Faculty Bibliography

PURPOSE: This study was designed to evaluate the frequency and nature of neovascularization in age-related macular degeneration (ARMD) utilizing the combination of digital imaging techniques, fluorescein angiography (FA), indocyanine green (ICG) angiography, and optical coherence tomography (OCT). METHODS: A complete clinical examination was performed on 100 eyes of 93 consecutive newly diagnosed patients with neovascular ARMD. Digital fluorescein angiography, ICG angiography, and OCT were also used in evaluating those patients. Comparison of the imaging techniques to determine their value in studying the nature of the lesions. RESULTS: On the basis of existing fluorescein standards, 15 eyes were diagnosed with classic choroidal neovascularization (CNV), 15 with minimally classic CNV, and 70 with occult CNV. ICG angiography was superior for detecting the active vascular component in polypoidal CNV (16 eyes) and retinal angiomatous proliferation (14 eyes). OCT was more sensitive than FA for determining the presence of cystoid macular edema evident in the vast majority of eyes with retinal angiomatous proliferation (RAP). CONCLUSIONS: These results suggest that FA, ICG angiography, and OCT, when used in combination, will assist clinicians in best determining the precise nature of the neovascular process in ARMD

PURPOSE/OBJECTIVE:To describe the fundus autofluorescence photographic pattern in a case of deferoxamine retinopathy. METHODS:Observational case report. RESULTS:A 91-year-old woman receiving intravenous deferoxamine treatment presented with a history of deteriorating vision in both eyes. Autofluorescence photography revealed well circumscribed areas of hyperautofluorescence that correlated with areas of pigmentation shown by color photography. Deferoxamine retinopathy was diagnosed. CONCLUSION/CONCLUSIONS:Fundus autofluorescence photography is a noninvasive imaging method for early detection of deferoxamine retinopathy and can be used to monitor the status of the macula in patients at risk for this toxicity.

PURPOSE: To investigate the use of anecortave acetate, a new angiostatic cortisene, for the treatment of the leakage and/or neovascularization associated with idiopathic perifoveal telangiectasia (IPT) in an open label prospective pilot study. METHODS: Seven eyes of six patients were treated with posterior juxtascleral administration of anecortave acetate delivered adjacent to the macula using a specially designed curved cannula. A full clinical examination and fluorescein angiography were performed at baseline and at 3-month intervals. The primary efficacy outcome for this pilot study was the mean change in visual acuity (Early Treatment Diabetic Retinopathy Study) from baseline. RESULTS: The visual acuity remained unchanged in two eyes of two patients with nonproliferative disease after 24 months. The five eyes of four patients presenting with subretinal neovascularization, the proliferative stage of IPT, showed stabilization or improvement of lesion size, resolution of leakage, and stabilization of vision at last follow-up. CONCLUSION: The results of this study suggest that anecortave acetate may inhibit retinal and subretinal permeability as well as neovascular proliferation in patients with IPT. A larger study accordingly should be designed in the future to evaluate the effectiveness and treatment of IPT with this drug

PURPOSE: The purpose of this study was to evaluate anecortave acetate treatment of retinal angiomatous proliferation (RAP), a neovascular form of age-related macular degeneration, with specific regard to inhibition of neovascularization and maintenance of vision. METHODS: Thirty-four patients with RAP with any stage of neovascularization were randomized 1:1:1 for treatment with three different quantities (30 mg, 15 mg, 3 mg) of anecortave acetate sterile suspension for juxtascleral administration. Best-corrected visual acuity (Early Treatment Diabetic Retinopathy Study chart), intraocular pressure measurement, biomicroscopy, funduscopy, digital fluorescein, and indocyanine green angiography were recorded at baseline and at 3 months. A 6-month retreatment interval was established for this study with a follow-up of 12 months. In selected patients optical coherence tomography was performed. The outcomes were mean changes in visual acuity and lesion size at 1 year. RESULTS: The detachment of the neurosensory retina and retinal pigment epithelium improved in all eyes, but all neovascular lesions increased in size. Vision loss occurred in the majority of study eyes (22 out of 34 eyes, 64.7%) independent of the concentration administered. CONCLUSION: The results suggest that a posterior juxtascleral injection of anecortave acetate reduces capillary permeability in patients with RAP. However, in spite of improvement of the exudation there is a progression of neovascularization and a significant loss of vision in all these patients. Like other monotherapeutic methods used to treat this variant of neovascular age-related macular degeneration, anecortave acetate alone does not appear to benefit these patients. Future studies should investigate a combination form of therapy

