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PubMed2006

Macular choroidal neovascularization in myopic eyes after phakic intraocular lens implantation.

PURPOSE: To analyze the development and characteristics of choroidal neovascularization in highly myopic patients corrected by the implantation of phakic intraocular lenses (PIOLs). METHODS: This retrospective, noncomparative interventional case series studied the development of choroidal neovascularization in 522 consecutive highly myopic eyes (spherical equivalent refraction >-6.00 diopters [D] and/or axial length >26 mm) (323 patients) corrected by the implantation of PIOLs, the treatment performed, and the results obtained. Parameters evaluated were best spectacle-corrected visual acuity (BSCVA) before and after treatment of choroidal neovascularization, and the interval between refractive surgery and the development of choroidal neovascularization. RESULTS: Follow-up ranged from 12 to 145 months (mean: 60.4 +/- 39.1 months). In 12 (2.29%) eyes, choroidal neovascularization developed after PIOL implantation at a mean interval time of 33.7 +/- 29.6 months (range: 1 to 87 months). Using Kaplan-Meier analysis, the risk of choroidal neovascularization in patients with high myopia corrected by PIOL implantation was 0.57% at 5 months, 0.81% at 18 months, 1.31% at 24 months, and 3.72% at 87 to 145 months. No statistically significant differences were found between patients with and without choroidal neovascularization in the following parameters: axial length (P=.826), age (P=.296), initial BSCVA (P=.085), spherical equivalent refraction (P=.663), and follow-up (P=.955). CONCLUSIONS: Phakic intraocular lens implantation for the correction of high myopia does not play a role in the development of choroidal neovascularization.

Adult↗
PubMed2000

The role of submacular surgery in the treatment of choroidal neovascular membranes.

The growth of choroidal neovascular membranes (CNVM) beneath the macula can cause significant disturbances of central vision. Conditions such as age-related macular degeneration (AMD) and presumed ocular histoplasmosis syndrome (POHS) are the most common etiologies. The Macular Photocoagulation Study group presented data that clearly showed laser photocoagulation to be beneficial in the treatment of CNVM. Poor visual results and a high rate of recurrence have prompted clinicians to seek out alternative treatments. Experiences with CNVM removal utilizing submacular surgical techniques have shown that central visual function may be restored or preserved in POHS, multifocal choroiditis and idiopathic causes. The Submacular Surgery Trials were designed to investigate whether submacular surgery is more effective in retaining central acuity in patients with subfoveal CNVM, than observation alone. The goal of this paper is to review the role of submacular surgery in the treatment of subfoveal choroidal neovascular membranes.

Journal Article↗
PubMed2000

Submacular surgery to remove choroidal neovascularization associated with central serous chorioretinopathy.

PURPOSE: To report the results of submacular surgery for removal of choroidal neovascularization associated with central serous chorioretinopathy. METHODS: Ten eyes of nine consecutive patients with central serous chorioretinopathy and subfoveal or juxtafoveal choroidal neovascularization underwent pars plana vitrectomy with removal of the choroidal neovascular membrane between January 1994 and January 1999. RESULTS: All 10 eyes (nine patients) were followed postoperatively for at least 6 months. The mean postoperative follow-up was 23 months (range, 6 to 56.5 months). The patients were followed for an average of 6.2 months from the time of symptoms to the removal of the choroidal neovascularization. Preoperative mean best-corrected visual acuity was 20/100 (range, 20/25 to 20/400), and postoperative best-corrected mean visual acuity was 20/60 + 2 (range, 20/20 to 20/400). Seven eyes had improved postoperative visual acuity, with an average of 3.4 lines gained. Of the three eyes that had worse acuity, an average of 1.3 lines of visual acuity was lost; final mean postoperative visual acuity was 20/80 + 1 (range, 20/25 to 20/400). Of the six eyes with symptoms of less than 3 months' duration, four had a final visual acuity of 20/50 or better. All three eyes with 20/300 or worse final visual acuity had loss of foveal retinal pigment epithelium after surgery; the remaining eyes had preserved retinal pigment epithelium with a visual acuity of 20/70 or better. Two eyes had intraoperative peripheral retinal tears, and two eyes had recurrence of the choroidal neovascular complex. CONCLUSIONS: The anatomic and visual results in eyes with choroidal neovascularization associated with central serous chorioretinopathy are modestly encouraging and suggest that submacular surgery for choroidal neovascularization in patients with central serous chorioretinopathy is a treatment option that may salvage good macular function in some eyes.

Adult↗
PubMed2000

Comparison of fluorescein angiography and indocyanine green angiography for imaging of choroidal neovascularization in hemorrhagic age-related macular degeneration.

