Choroidal Damage Research Articles

Long-Term Retinal Neurovascular and Choroidal Changes After Panretinal Photocoagulation in Diabetic Retinopathy.

Purpose: To evaluate the long-term retinal microvascular, neural, and choroidal changes in the patients with severe nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) following panretinal photocoagulation (PRP).Methods: Forty-five eyes of 28 patients with treatment-naive severe NPDR and PDR were included and followed for 12 months after PRP. Microvascular and neural changes in the macular and peripapillary areas were assessed by using optical coherence tomography angiography. Subfoveal choroidal thickness (SFCT) was measured by using optical coherence tomography. A Linear mixed-effects model was used to highlight the differences for the variables after adjusting for sex, age, and axial length.Results: Compared to baseline, there were no statistical differences in the best corrected visual acuity (BCVA), macular and peripapillary vessel density (VD), and SFCT following PRP. Macular thickness significantly increased at 1 and 3–6 months after PRP (p < 0.05), while the peripapillary retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness significantly increased at 1 month postoperatively (p < 0.01). Global loss volume and focal loss volume significantly decreased at the same time point (p < 0.05).Conclusion: The unchanged BCVA, VD, the thickness of RNFL and GCC, and SFCT during the 12-month follow-up period suggest that PRP may prevent the retinal neurovascular and choroidal damage.

Risk Factors and Prognosis of Pediatric Open Globe Injuries without Initial Light Perception

Purpose: The aim of this study was to investigate the possible risk factors and prognosis of initial no light perception (NLP) in pediatric open globe injuries (POGI). Procedures: This retrospective, comparative, interventional case-control study included 865 eyes of POGI patients presenting to a tertiary referral ophthalmic center from January 1, 2011 to December 31, 2015. Eyes were divided into 2 groups: the NLP group included eyes with initial NLP, and the light perception (LP) group included eyes with initial LP or vision better than LP. Results: The following risk factors were significantly related to initial NLP: severe intraocular hemorrhage (OR 3.287, p = 0.015), retinal detachment (RD; OR 2.527, p = 0.007), choroidal damage (OR 2.680, p = 0.016), and endophthalmitis (OR 4.221, p < 0.001). Choroidal damage is related to remaining NLP after vitreoretinal surgery (OR 12.384, p = 0.003). At the last visit, more eyes in the NLP group suffered from silicone oil-sustained status (OR 0.266, p = 0.020) or ocular atrophy (OR 0.640, p = 0.004), and fewer eyes benefitted from final LP (OR 41.061, p < 0.001) and anatomic success (OR 4.515, p < 0.001). Conclusion: Severe intraocular hemorrhage, RD, choroidal damage, and endophthalmitis were possible predictors of initial NLP in POGI. Choroidal damage was the major factor related to an NLP prognosis. Traumatized eyes with initial NLP could be anatomically and functionally preserved by vitreoretinal surgery.

Traumatic choroidal injuries - classification, incidence, diagnosis and prognosis twenty-year results of Eye Injury Vitrectomy Study.

To characterize the classification, incidence, diagnosis and prognosis of traumatic choroidal injuries. Subjects were selected from the database of the Eye Injury Vitrectomy Study (EIVS) and were examined for occurrences of different categories of choroidal injuries. Standard photographs were collected. Anatomical and visual outcomes were assessed in patients with greater than 1year of follow-up. Eyes that had no light perception (NLP) and/or phthisis bulbi were defined as having had unfavourable outcomes. The percentage of eyes with an unfavourable outcome was analysed for different types of choroidal injuries. Nine categories of choroidal injuries with distinctive features were identified in the EIVS database. The incidence and the percentage of eyes with an unfavourable outcome in each injury category were as follows: suprachoroidal effusion, 21.2% (7.2%); suprachoroidal haemorrhage, 12.8% (11.2%); massive suprachoroidal haemorrhage, 4.0% (64.9%); choroidal avulsion, 4.2% (92.2%); traumatic chorioretinal rupture, 1.8% (13.3%); choroidal rupture, 4.8% (6.8%); choroidal loss, 1.6% (79.3%); choroidal hole, 1.1% (5.3%); and choroidal damage at the wound site, 39.2% (17.7%). Ocular trauma can cause a variety of choroidal injuries that have distinctive features, some of which are associated with a high frequency of unfavourable prognoses.

