Fluorescein Angiographic Findings Research Articles

Subthreshold Diode Micropulse Photocoagulation for the Treatment of Chronic Central Serous Chorioretinopathy with Juxtafoveal Leakage

To report the visual and clinical outcomes of subthreshold diode micropulse (SDM) laser photocoagulation for chronic idiopathic central serous chorioretinopathy (ICSC) with juxtafoveal leakage. Prospective, noncomparative, interventional case series. Twenty-six eyes in 25 patients with persistent ICSC and juxtafoveal leakage longer than 4 months' duration. All eyes were assigned to SDM photocoagulation. Eyes were divided into 3 groups based on the findings of fluorescein angiography. Groups 1 and 2 were those patients with source leakage without and with associated retinal pigment epithelial atrophy (RPE), respectively, whereas group 3 consisted of patients with diffuse RPE decompensation with indeterminate source leakage. All patients were followed-up for at least 6 months. The preoperative and postoperative best-corrected visual acuity, number of sessions of SDM photocoagulation, foveal thickness, and resolution of subretinal fluid (SRF) evaluated by ocular coherence tomography (OCT) were recorded. Patients also were tested for the presence or absence of laser-related scotoma with Amsler grid screening. Groups 1, 2, and 3 consisted of, respectively, 6, 9, and 11 eyes. In group 1, all patients had total SRF resorption after 1 session of SDM photocoagulation. Eight eyes in group 2 had total SRF resorption after 1 to 3 sessions of SMD laser, whereas 1 patient had persistent SRF. In group 3, only 5 eyes had SRF resorption at the end of the follow-up, and the other 6 eyes needed photodynamic therapy for final SRF resorption. At the end of follow-up, the average preoperative foveal thickness was reduced by more than half of its original thickness. A gain of visual acuity of 3 lines or more was achieved in 15 eyes (57.7%), and a gain of between 1 and 3 lines was achieved in 6 eyes (23.1%). Subthreshold diode laser is effective in the treatment of ICSC with point source leakage. However, for eyes with diffuse leakage, a less favorable response was noted. A multicenter, randomized clinical trial is needed to ascertain the real efficacy and the appropriate settings of SMD for chronic ICSC. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Inhibitory effects of bevacizumab on angiogenesis and corneal neovascularization

To evaluate the inhibitory effects of bevacizumab (Avastin) on angiogenesis using cultured human umbilical vein endothelial cells (HUVECs) in vitro and on corneal neovascularization by subconjunctival injection of bevacizumab in vivo. After the HUVECs were exposed to different concentrations of bevacizumab stimulated with VEGF (10 ng/ml) for 2, 6, and 24 hours, cellular-activity-like proliferation, migration and tube formation were assessed. Subconjunctival injection of bevacizumab (2.5 mg/0.1 ml) was performed after corneal chemical burn injury. Then the cornea was evaluated by biomicroscopy, fluorescein angiography, and light microscopy. The inhibitory effects of bevacizumab on VEGF-induced HUVECs proliferation showed a dose-dependent response for 2 and 6 hours, but all groups were effectively inhibited regardless of the concentration of bevacizumab for 24 hours. The inhibitory effects of bevacizumab on the migration of VEGF-induced HUVECs showed a time- and dose-dependent response. The inhibitory effects of bevacizumab on VEGF-induced HUVECs tube formation showed a dose-dependent response only for 24 hours. On days 3 and 8 after the subconjunctival injection, bevacizumab-treated eyes showed less neovascular growth than BSS-treated eyes in biomicroscopic, fluorescein angiographic, and light microscopic findings in vivo. Bevacizumab effectively inhibits angiogenesis and corneal neovascularization, and could be used as a inhibitor of corneal neovascularization in the future.

