SDF1-alpha is associated with VEGFR-2 in human choroidal neovascularisation.

Endothelial progenitor cells (EPCs) have been shown to contribute to experimentally induced choroidal neovascularisation (CNV) in animal models. The recruitment pathway for EPCs is dependent on the chemokine stromal cell derived factor 1-alpha (SDF) and its receptor CXCR4 on the progenitor cell. We examined 23 specimens of CNV occurring secondary to a variety of aetiologies (10 secondary to age-related macular degeneration (AMD), 4 inflammatory, 4 idiopathic and 5 melanoma-associated) for the presence and distribution of SDF and CXCR4 in order to determine if this pathway may play a role in neovascularisation. Specimens were examined by immunohistochemistry using a panel of antibodies against SDF, CXCR4, vascular endothelial growth factor receptor 2 (VEGFR-2), CD34 (endothelial cells), CD68 (macrophages) and cytokeratins (retinal pigment epithelium; RPE). SDF was detected in 2 cases of CNV in AMD, 1 inflammatory CNV, 3 idiopathic CNVs and in 3 cases of CNV associated with melanoma. A significant association was found between SDF and VEGFR-2 immunostaining in individual membranes (p<0.001). Localisation of SDF immunostaining to the presumed RPE was also significant (p<0.05). CXCR4 immunostaining was widespread in all membranes in keeping with the published work of other investigators. Our study suggests that SDF, which may be produced by the RPE, could play a role in CNV.

Polypoidal choroidal vasculopathy associated with Doyne's familial choroiditis: treatment with thermal laser.

PURPOSE: To report the unusual occurrence of polypoidal choroidal vasculopathy (PCV) in a patient with Doyne's familial honeycomb choroiditis (DFHC) and its course after laser treatment. DESIGN: Interventional case report. METHODS: Indocyanine green (ICG) angiography guided laser was performed on active polypoidal lesions. RESULTS: A 45-year-old man with a 15-year history of bilateral DFCH and a scarred macular choroidal neovascularization in the right eye (RE) was referred to us with exudative maculopathy in the left eye (LE). His best-corrected visual acuity (BCVA) was 20/800 in the RE and 20/40 in the LE. ICG angiography revealed a picture that was characteristic for PCV in both eyes. ICG guided argon green laser was performed on the active parapapillary and perifoveal polypoidal lesions of the LE. Eight months after the laser photocoagulation treatment, the macular exudative lesions had subsided and the BCVA improved to 20/20. The favorable anatomic and functional results have remained stable over 3 years. CONCLUSIONS: This is, to our knowledge, the first case of a PCV that occurred secondary to DFHC.

[Nocardia farcinica: life-threatening chorioiditis under systemic immunosuppression]. / Nocardia farcinica: Schwere Chorioiditis mit lebensbedrohlicher Generalisierung unter systemischer Immunsuppression.

BACKGROUND: Immunosuppressed patients occasionally suffer from a multifocal infection with Nocardia. It is important to distinguish Nocardia farcinica from Nocardia asteroides, because of different sensitivity against antibiotics. PATIENT AND METHODS: A 40-year-old patient with polycystic renal disease successfully underwent a kidney transplantation without complications. Immunosuppression consisted of: corticosteroids, azathioprin and ciclosporin A. Ten weeks later he developed acute choroiditis with consecutive retinal detachment and neovascular glaucoma in one eye. In addition, 14 weeks after transplantation CT scans revealed multiple cerebral abscesses. RESULTS: In the course of the disease Nocardia farcinica (N. f.) was identified by cerebral stereotactic biopsy of a cerebral lesion, histological examination of the enucleated globe and sputum culture. Histologically filamentous, eosinophilic organisms were found. Microbiology identified aerobic actinomycetes in cultures and Nocardia farcinica by PCR. Therapeutically the combination of vancomycin, ampicillin, and sulbactam was successful. CONCLUSION: In immunosuppressed patients Nocardia farcinica can become life-threatening. One of the first manifestations may be a choroiditis. Infection of the respiratory tract followed by hematogenous spread is the common way of systemic nocardiosis. Biopsy followed by identification of species by PCR is recommended because of the specific therapeutic strategies associated with each species.

[Current views on the pathogenesis and treatment of central serous choroidopathy]. / Wspólczesne poglady na patogeneze i leczenie srodkowej, surowiczej choroidopatii.

The majority of authors as a cause of formation of a leakage in central serous choroidopathy considers the disturbances of function of the pigmentary layer. According to Spitznas it is based on transformation of these cells from absorbing to extracting towards the choroid and retina under the influence of unknown factors (immunological processes, circulatory, inflammatory factors or stress). Marmor sees the lesion of the pigmentary epithelium as a disturbance of a cyclic action of the AMP neeth the neurosensory layer of the retina. There exist contemporary 2 methods of treatment of the central serous retinopathy. One part of the authors thinks that one should wait till the spontaneous remission, the other one--that in cases with the leakage situated beyond the risk area laser therapy can be applied.

[The role of laser therapy in central serous choroidopathy]. / Rola laseroterapii w srodkowej, surowiczej choroidopatii.

