Foveal Neovascularization Research Articles

Foveal neovascularization in proliferative diabetic retinopathy: Characterization with OCTA

Foveal neovascularization (FNV) is a rare clinical finding in conditions with vascular compromise, leading to ischemia of the retina. We present a case of proliferative diabetic retinopathy (PDR) with FNV, where optical coherence tomography angiography (OCTA) confirmed the architecture, extent, activity, and origin of a hemorrhage-like clump at the fovea. Digital Florescein Angiography (DFA) showed PDR (both eyes), but intra-retina microvascular abnormalities (IrMAs) or FNV could not be differentiated at the site of leak in right eye fovea. OCTA confirmed a FNV breaching the internal limiting membrane (ILM), protruding into vitreous, and determined its origin from superficial vascular plexus (SVC). Also, segmentation revealed flow voids in choriocapillaris slab, suggesting choroidal ischemia.

Foveal neovascularization on optical coherence tomography angiography

Foveal neovascularization on optical coherence tomography angiography

Contributory factors for developing foveal neovascularization in proliferative diabetic retinopathy

Foveal neovascularisation (NV) in proliferative diabetic retinopathy (PDR) is uncommon. The study aim is to analyse a series of cases of foveal NV in PDR and ascertain the factors leading to its development. In this retrospective case-control study, optical coherence tomography (OCT) and OCT-angiography (OCTA) images of PDR cases with/without foveal NV diagnosed on fluorescein angiography were analysed. From 124 consecutive PDR eyes, foveal NV was identified in 12 (10%) eyes. Eyes with foveal NV showed thin choroid (p = 0.001), increased FAZ area and reduced vessel density at the macula compared to control group on OCT and OCTA. After regression analysis, an increased FAZ in the superficial capillary plexus slab (p = 0.002) was associated with foveal NV development. Our case series suggest that foveal NV is an uncommon finding, occurring due to reduced choroidal and inner retinal perfusion at the macula. Further studies are required to assess the treatment outcomes in such eyes.

Optical coherence tomography angiography of epiretinal neovascularization in a case of macular telangiectasia type 2 and coexistent proliferative diabetic retinopathy

Epiretinal neovascularization (ERN) is a novel optical coherence tomography angiography (OCTA) finding, which has been recently described in association with macular telangiectasia type 2 (MacTel 2). To our knowledge, this is the first documentation of ERN and coexistent proliferative diabetic retinopathy (PDR), which could be clinically confused with diabetic foveal neovascularization. OCTA is a useful tool to evaluate ERN and differentiate it from diabetic foveal neovascularization.

Surgical excision of neovascularization in retinal angiomatous proliferation

We report the postoperative outcomes of surgical neovascularization excision in patients with retinal angiomatous proliferation (RAP). Nine eyes of eight patients with RAP who underwent surgical excision of neovascularization were studied. Surgical indications were as follows: RAP diagnosed by fluorescein and indocyanine green angiography, foveal or perifoveal neovascularization, preoperative visual acuity of 0.1 or less, Yannuzzi's stage II with detachment of retinal pigment epithelium (RPE) or stage III, and leakage on late-phase fluorescein angiography. After cataract surgery, vitreous surgery and neovascularization excision were conducted, followed by fluid-air or fluid-gas exchange. Visual acuity was 0.02-0.1 before surgery and 0.03-0.2 after surgery. Macular hole formation was seen in one eye but did not lead to retinal detachment. In two eyes, subretinal bleeding occurred during excision leading to vitreous bleeding after surgery. Although defects of the RPE and choriocapillaries were observed after surgery, the exudation and bleeding were absorbed. In stage II RAP cases with RPE detachment, surgical excision maintains constant postoperative visual acuity but results in defects of RPE and choriocapillaris; therefore, other treatment options should be examined. Surgical excision of stage III RAP seems to be promising, as postoperative visual acuity remains stable after neovascularization removal in those advanced pathologic situations.

Transplantation of autologous retinal pigment epithelium in eyes with foveal neovascularization resulting from age-related macular degeneration: a pilot study

PURPOSE: To describe the indications, surgical technique, and clinical results of 14 eyes in 13 patients with age-related macular degeneration and foveal choroidal neovascularization, in which subretinal surgery was combined with simultaneous transplantation of autologous retinal pigment epithelial cells.METHODS: Between March 1999 and February 2000, in a prospective study, 14 eyes (13 patients) with age-related macular degeneration underwent subretinal surgery because of foveal choroidal neovascularization with simultaneous transplantation of retinal pigment epithelium harvested from the nasal subretinal area of the same eye. Preoperatively, 1 month postoperatively, 3 months postoperatively and at 3-month intervals thereafter, examinations were performed including best-corrected visual acuity, visual field, biomicroscopy of anterior and posterior segment, tonometry, fluorescein and indocyanine angiographies, autofluorescence, scotometry, and fixation tests.RESULTS: Postoperatively, after median observation of 17 months (range, 12 to 24 months) best-corrected visual acuity was improved 2 or more lines in eight eyes (57.1%), remained the same (± 1 line) in five eyes (35%), and decreased by more than 2 lines in one eye (7.1%). Pairwise t test showed significant improvement after 1 month (P = .0031, P = .0062) as well as 1 year (P = .0066, P = .0105). Satisfactory reading vision between Jaeger 1 and 4 was achieved in three eyes (21.2%). No significant intraoperative or postoperative complications occurred in any eye. No recurrence of choroidal neovascularization was observed during the observation period.CONCLUSIONS: In eyes with age-related macular degeneration and foveal choroidal neovascularization, autotransplantation of retinal pigment epithelium was performed in addition to conventional removal of the choroidal neovascularization without significant intraoperative or postoperative complications. Visual acuity improvement of 2 or more lines in 57% of the eyes was achieved. No recurrent choroidal neovascularization formation was observed during the observation period. The results of this pilot study suggest that autologous transplantation of retinal pigment epithelium combined with submacular surgery might be a reasonable treatment option for patients with foveal choroidal neovascularization secondary to age-related macular degeneration.

4125 Evaluation of frequency doubled ND-YAG versus krypton red laser for photocoagulation of extra foveal and juxta foveal chroidal neovascularization due to age related maculopathy (A.M.D.)

4125 Evaluation of frequency doubled ND-YAG versus krypton red laser for photocoagulation of extra foveal and juxta foveal chroidal neovascularization due to age related maculopathy (A.M.D.)

Foveal Neovascularization in Diabetic Retinopathy

Retinal neovascularization in diabetes mellitus almost always occurs at the optic disc and/or near the major nasal and temporal vascular arcades, sparing the foveal area. We examined seven eyes of seven patients with long-standing insulin-dependent diabetes mellitus who had unilateral foveal retinal neovascularization. The neovascularization originated from the perifoveal capillaries and demonstrated typical leakage on fluorescein angiography.

Spontaneous Resolution of Idiopathic Foveal Subretinal Neovascularization with Preservation of Vision (With 1 color plate)

A 40-year-old women with a 17-year-history of glaucomatocyclitic crises in 1 eye developed idiopathic foveal subretinal neovascularization in the other eye. The subretinal neovascular membrane spontaneously regressed over a 2-month period, and useful reading vision was subsequently maintained for more than 6 years. This favorable outcome is discussed in relation to the previously reported cases of idiopathic macular subretinal neovascularization.