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Visual acuity outcomes of patients 50 years of age and older with high myopia and untreated choroidal neovascularization.

OBJECTIVE: To evaluate visual outcomes of untreated submacular choroidal neovascularization (CNV) in patients 50 years of age and older with high myopia. DESIGN: Retrospective observational case series. PARTICIPANTS: Twenty-two eyes in 22 patients were studied. All were 50 years of age and older with myopia of 6.0 diopters (D) or greater or an axial length of 25.5 mm or greater. Patients had untreated CNV documented by clinical examination and fluorescein angiography at two medical centers between 1986 and 1997. INTERVENTION: Demographic and clinical data were abstracted from patients' medical records. MAIN OUTCOME MEASURE: Visual acuity at 1 year after CNV diagnosis. RESULTS: The study included 22 eyes of 22 patients (mean age, 63.1 years; mean refraction, -11.0 D). Baseline visual acuity (VA) in the study eye was 20/40 or greater in 2 (9%) patients, 20/50 to 20/150 in 9 (41%) patients, and 20/200 or less in 11 (50%) patients. Drusen were present in seven (32%) eyes, and lacquer cracks were noted in ten (45%) eyes. Mean refractive error was -7.0 D for patients with drusen and -12.5 D for patients without drusen. Choroidal neovascularization was less than 0.25 disc diameters (DD) in 11 (50%) eyes, 0.25 to 0.5 DD in 5 (23%) eyes, and greater than 0.5 DD in 6 (27%) eyes. Visual acuity in the study eye 1 year after CNV diagnosis was 20/40 or greater in 3 (14%) patients, 20/50 to 20/150 in 3 (14%) patients, and 20/200 or less in 16 (73%) eyes. The presence of drusen was significantly associated with older age and a lower degree of myopia but was not associated with size of the CNV or visual acuity outcome. CONCLUSION: When compared to patients younger than 50 years of age with high myopia and CNV reported in previous publications, the patients in the current series generally have poorer visual outcomes.

Aged↗

Comparison of three techniques of foveal translocation in patients with subfoveal choroidal neovascularization resulting from age-related macular degeneration.

PURPOSE: To report the results of three methods of foveal translocation in the presence of subfoveal choroidal neovascular membrane resulting from age-related macular degeneration. METHODS: We treated 51 eyes of 51 consecutive patients with subfoveal choroidal neovascular membranes resulting from age-related macular degeneration with one of three techniques of foveal translocation surgery: foveal translocation with partial retinotomy (n = 6), limited translocation (n = 9), and translocation with 360-degree retinotomy (n = 36). All patients were followed for at least 6 months postoperatively. The size of the choroidal neovascular membrane and the amount of foveal displacement, the best-corrected visual acuity, and complications were recorded preoperatively and postoperatively. RESULTS: The mean distance of the foveal translocation was greater in the 360-degree retinotomy group (3340 microm) than in the partial retinotomy (1060 microm, P <.001) and the limited translocation groups (1120 microm, P <.001). A final visual acuity of 20/200 or better was achieved in two eyes (33%) in the partial retinotomy group, seven eyes (78%) in the limited translocation group, and 23 eyes (64%) in the 360-degree retinotomy group. The final visual acuity improved by 0.2 logarithm of minimal angle of resolution (logMAR) unit or more in one eye (17%), one eye (11%), and seven eyes (19%), respectively. The final visual acuity was maintained within 1 line in zero eyes, five eyes (56%), and 19 eyes (53%), respectively. A retinal detachment developed postoperatively in five eyes (83%), zero eyes (0%), and 15 eyes (42%), respectively. CONCLUSIONS: A significant number of patients improved or maintained best-corrected visual acuity after translocation with 360-degree retinotomy, and limited translocation, whereas translocation with 360-degree retinotomy is suitable for larger choroidal neovascular membranes because it resulted in the greatest foveal displacement among the three translocation procedures.

