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Fluorescein Angiography (fluorescein + angiography)

Distribution by Scientific Domains

Medical Sciences	97%

Selected Abstracts

Optimized Architecture for Nutrition in the Avascular Retina of Megachiroptera

ANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 5 2007
D. K. Brudenall
Summary Investigations were undertaken to evaluate the unique choroidal vascular system of the Megachiroptera (fruit bats) and its possible significance for retinal nutrition. Fluorescein angiography was performed and documented on Pteropus poliocephalus. Vascular casts were made of the eye of Pteropus scapulatus. Histologic evaluation was performed on P. scapulatus. Results confirmed that each papilla has a vascular core, and a unique vascular system emanating from the optic disc. The histological appearance of the choroid and retina of P. scapulatus confirmed a vascular core to the papillae with a thin, but definite Bruch's membrane. Megachiroptera have a unique vascular system to supply nutrition to the retina consisting of capillary loops within a dense, uniform mosaic of choroidal projections or papillae, which permit the diffusion of metabolites to the retina and a heretofore undescribed vascular tuft emanating from the optic disc. We suggest that this vascular system provides nutrition by diffusion to a thick avascular retina, without any shadowing by vessels, and allows for nocturnal visual acuity and light-gathering capabilities. [source]

1332: Fluorescein angiography: first step for macular degeneration diagnosis

ACTA OPHTHALMOLOGICA, Issue 2010
G SOUBRANE
Purpose To recall that fluorescein angiography (FA) is not only the basis of our knowledge but also mandatory to improve our understanding. Methods Macular disciform lesions have been described and drawed since about 150 years. It is only in 1977 with the advent of fluorescein that the connection with choroidal new vessels (CNV) was performed. The identification of drusen as precursors of CNV was the following stage. With time a number of precursors and clinical forms of macular degeneration were described. Results Currently, the precursors (Age-Related Maculopathy) are distinguished from the neovasdcular or atrophic complications (Age-Related Macular Degeneration). The precursors presenting an early hyperfuorescence can be either hard drusen or RPE atrophy distinguished from each other on the late phase of FA. The late hyperfluorescence of soft drusen particularly when confluent requires a careful analysis of the complete FA sequence to ensure the diagnosis. The neovascular stage presents mainly as sub epithelial occult lesions of which the other types develop that display different angiographic behaviours. Specific aspects have been described gradually based on their FA features. The atrophic stage of the disease seems to behave in a stereotyped way but sub goups are presently identified. Conclusion The fluorescein features of the different component of AMD remain the reference for all other more recent imaging technics and helps to understand and differentiate the various aspects of the disease. [source]

Ketoconazole in the treatment of central serous chorioretinopathy: a pilot study

ACTA OPHTHALMOLOGICA, Issue 5 2010
Azadeh Golshahi
Abstract. Purpose:, The aim of this study was to evaluate a possible effect of systemic ketoconazole on visual acuity (VA) and retinal thickness in patients with acute central serous chorioretinopathy (CSCR). Methods:, Fifteen consecutive patients were treated with ketoconazole 200 mg/day for a period of 4 weeks. Another 15 patients served as a control group. Baseline examination and review after 4 weeks included VA testing and measurement of neuroretinal or pigment epithelial detachment by optical coherence tomography (OCT). Fluorescein angiography was performed to verify the diagnosis. Results:, At baseline, mean VA in Snellen units was 0.6 ± 0.2 (logMAR 0.2 ± 0.7) in the treatment group and 0.7 ± 0.3 (logMAR 0.2 ± 0.5) in the control group. On OCT, mean neuroretinal or pigment epithelial detachment measured 288 ± 163 ,m in the ketoconazole group and 225 ± 51 ,m in the control group, respectively. Four weeks later, mean VA improved in both groups. On OCT, neuroretinal or pigment epithelial detachment decreased in both the treatment and control groups. The differences were not statistically significant. Conclusions:, Although a pharmacological decrease in endogenous cortisol synthesis appears to be a rational approach in the treatment of CSCR, systemic ketoconazole at 200 mg/day was not associated with a significantly better outcome in this preliminary study. [source]

Unilateral choroidal excavation in the macula detected by spectral-domain optical coherence tomography

ACTA OPHTHALMOLOGICA, Issue 3 2010
Yuka Wakabayashi
Abstract. Purpose:, To report clinical findings of three patients with unilateral peculiar choroidal excavation in the macula detected by spectral-domain (SD) optical coherence tomography (OCT). Methods:, Three cases with unilateral choroidal excavation in the macula detected by SD OCT. Fluorescein angiography (FA), indocyanine green angiography (IA), ultrasonography, visual field tests and multifocal electroretinography (mfERG) were performed. Results:, Although all three patients complained of metamorphopsia, visual acuity and central visual field were normal in the affected eyes. SD OCT demonstrated choroidal excavation in the macula despite a normal foveal contour along the inner retinal surface. The excavation involved the outer retinal layers up to the external limiting membrane in cases 1 and 2, while only the retinal pigment epithelium was involved in case 3. The excavation corresponded to foveal pigment mottling in cases 1 and 2 and to a parafoveal yellowish fusiform lesion in case 3. The lesions appeared hypoautofluorescent and unremarkable in FA except for circumferential hyperfluorescence in case 3 and hypofluorescent in IA. B-scan ultrasonography was unremarkable. MfERG in cases 1 and 2 was normal. Conclusions:, SD OCT demonstrated two types of choroidal excavation in the macula. More case accumulation and a longer follow-up will elucidate the pathogenesis and prognosis of the lesions. [source]

