INTRAVITREAL ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR FOR THE TREATMENT OF CHOROIDAL NEOVASCULARIZATION SECONDARY TO OCULAR HISTOPLASMOSIS: Ten-Year Follow-Up.

PURPOSE: To assess the long-term efficacy of intravitreal antivascular endothelial growth factor injections (IVI), alone or in combination with verteporfin photodynamic therapy (IVI/PDT), for management of choroidal neovascularization secondary to presumed ocular histoplasmosis syndrome (POHS). METHODS: Retrospective, comparative, interventional case series analyzing 82 eyes in 74 patients treated with either IVI or IVI/PDT for presumed ocular histoplasmosis syndrome choroidal neovascularization from January 2006 to January 2021. RESULTS: The average logarithm of the minimum angle of resolution VA in year 5 was 0.40 (20/50) and 0.52 (20/67) for IVI versus IVI/PDT groups, respectively ( P = 0.33), and in year 10 was 0.53 (20/58) and 0.64 (20/86), respectively ( P = 0.50). The average number of annual injections over the first 5 years of follow-up was 3.3 versus 1.7 for IVI versus IVI/PDT groups, respectively ( P < 0.001), and over 10 years was 3.3 versus 1.6, respectively ( P < 0.001). Treatment-free interval of 5 years was reached by 39% versus 60% in IVI versus IVI/PDT groups, respectively ( P = 0.95). CONCLUSION: Our study found both IVI and IVI/PDT to be effective in long-term management of presumed ocular histoplasmosis syndrome choroidal neovascularization, with a fewer number of annual injections and longer treatment-free interval in the combination group. However, given the limitations of a retrospective study, a prospective randomized study is necessary to determine whether the addition of PDT significantly decreases treatment burden.

Comparison of outcomes: scleral buckling and pars plana vitrectomy versus vitrectomy alone for primary repair of rhegmatogenous retinal detachment.

OBJECTIVE: To assess the combination of scleral buckling (SB) and pars plana vitrectomy (PPV) versus PPV alone in the primary repair of rhegmatogenous retinal detachments (RRDs). METHODS: The current study was a retrospective, comparative, interventional, consecutive case series of 179 eyes of 174 patients who underwent primary RRD repair by five surgeons between January 1, 2008 and December 31, 2010, utilizing SB with PPV or PPV. Univariate and multivariate analyses were used to compare the efficacy of the two surgical strategies and assess for risk factors of proliferative vitreoretinopathy (PVR). RESULTS: Single surgery anatomic success (SSAS) was similar (P=0.76) between the PPV group (112 of 132 eyes, 85%) and SB with PPV group (39 of 47 eyes, 83%). Final anatomic success was 100% in each group. There was no difference in rates of PVR formation (PPV 16% vs SB with PPV 19%, P=0.70). Final logarithm of the minimum angle of resolution acuity was 0.33 (20/43) in the PPV group and 0.37 (20/47) in the SB with PPV group (P=0.62). Postoperative anterior chamber fibrin was highly correlated with PVR formation (PVR 13% vs no PVR 0.7%, P=0.003; odds ratio =68.37, P=0.007). Separate analysis of medium- to high-complexity cases showed similar SSAS (PPV 86% vs SB with PPV 83%, P=0.45). CONCLUSION: SB with PPV versus PPV alone were similarly efficacious for repair of primary RRDs of varying complexity. SSAS rates, PVR incidence, and final visual acuities were not significantly different.

Retinal vascular occlusion: a window to diagnosis of familial and acquired thrombophilia and hypofibrinolysis, with important ramifications for pregnancy outcomes.