Aged↗

Characteristics and outcomes of choroidal neovascularization occurring after macular hole surgery.

PURPOSE: To study the characteristics and outcomes of choroidal neovascularization (CNV) developing after surgery for idiopathic macular holes. METHODS: Retrospective, noncomparative case series. Search of diagnostic and procedure databases of four participating institutes identified nine eyes of eight patients with CNV after surgery for idiopathic macular hole. Demographic, clinical, and fundus fluorescein angiographic data were abstracted from patients' medical records. RESULTS: Choroidal neovascularization developed 6 weeks to 30 months after macular hole surgery. The macular hole was closed in all cases. The CNV complex involved the foveal region in 9 (100%) eyes, was predominantly classic in 8 (89%) eyes, and was associated with moderate to severe leakage of fluorescein in 8 (89%) eyes. The CNV was crescent-shaped and spared the central area of retinal pigment epithelial mottling that corresponded to the site of the macular hole in 6 (67%) cases. Other fluorescein angiographic features included retinal pigment epitheliopathy in 6 (67%) eyes and presence of drusen in 7 (78%) eyes. The final visual acuity after a mean follow-up period of 11.2 months (range, 3-16 months) was 20/50 to 20/80 in 2 (22%) eyes, 20/100 to 20/200 in 1 (11%) eye, and less than 20/200 in 6 (67%) eyes. CONCLUSION: Choroidal neovascular complexes occurring after macular hole surgery tend to share certain characteristics, including foveal involvement, frequent sparing of the central area corresponding to the site of the closed macular hole, and generally poor visual outcomes. Therapeutic modalities including photodynamic therapy and surgical options may be considered in these patients.

Aged↗

Clinical characteristics of choroidal neovascular membranes.

Eighty-three choroidal neovascular membranes (CNVMs) associated with pathologic entities other than age-related macular degeneration (study group) were compared with 64 CNVMs associated with macular degeneration (comparison group). Nine CNVMs (11%) in the study group, compared with 28 CNVMs (44%) in the comparison group, were occult membranes. Of the remaining well-defined CNVMs, 16 (22%) in the study group, compared with 21 (58%) in the comparison group, were subfoveal. Of the well-defined subfoveal membranes, four (25%) in the study group, compared with 17 (81%) in the control group, were large (greater than 1500 micron in size). All large subfoveal membranes occurred in patients over 55 years of age. Thus, in this study the majority of CNVMs associated with pathologic entities other than age-related macular degeneration were well defined and not subfoveal at initial presentation. The majority of CNVMs associated with macular degeneration were occult or subfoveal. Membranes in patients over 55 years of age, regardless of cause, were commonly found to be occult or subfoveal at presentation.

Adolescent↗

Expressions of angiopoietins and Tie2 in human choroidal neovascular membranes.

PURPOSE: To elucidate the potential role of angiopoietins and the Tie2 system in choroidal neovascularization. METHODS: Surgically excised choroidal neovascular membranes (CNVMs) were obtained at vitrectomy from five eyes with age-related macular degeneration, three eyes with idiopathic neovascular maculopathy, and two eyes had degenerative myopia and two eyes had angioid streaks. Light microscopic immunohistochemistry was performed to detect cytokines such as vascular endothelial growth factor (VEGF), Ang1, and Ang2 and cellular components such as retinal pigment epithelial (RPE) cells, macrophages, and endothelial cells. Immunofluorescent double staining using confocal microscopy was performed to identify the cell types that secrete specific cytokines. RESULTS: Ang1 and Ang2 were positive in all surgically excised CNVMs, regardless of the primary disease. Double staining revealed that many of the cytokeratin, CD68 and factor VIII positive cells also had Ang1 and Ang2 immunoreactivities. In contrast to Ang1, Ang2 immunoreactivity tends to be higher in the highly vascularized regions of many CNVMs, and the localization was very similar to that of VEGF staining. Almost all vascular structures had prominent immunoreactivity for Tie2, which was confirmed by double staining for Tie2 and factor VIII. Tie2 immunoreactivity was also observed in the RPE monolayer and in pigmented, polygonal, and fibroblast-like cells in the stroma. CONCLUSIONS: Present findings that Ang2 and VEGF are co-upregulated and that Tie2 is expressed in a variety of cell types in CNVMs further support a crucial role of the interaction between VEGF and Ang2 in pathologic angiogenesis of CNVM formation.

