Disc Neovascularization Research Articles

Retinal arteriolar occlusions due to cytomegalovirus retinitis in elderly patients without HIV

BackgroundFive of 7 (71%) elderly immunocompetent patients with cytomegalovirus retinitis had retinal arteriolar occlusions versus 2 of 8 (25%) elderly immunocompromised patients and 1 of 19 (5%) younger HIV-infected patients. Compared to HIV-infected patients, elderly patients were more likely to have occlusive events, neovascularization or hemorrhage, and underlying vasculopathy. The purpose of this study is to report the novel finding of extensive retinal arteriolar occlusions and neovascularization in immunocompetent patients with cytomegalovirus retinitis. This is a retrospective observational cohort study of cytomegalovirus retinitis (CMVR) in a university setting. Seven patients were elderly but not immunocompromised, 8 were elderly and iatrogenically immunocompromised, and 16 were HIV-infected. All patients underwent polymerase chain reaction testing of intraocular fluid. Primary outcome measure was visual acuity. Secondary outcome measures were vascular occlusions, ischemic complications, and response to treatment.ResultsMean age was 73, 70, and 41 years for immunocompetent, immunocompromised, and HIV-infected patients, respectively. Diabetes and vascular disease were common in the elderly. Vision loss to less than 5/200 occurred in 50% of the immunocompetent elderly patients, and 17% of CMV eyes in immunocompromised and HIV patients. Occlusion of the entire retinal vasculature occurred in 4/7 (57%) of immunocompetent patients despite lack of Zone I involvement, and rubeosis occurred in three, disc neovascularization in one, and vitreous hemorrhage in two patients. Vascular occlusive events were less common in immunocompromised patients and rare in the HIV-infected.ConclusionsCMVR in non-HIV-infected elderly patients is associated with retinal arteriolar occlusions. An intact host immune response may increase damage to retinal vessels. Prompt diagnosis may avert catastrophic vision loss.

Frosted Branch Angiitis as Ocular Manifestation of Behçet's Disease: Unusual Case Report and Literature Review

We report an unusual case of unilateral frosted branch angiitis associated with Behçet's disease, including a review of previously reported cases. A 39-year-old male with history of recurrent oral and genital ulcers presented with visual loss in his left eye. Fundus findings demonstrated occlusive retinal vasculitis resembling acute frosted branch angiitis. Laboratory examinations including viral markers revealed no abnormal findings except positive HLA-B51. The patient was treated with systemic steroid and cyclosporine. Six months after presentation, new oral ulcers and pseudofolliculitis appeared, and he was diagnosed with Behçet's disease following rheumatology consultation. During follow-up, there was no change in visual acuity of hand movement, and disc neovascularization developed even after complete panretinal photocoagulation. Ocular manifestations of Behçet's disease can present as unilateral frosted branch angiitis, and may consecutively involve in both eyes. Early immunosuppressive treatment is recommended.

Topographical Distribution of Retinal and Optic Disc Neovascularization in Early Stages of Proliferative Diabetic Retinopathy

We analyzed the topography of proliferative diabetic retinopathy (PDR), and visualized the distribution of neovascularization of the optic disc (NVD) and elsewhere in the retina (NVE). The study included 174 eyes of 106 patients with early PDR. Data on the size and location of 391 NVE and 73 NVD were converted into a database of two-dimensional retinal and optic disc charts. The geometric centers of the neovascular lesions were plotted into corresponding areas of the charts, and the topographic distributions of the NVE and NVD were visualized by merging the charts and displaying the number of overlapping lesions on color-coded contour maps. A total of 141 (36%) NVE was located in the temporal and 250 (64%) in the nasal hemisphere (P < 0.0001). The distribution of the NVD in the temporal and nasal half of the optic disc was 46 (63%) and 27 (37%), respectively (P = 0.03). NVE in type 1 diabetes were located significantly farther from the fovea and optic disc, and were more numerous and larger than in type 2 diabetes. The number and diameter of the NVE were also significantly higher when the time from the last examination to the appearance of PDR exceeded 12 months. The majority of NVE lesions are located inferonasal to the optic disc and along the superior vascular arcades, while NVD have a predilection for the upper temporal disc rim. More extensive PDR is found in patients with type 1 diabetes and those with examination intervals longer than one year.