AIM: Our specific aim was to document the pathoetiologic importance of thrombophilia among females presenting with severe ischemic retinal vein (RVO) or retinal artery (RAO) occlusion, without typical risk factors, and to emphasize that the ophthalmologists' diagnosis of thrombophilia has important diagnostic and therapeutic downstream ramifications for nonocular thrombosis, including reproductive outcomes. METHODS: We evaluated familial and acquired thrombophilia in 60 females with RVO (central RVO, n=52; branch RVO, n=8) and 16 with RAO (central RAO, n=11; branch RAO, n=5). They were referred by retinologists, without typical risk factors for RVO/RAO and/or severe ocular ischemic presentation. We focused on extraocular thrombotic events, particularly pregnancy complications, including unexplained spontaneous abortion, pre-eclampsia-eclampsia. Thrombophilia measurements in the 76 females were compared with 62 healthy normal females without ocular vascular occlusions (OVOs). RESULTS: The 76 females with OVO were more likely than 62 normal female controls to have high homocysteine (24% vs 0%, P<0.0001), high anticardiolipin antibody (immunoglobulin M, 17% vs 3%, P=0.012), high (>150%) factor VIII (42% vs 11%, P<0.0001), and high (>150%) factor XI (22% vs 4%, P=0.004). Of the 76 females, 26 (34%) had ≥1 spontaneous abortion; 17 (22%) had ≥2 spontaneous abortions and/or pre-eclampsia-eclampsia. Compared to 62 healthy female controls, these 17 females with pregnancy complications had high homocysteine (29% vs 0%, P=0.0003), high anticardiolipin antibody immunoglobulin M (24% vs 3%, P=0.02), high factor VIII (38% vs 11%, P=0.02), and were marginally more likely to be heterozygous for the factor V Leiden mutation (19% vs 3%, P=0.058). CONCLUSION: In females lacking typical risk factors for retinal vascular occlusion or severely ischemic presentation, by diagnosing thrombophilia as an etiology for OVO, the ophthalmologist opens a window to family screening and preventive therapy, with particular relevance to pregnancy outcomes and venous thromboembolism.

Retinal artery and vein thrombotic occlusion during pregnancy: markers for familial thrombophilia and adverse pregnancy outcomes.

BACKGROUND: Ocular vascular occlusion (OVO), first diagnosed during or immediately after giving birth, often reflects superposition of the physiologic thrombophilia of pregnancy on previously undiagnosed underlying familial or acquired thrombophilia associated with spontaneous abortion, eclampsia, or maternal thrombosis. SPECIFIC AIM: We describe OVO, first diagnosed during pregnancy or immediately postpartum, in three young females (ages 32, 35, 40) associated with previously undiagnosed familial thrombophilia. RESULTS: Branch retinal artery occlusion (BRAO) occurred at 9 and 13 weeks gestation in two females, aged 32 and 35. Central retinal vein occlusion occurred immediately postpartum in a 40-year-old. One of the two females with BRAO subsequently developed eclampsia, and one had a history of unexplained first trimester spontaneous abortion. All three females were found to have previously unexplained familial thrombophilia. The two females with BRAO had low first trimester free protein S 42 (41%), lower normal limit (50%), and one of these two had high factor VIII (165%, upper normal limit 150%). The woman with central retinal vein occlusion had high factor XI (169%, upper normal limit 150%). Enoxaparin (40-60 mg/day) was started and continued throughout pregnancy in both females with BRAO to prevent maternal-placental thrombosis, and of these two females, one had an uncomplicated pregnancy course and term delivery, and the second was at gestational week 22 without complications at the time of this manuscript. There were no further OVO events in the two females treated with enoxaparin or in the untreated patient with postpartum eclampsia. CONCLUSION: OVO during pregnancy may be a marker for familial or acquired thrombophilia, which confers increased thrombotic risk to the mother and pregnancy, associated with spontaneous abortion or eclampsia. OVO during pregnancy, particularly when coupled with antecedent adverse pregnancy outcomes, should prompt urgent thrombophilia evaluation and institution of thromboprophylaxis to prevent adverse maternal and fetal-placental thrombotic events.

Diagnostic ramifications of ocular vascular occlusion as a first thrombotic event associated with factor V Leiden and prothrombin gene heterozygosity.