Adult↗

[Fundus flavimaculatus and choroidal neovascularization].

OBJECTIVE: Fundus flavimaculatus is an aspect of Stargardt disease, which is characterized by juvenile onset, rapidly progressive deterioration, and poor visual outcome due to atrophic areas or flecks. Recently, a late-onset form has been described, on the borderline with AMD. However, choroidal neovascular complications are not frequent and rarely described in Stargardt's disease. CASE REPORT: Late discovery of FFM in a patient over 50 years old. During her follow-up, she presented a decrease in visual acuity due to juxtafoveal choroidal neovascularization. In spite of laser treatment, a retrofoveal recurrence appeared, which was treated with perifoveal laser. DISCUSSION: Confusion between AMD and a late-onset Stargardt may occur because of their many clinical similarities. The population and the fundus results can be similar to AMD and an examiner may be confused. In the literature, choroidal neovascular complications appear in patients over 50 years of age who may suffer from AMD. In fundus flavimaculatus, pigmentary epithelium alterations are due to progressive lipoproteic scrap storage that predisposes to Bruch's membrane rupture and choroidal neovascularization. This physiopathology resembles the that of AMD. CONCLUSION: Choroidal neovascular complications are possible in late-onset Stargardt disease. Their appearance together may be greater than previously believed.

Choroidal Neovascularization↗

Clinicopathologic correlation of krypton and argon laser photocoagulation in a patient with a subfoveal choroidal neovascular membrane.

Krypton-red laser photocoagulation for choroidal neovascular membranes has been shown to produce inner retinal sparing in contrast to argon blue-green or argon-green laser photocoagulation, which causes full-thickness retinal destruction. However, previous histopathologic reports have involved only primates or humans without known macular degeneration. Clinicopathologic features of a case in which a human eye with a choroidal neovascular membrane, associated with age-related macular degeneration, was photocoagulated on four occasions with the argon-green and krypton-red lasers are presented. The results of this study confirm previous reports of the inner retinal sparing noted with krypton-red laser photocoagulation in comparison with argon blue-green or argon-green laser photocoagulation.

Aged↗

Subfoveal choroidal neovascularization: radiotherapy or perifoveal photocoagulation? A fellow eye study.

Perifoveolar photocoagulation is advised for subfoveal choroidal neovascularization responding to the MPS eligibility criteria. Recently, radiation therapy has been proposed but has not yet proved its efficacy. We compared these two treatments. We retrospectively reviewed 27 patients with age related macular degeneration and subfoveal choroidal neovascularization in both eyes. The first eye was treated with perifoveolar photocoagulation and the second eye with radiotherapy. In case of simultaneous diagnosis, radiotherapy was performed in the eye with the best visual acuity. Although the follow up is two times longer and the initial visual acuity is lower in the group of the photocoagulated eyes, both groups have similar results at the end of their respective follow up. However, in the eyes treated with radiotherapy the lesions are still active and edematous while in the eyes treated with perifoveolar photocoagulation, the lesions are stable and dry. The percentage of patients who subjectively prefer the photocoagulated eye has increased progressively from 0% to 71.5% along the 20 months of follow-up post radiotherapy. The perifoveolar photocoagulation of the subfoveal choroidal neovascularization seems, at median term, to give better objective and subjective results than the radiation therapy.

Aged↗

Subretinal choroidal neovascularization in birdshot retinochoroidopathy.