Optic Disc Neovascularization Revealing Neurosyphilis

Purpose: To report a case of neurosyphilis revealed by bilateral optic disc neovascularization.Design: Case report. Methods: A 39-year-old man presented with a 6-month history of progressive visual loss (20/25 RE, 20/1200 LE) and transient headaches. Fundus examination demonstrateda 1+ vitritis, mild macular edema and large optic disc neovascularization in both eyes. Serological tests for syphilis were positive. Results: Specific antibiotics and systemic steroids were undertaken and complete regression of disc neovascularization was observed within 6 months.Conclusion: Optic disc neovascularization, which is a rare manifestation of chronic uveitis, may lead to the diagnosis of neurosyphilis and be successfully treated by specific antibiotic and steroid therapy.

OCULAR NEOVASCULARIZATION ASSOCIATED WITH CENTRAL AND HEMICENTRAL RETINAL VEIN OCCLUSION

To investigate the incidence of ocular neovascularization (NV) in central and hemicentral retinal vein occlusion. The study comprised consecutive 912 (673 nonischemic and 239 ischemic) central retinal vein occlusion and 190 (147 nonischemic, 43 ischemic) hemicentral retinal vein occlusion eyes. Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations and fluorescein fundus angiography. In ischemic central retinal vein occlusion, within 6 months from time of onset, the cumulative probability of development of iris NV was 49%, angle NV 37%, NV glaucoma 29%, retinal NV 9%, and disk NV 6%. More severe peripheral retinal hemorrhages were significantly associated with iris NV (P = 0.005), angle NV (P = 0.0004), and NV glaucoma (P = 0.012). Eyes that developed disk NV had more cotton wool spots (P = 0.058) than those without. In ischemic hemicentral retinal vein occlusion, within 12 months of onset, the cumulative probability of development of retinal NV was 29%, disk NV 12%, and iris NV 12%; within 6 months of onset, angle NV was found in 10% and NV glaucoma in 5%. Anterior chamber flare was associated with anterior segment NV and may precede the development of NV. Patients who developed NV were significantly younger, and there was a greater prevalence of NV glaucoma in patients with primary open angle glaucoma. In ischemic central retinal vein occlusion, anterior segment NV is much more common than posterior segment NV, and the cumulative chance of developing anterior segment NV is maximum during the first 6 months. In ischemic hemicentral retinal vein occlusion, posterior segment NV is much more common than anterior segment NV.

Symptoms and signs of posterior uveitis

AbstractPurpose Posterior uveitis (PU) is an important anatomic form of uveitis in which the primary site of infl ammation is the choroid or retina, with or without subsequent vitreous involvement.Methods Review of symptoms and signs of PU.Results The onset of PU can be sudden or insidious, involving one or both eyes. Most common ocular symptoms include blurred vision, loss of vision, and floaters. PU is usually associated with vitritis. Both vitreous cells and fl are should be graded according to standardized grading systems. Other vitreous changes may include vitreous strands, vitreous hemorrhage, vitreous traction, and posterior vitreous detachment. Depending on the primary site of inflammation, PU can present in the form of retinitis, choroiditis, retinochoroiditis, or chorioretinitis. Retinal and/or choroidal inflammation can be focal, multifocal, or more diff use, involving the periphery or posterior pole. It is important to distinguish between active and inactive chorioretinal disease. Retinal vasculitis can occur in the setting of several PU entities involving retinal veins or arteries. It appears as focal, multifocal, or diff use vascular cuffing or sheathing. Other retinal vasculitic changes include retinal hemorrhages, features of retinal vascular occlusion, retinal/optic disc neovascularization, and aneurysms. Macular involvement may result from direct inflammatory infiltration, macular edema, serous retinal detachment, retinal ischemia, epiretinal membrane, or macular hole. Optic nerve involvement may include optic disc hyperemia, optic disc edema, optic neuritis, neuroretinitis, optic disc exudate, and optic disc granuloma.Conclusion Clinician should be aware of the array of ocular symptoms of signs and their importance in orienting work‐up.

