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.     

单眼视网膜静脉阻塞患者对侧眼黄斑功能的多焦视网膜电图检测

目的 观察单眼视网膜静脉阻塞(RVO)患者对侧眼黄斑功能的变化.方法 对比分析24例经荧光素眼底血管造影(FFA)确诊为单眼RVO患者的24只对侧眼及18位正常受试者18只正常眼的多焦视网膜电图(mfERG)检测结果,比较两组受试者黄斑功能的差异.采用罗兰RETIsean电生理仪记录mfERG,将记录图形分别按照6个同心圆和4个象限对P1、N1波的振幅密度及潜伏期进行比较和分析.结果 RVO患者对侧眼在中心第1、2环处P1、N1波的振幅密度显著低于正常眼,差异有统计学意义(t=4.520,2.147;P＜0.05);其它各环、各象限振幅密度及潜伏期在两组间均未见明显差异(P＞0.05).结论 与正常眼相比,RVO患者对侧眼黄斑中心凹视功能受损.     

The risk of fellow eye visual loss with unilateral retinal pigment epithelial tears

To identify the magnitude of risk of fellow-eye visual loss, we reviewed the records of 43 patients with unilateral central visual loss caused by a tear of detached retinal pigment epithelium seen in our institution over a period of one to 13 years. Loss of vision because of complications of age-related macular disease occurred in 16 of 43 patients (37%) in the first year, seven of 23 patients (30%) in the second year, and eight of 16 patients (50%) in the third year. An additional five patients lost visual acuity between the third and eighth years of follow-up. The cumulative risk of loss of visual acuity was 37% in one year, 59% in two years, and 80% in three years. Visual loss occurred in 29 of the 36 eyes as a result of a complication of retinal pigment epithelial detachment. The magnitude of risk to the fellow eye was greater than has been documented in unselected age-related macular degeneration.     

The fellow eye in patients with unilateral retinal detachment: findings and prophylactic treatment

During a 4-year period, 1978-1981, 312 patients were operated on for unilateral rhegmatogenous detachment of the retina. Of the fellow eyes, 11% showed moderate (VA 0.15-0.4) and 5% severe (VA less than or equal to 0.1) visual impairment. Of the fellow eyes 49% were myopic (- 1.0 D. or more), and aphakia was present in 14%. Details of the peripheral fundus were adequately recordable for 260 fellow eyes. Degenerations considered to predispose to retinal detachment were found in 98 eyes (38%): lattice degeneration in 54 (21%), granular tuft in 17 (7%), retinal tear(s) in 12 (5%), and retinoschisis in 15 (6%). Prophylactic treatment of predisposing degenerations was performed in 91 of the 98 eyes using cryo- or photocoagulation (argon laser). No intra- or permanent post-operative complications were noticed. One of the treated fellow eyes (1.1%) detached 10 months after prophylactic treatment due to new tears. In the untreated group, 6 of the 221 eyes detached (2.7%). The difference was not statistically significant, but the groups were not comparable because 93% of the eyes showing predisposing degenerations were treated. None of the eyes treated for retinal breaks or lattice degeneration has detached. In these cases prophylactic treatment of the fellow eye is recommended. In most eyes cryocoagulation seems to be preferable to photocoagulation.     

The prevalence of retinal angiomatous proliferation in age-related macular degeneration with occult choroidal neovascularization

Background The purpose of the study was to ascertain the prevalence of retinal angiomatous proliferation (RAP) by means of dynamic indocyanine green angiography (d-ICGA) in patients with newly diagnosed fibrovascular pigment epithelium detachment (type 1) or late leakage of undetermined source (type 2) occult choroidal neovascularization (CNV) on fluorescein angiography. Methods We carried out a review of digital fluorescein and ICG angiograms obtained by confocal scanning laser ophthalmoscope (HRA; Heidelberg Engineering GmbH, Dossenheim, Germany) in 253 consecutive patients (270 eyes) with a clinical diagnosis of type 1 or type 2 occult CNV on fluorescein angiography (1998 through 2003). Results Sixty eyes had type 1 and 210 eyes type 2 occult CNV on fluorescein angiography. Overall, 57 cases of RAP were identified in 54 eyes (20%) with d-ICGA. RAP was present in 6 out of 60 eyes with type 1 (10%) and in 51 out of 210 eyes with type 2 occult CNV (24%). Mean distance of the lesion from the fovea was 682 ± 304 μm (mean ± SD). Conclusions d-ICGA is invaluable for early diagnosis of RAP in exudative age-related macular degeneration (ARMD). In our series, up to one fourth of type 2 occult CNV were in fact RAP. Presented in part at the Association for Research in Vision and Ophthalmology (ARVO) annual meeting, 2004, Fort Lauderdale, Florida, USA.     