Appraisal and management of subclinical choroidal inflammation: the iceberg phenomenon

ACTA OPHTHALMOLOGICA, Issue 2009
CP HERBORT
Purpose To explore further the ocular fundal structures after funduscopy has been performed in intraocular inflammatory diseases, we have at our disposal among other investigational imaging methods, fluorescence angiography comprising fluorescein angiography (FA) and indocyanine green angiography (ICGA). In most cases dual FA & ICGA is necessary as the two methods image completely different structures. Fluorescein angiography is giving information on superficial structures including the optic disc, the retinal vessels and the retina as well as on the RPE, whereas ICGA is exploring the choroidal compartment. In contrast to FA that usually does not furnish additional information but is only giving more precise images of the superficial structures explored, ICGA is revealing elements, in case of choroidal inflammatory involvement, that no other method can show. The choroidal inflammatory lesions can be very extensive while often causing only faint or no signs during clinical examination and with other investigational imaging methods, a phenomenon which corresponds to the so-called "iceberg effect". This aptitude of ICGA to show lesions that are otherwise inaccessible make it an essential method to detect and follow choroidal lesions. Methods Cases where diagnosis cannot be made without ICGA or cases where inflammation can only be followeb by ICGA, the so-called iceberg constellation because other methods show only faint or no signs, will be presented. Conclusion Inflammatory lesions limited to the choroid cannot be detected without performing ICGA which is indispensible to diagnose purely choroidal diseae and to monitor the evolution of choroidal inflammation. [source]

Telangiectasis as a cause of intra-schitic haemorrhage in optic disc pit maculopathy

ACTA OPHTHALMOLOGICA, Issue 1 2004
Shauna M. Quinn
Abstract. Purpose:, To present a patient with the novel finding of vascular telangiectasis as a cause of intra-schitic haemorrhage, occurring in optic disc pit-associated maculopathy. Methods:, A clinical history was detailed. Clinical examination included visual acuity assessment and slit-lamp microscopy. Fluorescein angiography was performed. Results:, A temporal optic disc pit, macular retinoschisis and a circumscribed detachment of the outer retinal layer and inner leaf holes were noted. A retinal haemorrhage extending into the schitic cavity was present, along with an associated vitreous haemorrhage. Fluorescein angiography showed telangiectatic vessels in association with the haemorrhage. Conclusion:, This is the first reported case of vascular telangiectasis as a cause of intra-schitic haemorrhage occurring in optic disc pit-associated maculopathy. [source]

Retinitis pigmentosa associated with peripheral sea fan neovascularization

ACTA OPHTHALMOLOGICA, Issue 5 2000
Sibel Kaday
ABSTRACT. Purpose: To describe a case with retinitis pigmentosa associated with sea fan type retinal neovascularization. Methods: Complete ocular examination including fluorescein angiography was performed in a 9-year-old girl. Results: Ophthalmoscopically, in addition to arteriolar narrowing and bone corpuscular pigmentation of both retinae, a vascular lesion with surrounding intraretinal exudation was noted in the upper equatorial region of the right eye. On fluorescein angiography, the lesion stained in the form of a sea fan neovascularization. Conclusion: Sea fan type of neovascularization can be seen in association with retinitis pigmentosa. Fluorescein angiography is important in identifying the exact nature of such a lesion. [source]

Intravitreal bevacizumab (Avastin) as a treatment of the neovascular complications of laser-induced chorioretinal anastomosis for nonischaemic central retinal vein occlusion

CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 5 2009
Kenneth C S Fong FRCOphth
Abstract Purpose:, To describe the use of intravitreal bevacizumab followed by sectorial retinal photocoagulation to treat the neovascular complications of laser-induced chorioretinal anastomosis (L-CRA) for nonischaemic central retinal vein occlusion (CRVO). Methods:, Prospective interventional case series of three patients with nonischaemic CRVO who were treated with L-CRA. Patients were followed up every 2 weeks after the laser treatment. If neovascularization occurred at the site of the anastomosis, intravitreal bevacizumab (1.25 mg) was injected followed by laser photocoagulation to areas of retinal ischaemia and the area of retina anterior to the L-CRA 1 week later. Fluorescein angiography was performed to confirm the presence of neovascularization. Best-corrected visual acuity measurements were performed at every visit. Results:, Three patients (one woman, two men) with a mean age of 76.3 years developed neovascularization at the L-CRA site and underwent treatment as described with a mean follow-up time of 7 months. The neovascularization developed within 1 month after the laser anastomosis in all three cases. All patients only required one intravitreal bevacizumab injection to control the neovascularization. No complications of the intravitreal injections were noted. Conclusions:, Intravitreal bevacizumab appears to be an effective tool in the immediate control of neovascularization following L-CRA for nonischaemic CRVO. This appears to cause immediate regression of the neovascular frond and allows time for the laser, which is applied subsequently to have its effect. [source]

Changes of aqueous vascular endothelial growth factor and pigment epithelium-derived factor following intravitreal bevacizumab for macular oedema secondary to branch retinal vein occlusion

CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 5 2009
Sung P Park MD
Abstract Background:, To investigate sequential changes of aqueous vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) in macular oedema secondary to branch retinal vein occlusion (BRVO) following intravitreal injection of bevacizumab (IVB). Methods:, We recruited 10 healthy controls and 40 patients with BRVO. Aqueous levels of VEGF and PEDF were measured by ELISA at the time of IVB and 6 weeks later. Non-response to IVB was defined as showing persistent macular oedema based on reduction of central macular thickness by less than 20% from baseline measurements by optical coherence tomography and vision improvement by <0.3 logMAR at 6 weeks after IVB. Fluorescein angiography was performed after resolution of foveal haemorrhage. We compared aqueous levels of VEGF and PEDF between responders and non-responders. Results:, The aqueous levels of VEGF and PEDF were significantly higher in 16 non-responders than in 24 responders at baseline measurements (491 ± 231 pg/mL vs. 250 ± 112 pg/mL, P < 0.001; 32 ± 4 ng/mL vs. 25 ± 5 ng/mL, P < 0.001, respectively). Six weeks after IVB, the aqueous levels of VEGF and PEDF were still higher in non-responders than in responders (388 ± 141 pg/mL vs. 104 ± 40 pg/mL, P < 0.001; 30 ± 8 ng/mL vs. 18 ± 5 ng/mL, P < 0.001, respectively). Fluorescein angiography revealed that non-responders showed higher frequencies of macular ischaemia and ischaemic BRVO. Conclusions:, Our results indicate that aqueous VEGF levels are associated with persistent macular oedema secondary to ischaemic BRVO following IVB. [source]

Clinical use and research applications of Heidelberg retinal angiography and spectral-domain optical coherence tomography , a review

CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 1 2009
Andrea Hassenstein MD
Abstract Fluorescein angiography (FA) was discovered by Nowotny and Alvis in the 1960s of the 20th century and has evolved to become the ,Gold standard' for macular diagnostics. Scanning laser imaging technology achieved enhancement of contrast and resolution. The combined Heidelberg retina angiograph (HRA2) adds novel innovative features to established fundus cameras. The principle of confocal scanning laser imaging provides a high resolution of retinal and choroidal vasculature with low light exposure providing comfort and safety for the patient. Enhanced contrast, details and image sharpness image are generated using confocality. For the visualization of the choroid an indocyanine green angiography (ICGA) is the most suitable application. The main indications for ICGA are age-related macular degeneration, choroidal polypoidal vasculopathy and choroidal haemangiomas. Simultaneous digital FA and ICGA images with three-dimensional resolution offer improved diagnosis of retinal and choroidal pathologies. High-speed ICGA dynamic imaging can identify feeder vessels and retinal choroidal anastomoses, ensuring safer treatment of choroidal neovascularization. Autofluorescence imaging and fundus reflectance imaging with blue and infrared light offer new follow-up parameters for retinal diseases. Finally, the real-time optical coherence tomography provides a new level of accuracy for assessment of the angiographic and morphological correlation. The combination of various macular diagnostic tools, such as infrared, blue reflectance, fundus autofluorescence, FA, ICGA and also spectral domain optical coherence tomography, lead to a better understanding and improved knowledge of macular diseases. [source]

Use of oral fluorescein angiography in the diagnosis of macular oedema within a diabetic retinopathy screening programme

DIABETIC MEDICINE, Issue 12 2001
F. M. Razvi
Abstract Aims To assess if oral fluorescein angiography (OFA) is a suitable screening method to detect macular oedema in diabetic retinopathy. Methods Eighty-four diabetic patients were included in the study. They were from a consecutive series of patients attending the diabetic eye-screening clinic, with retinopathy at the macula requiring ophthalmology assessment. All patients were subsequently examined in the eye hospital, by ophthalmologist slit lamp biomicroscopy assessment as the gold standard, followed by oral fluorescein angiography. Results This study indicates a sensitivity of 92% and specificity of 81%. Only 4.8% of patients developed a minor reaction to oral fluorescein; 84.5% of images were of good quality. Conclusions Oral fluorescein angiography is an efficient and highly sensitive tool for the detection of macular oedema. It can be used as an adjunct in the diabetic screening service to identify patients with oedema within a disc diameter of the macula. Ultimately it will ensure that only necessary and smaller numbers of patients are referred to ophthalmologists. Diabet. Med. 18, 1003,1006 (2001) [source]

Effects of intravitreal bevacizumab (Avastin®) therapy on retrobulbar blood flow parameters in patients with neovascular age-related macular degeneration

JOURNAL OF CLINICAL ULTRASOUND, Issue 2 2010
Ahmet Mete MD
Abstract Background. To investigate the effects of intravitreal bevacizumab on retrobulbar circulation in patients with neovascular age-related macular degeneration (AMD). Method. Thirty patients with neovascular age-related macular degeneration were assessed prospectively by both color Doppler imaging and fundus fluorescein angiography. Spectral Doppler analysis allowed the measurement of the maximum velocity (Vmax) and minimum velocity (Vmin) of the central retinal vein (CRV), and peak systolic (PSV), end-diastolic (EDV) velocities of blood flows, and pulsatility index (PI) and resistance index (RI) values in the central retinal artery (CRA), nasal and temporal posterior ciliary arteries (NPCA, TPCA), and ophthalmic artery (OA). The t test for paired samples was used to compare retrobulbar blood flow values before and after intravitreal bevacizumab injection. Result. PSV and EDV of the NPCA and PSV of the TPCA were significantly decreased after intravitreal bevacizumab injection (p < 0.05). There was no statistically significant difference in the other parameters. Conclusion. Our results suggest that intravitreal bevacizumab therapy has a measurable effect on retrobulbar blood flow. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2010 [source]

Does opportunistic screening for diabetic retinopathy result in timely and appropriate referral?

PRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 8 2001
S. Prasad Vitreo-Retinal Fellow
Abstract Aims We studied the quality of opportunistic screening for diabetic retinopathy, which existed in the absence of a formal screening programme. Methods Patients referred during the period from June 1992 to May 1997 were identified. The findings and outcome at first ophthalmic consultation were used as surrogate measures to determine the appropriateness of referral. We considered patients to have had sight-threatening retinopathy (STDR) if laser treatment or fluorescein angiography was recommended, or follow-up at 6 months or less was arranged. Patients whose fundi could not be visualised were also included in the STDR group. Results Two hundred and eighty-nine case records were available for analysis; 190 of these (65.7%) were considered to have STDR and 41 (14.2%) had other pathology, without concurrent diabetic retinopathy. The agreement between the referrer's diagnosis and the diagnosis made by the ophthalmologist was only fair, when comparing major diagnostic categories (kappa 0.35, 95% CI 0.30,0.41) and also for grading of retinopathy (kappa 0.30, 95% CI 0.23,0.37). Conclusions Our findings suggest that opportunistic screening can identify retinopathy only at a late stage. Our data should be valuable in measuring the benefits of formal screening for diabetic retinopathy as compared to previously existing services. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Increase of vascular endothelial growth factor and interleukin-6 in the aqueous humour of patients with macular oedema and central retinal vein occlusion

ACTA OPHTHALMOLOGICA, Issue 6 2010
Hidetaka Noma
Acta Ophthalmol. 2010: 88: 646,651 Abstract. Purpose:, This study aimed to investigate whether vascular endothelial growth factor (VEGF) or interleukin-6 (IL-6) influence macular oedema in patients with central retinal vein occlusion (CRVO). Methods:, Sixteen consecutive patients with unilateral CRVO and macular oedema were studied, along with eight age- and sex-matched patients without ischaemic ocular disease. Retinal ischaemia was evaluated from capillary non-perfusion on fluorescein angiography. Macular oedema was examined by optical coherence tomography. Aqueous humour (AH) samples were obtained during combined pars plana vitrectomy and cataract surgery, and were examined by enzyme-linked immunosorbent assay. Results:, Aqueous levels of VEGF and IL-6 were significantly elevated in patients compared with controls (p = 0.0142 and p < 0.0001, respectively). Aqueous levels of both molecules were significantly higher in patients with ischaemia than in those without ischaemia (p = 0.0026 and p = 0.0487, respectively). Furthermore, AH levels of VEGF and IL-6 were correlated with the severity of macular oedema (, = 0.7265, p = 0.0049, , = 0.5324, and p = 0.0392, respectively). Conclusions:, Both VEGF and IL-6 were elevated in the AH of patients with macular oedema and ischaemic CRVO, suggesting that these molecules may be related to the increase in vascular permeability in such patients. [source]

Clinical features and follow-up results of pulsating polypoidal choroidal vasculopathy treated with photodynamic therapy

ACTA OPHTHALMOLOGICA, Issue 6 2010
Suk Ho Byeon
Acta Ophthalmol. 2010: 88: 660,668 Abstract. Purpose:, To report on the clinical course of pulsating polypoidal choroidal vasculopathy (PCV) treated with photodynamic therapy (PDT). Methods:, A total of 63 eyes of 58 consecutive patients diagnosed with PCV, treated with PDT and followed up for at least 6 months were enrolled. Best-corrected visual acuity (BCVA), fluorescein angiography and high-speed indocyanine green angiography (ICGA) using confocal scanning laser ophthalmoscopy (HRA) were performed. Results:, Of the 63 PCV eyes, 14 eyes (22.2%) of 14 patients were classified as having pulsating PCV. The mean age of pulsating PCV patients was 60.6 ± 7.0 years (48,69 years), which was younger than non-pulsating PCV patients (65.7 years, p = 0.035). The mean follow-up period was 23.9 ± 10.7 months, and PDT was administered 1.6 ± 0.9 times to pulsating PCV patients. The mean logMAR BCVAs were 0.85 ± 0.47 at presentation and 0.71 ± 0.52 at final examination. Extensive haemorrhagic events were more common in pulsating than in non-pulsating PCV patients (57.1% versus 26.5%, p = 0.032). However, the risk of haemorrhage within 3 months of PDT was similar for both pulsating PCV and the remaining patients (14.3% versus 20%, p = 0.723). Conclusion:, Pulsating PCV showed distinctive features including a relatively younger patient age at presentation, and a haemorrhagic tendency (especially extensive). However, the use of PDT did not directly increase the risk of haemorrhage in pulsating PCV patients. [source]