PURPOSE: To compare fluorescein angiography and indocyanine green angiography for imaging of choroidal neovascularization located under subretinal hemorrhage, in age-related macular degeneration. METHODS: In a retrospective study, 30 eyes of 30 consecutive patients with hemorrhagic age-related macular degeneration were evaluated with fluorescein angiography and indocyanine green angiography. In each eye, areas of macular hemorrhage, choroidal neovascularization, and total lesion (hemorrhage plus choroidal neovascularization) were measured, and the choroidal neovascularization was categorized as classic, occult, or mixed on fluorescein angiography, and as hot spot, plaque, or combined lesion on indocyanine green angiography. Results of the two techniques were compared for the ability to identify a laser-treatable lesion. RESULTS: Fluorescein angiography showed fluorescence in most cases (28, 93.3%). In 23 cases (76.6%), the fluorescence pattern was compatible with occult choroidal neovascularization. Indocyanine green angiography revealed defined patterns of fluorescence in 27 cases (90%): 12 hot spots, seven plaques, and eight combined hot spots and plaques. Twenty lesions (66.6%) detected by indocyanine green angiography were considered eligible for laser therapy. Nine of them (45%) were extrafoveal. CONCLUSIONS: Indocyanine green angiography is beneficial for imaging choroidal neovascularization located under subretinal hemorrhage. Choroidal neovascularization demonstrated on indocyanine green angiography may be considered eligible for laser treatment. Therefore, indocyanine green angiography should be considered in cases of hemorrhagic age-related macular degeneration.

Choroid↗
PubMed1995

Photodynamic therapy of experimental choroidal neovascularization using lipoprotein-delivered benzoporphyrin.

OBJECTIVE: To investigate photodynamic therapy of experimental choroidal neovascularization using benzoporphyrin derivative monoacid (Verteporfin). METHODS: Photodynamic therapy using benzoporphyrin derivative monoacid was investigated in cynomolgus monkeys. Following intravenous injection of benzoporphyrin derivative monoacid (1 to 2 mg/kg) complexed with low-density lipoprotein, the eyes were irradiated with 692-nm light at a fluence of 50 to 150 J/cm2 and irradiance of 150 to 600 mW/cm2. Choroidal neovascularization was documented before photodynamic therapy and closure was demonstrated by fundus photography, fluorescein angiography, and light and electron microscopic examination. RESULTS: Following photodynamic therapy, vessels within choroidal neovascularization were occluded, and there was damage to the choroidal neovascularization endothelium and the subjacent choriocapillaris. Damage to the retinal pigment epithelium and photoreceptors was also observed. CONCLUSION: Photodynamic therapy with lipoprotein-delivered benzoporphyrin derivative monoacid was effective in this animal model of choroidal neovascularization and may be a promising, potentially selective, therapy for choroidal neovascularization.

Animals↗
PubMed1989

[Localization of occult choroid neovascularizations].

The purpose of this study was to investigate the localization of the choroidal neovascular membrane of 17 eyes in the disciform stage of age-related macular degeneration. Indocyanine green videoangiography could reliably define the presence of the choroidal neovascular membrane despite the failure of fluorescein angiography. Where the indocyanine green videoangiographic and fluorescein angiographic findings were compared we found that (1) in 11 out of 17 eyes, the choroidal neovascular membrane in indocyanine green videoangiography was observed in the subretina or the subretinal pigment epithelium, although this was found to be overlaid with hemorrhage or serous fluid in fluorescein angiography; (2) in 6 eyes, the choroidal neovascular membrane was demonstrated in the area without retinal pigment epithelial detachment. In fact, even though the choroidal neovascular membrane was only visible as a "window defect" due to minimal retinal pigment epithelial damage that in fluorescein angiography, in indocyanine green videoangiography the membrane was seen as early abnormal choroidal vessels and late leakage. This implies that a disciform lesion may be caused by the choroidal neovascular membrane, even when this is only minimally invading the subretinal pigment epithelial space.

Aged↗
PubMed1996

Basic fibroblast growth factor and vascular endothelial growth factor are present in epiretinal and choroidal neovascular membranes.