We studied four eyes of two patients with bilateral birdshot retinochoroidopathy which developed subretinal choroidal neovascular membranes involving the macula. The subretinal choroidal neovascular membranes in our patients developed six months to five years after the onset of the disease. Both patients described decreasing visual acuities at the time when the choroidal neovascular membranes were identified. Adjacent to the classic depigmented areas of birdshot retinochoroidopathy were increased pigmentation, hemorrhage, or fluid indicative of subretinal neovascularization. Fluorescein angiography confirmed the presence and demonstrated the location of these membranes.

Choroid↗

Macrophage depletion diminishes lesion size and severity in experimental choroidal neovascularization.

PURPOSE: Macrophage recruitment to the choroid has been proposed to contribute to the pathogenesis of choroidal neovascularization (CNV) in AMD. The study was conducted to determine whether treatment with clodronate liposomes (CL(2)MDP-lip), which cause depletion of blood monocytes and lymph node macrophages, diminishes the severity of neovascularization in a mouse model of laser-induced CNV. METHODS: Laser-induced CNV was performed in female 16-month-old C57BL/6 mice. Macrophages were depleted by use of CL(2)MDP-lip intraperitoneally and subcutaneously 72 and 24 hours before and every 2 to 3 days after laser injury. Control mice received injections of either PBS alone or PBS liposomes. Blood monocyte and choroidal macrophage depletion were documented by flow cytometry and choroidal flatmount preparation analysis, respectively. Two weeks after laser injury, mice were injected intravenously with fluoresceinated dextran. The right eyes were removed and prepared for flatmount analysis of CNV surface area (in relative disc areas or DA), vascularity (relative fluorescence), and cellularity (propidium iodide stain). The mice were then perfused with 10% formaldehyde, and the left eyes were removed for histopathology. The means of the various parameters for four CNV lesions per eye were calculated. Fluorescein angiography was also performed. RESULTS: Flow cytometry of circulating monocytes and immunohistochemical analysis of choroidal macrophage density confirmed the effective depletion of blood monocytes and choroidal macrophages respectively in CL(2)MDP-lip-treated mice. Compared with the control, flatmount analysis of macrophage depleted mice demonstrated a significant reduction in size of the CNV area (2.8 +/- 0.5 DA vs. 1.4 +/- 0.1 DA; P < 0.043). The treated group also revealed less vascularity (1.6 +/- 0.1 units vs. 1.1 +/- 0.0 units; P < 0.0092) and cellularity of CNV lesions (3.3 +/- 0.6 DA vs. 1.7 +/- 0.1 DA, P < 0.04). Histopathology revealed that, in the macrophage-depleted group, CNV was smaller in diameter (1270 +/- 73 pixels vs. 770 +/- 82 pixels, P < 0.0006) and thickness (120 +/- 7 pixels vs. 96 +/- 7 pixels, P < 0.019). CONCLUSIONS: Macrophage depletion using CL(2)MDP-lip reduces size, cellularity, and vascularity of CNV. This observation supports the hypothesis that macrophages contribute to the severity of CNV lesions.

Animals↗

Indocyanine green angiography: an evaluation of image enhancement for the identification of occult choroidal neovascular membranes.

PURPOSE: To determine the diagnostic yield of occult choroidal neovascularization from examination of nonenhanced digital indocyanine green (ICG) angiograms versus examination of both nonenhanced and contrast-enhanced angiograms. METHODS: Fifty consecutive occult choroidal neovascular membranes were examined using ICG angiography at the Queen's University Eye Department. These studies were retrospectively reviewed in a masked fashion using the nonenhanced images. A subsequent examination of the same images was then performed using both the nonenhanced and contrast-enhanced images. Each study was graded as focal hyperfluorescence, plaque hyperfluorescence, isofluorescence, or hypofluorescence. RESULTS: Of the cases reviewed, only 36% (18/50) of the membranes were well-defined on nonenhanced ICG angiography, compared with 58% (28/50) using image enhancement in addition to the nonenhanced images. This was a statistically significant difference in image definition between the two groups (chi-square test; P < 0.005). CONCLUSION: Contrast-enhanced angiograms, when used in conjunction with nonenhanced ICG images, allowed for a significantly higher diagnostic yield when compared with the study of nonenhanced images alone.

