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1.
Invest Ophthalmol Vis Sci ; 60(4): 1096-1104, 2019 03 01.
Article in English | MEDLINE | ID: mdl-30901386

ABSTRACT

Purpose: To evaluate the 2-year changes in myopic maculopathy and its associations in highly myopic eyes. Methods: This was a longitudinal, observational cohort study involving 657 Chinese participants with bilateral high myopia (≤ -6.00 diopters spherical power), who were followed for 2 years. The worst eye of each participant was considered for the analysis. Myopic maculopathy was graded based on fundus photographs, using the International Photographic Classification and Grading System for Myopic Maculopathy. Results: The mean baseline age was 21.6 ± 12.2 years (range, 6.8-69.7 years). Myopic maculopathy progressed in 97 (14.8%) of 657 eyes, of which 24 eyes progressed to a higher category of myopic maculopathy, including from no maculopathy to tessellated fundus in 17 eyes, from tessellated fundus to diffuse atrophy in 6 eyes, and from diffuse to patchy atrophy in 1 eye. Among 122 lesion changes identified, the most common changes were enlargement of diffuse atrophy (n = 50, 41.0%), appearance of lacquer cracks (n = 28, 23.0%), enlargement of patchy atrophy (n = 10, 8.2%) and development of additional lacquer cracks (n = 7, 5.8%). In addition, we identified 1 eye with enlargement of a Fuch's spot, and 1 eye with active choroidal neovascularization. In multiple logistic regression analysis, myopic maculopathy progression was associated with older age, longer axial length, greater change in myopic spherical equivalent and more severe myopic maculopathy at baseline. Conclusions: Myopic maculopathy progressed in approximately 15% of highly myopic eyes over a 2-year period. Further studies with longer follow up periods are required to confirm identified risk factors for progression.


Subject(s)
Asian People/ethnology , Choroid Diseases/diagnosis , Myopia, Degenerative/complications , Retinal Diseases/diagnosis , Adolescent , Adult , Aged , Child , China/epidemiology , Choroid Diseases/ethnology , Cohort Studies , Diagnostic Techniques, Ophthalmological , Disease Progression , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myopia, Degenerative/ethnology , Photography , Retinal Diseases/ethnology , Risk Factors , Visual Acuity
2.
Ophthalmic Surg Lasers Imaging Retina ; 49(10): 748-756, 2018 10 01.
Article in English | MEDLINE | ID: mdl-30395660

ABSTRACT

BACKGROUND AND OBJECTIVES: To describe the imaging characteristics of polypoidal choroidal vasculopathy (PCV) in optical coherence tomography angiography (OCTA) and demonstrate its use as diagnostic method for this pathology in a Latin American population. PATIENTS AND METHODS: A case series. RESULTS: Fourteen eyes were evaluated. At baseline, the most frequent morphology was the "oval" type (76.9%), obtaining a reduction of 53.8% after treatment. The intrinsic finding of the polyps was hyporeflective content prior to treatment (80.8%), which reduced after treatment (7.7%) (P = .016). CONCLUSIONS: OCTA is a useful imaging tool for detecting findings that can guide the diagnosis of PCV without contrast medium. Likewise, it provides signs that can suggest the behavior of the lesion prior to and after treatment, enriching the understanding of the pathology and therefore aiming to an efficient therapy. To the best of the authors' knowledge, this is the first study in a Latin American population. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:748-756.].


Subject(s)
Choroid Diseases/diagnosis , Choroid/blood supply , Fluorescein Angiography/methods , Hispanic or Latino , Polyps/diagnosis , Retinal Vessels/pathology , Tomography, Optical Coherence/methods , Aged , Choroid Diseases/ethnology , Female , Follow-Up Studies , Fundus Oculi , Humans , Incidence , Male , Middle Aged , Polyps/ethnology , Retrospective Studies , United States/epidemiology
3.
Invest Ophthalmol Vis Sci ; 59(12): 4963-4967, 2018 10 01.
Article in English | MEDLINE | ID: mdl-30326064

ABSTRACT

Purpose: Tessellation of the ocular fundus is commonly found at a mild stage in myopic eyes, and their locations vary among individuals. We conducted this study to determine the distribution of tessellation locations in a population study. Methods: A cross-sectional, population-based study. Residents of Kumejima older than 40 years were studied. The subjects filled out a comprehensive questionnaire, had their body height (BH) measured, and had an ocular examination. The location of the tessellation was classified into 6 patterns. Correlations between each pattern and the axial length (AL), age, and BH were statistically determined. Results: Reliable measurements of the AL and fundus photographs of the right eyes were obtained from 1670 subjects. Nine hundred eleven eyes had no tessellation, 113 eyes had tessellation in the posterior pole, 118 eyes had tessellation in the macular area, 383 eyes had tessellation in the peripapillary region, 6 eyes had tessellation in the nasal region, and 239 eyes had tessellation in the inferior region. The AL of the "no tessellation" group was significantly shorter than that of the posterior pole and macular groups (P < 0.01). The individuals of the posterior pole and peripapillary groups were significantly older than in all other groups (P < 0.05) except for the nasal group. The individuals in the inferior tessellation group were significantly taller than those in the no tessellation, posterior pole, and peripapillary groups (P < 0.01). Conclusions: The location distribution of the tessellation is important in correctly interpreting and predicting myopic changes.