PURPOSE: To determine whether vascular endothelial growth factor and basic fibroblast growth factor, which may be critical mitogens for neovascularization, are present together in human retinal and choroidal neovascular membranes. METHODS: Light microscopic immunocytochemistry using antibodies against vascular endothelial growth factor, basic fibroblast growth factor, and several cellular "marker" proteins on frozen sections from three choroidal neovascular membranes from patients with age-related macular degeneration, seven surgically excised epiretinal membranes from patients with proliferative diabetic retinopathy, and six epiretinal membranes from patients with nonischemic proliferative retinopathies. RESULTS: All three choroidal neovascular membranes and all seven epiretinal membranes stained positive for vascular endothelial growth factor. Two choroidal neovascular membranes and six of the epiretinal membranes were positive for basic fibroblast growth factor. The same cells were often positive for both antigens. None of the epiretinal membranes from patients with nonischemic proliferative retinopathies were positive for either growth factor. Many of the cells that demonstrated growth factors were glial cells, vascular endothelial cells, and retinal pigment epithelial cells. CONCLUSIONS: Colocalization of two growth factors in the same cells of ocular neovascular membranes suggests that more than one growth factor may contribute to pathologic angiogenesis. Growth factors in neovascular tissues are not localized exclusively in the vascular endothelium. Because expression of some growth factors is stimulated by hypoxia, their localization within choroidal neovascular membranes suggests that hypoxia may be an etiologic factor for choroidal as well as for retinal neovascularization.

Adult↗
PubMed1997

[Histological characterization and classification of surgically excised choroid neovascular membranes].

PURPOSE: This study was undertaken in order to histologically characterize surgically-excised choroidal neovascular membranes and to correlate theses histologic findings with the fundus and fluorescein angiographic appearance. MATERIAL AND METHODS: Surgically-excised subfoveal choroidal neovascular membranes submitted in the time period from November 1994 to July 1996 were included in this study. The membranes were processed and evaluated by light and transmission electron microscopy. Some membranes were oriented by the surgeon and marked on their inner surface with India ink and the configurations of these membranes were recorded and correlated with the fundus and fluorescein angiographic features. RESULTS: Sixty-two choroidal neovascular membranes were available for this study. In 74% age-related macular degeneration was the underlying disease. Retinal pigment epithelium and endothelial lined vascular channels were present in over 87.5% of cases. Basal laminar (linear) deposit was only present in membranes excised from patients with age-related macular degeneration. In six cases with Gass Type II choroidal neovascular membranes the histologic-clinical-fluorescein angiographic correlation showed well-defined (classic) neovascular membranes according to the criteria of the Macular Photocoagulation Study. Two membranes were not surrounded by retinal pigment epithelium and were classified as Type IIa membranes. Four membranes were surrounded by retinal pigment epithelium and classified as Type IIb membranes. CONCLUSIONS: Choroidal neovascular membranes represent a stereotypic, non-specific wound repair response to a specific stimulus. Retinal pigment epithelium may proliferate around and attempt to wall off choroidal neovascular membranes. We propose a new classification of surgically-excised choroidal neovascular membranes as Types I, IIa, and IIb.

Adult↗
PubMedDate not supplied

Immunohistochemical study of surgically excised choroidal neovascular membranes.

We carried out an immunohistochemical investigation of the choroidal neovascular membranes from 12 eyes surgically excised as a result of age-related macular degeneration (n = 6) or idiopathic choroidal neovascularization (n = 6). Immunohistochemical staining was performed with antibodies specific for basic transcriptional element binding protein-2, actin or smooth muscle cell 1. In all membranes, the endothelial cells and stromal components around the vessels were immunoreactive for expression of basic transcriptional element binding protein-2, while immunoreactive expression of actin and smooth muscle cell type 1 was found in the surrounding stromal cells. These results suggest that basic transcriptional element binding protein-2, a zinc finger transcription factor, may contribute to the establishment of the choroidal neovascularization observed in the pathogenesis of age-related macular degeneration and idiopathic choroidal neovascularization.

Actins↗
PubMed2002

Visual and anatomical outcome following submacular surgery for choroidal neovascularization secondary to Candida endophthalmitis.

PURPOSE: To report the long-term visual and anatomical outcomes for patients treated with submacular surgery for choroidal neovascularization associated with endogenous candidal endophthalmitis. METHODS: Review of the medical records, fluorescein angiograms, fundus photographs, and histopathologic specimens of patients treated with submacular surgery for choroidal neovascularization following candidal endophthalmitis. RESULTS: This series included 3 patients (1 woman and 2 men) who were 26, 30, and 60 years of age. Each patient had received systemic antifungal treatment for culture-proven candidal septicemia before the development of choroidal neovascularization. Each patient had bilateral choroidal neovascularization diagnosed by biomicroscopic examination and angiographic appearance: 2 eyes had an active subfoveal membrane; 2, an active juxtafoveal subretinal membrane; and 2, a mixture of active subfoveal neovascularization with subfoveal fibrosis. Submacular surgery was performed on five eyes with choroidal neovascularization; one eye with subfoveal fibrosis was observed. Visual acuity improved substantially in 4 eyes of 3 patients treated with submacular surgery. Visual improvement was limited in the two eyes with preexisting submacular fibrosis. During 13-month to 82-month follow-ups, vision remained stable, with no recurrence of neovascularization. CONCLUSION: Choroidal neovascularization can cause severe visual loss in patients with endogenous candidal infection. Submacular surgery with removal of choroidal neovascularization may restore vision in selected patients. Subfoveal fibrosis may limit visual improvement.

