Fluorescein and indocyanine green angiography findings in Behçet's disease.

AIM: To evaluate and compare the fluorescein (FA) and indocyanine green angiographic (ICGA) findings, and to investigate the choroidal involvement in Behçet's disease. METHODS: FA and ICGA were performed on 112 eyes of 62 patients with Behçet's disease, between November 1993 and July 2002, using Topcon IMAGEnet Digital System. Patients were aged 16-50 years; 48 (77.4%) were male and 14 (22.6%) were female. RESULTS: FA showed dye leakage from retinal vessels in 57 (50.9%) eyes, cystoid macular oedema in 18 eyes (16.1%), optic disc oedema in four eyes (3.6%), disc neovascularisation in three eyes (2.7%), and retinal neovascularisation in two eyes (1.8%). ICGA showed hyperfluorescent lesions in 40 eyes (35.7%), hypofluorescent lesions in 17 eyes (15.2%), hyperfluorescent and hypofluorescent lesions in 12 (10.7%) eyes, ICG leakage from choroidal vessels in 11 eyes (9.8%), irregular filling of choriocapillaris in five eyes (4.5%), and choroidal filling defect in four eyes (3.6%). Hyperfluorescent and hypofluorescent lesions which were seen in 53 out of 69 eyes (76.8%) on ICGA, were not visible on FA. 55 eyes (49.1%) showed hyperfluorescence on the disc on both FA and ICGA, whereas 36 (32.1%) showed hyperfluorescence only on FA. CONCLUSION: The hyperfluorescence and/or hypofluorescence, irregular filling of the choriocapillaris, choroidal filling defect, and ICG leakage from choroidal vessels seen only on ICGA may suggest choroidal involvement in Behçet's disease.

Levels of zinc in plasma, erythrocytes, and hair, and levels of serum copper in patients with retinitis pigmentosa in Turkey.

This study was made on 100 patients with retinitis pigmentosa and 23 of their relatives. Their plasma, erythrocyte, and hair Zn and serum Cu levels were compared with those of a control group of 14 healthy persons. No statistically significant difference in these levels was found between the patients with retinitis pigmentosa and the relatives or controls.

Eales' disease with hemiplegia.

A case of Eales' disease with hemiplegia is reported. The patient had a right hemiparesis and a left hemiplegia occurring after a sudden loss of vision in the left eye two years earlier. The diagnosis was based on fluorescein angiography showing neovascularisation, fluorescein leakage, perivascular sheating and hemorrhages and on CT scan showing multiple hypodense lesions in right and left hemispheres and on IDSA showing bilateral occlusion of anterior cerebral arteries. The patient did not have further relapses.

Visualization of retinal vasculitis in Eales' disease.

Between 1970 and 1991 the authors examined 466 patients with Eales' disease. The mean age at diagnosis was 30, ranging between 14 and 55 years. The mean follow-up period was 43.5 months. At the initial examination, 356 cases were bilateral and 110 cases were unilateral (822 eyes). Vitreous hemorrhage was present in 257 of the 822 eyes. In the remaining 565 eyes, the major retinal lesions were retinal neovascularization (40.7%), vascular sheathing (20.7%), vascular sheathing and retinal hemorrhages (10.6%), retinitis proliferans (9.4%), disc neovascularization (9.0%), branch vein occlusion (3.2%), tractional retinal detachment (2.4%), central vein occlusion (1.8%), central vascular sheathing (1.1%), obliterated vessels (1.1%). Forty-nine out of the 110 initially unilateral cases eventually developed bilateral involvement after a mean period of 42 months. The percentage of eyes with a vision of 0.1 and better rose from 68.1% in the initial examination to 77.9% in the final examination. Fluorescein angiograms of the affected eyes show dye leakage with retinal staining, microaneurysms, capillary non-perfusion and neovascularization. Fundus changes are characteristic of Eales' disease. Unilateral cases should be closely followed because of the risk of involvement of the other eye. Fluorescein angiography is a requirement for early identification of vascular changes and for proper follow-up in Eales' disease.

Photocoagulation in Eales' disease.