Intravitreal Bevacizumab Treatment for Choroidal Neovascularization in Pathologic Myopia: 12-month Results

To evaluate the short-term efficacy and safety of intravitreal bevacizumab for the treatment of myopic choroidal neovascularization (CNV). Prospective, nonrandomized, interventional case series. Twenty eyes from 20 patients with CNV secondary to pathologic myopia participated in this prospective nonrandomized interventional case series. All patients were scheduled for three monthly intravitreal bevacizumab 1.25 mg injections. Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), foveal center thickness (FCT) on optical coherence tomography (OCT), and fluorescein angiographic findings were examined before and after treatment. Patients were followed up for 12 months. The mean BCVA (+/- standard deviation [SD]) at baseline was 24.8 (+/- 11.86) letters (Snellen equivalent: 20/80). At 12 months after treatment, the mean BCVA (+/- SD) improved significantly (P = .000001) to 43 (+/- 12.38) letters (Snellen equivalent: 20/35). At 12 month follow-up, BCVA improved 10 letters or more in 18 (90%) out of 20 treated eyes and improved 15 letters or more in 14 (70%) out of 20 treated eyes. No treated eyes experienced a worsening of BCVA from baseline. The mean FCT (+/- SD) at baseline was 223 (+/- 47.43) microns. At 12 months after treatment, the mean FCT (+/- SD) reduced to 206 (+/- 50.87) microns. This reduction in FCT after treatment was not statistically significant (P = .11). At 12 months follow-up, absence of fluorescein leakage from the CNV was demonstrated in 19 (95%) out of 20 treated eyes and persistent leakage in one eye (5%). None of the 19 eyes that had CNV closure experienced recurrence at 12-month follow-up. No ocular or systemic adverse effects from treatment were encountered. These results of intravitreal bevacizumab in myopic CNV are very promising with no apparent short-term safety concerns. At 12 months, treated eyes had a significant improvement in visual acuity (VA). OCT findings, as well, showed a trend consistent with the beneficial changes observed for VA. Treatment resulted in complete absence of angiographic leakage in 95% of eyes. Further studies will be needed to better determine long-term efficacy and safety.

Effects of photodynamic therapy on the choriocapillaris and retinal pigment epithelium in the irradiated area

To evaluate the effect of photodynamic therapy (PDT) on the choriocapillaris and retinal pigment epithelium (RPE) in the irradiated area surrounding choroidal neovascularization (CNV) during 12 months of follow-up. We reviewed the medical records, and indocyanine green angiography (IA), fluorescein angiography (FA), and fundus photographic findings of 72 eyes (72 patients) with CNV associated with age-related macular degeneration (AMD) or polypoidal choroidal vasculopathy (PCV). Patients were divided into three groups based on the number of PDT sessions. Twelve months after PDT, we evaluated the relationship between the number of sessions and both the presence of hypofluorescence in the late phase of IA and window defects observed on FA in the irradiated areas. Twenty-three patients had one PDT session (group I), 25 had two (group II), and 24 had three or four (group III). IA revealed hypofluorescence indicating a choriocapillaris filling defect within the irradiated area in 11 eyes (48%) in group I, 18 (72%) in group II, and 22 (91%) in group III. The correlation between the number of PDT sessions and hypofluorescence in the irradiated areas was significant. FA showed window defects surrounding CNV in 26%, 52%, and 71% of eyes from groups I, II, and III, respectively. Subretinal hemorrhages had been present in 23 eyes (32%) and exudation in 13 (18%) prior to PDT. Areas without hemorrhages or exudation prior to PDT had a normal appearance within the irradiated area in all 72 eyes. Although the RPE in the irradiated area was preserved, 12 months after PDT, mild choriocapillaris occlusion was detected in the irradiated area in eyes that had undergone multiple PDT sessions.

Uveitic macular oedema: correlation between optical coherence tomography patterns with visual acuity and fluorescein angiography

Aims:(1) To associate optical coherence tomography (OCT) patterns with particular fluorescein angiography (FA) findings in uveitis patients with macular oedema. (2) To investigate the correlation between tomographic features and visual...

