[Photodynamic therapy for choroidal neovascularizations in age-related macular degeneration].
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Aged↗
Biomedical subjects
C Valmaggia
Publications and source records attributed to C Valmaggia.
Photodynamic therapy in the treatment of chronic central serous chorioretinopathy.
BACKGROUND: Central serous chorioretinopathy (CSC) is usually a benign disorder which resolves spontaneously, and requires no treatment. Nevertheless, in cases of chronic or recurrent detachment of the neurosensory retina a durable decrease of the visual acuity may be measured due to lesion of the photoreceptors. To avoid this evolution we performed a pilot study to assess the effect of photodynamic therapy (PDT) in patients with CSC without clinical normalization 6 months after the begin of the symptoms. PATIENTS AND METHODS: We report on 14 eyes in 13 patients presenting a chronic CSC without leaking point accessible for focal laser photocoagulation. The diagnosis was confirmed by fluorescein angiography (FA), and optical coherence tomography (OCT). PDT with verteporfin was performed according to the protocol used for treating choroidal neovascularization in age-related macular degeneration. RESULTS: One month after PDT, leakage on FA and detachment of the neurosensory retina on OCT had disappeared, and visual acuity had improved in all patients. CONCLUSIONS: The mechanism of action of PDT in chronic CSC is still hypothetical. PDT should decrease the passage of fluid towards the retina by affecting the choroidal blood flow, and allow a better resorption of the subretinal fluid. PDT could be an alternative to treat patients with chronic CSC.
Adult↗
[Visual improvement of an amblyopic eye in an adult patient after visual loss in the non-amblyopic eye].
BACKGROUND: The sensitive period for a successful amblyopia treatment is limited to the age of 11 to 13 years. HISTORY AND SIGNS: We present a 60-year-old patient with complete visual loss on his dominant eye after retinal arterial occlusion. The fellow eye had a known severe amblyopia with a corrected visual acuity of 0.1. THERAPY AND OUTCOME: After retinoscopy the patient received a full correction for his amblyopic eye and the vision increased to 0.25. After three months follow-up visual acuity was 0.5 for single optotypes. CONCLUSIONS: Even in adulthood a attempt at full correction of an amblyopic eye after loss of vision in the dominant eye should be performed for optimising the quality of life.
Amblyopia↗
Asymmetry of the optokinetic nystagmus in lesion of the central nervous system.
BACKGROUND: Unilateral lesions of the central nervous system (CNS) may be associated with a reduction of the optokinetic nystagmus (OKN) slow component in the direction of the lesion. The aim of our study was to assess the role played in these cases by the direct injury of the OKN pathways and/or by a possible associated visual field defect. METHODS AND PATIENTS: Monocular OKN was elicited with black and white stripes moving temporally-to-nasally (TN) or nasally-to-temporally (NT) at velocities of 15, 30, 45 and 60 degrees /s. Patients with cortical or chiasmal lesions associated with visual field defects were investigated. OKN was considered asymmetrical if the gain difference between TN and NT stimulation was not within 2 standard deviations of an age-matched control group (n = 86). RESULTS: We examined 12 patients with cortical lesions and 4 patients with chiasmal lesions. Asymmetric OKN gain was measured in 7 patients with cortical lesions associated with a visual field defect, and in 2 patients with chiasmal compression and bitemporal hemianopia. In 2 patients with isolated occipital lesions, OKN asymmetry was explained by the associated visual field defect. CONCLUSION: The interpretation of OKN asymmetry in patients with CNS lesions should not only consider a direct lesion of the OKN pathways but also a sensory deficit due to a visual field defect.
Adolescent↗
[Fundus quiz 2004].
Six cases with characteristic fundus pathologies are presented and discussed using multiple choice questions.
Adult↗
Simultaneous fluorescein and indocyanine green angiography for exudative macular degeneration.
BACKGROUND: The present study investigates how often a simultaneous fluorescein and indocyanine green (ICG) angiography had therapeutic consequences and if it is useful as a clinical routine diagnostic tool. PATIENTS AND METHODS: 502 consecutive simultaneous angiographies in eyes with exudative macular degeneration were retrospectively studied. RESULTS: A classic extra- or juxtafoveolar choroidal neovascularisation (CNV) was found in 3.5 % of the eyes. A subfoveal predominantly classic CNV was present in 19 % of the angiographies. ICG angiography showed a vascular network in 3 % of the eyes with occult CNV in fluorescein angiography. A neovascularisation supplied by retinal vessels (retinal angiomatous proliferation) was found in 9 % and a polypoidal choroidal vasculopathy (PCV) in 6 %. Other plaques or hot spots were visible in 4 %. In 11 eyes with progressive exudation from PCV and threatening of the fovea, laser treatment was successfully performed. CONCLUSIONS: Combined angiography identifies treatable PCV. Advantages of a combined procedure (easier logistics, no missing of treatable cases) and arguments for a two step procedure with ICG angiography only in selected cases (lower costs, lower rate of adverse reactions) must be weighed against each other.