Evaluation of choroidal thickness in prodromal Alzheimer's disease defined by amyloid PET.

To assess and compare the involvement of choroidal thickness (CT) in patients with mild cognitive impairment (MCI) and dementia due to Alzheimer's disease (AD) defined by amyloid PET and healthy controls (HC). Sixty-three eyes from 34 AD patients [12 eyes (19.0%) with dementia and 51 eyes (80.9%) with MCI], positive to 11C-labelled Pittsburgh Compound-B with positron emission tomography (11C-PiB PET/CT), and the same number of sex- and age-paired HC were recruited. All participants underwent enhanced depth imaging optical coherence tomography (EDI-OCT) assessing CT at 14 measurements from 2 B-scans. Paired Student t-test was used to compare CT measurements between MCI, dementia and sex- and age-paired HC. A univariate generalized estimating equations model (GEE) test was performed to compare MCI and dementia individually with all HC included. Compared with HC, eyes from patients with positive 11C-PiB PET/CT showed a significant CT thinning in 5 selected locations (in foveal thickness in vertical scan, in temporal scan at 1500μm, in superior scan at 500μm and in inferior scan at 1000μm and 1500μm, p = 0.020-0.045) whilst few significant CT reduction data was reported in MCI or dementia individually versus HC. However, the GEE test identified significant CT thinning in AD compared with all HC included (p = 0.015-0.046). To our knowledge, the present study is the first measuring CT in eyes from MCI and dementia eyes positive to 11C-PiB PET/CT reporting a significant trend towards CT thinning in MCI patients which became more pronounced in dementia stage. We support further investigation involving larger and prospective OCT studies in AD population characterized with available biomarkers to describe whether choroidal vascular damage occurs specifically in prodromal stages of AD.

Choroidal Thickness and Microperimetry Sensitivity in Age-Related Macular Degeneration

Purpose: To assess choroidal thickness (CT) and its relationship to retinal sensitivity in mild/moderate age-related macular degeneration (AMD). Methods: Seventy-two eyes of 51 participants with mild/moderate AMD and 36 eyes of 18 age-matched normal participants were prospectively recruited to undergo enhanced-depth imaging optical coherence tomography (EDI-OCT) imaging and microperimetry (MP) functional assessment. OCT-measured CT and retinal thickness (RT) were matched with MP sensitivity at 13 retinal loci, and correlations were analysed. Results: Patients with AMD had an average RT 56.5 μm greater than those without AMD (p < 0.001). There was no significant difference in CT between normal and AMD participants (p = 0.36). In patients without atrophy or pigment epithelial detachment, there was no correlation between MP sensitivity and CT (p = 0.08); however, a correlation between RT and MP was detected (b = 0.006, p = 0.046). Among patients without AMD, MP sensitivity was positively correlated with RT (b = 0.007, p < 0.001) and negatively correlated with CT (b = 0.0046, p = 0.035). Conclusions: CT does not correlate with retinal sensitivity in AMD. Although choroidal damage and impaired choroidal perfusion appear to be important concepts in AMD pathogenesis, increasing choroidal thinning may not be associated with worsening retinal function in AMD.

Clinical features and prognosis of eyeball rupture: eye injury vitrectomy study.

The objective of the study was to delineate clinical characteristics, surgical interventions, anatomic and visual outcomes of ruptured eye balls after trauma, and establish the prognostic indicators, which can assist clinicians in making correct surgical decisions during globe exploration for ruptured eyes. The study design used was a multicentre prospective cohort study, including six university-affiliated tertiary hospitals. We selected 242 cases of ruptured globe from the Eye Injury Vitrectomy Study database, until 31 December 2012. All selected cases underwent vitreoretinal surgery, enucleation or evisceration, and were followed up for at least 6 months. Age, visual acuity (VA) after injury, ocular trauma zone, time to surgery, corneal laceration, scleral wound, extrusion of iris or lens, ciliary body damage, intraocular haemorrhage, retinal detachment or defect, proliferative vitreoretinopathy (PVR) and choroidal damage were the predisposing factors evaluated by logistic regression models. We compared the pre-surgical indicators between cases of anatomically restored eyes with VA of 4/200 or better, or eyes with initial no light perception restored light perception or better, and cases of VA worse than 4/200, silicone oil-sustained eyes, phthisis or enucleation. Nearly 40% of cases with ruptured globe were anatomically restored through vitreoretinal surgery. The closed-funnel retinal detachment or extensive retinal loss (odds ratio [OR] = 3.38, P = 0.026), PVR-C (OR = 3.45, P = 0.008), and choroidal damage (OR = 4.20, P = 0.004) were correlated with poor outcomes. The closed-funnel retinal detachment or extensive retinal loss, PVR-C, and choroidal damage are the risk factors for unfavourable outcomes in globe ruptures.