The authors present early results of treatment of central serous choroidopathy by means of argon laser. Additionally they compare the fate of the patients with this condition treated conservatively in the last years. The results obtained confirm the world reports that application of laser in therapy of central serous choroidopathy shortens the course of the disease.

[Multifocal choroiditis: diagnostic aspects and results of photocoagulation. Apropos of 25 cases]. / La choroïdite multifocale: aspects diagnostiques et résultats de la photocoagulation. A propos de 25 cas.

A retrospective study was conducted on 25 patients who presented with both recurrent multifocal choroiditis and subretinal neovascularisation. As in other series, striking features were the young age of the patients (mean age 33 years), frequent recurrences of the macular lesions during a limited follow-up period, inflammation of the vitreous or the optic disk, and macular fibrosis. However, unlike previously reported data, refraction was more often in the emetropic range, there was no female predominance, and inflammatory signs were mild or limited to papillitis. Moreover serologic tests did not indicate an acute infection due to Epstein-Barr virus in any of the patients. This study also emphasized the results of Krypton laser treatment of the subretinal neovascularisation. Final visual acuity improved or remain the same in 26 eyes (72%) and worsened in 11 eyes (28%) during a mean follow-up period of 13 months (range 2-48 months). The best results were obtained in 15 eyes with neovascular membranes located more than 200 mu from the foveal avascular zone (mean final visual acuity: 20/40). However the mean final visual acuity of the nine eyes with neovascular membranes closer than 200 mu from the FAZ, was over 20/60. Recurrences of subretinal neovascularisation occurred in 7 out of 24 treated eyes and 3 were under the center of the FAZ. These results should be confirmed by a randomized prospective clinical trial in order to assess the benefits of laser treatment in recurrent multifocal choroiditis.

Subretinal and disc neovascularisation in serpiginous choroiditis.

Three out of 15 patients with serpiginous choroiditis who have been followed up for 1 to 10 years (mean 4.9 years) developed subretinal neovascularisation in the macula. In one eye new vessels were treated with argon laser without attaining permanent obliteration, in the second eye the neovascular membrane was regarded as untreatable because it was under the fovea, and in the third eye new vessels became obliterated spontaneously after atrophy of the surrounding choriocapillaris and the pigment epithelium of the retina. In a furth patient disc new vessels were seen at the active stage of serpiginous choroiditis; these new vessels disappeared after scarring of the initial chorioretinal lesions.

[Juvenile hemorrhagic ocular choroidopathy (author's transl)]. / La choroïdopathie maculaire hémorragique du sujet jeune ou pseudo-histoplasmose.

We observed in 13 young patients a serous or hemorrhagic paramacular detachment of one third to one half disc diameter size. In eight, we have seen also atrophic choroidal scars. In one patient the serous detachment occured at the site of a previously studied choroidal scar. Our cases resemble the presumed ocular histoplasmin choroiditis described in American literature. In our cases histoplasmosis can be excluded. Visual prognosis is dependent upon proximity of the choroidal lesion to the fovea. In most cases this prognosis is poor. The term juvenile hemorrhagic ocular choroidopathy is suggested for the disease.

[Disciform syndrome secondary to focal choroiditis in the macular region (author's transl)]. / Disziformes Syndrom infolge Chorioiditis im Makulabereich.

In 10 patients with an average age 44 years there developed from focal choroiditis in the macular region a disciform syndrome, clinically resembling the senile macular degeneration and with a poor prognosis.

[Light coagulation in central and paracentral choroiditis (author's transl)]. / Lichtkoagulation bei Chorioiditis centralis und paracentralis

Since 1966 photocoagulation has been performed in 52 cases and 54 eyes of choroiditis located on the posterior pole. The course of the cases treated is compared with a control group treated with drugs. Photocoagulation shortens the duration of the acute inflammatory process, decreases the frequency of recurrences by about 40% and improves the visual prognosis. The follow-up 1 year to 9 years later (average 7 years) showed in the control group a visual function of 0.5, in the treated group of 0.8.

[Diagnosis and treatment of macular lesions in multifocal chorioiditis (presumed histoplasmosis) (author's transl)]. / Erscheinungsbild und Behandlung makulärer Läsionen bei multifokaler Chorioiditis (presumed histoplasmosis)

The authors describe the clinical picture of "presumed histoplasmosis" with the typical disciform mascular lesion which is found in a increasing number of Dutch patients. Although systemic histoplasmosis is not endemic in the Netherlands, the authors feel they are dealing with the same entity. The therapy is elucidated, especially (Argon laser) photocoagulation of favourably situated subretinal neovascularisations. The importance of adequate coagulation technique and frequent (fluographic) follow-up studies in view of possible complications is stressed.

Partial xenon coagulation of net in histoplasmic choroiditis.

Ten patients with ocular histoplasmosis (photocoagulated 17 times) were retrospectively selected, in what was considered an unbiased manner, for examination of their response to partial xenon photocoagulation of their neovascular nets. Of the 17 photocoagulations, the part of the neovascular net not coagulated remained the same in 7, was stimulated in 5, and suppressed in 5. This distribution was not statistically different from a control group receiving corticosteroids alone. A direct relation of suppression of the uncoagulated part of the net with the distance of this coagulation from the fovea was demonstrated.