Peripapillary subretinal neovascularization in retinoblastoma

Background Peripapillary subretinal neovascularization (PSRNV) is a rare type of choroidal neovascularization. Herein we report a case of retinoblastoma complicating PSRNV, and discuss the histopathological findings. Methods A 1-year-old male underwent enucleation of his right eyeball based on the clinical diagnosis of bilateral retinoblastoma after chemotherapy. Results There was a mass arising from the retina showing highly calcified and necrotic retinoblastoma. The peripapillary region revealed neovascular membrane extending from the optic nerve head to the subretinal space. The membrane included retinal pigment epithelial (RPE) cells and glial cells, as well as endothelial cells. Immunohistochemistry revealed cytokeratin 18-positive RPE cells situated beneath glial fibrillary acidic protein-positive glial cells and their processes. The neovascular membrane did not have a connection with vessels arising from the optic nerve head. There were multiple mound foci made up of proliferated RPE cells in the globe. Conclusion These results suggest that migration of RPE cells and glial cells plays a crucial role in the pathogenesis of PSRNV, which might be directly or indirectly mediated by retinoblastoma.     

Complications of krypton red laser photocoagulation to subretinal neovascular membranes

The use of krypton red laser photocoagulation (KRLPC) to treat subretinal neovascular membranes (SRNVM) is increasing. The complications of this treatment in a large series of patients have not been reported. Over a 15-month period, 195 patients had KRLPC to SRNVM of the following etiologies: senile macular degeneration (151), presumed ocular histoplasmosis (33), miscellaneous (11). Fourteen patients had the following complications attributable to KRLPC: choroidal hemorrhage (9), retinal pigment epithelial tears (3), choroidal ischemia (1) and choroidal folds (1). The visually significant complication rate was 3.6%. Proper patient selection and treatment technique may decrease the risk of complications.     

视网膜下液体对人视网膜色素上皮细胞生长的刺激作用及其临床特征

研究了28例孔源性视网膜脱离患者视网膜下液对人眼视网膜色素上皮细胞生长的作用。所有标本均可刺激视网膜色素上皮细胞增殖，但存在较大范围的活动性，发现增殖刺激活力与视网膜脱离的增殖性玻璃体视网膜病变程度、视网膜脱离范围和脱离持续时间呈正相关，且与视网膜脱离增殖性玻璃体视网膜病变程度及脱离范围相关性最大（P＜0．01）。结果表明：增殖性玻璃体视网膜病变在C级以上，脱离范围超过2个象限、脱离时间超过4周者，视网膜下液促增殖活力显著增强。     

Slow leakage from the retinal pigment epithelium (ooze) in age-related macular degeneration

The authors describe a condition called retinal pigment epithelial (RPE) ooze in patients with age-related macular degeneration. Patients with ooze have a neurosensory retinal detachment, a slowly progressive indiscrete leakage of fluorescein dye from the level of the retinal pigment epithelium, and no other signs of choroidal neovascularization. Sixteen patients with RPE ooze were followed for a mean of 4.5 years without treatment. Nine patients had a single round or oval area of leakage. In seven of these patients, choroidal neovascular membranes developed, with moderate to poor visual outcomes. The other seven patients had multiple smaller areas of leakage from the level of the RPE. None of these patients had a choroidal neovascular membrane, and all had resolution of the subretinal fluid with good final visual acuities. Patients with discrete round or oval RPE oozes appear to be at a high risk for the development of more definite choroidal neovascular membranes and vision loss.     

上皮-间质转化在视网膜下纤维化发病机制中的研究进展

视网膜下纤维化(SRFi)被定义为视网膜内或视网膜下混合的纤维血管结构，本质是新生血管性年龄相关性黄斑变性(nAMD)中脉络膜新生血管形成后伤口过度愈合的结果，这是导致nAMD患者终末期视力丧失的主要原因。nAMD患者终末期视网膜色素上皮细胞向上皮-间质细胞转化的过程被认为是影响SRFi形成的主要细胞基础。针对SRFi中上皮-间质转化的相关细胞及分子机制研究可能是未来终末期nAMD疾病防治的重要发展方向。     

Subretinal neovascular membranes associated with chronic membranoproliferative glomerulonephritis type II

Subretinal neovascular membranes were observed in three patients with chronic membranoproliferative glomerulonephritis type II (dense deposit disease). The first signs of glomerulonephritis occurred at respective ages of 13, 10 and 10 years; subretinal neovascular membranes were noted at respective ages of 25, 32 and 32 years. All patients had bilateral, widespread retinal pigment epithelial abnormalities. Our findings indicate that subretinal neovascularization is a complication of dense deposit disease. In one patient, the early recognition and laser treatment of an extrafoveal subretinal neovascular membrane prevented further loss of vision.     

