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

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. 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.

Choroidal neovascularization in a child with traumatic choroidal rupture: clinical and ultrastructural findings.

Choroidal neovascularization in children is uncommon and mostly associated with inflammation, infectious diseases or trauma. The clinical and histological findings of a choroidal neovascular membrane that developed in a 9-year-old boy after traumatic choroidal rupture are reported.

Choroidal hemodynamic changes during isometric exercise in patients with inactive central serous chorioretinopathy.

PURPOSE: Imaging studies suggest that the choroidal vasculature may be altered in central serous chorioretinopathy. Little is known, however, about the regulation of ocular blood flow in patients with central serous chorioretinopathy (CSC). The hypothesis for the present study was that choroidal blood flow changes during an increase in ocular perfusion pressure induced by isometric exercise may be altered in CSC. METHODS: An observer-masked, two-cohort study was performed in 14 nonsmoking patients with chronic-relapsing but inactive CSC and in 14 healthy nonsmoking volunteers. Both groups were matched for age and sex. Subfoveal choroidal blood flow (CBF) was assessed with laser Doppler flowmetry, and ocular perfusion pressure (OPP) was calculated from mean arterial pressure (MAP) and intraocular pressure (IOP). Changes of CBF during isometric exercise over a period of 6 minutes were measured. RESULTS: Whereas the increase of MAP, the pulse rate, and the OPP were comparable between the two study groups, subfoveal CBF increased significantly more in the group of patients with CSC (P < 0.001). IOP remained unchanged in both groups during isometric exercise. At an 85% increase in OPP, subfoveal CBF was approximately twice as high in the patients with CSC compared with the healthy control group. CONCLUSIONS: The data indicate an abnormal subfoveal CBF regulation in patients with relapsing CSC compared with age-matched, nonsmoking, healthy volunteers during isometric exercise.

Effect of laser photocoagulation on the retinal vessel diameter in branch and macular vein occlusion.

OBJECTIVE: To investigate the response of retinal vessel diameters to photocoagulation treatment and their role for the success of laser treatment in patients with retinal vein occlusion. METHODS: The study included 14 patients with branch vein occlusion or macular vein occlusion. The ophthalmologic examination included best-corrected visual acuity, biomicroscopy, fundus photography, and fluorescein angiography. Retinal vessel diameters were quantified before and after laser photocoagulation using a retinal vessel analyzer. MAIN OUTCOME MEASURE: Retinal vessel diameters. RESULTS: In cases manifesting macular vein occlusions, no significant change of the vessel diameter in any vessel was observed during the follow-up period. In the group with branch vein occlusion, all vessels tended to constrict after the laser photocoagulation. The effect of laser treatment on retinal vessel diameters was significant for superotemporal (P =.045, analysis of variance [ANOVA]) and inferotemporal branch veins (P =.03, ANOVA). Vasoconstriction was more pronounced in the occluded branch veins (P =.009, ANOVA) compared with the nonaffected veins (P =.12; ANOVA). The change of visual acuity after 3 months was correlated with the change of vessel diameter 3 months after laser treatment for occluded venular branches (r = 0.78, P =.02, linear regression). There was no correlation between the number of laser burns and the change of vessel diameters in the affected veins in this period (r = 0.12, P =.75, linear regression). CONCLUSIONS: Our results show that retinal photocoagulation in patients with branch vein occlusion has a vasoconstrictive effect on occluded veins. The correlation between the change in visual acuity and the change in vessel diameter indicates that branch vein constriction after photocoagulation may be an early indicator of the success of laser treatment.

Photodynamic therapy with verteporfin in subfoveal choroidal neovascularization secondary to central serous chorioretinopathy.

OBJECTIVE: To examine the efficacy and safety of photodynamic therapy with verteporfin in the treatment of subfoveal choroidal neovascularization secondary to central serous chorioretinopathy (CSC). DESIGN: Prospective interventional, noncomparative case series. METHODS: After the diagnosis of a subfoveal choroidal neovascularization secondary to CSC, 26 eyes of 24 patients were treated with photodynamic therapy with verteporfin. Patients were then followed up every 2 to 3 months, with further treatments performed as deemed necessary through fluorescein angiography. The mean observation was 22.2 months (range, 6-36 months; median, 24 months). RESULTS: There was marked visual improvement, with patients gaining a mean of 1.6 lines after 1 year and a mean of 2.2 lines after 2 years. There was a statistically significant change in visual acuity from baseline to 12 and 24 months (mean difference, -0.16, P =.03; and mean difference, -0.22, P =.02; respectively; t test for both). There was no correlation between patients' age or greatest linear dimension of the lesions and the final outcome (P>.10 for all). No patient experienced any adverse effects. CONCLUSION: Photodynamic therapy with verteporfin resulted in a beneficial outcome in the treatment of subfoveal choroidal neovascularization secondary to CSC, without serious adverse effects in this case series.

Topical fundus pulsation measurement in patients with active central serous chorioretinopathy.

OBJECTIVE: To determine regional pulsatile choroidal blood flow using laser interferometry in patients with active central serous chorioretinopathy (CSC). METHOD: The study compared an equally sized age-, sex-, and refractive error-matched control group of healthy volunteers obtained from the Department of Clinical Pharmacology with 18 consecutive patients who had newly diagnosed active, unilateral CSC obtained from the University of Vienna Eye Clinic, Vienna, Austria. MAIN OUTCOME MEASURES: Regional fundus pulsation amplitude as assessed using laser interferometry. RESULTS: The median age of the patients was 40 years; the male-female ratio was 16:2. Foveal fundus pulsation amplitude was significantly higher in eyes with CSC (mean [SD], 5.5 [1.7] micro m) than in the eyes of the control subjects (4.1 [1.1] micro m; P =.005). In addition, eyes with CSC had a significantly higher variability in fundus pulsation amplitude (mean [SD], 48% [20%]) assessed at different fundus locations around the leak than the controls did (20% [9%]; P<.001). CONCLUSIONS: To our knowledge, this is the first study that measures topical fundus pulsations in patients who have active, unilateral CSC. These data indicate a generally increased foveal pulsatile choroidal blood flow and an abnormal distribution of fundus pulsation amplitude in the area close to the leak. Whether these findings reinforce the concept that choroidal perfusion abnormalities play a role in the pathogenesis of CSC remains to be established.

Evaluation of pulsatile choroidal blood flow in branch retinal vein occlusion.

BACKGROUND: The present study was undertaken to compare pulsatile choroidal blood flow in patients with branch retinal vein occlusion (BRVO) with the values in normal controls. METHODS: The study included male and female patients with manifest BRVO (n=16) and a healthy sex- and age-matched control group (n=36). Fundus pulsation amplitude (FPA) was measured in the fovea by laser interferometry to assess pulsatile choroidal blood flow. RESULTS: The FPA in eyes with BRVO (4.4 microm) was significantly higher than in the fellow eye (3.8 microm; P<0.0005). There was also a significant difference between the affected eye of the patients and the healthy control group (3.3 microm; P<0.0009). CONCLUSION: The increase in FPA indicates increased choroidal blood flow resulting from some local mechanisms compensating for the decrease in retinal blood flow.