1252: Diagnostic tools for adult intraocular tumours

ACTA OPHTHALMOLOGICA, Issue 2010
L ZOGRAFOS
Purpose Fundus examination completed with Fundus drawings and panoramic, fundus pictures, standard and panoramic fluorescein angiography, standard and panoramic ICG, 10, 20 and 50 MHz ultrasonography, and OCT are the main diagnostic tools for intraocular tumours in adult's patients. Methods These various diagnostic techniques provide complementary informations contributing to the final diagnosis. A document tumour growth during a periodic observation may be recorded with standard or panoramic fundus pictures. The modifications of the pigmant epithelium as well as an increase permeability of the tumour vessels may be recorded with standard or panoramic fluorescein angiography. Intra-tumoral and Peri-tumoral with hemodynamic modifications may be recorded with standard and panoramic ICG. Results Tumour shape, and tumour height is recorded with standard 10 or 20 MHz ultrasonography. The volume and the shape of anteriorly located intra ocular tumours are recorded with 50 MHz UBM. Conclusion The presence of the retinal detachment in contact with the tumours may be recorded with modern OCT. Additional examinations which can be used in ocular oncology are: Fundus auto- fluorescence, MRI, and computed tomography. An intraocular biopsy can be required in specific cases. [source]

1332: Fluorescein angiography: first step for macular degeneration diagnosis

2255: Inflammatory neovascular membrane

ACTA OPHTHALMOLOGICA, Issue 2010
P NERI
Purpose To describe the most common mistakes in the management of inflammatory choroidal neovascularization (CNV). Methods The current literature is reviewed and the experience of a tertiary referral centre is reported. Results CNV is a potentially sight-threatening sequela of uveitis. Several mistakes can be done during patients examination: CNV might not be recognized both at biomicroscopy and at fluorescein angiography (FA), for instance. Moreover, since some doctors are not aware of the importance of Indocyanine Green Angiography (ICGA), the choroidal involvement during inflammatory CNV might not be appreciated. These are just some examples of possible errors which can be done during the daily practice. The outcome of subfoveal CNV is poor if untreated: several procedures have been considered, even though there is lack of guidelines. The most important mistake can be represented by the lack of criticism on the treatment techniques: several methods have been proposed, albeit some of them should not be used on the basis of the treatment rationale and on the better knowledge of CNV pathophysiology. The presentation shows the most typical cases where the above mentioned mistakes have been done, suggesting some methods in order to avoid them. Conclusion CNV secondary to uveitis is a severe sequela, which can lead to significant visual impairment. Several mistakes can be done during both the diagnosis and the therapeutic procedures. Although no guideline is provided, the current medical literature can give the basis for a successful treatment strategy. [source]

4335: Correlation of diabetic corneal neuropathy and retinopathy

ACTA OPHTHALMOLOGICA, Issue 2010
E NITODA
Purpose Corneal confocal microscopy is a rapid, non-invasive and reiterative technique, suitable for the accurate detection and quantification of corneal subbasal nerve plexus. The aim of this study is to correlate corneal nerve fibre alterations with the abnormalities in the retina of diabetic patients and compare them with those of nondiabetic people Methods 278 diabetic corneas and 94 corneas of age-matched control subjects were included in the study. Diabetic patients were further classified with respect to the stage of retinopathy, according to indirect fundoscopy, fundus photography and fluorescein angiography. The central corneas were scanned with HRT II and we estimated nerve fibre density (NFB) nerve branch density (NBD), nerve fibre length (NFL) and nerve fibre tortuosity (NFT). Finally, we made out the glycemic and lipidemic profile of patients. Results NFD values for control, NDR, NPDR and PDR groups were 31.27 ± 0.99, 27.35 ± 0.77, 23.67 ± 0.83 and 18.77 ± 0.77 respectively and NBD values were 45.12± 2.85, 39.86 ± 3, 30.56 ± 2.71 and 24.98 ± 2.08 respectively. NFL values for control, NDR, NPDR and PDR were 16.58 ± 0.55, 14.82 ± 0.56, 12.27 ± 0.49 and 10.41± 0.45 respectively and NFT values were 5.78 ± 0.28, 6.6 ± 0.52, 6.57 ± 0.22 and 7.02 ± 0.39 respectively. NFD, NBD, NFL were significantly reduced and NFT appeared to be higher in diabetic patients, according to the stage of diabetic retinopathy. The glycemic profile was analogue to the retina status, but the lipidemic one appeared to vary. Conclusion Alterations in corneal nerve plexus are apparent in diabetic patients and more pronounced in PDR.Corneal confocal microscopy could be a promising technique for the early diagnosis and treatment of diabetic neuropathy. [source]

Choroidal neovascularization associated with cancer-associated retinopathy

ACTA OPHTHALMOLOGICA, Issue 5 2010
Giuseppe Querques
Abstract. Purpose:, To report an unusual association between cancer-associated retinopathy (CAR) associated with invasive thymoma and choriodal neovascularization (CNV), treated by photodynamic theraphy (PDT). Methods:, A 39-year-old man affected with thymoma and paraneoplastic syndrome (myasthenia gravis and diarrhoea) was observed between October 1997 and September 2007. The patient developed progressive visual dysfunction including bilateral visual acuity loss and concentric constriction of visual fields. Ophthalmological, immunological and systemic examinations were performed. Immunological evaluations included an assessment of antibody activity by indirect immunohistochemistry on sectioned rhesus monkey eye, and Western blot reactions upon an extract of pig retina. Results:, Fundus ophthalmoscopy and fluorescein angiography revealed retinal vessel attenuation and retinal pigment epithelium degeneration. Electroretinogram suggested both rod and cone dysfunction. Indirect immunohistochemistry identified antibody activity within the photoreceptor outer segments. Western blots on the retina revealed that most of the patient's antibody activity was focused upon a retinal protein antigen approximating 145 kD. These findings share the commonalities of size and retinal distribution of the interphotoreceptor retinoid-binding protein (IRBP), a recognized autoantigen. The surgically resected mediastinal tumour was diagnosed as invasive thymoma. No other malignancy has since been found throughout nearly 10 years of follow-up. In March 2006, the patient developed a subfoveal CNV in his left eye, which was treated by PDT. Conclusion:, We describe the third case of paraneoplastic retinopathy associated with invasive thymoma. This is the first example of CAR involving autoantibodies reactive with a retinal protein having the characteristics of the IRBP, and is also the first complicated by CNV treated by PDT. [source]