Autofluorescence of metastatic choroidal tumor

Metastatic choroidal carcinomas are the most common intraocular neoplasms [1]; diagnosis is made by ophthalmoscopic, fluorescein angiographic (FA), and indocyanine green angiographic (IA) findings together with a history of cancer especially of the breasts and lungs. However, the general health of these patients is often poor, and it is difficult to perform these invasive examinations. Fundus autofluorescence (AF) is a noninvasive imaging technique that can detect lipofuscin in the retinal pigmented epithelial (RPE) cells [2]. A continuous AF pattern is an indication of normal metabolic activity of the RPE cells, and the loss of AF indicates that the photoreceptors or RPE cells are dysfunctional. Because FA and IA are generally not recommended in such ill patients, we questioned whether the AF pattern can be used to diagnose and follow the course of carcinomas after treatment. A Medline search did not extract any articles describing the AF findings in eyes with choroidal carcinomas. A retrospective review of patients with a choroidal carcinoma in our hospital extracted two patients who had undergone FA, IA, and AF. Thus, the purpose of this study was to determine the AF characteristics in these two eyes with a choroidal carcinoma.

Central Retinal Vein Occlusion Associated With Cilioretinal Artery Occlusion

To describe the clinical characteristics and pathogenesis of central retinal vein occlusion (CRVO) associated with cilioretinal artery occlusion (CLRAO). The study included 38 patients (38 eyes) who had CRVO associated with CLRAO and were seen in our clinic from 1974 to 1999. At their first visit to our clinic, all patients provided a detailed ophthalmic and medical history and underwent comprehensive ophthalmic evaluation, color fundus photography, and fluorescein fundus angiography. At each follow-up visit, the same ophthalmic evaluations were performed, except for fluorescein fundus angiography. Of 38 eyes, 30 had nonischemic CRVO, 5 had ischemic CRVO, and 3 had nonischemic hemi-CRVO. Patients with nonischemic CRVO were significantly younger (mean age +/- SD: 45.3 +/- 16.0 years) than those with ischemic CRVO (72.3 +/- 9.2 years; P = 0.001) and those with nonischemic hemi-CRVO (64.7 +/- 7.5 years; P = 0.018). At least one third of the patients gave a definite history of episode(s) of transient visual blurring before the onset of constant blurred vision. Initially, the ophthalmoscopic and fluorescein angiographic findings were similar to those seen in CRVO and hemi-CRVO, except that all these eyes had retinal infarct in the distribution of the cilioretinal artery; its size and site varied widely. Fluorescein angiography typically showed only transient hemodynamic block and not the typical CLRAO. During follow-up, visual acuity improved markedly in nonischemic CRVO (P < 0.001) and nonischemic hemi-CRVO but deteriorated in ischemic CRVO. Retinopathy resolved spontaneously in 22 eyes with nonischemic CRVO (mean duration +/- SD: 42.0 +/- 101.0 months), in 2 eyes with ischemic CRVO (15.4 +/- 4.5 months), and in 1 eye with nonischemic hemi-CRVO. Retinociliary collaterals developed in 30% of eyes with nonischemic CRVO, in 40% of eyes with ischemic CRVO, and in 66% of eyes with nonischemic hemi-CRVO. CRVO associated with CLRAO constitutes a distinct clinical entity. The pathogenesis of CLRAO in CRVO is due to transient hemodynamic blockage of the cilioretinal artery caused by a sudden sharp rise in intraluminal pressure in the retinal capillary bed (due to CRVO) above the level of that in the cilioretinal artery.

