RESUMO
PURPOSE: To evaluate the digital indocyanine green (ICG) videoangiography characteristics of well-defined choroidal neovascularization (CNV). METHODS: The authors retrospectively reviewed all ICG angiograms performed at the New England Eye Center over a 2-year period. Included in this study were all patients with the clinical and fluorescein angiographic diagnosis of well-defined CNV according to the Macular Photocoagulation Study Group criteria. RESULTS: Of the 25 eligible patients, 18 (72%) had a well-demarcated area of ICG hyperfluorescence that was observed either both early and late (6 patients = 24%) or only late (12 patients = 48%) on the ICG angiogram. Five patients (20%) showed only poorly demarcated late hyperfluorescence on ICG angiography. Two patients (8%) had type II occult CNV associated with classic CNV as per the Macular Photocoagulation Study Group criteria. Both patients showed a late, well-demarcated area of ICG hyperfluorescence greater than the area imaged with fluorescein angiography. CONCLUSIONS: Choroidal neovascularization which is well-defined on fluorescein angiography has variable ICG appearances. When there is late leakage associated with a well-defined CNV on fluorescein angiography (type II occult CNV), ICG angiography may more completely delineate the extent of the lesion.
Assuntos
Corioide/irrigação sanguínea , Verde de Indocianina , Neovascularização Patológica/patologia , Idoso , Idoso de 80 Anos ou mais , Corioide/patologia , Feminino , Angiofluoresceinografia/métodos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Gravação em VídeoRESUMO
We conducted a prospective study to determine the incidence of ocular neo-vascularization following acute central retinal artery obstruction. Only patients initially evaluated within 7 days of visual loss were eligible. Any patient with pre-existing ocular neovascularization or clinical evidence of the ocular ischemic syndrome noted at the initial evaluation was excluded. During the 18-month study, 33 consecutive patients were enrolled. Six patients subsequently developed neovascularization of the iris, an incidence of 18.2%. In these six patients, neovascularization of the iris appeared as early as 12 days to as late as 15 weeks following the artery obstructions. Five of the six patients (15.2% of the total) later developed neovascular glaucoma. Another patient in this series developed neovascularization of the optic disc without neovascularization of the iris, an incidence of 3.0%. Only two of the seven patients with ocular neovascularization had ipsilateral hemodynamically significant carotid artery disease as determined by noninvasive carotid artery testing. This study confirms results of previous retrospective studies that the incidence of ocular neovascularization after central retinal artery obstruction is higher than commonly thought. It also shows that, in the majority of cases, carotid artery disease is not responsible for the neovascularization seen after central retinal artery obstruction.
Assuntos
Iris/irrigação sanguínea , Neovascularização Patológica , Disco Óptico/irrigação sanguínea , Oclusão da Artéria Retiniana/complicações , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/complicações , Feminino , Glaucoma Neovascular/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
A systemically healthy 22-year-old man presented with unilateral acute retinal necrosis (ARN) that featured diffuse retinal whitening throughout the posterior retina, exudative retinal detachment, and a visual acuity of no light perception. Diagnostic vitrectomy revealed necrotic retinal cells containing intranuclear inclusions visible with light microscopy. On electron microscopy, viral particles consistent with a herpes family virus were detected. Culture of the vitrectomy specimen showed herpes simplex, type 1 (HSV 1) and rising convalescent serum ELISA titers to HSV 1 confirmed a recent infection. This case of ARN is unusual for its severity, early macular involvement, and development of exudative retinal detachment. In addition, it represents one of the few reported cases in which HSV 1 has been confirmed by both vitreous culture and serum titers as the etiologic agent. A review of the literature suggests that posterior segment inflammatory conditions secondary to HSV 1 can be associated with exudative retinal detachment, a clinical finding that may help differentiate such conditions from other infectious causes of chorioretinitis.
Assuntos
Ceratite Dendrítica/complicações , Doenças Retinianas/etiologia , Adulto , Antígenos Virais/sangue , Ensaio de Imunoadsorção Enzimática , Angiofluoresceinografia , Fundo de Olho , Humanos , Masculino , Necrose , Descolamento Retiniano/etiologia , Descolamento Retiniano/patologia , Doenças Retinianas/patologia , Simplexvirus/isolamento & purificação , Simplexvirus/ultraestrutura , Acuidade Visual , Vitrectomia , Corpo Vítreo/microbiologia , Corpo Vítreo/ultraestruturaRESUMO
Forty-one patients with a unilateral, macular epiretinal membrane (ERM) underwent pars plana vitrectomy and membrane peeling to improve the visual acuity. The authors retrospectively reviewed the histopathology of the vitrectomy specimen in each instance to determine whether the presence of internal-limiting membrane (ILM) had an adverse effect on visual acuity. Eleven specimens contained long segment of ILM, as determined by light microscopy. With a minimum of 6 months of follow-up, none of these 11 eyes achieved a visual acuity of better than 20/60. Of 30 eyes that did not have ILM present, 41% achieved a visual acuity of 20/60 or better. Overall, 29% of the eyes in the entire series achieved 20/60 or better visual acuity. The difference between the group with ILM versus that without ILM was statistically significant (P = 0.01). The presence of long segments of ILM within the histopathologic specimen after vitreous surgery for removal of a macular ERM appears to indicate a less favorable visual outcome.