Ranibizumab in patients with dense cataract and proliferative diabetic retinopathy with rubeosis

Background:To evaluate the safety of ranibizumab as a surgical adjunct during cataract surgery in patients with proliferative diabetic retinopathy (PDR) with rubeosis, and to evaluate the efficacy and adverse effects of ranibizumab in treating PDR with rubeosis.Materials and Methods:Three intravitreal injections of 0.5 mg ranibizumab were administered on day-1, months-1 and -2 with cataract surgery 6-16 days after first injection. Retreatments with ranibizumab injections and pan-retinal photocoagulation (PRP) were given if recurrence or persistence of PDR was noted between months-3 and -11. Safety observation visits occurred at months-12, -18 and -24. Primary end points were incidence and severity of adverse events (AEs) that were related to both cataract surgery and treatment of PDR with rubeosis through month -12.Results:Of six patients screened, four (mean age 61.3 years) were enrolled. No AEs were noted with either cataract surgery or treatment of PDR. Neovascularization of iris (NVI) promptly regressed by 4 days after first ranibizumab injection, prior to cataract surgery in three of four patients (one had significantly regressed NVI by post-injection day-3 visit); NVI was not noted in any patient at 2 weeks after first ranibizumab injection. Recurrence of rubeosis or NVA after 3 monthly injections was not observed in any. At month-12, PDR was not present when assessed clinically and by fluorescein angiogram (FA). Only one patient developed neovascularization of disc and neovascularization elsewhere and required retreatments at months-5 and -9.Conclusions:Multiple intravitreal injections of ranibizumab may be a safe, effective treatment adjunct for PDR and diabetes-related rubeosis.

Primary branch retinal artery occlusion in idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome associated with hyperhomocysteinemia.

The purpose of this study was to report primary branch retinal artery occlusion in a case with idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome. Review of medical case records, color fundus photographs, and fundus fluorescein angiography of a 23-year-old man diagnosed with idiopathic retinal vasculitis, aneurysms, and neuroretinitis. A 23-year-old man presented with sudden painless decreased vision in right eye since 1 day. Ocular examination revealed a best-corrected visual acuity of counting fingers 1 feet in the right eye and 20/20 in the left eye, relative afferent pupillary defect in the right eye, 1+ vitreous cells in both eyes, optic disk neovascularization with massive peripapillary and perivascular lipid exudation, and occluded smaller vessels in both eyes. In addition, there was an area of retinal opacification in the posterior pole along the inferotemporal arcade in the right eye. The patient underwent color fundus photography, fluorescein angiography, and a detailed systemic workup. Fundus fluorescein angiographic features were suggestive of idiopathic retinal vasculitis, aneurysms, and neuroretinitis in both eyes with branch retinal artery occlusion in the right eye. Detailed systemic workup revealed raised serum homocysteine levels. The patient underwent scatter retinal photocoagulation in both eyes and also was started on folic acid and pyridoxine supplementation. At 1 year of follow-up, the best-corrected visual acuity in the right eye improved to 20/60. Posterior segment examination showed reduced exudation, resolution of optic disk neovascularization in both eyes, and clearing of retinal opacification in the right eye. Also, the levels of serum homocysteine decreased over 1 year. Primary branch retinal artery occlusion can be an atypical presentation of idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome. Such a case should be thoroughly investigated for underlying hypercoagulable state. Also, a careful long-term follow-up is required for these patients to prevent any neovascularization sequelae.