AIM: This study aimed to assess the diagnostic ramifications of vascular occlusion of the ocular vein and artery as a first thrombotic event associated with factor V Leiden (FVL) and/or prothrombin gene (PTG) heterozygosity. METHODS: Patients with ocular vein (n=191) and artery (n=74) occlusion, free of cardioembolic etiologies, were sequentially referred from vitreoretinal specialists for measurement of thrombophilia-hypofibrinolysis and compared to 110 healthy normal controls. RESULTS: Of the 265 patients, 29 (11%; 17 women, 12 men) of all referred ocular vascular occlusion (OVO) cases were found to be heterozygous for FVL and/or PTG, including 16 with FVL, 12 with PTG, and 1 with both. Of the 29 cases, 16 had central retinal vein occlusion (CRVO), 2 branch retinal vein occlusion (BRVO), 5 nonarteritic anterior ischemic optic neuropathy (NA-AION), 3 retinal artery occlusion (RAO), 2 amaurosis fugax (AF), and 1 had both CRVO and RAO. Of the 16 FVL cases, 15 (94%) had OVO as a first thrombotic event without prior deep venous thrombosis (DVT) or pulmonary embolism (PE); 6 (38%) also had other thrombotic events, including recurrent miscarriage, osteonecrosis, ischemic stroke, and/or ischemic colitis; and 5 (31%) had immediate family members with previous venous thromboembolism (VTE). Of the 12 PTG cases, 9 (75%) had OVO as a first thrombotic event, 5 (42%) experienced VTE other than DVT or PE, and 6 (50%) had immediate family members with VTE. In one patient with both FVL and PTG, DVT occurred before BRVO. Of the 17 women with FVL and/or PTG mutations, 7 (41%) experienced ≥1 miscarriage, 6 (35%) were on estrogen therapy, and 1 (6%) was on clomiphene. CONCLUSION: Of the 265 patients with OVO, 29 (11%) had FVL and/or PTG, and 83% of these 29 cases presented with OVO as their first thrombotic event. By diagnosing thrombophilia as an etiology for OVO, the ophthalmologist opens a window to family screening and preventive therapy.

Cost comparison of intravitreal aflibercept with bevacizumab and ranibizumab for the treatment of wet age-related macular degeneration.

BACKGROUND AND OBJECTIVE: To test the hypothesis that although intravitreal aflibercept (IVA) is expected to be more expensive, the extra cost of treatment would not result in additional vision gain compared with intravitreal bevacizumab (IVB) for the treatment of wet age-related macular degeneration (AMD). PATIENTS AND METHODS: A retrospective chart review of patients receiving IVB or intravitreal ranibizumab (IVR) who were subsequently changed to IVA for active wet AMD. RESULTS: Thirty-three eyes were included in the study. The mean number of IVB, IVR, and IVA injections per eye over a 6-month period was seven, six, and five, respectively. Visual outcomes were similar in all three groups at the end of the study period. The average drug cost of IVB, IVR, and IVA injections per eye over 6 months was $326, $11,400, and $9,720, respectively. CONCLUSION: Aflibercept may allow a modest extension of the treatment interval, but cost makes IVA an expensive alternative without a visual benefit compared with IVB in patients with active wet AMD.

Thrombophilia and retinal vascular occlusion.

PURPOSE: The purpose of this research was to assess associations of thrombophilia with central retinal vein occlusion (CRVO), central retinal artery occlusion (CRAO), and amaurosis fugax (AF); to evaluate outcomes of normalizing high homocysteine; and to study CRVO, CRAO, and AF developing in estrogens/estrogen agonists in women subsequently shown to have thrombophilia. METHODS: Measures of thrombophilia-hypofibrinolysis were obtained in 132 CRVO cases, 15 CRAO cases, and 17 AF cases. Cases were compared to 105 healthy control subjects who did not differ by race or sex and were free of any ophthalmologic disorders. All cardiovascular disease (CVD) risk factors were compared to healthy general populations. MAIN OUTCOME MEASURES: The main outcome measure of this study was thrombophilia. RESULTS: CRVO cases were more likely than controls to have high homocysteine (odds ratio [OR] 8.64, 95% confidence intervals [CI]: 1.96-38), high anticardiolipin immunoglobulin M (IgM; OR 6.26, 95% CI: 1.4-28.2), and high Factor VIII (OR 2.47, 95% CI: 1.31-7.9). CRAO-AF cases were more likely than controls to have high homocysteine (OR 14, 95% CI: 2.7-71.6) or the lupus anticoagulant (OR 4.1, 95% CI: 1.3-13.2). In four of 77 women with CRVO (two found to have high homocysteine, two with inherited high Factor XI), CRVO occurred after starting estrogen-progestins, estrogen-testosterone, or estrogen agonists. In one of eight women with CRAO found to have high anticardiolipin antibody IgG, CRAO occurred after starting conjugated estrogens, and AF occurred after starting conjugated estrogens in one of eleven women with AF (inherited protein S deficiency). Therapy for medians of 21 months (CRVO) and 6 months (CRAO-AF) was 5 mg folic acid, 100 mg B6, and 2000 mcg/day B12 normalized homocysteine in 13 of 16 (81%) CRVO cases and all five CRAO-AF cases with pretreatment hyperhomocysteinemia. The CRVO cases had an excess of hypertension; CRAO-AF cases had an excess of type 2 diabetes and hypertension. CONCLUSION: Treatable thrombophilia, hyperhomocysteinemia in particular, is more common in RVO cases than in normal controls. RVO occurs after estrogens or estrogen agonists were administered in women subsequently shown to have thrombophilia.