Subject(s)
Choroid Diseases/diagnosis , Choroid/pathology , Myopia, Degenerative/diagnosis , Adult , Aged , Aged, 80 and over , Asian People/ethnology , Axial Length, Eye/pathology , Choroid Diseases/ethnology , Cross-Sectional Studies , Dilatation, Pathologic/diagnosis , Dilatation, Pathologic/ethnology , Female , Fundus Oculi , Humans , Japan/epidemiology , Male , Middle Aged , Myopia, Degenerative/ethnology
4.
Sci Rep ; 6: 28639, 2016 06 24.
Article in English | MEDLINE | ID: mdl-27338780

ABSTRACT

Exudative age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) share similar abnormal choroidal vasculature, but responses to treatments are different. In this study, we sequenced the whole HTRA1 gene and its promoter by direct sequencing in a Hong Kong Chinese PCV cohort. We identified rs11200638, c.34delCinsTCCT, c.59C>T, rs1049331 and rs2293870 significantly associated with PCV. Notably, rs2672598 was significantly associated with exudative AMD (p = 1.31 × 10(-4)) than PCV (p = 0.11). Logistic regression indicated that rs2672598 (p = 2.27 × 10(-3)) remained significant after adjusting for rs11200638 in exudative AMD. Moreover, the rs11200638-rs2672598 joint genotype AA-CC conferred higher risk to exudative AMD (43.11 folds) than PCV (3.68 folds). Promoter analysis showed that rs2672598 C-allele showed higher luciferase expression than wildtype T-allele (p = 0.026), independent of rs11200638 genotype (p = 0.621). Coherently, vitreous humor HTRA1 expression with rs2672598 CC genotype was significantly higher than that with TT genotype by 2.56 folds (p = 0.02). Furthermore, rs2672598 C-allele was predicted to alter the transcription factor binding sites, but not rs11200638 A-allele. Our results revealed that HTRA1 rs2672598 is more significantly associated with exudative AMD than PCV in ARMS2/HTRA1 region, and it is responsible for elevated HTRA1 transcriptional activity and HTRA1 protein expression.


Subject(s)
Choroid Diseases/genetics , Genetic Predisposition to Disease/genetics , High-Temperature Requirement A Serine Peptidase 1/genetics , Polymorphism, Single Nucleotide , Promoter Regions, Genetic/genetics , Wet Macular Degeneration/genetics , Adult , Aged , Aged, 80 and over , Alleles , Asian People/genetics , Choroid Diseases/diagnosis , Choroid Diseases/ethnology , Diagnosis, Differential , Female , Gene Frequency , Genetic Predisposition to Disease/ethnology , Genotype , Haplotypes , Hong Kong , Humans , Male , Middle Aged , Wet Macular Degeneration/diagnosis , Wet Macular Degeneration/ethnology
5.
Graefes Arch Clin Exp Ophthalmol ; 254(11): 2119-2129, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27106626