Clinical features and outcomes of vitrectomy in pediatric ocular injuries-eye injury vitrectomy study

Context:Severe pediatric ocular injury remains a frequent and difficult problem. Vitrectomy is a major technique that has been used to manage severely damaged eyes. However, limited follow-up studies exist currently.Aims:To evaluate the clinical features and predictive factors of visual and anatomic outcomes in Eye Injury Vitrectomy Study (EIVS).Settings and Design:Retrospective, consecutive, interventional case series.Materials and Methods:Reviewing and analyzing records of children, aged 15 years or younger, who had undergone vitrectomy for eye injuries in EIVS database between January 1997 and December 2009.Statistical analysis used:Descriptive analyses and multiple Logistic regressions were employed for all variables using SPSS software (version 17.0, SPSS Inc.).Results:Eighty-seven children (89 eyes) with more than 6 months follow-up and complete records identified in EIVS were included in this study. Average follow-up was 12.7 months. The mean age was 9.4 ± 3.8 years. Seventy-seven eyes (86.5%) had open globe injuries, and 12 (13.5%) had closed globe injuries. Seventeen eyes (19.3%) presented with endophthalmitis. Seventy-five eyes (88.2%) presented with visual acuity of 4/200 or worse; however, 42 eyes (47.7%) achieved 4/200 or better vision with anatomical restoration after vitrectomy. Multiple analysis showed that choroidal damage, large scleral wound, and endophthalmitis were significantly associated with unfavorable outcome, the OR values were 16.7 (95% CI: 2.7-102.4, P = 0.002), 10.9 (95% CI: 1.7-71.6, P = 0.013), and 6.6 (95% CI: 1.0-42.4, P = 0.048), respectively.Conclusions:Vitrectomy intervention resulted in favorable visual and anatomic outcomes in almost half of the injured eyes. Choroidal damage, large scleral wound, and endophthalmitis were the prognostic indicators of unfavorable outcome.

Stony Intraocular Foreign Body (Eye of Stone)

Ocular traumata are relevant sight threatening incidents [1]. Males are more often involved than females as well as rural dwellers more often than urban inhabitants [2]. Most accidents occur at work (60 %) followed by accidents at home (24 %) [2]. Risk factors for a poor visual outcome are rupture of the globe, scleral wound extending further than 5 mm posterior to the limbus, scleral wound of equal or more than 10 mm, ciliary body damage, severe intraocular hemorrhages and choroidal damage (i. e. choroidal laceration, choroidal detachment, choroidal rupture, choroidal incarceration, and choroidal defect), closed funnel retinal detachment or extraocular retinal prolapse [3]. A consistent terminology and a precise trauma classification are indispensible to ensure optimal trauma management. Commonly used are the Birmingham-Eye-Trauma-Terminology (BETT, [Fig. 1]) [4][5] and the Ocular-Trauma-Score (OTS) [5][6][7][8].