Adult↗
Look and stare optokinetic nystagmus in healthy subjects and in patients with no measurable binocularity. A prospective study.
BACKGROUND: The aim of our study was to assess the difference between look and stare optokinetic nystagmus (OKN) in healthy subjects and in patients with early onset strabismus and no measurable binocularity. METHODS AND PATIENTS: OKN was elicited monocularly with black and white stripes moving horizontally or vertically at 15, 30, 45 and 60 degrees /s. Subjects were instructed either to follow individual stripes across the screen (look OKN) or to fixate stripes in the centre of the screen (stare OKN). We examined 20 healthy subjects (mean age 29 years; range 21 - 39), and 10 patients with no measurable binocularity (mean age 12.7 years; range 5 - 37). OKN gain was measured with photo-oculography. RESULTS: In both groups and at stimulation with the higher velocities gains for look OKN were significantly better than for stare OKN, and gains with horizontal stimuli were significantly better than with vertical stimuli (p < 0.05). In the group with no measurable binocularity horizontal look and stare OKN answers were significantly better for temporal-to-nasal stimulation than for nasal-to-temporal stimulation (p < 0.05). CONCLUSIONS: The performance of look or stare OKN influences the gain in healthy subjects and in patients with no measurable binocularity. Data about both modes of OKN stimulation are helpful to better interpret OKN responses especially in subjects with poor cooperation.
Adolescent↗
Role of the stimulus size in the generation of optokinetic nystagmus in normals and in patients with retinitis pigmentosa.
BACKGROUND: To find out the smallest stimulus size still able to elicit optokinetic nystagmus (OKN). To discuss the differences in the generation of OKN between normals and patients with tunnel vision. METHODS AND PATIENTS: OKN was elicited monocularly with black and white stripes of 2 degrees moving on a screen temporally-to-nasally or nasally-to-temporally at velocities of 15, 30, 45, and 60 degrees /s. In healthy subjects (n = 10) the size of the stimulus was gradually increased from minimal 8 degrees x 0.5 degrees to maximal 48 degrees x 10 degrees. OKN was elicited in retinitis pigmentosa (RP) patients (n = 2) with visual field reduced to the central 10 degrees. OKN gain was measured using infrared oculography. OKN response was considered as normal if it was within 2 standard deviations of the mean OKN of age-matched control groups (n = 29). RESULTS: In healthy subjects the size of the stimulus necessary to elicit normal OKN gain was smaller at low velocity of 15 degrees /s (16 degrees x 1 degrees ) than at higher velocities of 30, 45, and 60 degrees /s (16 degrees - 24 degrees x 3 degrees ). Normal OKN gain was measured in the RP patients only at the low velocity of 15 degrees /s. CONCLUSIONS: Small stimuli are sufficient in normals to elicit good OKN answers. Therefore, poor OKN gain in RP patients may not be explained by their tunnel vision only. We postulate that in these patients the reduction of gain is due to a multifactorial decrease of their visual perception related to disorders of the visual field, the visual acuity, and the contrast sensitivity.
Adult↗
Endoscopic laser coagulation of the ciliary processes in patients with severe chronic glaucoma.
BACKGROUND: To investigate the effect of endoscopic laser coagulation on the ciliary processes in order to control intraocular pressure (IOP) in patients with severe chronic glaucoma. PATIENTS AND METHODS: 6 eyes (5 pseudophakic, 1 phakic) of 5 patients (mean age 60 years, range 46 - 70) were treated. Glaucoma was related to previous detachment surgery (patients 1), panuveitis (patient 2), iris dystrophy (patient 3), or neovascularization (patient 4: central venous occlusion; patient 5: proliferative diabetic retinopathy). Preoperatively, all patients had not responded to intensive glaucomatous topical and systemic treatment (mean 4.2 drugs, range 3 - 5). Trabeculectomy has been unsuccessfully performed in patients 2 and 3. After pars plana vitrectomy, the ciliary processes were coagulated under endoscopic view over 180 - 270 degrees using endolaser (argon green with spots of 300 - 500 mW for 0.4 - 0.5 s). Patient 5 was treated in both eyes. RESULTS: The mean preoperative IOP was 39 mm Hg (range 32 - 47). The mean postoperative follow-up was 339 days (range 125 - 485). The postoperative IOP was over 1 year under 21 mm Hg in patient 1 with one topical drug, and in patients 2 and 3 without any further treatment. Patient 4 needed trabeculectomy and one topical drug to control IOP. The IOP was not controlled in patient 5 with the shortest follow-up despite additional topical treatment. No serious treatment-related complication was noted. CONCLUSIONS: Endoscopic laser coagulation allows a precise destruction of the ciliary processes, and permits a better control of IOP in certain cases of severe chronic glaucoma. Further investigations are necessary to better evaluate this therapy.