ABSTRACT

PURPOSE: We aimed to study the morphological characteristics of myopic posterior staphyloma in Caucasians and to evaluate the correlation between posterior staphyloma, myopic macular lesions and visual acuity. METHODS: Ninety eyes of 67 consecutive patients affected by high myopia associated with posterior staphyloma were recruited between January 2012 and December 2013. Posterior staphyloma was classified according to Curtin's criteria. Every patient underwent fundoscopic examination and best corrected visual acuity measurement (BCVA). A and B-scan ultrasound (US), high-resolution, three-dimensional magnetic resonance image (MRI), optical coherence tomography (OCT), fundus autofluorescence (FAF), red free (RF) and color fundus photography studies were performed. RESULTS: The mean age was 64.4 ± 9.48 years (range: 41-82). The mean BCVA was 0.7 ± 0.5 logMAR (range: 0-2). The mean axial length was 29.92 ± 2.39 millimeters (range: 24.25-36.53). The authors found four types of posterior staphyloma according to Curtin's classification: I, II, IV and IX. Significant prevalence of posterior staphyloma in female sex was observed (p = 0.0235). Significant correlation between the depth and the diameters of posterior staphyloma was demonstrated (p < 0.0001). Significant association between posterior staphyloma type and tomographic foveal patterns (p = 0.0230) was highlighted. Posterior staphyloma type I was more frequently associated with peripapillary atrophy and less with macular atrophy compared to type II and IX (p = 0.0169). The prevalence of macular atrophy was more than double in posterior staphyloma type II (33.3 %) in comparison to posterior staphyloma type I (12.5 %). CONCLUSIONS: This study confirms that the type I and II are the most common types of posterior staphyloma, as already highlighted in the literature. A significant association between the type of posterior staphyloma and the MRI ocular shape pattern, the OCT patterns of macular profile and the location of chorioretinal atrophy was highlighted. The correlation between the depth and the width of posterior staphyloma has demonstrated that the deeper the staphyloma, the wider it was. The deepest area of the posterior staphyloma was characterized by a greater thinning of the sclera and by a higher prevalence of chorioretinal atrophy compared to the other parts of the eye. More studies are necessary to support our findings and to add more information on the natural evolution of posterior staphyloma and on its associated complications.


Subject(s)
Choroid Diseases/diagnosis , Myopia, Degenerative/diagnosis , Posterior Eye Segment/pathology , Retinal Diseases/diagnosis , Scleral Diseases/diagnosis , Visual Acuity , White People , Adult , Aged , Aged, 80 and over , Axial Length, Eye/pathology , Choroid Diseases/ethnology , Female , Follow-Up Studies , Humans , Imaging, Three-Dimensional , Incidence , Italy/epidemiology , Magnetic Resonance Imaging , Male , Middle Aged , Myopia, Degenerative/ethnology , Retinal Diseases/ethnology , Retrospective Studies , Scleral Diseases/ethnology , Tomography, Optical Coherence
8.
Br J Ophthalmol ; 98(2): 188-94, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24246375

ABSTRACT

AIMS: To determine the prevalence of polypoidal choroidal vasculopathy (PCV) in patients with presumed neovascular age-related macular degeneration (AMD) who were considered poor responders to ranibizumab. METHODS: Caucasian patients with suspected neovascular AMD, presumed to be choroidal neovascularisation, previously treated with ≥8 intravitreal injections of ranibizumab 0.5 mg (Lucentis; Novartis AG, Basel, Switzerland) administered as required during optical coherence tomography-guided dosing were retrospectively included. Eyes were categorised according to the time from injection 1 to injection 6 (group 1: <12 months; group 2: ≥12 months). Indocyanine green angiography (ICGA) was used to re-evaluate eyes for PCV. Suitable candidates received reduced-fluence photodynamic therapy/ranibizumab combination therapy supplemented by ranibizumab monotherapy, as required. RESULTS: 202 eyes were included (group 1: 73.8%; group 2: 26.2%). The prevalence of PCV in group 1 (21.5%) was significantly higher than in group 2 (3.8%; p=0.003). After initiation of combination therapy, 16 eyes with PCV received 3.1±2.5 ranibizumab injections/year vs 8.4±2.4 injections/year before initiation of combination therapy (p<0.001). CONCLUSIONS: In Caucasian patients with presumed neovascular AMD, PCV prevalence is increased in eyes that respond poorly to ranibizumab monotherapy. ICGA improved PCV diagnosis in poor responders; combination therapy may be beneficial for eyes with PCV.


Subject(s)
Antibodies, Monoclonal, Humanized/administration & dosage , Choroid Diseases/ethnology , Choroid/blood supply , Macular Degeneration/complications , White People , Aged , Aged, 80 and over , Choroid Diseases/complications , Choroid Diseases/drug therapy , Choroidal Neovascularization/complications , Choroidal Neovascularization/diagnosis , Choroidal Neovascularization/drug therapy , Female , Fluorescein Angiography , Follow-Up Studies , Humans , Intravitreal Injections , Macular Degeneration/diagnosis , Macular Degeneration/drug therapy , Male , Middle Aged , Prevalence , Ranibizumab , Retrospective Studies , Switzerland/epidemiology , Tomography, Optical Coherence
9.
Retina ; 33(9): 1949-58, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23612049