视网膜后膜的超微结构观察

在34例视网膜脱离伴增殖性玻璃体视网膜病变的慢性病例中，观察到12例视网膜后膜，占35.3%.其中对1例经玻璃体手术切除的标本进行了透射电镜检查。神经胶质细胞、视网膜色素上皮细胞及大量胶原纤维是后膜的主要细胞或间质成分。 （中华眼底病杂志，1994，10：165-166）     

Peripheral retinal detachments and retinal pigment epithelial atrophic tracts secondary to central serous pigment epitheliopathy

Twenty-five patients with central serous pigment epitheliopathy (CSP), also known as central serous chorioretinopathy, have been observed to have inferior hemispheric retinal pigment epithelial atrophic tracts, presumptive of antecedent retinal detachments. Five of these patients were noted to have clinically discernible, dependent peripheral retinal detachments. The clinical and fluorescein angiographic features of these patients are reviewed. Alterations in the retina, the retinal pigment epithelium (RPE) and the choroid are also described. They include the commonly associated manifestations of CSP such as RPE leaks and macular detachment as well as some newly recognized disturbances such as retinal capillary dilatation (telangiectasia), retinal capillary leakage, retinal lipid deposition, cystoid macular edema, choriocapillaris atrophy, choroidal neovascularization and disciform scarring.     

复杂视网膜脱离视网膜下膜超微结构研究

目的研究复杂视网膜脱离病例中视网膜下膜的超微结构特征,探讨视网膜下膜的细胞成分。方法对21例复杂孔源性视网膜脱离伴视网膜下膜者行玻璃体切割术加视网膜下膜切除术,将所获得的视网膜下膜经处理后于光镜下选择细胞较密集处做超薄切片,染色后行透射电镜观察并摄影。结果复杂视网膜脱离视网膜下膜中,色素上皮细胞多呈散在分布,未见明显基底膜供细胞附着,在条索或片状膜当中的色素上皮细胞形态存在变化。神经胶质细胞胞浆内有较丰富的细胞器和直径约10nm的中间型微丝形成。视网膜下膜的细胞间质含有大量胶原纤维。成纤维细胞形状不规则,活跃,胞浆中见大量直径4～6nm微丝。结论视网膜下膜主要由视网膜色素上皮细胞、神经胶质细胞、成纤维细胞和胶原纤维组成。视网膜下膜中色素上皮细胞、神经胶质细胞和成纤维细胞有转化与增殖能力。     

Role of Fas-ligand in age-related maculopathy not established

PURPOSE: Fas-ligand expression on retinal pigment epithelium is hypothesized to have an inhibitory effect on human ocular neovascularization. METHODS: We studied Fas-ligand expression in the aging retinal pigment epithelium and in early and late stages of age-related maculopathy. Immunohistochemistry with antibodies against Fas-ligand was performed on paraffin-embedded sections of 23 human eye bank eyes (aged 45 to 96 years) and 12 eyes with exudative age-related maculopathy. RESULTS: Fas-ligand expression in retinal pigment epithelium was not related to age or to the presence of early age-related maculopathy. Furthermore, Fas-ligand expression in retinal pigment epithelium was similar in subretinal and subretinal pigment epithelium choroidal neovascular membranes. CONCLUSION: It appears to be unlikely that Fas-ligand expressed on retinal pigment epithelium controls the extension of choroidal neovascular membranes from subretinal pigment epithelium to subretinal.     

自体带Bruch膜视网膜色素上皮复合体移植治疗渗出性老年黄斑变性近期疗效观察

目的 探讨自体带Bruch膜视网膜色素上皮复合体移植术治疗渗出性老年性黄斑变性近期疗效.方法 回顾性分析30例确诊为渗出性老年性黄斑变性的患者,采用脉络膜新生血管膜切除联合自体带Bruch膜视网膜色素上皮复合体移植手术方法.手术前后行视力、荧光素眼底血管造影、吲哚氰绿眼底血管造影、多焦视网膜电图、光学相干断层扫描检查评价疗效.结果 移植术后随访6个月时,25例(83.33%)患者视力获得提高,2例(6.66%)患者视力不变,3例(10%)患者视力下降;所有患者黄斑区RPE植片平铺在位,未见CNV复发.结论 自体带Bruch膜视网膜色素上皮复合体移植治疗渗出性老年性黄斑变性近期疗效确切,是治疗渗出性老年性黄斑变性安全有效的手段之一.     