Transpupillary thermotherapy for atypical central serous chorioretinopathy

BackgroundCentral serous chorioretinopathy (CSC) has been traditionally treated with laser photocoagulation. We thought that transpupillary thermotherapy (TTT) utilizing a lower temperature than that of conventional laser photocoagulation might minimize permanent retinal and choroidal damage. Studies suggest that undesirable effects on vision due to TTT are minimal even if it is applied to foveal and/or parafoveal lesions when TTT requires a larger irradiation spot. The aim of this study was to evaluate the efficacy of TTT in the management of atypical CSC.MethodsWe defined atypical CSC as bullous retinal detachment with diffuse or several leakages, severe leakage with fibrin formation under serous retinal detachment, or leakage within a pigment epithelium detachment. Eight consecutive patients with atypical CSC underwent visual acuity testing, ophthalmic examination, color photography, fluorescein angiography, and optical coherence tomography to evaluate the results of transpupillary thermotherapy. Retreatment of atypical CSC was based on ophthalmic examination, optical coherence tomography, and fluorescein angiography. TTT was performed on the leaking spots shown in fluorescein angiography, with a power of 50–250 mW, spot size of 500–1200 μm, and exposure time of 13–60 seconds to minimize retinal damage.ResultsIn five of eight affected eyes, serous detachments completely resolved within 1 month after the initial TTT. One eye had persistent subretinal fluid and required a second TTT treatment. Two eyes showed no resolution of CSC and were treated by conventional photocoagulation. Initial best-corrected visual acuity (BCVA) ranged from 20/600 to 20/20 (mean, 20/40; median, 20/30). Final BCVA ranged from 20/200 to 20/20 (mean, 20/25; median, 20/20). BCVA improved in all cases. Only two eyes with persistent subretinal fibrin and existing retinal pigment epithelial alternations in macular area showed limited improvement of BCVA despite the absence of subretinal exudation. The presence of retinal attachment was confirmed by optical coherence tomography in six eyes (75%).ConclusionsTTT seems to be effective for the treatment of atypical CSC in the short term. Additional studies are necessary to evaluate the long-term effectiveness and safety.

CASE–CONTROL STUDY OF RISK FACTORS FOR NO LIGHT PERCEPTION AFTER OPEN-GLOBE INJURY

Investigate possible risk factors of no light perception (NLP) after open-globe injury. Explore whether these risk factors are predictors for an unfavorable visual outcome. This case-control study matched 72 eyes with NLP according to type and zone of injury to 2 controls per case with light perception or better vision. Cases were selected from the Eye Injury Vitrectomy Study database. All injured eyes in the study underwent surgical intervention. Ciliary body damage (odds ratio = 2.94), closed funnel retinal detachment (odds ratio = 2.43), and choroidal damage (odds ratio = 2.80) were independent risk factors for NLP after open-globe injury. There were 67 traumatized eyes with NLP that had ≥1 of these risk factors. In 43 of the cases (64.2%), the eyes recovered light perception or better after vitreoretinal surgery. The five traumatized NLP cases without these risk factors obtained a favorable visual outcome after vitreoretinal surgery. There was no statistical significance in visual outcome between them (P = 0.162). Ciliary body damage, closed funnel retinal detachment, and choroidal damage are independent risk factors for NLP posttrauma but not prognostic indicators for NLP visual outcome. Traumatized eyes with NLP may recover light perception or better vision if appropriate interventional measures are used for treatment of the injured ciliary body, retina, and choroid.

