Ten-year follow-up of eyes treated with stereotactic fractionated external beam radiation for neovascular age-related macular degeneration.

PURPOSE: To determine the long-term effects of stereotactic fractionated external beam radiation on eyes treated for neovascular age-related macular degeneration. METHODS: A retrospective review of all eyes treated with stereotactic fractionated external beam radiation (20-40 Gy, 2-Gy fractions) between 1997 and 2000 was performed to identify eyes with ≥ 2-year follow-up for analysis. A subset was imaged prospectively using a high-resolution Fourier-domain optical coherence tomography. RESULTS: Among 94 eyes treated, 33 eyes (32 subjects) had ≥ 2-year follow-up information (mean follow-up, 6.2 years; range, 2-10 years). Final visual acuity ranged from 20/50 to no light perception. Final macular findings included central geographic atrophy (49%), disciform scar (30%), and active choroidal neovascular membrane (9%). Fourier-domain optical coherence tomography images of three eyes with geographic atrophy revealed photoreceptor layer loss within areas of geographic atrophy with intact retinal morphology in areas of radiation exposure outside geographic atrophy. Radiation retinopathy was suspected in 18% and confirmed by fluorescein angiography in 15%, ranging from mild to neovascular glaucoma/phthisis bulbi (2 eyes). Mean time from stereotactic fractionated external beam radiation to development of radiation retinopathy was 5.4 years (range, 1-10 years). CONCLUSION: A moderate rate of delayed radiation retinopathy was noted in eyes with neovascular age-related macular degeneration treated with stereotactic fractionated external beam radiation. Geographic atrophy was a common finding.

B-cell lymphoma line (Raji) viability and surface marker expression minimally affected by 20- and 25-gauge vitrectomy systems analyzed by flow cytometry.

PURPOSE: The purpose of this study was to evaluate the effect of 20-gauge (20-G) and 25-gauge (25-G) vitrectomy on cell viability and diagnostic yield (surface marker expression) using flow cytometry and human lymphoma cells in culture. METHODS: Cultured human Burkitt lymphoma cells (Raji B-cell lymphoma line) were allocated into five study groups in Roswell Park Memorial Institute media. By using manual aspiration, cells were then processed by aspiration alone, by 20-G vitrectomy at 600 cuts per minute (cpm) and 1,500 cpm, or by 25-G vitrectomy at both 600 and 1,500 cpm. To assess cell viability and cell surface marker expression, samples underwent standard flow cytometry analysis for suspected lymphoma using 7-amino-actinomycin D and antibodies against CD45, CD19, lambda, and kappa light chains. RESULTS: Twenty-five samples were processed after being divided into four vitrectomy groups and one nonvitrectomy group (control). The mean cell viability was 98.5 for both the nonvitrectomized and vitrectomized specimens. The percentage of cells positive for CD45 or kappa light chain was the same in the nonvitrectomized and vitrectomized groups. In addition, the level of expression of these molecules was not significantly different in all five groups. Similarly, no difference was seen for these markers between 20-G and 25-G vitrectomy at either a cut rate of 600 or 1,500 cpm. The percentage positive for CD19 was significantly lower for the 20-G vitrectomy at 1,500 cpm compared with the 25-G vitrectomy at both 600 and 1,500 cpm. Percentage of CD19 cells was greater for the 25-G vitrectomy at 600 cpm than the nonvitrectomy group. CONCLUSION: Compared with simple aspiration, both 20-G and 25-G vitrectomy seem to have no significant effect on cell viability or diagnostic yield for B-cell lymphoma cells (Raji cell line) in suspension based on flow cytometry. Further studies need to be conducted to study and compare 20-G versus 25-G vitrectomy on lymphoma cells in human vitreous or in an animal model.

Optical Coherence Tomography Findings of Exophytic Retinal Capillary Hemangiomas of the Posterior Pole.

Exophytic retinal capillary hemangiomas (RCH) can be a diagnostic challenge in subjects without von Hippel-Lindau disease (VHL). This report of two cases describes the optical coherence tomographic (OCT) characteristics of RCH in two eyes of a subject with VHL and in one eye of an otherwise normal subject. Three different OCT instruments were used (Stratus, Cirrus and/or custom high resolution Fourier-domain OCT with 4.5 mum axial resolution) depending on availability. All instruments localized the tumor to the outer retina. A sharp border between the tumor and overlying inner retina was noted. The tumor bulged into the subretinal space and showed marked shadowing. Associated cystoid macular edema and subretinal fluid were noted. High-resolution Fourier-domain OCT showed a focal photoreceptor layer rip in the adjacent tumor-free macula in one eye with poor vision after treatment. OCT may be a useful tool in diagnosing RCH and studying associated morphologic changes.