Retinal Photocoagulation Density in the Treatment of Neovascular Glaucoma due to Diabetic Retinopathy

Purpose: The risk factors for pan-retinal photocoagulation (PRP) failure and the efficacy of achieving a PRP burn density of ≥ 40% in the mid-periphery against diabetic neovascular glaucoma (NVG) were retrospectively evaluated.Methods: All eyes were treated in order to exceed more than 40% PRP density by fluorescein fundus angiography before and after PRP. Risk factors for failed IOP control (≤22 mmHg or baseline) were evaluated by dividing into two groups; eyes received previous retinal photocoagulation (RP) before NVG (group I) and eyes with no RP before NVG (group II).Results: Thirty one eyes of 25 patients were used (group I: 12 eyes, group II: 19 eyes).RP density before NVG in all eyes in group I was less than 40%. Risk factors for failed IOP control were prolonged PRP treatment of more than 12 months in group I (p=0.00053), and higher IOP at the diagnosis of NVG (p=0.01157), preexisting glaucoma or ocular hypertension (OH) (p=0.04664) and the persistence of optic disc neovascularization (NVD) in group II (p=0.01766).Conclusion: Eyes with RP density of less than 40% may have a risk for later development of NVG. The prompt initiation of PRP, a PRP burn density of greater than 40%, and the completion of PRP within 6 months are strongly recommended for the treatment of NVG. Special care should be taken in NVG-affected eyes with small pupils, preexisting glaucoma or OH, or persistent NVD as well as those that are subjected to PRP for more than 12 months.

Symptoms and signs of posterior uveitis

AbstractPurpose Posterior uveitis (PU) is an important anatomic form of uveitis in which the primary site of inflammation is the choroid or retina, with or without subsequent vitreous involvement.Methods Review of symptoms and signs of PUResults The onset of PU can be sudden or insidious, involving one or both eyes. Most common ocular symptoms include blurred vision, loss of vision, and floaters. PU is usually associated with vitritis. Both vitreous cells and flare should be graded according to standardized grading systems. Other vitreous changes may include vitreous strands, vitreous hemorrhage, vitreous traction, and posterior vitreous detachment. Depending on the primary site of inflammation, PU can present in the form of retinitis, choroiditis, retinochoroiditis, or chorioretinitis. Retinal and/or choroidal inflammation can be focal, multifocal, or more diffuse, involving the periphery or posterior pole. It is important to distinguish between active and inactive chorioretinal disease. Retinal vasculitis can occur in the setting of several PU entities involving retinal veins or arteries. It appears as focal, multifocal, or diffuse vascular cuffing or sheathing Other retinal vasculitic changes include retinal hemorrhages, features of retinal vascular occlusion, retinal/optic disc neovascularization, and aneurysms. Macular involvement may result from direct inflammatory infiltration, macular edema, serous retinal detachment, retinal ischemia, epiretinal membrane, or macular hole. Optic nerve involvement may include optic disc hyperemia, optic disc edema, optic neuritis, neuroretinitis, optic disc exudate, and optic disc granuloma.Conclusion Clinician should be aware of the array of ocular symptoms of signs and their importance in orienting work‐up.