This issue of Acta, printed and electronic

The illustrations on the cover show adaptive optic images of photoreceptor pattern in the retina as well as infrared reflectance and high definition spectral domain optical coherence tomography images described in the letter by Massamba et al. in the electronic part of the journal. Witmer et al. in Florida review acute retinal necrosis and emphasize that in addition to retinal detachment, macular edema and ischemia, optic neuropathy is an important component. Seland et al. in Norway and several European countries found that visual impairment in Europe was <3% in prevalence and blindness ranged in prevalence from 0.5% to 2%, more in southern than northern Europe. Falk et al. in Finland report that intraocular pressure decreases by about 3 mmHg following cataract surgery and remains at this level for 4 years. Yoshino et al. in Tokyo found good and stable visual outcome with a refractive aspheric silicone multifocal intraocular lens. Heussen et al. in Germany, UK and Switzerland compared vitrectomy and scleral buckling for retinal detachment. In phakic eyes vitrectomy has more reoperations, whereas in pseudophakic eyes scleral buckling has more reoperations than vitrectomy. Velikay-Parel et al. in Austria used encircling band, laser, perfluorcarbon and silicone oil for complicated retinal detachments with proliferative vitreoretinopathy. Yeh et al. in Taiwan found that intravitreal bevacizumab treatment may reduce the need of revitrectomy for recurrent vitreous hemorrhage after diabetic retinopathy. Matri et al. in Tunisia found bevacizumab to be useful for choroidal neovascularization in angioid streaks. Mekjavic et al. in Slovenia report good results with 3 monthly bevacizumab injections followed by OCT guided continuous treatment for neovascular age-related macular degeneration. Degenring et al. in Germany attempted to translocate retinal pigment epithelium and choroid to treat neovascular AMD, with variable and disappointing results. Rojas et al. in Spain found that treatment with statin reduced choroidal damage and ischemia in hypercholesterolemic rabbits. Teuchner et al. in Austria, Hungary and USA injected brain derived neurotrophic factors and other potentially neuroprotective molecules into the vitreous cavity in rats in order to delay ganglion cell loss. Martinez-de-la-Casa et al. in Spain found that rebound and noncontact tonometry gave similar results as Goldman applanation tonometry and were similarly influenced by central corneal thickness. Wang et al. in Copehagen and China show that cyclooxygenase-2 is expressed in normal human eyes and less so in some eye tumors. Kim et al. in Korea report good outcomes with porous polyethylene orbital implants. Ganesh et al. in Oman and Sweden found that 21% of patients who had esotropia surgery in childhood later developed exotropia. Swan et al. in USA comment on this article in a letter to the editor. Theodossiadis et al. in Athens document spontaneous closure of macular holes. Following is the electronic part of this issue, which is available on http://www.actaophthalmologica.com. Resch et al. in Austria and Germany found that reduced optic nerve head bloodflow is associated with worsening visual field defect and morphological changes in the optic disc. Cause and effect is unclear. Jindal et al. in USA did not find statistically significant improvements in perimetry or multifocal visual evoked potential with acute lowering of intraocular pressure. Thaler et al. in Germany and Poland demonstrate neuroprotective effects of tempol in optic nerve crush in rats. Inoue et al. in Japan found that both refractive and diffractive multifocal intraocular lenses reduced contrast of the retinal image. Filho et al. in Brazil report that intravitreal ranibizumab reduces fluorescein leakage and macular swelling sometimes associated with panretinal photocoagulation. Chrysanthi et al. in Greece and UK measured macular pigment optical density in patients with wet and dry age-related macular degeneration. Alnawaiseh et al. in Germany and USA report that Ni++ and Ca++ channels contribute to transretinal signaling in the mouse. Brignole-Baudouin et al. in France and Italy report that omega 3 and omega 6 fatty acid supplements may improve dry eye symptoms. Gatzioufas et al. in Germany comment on the paper by Fahnehjelm et al. on corneal hysteresis and Fahnehjelm and Chen reply. Swan et al. in USA comment on the strabismus paper by Ganesh et al. in this issue. Larsen et al. Copenhagen describe myofibroma of the orbit in a 1 year old. Massamba et al. in France used adaptive optics to image macular telangiectasia, as seen on the cover of the journal. Gibson et al. in UK describe negatively results in AMD genetics. Zarnowski et al. in Poland used topical bevacizumab to prevent bleb failure following trabeculectomy. Jonas et al. in Germany and Italy used intravitreal bevacizumab successfully for perifoveal telangiectasia. I hope that you find this issue of Acta to be educational and enjoyable. Please take advantage of both the printed and electronic version of the journal. Also keep in mind that older versions of Acta Ophthalmologica are available under http://www.actaophthalmologica.com where you can read interesting publications dating back to the 1920s.

Prognostic Indicators for No Light Perception After Open-Globe Injury: Eye Injury Vitrectomy Study

