Vitreoretinal surgery of retinal detachment and macular hole associated with optic nerve pit: an optical coherence tomography study.

PURPOSE: To describe the course of a case of macular elevation and a full-thickness macular hole associated with optic nerve pit. METHODS: Case report. A 28-year-old woman who had laser-assisted in situ keratomileusis surgery 2.5 years ago presented with decreased vision, full-thickness macular hole, and macular detachment in association with optic nerve pit. Complete ophthalmic examination was done and optical coherence tomography (OCT) was performed before and after vitreoretinal surgery. RESULTS: OCT showed that the macular elevation consisted of both separation of the inner and outer retinal layers with neurosensory retinal detachment. There was a full-thickness macular hole. After vitreous surgery and intraocular gas tamponade, the macular elevation completely resolved, and OCT showed the flattening of the outer and inner retinal layers but the macular hole was not closed. CONCLUSIONS: OCT is a reliable technique to study macular elevation with a hole associated with optic nerve pit before and after vitrectomy and gas tamponade.

Vitreoretinal surgery of retinal detachment and macular hole associated with optic nerve pit: an optical coherence tomography study.

PURPOSE: To describe the course of a case of macular elevation and a full-thickness macular hole associated with optic nerve pit. CASE REPORT: A 28-year-old woman who had laser-assisted in situ keratomileusis surgery 2.5 years ago presented with decreased vision, full-thickness macular hole, and macular detachment in association with optic nerve pit. Complete ophthalmic examination was done and optical coherence tomography (OCT) was performed before and after vitreoretinal surgery. RESULTS: OCT showed that the macular elevation consisted of both separation of the inner and outer retinal layers with neurosensory retinal detachment. There was a full-thickness macular hole. After vitreous surgery and intraocular gas tamponade, the macular elevation completely resolved, and OCT showed the flattening of the outer and inner retinal layers but the macular hole was not closed. CONCLUSIONS: OCT is a reliable technique to study macular elevation with a hole associated with optic nerve pit before and after vitrectomy and gas tamponade.(Eur J Ophthalmol 2004; 14: 355-7).

Goldmann-Favre vitreoretinal degeneration.

PURPOSE: To describe a case of Goldmann-Favre vitreoretinal degeneration with typical clinical findings. METHODS: The case report of a healthy 47-year-old woman with typical clinical findings of Goldmann-Favre vitreoretinal degeneration is presented. She had complaints of reduced visual acuity and night blindness. Her parents were first cousins. RESULTS: Fundus examination revealed annular pigmentary degenerative changes, macular edema, and peripheral retinoschisis in both eyes. Electroretinography results were abnormal. Optical coherence tomography scans revealed hyporeflective spaces in the macular area and irregularities of the chorioretinal complex in the degenerative pigmentary areas. CONCLUSIONS: Typical fundus findings combined with night blindness and electroretinogram abnormalities permited the diagnosis of Goldmann-Favre vitreoretinal degeneration.

Inflammatory pigmented paravenous retinochoroidal atrophy.

PURPOSE: To describe an active inflammatory cause of pigmented paravenous retinochoroidal atrophy. METHODS: A 54-year-old female patient presented with complaints of worsening visual acuity and poor night vision was examined. Fundus examination was performed and color fundus photographs were taken. In addition to fluorescein angiography, visual field examinations and electroretinographic tests were performed. Macular evaluation was performed with optical coherence tomography. RESULTS: Both fundi showed circumscribed patches of retinochoroidal atrophy and pigmentation along the retinal veins. She had also marked vitreous cells with snow ball opacities and cystoid macular edema in both eyes. Fluorescein angiography confirmed the presence of a hyperfluorescence due to widespread paravenous retinal pigment epithelial defect while ICG angiography disclosed hypofluorescence in all phases. The electroretinogram showed reduced responses especially in the left eye. Visual field tests showed scotomas corresponding with areas of atrophy along the retinal veins. CONCLUSIONS: This is a report of the findings in pigmented paravenous retinochoroidal atrophy that is a nonspecific degenerative disease and may occur in association with systemic infections or inflammation. Ocular inflammation with cystoid macular edema is an unusual manifestation of the disease.

Effect of hormone replacement therapy on ocular hemodynamics in postmenopausal women.