Long-term control of cystoid macular oedema in noninfectious uveitis with Mycophenolate Mofetil

To evaluate the long-term safety and efficacy of Mycophenolate Mofetil (MMF) for the control of cystoid macular oedema (CMO) secondary to noninfectious uveitis (NU). The medical records of 19 consecutive patients with inflammatory CMO treated with MMF were retrospectively reviewed. Patient demographics, best corrected visual acuity (BCVA), fluorescein angiography (FA), and optical coherence tomography (OCT) findings were evaluated. There were eight females and 11 males with a mean age of 32.9 +/- 8.9 years. After a 1-year follow-up, 18/19 patients (31 eyes, 96.9%, P < 0.05) no longer had signs of CMO, as per their FA and OCT findings; the mean central foveal thickness (CFT) was 167.2 +/- 12.8 microm. At the last follow-up, only 3/19 patients, all affected by Behçet panuveitis, had recurrences of CMO. Mean BCVA improved from 0.34 +/- 0.14 SD at baseline to 0.65 +/- 0.2 SD at last follow-up. MMF was safe and effective in controlling CMO and in reducing the uveitis relapse rate in patients not responding to traditional immunosuppressants. Further case-controlled studies are mandatory to validate those preliminary results.

Correlation between intraretinal changes in diabetic macular oedema seen in fluorescein angiography and optical coherence tomography

To study the relationship between intraretinal optical coherence tomography (OCT) and fluorescein angiography (FA) findings in eyes with diabetic macular oedema (DMO). We carried out a retrospective observational case series. Thirty eyes with previously untreated DMO underwent FA and OCT. The same ETDRS template was overlaid on the FA images in order to compare OCT and FA. Transfoveal linear high-resolution OCT scans (at the 0- and 90-degree meridians) and FA pictures were compared according to the ETDRS rings. Six distinct patterns of intraretinal changes in OCT correlated with changes in FA: (a) focal angiographic leakage did not correspond to any obvious intraretinal abnormality in OCT in four eyes; (b) localized thickening of the outer nuclear layer in OCT corresponded to focal leaking microaneurysm (focal oedema) in FA in 11 eyes; (c) diffuse thickening of the outer nuclear layer in OCT corresponded to diffuse angiographic leakage in 21 eyes; (d) cystoid expansion of the outer nuclear layer was found in seven eyes with a petaloid angiographic pattern of leakage; (e) cystoid expansion of the inner nuclear layer was found in relation to honeycomb angiographic oedema in five eyes, and (f) serous detachment of the fovea in OCT did not correspond to any distinct finding in FA in four eyes. Intraretinal abnormalities found in OCT correlate systemically with changes in FA. Very early DMO morphological changes may be seen better with FA than with OCT. Serous detachment of the fovea is seen in OCT, but not in FA. The combination of OCT and FA is useful in facilitating understanding of the pathophysiological changes that occur in DMO.

The Focal Aggravation of the Macular Edema on Optical Coherence Tomography After Intravitreal Triamcinolone Injection

Purpose: To evaluate the relationship between focal aggravation of the macular edema on retinal thickness change analysis (RTCA) of optical coherence tomography (OCT) and fluorescein angiographic findings in patients after an intravitreal triamcinolone injection (IVTA). Methods: From May 2004 to April 2005, RTCA in a fast macular thickness map (FMTM) of OCT was performed before and 4 weeks after IVTA in patients who had macular edemas caused by diabetic retinopathy and retinal vein occlusion. Patients underwent IVTA, and focal aggravation of the edema was detected. After overlapping the OCT findings onto angiographic pictures, the relationship between the focal aggravation on OCT and the leaking point on angiography was investigated. Result: In the patient group, focal aggravation was found in 5 of 27 eyes (18.5%); in the control group, only 2 of 30 eyes (6.7%) showed focal aggravation. As compared with angiographic pictures, 4 eyes with focal aggravation showed no relation to the leakage on angiography. Conclusions: Focal aggravation of macular edemas after IVTA on RTCA are not related to the leakage on angiography and could be an error from several artifacts. J Korean Ophthalmol Soc 49(5):753-762, 2008

Treatment of Neovascular Age-Related Macular Degeneration with Pegaptanib and Boosting with Bevacizumab or Ranibizumab as Needed