Analysis of outcomes for intravitreal bevacizumab in the treatment of choroidal neovascularization secondary to ocular histoplasmosis.

PURPOSE: To assess the long-term outcomes of intravitreal bevacizumab (IVB) in the treatment of choroidal neovascularization (CNV) secondary to presumed ocular histoplasmosis syndrome (POHS). DESIGN: Retrospective, comparative case series. PARTICIPANTS: Interventional series of 150 eyes in 140 patients treated for subfoveal or juxtafoveal CNV secondary to POHS from January 2006 to January 2010. INTERVENTION: Intravitreal bevacizumab monotherapy or combination IVB and verteporfin photodynamic therapy (IVB/PDT). MAIN OUTCOME MEASURES: Visual acuity (VA) at 12 and 24 months was analyzed. Secondary outcome measures included the number of injections per year and treatment-free intervals. RESULTS: A total of 117 eyes received IVB monotherapy, and 34 eyes underwent combination IVB/PDT treatment. For all patients, the average pretreatment logarithm of minimum angle of resolution (logMAR) was 0.63 (Snellen equivalent 20/86) with a 12-month logMAR VA of 0.45 (Snellen equivalent 20/56) and a 24-month logMAR VA of 0.44 (Snellen equivalent 20/55). The mean follow-up was 21.1 months with an average of 4.24 IVB injections per year. There was no significant difference in initial VA, VA at 12 months, VA at 24 months, or number of eyes with a 3-line gain between the IVB monotherapy and IVB/PDT groups. Thirty-eight percent (39/104) of eyes gained 3 lines or more, and 81.2% (84/104) of subjects had maintained or improved their starting VA at 1 year. The proportion of subjects maintaining a 3-line gain in VA was relatively preserved at 2 years (29.8%, 17/57) and 3 years (30.3%, 10/32) follow-up. There was no increase in the proportion of subjects losing 3 lines or more over 3 years of follow-up. CONCLUSIONS: There is no significant difference in VA outcomes between IVB monotherapy versus IVB/PDT combination therapy. The use of IVB alone or in combination with PDT results in significant visual stabilization in the majority of patients with CNV secondary to POHS.

Outcomes of 25-gauge pars plana vitrectomy in the surgical management of proliferative diabetic retinopathy.

BACKGROUND AND OBJECTIVE: To report outcomes and complications of 25-gauge pars plana vitrectomy (PPV) for patients with complications of proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: Retrospective, interventional, consecutive case series of 174 eyes undergoing primary 25-gauge PPV for PDR from 2006 to 2009. Primary outcomes were visual acuity changes and rates of postoperative complications. RESULTS: Visual acuity improved from 20/187 before to 20/69 after surgery (P < .0001). Postoperative vitreous hemorrhage occurred in 38.7% of eyes and 10.4% of all eyes required another PPV for non-clearing vitreous hemorrhage. Complications included limited choroidal effusion (5.2%), rhegmatogenous retinal detachment (4.6%), hypotony, rubeosis, and ocular hypertension (4.1%), neovascular glaucoma (2.3%), hyphema (1.2%), and phthisis bulbi (0.6%). CONCLUSION: The authors found 25-gauge PPV to be effective for vitreous removal and membrane dissection. The spectrum and frequency of complications were similar to those reported for 20-gauge PPV for PDR. In the surgical management of PDR, 25-gauge PPV is an alternative.

Necrotizing herpetic retinopathy after intravitreal triamcinolone acetonide injection.

PURPOSE: To report a new complication of intravitreal triamcinolone acetonide (TA) injection. METHODS: In this observational case report, an 87-year-old woman received an intravitreal injection of TA as an adjunct to photodynamic therapy for wet age-related macular degeneration in the left eye. Four months later, she developed ipsilateral necrotizing herpetic retinopathy (NHR). RESULTS: Retinal whitening of the macula was noted in the absence of vitritis that progressed over 5 days to diffuse retinitis with moderate vitritis and anterior chamber cell. Visual acuity decreased from 20/30 to 20/400. TA was still present inferiorly in the vitreous cavity. Polymerase chain reaction testing of samples obtained by vitrectomy with vitreous aspiration and retinal biopsy demonstrated varicella-zoster virus DNA. Two weeks later, repeated vitrectomy, silicone oil injection, and implantation of a ganciclovir sustained-release device were performed. Final visual acuity was 5/200. CONCLUSIONS: NHR can develop as a complication of intravitreal TA injection in an eye with a history of herpes zoster ophthalmicus.