Aged↗
[Fundus quiz 2003].
6 cases with pathognomonic fundus pathologies are presented and discussed using multiple-choice questions.
Adult↗
Age related change of optokinetic nystagmus in healthy subjects: a study from infancy to senescence.
BACKGROUND: Optokinetic nystagmus (OKN) gain is asymmetrical between temporal to nasal (TN) and nasal to temporal (NT) stimulation in infancy and decreases at older ages. The age at which OKN gain becomes symmetrical and decreases is debated. The aim was to investigate OKN over the whole lifespan in a large sample of healthy subjects. METHODS: In a prospective, cross sectional study OKN was tested monocularly using TN and NT small field stimulation. Stimulation velocity was 15 degrees /s and 30 degrees /s for children aged under 1 year (n = 97), and 15 degrees /s, 30 degrees /s, 45 degrees /s, and 60 degrees /s for older subjects (1-9 years, n = 66; 10-89 years, n = 86). Gain was measured using infrared oculography. RESULTS: Significant OKN gain asymmetry in favour of TN versus NT stimulation was found during the first 5 months of life (p<0.05). Only at 11 months of age was OKN symmetrical in 100% of the subjects. The percentage of children with symmetrical OKN decreased with increasing stimulus velocity. OKN gain increased in the second and third years (p<0.05 for 15 degrees /s), remained stable until 50 years of age, and showed a small but significant decrease afterwards for the tested velocities (between 6% and 18%, p<0.05). CONCLUSIONS: Infrared oculography is an accurate method to assess OKN, especially in children. Knowledge about change of OKN in healthy subjects could be helpful to interpret OKN in patients with abnormal binocular vision or lesions of the central nervous system.
Adolescent↗
[Inferior retinal detachment with whitish subretinal lesion].
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Adult↗
A 5-year follow-up study for distance visual acuity after low dose radiation on subfoveal choroidal neovascularization in age-related macular degeneration.
In a prospective study with a 5-year follow-up, we assessed the effect of a single series of low-dose radiation on the distance visual acuity in eyes with angiographically confirmed subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (ARMD). The posterior pole of 12 eyes was treated with 5 Gy (4 x 1.25 Gy), and 34 eyes treated with 8 Gy (4 x 2 Gy). The best corrected distance visual acuity was measured at the time of treatment, and annually thereafter for 5 years. The study obtained complete follow-up for 11 patients in the 5-Gy group (nine classic, two occult CNVs), and 29 patients in the 8-Gy group (12 classic, 17 occult CNVs). At baseline, the mean distance visual acuity of the treated eyes was 0.16 (20/125) in the 5-Gy group, and 0.2 (20/100) in the 8-Gy group. Five years later, an average loss of 3.2 lines was present in the 5-Gy group, and 4 lines in the 8-Gy group. After 5 years, an average loss of 2 lines was found in a control group consisting of 18 second eyes with low stage dry ARMD, with a mean distance visual acuity of 0.5 (20/40) at baseline. Statistical analyses with Wilcoxon and Mann-Whitney U-tests showed that a single series of low dose radiation with either 5 Gy or 8 Gy was not able to stabilize the distance visual acuity of eyes with subfoveal CNV in ARMD during a 5-year follow-up.
Aged↗
Cocaine abuse, generalized myasthenia, complete external ophthalmoplegia, and pseudotonic pupil.
We present the case of a 29-year-old woman with generalized myasthenia. Myasthenia with complete external ophthalmoplegia was unmasked by cocaine abuse. It was associated with changes of the pupillary motility, including light-near dissociation and positive 0.1% pilocarpine test. Treatment with acetylcholinesterase inhibitors improved the patient's condition rapidly, and led to complete normalization of extraocular movements and pupillary function. To our knowledge, this is the fourth case of cocaine-related myasthenia, and the first case of myasthenia with pseudotonic pupil.