Combined intravitreal anti-vascular endothelial growth factor (Avastin®) and photodynamic therapy to treat retinal juxtapapillary capillary haemangioma

ACTA OPHTHALMOLOGICA, Issue 5 2010
Stefan Mennel
Abstract. Objective:, Retinal capillary haemangioma complications are characterized by progressive exudation with consecutive intraretinal and subretinal leakage. A successful therapy without side-effects has not been found. We report a case of retinal juxtapapillary capillary haemangioma causing consecutive leakage with macular involvement. The tumour was treated with a combination of anti-vascular endothelial growth factor (VEGF) and photodynamic therapy (PDT) and was followed for 1 year. Methods:, A 44-year-old woman with retinal juxtapapillary capillary haemangioma in the right eye experienced a decrease of visual acuity from 20/20 to 20/60 because of a severe leakage from the tumour involving the macula with lipid depositions. Two sessions of PDT (sparing the part of the haemangioma located within the optic disc) and five injections of bevacizumab were applied in a period of 5 months. Visual acuity, visual field testing, retinal thickness measurements, fundus photography and fluorescein angiography were performed to evaluate the treatment effect. Results:, One year after the last injection, visual acuity increased to 20/40. All lipid exudates at the posterior pole resolved. Retinal thickness decreased from 490 to 150 ,m with the restoration of normal central macular architecture. Leakage in fluorescence angiography reduced significantly, but hyperfluorescence of the tumour was still evident. Visual field testing and angiography did not show any treatment-related vaso-occlusive side-effects. Conclusion:, In this single case, the combination of anti-VEGF and PDT appeared to be an effective strategy for the treatment of retinal juxtapapillary capillary haemangioma without side-effects. Further studies with a greater number of eyes and adequate follow-up are necessary to support these first clinical results. [source]

Significant improvements in near vision, reading speed, central visual field and related quality of life after ranibizumab treatment of wet age-related macular degeneration

ACTA OPHTHALMOLOGICA, Issue 4 2010
Christina Frennesson
Abstract. Purpose:, To investigate the effects on near visual acuity, reading speed, central visual field and related quality of life of ranibizumab treatment of wet age-related macular degeneration (AMD). Methods:, The study was a prospective, non-comparative consecutive case series, followed for 3 months and investigator-driven. Thirty eyes of 30 patients with wet AMD were included, mean age 75 years (range 69,95 years). In addition to a full ophthalmological examination , including best-corrected visual acuity (BCVA; Early Treatment Diabetic Research Study chart), fundus biomicroscopy, fundus photography, fluorescein angiography, indocyanine green angiography (occult cases) and ocular coherence tomography , near visual acuity, reading speed, central visual field and quality of life for related activities were also investigated at baseline and at 3 months after ranibizumab treatment. Results:, Mean BCVA increased from 62 ± 11 to 66 ± 14 letters at 3 months (7%; p = 0.018). Near vision improved from 9 ± 5 to 6 ± 3 points (33%; p = 0.0006) and reading speed increased from 59 ± 40 to 85 ± 50 words/min (44%; p < 0.0001). The mean deviation from normal of the visual field improved from ,9 ± 7 to ,6 ± 5 dB (33%; p < 0.0001). Quality of life improved for distance activities from 54 ± 28 to 63 ± 28 points (17%; p < 0.0001) but significantly (p = 0.024) more for near activities, from 49 ± 26 to 63 ± 26 points (29%; p < 0.0001). Reading newspaper text in the group in which the better eye was treated showed the highest increase in quality of life score of all: 116%. Conclusion:, The increase in BCVA after ranibizumab treatment is well established. The present study also showed significant improvements in other important visual qualities, such as near visual acuity, reading speed, central visual field and several activities influencing quality of life. The improvement was greater for near activities than for distance activities. Therefore, the beneficial effects of ranibizumab treatment shown here are more extensive than those reported previously. [source]

Long-term study of vascular perfusion effects following arteriovenous sheathotomy for branch retinal vein occlusion