自体带Bruch膜视网膜色素上皮复合体移植治疗渗出性老年黄斑变性近期疗效观察

目的 探讨自体带Bruch膜视网膜色素上皮复合体移植术治疗渗出性老年性黄斑变性近期疗效.方法 回顾性分析30例确诊为渗出性老年性黄斑变性的患者,采用脉络膜新生血管膜切除联合自体带Bruch膜视网膜色素上皮复合体移植手术方法.手术前后行视力、荧光素眼底血管造影、吲哚氰绿眼底血管造影、多焦视网膜电图、光学相干断层扫描检查评价疗效.结果 移植术后随访6个月时,25例(83.33%)患者视力获得提高,2例(6.66%)患者视力不变,3例(10%)患者视力下降;所有患者黄斑区RPE植片平铺在位,未见CNV复发.结论 自体带Bruch膜视网膜色素上皮复合体移植治疗渗出性老年性黄斑变性近期疗效确切,是治疗渗出性老年性黄斑变性安全有效的手段之一.     

自体带Bruch膜视网膜色素上皮复合体移植治疗渗出性老年黄斑变性近期疗效观察

目的 探讨自体带Bruch膜视网膜色素上皮复合体移植术治疗渗出性老年性黄斑变性近期疗效.方法 回顾性分析30例确诊为渗出性老年性黄斑变性的患者,采用脉络膜新生血管膜切除联合自体带Bruch膜视网膜色素上皮复合体移植手术方法.手术前后行视力、荧光素眼底血管造影、吲哚氰绿眼底血管造影、多焦视网膜电图、光学相干断层扫描检查评价疗效.结果 移植术后随访6个月时,25例(83.33%)患者视力获得提高,2例(6.66%)患者视力不变,3例(10%)患者视力下降;所有患者黄斑区RPE植片平铺在位,未见CNV复发.结论 自体带Bruch膜视网膜色素上皮复合体移植治疗渗出性老年性黄斑变性近期疗效确切,是治疗渗出性老年性黄斑变性安全有效的手段之一.     

Occurrence of atypical acute bilateral multifocal choroidal neovascularization in membranoproliferative glomerulonephritis type II

We report an unusual case of acute recurrent bilateral multifocal choroidal neovascularization that was associated with histologically proven membranoproliferative glomerulonephritis type II and did not resolve with laser photocoagulation. Early development of subretinal neovascular membranes with widespread retinal pigment epithelial changes in this condition may heraid poor prognosis despite laser ablation of the neovascular tuft.     

Neovascularization Associated with Large Retinal Pigment Epithelial Detachment in Elderly Korean Patients: Subdivision According to Indocyanine Green Angiographic Features

PURPOSE: In Korean patients, to subdivide the neovascular forms of age-related macular degeneration (AMD) associated with large retinal pigment epithelial detachment (PED), according to the indocyanine green angiographic features. METHODS: Indocyanine green angiograms (ICGA) of 67 elderly patients (72 eyes) who presented with a PED of at least 1 disc diameter were evaluated retrospectively. RESULTS: Polypoidal choroidal vasculopathy (PCV) and typical choroidal neovascularization (CNV)-associated PEDs were identified in 18 eyes (25%) and 19 eyes (26%), respectively. In ten eyes (13.9%), the exact type of neovascularization, whether PCV or CNV, could not be determined. Pure serous PEDs were identified in seven eyes (10%). The remaining 18 eyes (25%) were classified as having retinal angiomatous proliferation (RAP)-associated PED based upon the angiographic findings of vascular connections between the retinal vasculature and the neovascular complex. CONCLUSIONS: Three subset groups of PCV, CNV, and RAP were present with similar frequency in neovascularized AMD with a large PED in these Korean patients. In particular, RAP, previously thought to be rare in Asian patients, was found to be present with considerable frequency.     

Optical Coherence Tomography in the Acute and Chronic Phases of Vogt-Koyanagi-Harada Disease

Purpose: To assess the potential of optical coherence tomography (OCT) in the diagnosis and monitoring of serous retinal detachment in Vogt-Koyanagi-Harada (VKH) disease and to describe OCT characteristics of subretinal sequelae of the disease. Methods: Six patients in the acute phase of VKH disease with serous retinal detachment were followed in our department from July 2001 to December 2003 using slit-lamp biomicroscopy, OCT, and fluorescein angiography. Results: OCT was effective in objectively quantifying the amount of serous retinal detachment present and then in following the resolution of subretinal fluid accumulation. Subretinal pigmented lesions on angiography corresponded with retinal pigment epithelium hypertrophy and fibrosis on OCT. Conclusion: A beneficial effect of treatment was observed within days, paralleling the improvement in visual acuity. Retinal pigment epithelium hypertrophy and fibrosis in the chronic phase of the disease were analyzed with OCT for the first time.     