To describe ocular characteristics, surgical interventions, and anatomic and visual outcomes of traumatized eyes with no light perception (NLP) following open-globe injury and to investigate prognostic predictors for NLP cases after open-globe injury. Interventional case series study. Thirty-three traumatized eyes with NLP were selected from the Eye Injury Vitrectomy Study database, a hospital-based multicenter prospective cohort study. Inclusion criteria were NLP cases following open-globe injury with outcomes of anatomic restoration, phthisis bulbi, or enucleation. Exclusion criteria were cases with missing records, undergoing vitrectomy after injury at nonparticipating hospitals, direct optic head injury, endophthalmitis, and hypotonous or silicone oil-sustained eyes. All cases underwent vitreoretinal surgery or enucleation after exploratory surgery and were followed up for at least 6 months. Two outcomes were assessed: favorable outcome (anatomically restored eye globes with light perception [LP] or better vision) and unfavorable outcome (NLP, phthisis bulbi, or enucleation). The following 7 risk factors were significant between the 2 groups: rupture (P = .021); open globe III (P = .046); scleral wound ≥10 mm (P = .001); ciliary body damage (P < .001); severe intraocular hemorrhage (P = .005); closed funnel retinal detachment or retinal prolapse (P = .005); and choroidal damage (P = .001). These 7 risk factors are possible predictors of poor prognosis. Traumatized eyes with NLP can be anatomically restored with LP or better vision if vitreoretinal surgery is attempted, and a favorable anatomic and visual outcome is increased by having a decreased number of these risk factors.

Pilot Study of the Delivery of Microcollimated Pars Plana External Beam Radiation in Porcine Eyes

To investigate the effects of a novel stereotactic radiosurgical system for pars plana delivery of microcollimated x-rays to the retina and determine the retinal radiological dose response and toxicity threshold in a pig model. The x-rays were delivered through the pars plana to the maculae of Yucatan miniswine to verify the targeting and safety of a cornea-scleral, stabilized, office-based delivery system. Twelve eyes were randomized to receive 0, 16, 24, 42, 60, or 90 Gy in a single dose to the retina. Eye examinations, fundus photography, fluorescein angiography, and spectral-domain optical coherence tomography were obtained at days 7, 30, 60, and 90. Indocyanine green angiography was done at day 90. Through day 90 interim analysis, no abnormalities of external structures were noted. A small cortical lens opacity was noted in the 60-Gy group. Fundus evaluation revealed no abnormalities at 16 or 24 Gy. Beginning at day 30, circular pale retinal lesions with sharp margins were noted in the maculae of the eyes that received 42, 60, and 90 Gy. Higher-dose lesions showed late staining on fluorescein angiography, choroidal hypoperfusion on indocyanine green angiography, and defined photoreceptor loss and retinal thinning on spectral-domain optical coherence tomography. Transscleral stereotactic radiation dosing of porcine eyes demonstrates no apparent clinical abnormalities in doses less than 24 Gy. Doses of 42 Gy or higher led to focal choroidal and retinal damage within the target area. Radiation can induce small-blood vessel closure and thereby has therapeutic potential in neovascular diseases such as age-related macular degeneration.

Quantitative evaluation of experimental choroidal neovascularization by confocal scanning laser ophthalmoscopy: fluorescein angiogram parallels heparan sulfate proteoglycan expression

The objective of the present study was to develop a quantitative method to evaluate laser-induced choroidal neovascularization (CNV) in a rat model using Heidelberg Retina Angiograph 2 (HRA2) imaging. The expression of two heparan sulfate proteoglycans (HSPG) related to inflammation and angiogenesis was also investigated. CNV lesions were induced with argon laser in 21 heterozygous Zucker rats and after three weeks a fluorescein angiogram and autofluorescence exams were performed using HRA2. The area and greatest linear dimension were measured by two observers not aware of the protocol. Bland-Altman plots showed agreement between the observers, suggesting that the technique was reproducible. After fluorescein angiogram, HSPG (perlecan and syndecan-4) were analyzed by real-time RT-PCR and immunohistochemistry. There was a significant increase in the expression of perlecan and syndecan-4 (P < 0.0001) in retinas bearing CNV lesions compared to control retinas. The expression of these two HSPG increased with increasing CNV area. Immunohistochemistry demonstrated that the rat retina damaged with laser shots presented increased expression of perlecan and syndecan-4. Moreover, we observed that the overexpression occurred in the outer layer of the retina, which is related to choroidal damage. It was possible to develop a standardized quantitative method to evaluate CNV in a rat model using HRA2. In addition, we presented data indicating that the expression of HSPG parallels the area of CNV lesion. The understanding of these events offers opportunities for studies of new therapeutic interventions targeting these HSPG.