ACTA OPHTHALMOLOGICA, Issue 3 2010
Mahiul M. K. Muqit
Abstract. Purpose:, To evaluate the perfusion effects and long-term visual outcome of pars plana vitrectomy (PPV) combined with arteriovenous sheathotomy (AVS) with or without triamcinolone for nonischaemic branch retinal vein occlusion (NI-BRVO). Methods:, Prospective, interventional case series of eight patients with NI-BRVO and haemorrhagic macular oedema. Patients underwent PPV and AVS (n = 5), or PPV, AVS and intravitreal triamcinolone (IVT, n = 3). A masked grading technique assessed fundus photographs and fluorescein angiography (FFA) following surgery. Scanning laser ophthalmoscopy/optical coherence tomography (SLO/OCT) evaluated macular oedema and outer retinal architecture. Main outcomes examined included visual acuity (VA), retinal reperfusion, collateral vessel regression, vascular dilatation, cystoid macular oedema (CMO), and ocular neovascularization. Results:, Seven of eight patients underwent uncomplicated surgery, with increased intraretinal perfusion and reduced engorgement of distal retinal veins. The mean pre-logMAR VA was 0.8 (SD 0.17) and did not improve significantly after surgery (post-logMAR 0.6, SD 0.38; p = 0.11, paired t -test). SLO/OCT showed persistent CMO in four patients, and subfoveal thinning of the photoreceptor layer. Collateral vessels disappeared at the blockage site post-AVS in 7/8 eyes, and this was associated with improved retinal perfusion. Six of eight patients developed epiretinal membrane. No patients developed ocular neovascularization. The average follow-up was 34.5 months. Conclusions:, PPV with AVS is a safe procedure, and adjunctive IVT had no additional effects on vascular perfusion. Successful decompressive surgery was followed by disappearance of collateral vessels at the BRVO blockage site and was a clinical marker for intravascular reperfusion. Long-term epiretinal gliosis and subfoveal photoreceptor atrophy limited functional and visual recovery. [source]

Three-dimensional angiographic imaging of leakage in branch retinal vein occlusion

ACTA OPHTHALMOLOGICA, Issue 2 2010
Ursula Margarethe Schmidt-Erfurth
Abstract. Purpose:, Optical coherence tomography (OCT) is used to image branch retinal vein occlusion (BRVO) but lacks information about leakage dynamics and perfusion status. Topographical angiography (TAG) is capable of providing this information and has been described previously in age-related macular degeneration. This study evaluates TAG in BRVO. Methods:, We included 56 eyes of 40 consecutive patients with BRVO and a reduction in central vision. Two groups were established based on whether argon laser coagulation was performed or not. A standardized follow-up was performed. The chorioretinal fluorescence pattern was reconstructed following TAG. Quantitative measurements were also performed. Results:, TAG performed from indocyanine green angiography (ICGA) showed smaller lesion size (LS) compared to fluorescein angiography (FA) (mean difference: early phase = ,1.6 mm2, late phase = ,1.8 mm2). The extent of mean LS from early to late phase increased by 0.8 mm2 in FA and by 0.6 mm2 in ICGA. TAG could visualize different degrees of leakage topographically. Conclusion:, TAG gives new insights into the pathophysiology of BRVO: it enables the visualization of dynamics of leakage and the demonstration of the effects of intravasal stasis. Furthermore, TAG is less impaired by masking phenomena than FA. Functional retinal imaging shows distinct advantages over OCT: quantification of leakage activity is possible using TAG. [source]

Time-course and characteristic morphology of retinal changes following combination of verteporfin therapy and intravitreal triamcinolone in neovascular age-related macular degeneration

ACTA OPHTHALMOLOGICA, Issue 2 2010
Shilla Lie
Abstract. Purpose:, To identify characteristic morphological changes of the retina over time and the association with visual function after combined photodynamic therapy (PDT) and intravitreal triamcinolone (IVTA). Methods:, In this retrospective study, 40 patients (40 eyes) were treated with PDT and same-day IVTA. Optical coherence tomography (OCT), fluorescein angiography (FA) and evaluation of distance visual acuity (VA) were performed. The anatomical changes within intra- and subretinal compartments and their detailed analysis and grading were the main outcome measures. Results:, Intraretinal fluid (IRF) and subretinal fluid (SRF) by OCT decreased until 3 months (p < 0.01). At month 3, intraretinal cystoid spaces (ICS) had resolved or decreased in 84% of eyes, SRF in 58% and pigment epithelial detachment (PED) in 50%. Mean best-corrected VA (BCVA) improved significantly at month 1 (p < 0.01). Mean central retinal thickness (CRT) increased from 334 ,m at baseline to 439 ,m at day 1 (p = 0.03) before decreasing to 286 ,m at day 7 (p = 0.06), 233 ,m at month 1 (p = 0.001) and 255 ,m at month 3 (p = 0.001). Conclusion:, Combined verteporfin/IVTA therapy induces distinct time-related effects on the retina within the different intra- and subretinal compartments. [source]

Efficacy of intravitreal bevacizumab (Avastin®) therapy for early and advanced neovascular age-related macular degeneration

ACTA OPHTHALMOLOGICA, Issue 6 2009
Ilse Krebs
Abstract. Purpose:, To evaluate the safety and efficacy of intravitreal bevacizumab therapy for early and advanced neovascular age-related macular degeneration (ARMD). Methods:, A consecutive series of eyes with neovascular ARMD treated with monthly intravitreal injections of bevacizumab (1.25 mg/0.05 ml) as long as there was evidence of activity on fluorescein angiography (FA) and optical coherence tomography (OCT) was included and observed for 6 months. For further analysis they were assigned to either an early (untreated/newly diagnosed) or an advanced (predominantly fibrotic/pre-treated) ARMD group. We examined distance visual acuity (VA) with Early Treatment Diabetic Retinopathy Study (ETDRS) charts and central retinal thickness with OCT, as well as lesion size and safety aspects. Results:, Forty-four patients (44 eyes) were enrolled (21 early lesions, 23 advanced lesions). Mean VA changed from 0.74 logMAR at baseline to 0.68 logMAR at month 6 (P = 0.01). Improvement in VA was statistically significant only in eyes with early lesions (n = 21) from month 1 (P = 0.015) up to month 6 (P = 0.03). The changes in central retinal thickness (CRT) (P < 0.001) and total lesion size (P < 0.001) were significant in both groups (early and advanced) at all time-points during follow-up. No significant ocular or systemic adverse effects were observed. Conclusion:, Intravitreal bevacizumab was tolerated well by our patients and we did not identify any apparent short-term safety concerns. We observed stabilization in VA overall, with significant improvement in the early lesion group. [source]

