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.     

Atypical choroidal neovascularization in radiation retinopathy

PURPOSE: To report atypical choroidal neovascularization associated with radiation retinopathy. DESIGN: Case report. METHODS: The patient was examined with ophthalmoscopy, fluorescein angiography, and indocyanine green angiography. RESULTS: A 32-year-old woman presented with an accelerated course of radiation retinopathy with macular edema, capillary telangiectasis, subretinal fluid, and lipid during and after pregnancy. Indocyanine green, but not fluorescein angiography, demonstrated an unusual area of choroidal neovascularization with prominent saccular dilations adjacent to a large zone of poor choroidal perfusion. Laser photocoagulation of the choroidal neovascularization resulted in an angiographic closure with absorption of the subretinal fluid and improvement of visual acuity. CONCLUSIONS: Choroidal neovascularization may be associated with radiation retinopathy and, when present, may require indocyanine green angiography for its diagnosis.     

Iatrogenic choroidal neovascularization occurring in patients undergoing macular surgery

PURPOSE: To report three cases of choroidal neovascularization (CNV) that occurred following surgical disruption of Bruch membrane during macular surgery. METHODS: A retrospective case series was compiled. Macular translocation surgery with punctate retinotomy was performed in two patients for subfoveal CNV, and pars plana vitrectomy with epiretinal membrane (ERM) peeling was performed in one patient for idiopathic ERM. RESULTS: CNV developed at a site of subretinal cannulation in two cases of macular translocation, and at a site of inadvertent injury to Bruch membrane with a vitreoretinal pick in the one case that underwent ERM peeling. CONCLUSIONS: These cases underscore the need to monitor breaks in Bruch membrane for CNV following macular surgery.     

Latent proliferative sickle cell retinopathy in sickle cell trait

PURPOSE: To describe a patient with sickle cell trait who developed latent proliferative sickle cell retinopathy after mild blunt trauma. METHOD: Case Report. A 20-year-old man with unilateral Stage 3 sickle retinopathy associated with an ischaemic ridge presenting three years after the initial mild blunt ocular trauma. RESULTS: Fundus examination of the left eye showed an ischaemic ridge delineating avascular from vascular retina. Fluorescein angiography of the left eye showed an avascular peripheral retina and multiple sea fan neovascularization. Blood studies showed him to be Hb AS. CONCLUSIONS: In our patient the proliferative changes were the result of his initial mild trauma associated with an increase in the intraocular pressure. The latent development of the sea-fan neovascularization associated with an ischaemic ridge is unusual. Advice about potential complications to patients with Hb AS after ocular trauma is advocated.     

Development of sickle cell retinopathy

Summary The evolution, of cases of full blown sickle cell retinopathy have been documented by fundus photographs. Interpretation of these sequential changes have led to a reconstruction of the probable pathogenesis of this unique retinopathy.

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Zusammenfassung Die Entwicklung und der Verlauf der Retinopathie mit Sichelzellen wurde durch eine Reihe von Fundusphotographien objektiviert. Die Interpretation der Veränderungen erlaubt es, die wahrscheinliche Pathogenese dieser einzigartigen Retinopathie zu rekonstruieren.

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Résumé L'évolution de rétinopathies à cellules falciformes a été suivie par des rétinographies en série. L'interprétation de ces modicifations permet d'établir la pathogénie probable de cette rétinopathie très particulière.

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This investigation was supported in part by a research grant, NB101789-1I, from the National Institute of Neurological Diseases and Blindness, National Institutes of Health, Bethesda, Maryland.

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Fundus photographs shown in figures 1 through 9 were taken by the author a Nindb, Ophthalmology Branch, Clinical Center, Bethesda, Maryland. (Director: Professor Ludwig von Sallmann)     

骨髓来源细胞在脉络膜新生血管形成中的作用研究进展

脉络膜新生血管(choroidal neovascularization,CNV)和多种眼病有关,如年龄相关性黄斑变性、中心性渗出性脉络膜视网膜病变、病理性近视黄斑变性、特发性脉络膜新生血管等。CNV是上述疾病造成视力损害的主要因素之一。近年来许多研究发现骨髓来源细胞在CNV的发生和发展中起着重要的作用,本文就此方面的研究进行综述。     

Photodynamic therapy with verteporfin for choroidal neovascularization in patients with diabetic retinopathy.

