Werner Inhoffen

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.

Visualization and follow-up of acute macular neuroretinopathy with the Spectralis® HRA+OCT device

BackgroundAcute macular neuroretinopathy (AMNR) is a rare disease entity, the diagnosis of which is frequently complicated by the subtlety of biomicroscopic findings.MethodsTwo cases of AMNR are presented, in which the diagnosis and follow-up was enabled using the Spectralis® HRA+OCT in the absence of clear biomicroscopic findings.ResultsThe typical lesions were visualized by hyporeflexion during infrared imaging and faded over time. With spectral domain optical coherence tomography, changes in the outer retina in the affected regions were documented, with no change over time.ConclusionThe broader availability of this technology may enhance the diagnosis and follow-up of AMNR.

Clinicopathological findings of choroidal neovascularisation following verteporfin photodynamic therapy

Aims: To report the clinicopathologic findings of surgically excised choroidal neovascularisation (CNV) three days after verteporfin photodynamic therapy (PDT). Methods: In three patients (three eyes) with age related macular degeneration, the CNV was surgically removed three days after PDT. The CNV specimens were examined by light microscopy. Results: The patients had subfoveal classic CNV. Fluorescein angiography revealed non-perfusion of the CNV after PDT and before surgery in all eyes. The light microscopy of the CNV membranes showed swollen and damaged endothelium. Thrombus formation or vascular occlusion in the CNV vessels was not detected. Conclusion: PDT did not cause a thrombosis of the vessels within the CNV three days after PDT. Severe endothelial damage of the CNV was observed and is likely a primary effect of PDT. Non-perfusion of the CNV at this stage is possibly secondary to occlusion at a deeper level, namely the underlying feeding choroid.

In vivo assessment of subretinally implanted microphotodiode arrays in cats by optical coherence tomography and fluorescein angiography

BackgroundFollowing multiple promising investigations into restoration of vision in degenerative retinal disease by implantation of a sub- or epiretinal prosthesis, the step to clinical use in humans is impending. In this study we intended to establish optical coherence tomography (OCT) and fluorescein angiography (FA) first in research animals for noninvasive assessment of the condition of the posterior pole of eyes after intraocular implant surgery.MethodsThree adult cats that had undergone subretinal implant surgery were evaluated by OCT and FA between 1 and 470 days postoperatively. Eight adult cats served as control. In addition histology was performed.ResultsIn all three cats OCT demonstrated stable positioning of the implants in the subretinal space during the complete examination period. Transient retinal edema was found in the early postoperative period but decreased during follow-up. The retina over the implants was well attached at all times in cats 1 and 2; however, in cat 3 localized retinal detachment was demonstrated. FA showed intact retinal vasculature over the subretinal implant in high detail without interference from choroidal background fluorescence.ConclusionsOCT and FA have been fruitfully applied to cats to assess the morphological and circulatory conditions of the neuroretina and of its interface with the subretinal implant. The techniques may therefore provide a tool for objective, noninvasive in vivo evaluation of eyes that have undergone subretinal implant surgery, both in research animals and in humans.

Verteporfin photodynamic therapy induced apoptosis in choroidal neovascular membranes

Aim: To evaluate the impact of verteporfin photodynamic therapy (PDT) on the induction of apoptosis in choroidal neovascular membranes (CNV) secondary to age related macular degeneration. Methods: Retrospective review of 22 surgically excised CNV. 12 of these patients had been treated with PDT 3–146 days previously. Apoptotic cells were detected with the TUNEL technique and compared to the expression of CD34 (endothelial cells, EC), CD105 (activated endothelial cells), Ki-67 (proliferation marker), and cytokeratin18 (retinal pigment epithelial cells, RPE). Results: CNV excised 3 days after PDT were characterised both by collapsed and patent vessels. The EC displayed a statistical significant positive TUNEL reaction when compared to the remaining treated CNV (p<0.001) and untreated CNV (P = 0.002). The proliferative activity was reduced. CNV excised 1–5 months after PDT displayed a patent vascularisation and high proliferative activity. All membranes either treated or untreated disclosed only sporadic TUNEL positive cells within the stroma and the RPE. Conclusions: Verteporfin PDT leads to selective and effective damage of EC within CNV. Both patent and occluded vessels were lined by apoptotic EC. This finding and the increased expression of proliferation marker at later time points suggest that revascularisation after PDT is caused by angiogenesis rather than recanalisation.

Assessment of visual function in choroidal neovascularization with scanning laser microperimetry and simultaneous indocyanine green angiography.

Abstract• Background: Clinical management and treatment of diseases with choroidal neovascularization (CNV) are mainly based on visual acuity, which may give an incomplete picture of the associated visual dysfunctions. With the advent of new experimental treatment modalities such as alfa-interferon, radiation, or surgical excision of CNV, it is increasingly important to develop better methods for characterizing the associated visual function. Microperimetry with the scanning laser ophthalmoscope (SLO) allows precise point-to-point correlation between visual function and the macular pathology. However, precise delineation of CNV is a prerequisite for accurate correlation of the functional results with the CNV. • Methods: A total of 40 eyes with CNV secondary to age-related macular degeneration were evaluated with static manual microperimetry using the SLO to quantitate relative and absolute scotomata within the CNV. For precise delineation of the CNV, indocyanine green (ICG) angiography was simultaneously performed, allowing stimulus presentation at any desired retinal location under visual feedback of the angiogram. • Results: A relative scotoma was detected in 19 and an absolute scotoma in 21 out of 40 eyes. The depth of the scotomata was correlated with the duration of symptoms (P<0.01). Eyes with well-defined CNV had significantly deeper scotomas than eyes with occult CNV (P<0.005). • Conclusion: Microperimetry using the SLO and simultaneous ICG angiography demonstrated relative and absolute scotoma within the CNV. The depth of the scotoma may guide the ophthalmologist in selecting the adequate treatment.

