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At least 163 records · Page 9Linked to original sources

Submacular surgery complicated by a choroidal neovascular membrane at the retinotomy site.

PURPOSE: We report a case of a submacular surgery complicated by a choroidal neovascular membrane at the retinotomy site. METHOD: The patient underwent submacular surgery for the removal of an idiopathic choroidal neovascular membrane. RESULT: Three weeks after surgery, the patient developed a choroidal neovascular membrane at the retinotomy site. CONCLUSION: A choroidal neovascular membrane can occur at a retinotomy site even without the use of endolaser or endodiathermy. The optimal placement of a retinotomy to prevent or minimize symptomatic visual loss from choroidal neovascular membrane requires further study.

Adult↗

[The effect of interferon-beta on experimental choroidal neovascularization].

We studied histologically the effect of systemic administration of human interferon-beta (IFN-beta) on experimental choroidal neovascularization which was caused by intensive laser photocoagulation at the posterior pole of monkey eyes. The regression of choroidal neovascularization was observed in IFN-treated monkeys. Histologically, retinal pigment epithelium (RPE) was remarkably abundant around choroidal neovascularization in the subretinal space, and the activity of neovascularization was weaker in IFN-treated monkeys than in untreated monkeys. These results indicate that IFN-beta promotes the proliferation of RPE and suppresses the activity of endothelial cells of neovascularization to cause regression of choroidal neovascularization. The results suggest that IFN-beta is clinically useful to treat the choroidal neovascularization of age-related macular degeneration.

Animals↗

Choroidal neovascularization associated with aplasia of the optic nerve.

PURPOSE: To report an unusual case of unilateral aplasia of the optic nerve associated with choroidal neovascularization. DESIGN: Observational case report. METHODS: In a 29-year-old female with optic nerve aplasia of the right eye and no choroidal neovascularization at age 23 years, choroidal neovascularization of the right eye was present by ophthalmoscopy and fluorescein angiography. RESULTS: Fluorescein angiography disclosed de novo choroidal neovascularization corresponding to fibrovascular proliferation evident on ophthalmoscopy at age 29 years. CONCLUSION: Choroidal neovascularization may develop de novo during adult life in an eye with optic nerve aplasia.

Adult↗

The role of leptin in choroidal neovascularization.

PURPOSE: The purpose of this study was to investigate the role of leptin in choroidal neovascularization. METHODS: We examined the localization of leptin by immunohistochemistry in nine choroidal neovascular membranes surgically excised from patients with age-related macular degeneration, idiopathic choroidal neovascularization, and ocular histoplasmosis. Controls included omission of primary antibody, use of an irrelevant primary antibody and leptin staining of posterior segment of four normal donor eyes. RESULTS: Leptin was present in eight membranes and appeared vesicular, within the cytoplasm. The more vascular membranes and those consisting of a larger number of retinal pigment epithelium cells were associated with greater leptin staining. Leptin was not seen in the posterior segment of the four normal eyes. CONCLUSION: We suggest that leptin plays an active role in choroidal neovascularization, although further experiments are necessary to establish a causal relationship.

Adolescent↗

Visual symptoms associated with choroidal neovascularization. Photopsias and the Charles Bonnet syndrome.

One hundred consecutive patients with macular choroidal neovascularization were studied in a cross-sectional fashion. Evidence of bilateral choroidal neovascularization was present in 31 patients. Among the 100 subjects, 59% related a history of seeing flickering or flashing lights (photopsias) in the affected eye or eyes. The colors varied, but in 59% of instances the lights were white. Twelve subjects experienced formed hallucinations (Charles Bonnet syndrome); in nine (75%) of these patients, the sequelae of choroidal neovascularization were bilateral. Symptoms that are commonly attributed to vitreoretinal tractional phenomena as well as neurologic and/or psychiatric disease are also frequently encountered in patients with macular degeneration associated with choroidal neovascularization.

Adult↗

Choroidal neovascularization as a late complication of ocular toxoplasmosis.

