。     

Surgical removal of subfoveal choroidal neovascular membranes in high myopia

· Background: A study was carried out to elucidate the anatomical and functional outcome after surgical excision of subfoveal choroidal neovascular membranes in high myopia. · Methods: Sixty-five patients with high myopia (≥6 diopters), well-defined subfoveal neovascular membranes on fluorescein angiography and preoperative visual acuity ≤20/100 were selected for surgery. A standardized surgical technique was used in all cases, by a single surgeon. The main outcomes assessed were Snellen visual acuity, surgical retinal pigment epithelium defect and postoperative perfusion of the choriocapillaris. Multifactor analysis of variance and chi-square/Fisher’s exact test statistics were used to assess the association between patients’ pre- and postoperative characteristics and outcome measures. · Results: Follow-up ranged from 6 to 48 months (mean 16 months). Mean postoperative visual acuity (0.18) was significantly better than mean preoperative visual acuity (0.09). Visual acuity improved by at least two lines in 29 eyes (45%) and was unchanged in 24 (37%). Overall, 43 eyes (66%) had visual acuity of 20/200 or better and 15 (23%), 20/60 or better. Predictive factors with a significant effect on final visual acuity were mean visual acuity, preoperative status of retinal pigment epithelium and postoperative perfusion of the choriocapillaris. Postoperative perfusion was detected in 31 (48%) of the total 65 eyes and in 12 (67%) of the 18 eyes with normal retinal pigment epithelium at baseline. The mean postoperative retinal pigment epithelium defect was 4.6 times larger than the original neovascular membrane. In selected patients, SLO macular scotometry showed areas of retained retinal sensitivity within the atrophic scar. · Conclusion: The natural history of subfoveal neovascularization in high myopia is rarely visually restorative. By contrast, surgical excision of the membranes is feasible and may restore visual acuity in selected patients. This therapeutic approach merits a formal multicenter clinical trial. Received: 27 August 1998 Revised version received: 9 November 1998 Accepted: 10 November 1998     

Association of preoperative vitreous IL‐8 and VEGF levels with visual acuity after vitrectomy in proliferative diabetic retinopathy

Acta Ophthalmol. 2010: 88: e311–e316

Abstract.

Purpose: To determine whether the vitreous levels of interleukin 8 (IL‐8) and vascular endothelial growth factor (VEGF) of patients with proliferative diabetic retinopathy (PDR) were associated with poor visual acuity after vitrectomy. Methods: Observational cross‐sectional study. Patient clinical characteristics and preoperative eye characteristics (63 eyes): visual acuity, iris neovascularization, vitreous haemorrhage, macular detachment, macular oedema, active retinal neovascularization, neovascularization of the disc, burned out PDR (defined as natural end stage of PDR with inactive membranes without previously performed laser photocoagulation) and panretinal photocoagulation were registered prior to vitrectomy for each patient. Vitreous VEGF and IL‐8 levels were measured using the cytometric bead array method. Poor postoperative visual acuity was defined as visual acuity of <20/200 and was checked 2 years after vitrectomy. Results: Twenty‐one of the 63 eyes (33.3%) had poor visual acuity after vitrectomy. Univariate analysis showed that vitreous levels of IL‐8, the absence of panretinal photocoagulation, preoperative macular detachment and poor preoperative visual acuity were significantly associated with poor final visual acuity after vitrectomy. A stepwise multiple logistic regression analysis showed that elevated vitreous levels of IL‐8 (p < 0.0001), macular detachment (p = 0.011) and the absence of panretinal photocoagulation (p = 0.03) were independent predictors for poor visual outcome. Conclusions: Elevated vitreous IL‐8 level could either be a marker of ischaemic inflammatory reaction, or it could play a role in deteriorating visual acuity by DR progression or both. Further studies are needed to provide better understanding of IL‐8 and inflammation involvement in visual prognosis in PDR.