Faculty Bibliography

PURPOSE: To characterize a newly discovered choroidal vascular abnormality in patients who have received radiation therapy for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration. DESIGN: Two-center cross-sectional study. PARTICIPANTS: In the United States, there were 95 patients who were treated with 10 or 12 Gy of external beam photons. In Belgium, 98 patients were treated with 20 Gy. These patients were examined retrospectively for the presence of a specific CNV abnormality. RESULTS: During the follow-up period, an unusual vascular growth pattern was identified in 12 patients (12.6%) of those treated in the United States and in 7 (7.1%) of those treated in Belgium. These patients developed round or oval vascular blebs along the outer border of their neovascular lesions. These blebs profusely leaked fluorescein dye and could be imaged best by indocyanine green angiography. Patients with these blebs appeared to have a marked propensity for loss of visual acuity. CONCLUSION: An unusual pattern of new vessel growth occurred in 19 of the 193 patients with CNV treated with radiation. This new entity, termed radiation-associated choroidal neovasculopathy, is a recognizable disorder that appears to have a particularly poor prognosis

OBJECTIVE: To determine the nature and frequency of polypoidal choroidal vasculopathy (PCV) in a series of patients suspected of having neovascularized age-related macular degeneration (AMD). METHODS: A prospective analysis of 167 consecutive, newly diagnosed patients aged 55 years or older with presumed neovascularized AMD was performed. All patients were examined with fundus biomicroscopy as well as fluorescein and indocyanine green angiography. RESULTS: Choroidal neovascularization secondary to AMD was diagnosed in 154 (92.2%) of 167 patients; 13 (7.8%) patients had PCV. The patients affected by PCV were younger than those with AMD (P = .01). Peripapillary choroidal neovascularization was seen in 3 (1.9%) of 154 patients with AMD and 3 (23.1%) of 13 patients with PCV (P = .006). Significant drusen were present in 63 (70%) of 90 fellow eyes with unilateral AMD compared with only 1 (16.7%) of 6 eyes with PCV (P = .02). Only 5 patients with AMD (3.2%) were nonwhite compared with 3 patients with PCV (23.1%) (P = .02). CONCLUSIONS: A measurable number of elderly patients with findings suggestive of neovascularized AMD and serosanguineous macular manifestations will instead have PCV. Polypoidal choroidal vasculopathy can occur in any sex or race, but is more commonly seen in the peripapillary area, without associated drusen, and in nonwhite patients. It is important to differentiate AMD from PCV because there are significant differences in the demographic risk profile, natural course, visual prognosis, and management of these patients

PURPOSE: To determine systemic factors associated with central serous chorioretinopathy. METHODS: In a retrospective study, 230 consecutive patients with central serous chorioretinopathy examined in a referral setting were compared with a historical gender-matched and age-matched control group of 230 patients with ocular findings who were examined in the same referral setting. RESULTS: The median age of the patients was 49.8 years, and of the control subjects, 50.0 years. The male-female ratio for both groups was 2.7:1. Patients with central serous chorioretinopathy were more likely to use psychopharmacologic medications (odds ratio = 2.6; 95% confidence interval = 1.30 to 5.19; P = .0049) and corticosteroids (odds ratio = 3.17; 95% confidence interval = 1.30 to 7.70; P = .0067) and were more likely to have hypertension (odds ratio = 2.25; 95% confidence interval = 1.39 to 3.63; P = .0008) than were the control subjects. CONCLUSIONS: This study identified psychopharmacologic medication use, corticosteroid use, and hypertension as factors associated with central serous chorioretinopathy. These findings reinforce the concept that stress and adaptations to stress play a role in this disorder. The findings of possible associations between central serous chorioretinopathy and both hypertension and corticosteroid usage suggest that these modifiable factors may influence morbidity of central serous chorioretinopathy

OBJECTIVE: This study aimed to use a new technique for ocular imaging, digital subtraction indocyanine green angiography (DS-ICGA), to evaluate patients with occult choroidal neovascularization (CNV). DESIGN: The design was a cross-sectional study of patients with occult CNV. PARTICIPANTS: A total of 31 eyes of 31 patients were studied. INTERVENTION: Digital subtraction of sequentially acquired indocyanine green angiographic frames was used to image the progression of the dye front in eyes with occult CNV. A method of pseudocolor imaging of the choroid was developed that allows differentiation and identification of underlying choroidal arteries and veins. RESULTS: The DS-ICGA of occult CNV showed consistent findings. Occult CNV was imaged with greater detail and in a shorter period of time than with conventional indocyanine green angiography. The fundus landmarks were retained with DS-ICGA much better than with conventional indocyanine green angiography. CONCLUSIONS: The DS-ICGA uses time to dissect the choroidal circulation. With DS-ICGA, occult CNV could be imaged more quickly and in greater detail than with conventional imaging techniques. The DS-ICGA may improve the authors ability to image, and subsequently treat, occult CNV

OBJECTIVE: This study aimed to determine the effect of external beam radiation therapy on choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). DESIGN: The study design was a nonrandomized clinical trial with an historic control group. PARTICIPANTS: A total of 91 patients were treated with external beam radiation. These patients were compared retrospectively to the 119 patients in a control group. INTERVENTION: Patients with subfoveal CNV who did not meet the criteria for laser treatment defined by published reports from the Macular Photocoagulation Study Group or who did not want laser treatment were considered for radiation therapy in a nonrandomized, prospective clinical trial. Additional entry criteria for this prospective study included visual acuity better than or equal to 20/320 on the Early Treatment Diabetic Retinopathy Study chart and a lesion size less than 12 disc areas. The patients were treated with 5 fractions of 200 cGy 6 MV external beam photons. MAIN OUTCOME MEASURES: The visual acuity measured at baseline was compared to the visual acuity after 1 year of follow-up. RESULTS: The mean baseline visual acuity of the 91 patients entered into the Radiation Study was 20/80. After 1 year, 83 patients (91.2%) completed follow-up, and their mean visual acuity dropped to 20/200. By comparison, the mean baseline visual acuity of the control patients also was 20/80, and after 1 year, the control subjects had a mean visual acuity of 20/125. At 1 year of follow-up, 49.4% of patients treated with radiation and 38.1% of the control subjects lost 3 or more lines of visual acuity (P = 0.16). CONCLUSIONS: This study found that external beam radiation using 1000 cGy in 5 fractions, a dose similar to that used in previous studies, was not effective in the treatment of CNV secondary to AMD. These results suggest that patients should not be treated with this dose of external beam radiation for CNV secondary to AMD

BACKGROUND: Evaluation of the vasculature and blood flow in the fundus is limited by the small field of view of conventional fundus cameras. We sought to develop an easy method to image wide areas of the fundus. METHODS: Wide-angle contact fundus lenses with antireflective coatings in the infrared range were placed on the eye and indocyanine green angiography was done on the fundus through the contact lenses. More than 50 patients with varying fundus pathology have been examined. RESULTS: The angular field of view using this method can reach 160 degrees. Obtaining angiograms where the field of view extended anterior to the ora serrata was simplified, and studying the choroidal vasculature in detail was possible. In addition, imaging of entities such as peripheral choroidal neovascularization and choroidal tumors was enhanced with the present technique as compared with conventional techniques. CONCLUSIONS: Angiography through wide-angle fundus lenses is an easy and inexpensive method of visualizing large areas of the fundus. This technique may help improve our ability to image the angioarchitecture, hemodynamics, and pathologic changes in the retina and choroid