Neovascular age-related macular degeneration presents a therapeutic challenge. The efficacy of pegaptanib sodium, a selective inhibitor of vascular endothelial growth factor 165, was examined as a therapeutic mainstay combined with "as needed" boosts of nonselective vascular endothelial growth factor blockade with bevacizumab or ranibizumab. A retrospective chart review of outcomes of patients treated with pegaptanib and later boosted with bevacizumab or ranibizumab was conducted. Visual acuity, optical coherence tomography, and fluorescein angiography findings were recorded and assessed. During a mean follow-up of 12.1 months, an average of 7.8 injections of pegaptanib 0.3 mg, 1.4 injections of bevacizumab 1.25 mg, and 0.9 injections of ranibizumab 0.5 mg were administered to 17 eyes. In all, 47% of eyes gained 3 or more lines of visual acuity and 76% gained 0 or more lines. Pegaptanib as a mainstay of neovascular age-related macular degeneration therapy with an occasional boost of bevacizumab or ranibizumab appears to be an effective treatment option.

Electroretinography and microperimetry as noninvasive diagnostic tools for cilioretinal artery occlusion.

To report a case of cilioretinal artery occlusion with normal fluorescein angiography findings that was evaluated by electroretinography (ERG) and microperimetry. A 64-year-old-man presented with an oval paracentral scotoma in the temporal field of the left eye that became more evident after cataract surgery. Fundus photography, fluorescein angiography, ERG, multifocal ERG, and microperimetry were performed. Multifocal ERG showed decreased signal amplitudes in areas corresponding to areas with a visual defect as detected by microperimetry. Pattern ERG also showed a defect in the P50 component. Findings of fundus photography, fluorescein angiography, and full-field ERG were within normal limits. This case demonstrates the possibility of using ERG and microperimetry as noninvasive tools in the diagnosis of cilioretinal artery occlusion.