ABSTRACT

PURPOSE: To determine baseline factors predictive of outcomes 1 year after 3 monthly intravitreal ranibizumab injections followed by as-needed injections for polypoidal choroidal vasculopathy. METHODS: A nonrandomized prospective 1-year trial collected data from 144 Japanese patients (144 eyes) with symptomatic polypoidal choroidal vasculopathy who received one 0.5-mg intravitreal ranibizumab injection monthly for 3 months followed by as-needed retreatments. Statistical analysis evaluated baseline independent factors predictive of better visual acuity and the need for fewer injections 1 year after the first injection. RESULTS: After the initial 3 monthly injections, a mean ± standard deviation of 1.2 ± 1.1 as-needed injections was administered. The mean visual acuity improved significantly (P < 0.01) from 20/80 to 20/50. Better visual acuity and no history of photodynamic therapy or clusters of grape-like polypoidal lesions were significant independent baseline factors predictive of better visual acuity 1 year after the first injection. No factors were significantly associated with a need for fewer ranibizumab reinjections during follow-up. CONCLUSION: The baseline clinical characteristics predicted favorable visual acuity outcomes. These findings might be useful to explaining the prognosis of ranibizumab treatment to the patients with polypoidal choroidal vasculopathy.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Choroid Diseases/drug therapy , Polyps/drug therapy , Aged , Aged, 80 and over , Asian People/ethnology , Choroid Diseases/diagnosis , Choroid Diseases/ethnology , Coloring Agents , Drug Administration Schedule , Female , Fluorescein Angiography , Humans , Indocyanine Green , Intravitreal Injections , Male , Middle Aged , Polyps/diagnosis , Polyps/ethnology , Prospective Studies , Ranibizumab , Retreatment , Treatment Outcome , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/physiology
11.
Retina ; 31(8): 1598-602, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21478804

ABSTRACT

PURPOSE: To evaluate the natural course and possible funduscopic risk factors for polypoidal choroidal vasculopathy in a Japanese population. METHODS: The records of 42 eyes from 41 patients (27 men and 14 women) diagnosed as having polypoidal choroidal vasculopathy located in the macula between November 1999 and October 2005 were retrospectively reviewed. The funduscopic findings at the first visit were evaluated. The changes in the best-corrected visual acuity (BCVA) from the baseline to 12 months were analyzed. The lesion types (clustered vs. nonclustered) found on indocyanine green angiography were compared for changes in the BCVA from the initial visit to 12 months. RESULTS: The mean age of the subjects was 73.8 ± 8.0 years. The mean logarithm of the minimum angle of resolution (LogMAR) BCVA was 0.48 ± 4.0 at baseline and deteriorated to 0.75 ± 5.7 after 12 months, which was statistically significant (P = 0.00075). The mean LogMAR BCVA in the patients showing "nonclustered" polypoidal choroidal lesions on indocyanine green angiography was maintained for 12 months, while that of the "clustered" group decreased significantly during the same period (P = 0.0014). CONCLUSION: Polypoidal choroidal vasculopathy did not show a favorable outcome in terms of the mean BCVA 12 months after the initial visit. The clustered polypoidal choroidal lesions on indocyanine green angiography may be related to poor prognosis of polypoidal choroidal vasculopathy over the natural course.


Subject(s)
Choroid Diseases/etiology , Choroid/blood supply , Peripheral Vascular Diseases/etiology , Aged , Aged, 80 and over , Asian People/ethnology , Choroid Diseases/diagnosis , Choroid Diseases/ethnology , Choroid Diseases/physiopathology , Coloring Agents , Female , Fluorescein Angiography , Follow-Up Studies , Humans , Indocyanine Green , Japan/ethnology , Male , Middle Aged , Ophthalmoscopes , Peripheral Vascular Diseases/diagnosis , Peripheral Vascular Diseases/ethnology , Peripheral Vascular Diseases/physiopathology , Prognosis , Retrospective Studies , Risk Factors , Visual Acuity/physiology
12.
Retina ; 31(8): 1680-91, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21499193

ABSTRACT

PURPOSE: To characterize the clinical features of punctate inner choroidopathy (PIC) in Chinese patients. METHODS: A retrospective chart review of all patients admitted with PIC from June 1999 to October 2009. RESULTS: Of the 75 patients (112 eyes) diagnosed with PIC, 72% were women, 80% were myopic, and 49% exhibited bilateral involvement. The mean age at presentation was 32 years. Blurred central vision (64%) and scotoma (40%) were the most common symptoms. Multifocal PIC lesions were mostly restricted to the posterior pole (95%). The acute lesions were yellow and demonstrated hyperfluorescence (61%) or mild hyperfluorescence (36%) on fluorescein angiography, mostly (75%) <200 µm in diameter and <10 in number. Indocyanine angiography showed subclinical hypofluorescent spots in 32% of the affected eyes. Choroidal neovascularization developed in 63% of affected eyes. Papilledema (3%) and segmental retinal phlebitis (2%) were rare. Intact follow-up data of 27 patients (43 eyes) were available. Acute lesions turned into punched-out atrophic lesions within 3 months. New visible lesions developed in 5 eyes within 1 year after symptom onset. New choroidal neovascularization developed in five eyes. The mean best-corrected visual acuity significantly improved at last follow-up (P = 0.039). CONCLUSION: Punctate inner choroidopathy in Chinese is not rare and primarily affects young myopic women. It features multifocal, small, yellow lesions that develop within a short period, principally in the posterior pole, with subsequent atrophy. Complicated choroidal neovascularization is frequent. General visual prognosis is moderately good.