Macular detachment caused by choroidal neovascularization in eyes with previous toxoplasmic infections is one possible explanation of sudden loss of visual acuity. Three patients with quiescent chorioretinal scars, presumed to be toxoplasmic in origin, developed choroidal neovascular membranes that caused sudden loss of visual acuity. In none of the three cases was there any ophthalmoscopic evidence of intraocular inflammation. In two patients, the choroidal neovascularization was subfoveal and, therefore, not suitable for photocoagulation. However, visual acuity in each of the affected eyes was only partially impaired (6/15 [20/50] in one patient and 6/30 [20/100] in the other). In the third patient, the choroidal neovascular membrane was treated with argon-laser photocoagulation. Two months after treatment, visual acuity in that eye was 6/9 (20/30), and there was angiographic evidence that the neovascular membrane had closed.

Adolescent↗

Idiopathic polypoidal choroidal vasculopathy (IPCV) presenting with simultaneous choroidal neovascular membrane (CNM).

Idiopathic polypoidal choroidal vasculopathy (IPCV), a rare retinal condition initially described in 1982, is characterized by retinal pigment epithelial (RPE) detachments associated with choroidal polypoidals. Although it is recognized as a unique entity, many consider it a peculiar representation of choroidal neovascular membrane (CNM), commonly associated with age-related macular degeneration (ARMD). We report a case of IPCV with simultaneous presentation of CNM. Dilated examination and fluorescein angiography (FA) revealed RPE detachments associated with choroidal polypoidals. FA also revealed a lacy hyperfluorescent vascular lesion. Ocular manifestations, differential diagnoses, and treatment options are discussed, with emphasis on similarities and differences between IPCV and CNM. It is imperative to consider IPCV in the differential diagnosis of RPE detachments, including those associated with CNM. Careful funduscopic evaluation, FA, and/or indocyanine green videoangiography analysis helps confirm the diagnosis.

Adult↗

Inhibitory effect of losartan on laser-induced choroidal neovascularization in rats.

PURPOSE: To investigate the inhibitory effects of losartan, an angiotensin receptor antagonist, on angiogenesis in a rat model of laser-induced choroidal neovascularization. METHODS: Experimental study. Fifteen Brown-Norway male rats received losartan (approximately 5 mg/kg/d) in drinking water, and 15 Brown-Norway male rats received unsupplemented drinking water 1 week before photocoagulation, and it was continued to the end of the study. Two weeks after intense laser photocoagulation, choroidal neovascularization was evaluated by fluorescein angiography and histopathologic evaluation. RESULTS: The incidence of choroidal neovascularization formation was 99.5 +/-.2% (mean +/- standard deviation) in controls and 72.5 +/- 8.8% in losartan-treated rats (P <.01). Quantitative morphometric assessment revealed mean choroidal neovascularization lesion thickness of 54 and 44.8 microm, respectively, in controls and losartan-treated rats (P <.01). CONCLUSION: Losartan seems to inhibit development of laser-induced choroidal neovascularization. Angiotensin receptor antagonists may be useful as prophylaxis against choroidal neovascularization associated with age-related macular degeneration.

Angiotensin Receptor Antagonists↗

Photodynamic therapy: a new approach to the treatment of choroidal neovascularization secondary to age-related macular degeneration.

Visual loss as a result of choroidal neovascularization secondary to age-related macular degeneration continues to be a major challenge for all ophthalmologists. Photodynamic therapy represents an exciting and novel technique that uses light-activated drugs and nonthermal light to achieve the selective destruction of choroidal neovascularization with minimal effects on the surrounding normal tissues. In Phase I-II clinical trials of photodynamic therapy with both benzoporphyrin derivative and tin ethyl etiopurpurin, closure of choroidal neovascularization was seen 24 hours after the treatment. However, recurrence of choroidal neovascularization can occur 2 to 3 months after treatment. Double-blind, multicenter, randomized Phase III clinical trials with benzoporphyrin derivative and tin ethyl etiopurpurin are currently underway.

Choroidal Neovascularization↗

Suppression of laser-induced choroidal neovascularization by oral tranilast in the rat.