Verteporfin photodynamic therapy for extrafoveal choroidal neovascularisation in pathologic myopia.

BackgroundTo report long-term functional and morphological outcome of verteporfin photodynamic therapy (PDT) for classic extrafoveal choroidal neovascularisation (CNV) secondary to pathologic myopia.MethodsThis retrospective case series included three eyes of three consecutive patients with classic extrafoveal CNV secondary to pathologic myopia, who underwent PDT at a tertiary retinal referral centre. Change in visual acuity and fluorescein leakage was the main outcome criteria.ResultsThe patients were followed up an average of 36 months (33–40 months). In all eyes increase of visual acuity (one eye 1 ETDRS line, two eyes 2 ETDRS line) and no fluorescein leakage of the CNV were seen.ConclusionsPDT can achieve long-term improvement of the visual acuity and morphological stability in selected cases with classic extrafoveal CNV in pathologic myopia. Large scale randomised studies are warranted for assessment of the benefit of PDT in such eyes.

Characteristics of visual field defects by scanning laser ophthalmoscope microperimetry after radial optic neurotomy for central retinal vein occlusion.

Purpose: To evaluate visual field defects after radial optic neurotomy (RON) for the treatment of central retinal vein occlusion (CRVO) by using scanning laser ophthalmoscope microperimetry. Methods: Thirteen eyes of 13 patients with severe vision loss (≤20/200) from CRVO who underwent pars plana vitrectomy and RON had postoperative Goldmann kinetic perimetry, scanning laser ophthalmoscope microperimetry, and fluorescein angiographic evaluation. Results: After a mean follow-up of 8 months, 6 of the 13 patients had visual improvement by ≥2 lines. Eight patients developed an anastomosis at the radial cut. Postoperatively, sectorial visual field loss arising from the optic head was found by Goldmann perimetry in six patients, and a thin nerve fiber bundle defect was found in three patients. Four patients had no detectable visual field defect shown by Goldmann perimetry, but microperimetry demonstrated an absolute nerve fiber bundle defect arising from the radial cut at the optic disk for three of these patients. Conclusion: Visual field loss after RON for the treatment of CRVO is a frequent complication. The etiology of this visual loss appears to be a combination of mechanical trauma to the nerve fiber layers and ischemia of the optic disk circulation.

DIAGNOSIS OF OCCULT SUBRETINAL NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION BY INFRARED SCANNING LASER VIDEOANGIOGRAPHY

Abstract: 180 consecutive patients with exudative age-related macular degeneration and clinical signs of subretinal neovascular membranes were examined by scanning laser fluorescein angiography. This technique demonstrated well-defined, newly formed subretinal vessels in approximately 50%, ill-defined subretinal vessels in approximately 20%, and not visible or occult subretinal vessels in the remaining 30% of the patients. Patients with ill-defined or occult neovascular membranes were also examined with scanning laser infrared angiography with cardiogreen. Newly formed subretinal vessels were well defined in approximately 40% of these patients, and ill defined in 23%. In 37% of the patients, neovascularizations were also not visible with infrared angiography. Results of scanning laser infrared angiography seem to be superior to earlier methods of infrared angiography. Conditions are discussed under which fluorescein and cardiogreen angiography can demonstrate subretinal membranes in age-related maculopathy.

Subfoveal hemorrhage after verteporfin photodynamic therapy in treatment of choroidal neovascularization

BackgroundTo identify the frequency of new subfoveal hemorrhage and its impact on visual acuity 2 weeks following verteporfin photodynamic therapy (PDT) in the treatment of predominantly classic subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).MethodsRetrospective, noncomparative, consecutive, interventional case series. At a tertiary retinal referral center, 104 eyes of 97 consecutive patients with predominantly classic subfoveal CNV were treated by PDT. Morphological outcomes include new subfoveal hemorrhage assessed on the photo review (pretreatment, 2 and 12 weeks after PDT). Visual acuity outcomes include moderate (3–5 ETDRS lines) and severe (6 and more ETDRS lines) loss of visual acuity at 2 weeks after PDT.ResultsIn this study, 104 eyes of 97 patients were analyzed. CNV in all eyes was secondary to AMD. New subfoveal hemorrhage was found in 22% (23/104) of the eyes 2 weeks following PDT. 17.4% (4/23) of the eyes with new subfoveal hemorrhage had moderate or severe loss of visual acuity. In such eyes the 12-week examination revealed considerable resorption of the new subfoveal hemorrhage with some improvement of visual acuity.ConclusionsIn 3.8% of the eyes that underwent PDT for predominantly classic subfoveal CNV secondary to AMD, new subfoveal hemorrhage may result in moderate or severe loss of visual acuity within 2 weeks. In all eyes with new subfoveal hemorrhage, considerable resorption of the hemorrhage and some improvement of the visual acuity were seen at 12 weeks. Candidates for PDT should be informed about the low risk of this complication.