Spinocerebellar ataxia type 7 presenting as Stargardt's disease

Sirs: Spinocerebellar ataxia type 7 (SCA7) is an autosomal dominant disorder characterised by progressive retinal and cerebellar degeneration [1]. Stargardt’s disease (STD) represents the most common hereditary (autosomal recessive) macular dystrophy manifesting with juvenile central visual impairment and progressive bilateral atrophy of the macula and the retinal pigmental epithelium (RPE) [2]. We report a case of juvenile SCA7 caused by de novo expansion of polyglutamine repeats, whose clinical presentation (isolated progressive visual impairment) simulated STD. A 12-year-old girl, with no family history of neurological or retinal disease, presented for ophthalmologic evaluation due to over six months of progressing bilateral visual loss. Based on the findings of the ophthalmologic examination (visual acuity of 0.2 was homozygote for a normal allele (< 19 repeats). The length of the SCA7 CAG repeat is inversely correlated with age of onset and dictates the initial symptom presentation. Longer CAG repeats lead to earlier onset of the disease, more rapid progression and increased chance of visual failure preceding cerebellar ataxia [1]. Interestingly, Johansson et al., after investigating the effect of repeat length on clinical manifestation in four Swedish SCA7 families, reported that in 80% of SCA7 cases with 59 repeats or more the disease started with visual impairment and visual symptoms preceded ataxia over a period of 1–6 years [4]. The retinal degeneration in SCA7 consists of a progressive cone-rod dystrophy causing substantial impairment of central visual acuity [1, 5]. The same phenotypic features may be shared by STD, which represents one of the most common causes of macular degeneration during the first two decades of life and is caused by homozygous mutations in the gene ABCA4 that encodes the photoreceptor-specific, ATP-binding transporter ABCA4 [6, 7]. The same gene, which has been mapped to the short arm of chromosome 1, is also associated with the phenotypic manifestation of fundus flavimaculatus (FFM) (Fig. 1D) [6, 7]. Recent, genotypephenotype correlation studies have highlighted the wide allelic heterogeneity of this gene. The spectrum of disease severity, associated with specific mutations in the ABCA4 gene, may vary from a mild phenotypic manifestation of STD (with absent dark choroid and normal electroretinographic amplitudes) to a severe and diffuse atrophy of the retinal pigmental epithelium and the choriocapillaris (present dark choroid) [6, 7]. Thus, in the absence of neurological manifestations and positive family history the differential diagnosis between bilaterally, impairment of color vision in the blue-yellow axis and subtle pigment mottling of the RPE; Fig. 1A), the visual field testing (central scotoma bilaterally), the unremarkable Ganzfeld electroretinography and the findings of fluorescein angiography (perifoveal flecks and absence of dark choroid), STD was diagnosed. Neurological examination and brain MRI were normal. Three years later she developed progressive truncal ataxia and poor motor coordination. The patient was admitted for further evaluation at our institution. Neurological examination revealed severe brainstem (bilateral pyramidal symptoms, dysphagia, tongue atrophy, markedly slowed ocular saccades) and cerebellar involvement (truncal ataxia, dysmetria, dysdiadochokinesia, gaze-evoked nystagmus and dysarthria). Repeat ophthalmologic examination disclosed pigmentary degeneration and accumulation, fundus atrophy with “bull’s eye configuration” (Fig. 1B). Substantial brainstem and cerebellar atrophy was noted on repeat brain MRI (Fig. 1C). Other systemic disorders with retinal and cerebellar degeneration (juvenile neuronal ceroid lipofuscinosis, abetalipoproteinemia, mitochondriopathies) were excluded on the basis of diagnostic work-up (negative skin punch biopsy, unremarkable muscle biopsy, negative DNA testing for Leber hereditary optic neuropathy, normal serum lipid electrophoresis). Molecular genetic testing identified one allele with abnormal CAG expansion (70 repeats, normal < 36) in the ataxin 7 gene and confirmed the diagnosis of SCA7. The patient’s father (asymptomatic with unremarkable neurological and ophthalmologic evaluations) was heterozygote for a mutable normal allele (intermediate allele, 34 repeats) [3]. The patient’s mother G. Tsivgoulis, MD ( ) · S. Vassilopoulou, MD · K. Spengos, MD Dept. of Neurology University of Athens School of Medicine Iras 39, Gerakas 15344 Athens, Greece Tel.: +306937178635 Fax: +302106742604 E-Mail: tsivgoulisgiorg@yahoo.gr

Clinical relevance of the new digital integration method for the precise correlation of fluorescein angiographic and optical coherence tomography findings

A fundamental weak point in the previous optical coherence tomography (OCT) pictures of Stratus OCT III is counterbalanced through the correction of eye movement artefacts by the new digital integration method (DIM). For the first time, DIM allows the precise anatomical OCT-scan localization in the fundus or fluorescein angiographic (FLA) image and leads to an objective morphological and topographic correlation. Using a newly developed fundus enhancement system (FES), DIM provides fundus images of OCT of high quality in almost every patient. To control and document any possible eye movement artefacts, a retinal tracking system was developed (RTS). The RTS tapes the fundus image in OCT during the scanning procedure. Using the new morphological information a new knowledge is obtained on uncertain angiographic phenomena by detecting serous retinal pigment epithelium (RPE) detachments and may lead to treatment consequences. In FLA images without leakages DIM reveals in OCT undetected serous RPE detachments. In addition, in 100% classic choroidal neovascularization (CNV) with a hypofluorescent halo DIM demonstrates a larger extent of the CNV than expected in FLA. Using DIM the OCT-scan position for the follow-up can be now assessed in a safe and reliable manner, which is mandatory for the evidence of OCT studies.

