41/513. Macular translocation--an innovative treatment for macular degenerative diseases. BACKGROUND: Age-related macular degeneration with subfoveal choroidal neovascularization (CNV) is difficult to handle with any treatment modality so far. Macular translocation is an innovative surgical approach to this disease. methods: The "full" macular translocation comprises phacoemulsification, complete vitrectomy, artificial retinal detachment, 360 degrees retinotomy, removal of the CNV, translocation of the neurosensory retina, and endotamponade with silicone oil. The "limited" macular translocation is accomplished by partial retinal detachment and scleral imbrication. The CNV can be removed during the operation or ablated by a laser postoperatively. RESULTS: Full macular translocation was performed on 3 eyes, and upward macular displacement was achieved from 10 to 45 degrees. Limited macular translocation was performed on 2 eyes, and downward macular displacement was achieved from 350 to 900 microns. One eye had visual improvement, 2 eyes remained stationary, and another 2 eyes had worse visual acuity postoperatively. No proliferative vitreoretinopathy occurred in any of these eyes. CONCLUSION: Macular translocation can relocate the macula to a healthy adjacent retinal pigment epithelium-choroid bed and is a promising surgical treatment for macular degenerative disorders. Further trials are mandatory to evaluate its benefits. ( info) |
42/513. Correction of cyclovertical strabismus induced by limited macular translocation in a case of age-related macular degeneration. PURPOSE: To report a case of strabismus surgery performed to treat cyclovertical strabismus induced by limited macular translocation. methods: Case report. RESULTS: A 62-year-old man suffering with age-related macular degeneration and subfoveal choroidal neovascularization, RE, underwent limited macular translocation surgery. The fovea was rotated downward, and his visual acuity improved from 20/100 to 20/25 postoperatively. Cyclovertical diplopia persisted for 6 months after the operation. A Hess screen test revealed a pattern that simulated an underaction of the superior oblique muscle and inferior rectus muscle with an overaction of the ipsilateral inferior oblique muscle. To treat the diplopia, advancement of the superior oblique muscle tendon and resection of the ipsilateral inferior rectus muscle were performed. Binocular single vision with 140 seconds of arc for stereopsis was obtained. CONCLUSION: Cyclovertical strabismus after limited macular translocation is corrective with conventional surgery on the treated eye. ( info) |
| PURPOSE: To report the pathology of surgically removed submacular tissue in recurrent choroidal neovascularization after laser photocoagulation of classic choroidal neovascularization in age-related macular degeneration. methods: A recurrent subfoveal choroidal neovascular membrane was surgically removed in two patients. The recurrence was identified as a classic membrane on fluorescein angiography at the foveal border of the laser scar. A net was visualized in the early venous phase of the indocyanine green angiogram, with associated late hyperfluorescence. Both patients had undergone laser photocoagulation for a classic interpapillomacular choroidal neovascular membrane about 1 1/2 years earlier. The specimens were serially sectioned and stained with hematoxylin-eosin, periodic acid-Schiff, Masson trichrome and phosphotungstic acid-hematoxylin. RESULTS: The two specimens consisted of subretinal fibrovascular tissue with fibrin exudation. Fibrovascular tissue bordered subretinal fibrous tissue adherent to Bruch's membrane and remnants of the choroid in one patient. The fibrovascular portion most likely corresponded to the recurrence, whereas the fibrous portion represented the original membrane, being obliterated after photocoagulation. Some peripapillary tissue was additionally removed in the other patient. The latter lesion was invisible on fluorescein angiography but stained in the late phase of indocyanine green angiography and corresponded histopathologically to poorly vascularized intra-Bruch's fibrovascular tissue. Granular deposits, periodic acid-Schiff positive and metachromatically purple on Masson trichrome stain, representing diffuse drusen (basal laminar/linear deposits), were identified in the three specimens. CONCLUSION: A subretinal fibrovascular membrane corresponded with the classic recurrent choroidal neovascularization. ( info) |