The fellow eye of patients with rhegmatogenous retinal detachment

OBJECTIVE: To determine how often the fellow eyes of patients with rhegmatogenous retinal detachment (RRD) without proliferative vitreoretinopathy (PVR) harbor vision-threatening conditions at presentation and during follow-up. DESIGN: Retrospective, observational case series. PARTICIPANTS: Two hundred forty-eight patients with RRD without PVR were studied. INTERVENTION: The authors observed the fellow eye of patients with RRD for vision-threatening pathology. MAIN OUTCOME MEASURE: Detection of vision-threatening pathology in the fellow eye of patients with RRD without PVR. RESULTS: Two hundred forty-eight patients were observed for an average of 5.2 years. One hundred fifty-seven vision-threatening events or diagnoses occurred in the fellow eye, including pre-existing and newly diagnosed conditions, 97 (62%) of which were rhegmatogenous in nature. Fifty-six patients (23%) had retinal detachments in their fellow eye, including those with a history of RRD repair (28 eyes), those presenting with bilateral RRD (4 eyes), and those developing new RRD during follow-up (24 eyes). In addition, 1 patient developed recurrent retinal detachment in the fellow eye during follow-up. Retinal tears were diagnosed and treated with laser retinopexy or cryotherapy in 30 (12%) fellow eyes (4 before the initial examination, 7 upon initial examination, and 19 on follow-up). Lattice degeneration was present in 27 (11%) fellow eyes. CONCLUSIONS: Patients who develop RRD are at considerable risk for developing vision-threatening events, particularly rhegmatogenous events, in the fellow eye.     

The fellow eye of patients with phakic lattice retinal detachment

A retrospective study was performed to determine whether the prophylactic treatment of areas of lattice degeneration, holes, or breaks reduced the risk of subsequent new breaks or detachment in the fellow undetached phakic eyes of patients with a phakic lattice retinal detachment (RD). Three hundred eighty-eight consecutive patients who presented to the University of Iowa between 1959 and 1984 were followed for a mean of 7.9 +/- 5.8 years after the detachment in the first eye. Fellow eyes which received no prophylactic treatment had a 2.5 times greater risk of a new break or RD over 7 years than eyes receiving full prophylactic treatment (19.4 versus 7.5%; P = 0.0002). Fellow eyes receiving no treatment also had a greater risk of a new RD over 7 years than eyes receiving full treatment (5.1 versus 1.8%; P = 0.0125). These results do not allow us to make recommendations concerning which fellow eyes, if any, should be prophylactically treated. On the one hand, prophylactic treatment did significantly reduce the risk of new breaks and detachments. On the other hand, however, prophylactic treatment reduced the risk of new RD alone in the fellow eye only from 5.1 to 1.8% over 7 years. In addition, prophylactic treatment did not reduce the risk of detachment in the higher risk eyes with high myopia or extensive lattice.     

孔源性视网膜脱离患者对侧眼的临床观察

目的:探讨孔源性视网膜脱离患者对侧眼底检查的临床意义。方法:采用前瞻性设计的新发患者登记方法收集病例资料,对131例原发性的孔源性视网膜脱离患者的对侧眼在充分散瞳下进行详细的眼底检查并绘制眼底模式图。结果:131例中有54例(41.2%)检出与视网膜脱离相关的眼底病理性改变,其中以周边部视网膜格子样变性最为多见,占32.8%,视网膜干性裂孔的发生率为9.9%,双眼视网膜脱离的发生率为8.4%。     