Treatment of neovascular age-related macular degeneration with a variable ranibizumab dosing regimen and one-time reduced-fluence photodynamic therapy: the TORPEDO trial at 2 years

The combination of verteporfin photodynamic therapy (PDT) and anti-angiogenics has been shown to be safe and efficacious in the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). The purpose of this study is to demonstrate long-term prevention of vision loss and improvement in best-corrected visual acuity (BCVA) after treatment with one-time reduced-fluence-rate PDT followed by administration of ranibizumab on a variable dosing regimen over 24 months in patients with neovascular AMD. Secondary outcome measures included the change in central macular thickness (CMT), reinjection frequency, and safety. This prospective, nonrandomized, open-label, single-center study enrolled 27 consecutive patients (27 eyes) presenting at the Leuven University Eye Hospital with previously untreated, active neovascular AMD between September 2006 and January 2007. All patients were treated with one-time, reduced-fluence-rate verteporfin PDT, followed by intravitreal ranibizumab 0.5 mg on the same day. A second and third ranibizumab injection were given at weeks 4 and 8, respectively, after which patients were followed up monthly for 24 months. Additional treatment with ranibizumab was administered to eyes with active neovascularization as indicated clinically and on imaging studies. Retreatment was based on the following criteria: (1) presence of subretinal fluid (SRF), intraretinal edema or sub-retinal pigment epithelial fluid, as seen on OCT; (2) increase of CMT by >100 mm on OCT; (3) signs of active CNV leakage on fluorescein angiography; (4) new sub- or intraretinal hemorrhage; and (5) BCVA decreased of > or =5 letters on the Early Treatment of Diabetic Retinopathy Study (ETDRS) chart. If any single criterion for reinjection was fulfilled, retreatment with ranibizumab was administered. Twenty-five patients completed the 2-year study. Occult CNV was present in 64% and retinal angiomatous proliferative (RAP) lesions were present in 24% of the study eyes. The remaining three eyes had lesions classified as classic (one eye) or predominantly classic (two eyes) CNV. Month 24 data are available for 25 eyes (25 patients; age 55-86 years; mean 77; standard deviation (SD) = 7.2). Mean baseline VA was 58.6 letters (range: 35-70; SD = 8.4); 24-month VA was 66.2 letters (35-82; 12.7), not including one warfarin-treated patient who suffered vitreous hemorrhage. The mean visual acuity improved by 7.2 letters (p < 0.05) and the mean CMT decreased by 146 mum. VA improved >3 lines (15 letters) in 16%; improved 1-3 lines in 20%; remained within one line of baseline in 32%, decreased 1-3 lines in 16%, and decreased >3 lines in 16%. Losses of >3 lines were due to vitreous hemorrhage, geographic atrophy, fibrosis, and growth of an initially small CNV lesion. An average of 5.1 injections (range: 3-9) were administered during the first 12 months, and 7.1 injections (3-13) over 24 months. A total of 178 injections were performed; no systemic side-effects, uveitis, or choroidal collateral vascular damage were observed. Two patients were lost to follow-up. Combined PDT and ranibizumab injection the same day was well tolerated in all patients. Eighty-four percent of patients had stable or improved vision at month 24.

Low-dosage statins reduce choroidal damage in hypercholesterolemic rabbits

To describe the ultrastructural changes in the choroid of long-term hypercholesterolemic rabbits after a low-dosage statin treatment and to evaluate some pleiotropic effects of these drugs on the morphology of endothelial cells (EC) and vascular smooth-muscle cells (VSMC). New Zealand rabbits were divided into three groups: G0, fed a standard diet; G1, fed a 0.5% cholesterol-enriched diet for 8 months and G2, fed a 0.5% cholesterol-enriched diet for 8 months plus administration of fluvastatin sodium or pravastatin sodium at a dose of 2 mg/Kg/day each. Eyes were processed for transmission-electron microscopy. G1 had a lipid build-up at the suprachoroidea that compressed the vascular layers with the lumens of the vessels to the point of collapse in some instances. By contrast, G2 underwent a substantial decrease in suprachoroidal foam cells and of lipids in the vascular layers while the vascular lumens were normal. The preservation of cytoplasmic organelles, caveolar system and other ultrastructural features of EC and VSMC in G2 contrasted with the numerous signs of necrosis observed in G1. Bruch's membrane (BM) in G2 contained fewer lipids and more collagen than in G1. Treatment with a low dosage of fluvastatin sodium or pravastatin sodium reduced the lipid build-up as well as the macrophages in the choroid and restored the vascular lumens of choroidal vessels independently of the cholesterol effect. The normal ultrastructural features of choroidal EC and VSMC in statin-treated animals suggest that the endothelial function is preserved and the ischaemia reduced.