| PURPOSE: To describe the development of new and enlargement of preexisting atrophy confined to areas with abnormally high levels of in vivo autofluorescence in eyes with geographic atrophy (GA) associated with age-related macular degeneration (ARMD). methods: The spatial distribution and intensity of fundus autofluorescence as well as the spread of GA and occurrence of new GA was recorded over a period of 3 years in three patients with ARMD using a confocal scanning laser ophthalmoscope. RESULTS: A diffuse irregular increased autofluorescence at the posterior pole was recorded at baseline in the presence of unifocal or multifocal patches of geographic atrophy. Within these areas of elevated autofluorescence, new atrophic areas developed, and existing patches of atrophy enlarged during the review period, whereas this was not observed in areas with normal background autofluorescence. The total area of abnormal autofluorescence also showed enlargement over time. CONCLUSIONS: These preliminary findings suggest that areas of increased autofluorescence precede the development and enlargement of outer retinal atrophy in eyes with ARMD. Because the dominant fluorophores of fundus autofluorescence are part of lipofuscin granules of RPE cells, the observations indicate that excessive RPE lipofuscin accumulation may be of significance in the pathogenesis of GA associated with ARMD. With GA being a major cause for severe visual loss in ARMD, in vivo fundus autofluorescence recording over time may allow identification of prognostic determinants and may give important clues to the understanding of mechanisms of disease. ( info) |
45/513. Retinal pigment epithelial cell transplantation after subfoveal membranectomy in age-related macular degeneration: clinicopathologic correlation. PURPOSE: To report the histopathology after retinal pigment epithelial cell transplantation and subfoveal membranectomy in age-related macular degeneration. methods: An 85-year-old white woman with bilateral choroidal neovascularization underwent subfoveal membranectomy combined with transplantation of a sheet of human adult retinal pigment epithelium (retinal pigment epithelium) under the foveal center in the right eye. The patient was immunosuppressed postoperatively with prednisone, cyclosporine, and azathioprine. The patient died from congestive heart failure 114 days after surgery. RESULTS: A patch of hyperpigmentation was visible at the transplant site under the foveola after surgery. Mound-like clusters of individual round, large densely pigmented cells were present in the subretinal space and outer retina in this area. There was loss of the photoreceptor outer segments and native retinal pigment epithelium in the center of the transplant bed, with disruption of the outer nuclear layer predominantly over regions of multilayered pigmented cells. Cystic spaces were present in the inner and outer retina. A residual intra-Bruchs membrane component of the original choroidal neovascular complex was present under the transplant site. CONCLUSIONS: The transplant site contained clusters of round, pigmented cells that did not form a uniform monolayer in most areas. The morphology at the transplant site is consistent with the lack of visual improvement seen after surgery in this patient. ( info) |
46/513. Retinal pigment epithelial tear after photodynamic therapy for choroidal neovascularization. PURPOSE: To report a case of retinal pigment epithelial tear after photodynamic therapy for choroidal neovascularization. methods: Case report. A 74-year-old woman with exudative age-related macular degeneration and classic subfoveal choroidal neovascularization RE underwent photodynamic therapy with verteporfin. RESULTS: ophthalmoscopy and fluorescein angiography RE disclosed a retinal pigment epithelial tear in the area of photodynamic therapy. CONCLUSION: This case presents the first report of a retinal pigment epithelial tear after photodynamic therapy with verteporfin for subfoveal choroidal neovascularization in age-related macular degeneration. ( info) |