Fluorescein angiography in uveitis

AbstractPurpose Fluorescein angiography (FA) is an important test in the evaluation and management of patients with uveitis. FA in uveitis is giving information principally on the superficial structures of the fundus (retina, retinal vessels and optic nerve head / disc), on the retinal pigment epithelium, on the choriocapillaris in the first 60 seconds of angiography as well as immediatelly subclinical pathology such as subretinal neovascular membranes.Methods FA is indicated when a posterior segment involvement is present or suspected. It should examine the posterior pole, optic disc, and periphery, with angiograms at early, intermediate, and late phases. FA results should be interpreted in relation to the results of clinical examination and other testsResults There are many roles for FA in the evaluation of patients with uveitis 1. Evaluation of the activity and extent of chorioretinitis: 2. Diagnosis of uveitic entities with typical features. 3. Evaluation of retinal vascular involvement : focal, multifocal, or diffuse retinal vascular leakage, occlusive complications, optic disc or retinal neovascularization, 4.Identication of macular complications 5. Evaluation of optic disc involvement. 6. Monitoring of response to treatmentConclusion FA can be helpful in the diagnosis, treatment, and monitoring of patients with posterior segment inflammation.

Descending doses of intravitreal bevacizumab for the regression of diabetic neovascularization

To report short-term regression of neovascularization after varying intravitreal doses of bevacizumab (Avastin®; Genentech, San Francisco, California, USA) in patients with proliferative diabetic retinopathy (PDR). Eighty eyes from 76 patients with active neovascularization of the disc (NVD) or elsewhere (NVE) caused by PDR were divided into four groups and treated with a single intravitreal bevacizumab (IVB) injection of 1.25 mg, 600 μg, 300 μg or 150 μg, respectively. All patients underwent ophthalmoscopic examination and fluorescein angiography at baseline, 1 week, 1 month and 2 months later. No significant ocular or systemic adverse events were observed. In all patients with NVD or NVE, complete resolution of leakage was recorded within the first week or the first month of the injection. Even with the lowest dose (150 μg), regression of neovascularization appeared as early as the first week and lasted for over a month. Recurrence of fluorescein leakage was observed in all groups after the first month and did not correlate with the extent of neovascularization or IVB dose. Short-term results suggest that IVB given below the standard dosage (150–300 μg compared to 1.25 mg) can lead to the achievement of complete regression of diabetic retinal neovascularization within 30–45 days of injection.

SCORE Study Report #11: Incidences of Neovascular Events in Eyes with Retinal Vein Occlusion

To investigate in The Standard Care versus COrticosteroid for REtinal Vein Occlusion (SCORE) Study: (1) incidences of neovascular events and retinal capillary nonperfusion (abbreviated as "nonperfusion"), and their relationship with treatment groups; (2) neovascular incidences by nonperfusion status; and (3) pertinent baseline factors for their potential risk for neovascular events. Two multicenter, randomized clinical trials, 1 evaluating participants with central retinal vein occlusion (CRVO) and the other evaluating participants with branch retinal vein occlusion (BRVO). At 36 months, data were available for 81 participants with CRVO and 128 with BRVO. Standard care (observation or grid photocoagulation) versus 1 or 4 mg intravitreal triamcinolone. Neovascularization of the iris (NVI), neovascular glaucoma (NVG), disc or retinal neovascularization (NVD/NVE), preretinal or vitreous hemorrhage (PRH/VH), and nonperfusion. The cumulative 36-month incidences for CRVO and BRVO eyes, respectively, were 8.5% and 2.4% for NVI or NVG; 8.8% and 7.6% for NVD/NVE or PRH/VH. There were no differences in incidences of neovascular events or risk of nonperfusion when comparing the 3 treatment groups within diseases. For CRVO at 36 months, 16.6% of eyes with ≥5.5 disc areas of nonperfusion versus 4.0% of eyes with <5.5 disc areas of nonperfusion developed NVG (P = 0.0003); for BRVO at 36 months, 14.6% versus 2.4% developed NVD/NVE (P<0.0001). Similar results were noted for most other neovascular events. Nonperfusion was the only significant baseline factor for neovascularization in BRVO, with the risk of a neovascular event increasing with greater disc areas of nonperfusion, and the highest risk noted at ≥5.5 disc areas. In the SCORE Study, triamcinolone treatment was not associated with lower incidences of neovascular events or nonperfusion status compared with observation or grid photocoagulation. Cumulative 36-month incidences for most neovascular events were significantly higher for nonperfused than perfused eyes. Greater baseline disc areas of nonperfusion increased the risk of neovascularization in BRVO but not CRVO eyes, possibly owing to obscuration of retinal capillary details caused by dense hemorrhage at baseline for CRVO eyes. Increased risk of neovascularization was noted below the historical threshold of 10 disc areas of nonperfusion for retinal vein occlusion.