Retinal endovascular surgery for central retinal vein occlusion: initial experience of four surgeons.

PURPOSE: The rate and magnitude of spontaneous visual recovery are very poor in central retinal vein occlusion (CRVO). In the first follow-up year, the Central Vein Occlusion Study Group reported that only 6% of eyes recovered > or = 3 lines of vision and none recovered > or = 8 lines of vision. Retinal endovascular surgery (REVS) is vitrectomy followed by cannulation of retinal vessels with injection of tissue plasminogen activator. After reports of one surgeon's experience suggested that the procedure promotes recovery of vision, other surgeons began to offer REVS to their patients. This report discusses the initial experience of four surgeons using REVS to treat CRVO. METHODS: In this prospective, consecutive case series, patients with CRVO for > 1 week and visual acuity of < 20/50 were offered REVS and were followed by the authors. The main outcome measure was recovery of visual acuity. RESULTS: This series represents the initial 25 consecutive REVS cases of the 4 authors (5-7 cases per author). The median CRVO duration was 2 months (mean 2.9, months), and the average preoperative visual acuity was 20/400 (< or = 20/200 in 80% of cases). Intravitreal triamcinolone acetonide (IVTA) was administered intraoperatively in three cases and at some time postoperatively in six cases. Overall, 18 eyes (72%) recovered > or = 3 lines of visual acuity, and 9 (36%) recovered > or = 8 lines of vision. Among the surgeons, the rates of > or = 3-line visual recovery ranged from 57% to 100%, and the rates of > or = 8-line visual recovery ranged from 14% to 71%. Of the 22 eyes that initially underwent REVS without intraoperative IVTA injection, 13 (59%) recovered > or = 3 lines of vision and 5 (23%) recovered > or = 8 lines of vision. Complications included macular edema (28%), anterior segment or retinal neovascularization (24%), and subsequent cataract surgery (5 [23%] of the 22 preoperatively phakic eyes). One eye had an intraoperative retinal detachment that was treated but recurred 4 months after REVS, and two of the eyes with anterior segment neovascularization developed late-onset traction retinal detachments (at 8 and 13 months after REVS). CONCLUSION: Although the authors were on the "learning curve" of experience during this series, REVS appears to promote visual recovery far in excess of what would be expected to occur spontaneously, and IVTA injection greatly improved outcomes. We believe that mastery of REVS techniques and the inclusion of IVTA injection may lead to better visual results and lower complication rates.

Pseudomonas aeruginosa endogenous endophthalmitis with choroidal abscess in a patient with cystic fibrosis.

PURPOSE: To describe the clinical presentation, management, and outcome of a case of endogenous intraocular infection due to Pseudomonas aeruginosa in a patient with cystic fibrosis (CF). METHODS: The authors describe a case of an adult patient with CF who developed an intraocular infection by P. aeruginosa. RESULTS: Diagnosis was confirmed by culture of purulent fluid obtained by transcleral incision and drainage. The infection persisted in spite of aggressive surgical intervention including extensive endoresection of the visibly affected retina and choroid and multiple administrations of appropriate intraocular, subconjunctival, and systemic antibiotics. Eventually, the eye became blind and painful and was enucleated. CONCLUSIONS: Endogenous intraocular infection by P. aeruginosa can occur in patients with CF who have not undergone lung transplantation. An infection of this type may be impossible to eradicate by aggressive surgical intervention and appropriate antibiotic therapy.

Fibrovascular ingrowth at sclerotomy sites in vitrectomized diabetic eyes with recurrent vitreous hemorrhage: ultrasound biomicroscopy findings.