Subject(s)
Choroid Diseases/diagnosis , Adolescent , Adult , Asian People/ethnology , China/epidemiology , Choroid/pathology , Choroid Diseases/ethnology , Female , Fluorescein Angiography , Humans , Male , Middle Aged , Myopia/complications , Retrospective Studies , Vision Disorders/diagnosis , Vision Disorders/ethnology , Visual Acuity , Young Adult
13.
Graefes Arch Clin Exp Ophthalmol ; 249(7): 975-9, 2011 Jul.
Article in English | MEDLINE | ID: mdl-21153654

ABSTRACT

PURPOSE: To describe the clinical characteristics of polypoidal choroidal vasculopathy (PCV) in a large number of Chinese patients. METHODS: This study enrolled 204 consecutive patients (246 eyes) in our department who were diagnosed as having polypoidal choroidal vasculopathy PCV. Patients underwent ophthalmologic examinations including best-corrected visual acuity (BCVA) testing, ophthalmoscopy, fundus photography, fluorescein angiography, indocyanine green angiography, and optic coherence tomography. RESULTS: Mean patient age was 66.1 years and 60.3% were men. Of the cases, 79.4% were unilateral and 51.2% of BCVA was less than 35 letters. In 171 eyes (69.5%), polypoidal lesions were located in the macula area. Among them, polypoidal lesions were located in the foveal area in 29 eyes (11.8%), in the parafoveal area in 50 eyes (20.3%), and in the extrafoveal area in 88 eyes (35.8%), in both the foveal and parafoveal area in three eyes (1.2%), and in both the parafoveal and extrafoveal area in one eye (0.4%). In 37 eyes (15.0%), PCV lesions were under the temporal retinal vascular arcade; in 11 eyes (4.5%), PCV lesions were found peripapillary. PCV lesion formation was single in 88 eyes (35.8%), cluster in 145 eyes (59.0%), string in two eyes (0.8%), and branch in two eyes (0.8%). In nine eyes (3.6%), the formation of PCV lesions showed both single and cluster shape in the same eye. There were 54.5% with drusen, 44.7% with serous PED, 20.7% with hemorrhagic PED, and 39.0% with neuroretinal detachment. CONCLUSIONS: The majority of Chinese PCV patients were male, unilateral, and showed macular polyps. Drusen, serous PED, hemorrhagic PED, and neuroretinal detachment on OCT were commonly seen.


Subject(s)
Choroid Diseases/diagnosis , Choroid/blood supply , Peripheral Vascular Diseases/diagnosis , Adult , Aged , Aged, 80 and over , Asian People/ethnology , Choroid Diseases/ethnology , Coloring Agents , Female , Fluorescein Angiography , Humans , Indocyanine Green , Macular Degeneration/diagnosis , Macular Degeneration/ethnology , Male , Middle Aged , Peripheral Vascular Diseases/ethnology , Retinal Detachment/diagnosis , Retinal Detachment/ethnology , Retrospective Studies , Tomography, Optical Coherence , Visual Acuity/physiology
14.
Retina ; 31(5): 857-65, 2011 May.
Article in English | MEDLINE | ID: mdl-21124252

ABSTRACT

PURPOSE: The purpose of this study was to determine the factors predictive of visual acuity (VA) outcomes 1 year after photodynamic therapy (PDT) for polypoidal choroidal vasculopathy. METHODS: We prospectively studied 220 eyes of 210 Japanese patients with polypoidal choroidal vasculopathy treated with primary application of PDT. A stepwise logistic regression model was used to estimate the independent factors predictive of better VA and improvement of VA 1 year after the primary PDT. RESULTS: Visual acuities at the various follow-up evaluations improved significantly compared with baseline (P = 0.001 for all comparisons). The VA improved and decreased more than 0.3 logarithm of minimum angle of resolution unit 1 year after the primary PDT in 55 (25%) and 21 (10%) eyes, respectively. Stepwise logistic regression analysis showed that younger age, smaller greatest linear dimension, better baseline VA, and less baseline hemorrhage were significant and independent factors predictive of better VA 1 year after PDT, and younger age, smaller greatest linear dimension, better baseline VA, less hemorrhaging, and the presence of a serous macular detachment at baseline were significant and independent factors predictive of VA improvement. CONCLUSION: Photodynamic therapy stabilized eyes anatomically and functionally. Clinical characteristics at baseline were predictors of favorable VA outcomes after PDT. These findings may help establish the strategy of treatment for polypoidal choroidal vasculopathy.