Aged↗

Photodynamic therapy with verteporfin for choroidal neovascularization associated with angioid streaks.

BACKGROUND: Choroidal neovascularizations (CNV) is the major cause of significant visual loss in patients with angioid streaks. We evaluated the functional and morphological outcome of Verteporfin photodynamic therapy (PDT) in the treatment of these patients. METHODS: This was a retrospective study in two tertiary referral centres over a 3-year period. Examinations included visual acuity assessment with ETDRS charts, binocular fundoscopy and fluorescein angiography. PDT was performed with standard parameters; earlier retreatments were feasible in active CNV. RESULTS: Fifteen eyes from 12 patients (9 male, 3 female) with a follow-up of 12-50 months (mean 26.1, median 19 months) were included. Five lesions were extra-or juxtafoveal and ten were subfoveal. Baseline visual acuity was between 20/63 and 20/16 (mean 20/32, median 20/32). Eyes were treated with two to eight treatments of PDT (mean 4.2, median 4). Treatment intervals were between 5.6 and 72 weeks (mean 12.1, median 9.2 weeks). At the 1-year follow-up, visual acuity was below 20/200 in 27% (4/15), 20/200 or better in 73% (11/15) and 20/63 or better in 47% (7/15) with an improvement of >3 lines in 13% (2/15), no change in 27% (4/15) and a decrease of >3 lines in 60% (9/15). At the final follow-up examination, all lesions were located subfoveally. Visual acuity was below 20/200 in 47% (7/15), 20/200 or better in 53% (8/15) and 20/63 or better in 13% (2/15) with a change in visual acuity between +2 and -18 lines (mean -9 lines, median -8 lines). No change was noted in 7% (1/15) and a decrease of >3 lines in 93% (14/15) of eyes. The maximum measured greatest linear dimension of the lesion during the follow-up varied between 2400 microm and 6200 microm (mean 3680 microm, median 3600 microm) with an increase in the lesion size compared with baseline values between +/-0 microm and +3700 microm (mean+1420 microm, median+1500 microm). CONCLUSION: PDT for CNV associated with angioid streaks seemed to slow down but not prevent the progression of the disease and associated visual loss. Further modifications of the treatments parameters or a combination with other therapeutical options seem warranted for a more effective treatment of these lesions.

Adult↗

Selection for inferior limited macular translocation on the basis of distance from the fovea to the inferior edge of the subfoveal choroidal neovascularization.

PURPOSE: To assess the visual outcome of inferior limited macular translocation in eyes selected based on the distance from the fovea to the inferior edge of the subfoveal choroidal neovascularization. DESIGN: Interventional case series. METHODS: We performed inferior limited macular translocation in 12 consecutive eyes (12 patients) with age-related macular degeneration or polypoidal choroidal vasculopathy, in which the choroidal neovascularization did not extend for more than half of one disk diameter inferior to the fovea. RESULTS: In all eyes, the choroidal neovascularization was moved to an extrafoveal location. In seven of the 12 eyes, postoperative vision was 20/40 or better. The visual acuity improved by 2 or more lines in 11 eyes. CONCLUSION: Selection for inferior limited macular translocation on the basis of distance from the fovea to the inferior edge of the choroidal neovascularization may be associated with a greater likelihood of visual acuity improvement.

Aged↗

[Feeder vessel treatment of choroidal neovascularization in age-related macular degeneration].