PURPOSE: To determine whether tranilast administered to pigmented rats inhibits formation of choroidal neovascularization induced by diode-laser photocoagulation. METHODS: Female Brown Norway rats were used. On day 0, choroidal neovascularization was induced by diode-laser photocoagulation, using a setting of 75 microm spot size, 0.1 second's duration, and 100 mW intensity. Tranilast (200 or 600 mg/kg per day) was administered orally twice daily for 14 days. Indomethacin (1 and 5 mg/kg per day) was administered orally once a day for 14 days. Choroidal neovascularization was evaluated on days 7 and 14 by fundus photography and fluorescein angiography. Late-phase fluorescein angiography was scored according to four grades. The animals were killed on day 14, and the lesions were evaluated histologically. RESULTS: In the vehicle-treated group, 34 of 35 burns (97%) showed fluorescein staining and late leakage on day 14. Choroidal neovascularization was identified by light microscopy in all the lesions that showed fluorescein staining and late leakage. The score of fluorescein staining was reduced in rats given 200 mg/kg per day or 600 mg/kg per day (P < 0.01) of tranilast. The thickness of the laser-induced lesions was reduced in a dose-dependent manner by tranilast, a significant difference was observed with 600 mg/kg per day (P < 0.05). Oral indomethacin treatment did not reduce fluorescein staining on day 14. CONCLUSIONS: Tranilast inhibits the development of choroidal neovascularization in this experimental model.

Administration, Oral↗

Treatment of juxtafoveal choroidal neovascularization with photodynamic therapy using verteporfin in eyes with age-related macular degeneration.

To report the results of treating juxtafoveal choroidal neovascularization with photodynamic therapy using verteporfin in eyes with age-related macular degeneration. Seven patients with predominantly classic juxtafoveal choroidal neovascularization were treated by photodynamic therapy using verteporfin. Three of the 7 patients had a gain in visual acuity and 2 had a stabilization of vision. The remaining 2 patients had a decrease in visual acuity. Subfoveal extension of the choroidal neovascularization was not observed in any patient and all choroidal neovascularization lesions after treatment were found to be nonperfused on fluorescein angiography. The encouraging results based on this small pilot study suggest that photodynamic therapy should be considered for treatment of select juxtafoveal choroidal neovascularization due to age-related macular degeneration.

Aged↗

Bone marrow-derived progenitor cells contribute to experimental choroidal neovascularization.

PURPOSE: The pathogenesis of choroidal neovascularization (CNV) is postulated to be driven by angiogenesis, a process in which the cellular components of the new vessel complex are derived from cells resident within an adjacent preexisting capillary. Recently, an alternative paradigm, termed postnatal vasculogenesis, has been shown to contribute to some forms of neovascularization. In vasculogenesis, the cellular components of the new vessel complex are derived from circulating vascular progenitors from bone marrow. In the current study, transplantation of green fluorescent protein (GFP)-labeled bone marrow and laser-induced CNV were combined to examine the contribution of vasculogenesis to the formation of CNV. METHODS: Ten adult C57BL/6 female mice were used as recipients for bone marrow transplantation. Bone marrow was obtained from three C57BL/6 female mice transgenic for the beta-actin promoter GFP. One month after bone marrow transplantation, CNV was induced in recipient mice by making four separate burns in the choroid of each eye with a red diode laser. Four weeks after CNV was induced, eyes of recipient mice were processed for immunohistochemistry to detect GFP and markers for vascular smooth muscle cells (alpha-smooth muscle actin, desmin, and NG2 chondroitin sulfate proteoglycan), endothelial cells (CD31, BS-1 lectin), or macrophages (F4/80). RESULTS: GFP-labeled cells represented 17% of the total cell population in the lesion. Many of the GFP-labeled cells were immunoreactive for alpha-smooth muscle actin (39%), desmin, NG2, CD31 (41%), BS-1 lectin, or F4/80. GFP-labeled cells were morphologically indistinguishable from cells normally present in CNV lesions. CONCLUSIONS: This study is the first to demonstrate that bone marrow-derived progenitor cells are a source of endothelial and smooth musclelike cells in CNV.