Subject(s)
Choroid Diseases/drug therapy , Choroid/blood supply , Peripheral Vascular Diseases/drug therapy , Photochemotherapy , Visual Acuity/physiology , Aged , Aged, 80 and over , Asian People/ethnology , Choroid Diseases/ethnology , Choroid Diseases/physiopathology , Female , Fluorescein Angiography , Humans , Male , Middle Aged , Peripheral Vascular Diseases/ethnology , Peripheral Vascular Diseases/physiopathology , Prospective Studies , Tomography, Optical Coherence , Treatment Outcome
15.
Ocul Immunol Inflamm ; 17(4): 269-77, 2009.
Article in English | MEDLINE | ID: mdl-19657982

ABSTRACT

PURPOSE: To determine clinical features of patients with severe chronic central serous chorioretinopathy (diffuse retinal pigment epitheliopathy, DRPE) associated with bullous retinal detachment in Thailand. METHODS: The authors reviewed clinical and imaging characteristics, visual outcomes, and complications of 7 patients with severe DRPE associated with bullous retinal detachment. RESULTS: Included were 6 males and 1 female with average age at onset of 39 years (range 30-46 years) diagnosed with DRPE. Although 4 patients had unilateral complaints, retinal pigment epithelium (RPE) changes on fluorescein angiography (FA) were visible in both eyes in all patients and 10 out of 14 affected eyes exhibited large exudative bullous retinal detachments (RD) and evidence of multiple characteristic leakage points. The disease was induced by steroid medications in 3 patients and an additional 3 patients received steroid treatment after they were initially considered to have Harada disease. The administration of steroids caused worsening in all cases. CONCLUSION: Chronic central serous chorioretinopathy associated with bullous retinal detachment is a severe variant of DRPE, which might be mistaken for Harada disease. The early diagnosis of DRPE might prevent the complications from harmful medications as well as unnecessary surgery and visual loss.


Subject(s)
Asian People , Choroid Diseases/complications , Retinal Detachment/complications , Retinal Diseases/complications , Retinal Pigment Epithelium , Adult , Choroid Diseases/chemically induced , Choroid Diseases/ethnology , Chronic Disease , Diagnosis, Differential , Disease Progression , Exudates and Transudates/metabolism , Female , Fluorescein Angiography , Humans , Male , Middle Aged , Prognosis , Retinal Detachment/chemically induced , Retinal Detachment/ethnology , Retinal Detachment/metabolism , Retinal Diseases/chemically induced , Retinal Diseases/diagnosis , Retinal Diseases/ethnology , Retinal Pigment Epithelium/drug effects , Steroids/adverse effects , Uveomeningoencephalitic Syndrome/diagnosis , Visual Acuity
16.
J Fr Ophtalmol ; 31(6 Pt 1): 579-84, 2008 Jun.
Article in French | MEDLINE | ID: mdl-18772808

ABSTRACT

OBJECTIVES: To clarify the clinical and angiographic characteristics of idiopathic polypoidal choroidal vasculopathy (IPCV) and its natural course. METHODS: Descriptive, prospective, consecutive case series of patients with presumed IPCV seen at Fort-de-France Hospital Center (French West Indies) between January and June 2006. All participants underwent complete eye examination and fluorescein and indocyanine green (ICG) angiography. The nature and location of the lesions were assessed in all eyes. Inclusion criteria were demonstration of characteristic lesions of IPCV on ICG angiography. RESULTS: Diagnosis of IPCV was made in 26 eyes of 14 patients, ten women and four men, all of Afro-Caribbean origin. The mean age was 77.4 years (range 60-92 years). Drusen were present in 13 eyes (50%), age-related macular degeneration (AMD) in one eye, and branch retinal vein occlusion in one eye. Twelve patients (85.7%) had bilateral involvement. Twelve eyes (46.2%) had visual acuity (VA) (Snellen) worse than 20/200, six eyes (23.1%) had VA between 20/200 and 20/100, and eight eyes (30.8%) had VA better than 20/100. On ICG angiography, lesions were predominantly located in the peripapillary area but also in the midperiphery, the macular and interpapillomacular areas, and the far periphery. CONCLUSION: Peripheral locations of IPCV and associations with drusen or AMD are not rare. The prognosis of the disease is poor in its natural course. Its etiology is unknown but genetic factors are probably involved. It is the main differential diagnosis for exudative AMD in black patients.


