Allen C. Ho

The Natural History of Idiopathic Subfoveal Choroidal Neovascularization

PURPOSEnTo study the long-term natural history of idiopathic subfoveal choroidal neovascularization (CNV) in young patients.nnnMETHODSnA retrospective survey of 19 consecutive patients with idiopathic subfoveal CNV diagnosed in an urban eye hospital and a single practice.nnnRESULTSnTwenty-three (26%) of 87 consecutive patients with idiopathic CNV demonstrated subfoveal CNV. Nineteen patients with subfoveal involvement were followed for a median of 87 months (range, 5-230 months). On initial examination, the median best-corrected Snellen visual acuity was 20/100 (range, 20/40-counting fingers); at final examination, the median visual acuity was 20/70 (range, 20/20-counting fingers). A total of 95% of patients had stable or significantly improved visual acuity, whereas only 5% had significant visual loss. Size of the CNV was the only variable associated with long-term final visual acuity. Lesions 1 disc area or smaller at the time of initial fluorescein angiography were more likely to be associated with a final visual acuity of 20/60 or better and less likely to be associated with a final visual acuity of 20/200 or worse (P = 0.038) as compared with larger lesions. These results were confirmed with multiple logistic regression analysis (P = 0.027). Fellow eyes remained unaffected during the follow-up period.nnnCONCLUSIONSnThe natural history of idiopathic subfoveal CNV is not necessarily associated with a profound loss of vision. Therapies for this type of subfoveal lesion must take into consideration the possibility of a favorable natural course.

Laser treatment in eyes with large Drusen: Short-term effects seen in a pilot randomized clinical trial

OBJECTIVEnThis study aimed to describe the short-term effects of low-intensity laser treatment in eyes with drusen at risk of having choroidal neovascularization (CNV) develop secondary to age-related macular degeneration.nnnDESIGNnThe study design was a multicentered, randomized clinical trial of laser treatment versus observation.nnnPARTICIPANTSnOne hundred fifty-six patients without exudative age-related macular degeneration and with more than 10 large (> 63 microns) drusen in each eye were enrolled in the Bilateral Drusen Study. One hundred twenty patients with exudative age-related macular degeneration in 1 eye and more than 10 large drusen in the other eye were enrolled in the Fellow Eye Study.nnnINTERVENTIONnThe treatment protocol for most (85%) of the eyes consisted of 20 laser burns, 100 microns in diameter, in a pattern of 3 rows placed between the 12- and 6-oclock positions beyond the temporal perimeter of the foveal avascular zone. The desired intensity of the burns was a gray-white lesion. Whenever the area of drusen had not been reduced by 50% or more at 6 months, a second treatment was applied nasal to the fovea in a mirror image of the first treatment. During the last 6 months of enrollment, a second laser treatment protocol was adopted that specified 24 laser burns, 100 microns in diameter, in a circular pattern of 2 rows surrounding the macular drusen.nnnMAIN OUTCOME MEASURESnChange in visual acuity is the primary outcome measure. Incidence of CNV, change in contrast threshold, and change in critical print size are secondary outcome measures.nnnRESULTSnIn the Bilateral Drusen Study, CNV developed in 4 of 156 treated eyes and in 2 of 156 observed eyes (P = 0.62); in the Fellow Eye Study, the proportions are 10/59 treated eyes and 2/61 observed eyes (P = 0.02). Changes in visual acuity are similar in treated and observed eyes in the Bilateral Drusen Study through 18 months. However, by 18 months, observed eyes in the Fellow Eye Study have lost more visual acuity than treated eyes (P = 0.02). Changes in contrast threshold are similar in treated and observed eyes in each study.nnnCONCLUSIONSnLaser treatment to high-risk fellow eyes may increase the short-term incidence of CNV. Long-term effects in fellow eyes and effects in patients with bilateral drusen require additional observation.

One-year outcomes of panretinal photocoagulation in proliferative diabetic retinopathy.

PURPOSEnTo describe the clinical features and complications of diabetic retinopathy, visual acuity, and number of repeat treatments after panretinal photocoagulation for proliferative diabetic retinopathy in a tertiary care center.nnnMETHODSnA cohort study was conducted with data collection from medical records of patients undergoing panretinal photocoagulation between 1985 and 1995 at the Scheie Eye Institute; 297 eyes of 186 patients were eligible for study.nnnRESULTSnThe presence of neovascularization of the disk at baseline, an earlier onset of diabetes, and a shorter duration of disease before panretinal photocoagulation were the strongest risk factors for needing an additional panretinal photocoagulation treatment. Sixty-two percent of eyes with poor visual acuity (< or =20/200) at baseline still had poor visual acuity at 1 year, and 76% with good visual acuity (> or =20/40) at baseline maintained good visual acuity at 1 year. Poor vision at baseline was the only risk factor for having poor vision at 1 year. Vitreous hemorrhage was present in 44% of eyes at baseline. New vitreous hemorrhage developed in 37% of eyes during the first year after panretinal photocoagulation. A traction retinal detachment was present in 4% of eyes at baseline and newly developed in 6% of eyes during follow-up. A repeat panretinal photocoagulation treatment was performed in 39% of eyes after initial treatment. A vitrectomy was performed in 10% of eyes from baseline through the 1-year follow-up visit.nnnCONCLUSIONSnThe data from this study are useful for counseling patients with respect to likely visual outcome, possibility of major complications from proliferative diabetic retinopathy, and the chance of undergoing additional laser treatment after panretinal photocoagulation.

Rapidly Progressive Optic Disk Neovascularization After Diabetic Papillopathy

Purpose To determine if diabetic papillopathy may be associated with optic disk neovascularization and visual loss. Methods We examined two young adults with bilateral diabetic papillopathy who had permanent loss of vision associated with rapidly progressive posterior segment neovascularization. Results Within three months both patients developed florid optic disk neovascularization. This neovascularization was slow to regress despite full panretinal photocoagulation. One patient developed a macular tractional retinal detachment. Conclusions Diabetic papillopathy may be associated with rapid progression of diabetic retinopathy and, in particular, optic disk neovascularization. Patients should be monitored for this possibility.