Actins↗

Incremental cost effectiveness of laser photocoagulation for subfoveal choroidal neovascularization.

OBJECTIVE: To perform a patient preference-based, incremental cost-effectiveness analysis for laser treatment of subfoveal choroidal neovascularization. DESIGN: Computer-based econometric modeling. METHODS: The cost effectiveness of laser photocoagulation therapy was compared with the natural course of subfoveal choroidal neovascularization. The model applied long-term visual data from previous clinical trials, utility analysis (which reflects patient perceptions of quality of life associated with a health state), decision analysis with Markov modeling, and the economic principles of present value analysis with discounting to account for the time value of money. DATABASE: Data from patients eligible for treatment of subfoveal choroidal neovascularization obtained by researchers in the Macular Photocoagulation Study were used for the analysis. INTERVENTION: Modeled laser therapy for subfoveal choroidal neovasacularization in patients with age-related macular degeneration. MAIN OUTCOME MEASURE: Cost per quality-adjusted life-year ($/QALY gained) associated with laser therapy. RESULTS: Laser photocoagulation therapy for subfoveal choroidal neovascularization, as compared with no treatment, resulted in a mean gain of 0.257 QALYs per treated patient. Using a yearly discount rate of 3% to account for the time value of money and inflation, the resultant $/QALY gained was $5629. Sensitivity analysis used in the cost-effectiveness analysis resulted in a $/QALY gained of $4974 with no gained discount rate and $11,633 with a yearly discount rate of 10%. CONCLUSIONS: The incremental expense of laser therapy for the treatment of subfoveal choroidal neovascularization appears to be highly cost effective. The result, which takes into account patient preference-based utility data, compares quite favorably with other interventional therapies across different medical specialties.

Aged↗

[Laser photocoagulation of experimentally produced choroidal neovascularization. 2. Comparison of effects by dye and argon blue-green lasers].

Choroidal neovascularization was produced in 18 eyes of 12 rhesus monkeys by application of intense krypton laser photocoagulation. Eight weeks or later, a total of 34 choroidal neovascularizations were treated either by dye laser at wavelengths of 577 or 630 nm or by argon blue-green laser. The treated lesions were evaluated clinically and histopathologically from 24 hours to 3 months after treatment. All the treated lesions were apparently healed by each of the 3 laser modalities. Histopathologically, all the treated choroidal neovascularizations were occluded 24 hours after treatment. At 2 weeks to 3 months after treatment, newly-formed choroidal vessels were present in 3 of 9 lesions (33%) after 577 nm dye laser treatment, in 8 of 9 lesions (89%) after 630 nm dye laser treatment, and in 5 of 8 lesions (62%) after argon blue-green laser. These results seemed to show the clinical superiority of 577 nm dye laser in treating choroidal neovascularization.

Animals↗

Choroidal neovascularization in primary hyperoxaluria.

PURPOSE: To report a case of primary hyperoxaluria in which choroidal neovascularization developed bilaterally. DESIGN: Observational case report. METHODS: A 22-year-old man with a history of type I primary hyperoxaluria complained of a slow but progressive loss of vision in both eyes for the preceding 8 months. The clinical, fluorescein, and ocular coherence tomography findings are reported. RESULTS: Fluorescein angiography confirmed the presence of choroidal neovascularization in both eyes at the edge of previous macular scars. Ocular coherence tomography scans were obtained to better characterize the clinical pathology. CONCLUSION: In a patient with type 1 primary hyperoxaluria, the presence of choroidal neovascularization in both eyes outside but adjacent to an area of previous macular scarring is reported. These findings are in harmony with the assumption that mechanical factors from the oxalate deposition promote choroidal neovascularization.

Adult↗

Retinal pigment epithelial tear after transpupillary thermotherapy for choroidal neovascularization.