Adult↗
PubMed2005

A rare case of choroidal neovascularization following macular hole surgery.

BACKGROUND: Choroidal neovascularization occurs in a wide spectrum of conditions, including degenerative, inflammatory, traumatic and hereditary conditions, all of which are characterized by breaks in Bruch's membrane. A few cases of choroidal neovascular membrane (CNVM) have been reported in the literature following macular hole surgery. METHOD: We present a retrospective case study of a single patient who developed CNVM after successful macular hole surgery. The 70-year-old diabetic female underwent macular hole surgery in her right eye. Posterior hyaloid was separated with suction and vitrectomy was performed. Internal limiting membrane (ILM) was stained with trypan blue under air and ILM peeling was performed. Perfluoropropane (C3F8) gas was used as the tamponade. Six weeks post-operation, closure of macular hole was seen. Six months later, she presented with defective vision. Subfoveal classic CNVM was seen in the same eye. DISCUSSION: About 1%-3% of patients who undergo macular hole surgery develop CNVM. Age-related changes and surgical trauma are considered to be the predisposing factors in reported cases. Injury to the retinal pigment epithelium (RPE) during surgery may be an important factor in our case, since there were no pre-existing age-related changes. CONCLUSIONS: CNVM though rare can occur after macular hole surgery, especially in the setting of age-related changes. Injuries to the RPE should be avoided during surgery. We report a case of CNVM after macular hole in which trypan blue was used as a staining agent.

Aged↗
PubMed2006

Rationale for combination therapies for choroidal neovascularization.

PURPOSE: To provide a conceptual framework for the development and use of combination therapies for choroidal neovascularization secondary to age-related macular degeneration. DESIGN: Literature review, integration of data, and creation of hypothesis. METHODS: An assessment of angiogenesis, cancer therapy, and inflammation was performed as they may pertain to choroidal neovascularization. A conceptual framework was created in which therapies for choroidal neovascularization could be evaluated alone or in combination. RESULTS: Angiogenesis occurs because cells produce angiogenic stimuli to encourage blood vessels to develop. This growth of vessels involves an orchestrated interaction among many mediators offering opportunity to modulate or inhibit the entire process. A two-component model for choroidal neovascularization is proposed. The vascular component of choroidal neovascularization is comprised of vascular endothelial cells, endothelial cell precursors, and pericytes. The extravascular component, which by histopathology appears to be both the source of angiogenic stimuli and often the largest component volumetrically, is comprised of inflammatory, glial and retinal pigment epithelial cells, and fibroblasts. Tissue damage can be caused by either component. Each component can be targeted through as variety of monotherapies. Combination therapies offer the possibility of attacking one component in more than one way or by attacking both components simultaneously. CONCLUSIONS: The two-component model of choroidal neovascularization can be used to evaluate the mechanism of action and possible interactions of these agents in a conceptual framework. Extension of these ideas can help guide development of new treatment agents and approaches.

Angiogenesis Inhibitors↗
PubMed1993

Interferon alfa-2a in the treatment of subfoveal choroidal neovascularization.

We prospectively evaluated the effect of interferon alfa-2a on subfoveal choroidal neovascularization. Eight patients with recurrent subfoveal choroidal neovascularization after surgical excision and 12 patients with subfoveal choroidal neovascularization without previous surgical excision received interferon alfa-2a (3.0 to 6.0 million U/m2 of body surface area), every other night for an average of 12 weeks. Mean follow-up was nine months. Visual acuity improved in two of 20 (10%), remained stable in seven of 20 (35%), and worsened in 11 of 20 (55%) patients. The fluorescein angiogram improved in two of 20 (10%), remained stable in three of 20 (15%), and deteriorated in 15 of 20 (75%) patients. All patients had side effects, which led to the discontinuation of therapy in five of 20 (25%) patients. Side effects included flulike symptoms, leukopenia, thrombocytopenia, increased liver enzymes, alopecia, fever, nausea, and suicidal depression. Interferon alfa-2a failed to improve visual acuity or the fluorescein angiographic appearance of subfoveal neovascular membranes in 90% of cases and was associated with marked side effects. We discourage the widespread use of interferon alfa-2a in the treatment of choroidal neovascularization.