PURPOSE: To report the use of photodynamic therapy (PDT) with verteporfin in three patients with choroidal neovascularization (CNV) from age-related macular degeneration and underlying diabetic retinopathy. The level of diabetic retinopathy would have excluded these patients from participation in previously reported randomized clinical trials evaluating PDT with verteporfin due to a theoretic concern of damage to the overlying retinal vasculature. DESIGN: Retrospective interventional case series. METHODS: Three patients from a referral practice with at least severe nonproliferative diabetic retinopathy and a history of clinically significant macular edema developed loss of vision from concurrent choroidal neovascularization evaluated with fundus photography and fluorescein angiography before and after PDT with verteporfin to identify adverse retinal vascular events. RESULTS: Four eyes in three patients had PDT using verteporfin. Three eyes received two treatments. With short follow-up, visual acuity remained stable in two eyes, improved from 20/400 to 20/320 in one eye, and decreased from 20/200 to 20/400 in one eye. Fluorescein angiograms at intervals from 2 weeks to 3 months after PDT showed no damage to the retinal vasculature or progression of the diabetic retinopathy, but did show a decreased area of fluorescein leakage from CNV. One eye that had new subretinal hemorrhage following treatment appeared to show new vasculopathy on initial evaluation of the post-treatment angiogram. Retrospective review suggested that the subretinal hemorrhage provided increased contrast to more easily visualize vasculopathy that was present before the PDT. CONCLUSIONS: Three patients with diabetic retinopathy undergoing a total of seven PDT treatments with verteporfin in four eyes had no new retinal vascular abnormalities develop. No other atypical responses of CNV to PDT were noted except new subretinal hemorrhage, providing increased contrast of the overlying vasculature, which gave the false impression of the development of new vasculopathy in one eye. Patients with diabetic retinopathy who have concurrent CNV for which PDT with verteporfin is recommended should be cautioned regarding the theoretical concerns of harming the retinal vasculature. Periodic surveillance for such concerns seems warranted until more experience is obtained.     

Clinical findings in eyes with BEST1-related retinopathy complicated by choroidal neovascularization

Graefe's Archive for Clinical and Experimental Ophthalmology - To determine the characteristics of eyes diagnosed with Best vitelliform macular dystrophy (BVMD) and autosomal recessive...     

Choroidal neovascularization in a patient with blunt trauma-caused traumatic retinopathy without choroidal rupture

Purpose  

To report a case of choroidal neovascularization (CNV) following blunt trauma without choroidal rupture, with past history of central serous chorioretinopathy (CSC).     

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.     

Angiogenic factors in human proliferative sickle cell retinopathy

BACKGROUND/AIMS: Preretinal neovascular formations called sea fans develop at the border of non-perfused peripheral retina in sickle cell retinopathy. Angiogenic factors which could contribute to their development, however, have not been examined previously. The objective of this study was to determine immunohistochemically if vascular endothelial growth factor (VEGF) or basic fibroblast growth factor (bFGF) were associated with sea fan formations. METHODS: Immunohistochemistry on cryosections was used to localise bFGF, VEGF, heparan sulphate proteoglycan, human serum albumin, collagens IV and II, and von Willebrand factor in tissue from five sickle cell and one control subject. RESULTS: The greatest immunoreactivity for VEGF and bFGF was in the feeder and preretinal vessels of sea fans (p<0.01). The most prominent reaction product was localised to vascular endothelial cells. In retinal vessels, VEGF and bFGF immunoreactivities were greater in sickle cell subjects (both proliferative and non-proliferative) than in the control subject (p<0.01 and p<0.02 respectively). In the sickle cell retina, no angiogenic factor immunoreactivity was detected in non-perfused periphery and there was no significant difference in bFGF or VEGF immunoreactivity between perfused retina and the border of perfused and non-perfused areas. CONCLUSION: Our results demonstrate for the first time that VEGF and bFGF are associated with sea fan formations in sickle cell retinopathy. Both factors may function in an autocrine manner because immunoreactivity for these factors was greater within the neovascularisation than in adjacent retina.     

Diagnosis and treatment of sickle cell retinopathy

Examination of a 49-year-old black female with a history of sickle cell anemia revealed proliferative sickle cell retinopathy. A review of the pathophysiology of the systemic disease as it relates to the clinical diagnosis and treatment of the retinopathy is presented.