Surgical removal of large subretinal neovascular membranes: results and complications

Over the period from June 1992 to January 1994, six subretinal neovascular membranes were removed in our department. In five patients the damaged membranes were caused by age-related macular degeneration and in one patient the cause was choroiditis of unclear etiology. The diameter of the membranes ranged between 3 and 20 mm. The largest membrane was removed translimbally after previous lensectomy. In all patients internal silicone oil tamponade was performed.Subretinal hemorrhage was the most common peroperative complication observed. Early postoperatively, transitory corneal edema and serofibrinous reaction were recorded in some patients. Cataract formation in connection with the silicone oil tamponade, chronic uveitis, formation of epi- and subretinal membranes, retinal pigment epithelium and choroidal atrophy were also subsequently observed. Relevant additional operations were performed with the exception of one patient with internal silicone oil tamponade and cortical cataract who refused all further procedures.After a follow-up period of 24–36 months, one eye atrophied. In one eye retinal detachment, in one large subretinal membrane, in one atrophy of the pigment epithelium and in another epiretinal membranes under silicone oil were present. The visual acuity achieved is 0 in two eyes and it ranged between light perception and 0.5/60.Removal of large subretinal neovascular membranes is feasible, but the results are not justified by the surgeon's effort and the patient's psychic stress.     

The role of retinal pigment epithelium in the involution of subretinal neovascularization

The extravascular milieu around laser-induced experimental subretinal neovascularization (SRN) was studied during the evolution of the neovascular membrane from its early leaky stage to its late involuted stage. When the first signs of visible leakage appeared on angiography, newly formed vessels were spread in the subretinal space around the break in Bruch's membrane, fluid was accumulating in the subretinal space, and retinal pigment epithelial (RPE) cells were proliferating in a papillary pattern around the newly formed vessels; the RPE proliferation began with the undamaged cells at the edges of the laser injury. With further maturation, the RPE continued to envelope the subretinal vessels. This RPE proliferation was associated with the disappearance of fluid between the enveloped vessels and the sensory retina, and the gradual cessation of fluorescein leakage during angiography. At the end of the involution process, when the neovascular membrane no longer demonstrated any leakage, the subretinal vessels were found to be tightly enveloped by RPE cells, and no fluid separated them from the sensory retina. The authors' results suggest that involution of the neovascular membrane with maturation, as demonstrated by the cessation of visible fluorescein leakage, is the result of RPE proliferation that tightly envelopes the newly formed vessels and probably resorbs the previously accumulated subretinal fluid, as well as preventing its further accumulation in the subretinal space.     

Treatment of pigment epithelial detachments due to age-related macular degeneration with intra-ocular C3F8 injection*

Purpose: To flatten pigment epithelial detachments (PED) cue to age-related macular degeneration in an attempt to visualize the underlying choroidal neovascularization by fluorescein angiography (FA) and reveal a treatment target. Methods: Nine patients with PED received intravitreal gas injections via the pars plana and postured face down. Fluorescein angiograms were obtained before and after gas injection. In two patients, retinal scotopic sensitivity was also measured. Results: Eight patients demonstrated change in the shape and size of the PED following gas injection. Four patients showed a better delineation of underlying structures on FA. Three patients had focal laser treatment to the newly visible choroidal neovascular complex, but this was successful in only one patient with flattening of the PED. Conclusion: Pigment epithelial detachments can be modified by intravitreal gas injection in some patients, but this treatment did not have a major impact on overall outcome or management.     

Subretinal neovascularization in senile macular degeneration

When fluorescein angiograms from 563 patients with senile macular degeneration examined at a large community hospital during a 9.5-year period were retrospectively reviewed, 200 patients were found to have a dry atrophic type of senile macular degeneration, consisting of drusen and retinal pigment epithelial changes. Of the 363 patients with exudative senile macular degeneration, 244 had subretinal neovascular membranes. Seventy-eight membranes were less than 1 disk diameter in size. Most of the large (157 of 224) and small (44 of 78) membranes showed a predilection for the fovea. Only 13 large and six small neovascular membranes were 200 microns or more from the center of the foveal avascular zone.