Photopic Negative Response Reflects Severity of Ocular Circulatory Damage after Central Retinal Artery Occlusion

Purpose: To determine the relationship of the photopic negative response (PhNR) of the photopic electroretinogram (ERG) with the degree of circulatory disturbances in eyes following central retinal artery occlusion (CRAO). Methods: The circulatory disturbance was graded as mild (group 1) when the arm-to-retina transmission time was <30 s, moderate (group 2) when the time was >30 s and severe (group 3) when concurrent choroidal circulatory damage was found. For statistical analysis, groups 1, 2 and 3 were scored as 1, 2 and 3, respectively. Photopic ERGs were elicited by either short-flash (SF) or long-flash (LF) stimuli. Results: Both the SF and LF PhNR were significantly reduced in groups 2 and 3. The PhNR amplitude was negatively correlated with the severity of the ocular circulatory disturbances (p = 0.0498, ρ = –0.507 for SF PhNR; p = 0.0050, ρ = –0.750 for LF PhNR). Conclusion: The amplitude of the PhNR became more reduced as the severity of the circulatory disturbances increased in eyes with CRAO.

VEGF-induced choroidal damage in a murine model of retinal neovascularisation

Background/aims:Photoreceptor-specific upregulation of vascular endothelial growth factor (VEGF) in a transgenic mouse model (Kimba) of retinal neovascularisation induces retinal vascular damage which appears similar to that in diabetic retinopathy. Here...

Unilateral serous retinal detachment in a patient with thrombotic thrombocytopenic purpura

Ocular complications are a relatively common occurrence in patients with thrombotic thrombocytopenic purpura (TTP). Serous retinal detachment is a rare but reported complication, with most cases being bilateral and associated with concomitant hypertension. Therapeutic plasma exchange has been used to successfully treat patients with TTP. We report a case of a 46 year old woman who presented with TTP, received therapeutic plasma exchange, and developed unilateral serous retinal detachment with retinal pigment epithelial tear in the absence of reported hypertension. The increased perfusion pressure due to hypertension, combined with the choroidal vasculature damage from TTP are thought to lead to retinal epithelial tear. This suggests that although hypertension may play a role in retinal detachment in these patients, other mechanisms may be responsible.

Indocyanine green angiographic findings of hypertensive choroidopathy.

To evaluate fundus lesions in patients with malignant hypertension with indocyanine green angiography (ICGA). Cases of hypertensive choroidopathy were followed prospectively with ICGA, fluorescein angiography (FA), and optical coherence tomography (OCT). In Case 1, a 34-year-old man had a 10-day history of blurred vision in both eyes. Visual acuity was 0.2 in the right eye and 0.01 in the left eye. Blood pressure (BP) was 270/178 mmHg, and laboratory tests disclosed severe renal dysfunction. In Case 2, a 31-year-old man had noticed blurred vision in both eyes. Visual acuity was 1.2 in the right eye and 1.0 in the left eye. BP was 272/180 mmHg. Marked optic edema, retinal hemorrhage, cotton-wool patches, and Elschnig spots were seen in both cases. FA showed poorly perfused choroid in the early phase and fluorescein dye leakage from the optic disk. OCT demonstrated serous retinal detachment in both cases. ICGA revealed Elschnig spots corresponding to the patchy choroidal filling defect. ICGA demonstrated a larger area of choroidal filling defect than FA. In Case 1, ICGA revealed dye leakage from large choroidal vessels. These OCT and ICGA findings reduced after early systemic treatment for malignant hypertension. Hypofluorescent spots in the choroid thought to be choriocapillaris occlusion and choroidal vessel damage recover as result of early treatment for malignant hypertension. ICGA is useful to reveal the disturbance of choroidal circulation in hypertensive choroidopathy.