PURPOSE: To evaluate the frequency of fibrovascular ingrowth (FVIG) at sclerotomy sites in vitrectomized eyes of diabetic patients with postoperative vitreous hemorrhage referred for ultrasound biomicroscopy (UBM). DESIGN: Retrospective observational case series. PARTICIPANTS: Twenty-six eyes of 23 diabetic patients with recurrent, nonclearing postoperative vitreous hemorrhage subsequent to pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS: Ultrasound biomicroscopy evaluation of all sclerotomy sites in patients referred for postoperative nonclearing or recurrent vitreous hemorrhage after PPV for PDR. Correlation with intraoperative findings was obtained in eyes undergoing revision of the vitrectomy. Eight eyes underwent repeat UBM after revision of the vitrectomy, and changes at previous sclerotomy sites were evaluated. MAIN OUTCOME MEASURES: Ultrasound biomicroscopy images at each sclerotomy site were classified into 3 categories: none (grade 0), minor (grade 1), and major (grade 2). The UBM characteristics of each category were defined by the examiner. Logistic regression analysis was performed to identify prognostic factors associated with development of FVIG in the study patients. RESULTS: Grade 1 or 2 FVIG was detected in 85% of cases, and grade 2 FVIG was identified in >/=1 sclerotomy site in 58% of cases. Grade 1 or 2 FVIG was detected in 56% of microvitrector sites, 41% of infusion sites, and 61% of light port sites. Ten patients underwent repeat vitrectomy because of recurrent nonclearing vitreous hemorrhage and UBM images showing FVIG. Inspection of the sclerotomy site confirmed the UBM findings in every case. Eight of these patients underwent follow-up UBM evaluation subsequent to the repeat vitrectomy. In 6 of the 8 patients, follow-up UBM showed no residual FVIG. CONCLUSIONS: Ultrasound biomicroscopy showed FVIG in a high proportion of eyes that experienced recurrent nonclearing vitreous hemorrhage after PPV for PDR. Ultrasound biomicroscopy is capable of detecting and characterizing FVIG at sclerotomy sites and may aid in reoperative planning.

Chorioretinal lesions in nonfatal cases of West Nile virus infection.

OBJECTIVE: West Nile virus (WNV) disease is a zoonotic infection with recent outbreaks in the United States. Recent reports have highlighted the intraocular findings associated with WNV disease. We describe the intraocular findings observed in two patients infected by the West Nile virus. DESIGN: Observational case reports. METHODS: During an outbreak of WNV disease in Southwest Ohio, two patients with an acute onset of a systemic febrile illness accompanied by myalgia, arthralgia, headache, and a maculopapular rash were referred for blurred vision. Complete ophthalmologic examination, fundus photographs, and fluorescein angiograms were obtained on both patients. Both patients underwent serologic testing for viruses and cultures for bacteria, viruses, and fungi. RESULTS: Ophthalmologic examination in each patient revealed anterior segment and vitreous inflammatory cells and multiple partially atrophic and partially pigmented chorioretinal lesions clustered in the peripheral fundus. Fundus examination in case 2 also revealed mild disc edema in both eyes. Intracranial pressure as measured by lumbar puncture was borderline elevated. The chorioretinal lesions in both patients showed a striking similarity and appeared hypofluorescent centrally and hyperfluorescent around the edges on a fluorescein angiogram. Serologic testing for the WNV was positive in both patients, and tests for all other bacteria, fungi, and viruses were negative. CONCLUSIONS: WNV usually causes mild symptoms, but it occasionally causes neurologic illness with fatal outcome or severe morbidity. We present the cases of two patients with serology-proven WNV disease who developed chorioretinal lesions with a targetlike appearance and iridocyclitis.

Photodynamic therapy with verteporfin for subretinal neovascularization secondary to bilateral idiopathic acquired juxtafoveolar telangiectasis.

The clinical course of a patient treated with multiple sessions of photodynamic therapy (PDT) with verteporfin for subretinal neovascularization secondary to bilateral idiopathic acquired juxtafoveolar telangiectasis is described. The patient presented with subfoveal subretinal neovascularization in one eye secondary to bilateral idiopathic acquired juxtafoveolar telangiectasis. The visual acuity improved from 5/40 to 20/60 and fluorescein angiography documented near-complete closure of the subretinal neovascularization within 2 weeks following the initial session of PDT. The visual acuity decreased to 20/200 and fluorescein angiography documented reperfusion of the neovascular membrane 6 weeks later. Four additional sessions of PDT were administered during the next 13 months with similar results. This case indicates that PDT for subretinal neovascularization due to bilateral idiopathic acquired juxtafoveolar telangiectasis may achieve partial short-term neovascular membrane closure and improvement in visual acuity.