Assuntos
Doenças Retinianas/patologia , Acuidade Visual , Vitrectomia , Seguimentos , Humanos , Membranas/patologia , Prognóstico , Doenças Retinianas/cirurgiaRESUMO
The authors prospectively evaluated 387 consecutive patients with proliferative diabetic retinopathy (PDR) for asymmetry in posterior segment neovascularization and its relationship to carotid artery disease. For the purpose of this study, asymmetry is defined as the presence of PDR with high-risk characteristics (as per the Diabetic Retinopathy Study) in one eye, with neither proliferative nor preproliferative changes in the opposite eye. Over the 2-year time period of the study, 20 (5.2%) of 387 patients manifested asymmetric PDR by this definition. All 20 patients underwent carotid artery noninvasive testing and 4 (20%) were found to have hemodynamically significant carotid artery disease. Two of the four patients had their proliferative retinopathy ipsilateral to their severe carotid artery stenosis. This finding does not support the hypothesis that a hemodynamically significant carotid artery stenosis protects against the development of PDR.
Assuntos
Doenças das Artérias Carótidas/complicações , Retinopatia Diabética/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Angiofluoresceinografia , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Acuidade VisualRESUMO
We observed seven patients with the unusual combination of a central retinal vein obstruction in conjunction with a simultaneous branch retinal artery obstruction. The patients presented with sectoral retinal whitening, as well as diffuse peripapillary and superficial retinal hemorrhages. In five of the seven patients, the retinal hemorrhages appeared most florid in the territory of the obstructed arteriole, resulting initially in the consideration that these cases represented a combined branch retinal artery and branch retinal vein obstruction. In all cases, however, the presence of dilated, tortuous veins with diffuse retinal hemorrhages, in addition to generalized delay in arteriovenous transit on fluorescein angiography, localized the venous blockage to the central retinal vein. No intra-arterial retinal emboli were visualized. Initially, five of the seven patients suffered markedly diminished visual function; although visual acuity returned to near normal in all but two patients. In the two patients with non-resolving, markedly impaired visual acuity, neovascularization of the iris complicated the clinical course. Both of these patients were treated with panretinal photocoagulation, with resolution of the iris neovascularization. These seven patients highlight another variation of combined arterial and venous retinal vascular disease.
Assuntos
Oclusão da Artéria Retiniana/complicações , Oclusão da Veia Retiniana/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Angiofluoresceinografia , Fundo de Olho , Humanos , Iris/irrigação sanguínea , Iris/cirurgia , Fotocoagulação , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica/patologia , Oclusão da Artéria Retiniana/patologia , Hemorragia Retiniana/etiologia , Oclusão da Veia Retiniana/patologia , Acuidade VisualRESUMO
We evaluated retrospectively the cases of 25 patients (26 eyes) with a recent, temporal, branch retinal vein obstruction to determine the relative anatomic position of the obstructed vein in relation to its crossing artery. In 26 (100%) of 26 eyes, the artery lay anterior to the vein, toward the vitreous cavity. A control group was obtained by evaluating the relative anatomic position between the branch retinal artery and vein at an equivalent crossing site along the opposite vascular arcade within the same eye. In the control crossing sites, the artery lay anterior to the vein 65% (15/23) of the time. We conclude that the likelihood that the artery will lie anterior to the obstructed vein at the site of blockage in a branch retinal vein obstruction is substantially greater than what would be expected by chance alone. This anatomic relationship between artery and vein probably plays a role in the cause of a branch retinal vein obstruction and may have therapeutic significance in light of a recent report concerning surgical treatment of such obstructions.
Assuntos
Artéria Retiniana/patologia , Oclusão da Veia Retiniana/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Angiofluoresceinografia , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação , Hemorragia Retiniana/patologia , Veia Retiniana/patologia , Estudos RetrospectivosRESUMO
Panretinal photocoagulation (PRP) is widely used for a variety of ischemic ocular conditions. In diseases that produce neovascularization of the iris (NVI), such as diabetes mellitus and central retinal vein obstruction, a judiciously timed PRP can reduce the incidence of neovascular glaucoma. Neovascularization of the iris can occur after central retinal artery obstruction (CRAO) as well. In this article, the authors report the outcome of 17 patients who received PRP to treat rubeosis iridis secondary to CRAO. Eleven of the 17 patients (65%) showed regression of NVI after PRP. Although the uncontrolled and retrospective nature of this study precludes drawing definitive conclusions from these data, PRP appears to be effective in reducing the incidence of neovascular glaucoma, if it is delivered before the development of elevated intraocular pressure (IOP). Once neovascular glaucoma occurs, additional modalities appear to be necessary in order to adequately control the elevated IOP.
Assuntos
Iris/irrigação sanguínea , Fotocoagulação , Neovascularização Patológica/cirurgia , Retina/cirurgia , Oclusão da Artéria Retiniana/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Glaucoma/etiologia , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular , Terapia a Laser , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica/etiologiaRESUMO
The authors retrospectively reviewed 168 cases of central retinal artery obstruction (CRAO) to determine the rate of occurrence of iris neovascularization (NVI) and to identify any factors that may predispose to its development. Twenty-eight well-documented cases of NVI after CRAO were detected, an occurrence rate of 16.6%. After evaluating the intravenous fluorescein angiograms of these patients, the authors conclude that an extreme prolongation of the retinal arteriovenous transit time is an independent risk factor for the subsequent development of NVI. Twelve of 18 eyes (66.6%) in the NVI group, versus seven of 29 eyes (24.1%) in the control group, showed such prolongation (P less than 0.02).