Bevacizumab (Avastin) treatment in patients with retinal angiomatous proliferation

Aim To determine the anatomical and functional outcome after injection of bevacizumab (Avastin, Genentech) in eyes with retinal angiomatous proliferation (RAP). Design Prospective interventional case series. Methods Sixteen eyes of 16 consecutive patients with visual loss due to RAP underwent intravitreal injections of 1.25 mg (0.05 ml) bevacizumab. Best corrected visual acuity testing, fluorescein and ICG-angiography as well as OCT imaging were performed at baseline and at each follow-up visit within a 3-month period. Results Mean visual acuity pre-injection was 0.68 ± 0.36 logMAR (n = 16), mean reading ability 0.58 ± 0.26 logRAD (n = 11). Far vision increased significantly by a mean of 1.7 ± 2 lines 4 weeks after the injection (p = 0.004), as did reading (0.6 ± 2.3 lines, p > 0.05). Both remained stable up to 3 months. Central retinal thickness decreased from 367 ± 112 μm (mean±SD) to 272 ± 123 μm 3 months after injection (p = 0.006). Leakage decreased angiographically in 12 eyes (75%) and remained stable in four eyes (25%). Re-injection of bevacizumab within the 3-month follow-up period was performed once in eight eyes, and twice in one eye. No adverse events were observed. Conclusion Intravitreal bevacizumab (Avastin) resulted in a reduction of leakage, intra- and subretinal fluid. An increase in visual acuity was seen already 4 weeks after first injection. However, a complete occlusion of feeder vessels could not be achieved within this 3-month period. Randomized clinical trials would be required to evaluate dose and frequency of injections and possible beneficial effects of combination therapies, as well as the long-term results.     

The fellow eye in retinal detachment

The examination findings of the fellow eye of 534 patients affected by a unilateral retinal detachment are reported. Nearly 90% of these eyes showed degenerative areas and about 20% showed one or more retinal breaks. These findings are quite different from those reported in examinations of random eyes and suggest that fellow eyes are high risks that often need prompt prophylactic treatment.

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Zusammenfassung Die vorliegende Arbeit berichtet über die Untersuchung des Partnerauges von 534 Patienten, die von einseitiger Ablatio retinae betroffen waren. Fast 90% dieser Augen zeigten degenerative Areale und ungefähr 20% hatten einen oder mehrere Netzhautrisse.Diese Befunde sind recht unterschiedlich von Zufallsbefunden und zeigen, daß Partneraugen ein hohes Risiko haben und oft eine prompte prophylaktische Behandlung benötigen.

     

视网膜血管瘤增殖的研究进展

视网膜血管瘤增殖是近年来开始为人们所认识的一类新型新生血管性年龄相关性黄斑变性，它起源于黄斑旁视网膜深层毛细血管网并能不断增殖，向后突破入视网膜下间隙，最终与脉络膜新生血管形成吻合。本文对视网膜血管瘤增殖的分期、临床表现以及治疗方法作一综述。[眼科新进展2007；27（2）：150-154]     

Age-related macular degeneration and risk factors for the development of choroidal neovascularization in the fellow eye

Age-related macular degeneration (AMD) is one of the leading causes of blindness in the world. Most of the severe vision loss associated with AMD is due to the development of choroidal neovascularization (CNV). The specific causes of AMD and in particular, its neovascular phase, remain uncertain. During the past two decades a number of large prospective clinical trials, observational epidemiologic studies, and population-based cohort studies have furthered our understanding of this blinding ocular condition. The Macular Photocoagulation Study has received praise for its many contributions in the laser treatment of neovascular complications of AMD; however, these trials have made other significant contributions by helping to better define the natural history of AMD, and in particular, risk factors for the development of CNV in eyes with non-neovascular disease. This type of information may provide significant clues for researchers regarding disease pathogenesis and identify a high-risk group in whom to target new treatment strategies. For patients currently diagnosed with macular degeneration, this information can lead to a better understanding of their condition and a more accurate prognosis of their ocular health and vision status. This article reviews information from a variety of sources to investigate incidence rates and risk factors for the development of CNV in the fellow eye of patients with AMD and unilateral neovascular maculopathy.