INTRODUCTION: To report on the results of feeder vessel treatment for choroidal neovascularization in age-related macular degeneration (AMD). MATERIAL AND METHODS: Retrospective study of 40 patients presenting subfoveal classic choroidal neovascularization (CCNV) and/or occult choroidal neovascularization (OCNV) with or without fibrovascular pigment epithelium detachment (PED), based on fluorescein angiography (FA) and indocyanine green angiography (ICG). Visual acuity was measured using Snellen lines and/or ETDRS. The feeder vessels were visualized with high-speed ICG angiography (confocal scanning laser ophthalmoscope, Heidelberg HRA, Heidelberg, Germany). Feeder vessels were identified as very thin vessels with early filling and rapid emptying. Feeder vessel closure was achieved by laser photocoagulation treatment with either minipulse infrared laser therapy (810 nm), microburst, or yellow laser (568 nm). Post-treatment high-speed ICG angiography follow-up was recommended to the patient immediately or the day after the treatment. The number of treatments and location of the feeder vessels in relation to the macula as well as FA, ICG, and visual acuity results were assessed. If necessary, other treatment techniques such as photodynamic therapy (PDT) or transpupillary thermotherapy (TTT) were offered to the patient when leakage was still present. RESULTS: The patients were followed for an average of 6.2 months (2-9 months). Twenty-six women and 14 men (mean age, 72 years; range, 51-95) were included. Eight patients demonstrated classic neovascularization, 32 presented occult neovascularization, including 17 cases of vascularized PED and 15 retrofoveal plaques. The average number of treatments was 1.8 (range, 1-4 treatments). Location of feeder vessels were as follows: nine superior-macular, 18 inferior-macular, six nasal-macular and 11 temporal-macular. Visual acuity improved two lines or more in nine patients (22.5%), decreased 2 lines or less in five patients (12.5%) and was stable in 26 patients (65%). After feeder vessel treatment, seven patients showed improvement of the anatomical aspect of the AMD lesions, with a reduction in leakage. Except for one subretinal hemorrhage, no complications after feeder vessel treatment were observed. CONCLUSION: Feeder vessel treatment is a technique requiring high-speed ICG angiography to detect the feeder vessels located at a distance from the subfoveal OCNV, CCNV, and PED. Although the final visual acuity result was for the most part stabilization, the technique appeared to be safe and reproducible. In patients who were not eligible for other therapies such as PED, feeder vessel treatment seemed to be a reasonable alternative.

Aged↗

Retrovirus-mediated gene transfer to photocoagulation-induced choroidal neovascular membranes.

PURPOSE: To determine the feasibility of experimental gene transfer to laser-induced choroidal neovascular membrane (CNVM) in rats, with a retroviral vector containing the reporter construct beta-galactosidase (beta-gal). METHODS: Laser photocoagulation was used to induce CNVM in rats. To ascertain the duration of beta-gal expression in the CNVM, 23 rats received 10 burns (75 microm, 100 mW, 0.1 seconds) in their right eyes, and beta-gal expression was examined from day 3 to 4 months. In addition, 14 pigmented rats were treated with 3 photocoagulation burns in their right eyes. beta-gal vector was injected into the vitreous or subretinal space 2 days later. On day 14, fluorescein angiography was performed to detect choroidal neovascularization. Then, beta-gal expression in each photocoagulation-induced CNVM was examined by observing the exposed fundus of the eyes stained with the beta-gal substrate X-Gal. RESULTS: beta-gal expression was identified in the CNVM induced by photocoagulation from day 5 (16.2% +/- 6.8% of the lesions) to 4 months (3.7% +/- 2.4%). Histopathologic examination revealed beta-gal-transduced macrophages and spindle-shaped cells, which amounted to 1.12% +/- 0.58% (at 2 weeks) of the total cells in the CNVM. beta-gal expression was restricted to the CNVM, and there was no beta-gal transduction in surrounding normal retinochoroidal tissue. There was no correlation between choroidal neovascularization formation and beta-gal expression. CONCLUSIONS: The feasibility of gene transduction targeted to the photocoagulation-induced CNVM was demonstrated using retroviral vectors. By transducing functional genes, this model could be useful for investigating the possibility of gene therapy to inhibit formation of the CNVM in age-related macular degeneration.

