Dezheng Wu

Subtype lesions of neovascular age-related macular degeneration in Chinese patients

PurposeTo identify the subtype frequency and clinical features of neovascular age-related macular degeneration (AMD) in Chinese patients.MethodsFrom January 2003 to August 2006, we investigated prospectively 155 newly diagnosed patients with presumed neovascular AMD. Fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed in both eyes of all patients. Subtype frequency and clinical features were recorded according to their angiograms.ResultsThree subtypes of lesion were noted, which were polypoidal choroidal vasculopathy (PCV), retinal angiomatous proliferation (RAP) and mixed lesions. Of the 155 patients, 105 (67.7%) had choroidal neovascularization (CNV) of the typical type seen in AMD, 38 (24.5%) had PCV and seven (4.5%) had RAP. In five (3.2%) additional cases, mixed lesions were noted. In 38 cases (47 eyes) with PCV, the rates of subfoveal, juxtafoveal and extrafoveal lesion were respectively 29.8% (14 eyes), 8.5% (four eyes), and 61.7% (29 eyes), compared with 75.6%, 14.6% and 9.8% for CNV lesion (P < 0.01). The percentage of subfoveal lesion in PCV group was significantly lower than that in the CNV group (P < 0.01). The location of the RAP lesion was subfoveal in two (28.6%) eyes, juxtafoveal in three (42.9%) eyes and extrafoveal in two (28.6%) eyes. The five eyes with mixed lesions were all PCV coexisting with CNV at the same eye, and in all of the five cases, CNV was subfoveal while PCV was extrafoveal.ConclusionsIn this hospital-based study, PCV accounts for 24.5% of neovascular AMD and is the most common subtype, RAP is less frequent (4.5%), and mixed lesions are much less common in Chinese patients. PCV is least likely to involve the fovea in neovascular AMD.

Polypoidal choroidal vasculopathy in elderly Chinese patients

PurposeTo investigate the frequency and clinical features of polypoidal choroidal vasculopathy (PCV) in a consecutive series of elderly Chinese patients.MethodsA restrospective analysis of 166 consecutive patients 50 years or older with diagnosis of exudative age-related macular degeneration (AMD) was conducted. Color fundus photographs were taken and fluorescein and indocyanine green (ICG) angiography were performed in all patients.ResultsOf the 166 patients, 37 patients (22.3%) initially suspected of having exudative AMD were ultimately diagnosed as having PCV. Twenty-seven men (73.0%) were affected, 32 patients (86.5%) were unilaterally involved. Of 42 eyes with PCV, 27 eyes (64.3%) demonstrated polypoidal dilations with branching vascular network, and the other 15 eyes (35.7%) showed scattered polypoidal dilations without identifiable continuous branching vascular network on ICG angiography. The predominant location for these lesions was at the macular region in 26 eyes (61.9%), the temporal vascular arcade in 9 eyes (21.4%), the peripapillary area in 6 eyes (14.3%), and the midperiphery in 1 eye (2.4%).ConclusionsPCV is a common disease in elderly Chinese patients. In our study group PCV mainly affected men and was mostly unilateral. Most of the lesions were located in the macular region and temporal vascular arcade.

The local cone and rod system function in early age-related macular degeneration.

To compare cone and rod system function in patients with early age- related macular degeneration (ARMD) and control group using multifocal electroretinogram (MERG) and perimetry, to investigate whether there is rod system dysfunction in the central retina in ARMD. Cone-mediated MERG, photopic sensitivity, rod-mediated MERG, and scotopic sensitivity in 16 eyes of control subjects and 24 eyes of early dry-form ARMD were measured with VERIS Science TM 4.0 and Octopus 101 perimetry. The latencies and average response densities of the summed responses and five ring retinal regions, average sensitivity of all locus and eight ring retinal regions in control eyes were compared with those in ARMD. Mean scotopic and photopic sensitivity of ARMD patients were significantly lower than that of normal controls. Sotopic sensitivity reduced more than photopic sensitivity and the greatest deficit was 2.5–5.0°. The amplitudes of N1 and P1 wave in one ring (5.0°) of rod MERG were significantly lower of ARMD patients than that of normal subjects. Our results suggest that rod function decreased and the parafoveal rod cells were predominantly damaged in ARMD. The rod function testing in macula may be a useful tool to diagnose and measure the fundus dysfunction of ARMD.

The changes of multifocal electroretinography in the early stage of photodynamic therapy for choroidal neovascularization

To investigate short-term changes in the multifocal electroretinography (ERG) recordings after photodynamic therapy (PDT) for choroidal neovascularization (CNV), 16 patients (17 eyes) with classic CNV confirmed by fluorescein angiography (FA) and indocyanine green angiography (ICGA), including 11 cases (12 eyes) of exudative age-related macular degeneration (AMD), two cases (two eyes) of pathological myopia and three cases (three eyes) of idiopathic causes, were treated using PDT with verteporfin. The multifocal ERGs of these patients were tested with VERIS ScienceTM4.0 imaging system. The latencies and average response densities of all six ring retinal regions were measured and compared before PDT and 3 or 7 days after PDT. The latencies and amplitude densities of the N1 and P1 waves in all six rings remained unchanged at 3 or 7 days post-treatment (p>0.05). Therefore, there is no significant evidence to suggest an adverse effect from PDT for classic CNV on the outer retinal function in the early stage of treatment, with the aid of the multifocal ERG recordings.