47/513. Three-dimensional analysis of macular diseases with a scanning retinal thickness analyzer and a confocal scanning laser ophthalmoscope. OBJECTIVE: To compare three-dimensional analysis of macular diseases obtained using the scanning retinal thickness analyzer (RTA) with that obtained using the confocal scanning laser ophthalmoscope, Heidelberg Retina Tomograph (HRT). patients AND methods: Both the RTA and the HRT were used to examine 50 eyes of 36 patients with diabetic macular edema, macular edema following branch retinal vein occlusion, age-related macular degeneration, and idiopathic macular holes. RESULTS: In most macular diseases, the retinal thickness map constructed using the RTA agreed with the image obtained with the HRT. The two maps were not consistent with each other, however, in patients with dense retinal hemorrhages and with extrafoveal fixation. CONCLUSIONS: Although both the RTA and the HRT give additional information to clinically evaluate macular diseases, they do have limitations. The discrepancy between these two analyses in some specific macular pathologies might be caused by the different wavelengths of the laser beam and the different methodologies used to scan the retina. ( info) |
| PURPOSE: To report the occurrence of transient formed visual hallucinations following macular translocation. methods: Two case reports. RESULTS: Two white women aged 84 and 83 years with bilateral age-related macular degeneration and unilateral subfoveal choroidal neovascularization underwent macular translocation with punctate retinotomy (limited macular translocation) and chorioscleral infolding in the eye with neovascularization. They complained of formed visual hallucinations which began within 24 hours following macular translocation and ceased 7 and 3 days postoperatively, respectively. Their symptoms occurred in the presence of normal cognition, orientation and insight, were not associated with other psychiatric symptoms, and were characteristic of Charles Bonnet syndrome (CBS). CONCLUSION: The temporary deliberate retinal detachment and/or poor vision following macular translocation may be associated with postoperative CBS, and this report extends the spectrum of conditions associated with CBS. ( info) |
| PURPOSE: Acute angle-closure glaucoma resulting from massive subretinal hemorrhage is a rare and catastrophic complication in age-related macular degeneration. Anticoagulant usage had been strongly correlated with this complication in previously reported cases. methods: Four patients (4 eyes), 3 men and 1 woman, developed angle-closure glaucoma with diffuse subretinal hemorrhage and total hemorrhagic retinal detachment. RESULTS: Serial funduscopic examinations and echographic studies in 2 eyes showed that the blood gradually accumulated in the subretinal space. It took more than 10 days for the bleeding to build up to bullous hemorrhagic retinal detachment and secondary glaucoma. Anti-glaucomatous agents were given and sclerotomy was performed in 3 of the 4 patients. Phthisical changes were observed subsequently in these 3 eyes. The eye that received early drainage of blood was an exception, and a small degree of residual acuity was retained. Three of the 4 patients had diabetes mellitus, and hypertension and vascular diseases were also present in the same 3 patients. CONCLUSIONS: diabetes mellitus might be a predisposing factor for the impaired hemostasis. Anti-glaucomatous agents were of no effect in the management of intraocular pressure. Sclerotomy and drainage of blood help control intraocular pressure and relieve ocular pain. Poor final visual acuity is inevitable. However, phthisical changes might be prevented with early sclerotomy and drainage of blood. ( info) |
50/513. indocyanine green angiographic findings of chorioretinal folds. PURPOSE: To analyze indocyanine green (ICG) angiographic findings of chorioretinal folds. methods: Eight patients (9 eyes) in whom chorioretinal folds had been diagnosed were enrolled in this study. color photography, fluorescein angiography (FA) and ICG angiography (IA) were performed. RESULTS: indocyanine green angiography demonstrated choroidal venous congestion and a filling delay of the choroidal vessels in one case with an orbital tumor. In one posterior scleritis case, IA showed a filling delay of choroidal vessels in the early phase and multiple patchy hypofluorescent lesions scattered in the posterior pole during the late phase. Idiopathic cases showed choroidal venous dilatation. No abnormalities of the choroidal vasculature in the form of radial folds, were revealed in two cases of AMD. Linear hyperfluorescent areas suggestive of chorioretinal folds seen on IA were less numerous and wider than those observed on FA in some eyes. On the other hand, they were equally numerous and wider on IA than those on FA in other eyes. CONCLUSION: indocyanine green angiography is useful for evaluating both pathological conditions of the choroidal vasculature and the width of chorioretinal folds at the level of the choroidal vasculature. ( info) |