Adult↗
PubMed2002

Surgical outcome for removal of subfoveal choroidal neovascular membranes in children.

OBJECTIVE: To asses the surgical outcome of subfoveal choroidal neovascular membranes in children. METHODS: Two eyes with Best disease and one with idiopathic subfoveal choroidal neovascular membrane underwent vitrectomy and extraction of the subfoveal neovascular membrane. RESULTS: All the three eyes had significant improvement in their visual acuity and there was no recurrence of choroidal neovascular membrane. CONCLUSION: Surgical removal of subfoveal choroidal neovascular membrane in children carries good visual prognosis in selected cases.

Child↗
PubMed1996

Intravenous infusion of liposomal benzoporphyrin derivative for photodynamic therapy of experimental choroidal neovascularization.

OBJECTIVE: To compare the effectiveness of photodynamic therapy to close experimental choroidal neovascularization using an intravenous infusion of liposomal benzoporphyrin derivative (verteporfin) with previous work using a rapid intravenous injection, before initiating clinical trials. METHODS: Choroidal neovascularization was induced in cynomolgus monkey eyes using argon laser. Liposomal benzoporphyrin derivative was delivered by an intravenous infusion pump for 10 or 32 minutes at a dose of 0.375 mg/kg. Irradiation was performed with 689- or 692-nm laser light (600-mW/cm2 irradiance and 150-J/cm2 fluence) in 7 normal eyes and 11 eyes with choroidal neovascularization between 30 and 105 minutes after the start of dye infusion. Findings were documented by fundus photography, fluorescein angiography, and light and electron microscopy. RESULTS: Irradiation within 32 to 50 minutes of the start of the fast (10 minutes) or slow (32 minutes) dye infusion resulted in closure of choroidal neovascularization. In normal eyes, this technique caused choriocapillaris closure and retinal pigment epithelium damage with minimal damage to surrounding tissues. CONCLUSION: Photodynamic therapy using intravenous infusion of liposomal benzoporphyrin derivative selectively closed experimental choroidal neovascularization. This may be a suitable modality for clinical use.

Animals↗
PubMed2004

Matrix metalloproteinases expression in choroidal neovascular membranes.

PURPOSE: To investigate the expression of matrix metalloproteinases (MMPs) in choroidal neovascular membranes with age-related macular degeneration (AMD). METHODS: Seventeen choroidal neovascular membranes surgically removed from AMD patients with pars plana vitrectomy and subretinal membranes peeling were investigated. The expression of MMP-2 and MMP-9 was determined with immunohistochemical technique. RESULTS: Immunohistochemistry staining in choroidal neovascular membranes for MMP-2 and MMP-9 was observed in 17 specimens. There was no detective of MMP-2 and MMP-9 in normal retinas. CONCLUSIONS: MMP-2 and MMP-9 were found in choroidal neovascular membranes, may degrade the Bruch membrane and be associated with the perforation of new vessels into Bruch membrane, involving a basic pathogenic process of AMD.

Aged↗
PubMed1996

Choroidal neovascularization secondary to Candida albicans chorioretinitis.

PURPOSE: To study the clinical histories and courses of six patients with choroidal neovascularization secondary to endogenous Candida albicans chorioretinitis. METHODS: The medical records, fundus photographs, and fluorescein angiograms of six patients who developed C. albicans chorioretinitis secondary to candidemia and who subsequently developed choroidal neovascularization in one or both eyes were reviewed. RESULTS: The six patients ranged in age from 18 to 79 years. Four were women and two men; all but one showed evidence of bilateral chorioretinal scarring secondary to C. albicans chorioretinitis. All patients had been treated successfully with systemic antifungal therapy (amphotericin B). Two weeks to two years after the chorioretinitis, choroidal neovascularization developed in one eye (four cases) or both eyes (two cases). The neovascularization on initial examination was subfoveal in four eyes, extrafoveal in three eyes, and juxtafoveal in one eye. Laser photocoagulation was used in four of the eight involved eyes. In these cases, the active choroidal neovascularization was brought under control. In one eye, the patient had submacular surgery for excision of the choroidal neovascular membrane. Final visual acuities ranged from 20/20 to 20/200 in treated eyes and from 20/50 to 20/400 in untreated eyes. CONCLUSION: Choroidal neovascularization is a potential cause of late visual loss in patients who have had C. albicans sepsis and endogenous C. albicans chorioretinitis. Eyes that have chorioretinal scarring from C. albicans chorioretinitis should be watched for the development of choroidal neovascularization. Laser photocoagulation or perhaps surgical excision of the neovascular complex may be of benefit in selected cases.

Adolescent↗