Polypoidal choroidal vasculopathy coexisting with exudative age-related macular degeneration

Purpose To report two cases that had polypoidal choroidal vasculopathy (PCV) coexisting with choroidal neovascularization (CNV) of exudative age-related macular degeneration (AMD). Methods Both of the patients underwent color photographs, fluorescein and indocyanine green (ICG) angiography. Results On fundus examination, a grayish lesion in the foveal area, reddish-orange lesions and hemorrhagic retinal pigment epithelial detachments (PED) in the inferotemporal vascular arch were disclosed in the left eye of a patient, and macular scarring was observed in the fellow eye. ICG angiography revealed a typical branching vascular network and polyp-like aneurysmal dilations at terminals of branches in the inferotemporal vascular arcade and a well-demarcated hyperfluorescent area of CNV in the fovea in the left eye, and staining of macular scarring was present in the fellow eye. On fundus examination of the right eye of the other patient a gray–yellow lesion at the fovea, reddish-orange lesions in the extramacula were noted, and diffuse drusens were present in the fellow eye. ICG angiography revealed scattered polyp-like aneurysmal dilations without identifiable continuous branching vascular network in the extramacula, and a well-demarcated hyperfluorescence area of CNV in the fovea. Conclusions PCV can coexist with exudative AMD in some patients and the polypoidal lesions may less involve in the fovea than CNV. Evidence of AMD are present meanwhile in the fellow eyes these patients.

Unilateral retinitis pigmentosa with amblyopia in the fellow eye

PurposeThe purpose was to report a case of unilateral retinitis pigmentosa with amblyopia in the other eye.MethodsEight years ago, a 36-year-old woman complained of peripheral visual field loss in her left eye when she covered her right eye. Complete ophthalmological examinations including fundus photography and fluorescein angiography, full-field electroretinography, dark adaptation, and microperimetry were performed.ResultsBest-corrected visual acuity of the patient was 0.2 with +2.5 diopters in her right eye and 0.3 with +1.5 diopters in her left eye. Fundus examination did not reveal any abnormalities in the right eye, but narrow retinal vessels, optic disc pallor, and peripheral retinal pigment clumping was found in the left eye. The full-field electroretinography was normal in the right eye, but rod response, cone response, and combined response were non-recordable, and 30-Hz response was very small in the left eye. Dark adaptation thresholds were normal in the right eye, but were dramatically elevated in the left eye. Microperimetry was normal in the right eye, but the visual field was reduced to a 2×5° central field in the left eye.ConclusionUnilateral retinitis pigmentosa with amblyopia in the other eye is a rare condition. The patient presented here had a case of unilateral retinitis pigmentosa with the other eye with ametropic amblyopia. It is necessary to perform functional and morphological ophthalmological examinations to confirm the diagnosis.

Functional and clinical findings in 3 female siblings with crystalline retinopathy

Purpose To present functional and clinical findings in three female siblings with crystalline retinopathy. Methods Functional and clinical examinations, including full-field and multi-focal electroretinograms (ERG), visual field, dark adaptation and fundus fluorescein angiography (FFA) were performed in three female siblings of a nonconsanguineous Chinese family, who exhibited characteristic retinal crystalline flecks of Bietti crystalline retinopathy. Results Ophthalmological examination revealed similar findings in the first and second daughter of the family. Best-corrected visual acuity was hand movement and finger counting respectively and funduscopic examination showed RPE clumping and relatively fewer yellow-white deposits in the posterior pole and mid-peripheral retina. FFA revealed massive RPE and choriocapillaris destruction. Ganzfeld ERG was undetectable or reduced markedly and multifocal ERG showed all responses were markedly depressed. Ophthalmological examination showed relative preservation of retinal function in the third daughter of the family (the proband). Best-corrected visual acuity was 0.5 in the right eye and 0.4 in the left eye. Funduscopic examination showed numerous crystal deposits scattered throughout the posterior pole. Dark adaptation revealed rod thresholds elevated dramatically and visual field examination demonstrated paracentral scotomas in both eyes. Full-field ERG was decreased slightly and multifocal ERG showed the central responses were markedly depressed. Conclusion The present study describes typical crystalline retinopathy affecting three female siblings in a family.

Impairment of optic path due to radiotherapy for nasopharyngeal carcinoma

Purpose: To evaluate the impairment of optic path caused by radiotherapy for nasopharyngeal carcinoma (NPC). Methods: Visual evoked potential was used to evaluate the functional impairment of optic path by an 8 MV linear accelerator or 60Co γ-ray radiotherapy in 63 (23 women and 40 men) patients with nasopharyngeal carcinoma before radiotherapy, at the end of radiotherapy, 6 months and 1, 2 and 3 years after their radiotherapy respectively. Results: In the female group, the latency of VEP elicited by the three types of elements significantly delayed 2 and 3 years after radiotherapy than that before radiotherapy, at the end of radiotherapy, 6 months and 1 year after radiotherapy; there were no significant difference among VEP amplitudes elicited by the three types of elements before and after radiotherapy. In the male group, the latency of VEP elicited by the medium and the small elements significantly delayed 1 year after radiotherapy than that before radiotherapy and at the end of radiotherapy, the VEP latency elicited by the small elements was significantly prolonged 3 years after radiotherapy compared to that just after radiotherapy, while the VEP amplitude elicited by the large elements was significantly attenuated 1 year after radiotherapy compared to those before and just after radiotherapy. Conclusions: In the female group, the significant prolongation of VEP latency happened at the end of radiotherapy and lasted for 3 years, while the VEP amplitude did not change significantly during the 3 years after radiotherapy. It indicates that the sustained impairment by radiation within the female visual nerve system starts at the end of radiotherapy, but the impairment was mild. In the male group, the significant prolongation of VEP latency mostly happened 1 or 2 years after radiotherapy. It was shown that the radiotherapy for nasopharyngeal carcinoma certainly injured the optic path, and there was difference in the impairment between the two sexes.