Clinical features and carotid artery color Doppler imaging in patients with ocular ischemic syndrome

To report the clinical manifestations and results of carotid artery color Doppler imaging (CDI) of ocular ischemic syndrome (OIS). It was a retrospective case series study. Consecutive patients suspected with OIS were retrospectively studied from 1995 to 2009. We evaluated all patients with medical history, visual acuity, slit lamp, direct and indirect funduscopy, Fundus fluorescence angiography. CDI for internal carotid artery (ICA), Diagnostic Cerebral Angiography and magnetic resonance imaging were also performed. 17 patients (20 eyes) with OIS were studied, 13 males and 4 females. The age range of patients was 46 to 83 years old (median 70). 13 right eyes and 7 left eyes (3 bilateral) were involved. (1) SYMPTOMS: 70.6% (12/17) of the patients complained of visual decrease. 17.6% (3/17) had history of repeated amaurosis fugax (transient monocular visual loss); 11.8% (2/17) patients presented with floaters. The course before the first presentation was 2 days to 6 years (median 3 months). (2) Visual Acuity (VA): among the 20 involved eyes, the best corrected VA < 0.05 in 3 eyes (15.0%); 0.05 to < 0.3 in 7 eyes (35.0%); 0.3 to < 0.7 in 7 eyes (35.0%); ≥ 0.7 in 3 eyes (15.0%). (3) Fundus manifestations: 15.0% (3/20) eyes had cotton-wool spots; 25.0% (5/20) had retinal hemorrhages; retinal arterioles and vein became narrow; venous beading could be seen in severe cases. 30.0% (6/20) had microaneurysms in mid-peripheral area. The pressure of central retinal artery decreased; 25.0% (5/20) had optic disc or retinal neovascularization; 10.0% (2/20) had iris neovascularization. 5.0% (1/20) had neovascular glaucoma; 5.0% (1/20) had optic atrophy. (4) Fundus fluorescence angiography: arm-retinal circulation time prolonged to 14.5 to 39.9 seconds, (median 20.9 seconds). The retinal and choroidal circulation time was also prolonged. The wall of artery and venous could be staining. Hyperfluorescence dots indicating microaneurysms could be seen in the mid-peripheral area. Arterio-venous shunts, non-perfusion area and the leakage of new vessels were observed in some cases. (5) Internal carotid artery CDI examination: The ipsilateral ICA of the 19 involved eyes (another patient with pulseless disease had abnormal subclavian arterial flow) showed completely occluded in 5 cases (26.4%), > 80.0% to 95.0% stenosis in 7 cases (36.8%), 52.0% to 80.0% stenosis in 7 cases (36.8%). Among the 14 contralateral eyes of the same group of patients, CDI showed stenosis of 80.0%, 70.0%, 60.0%, 50.0% and 40.0% in 5 eyes, whereas no fundus abnormal was found. Peak of systolic velocity (PSV): Among the 20 involved eyes of the 17 patients, PSV of the ipsilateral ICA was undetectable in 8 cases which occluded completely or stenosis severely. Among the ipsilateral ICA of the other 12 eyes, 11 cases showed abnormal PSV; PSV increased to 92 to 524 cm/s in 9 cases and decreased to 41 cm/s in 1 case. The blood flow of subclavian artery reduced to 20 cm/s in one patient with pulseless disease. The blood flow of subclavian artery reduced to 20 cm/s in one patient with pulseless disease. The patients with OIS are usually older than 60 years of age. It is a chronic disease with unnoticed symptoms. The clinical manifestations may include: amaurosis fugax (transient monocular visual loss), hypoperfusion retinopathy and ischemic optic neuropathy. Internal carotid artery severe stenosis or occlusion are the most frequent cause of this disease. CDI is the best safe, reliable and non-invaded method for carotid artery examination.