Animals↗

Clinicopathological correlation of choroidal neovascularization after external beam radiotherapy in age-related macular degeneration.

PURPOSE: To analyze the histopathology of choroidal neovascularization after external beam radiotherapy in age-related macular degeneration. METHODS: A retrospective non-case-matched comparative histopathologic study. The histoarchitecture of nine surgically removed subretinal specimens from nine patients that had undergone external beam radiotherapy for exudative age-related macular degeneration was studied. Seven patients had received 20 Gy in 10 fractions and two 15 Gy in 5 fractions with an average time interval between radiotherapy and surgical extraction of 14 months (range 3-28). A consecutive series of classic, mixed and occult choroidal neovascular membranes served as controls. RESULTS: Clinical findings. Radiation-associated choroidal neovasculopathy was angiographically suspected in four patients: a coarse net of vessels on fluorescein angiography developing at the border of previously irradiated choroidal neovascularization was observed in three patients; blebs at the margin of a plaque on indocyanine green angiography were observed in two patients. Pathological findings. Diffuse drusen as well as intra-Bruch's fibrovascular tissue was found in all irradiated specimens. In four specimens an edematous vascularized layer was seen between diffuse drusen and normal-appearing intra-Bruch's fibrovascular tissue. This lesion was not found in the control specimens. A particular correlation for the bleb lesion was not recognized. CONCLUSION: The appearance of an edematous subretinal pigment epithelial vascularized layer between diffuse drusen and normal-appearing fibrovascular tissue in four of nine irradiated membranes may be secondary to previous irradiation. It may correlate with the unusual exudative manifestations observed after external beam radiotherapy.

Aged↗

Photodynamic therapy with verteporfin for subfoveal choroidal neovascular membranes in highly myopic eyes after laser in situ keratomileusis.

The authors describe the management of subfoveal choroidal neovascular membranes in highly myopic eyes after laser in situ keratomileusis with photodynamic therapy. Five cases of choroidal neovascular membrane after laser in situ keratomileusis for the correction of myopia (mean, 13.3 diopters; range, -8.00 to -16.25 diopters) treated with single or multiple sessions of photodynamic therapy with verteporfin are presented. Two cases had improved visual acuity (2 to 5 lines) after photodynamic therapy, two cases remained the same, and one case lost 4 lines of visual acuity. Photodynamic therapy with verteporfin seems to increase the chance of stabilizing or improving vision in patients with subfoveal choroidal neovascular membrane after laser in situ keratomileusis in highly myopic eyes.

Adult↗

[Correlation of photodynamic therapy outcome with choroidal neovascular membrane size].

AIM: To show the results of photodynamic therapy according to the size of choroidal neovascular membrane size. PATIENTS AND METHODS: A retrospective analysis included 94 patients undergoing photodynamic therapy at University Department of Ophthalmology, Sestre MilosrdniceUniversity Hospital from 2001 till 2005. There were 61 patients with age related macular degeneration (AMD) and 33 patients with high myopia. All patients had a predominantly classic choroidal neovascular membrane. Patients were divided into two subgroups according to the lesion size. The first subgroup included patients with a lesion equal to or less than one disc diameter, and the second subgroup had a lesion greater than one disc diameter. All patients were followed up for a minimum of 3 months. RESULTS: In the group of patients with AMD statistical analysis showed no significant difference in total closure and decrease in the size of choroid neovascularization (CNV) between the two subgroups. In the group of patients with high myopia a statistically significant difference was found in total closure and decrease in the size of CNV between patients with lesions smaller or equal to one disc diameter and those with lesions greater than one disc diameter. The former group also had better visual outcome. CONCLUSION: The size of CNV was not a prognostic factor in patients with AMD. In patients with high myopia, better outcome was recorded in the subgroup with CNV smaller or equal to one disc diameter.

Adult↗