PURPOSE: To evaluate the effect of hormone replacement therapy on ocular hemodynamics in postmenopausal women. METHODS: Ocular Doppler ultrasonography was performed in 20 postmenopausal women on hormone replacement therapy (HRT) and in 20 women without treatment, as the control group. Central retinal artery (CRA), posterior ciliary artery (PCA) and ophthalmic artery (OA) flow velocities and vascular resistances were measured prospectively by a radiologist blinded to the therapy. There were no associated systemic or ocular diseases or any medication history. RESULTS: The mean age of the patients on HRT was 50.05 +/- 4.5 yrs (range 44-62). The mean age of the control group was 52.8 +/- 4.09 yrs (range 46-65). The mean duration of HRT was 1.6 +/- 1.4 yrs (range 3 months - 5 years). There were no differences between the groups in terms of flow velocities, vascular resistivities or pulsatility indices of OA, CRA and PCA (p>0.05). CONCLUSIONS: HRT is essential in postmenopausal women for relief of vasomotor symptoms, cardioprotection and prevention of osteoporosis. Even though vaso-occlusive complications of hormone preparations have been reported, we did not observe any changes in ocular hemodynamics detectable with Doppler ultrasonography.

Amiodarone-related optic neuropathy.

BACKGROUND: To evaluate a case of atypical optic neuropathy that presented with blurred vision following the use of an antiarrythmic agent. CASE: Record of the patient was reviewed to determine the etiology of his optic neuropathy. OBSERVATIONS: Ophthalmological examination revealed unilateral optic disc edema with relatively well-preserved visual acuity. In routine tests, results of complete blood count, erythrocyte sedimentation rate, liver and kidney function tests, chest x-ray, Goldmann visual field examination, and brain computed tomography scan were normal. Orbital ultrasonography revealed optic disc edema with prominent optic nerve head and without orbital pathology. CONCLUSIONS: Systemic history and drug intake should be investigated in every patient with optic disc edema. Discontinuation of the medication can prevent further optic nerve damage or involvement of the other eye.

Indocyanine green videoangiography and color Doppler imaging in Behçet's disease.

PURPOSE: The purpose of this study was to examine the status of the retina and the choroid, and to evaluate blood flow velocity in the central retinal (CRA) and ophthalmic artery in Behçet's disease. METHODS: Digital fluorescein and indocyanine green (ICG) videoangiography were performed in 53 eyes and color Doppler ultrasonography in 61 eyes of 31 Behçet patients, between December 1993-January 1996. RESULTS: Fluorescein angiography revealed no vascular leakage in 7, and diffuse retinal and/or disc leakage due to vasculitis in 46 eyes. ICG angiography was normal in 14 eyes while it revealed hypo or hyperfluorescence in the remaining. For the CRA, peak systolic and end diastolic velocities were significantly lower in Behçet patients than in control cases. In the Behçet group, Doppler indices did not differ significantly in eyes which had choroidal abnormalities and those that did not, according to ICG angiography. CONCLUSION: In Behçet's disease, some abnormalities in the choroid may be seen. The disease appears to be associated with decreased mean flow velocities in CRA.

Fluorescein and indocyanine green videoangiography of choroidal melanomas.

PURPOSE: This study was performed to determine what role indocyanine green video angiography might play in the evaluation of choroidal melanomas, and to compare this role with that of fluorescein angiography. METHODS: Six patients with posterior segment uveal melanoma underwent digital fluorescein and indocyanine green videoangiography. All patients were women and their mean age was 50.7 years. RESULTS: In all eyes with melanoma, fluorescein angiography revealed irregular hyperfluorescence in the early phase and staining of the tumor in the late phase. A double circulation pattern was obvious in 1 eye with a mushroom-shaped melanoma. The patterns of indocyanine green videoangiography varied, depending on the degree of tumor pigmentation, thickness, and vascularity. Early frames of indocyanine green video angiography demonstrated hypofluorescence in all eyes, and the intrinsic choroidal vasculature was obvious in 3 eyes. In the late phase of indocyanine green videoangiograms, different patterns (hyperfluorescence, three-ring pattern) were observed. CONCLUSION: Indocyanine green videoangiography may be a useful adjunct to fluorescein angiography in the evaluation of choroidal melanomas.

Malignant melanomas of the iris.

The recognition of iris melanoma is important because a number of benign lesions clinically resemble these tumors. In this article, the epidemiological, clinical and histopathological features, treatment modalities, and prognosis of 41 iris melanoma patients, seen between 1964 and 1996 were evaluated. Of the patients, 20 were men and 21 women. Their mean age was 44.6 years. After determining the size, localization, and extension of the tumor, the management of choice was observation in 9, sector iridectomy in 15, iridocyclectomy in 6 and enucleation in 11 of the patients. During the follow-up, enucleation was also required in 6 and iridocyclectomy in 1 of the 7 patients who were in the observation or sector iridectomy group initially. Histopathologic examination revealed spindle cell in 27, mixed cell in 6 and epithelioid cell type melanomas in 2 of the 35 cases who underwent iridectomy, iridocyclectomy, and/or enucleation. The mean follow-up was 3.2 years and the mortality rate was found to be 2.4% during this period. One patient who died of metastases had epithelioid cell type melanoma.