Subject(s)
Choroid Diseases/diagnostic imaging , Choroid/blood supply , Aged , Aged, 80 and over , Choroid Diseases/complications , Choroid Diseases/ethnology , Choroid Diseases/pathology , Dilatation, Pathologic/diagnostic imaging , Disease Progression , Ethnicity , Female , Fluorescein , Fluorescein Angiography , Humans , Indocyanine Green , Macular Degeneration/complications , Macular Degeneration/diagnostic imaging , Male , Martinique/epidemiology , Middle Aged , Prospective Studies , Radiography , Retinal Drusen/complications , Retinal Drusen/diagnostic imaging , Retinal Vein Occlusion/complications , Retinal Vein Occlusion/diagnostic imaging , Visual Acuity
17.
Am J Ophthalmol ; 144(1): 15-22, 2007 Jul.
Article in English | MEDLINE | ID: mdl-17509509

ABSTRACT

PURPOSE: To clarify the clinical characteristics of exudative age-related macular degeneration (AMD) in Japanese patients. DESIGN: Retrospective, observational, consecutive case series. METHODS: Two hundred and eighty-nine patients with neovascular AMD were examined. RESULTS: The authors classified the patients into three subtypes of neovascular AMD: polypoidal choroidal vasculopathy (PCV), retinal angiomatous proliferation (RAP), and typical AMD. One hundred and fifty-eight patients (54.7%) were diagnosed with PCV and 102 patients (35.3%) with typical AMD. RAP was observed in 13 patients (4.5%). In 16 patients (5.5%), one eye had PCV and the other eye had typical AMD. Most patients with PCV and typical AMD had unilateral disease (81.6% and 94.1%, respectively) with a male preponderance (77.8% and 71.6%, respectively). Nine of 13 patients with RAP were female (69.2%). Patients with RAP were older (mean, 80.3 years for men and 75.3 years for women) than patients with other subtypes. Serous and hemorrhagic pigment epithelial detachment developed in 69 patients (43.7%) with PCV, 22 patients (21.6%) with typical AMD, and nine patients (69.2%) with RAP. In the patients with unilateral disease in each subtype, large drusen in the unaffected eye were seen in 24.0% with PCV, 30.2% with typical AMD, and 77.8% with RAP. CONCLUSIONS: Neovascular AMD in Japanese patients has different demographic features compared with that in White patients. In Japanese patients, there is a preponderance of PCV, male gender, unilaterality, and absence of drusen in the second eye, with the exception of RAP.


Subject(s)
Choroidal Neovascularization/diagnosis , Macular Degeneration/diagnosis , Aged , Aged, 80 and over , Asian People/ethnology , Choroid/blood supply , Choroid Diseases/diagnosis , Choroid Diseases/ethnology , Choroidal Neovascularization/ethnology , Exudates and Transudates , Female , Fluorescein Angiography , Humans , Japan/epidemiology , Macular Degeneration/ethnology , Male , Peripheral Vascular Diseases/diagnosis , Peripheral Vascular Diseases/ethnology , Retinal Neovascularization/diagnosis , Retinal Neovascularization/ethnology , Retrospective Studies
18.
Ophthalmology ; 113(5): 805-13.e5, 2006 May.
Article in English | MEDLINE | ID: mdl-16650676

ABSTRACT

PURPOSE: To describe the demographic and clinical characteristics of central serous chorioretinopathy (CSC) after solid organ transplantation. DESIGN: Case series. PARTICIPANTS: Fifteen patients who presented to the authors with CSC after solid organ transplantation. METHODS: We performed a retrospective chart review to identify patient demographics and clinical features of disease, including angiographic changes. MAIN OUTCOME MEASURES: Patterns of CSC. These patterns were compared with type of organ received, demographics, and visual outcome. RESULTS: We identified 25 eyes of 7 women (46.7%) and 8 men (53.3%) that developed CSC after solid organ transplantation. Patient ages ranged from 27 to 55 years (median, 40). Seven of the 15 patients (46.7%) were Caucasian, including 3 Hispanic patients (20%). Of the 8 remaining patients (53.3%), 2 were African American (13.3%), 2 were Filipino (13.3%), and 4 were Asian (26.7%). The organs received included 13 kidneys (86.7%), 1 liver (6.7%), and 1 heart (6.7%). Systemic hypertension was reported in 14 of 15 patients (93.3%). All patients were receiving systemic immunosuppressive drugs at presentation; 14 of 15 (93.3%) were also receiving systemic corticosteroids. Visual acuity at presentation ranged from 20/20 to counting fingers. Patterns of CSC included (1) geographic or diffuse alterations in the retinal pigment epithelium (5 eyes; 2 bilateral, 1 unilateral), (2) focal CSC (6 eyes, all unilateral), (3) multifocal CSC (6 eyes; 2 bilateral, 2 unilateral), and (4) CSC with bullous retinal detachment (8 eyes, all bilateral). Follow-up, available for 21 affected eyes of 13 patients, ranged from 1 month to 6 years (median, 12 months). Compared with other solid organ transplant recipients at our institutions, renal transplant recipients (P = 0.003), as well as Hispanic and Asian patients (P = 0.05), were more prevalent in this cohort. CONCLUSION: Central serous chorioretinopathy after solid organ transplantation varies in presentation and severity. Our observations support a role for choroidal vascular compromise in the pathogenesis of this disorder.