Adult↗
Optokinetic nystagmus in patients with central scotomas in age related macular degeneration.
BACKGROUND: Reports on the impact of a loss in the central field of vision on optokinetic nystagmus (OKN) are varied. A study was therefore undertaken to reassess the role of the central retina in the generation of OKN in a large group of patients with age related macular degeneration. METHODS: Four groups of 20 patients were examined: a control group without scotoma and three groups with absolute central scotomas measuring 1 degrees--10 degrees, 11 degrees--20 degrees, and 21 degrees--30 degrees. OKN was elicited with black and white stripes moving nasally to temporally or temporally to nasally on a screen subtending 54 degrees x 41 degrees at four velocities (15, 30, 45, and 60 degrees /s). OKN gain was measured using infrared oculography. RESULTS: There was no significant difference in OKN gain between the control group and those with scotomas of 1 degrees--10 degrees and 11 degrees--20 degrees. A significant difference in OKN gain was found between the group with scotomas of 21 degrees--30 degrees and all other groups at stimulus velocities of 30, 45, and 60 degrees/s (p<0.05). OKN gain significantly diminished with increasing stimulus velocity (p<0.05). No statistically significant difference was found in OKN gain between stimuli moving temporally to nasally and nasally to temporally. CONCLUSION: Abnormalities of OKN gain were noted only in patients with large scotomas. An intact macula is therefore not necessary for the generation of OKN.
Aged↗
Periodic alternating nystagmus in two children with a similar, unusual phenotype.
The report describes two unrelated male children, aged 6 and 8 years, respectively, with congenital periodic alternating nystagmus, congenital strabismus, microcephaly with cortical and cerebellar hypoplasia, mental retardation, low stature, and bat ears. Karyotypes were normal. Neuropediatric and ophthalmologic examinations, radiologic imaging of the brain, and laboratory analyses were performed to exclude other causes of periodic alternating nystagmus, such as ataxia-telangiectasia, acquired disease of the caudal brainstem or the cerebellum, albinism, or loss of vision resulting from cataract or vitreous hemorrhage. The similar morphologic and clinical features of both patients raise the possibility that they have an identical syndrome.
Body Height↗
Indocyanine green versus fluorescein angiography in the differential diagnosis of arteritic and nonarteritic anterior ischemic optic neuropathy.
PURPOSE: We evaluated in a prospective study the usefulness of indocyanine green (ICG) versus fluorescein angiography in the differential diagnosis between arteritic and nonarteritic anterior ischemic optic neuropathy (AION). METHODS: Simultaneous ICG and fluorescein angiography was performed on 22 eyes with AION. Appearance of both dyes in the choroid and in the retina, laminar flow, venous filling, and complete filling of the choroid were measured independently. Massive delayed choroidal filling corresponding to occluded posterior ciliary arteries was especially assessed, as it is almost always diagnostic of arteritic AION. We considered the choroidal filling as massive delayed if it was still incomplete after the venous filling. RESULTS: We diagnosed 5 arteritic AIONs, confirmed by biopsy, and 17 nonarteritic AIONs. In both types of angiography, 3 of 5 patients with arteritic AION showed massive delayed complete choroidal filling times (44.2, 45.8, and 70 seconds), and patients with nonarteritic AION had normal complete choroidal filling times. Dye appearance at the different angiographic times was similar for fluorescein and ICG angiography (P = 0.95-0.96). CONCLUSION: Fluorescein angiography alone is sufficient to reveal massive delayed choroidal filling time in arteritic AION. For our purpose, ICG angiography provides no additional information.
Aged↗
A case of Erdheim-Chester disease with orbital involvement.
The Erdheim-Chester disease is a rare idiopathic, systemic, histiocytic disorder. To our knowledge, ocular involvement has been reported in only 16 cases. We describe a 55-year-old man who had symmetrical exophthalmos and several skin nodules on the arms and trunk. A magnetic resonance imaging scan confirmed the presence of bilateral, intraconal, retrobulbar tumors. An examination of the histopathologic features of orbital and skin biopsy specimens revealed xanthogranulomatous infiltrate with Touton giant cells. Further systemic investigations showed bone and retroperitoneal involvement. Three years later, multiple eyelid xanthelasmas developed in the patient. These findings are consistent with the diagnosis of the Erdheim-Chester disease. The patient's condition is stable under therapy with low-dose corticosteroids. His survival is longer than usually described in the literature.
Bone Diseases↗