Between 1970 and 1991 the authors examined 466 cases with Eales' disease. 359 eyes of 295 of these 466 cases received photocoagulation treatment. The mean age was 30.4, ranging between 14 and 55 years. Ten eyes with persistent vitreous hemorrhage underwent pars plana vitrectomy before photocoagulation. 210 eyes were treated with xenon arc, 135 with argon laser, 12 with krypton laser and two with yellow dye laser. Hypoxic areas and retinal neovascularizations were closed completely in 298 eyes. In 21 eyes with elevated neovascularizations intruding into the vitreous cavity feeder vessel photocoagulation was used. 24 eyes with disc neovascularization were treated with panretinal photocoagulation. 12 eyes with branch vein occlusion and four eyes with central vein occlusion received photocoagulation treatment to areas of non-perfusion and retinal neovascularization. At a mean follow-up of 43 months, seven new retinal neovascularizations and three new disc neovascularizations developed in eyes which previously had received photocoagulation for retinal neovascularization and hypoxia. Nine out of 21 eyes with elevated neovascularizations developed vitreous hemorrhage. Disc neovascularization resolved completely in 13 out of 24 eyes, it partially regressed in eight eyes and did not respond to treatment in three eyes. The visual acuities were improved in 12.3%, maintained in 77.4% and deteriorated in 10.3% of the eyes after treatment. Periodic follow-up and early photocoagulation treatment is useful in stabilizing the retinal lesions and in maintaining functional levels of vision in Eales' disease.

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.

Bilateral glaucomatous optic neuropathy in Takayasu's disease without cervical arterial stenosis.

PURPOSE: Although significant decrease in retinal perfusion is usually not observed before all of the cervical arteries became markedly narrowed in patients with Takayasu's disease (TD), we present bilateral glaucomatous optic neuropathy in a patient with TD without any cervical arterial stenosis. METHODS: Ophthalmoscopic examination disclosed glaucomatous optic neuropathy in both eyes with 7/10-cup/disc ratio in the right eye and 9/10 in the left eye. Left subclavian selective arteriographic examination demonstrated segmental high-grade stenosis, namely 90 percent stenosis in the mid portion of the left subclavian artery. Arteriography, digital subtraction angiography (DSA), magnetic resonance angiography (MRA) and color Doppler sonography revealed patent cervical, carotid interna, ophthalmic, retinal and posterior ciliary arteries. RESULTS: Patient was followed up for 48 months with frequent intervals and there was no deterioration of visual acuity, visual field and optic neuropathy without any antiglaucomatous treatment. CONCLUSIONS: Although it is a known fact that classical ophthalmic manifestations of the TD occur only when major cervical arteries are occluded, no occlusion was observed in this patient with bilateral optic atrophy. The optic nerve damage is caused by various factors, but these factors require much elucidation before the optic neuropathy can be understood.

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.

Pars plana vitrectomy in chronic myelogenous leukemia with vitreous hemorrhage.

Pars plana vitrectomy operations were performed on two cases of vitreous hemorrhage due to chronic myelogenous leukemia. Fundus examination and fluorescein angiography revealed optic disc neovascularization in both, which is a rare fundus finding in chronic leukemias. The first case seen with vitreous hemorrhage in both eyes also had diabetes mellitus with a negative family history, and had received laser therapy on his right eye. His chronic myelogenous leukemia was diagnosed 4 months after vitrectomy was performed on this eye, when he presented with widespread subcutaneous hemorrhages. The second case showed a nonproliferative retinopathy with old laser scars in his right eye and vitreous hemorrhage in his left eye, and had no diabetes mellitus. The diagnosis of chronic myelogenous leukemia was made before the vitrectomy operation when the physical examination revealed splenomegaly. The pathogenesis of retinal and optic disc neovascularization in myeloproliferative diseases, its possible relation with chemotherapy, and the results of the vitrectomy operations were discussed with special emphasis on the importance of ruling out chronic leukemias and other blood dyscrasias in vitreal hemorrhages, retinopathies of unknown origin, and even in diabetic retinopathies with a negative family history.

[Macular involvement in angioid streaks. Gronblad-Strandberg syndrome]. / Atteinte maculaire dans les stries angioïdes. Syndrome de Gronblad-Strandberg.

Between 1971 and 1988, we examined 116 eyes of 58 patients with Gronblad-Strandberg syndrome in private practice and in the Retinal Department of the Eye Clinic, Faculty of Medicine, Ankara University. There was initial macular involvement in 79% of cases with angioid streaks. The most frequently encountered lesion, found in 53% of the cases, was choroidal neovascularization. Macular involvement had become bilateral in 80% of the cases after 12.5 months median follow up. Thirteen of the 50 eyes with choroidal neovascularization were treated by argon or red krypton laser photocoagulation. Vision decreased during follow-up in 15% of the 13 eyes treated whereas it decreased in 32% of the 69 eyes unsuitable for laser 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.

Follow-up of macular holes.