PURPOSE: To describe two patients who developed a retinal pigment epithelial tear after transpupillary thermotherapy for choroidal neovascularization. METHOD: Case reports. RESULTS: Retinal pigment epithelial (retinal pigment epithelium) tear developed in 2 (8%) of 25 eyes after transpupillary thermotherapy for occult choroidal neovascularization associated with age-related macular degeneration. In both eyes, the retinal pigment epithelium tear developed between the treatment session and first post-treatment examination. In both eyes, the visual acuity was unchanged, but the complication of retinal pigment epithelium tear may result in decreased visual acuity when transpupillary thermotherapy is performed in an eye with good initial visual acuity. CONCLUSION: Retinal pigment epithelium tear appears to occur more frequently after transpupillary thermotherapy for poorly defined choroidal neovascularization than after conventional laser photocoagulation for poorly defined choroidal neovascularization.

Aged↗

Laser photocoagulation for choroidal neovascularization associated with sympathetic ophthalmia.

PURPOSE: To present a case of choroidal neovascularization associated with sympathetic ophthalmia successfully treated with photocoagulation. DESIGN: Interventional case report. METHODS: A 41-year-old man with a history of penetrating injury right eye, as well as sympathetic ophthalmia left eye, developed a classic choroidal neovascular membrane that threatened the center of the fovea. RESULTS: The patient was treated with argon laser photocoagulation. He has maintained stable visual acuity without evidence of recurrence of the membrane with 4 years' follow-up. CONCLUSION: Thermal laser should be considered as a treatment option in cases of choroidal neovascularization associated with sympathetic ophthalmia.

Adult↗

Characteristics of visual loss by scanning laser ophthalmoscope microperimetry in eyes with subfoveal choroidal neovascularization secondary to age-related macular degeneration.

PURPOSE: To evaluate the effects of subfoveal choroidal neovascularization secondary to age-related macular degeneration on functional parameters obtained by scanning laser ophthalmoscope microperimetry. DESIGN: Retrospective observational case series and cross-sectional study. METHODS: At the Doheny Retina Institute and Wilmer Eye Institute a consecutive series of 179 eyes of 175 patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration was studied. The onset of visual symptoms, best-corrected visual acuity, fluorescein angiography, evaluation of fundus microperimetry and fixation pattern using the Rodenstock scanning laser ophthalmoscope were obtained for each patient. The main outcome measures were central retinal sensitivity and fixation pattern (fixation location and fixation stability) in eyes with subfoveal choroidal neovascularization and their relationship to the length of disease, type and characteristics of choroidal neovascularization, and visual acuity. RESULTS: Of 179 eyes, 135 (75%) had central fixation, 27 (15%) had poor central fixation, and 17 (9%) had predominantly eccentric fixation. Seventy-six eyes (42%) had stable fixation, 70 eyes (39%) had relatively unstable fixation, and 33 eyes (18%) had unstable fixation. In 50 eyes (28%) a dense central scotoma was noted. Eighty-nine of 100 eyes (89%) with length of symptoms of less than 3 months had predominantly central fixation and 58 (58%) had stable fixation; 14 of 34 eyes (41%) with length of symptoms of more than 6 months had predominantly central fixation, and 5 eyes (15%) had stable fixation. In 15 eyes of patients who elected not to receive treatment, successive scanning laser ophthalmoscope microperimetry were obtained over time (follow-up of 18 months after onset of symptoms). Three months or less after the onset of symptoms, 13 eyes (87.7%) had predominantly central fixation and 9 eyes (60%) had stable fixation. More than 3 months and 6 months or less after the onset of symptoms, 10 eyes (66.7%) had predominantly central fixation and 7 eyes (46.7%) had stable fixation. This trend was further demonstrated in eyes more than 6 months after the onset of symptoms. CONCLUSIONS: We conclude that the sequence of events leading to visual function deterioration appears to involve an initial mild decrease in central retinal sensitivity and visual acuity followed by progressive fixation instability and, ultimately, development of an absolute central scotoma with totally eccentric fixation. Increased length of disease is associated with worse fixation pattern and retinal sensitivity deterioration as assessed by scanning laser ophthalmoscope microperimetry. A better understanding of the characteristics of visual loss assessed by fixation pattern evaluation and microperimetry in age-related macular degeneration may help optimize timing, patient selection, and treatment options in eyes with this condition.

Aged↗