OPTICAL COHERENCE TOMOGRAPHY CHARACTERISTICS OF GROUP 2A IDIOPATHIC PARAFOVEAL TELANGIECTASIS

To describe the optical coherence tomography (OCT) characteristics of patients with group 2A idiopathic parafoveal telangiectasis (IPFT) and to correlate them with biomicroscopic and fluorescein angiographic (FA) findings based on Gass and Blodi staging classification for group 2A IPFT. Fifty-two eyes of 26 consecutive patients with IPFT underwent biomicroscopic fundus examination, color fundus photography, FA, and OCT. Main outcome measures were OCT characteristics and their correlation with biomicroscopy and FA. The most common OCT findings that help differentiate between stages in group 2A IPFT are 1) highly reflective dots in the inner retina that correspond with microvessels seen by FA in Stage 1 (5 eyes [62.5%]); 2) the presence of hyporeflective intraretinal spaces in the absence of retinal thickening and highly reflective dots in the retina in Stage 2 (9 [81.8%] and 10 eyes [90.9%], respectively); 3) in Stage 3, both outer and inner retina exhibit areas of similar high reflectivity. In addition, the retinal pigment epithelium (RPE)/choriocapillaris complex is thickened or disrupted as evidenced by an area of high reflectivity (13 eyes [81.2%]); 4) a highly reflective area nasal or temporal to the fovea in the inner or outer retinal layers in Stage 4 suggesting RPE proliferation and migration (13 eyes [100%]); and 5) a fusiform thickening and duplication of the highly reflective RPE/choriocapillaris complex corresponding to choroidal neovascularization in Stage 5 (4 eyes [100%]). Our OCT characteristics correlated well with biomicroscopic and FA findings for Stages 4 and 5. However, the hyporeflective spaces that are evident on OCT could not be seen clinically at the slit lamp or on FA. In addition, our OCT findings on eyes with group 2A IPFT Stage 3 have not, to our knowledge, been previously described. Optical coherence tomography findings in group 2A IPFT were characteristic for each stage and may be helpful in making the diagnosis as well as defining the anatomical staging proposed by Gass and Blodi. Optical coherence tomography complements biomicroscopic and FA findings in the evaluation of group 2A IPFT.

RELATIONSHIP BETWEEN RETINAL VEIN OCCLUSION AND CAROTID ARTERY LESIONS

To investigate the relationship between retinal vein occlusion (RVO) and carotid artery lesions. For patients with RVO who presented to the Ophthalmology Department of Tokyo Medical University Hospital between 2000 and 2003, carotid artery evaluation was possible on 58 eyes of 57 patients aged 51 years to 88 years (mean, 70.1 years). Thirty-nine patients (40 eyes) had central RVO (CRVO), and 18 patients (18 eyes) had branch RVO (BRVO). The observation period ranged from 6 months to 28 months (mean, 14 months). A diagnostic ultrasound device was used to detect carotid artery lesions. Carotid artery lesions were detected in 19 (49%) of 39 patients with CRVO and in 4 (22%) of 18 patients with BRVO. In CRVO, 6 eyes without carotid artery lesions but no eye with carotid artery lesions had good decimal visual acuity of >or=0.8 (P < 0.05). Fluorescein angiographic findings identified a significantly (P < 0.01) higher incidence of the ischemic type in cases with carotid lesions (15 eyes; 79%) than in cases without carotid lesions (8 eyes; 40%). The findings suggest that the presence of a carotid artery lesion has a considerable association with the development and prognosis of CRVO.

Six Patients with Bradyopsia (Slow Vision): Clinical Features and Course of the Disease

Recently, it was discovered that subjects who showed a prolonged response suppression on their electroretinogram (ERG) and had symptoms of photophobia, problems adjusting to bright light, and difficulties seeing moving objects shared a mutation in the RGS9 (regulator of G-protein signaling 9) gene that is involved in the deactivation of photoreceptor responses. The disorder was termed bradyopsia (slow vision). This paper reports the clinical presentation and long-term follow-up of 6 bradyopsia patients. Retrospective observational case series with a follow-up ranging from 6 to 30 years. Six patients with a homozygous mutation in the RGS9 gene. Clinical symptoms and signs were compared between the subjects and between their visits over time. Symptoms, visual acuity (VA), ocular findings, visual fields, dark-adaptation tests, color tests, fluorescein angiography, and ERG findings. Data showed a consistency in the individual symptoms and ERG recordings, but an extreme variation in VA between visits. Beside some irregularities in the macula in some patients, no other related eye abnormalities were seen. The low-to-subnormal VA varied with background luminance and typically increased by 2 to 3 lines when pinholes were used. Dark-adaptation tests, color tests, and fluorescein angiography were normal. Visual field tests showed a minor diffuse sensitivity loss. No progressive changes were seen over time. No signs of progression were noted in the 6 bradyopsia patients. Photophobia, impaired movement perception, variable reduced VA that improved with the use of pinholes and ERG abnormalities were typical for the disease.