Effect of pre-enucleation irradiation on the survival of patients with uveal melanoma.

The effect of pre-enucleation irradiation on the survival of patients with uveal melanoma was investigated in 140 patients. Of the patients, 42 received pre-enucleation cobalt external radiotherapy 2,000 cGy, in five fractions between 1981-1991. The control group consisted of 98 patients with uveal melanoma treated by enucleation alone between 1964 and 1994. The great majority of tumors in each group were confined to the choroid. The mean follow-up period was 58.3 months in the irradiated group and 61.6 months in the enucleation group. A comparison of the Kaplan-Meier survival curves of the patients managed by pre-enucleation irradiation and enucleation indicated no significant difference in survival between the groups. After 5 years of follow-up, the survival rates for the preoperatively irradiated group and the control group were, 86.5 and 86.8%, respectively. In both groups, women had a significantly better survival than men. It is more likely that pre-enucleation irradiation does not appear to improve survival in patients with uveal melanoma. The reason for this may be the micrometastases that occur before treatment.

ICG videoangiography of occult choroidal neovascularization in age-related macular degeneration.

Digital indocyanine green videoangiography has recently been reported to improve the imaging of occult choroidal neovascularization. In this study, 44 eyes with occult choroidal neovascularization in age-related macular degeneration were studied with fluorescein and indocyanine green videoangiography. On indocyanine green videoangiographic examination, 6 of the 44 eyes (13.6%) with occult choroidal neovascularization had vascularized pigment epithelial detachment and 27 (61.4%) had vascularized retinal pigment epithelium. In the remaining 11 (25%) eyes which had previous laser photocoagulation, indocyanine green videoangiography confirmed the presence of recurrence while fluorescein revealed no demonstrable neovascularization. The findings in our study indicate that patients with occult choroidal neovascularization have manifestations that are more clearly demonstrated with indocyanine green videoangiography and improved imaging of these abnormal vessels could potentially increase the number of patients eligible for photocoagulation treatment.

[Detection of subretinal neovessels with indocyanine green videoangiography]. / La détection des néovaisseaux sous-rétiniens au moyen de la vidéo-angiographie au vert d'indocyanine.

PURPOSE: To evaluate the ability of indocyanine green videoangiography to delineate the subretinal neovascular membranes and to compare with fluorescein angiography. METHODS: Between August 1993 and November 1994, digital fluorescein and indocyanine green videoangiography was performed in 214 eyes of 108 cases. Of the 108 cases, 96 had age-related macular degeneration, 6 had angioid streaks and 3 had degenerative myopia. RESULTS: On fluorescein angiography, 47 of the 214 eyes had well-defined and 42 had occult subretinal neovascular membrane. Occult membranes were clearly delineated with indocyanine green angiography. Using these two angiographies, we could detect subretinal neovascular membrane in 89 eyes. These membranes were in 79 of the 181 eyes with age-related macular degeneration, 5 of the 12 eyes with angioid streaks and 2 of the 6 eyes with degenerative myopia. In addition, 3 eyes of the 3 cases had idiopathic subretinal neovascular membranes. CONCLUSION: The results of this study indicate that ICG videoangiography is an adjunctive diagnostic tool to fluorescein angiography in the detection of subretinal neovascular membranes in age-related macular degeneration and in other chorioretinal pathologies.

Indocyanine green videoangiography of angioid streaks.

PURPOSE: This study was performed to define the indocyanine green angiographic features of angioid streaks and associated posterior pole lesions and to compare them with fluorescein angiography. METHODS: Digital fluorescein and indocyanine green videoangiography was performed on 16 eyes of 8 patients with angioid streaks. RESULTS: Streaks were hyperfluorescent in 15, hypo- and hyperfluorescent in 1 of the 16 eyes with fluorescein angiography. Indocyanine green angiography showed hyperfluorescent streaks in 10 and hypofluorescent streaks in 6 eyes. Of the hyperfluorescent streaks, 6 had a hypofluorescent line between fluorescent edges and 4 were made up of numerous hyperfluorescent spots. Peau d'orange appearance was more evident in indocyanine green angiography as dark, round spots throughout the posterior pole. Fluorescein angiography confirmed the presence of well-defined choroidal neovascularization in 5 eyes. In one eye, occult choroidal neovascularization which was not evident on fluorescein angiography, became well-demarcated on indocyanine green angiography. CONCLUSION: Indocyanine green angiographic features of angioid streaks are different from fluorescein angiography. Angioid streaks and peau d'orange are more evident with indocyanine green angiography.

A descriptive study on Behçet's disease.