Subject(s)
Choroid Diseases/etiology , Organ Transplantation/adverse effects , Retinal Diseases/etiology , Adult , Choroid Diseases/diagnosis , Choroid Diseases/ethnology , Choroid Diseases/surgery , Female , Fluorescein Angiography , Graft Rejection/drug therapy , Humans , Immunosuppressive Agents/therapeutic use , Laser Coagulation , Male , Middle Aged , Retinal Diseases/diagnosis , Retinal Diseases/ethnology , Retinal Diseases/surgery , Retrospective Studies , Risk Factors , Time Factors , Vision Disorders/etiology , Visual Acuity
19.
Am J Ophthalmol ; 138(4): 567-73, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15488782

ABSTRACT

PURPOSE: To study the genotypes, allelic frequencies, and polymorphisms of apolipoprotein E (Apo E) in unrelated Japanese patients with polypoidal choroidal vasculopathy (PCV) or exudative age-related macular degeneration (AMD) and control subjects without macular degeneration. DESIGN: Cross-sectional study. METHODS: Blood samples from 225 subjects older than 50 years were used. The 225 subjects included 58 patients with PCV, 85 with AMD, and 82 without macular degeneration. Coding exons of the Apo E gene were amplified by polymerase chain reaction, and the DNA sequences were determined by direct sequencing with an automated sequencer. RESULTS: Apo E epsilon3/epsilon3 was the most frequent genotype with a prevalence of 79.3% in PCV patients, 76.5% in AMD patients, and 67.1% in the control subjects. However, the differences in the percentages were not statistically significant among the three groups. The most frequently found allele in the three groups was epsilon3. Patients with PCV and AMD were less likely to have epsilon2 and epsilon4 than the control subjects, but the differences were not statistically significant. Five minor Apo E single nucleotide polymorphisms, including epsilon5 and epsilon7, were found. CONCLUSION: Japanese patients with PCV and AMD were less likely to have epsilon2 and epsilon4 polymorphisms, but the differences from the normals were not statistically significant for the Apo E genotypes and allelic frequencies.


Subject(s)
Apolipoproteins E/genetics , Choroid Diseases/genetics , Choroid/blood supply , Macular Degeneration/genetics , Polymorphism, Genetic , Aged , Aged, 80 and over , Alleles , Choroid Diseases/ethnology , Cross-Sectional Studies , DNA/analysis , Female , Fluorescein Angiography , Gene Frequency , Humans , Japan/epidemiology , Macular Degeneration/ethnology , Male , Middle Aged , Polymerase Chain Reaction
20.
J Natl Med Assoc ; 95(7): 553-9, 2003 Jul.
Article in English | MEDLINE | ID: mdl-12911253

ABSTRACT

PURPOSE: Central Serous Chorioretinopathy (CSCR) is presumed to be less prevalent in the African American population. The purpose of this study was to compare the characteristics of CSCR in African Americans and Caucasians. METHODS: A retrospective analysis was performed. Visual acuity (VA) evaluations that were recorded included best-corrected VA at diagnosis, worst VA recorded at follow-up, and best-corrected VA at the last clinic visit. Recurrences of CSCR, frequency of laser photocoagulation, and fluorescein angiographic patterns also were evaluated. RESULTS: Of the 74 patients with CSCR, 15 (20.3%) were African American and 59 (79.7%) were Caucasian. This ethnic distribution was similar to the ethnic distribution in the entire Henry Ford Health System population. The mean VA at presentation was significantly lower in African-Americans (20/55 vs. 20/30, P=0.004) and trended towards being lower during follow-up (20/58 vs. 20/32, P=0.04) and at final examination (20/28 vs. 20/22, P=0.04). Mean length of follow-up was 21 months for both groups. CONCLUSION: The rates and spectrum of symptomatic CSCR seen at Henry Ford Health System are comparable in African Americans and Caucasians.


Subject(s)
Black or African American , Choroid Diseases/ethnology , Retinal Diseases/ethnology , Female , Fluorescein Angiography , Humans , Incidence , Male , Retrospective Studies , Visual Acuity
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