Ocular haemodynamic changes after single treatment with photodynamic therapy assessed with non-invasive techniques

ACTA OPHTHALMOLOGICA, Issue 6 2009
Noemi Maar
Abstract. Purpose:, To investigate in patients with neovascular age-related macular degeneration (ARMD) the changes in ocular perfusion caused by single treatment with photodynamic therapy (PDT) by different non-invasive methods; to evaluate correlations between relative changes of ocular haemodynamic parameters after PDT among each other and compared to morphological parameters; and to assess this in relation to early changes of visual acuity. Methods:, Study population: 17 consecutive patients with subfoveal choroidal neovascularization (CNV) caused by ARMD scheduled for PDT without previous PDT treatment (four patients with predominantly classic CNV and 13 patients with occult CNV). Observation procedures: best-corrected visual acuity (before PDT, 6 and 8 weeks after PDT), fundus photography, fluorescein angiography, haemodynamic measurements with laser Doppler flowmetry (LDF), laser interferometry and ocular blood flow (OBF) tonometry (baseline and 1, 2, 6 and 8 weeks after treatment). Main outcome measures: choroidal blood flow (CHBF), fundus pulsation amplitude (FPA), pulsatile ocular blood flow (POBF), visual acuity. Changes smaller than 20% were considered clinically irrelevant. Results:, Ocular haemodynamic parameters did not change significantly in the follow-up period. Changes of haemodynamic parameters showed no correlation to treatment spot, morphological changes or visual acuity. Changes of visual acuity were comparable to results of earlier studies. Conclusion:, Single treatment with PDT did not modify ocular blood flow parameters above 20% as assessed with different non-invasive methods. [source]

Macular microcirculation in hypertensive patients with and without branch retinal vein occlusion

ACTA OPHTHALMOLOGICA, Issue 6 2009
Hidetaka Noma
Abstract. Purpose:, Our purpose was to determine whether a reduction in blood flow velocity (BFV) in the perifoveal capillaries is involved in the pathogenesis of branch retinal vein occlusion (BRVO) in patients with hypertension. Methods:, Subjects included hypertensive patients with (n = 12) and without (n = 16) BRVO and healthy volunteers (n = 16). Perifoveal BFV was measured by the tracing method using fluorescein angiography and a scanning laser ophthalmoscope. Logistic regression analysis was performed to assess factors that influenced the presence or absence of BRVO. Results:, Mean BFV showed a significant decrease across the three groups (healthy controls: 1.49 ± 0.11 mm/second; hypertensive patients without BRVO: 1.36 ± 0.12 mm/second; hypertensive patients with BRVO: 1.16 ± 0.24 mm/second; ptrend < 0.001). Multivariate logistic regression analysis showed that BFV was a significant risk factor for the presence of BRVO. Conclusions:, Perifoveal capillary BFV is reduced in hypertensive patients with and without BRVO. It is possible that a decrease in BFV may be involved in the occurrence of BRVO. Measurement of perifoveal capillary BFV may be useful for investigating the pathogenesis and progression of BRVO. [source]

Appraisal and management of subclinical choroidal inflammation: the iceberg phenomenon

Tolerance and safety of ocular use of recombinant human erythropoietin (rhEPO).

ACTA OPHTHALMOLOGICA, Issue 2009
Neuroprotective effects in ocular hypertension/glaucoma
Purpose The purpose of this study was to evaluate the long-term effects of monthly intravitreal injections of rhEPO in a rabbit model. Methods Sixteen New Zealand rabbits were divided into 4 groups: control (no injection), saline injection, or rhEPO injections of 500 U and 1000 U (N=4 per group). The right eye of each animal was injected monthly over a period of 7 months. Fundus examination and electroretinography (ERG) were performed at 1 day prior, and 1 week, 1 month, and 6 months after the initial injection. After the final ERG, animals underwent fluorescein angiography and sacrifice one week later. Scotopic and photopic ERG amplitude and implicit times were analyzed by calculating a ratio between the right and the left eyes. Angiograms were graded for the presence of neovascularization or leakage. Statistical analysis was carried out using two-way ANOVA. Results Fifteen animals were used for this experiment (1 developed a traumatic cataract and was excluded). Between all groups and time points, there were no statistically significant differences in the computed right eye:left eye ratios for the scotopic or photopic ERG components (p>0.05). No evidence of neovascularization or fluorescein leakage was seen on angiography. There were no visible differences in retinal architecture or thickness in the rhEPO groups when compared to uninjected controls. Conclusion Monthly 0.1 ml intravitreal injections of rhEPO at a dose of up to 1000 U over 7 months is well-tolerated and does not cause adverse effects on retinal function, architecture, or vasculature in a rabbit model. A review of published data on rhEPO and Glaucoma will also be presented. [source]