INTRAVITREAL BEVACIZUMAB COMBINED WITH PHOTODYNAMIC THERAPY FOR THE TREATMENT OF OCCULT CHOROIDAL NEOVASCULARIZATION ASSOCIATED WITH SEROUS PIGMENT EPITHELIUM DETACHMENT IN AGE-RELATED MACULAR DEGENERATION

To evaluate the efficacy of intravitreal injection of bevacizumab combined with photodynamic therapy (PDT) for the treatment of occult choroidal neovascularization (CNV) associated with serous pigment epithelium detachment (s-PED) due to age-related macular degeneration (AMD). In this retrospective study, six patients (six eyes) with subfoveal occult CNV associated with s-PED due to AMD were treated with intravitreal bevacizumab combined with PDT. All patients were treated at baseline with PDT followed by intravitreal bevacizumab 1.25 mg 1 hour later. Afterwards, according to the findings of optical coherence tomography and fluorescein angiography, repeat bevacizumab injections were given, if necessary, monthly for three doses followed by further doses every 3 months. PDT was repeated every 3 months according to the same criteria. Follow-up time was 9 months. All patients completed their treatment during the first 3 months from baseline. Best-corrected visual acuity (BCVA) improved or remained stable related to the baseline values in all patients at the end of the follow-up time. Mean BCVA improved from 20/67 to 20/42. S-PED and subretinal fluid decreased or disappeared. The mean central 1-mm retinal thickness was reduced from baseline value for the 9-month follow-up period by 128 microm. Intravitreal bevacizumab combined with PDT seems to be a promising treatment with good functional and anatomical results for occult CNV associated with s-PED due to AMD.

Dramatic response of choroidal neovascularization associated with choroidal osteoma to the intravitreal injection of bevacizumab (Avastin)

To report the dramatic response of juxtafoveal choroidal neovascularization (CNV) associated with choroidal osteoma to a single intravitreal injection of bevacizumab. A 19-year-old female presented with decreased visual acuity and metamorphopsia in her right eye. Best corrected visual acuity assessment, ophthalmic examination, fundus photography, fluorescein angiography, optical coherence tomography (OCT), and high-resolution computed tomography (CT) scan of the orbit was performed. A diagnosis of classic juxtafoveal CNV associated with choroidal osteoma was made. Intravitreal injection of 1.25 mg of bevacizumab was performed. Visual acuity of the right eye was 20/200 before treatment. Visual improvement to 20/25 and the resolution of metamorphopsia was noticed six weeks after the intravitreal injection of bevacizumab. Regression of the CNV was confirmed according to ophthalmoscopic, fluorescein angiographic, and OCT findings. The treatment effect persisted during a 9-month follow-up period. The intravitreal injection of bevacizumab can result in the rapid regression of CNV secondary to choroidal osteoma.

Fluorescein angiographic findings in a male infant with incontinentia pigmenti

Incontinentia pigmenti is a rare, X-linked dominant, genodermatosis and is almost always lethal in males. It is characterized by cutaneous, ocular, dental, and central nervous system (CNS) abnormalities and about 35% of patients develop some form of ocular abnormality, which may include retinal vascular abnormalities, ischemic retinal infarctions, retinal detachments, cataracts, uveitis, strabismus, and nystagmus. Incontinentia pigmenti has been linked to the NEMO gene, which is mapped to Xq28.