Antivascular Endothelial Growth Factor Bevacizumab for Radiation Optic Neuropathy: Secondary to Plaque Radiotherapy

To evaluate the intravitreal antivascular endothelial growth factor, bevacizumab, for treatment of radiation optic neuropathy (RON). A prospective interventional clinical case series was performed of 14 patients with RON related to plaque radiotherapy for choroidal melanoma. The RON was characterized by optic disc edema, hemorrhages, microangiopathy, and neovascularization. The entry criteria included a subjective or objective loss of vision, coupled with findings of RON. The study subjects received a minimum of two initial injections of intravitreal bevacizumab (1.25 mg in 0.05 mL) every 6-8 weeks. The primary objectives included safety and tolerability. The secondary objectives included the efficacy as measured using the Early Treatment Diabetic Retinopathy Study chart for visual acuity, fundus photography, angiography, and optical coherence tomography/scanning laser ophthalmoscopy. Reductions in optic disc hemorrhage and edema were noted in all patients. The visual acuity was stable or improved in 9 (64%) of the 14 patients. Of the 5 patients who had lost vision, 2 had relatively large posterior tumors, 1 had had the vision decrease because of intraocular hemorrhage, and 1 had developed optic atrophy. The fifth patient who lost vision was noncompliant. No treatment-related ocular or systemic side effects were observed. Intravitreal antivascular endothelial growth factor bevacizumab was tolerated and generally associated with improved vision, reduced papillary hemorrhage, and resolution of optic disc edema. Persistent optic disc neovascularization and fluorescein angiographic leakage were invariably noted. The results of the present study support additional evaluation of antivascular endothelial growth factor medications as treatment of RON.

Regression of Optic Disc Neovascularization in Patients with Behçet's Uveoretinitis After Infliximab Therapy

Optic disc neovascularization (NVD) in patients with Behçet's uveoretinitis is a relatively uncommon but severe complication that lacks standardized treatments. We report 2 cases of Behçet's uveoretinitis that achieved partial regression of NVD after infliximab therapy. Intravenous infliximab infusions were administrated to 2 immunosuppressive therapy-resistant Behçet's uveoretinitis patients with severe NVD accompanied by vitreous hemorrhage (both eyes in case 1 and the left eye in case 2 ). Best-corrected visual acuity, funduscopic findings, and fluorescein angiography were evaluated before and after the treatments. After being switched to infliximab therapy, NVD in both cases stopped developing and regressed partially, as confirmed by fluorescein angiography and resolution of vitreous hemorrhage, which led to an improvement of the best-corrected visual acuity. Results suggest that infliximab administration might be an effective treatment in NVD patients with Behçet's uveoretinitis.

Occlusive Vasculitis and Optic Disk Neovascularization Associated with Neuroretinitis

Purpose: To report a case of neuroretinitis associated with ischemic nasal branch retinal vein occlusion, periphlebitis, and neovascularization of the optic disk.Methods: Case report.Results: A 32-year-old man presented with a typical image of neuroretinitis, retinal hemorrhages and sheathing of the retinal veins in the nasal retina. His left hand had been bitten by a kitten 8 weeks before. Serology for Bartonella henselae was negative. On the 6th week of follow-up, optic disk neovascularization developed, which required retinal photocoagulation. Photocoagulation was performed again at the 12th and 18th week revision since further new vessels had developed. At the 32nd week of follow-up neovascularization had regressed.Conclusions: Neuroretinitis may be associated with severe complications such as retinal vascular occlusions and optic disk neovascularization.