PURPOSE: To report two cases of atypical late onset radiation chorioretinopathy occurring 15 and 25 years post exposure and the indocyanine green (ICG) angiographic findings in these patients. METHODS: Clinical examination and imaging including fluorescein and ICG angiography were performed. RESULT: Fundus examination of the first patient revealed microangiopathy with intraretinal hemorrhages, lipid exudation, telangiectatic and aneurysmal capillary changes. Indocyanine green angiography showed an apparent chorioretinal anastomosis and delayed perfusion of the choriocapillaris. Fundus examination of the second patient revealed a pigment epithelial detachment and retinal pigment epithelial changes. Indocyanine green angiography showed atypical, tortuous, dilated, choroidal vessels as well as areas of hypoperfusion. Both patients had multiple dot-like hyperfluorescent spots in the midphase of the ICG angiogram. CONCLUSIONS: External radiation exposure may lead to both retinal and choroidal alterations which may be independent events and which may manifest after a long period of quiescence. Furthermore, ICG angiography appears to be a useful diagnostic tool to study the alterations of the choroid following external eye irradiation

PURPOSE: To describe the short-term anatomical and visual acuity responses after intravitreal injection of bevacizumab (Avastin, Genentech) in patients with choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS: We conducted a retrospective study of patients with CNV secondary to AMD who were treated with intravitreal injection of bevacizumab (1.25 mg) during a 3-month period. Patients underwent best-corrected Snellen visual acuity testing, optical coherence tomography, and ophthalmoscopic examination at baseline and follow-up visits. RESULTS: There were 266 consecutive eyes of 266 patients who received injections, and follow-up information was available for 251 (94.4%). The mean age of the patients was 80.3 years, the mean baseline visual acuity was 20/184, and 175 (69.7%) had inadequate response to alternate methods of treatment. At the 1-month follow-up (data available for 244 patients), the mean visual acuity was 20/137 (P < 0.001 as compared with baseline), and 74 (30.3%) of patients had improvement in visual acuity as defined by a halving of the visual angle. At the 2-month follow-up (data available for 222 patients), the mean visual acuity was 20/122 (P < 0.001), and 78 (31.1%) of patients had visual improvement. At the 3-month follow-up (data available for 141 patients), the mean visual acuity was 20/109 (P < 0.001), and 54 (38.3%) of patients had visual acuity improvement. The mean central macular thickness at baseline was 340 mum and decreased to a mean of 247 microm at month 1 (P < 0.001) and 213 microm at month 3 (P < 0.001). At 1 month, two patients had mild vitritis, as did one patient at 2 months, who had a history of recurrent uveitis. No endophthalmitis, increased intraocular pressure, retinal tear, or retinal detachment occurred. The risk for thromboembolic disorders did not seem to be different than reported previously in studies concerning macular degeneration. CONCLUSION: There were no apparent short-term safety concerns for intravitreal bevacizumab injection for CNV. Treated eyes had a significant decrease in macular thickness and improvement in visual acuity. The follow-up was too short to make any specific treatment recommendations, but the favorable short-term results suggest further study is needed

OBJECTIVES: To study the clinical and angiographic features of lesions in a case series of multiple evanescent white dot syndrome (MEWDS), to describe a newly recognized clinical variation of the disorder, and to gain insight into its pathophysiological nature. METHODS: Five patients with MEWDS (selected based on angiographic manifestations of the disorder) were examined using slitlamp biomicroscopy and studied using fluorescein angiography and indocyanine green angiography. RESULTS: All 5 patients exhibited the newly recognized angiographic features termed dots and spots, which varied in size and location in the fundus. Small dots were in the inner retina or at the level of the retinal pigment epithelium, and larger spots were more external in the subpigment epithelial area. All patients exhibited other characteristics typical of MEWDS, including field loss and foveal granularity. CONCLUSIONS: In this case series of MEWDS, a clinical variant consisting of dual-layered lesions with specific features on clinical examination, fluorescein angiography, and indocyanine green angiography was identified. On late indocyanine green angiography, these lesions produced highly specific findings of small hypofluorescent lesions overlying larger hypofluorescent lesions. Based on the angiographic findings, it seems as if MEWDS is a chorioretinopathy with varying degrees of retinal and choroidal involvement