This study was performed in order to evaluate the age, sex, geographical distribution, ocular involvement, age of onset, and attacks in Behçet's disease. We examined 540 Behçet patients between 1973-1993. Of the patients, 453 were male and 87 female (m/f: 5.2/1). The average age was 30.7 +/- 0.35. The disease mostly appeared in the third decade and it was statistically significant that sex affected the age at onset of the initial symptoms. The onset of symptoms was more frequent among males in the 25-29-year age group, and among females below 19 and above 35 years of age. The duration of the disease was 28.7 +/- 3.1 months. The state of ocular attacks were evaluated in 598 eyes of 303 patients who were followed regularly during the first year. The risk and frequency of attacks were greater in the eyes with poorer visual acuity, and in such eyes, the number of attacks was greater < or = 24 while smaller > or = 35 years of age.

Retinal and disc neovascularization in Behçet's disease and efficacy of laser photocoagulation.

BACKGROUND: The vaso-occlusive episodes resulting from Behçet's disease can cause capillary dropout and vascular remodeling. Retinal and disc neovascularizations, which occur as a result of occlusive vasculitis, can cause recurrent vitreal hemorrhages and neovascular glaucoma leading to severe visual impairment. METHODS: 1080 eyes of 540 patients with Behçet's disease were examined between 1973 and 1993. Of the 912 eyes with posterior segment involvement, laser photocoagulation could be performed in 13 of 25 eyes with disc neovascularization (NVD), 12 of 22 eyes with retinal neovascularization (NVE), and 4 of 6 eyes with NVD and NVE. Laser was directed at areas of NVE and retinal capillary nonperfusion. In cases of NVD, panretinal photocoagulation was performed. RESULTS: The rate of regression of NVD was significantly greater in laser-treated eyes than in the untreated group. The results were similar in cases of NVD with NVE. In eyes with NVE which underwent laser photocoagulation, the NVE regressed. None of the treated eyes developed neovascular glaucoma during the follow-up period. Vitreous hemorrhage occurred in two laser-treated eyes. CONCLUSION: Laser photocoagulation is successful in preventing complications of retinal and disc neovascularizations. Thus, in cases of occlusive vasculitis associated with Behçet's disease, laser photocoagulation should be considered for prevention of complications such as vitreous hemorrhage and neovascular glaucoma.

Evaluation of choroidal neovascularization in age-related macular degeneration with fluorescein and indocyanine green videoangiography.

This study is performed to evaluate the fluorescein and indocyanine green (ICG) characteristics of choroidal neovascularization (CNV) in age-related macular degeneration (ARMD). 200 eyes of 101 patients were examined with digital ICG videoangiography (ICGV). 190 of the 200 eyes had macular lesions of ARMD, and CNVs were detected in 84 (44.2%) of them. Angiographies confirmed the presence of well-defined CNV in 40 (47.6%) eyes and occult CNV in 44 (52.4%) eyes. On ICG-videoangiographic examination, 6 (13.6%) of the 44 eyes with occult CNV had vascularized pigment epithelial detachment. 27 (61.4%) had a vascularized retinal pigment epithelium. Laser photocoagulation had been performed on the remaining 11 (25%) eyes. The results of this study suggest that ICGV is a valuable technique in the diagnosis and evaluation of occult CNVs and may be suggested as an additional diagnostic tool in cases with choroidal neovascular membranes.

The efficacy of cyclosporin-a in the treatment of Behçet's disease.

We used cyclosporin A (CA) to treat 14 patients (25 eyes) with Behçet's disease characterized by severe retinal vasculitis and active intraocular inflammation. All of the patients had been treated previously with corticosteroids, colchicine, and immunosuppressives, without satisfactory results. The patients were given an initial oral dose of 5 mg/kg/day. All medication was tapered and eventually completely stopped after 12 months. The number and severity of ocular attacks (anterior and/or posterior uveitis with vitreous haze) were significantly reduced below pretreatment levels during therapy (Kolmogorov Smirnov two-pair test: P < .05). Visual acuity improved in 32% and remained unchanged in 44%. No ocular attacks recurred in 11 eyes; they recurred 1 time in 8 eyes; 2 times in 3 eyes; and 3 times in 3 eyes during CA therapy. There were no significant changes in the level of retinal vasculitis. In two cases with vaso-obstructive changes, treatment with CA was not effective and laser photocoagulation was performed. Based on our study, we recommend that an initial dose of 5 mg/kg/day CA be used in the systemic medical treatment of ocular Behçet's disease. The CA can be continued at this low dosage for an unspecified time. If intraocular inflammation does not totally resolve at this dosage or the inflammatory process recurs, combining the CA with low doses of a steroid should be considered.