Symptoms and signs of posterior uveitis

Abstract Purpose Posterior uveitis (PU) is an important anatomic form of uveitis in which the primary site of inflammation is the choroid or retina, with or without subsequent vitreous involvement. Methods Review of symptoms and signs of PU. Results The onset of PU can be sudden or less frequently insidious. Most common ocular symptoms include blurred vision, loss of vision, and floaters. Some patients with PU may have no symptoms, especially if inflammatory process is asymmetric. PU is usually associated with vitritis that can vary from mild to severe. Vitritis should be graded according to standardized grading systems. Other vitreous changes may include vitreous strands, vitreous hemorrhage, vitreous traction, and posterior vitreous detachment. Retinal and/or choroidal inflammation can be focal, multifocal, or more diffuse. It is important to distinguish between active and inactive chorioretinal disease. Retinal vasculitis can occur in the setting of several PU entities. It can involve retinal veins or arteries. It appears as focal, multifocal, or diffuse vascular cuffing or sheathing. Other retinal vasculitic changes include retinal hemorrhages, retinal vascular occlusion, retinal/optic disc neovascularization, and aneurysms. Maculopathy is common patients with PU. It may result from direct inflammatory infiltration, macular edema, serous retinal detachment, retinal ischemia, epiretinal membrane, or macular hole. Optic nerve involvement that can occur in association with PU include optic disc hyperemia/edema, optic neuritis, neuroretinitis, optic disc exudate, and optic disc granuloma. Conclusion Clinical examination is a key step in the diagnostic approach to PU. Clinician should be aware of the array of ocular symptoms of signs and their importance in orienting the differential diagnosis.

Clinical characteristics of ocular ischemic syndrome

To study clinical characteristics of ocular ischemic syndrome (OIS). Retrospective study. Data, including sex, age, systemic diseases, best corrected visual acuity, anterior segment, fundus, fundus fluorescence angiography (FFA), transcranial Doppler (TCD) and digital subtraction angiography (DSA), were collected from 10 patients (12 eyes) with ocular ischemic syndrome from February 2008 to April 2009. The mean age was 59 years. There were six males and four females. All patients were combined with heart and/or cerebrovascular diseases. Best corrected visual acuity ranged from hand movement to 1.0. Neovascularization of the iris appeared in 5 eyes. Intraocular pressure over 21 mm Hg (1 mm Hg = 0.133 kPa) was present in 3 eyes. Fundus examination showed narrow retinal arteries, dilated but not tortuous veins, fleck-shaped hemorrhage of the retina, cotton-wool exudates, optic disc edema, optic disc neovascularization, and atypical macular cherry-red spots. TCD showed stenosis of internal carotid artery at different degrees. FFA was performed in 9 patients which showed artery front, prolonged arm-retinal circulation time, retinal circulation time and choroid circulation time. All patients accepted vasodilation and microcirculation improving treatments. Visual acuity was improved at different degrees. One patient (2 eyes) with iris neovascularization was treated with retinal photocoagulation and the neovascularization disappeared after the treatment. There were 3 patients (3 eyes) had neovascular glaucoma. One patient was treated by ciliary cryotherapy. One patient was treated by retinal photocoagulation and internal carotid artery stent implantation and one were treated by internal carotid artery stent implantation. Four patients were examined by DSA. Internal carotid artery stent implantation was performed in 3 patients, subclavian artery stent implantation was performed in one patient and internal carotid artery intima decollement was performed in one patient. Clinical manifestations of ocular ischemic syndrome patients are complicated which are depended on the different extents of ischemia. The management of ocular ischemic syndrome requires the collaboration of ophthalmologists, neurophysicians and neurosurgeons.

Rapid and persistent regression of severe new vessels on the disc in proliferative diabetic retinopathy after a single intravitreal injection of pegaptanib

Rapid and persistent regression of severe new vessels on the disc in proliferative diabetic retinopathy after a single intravitreal injection of pegaptanib