A qualitative study of the 72 patients presenting between 1969 and 1982 with full-thickness macular holes unassociated with extensive retinal detachment has been made. Twenty-two affected and 19 fellow eyes have been followed for 24 to 120 (median 56) months. Findings point up the need to investigate more closely the factors inhibiting macular hole development and the oftentimes fine distinctions between the ophthalmological, medical, and sociological contributions to this disability and its prevention.

Experience with photocoagulation in Behçet's disease.

Between 1973 and 1987 we examined both eyes of 300 patients with the uveoretinitis-type lesions characteristic of Behçet's disease. Of the 556 eyes whose fundus could be examined, 38 eyes (6.8%) in 33 patients (11%) had developed retinal capillary nonperfusion, branch retinal vein occlusion, or retinal or disc neovascularization. These eyes were treated by photocoagulation, primarily to forestall vitreous hemorrhage and the development of neovascular glaucoma, as well as to decrease the macular edema resulting from vein occlusion. The treatment, which was well tolerated, was successful in closing retinal capillary nonperfusion areas and eliminating retinal neovascularization. Disc neovascularization was resolved completely in some cases, and partially in others.

Fundus changes associated with Behçet's disease.

Between 1973 and 1987 we recorded 300 cases of Behçet's disease with fundus changes. Our routine preview of each case included examination with the Goldman three-mirror contact lens, ophthalmoscopy, referral for laboratory tests, color fundus photography and, most importantly, fluorescein angiography. The ophthalmological findings led to the proper diagnosis in 254 (85%) of our cases. Fluorescein angiography revealed incipient fundus changes in 38 eyes of 19 medically diagnosed patients with no visual complaints and normal fundi on ophthalmoscopy. Eighty-six percent of our cases had or developed diverse fundus changes bilaterally. The fundus changes we encountered most frequently were hyperemia of the optic disc, macula edema, retinal edema, vascular sheathing, retinal exudate, and retinal hemorrhage. With the exception of eyes with very poor prognoses, only 184 of the 403 eyes that were followed up for 3-120 months (median 12) experienced new insults in the posterior segment; 40 of these became totally blind while 59 maintained their visual status. Early diagnosis is necessary for proper treatment patients with Behçet's disease. Fluorescein angiography is required for early diagnosis and for monitoring the posterior segment involvement closely. This is the most characteristic and often the most serious consequence of Behçet's disease; it may also the first indicator of the disease.

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.

Acute frosted retinal periphlebitis.

A 30-year-old woman developed bilateral acute vision loss without any systemic symptoms. There was diffuse retinal edema and thick perivenous sheathing with moderate vitreous inflammation. Fluorescein angiography showed late staining and dye leakage from diseased vessels. Oral corticosteroid treatment stabilized the visual acuity and fundus of the left eye but did not halt the progression to total fibrosis in the right eye.

Changes in the fundus caused by blunt ocular trauma.

Generally encountered during adolescence, blunt ocular trauma results in a variety of changes in the fundus. Our study investigated the distribution of trauma-induced changes in the fundus on the basis of the incidence and the latent interval between the trauma and the occurrence of the symptoms. In addition, we studied the distribution of the cases in regard to patient age and sex and the cause of the trauma. Included in this study were the 445 eyes, whose fundi could be evaluated, of 435 patients, who applied to the Eye Clinic of the Faculty of Medicine, Ankara University, because of blunt eye trauma and patients from private practice during the period between 1980 and 1991. The following are the changes found in the fundus, either isolated or combined, that were detected in the 445 eyes included in this study: retinal detachment (194), retinal and choroidal atrophy (52), vitreous hemorrhage (50), optic atrophy (43), Berlin's edema (42), choroidal rupture (36), macular hole (18), macular hemorrhage (16), retinal hole (9), papillary-macular membrane (8), arterial occlusion (7), evulsion of the optic nerve (5), and retinal-papillary edema (3). Seventy-nine percent were male patients, and 21% were female. The most frequently encountered age group was 11 to 20 years (32.2% of the cases included in our study).

Farnsworth-Munsell 100-hue test for patients with diabetes mellitus.

We evaluated 164 eyes of 87 patients with diabetes mellitus compared with 50 eyes from 25 healthy subjects as the control group. We compared 87 patients with diabetes mellitus (164 eyes) in relation to their duration of diabetes, fundus findings, visual acuity, and color vision defects. In all patients, color vision defects were determined using the Farnsworth-Munsell 100-hue test, and the total error score was established on the basis of age norms from subjects without diabetes. No color vision defect was detected in the control group. In the diabetic group, fundus degeneration and color vision defects were observed and correlated with the duration of diabetes. The dominant color defect was of the blue-yellow type.