Purpose: To examine the 12- month results of a group of patients treated with combined photodynamic therapy (PDT)- with verteporfin and intravitreal triamcinolone acetonide for choroidal neovascularization (CNV) secon...Purpose: To examine the 12- month results of a group of patients treated with combined photodynamic therapy (PDT)- with verteporfin and intravitreal triamcinolone acetonide for choroidal neovascularization (CNV) secondary to age- related macular degeneration (AMD). Design: Noncomparative case series. Participants: Twenty- six eyes of 26 patients with CNV secondary to AMD. Thirteen with CNV, without restriction to type, were not treated with prior PDT (newly treated group)- . Thirteen patients with prior PDT therapy who experienced visual loss while being treated with PDT alone comprised the remainder (prior PDT group). Methods: Patients with CNV were treated with PDT, immediately followed by an intravitreal injection of4 mg of triamcinolone acetonide. Visual acuity was measured by Early Treatment Diabetic Retinopathy Study protocol refraction. Need for retreatment was based on fluorescein angiographic evidence of leakage at 3- month follow- up intervals. Main Outcome Measures: Visual acuity and retreatment rate. Results: In the newly treated group, the mean acuity change was an improvement of 2.5 lines (last observation carried forward [LOCF], + 2.4 lines; P=0.011, Wilcoxon signed ranks test, as comparedwith baseline acuity) for patients completing the 12- month follow- up. In the prior PDT group, the mean change was an improvement of + 0.44 lines (LOCF, + 0.31 lines; P=0.53). Retreatment rates were 1.24 for the newly treated group and 1.2 for the prior PDT group over the first year. Ten patients (38.5% ) developed an intraocular pressure (IOP) of >24 mmHg during follow- up, a threshold used to institute pressure reduction therapy. No patient developed endophthalmitis. Conclusion: Although the number of patients in this pilot study was limited, the improvement of acuity and the reduced treatment frequency in these patients suggest that combination therapy with PDT and intravitreal triamcinolone acetonide, particularly when used as first- line therapy, merits further investigation. Elevated IOP seems to be the most frequent early side effect of the treatment.展开更多
Purpose: To investigate the autofluorescence characteristics in patients with central serous chorioretinopathy. Design: Observational case series. Participants: Thirty consecutive patients examined in a private referr...Purpose: To investigate the autofluorescence characteristics in patients with central serous chorioretinopathy. Design: Observational case series. Participants: Thirty consecutive patients examined in a private referral practice. Methods: Patients were imaged with autofluorescence photography, fundus photography, fluorescein angiography, and optical coherence tomography (OCT). The mean and standard deviation (SD) of the grayscale values from a 100-pixel-diameter circle centered on the fovea were obtained and normalized with the level of autofluorescence of the posterior pole. Results: There were 30 patients, 23 male (76.7%) and 7 female (23.3%), with a median visual acuity (VA) of 20/25 and a range of 20/15 to 20/400. Stepwise linear regression that included individual fixed effects found that normalized central macular autofluorescence (P < 0.001), pigment mottling in the fovea (P=0.045), subfoveal fluid detected by OCT (P=0.033), and the SD of the central macular autofluorescence (P=0.025) produced a highly significant model (R2=0.92, P< 0.001) predicting VA. Increasing levels of autofluorescence were correlated with accumulation of material on the outer surface of the retina as seen by OCT. Decreased central macular autofluorescence, particularly in those eyes with central geographic retinal pigment epithelial atrophy, was associated with poor VA. Conclusions: This study established that autofluorescence changes occurring in central serous chorioretinopathy with explicit patterns can be measured in a noninvasive manner, and this information can be used to estimate the damage induced by central serous chorioretinopathywith a high degree of statistical significance. We hypothesize that the material on the outer surface of the elevated retina may represent accumulation of photoreceptor outer segments secondary to the lack of direct apposition and phagocytosis by the retinal pigment epithelium.展开更多
To report combined treatment of photodynamic therapy (PDT) with verteporfin an d intravitreal triamcinolone acetonide injection for subfoveal neovascularizatio n secondary to bilateral idiopathic juxtafoveal telangiec...To report combined treatment of photodynamic therapy (PDT) with verteporfin an d intravitreal triamcinolone acetonide injection for subfoveal neovascularizatio n secondary to bilateral idiopathic juxtafoveal telangiectasis. Interventional c ase report. A patient with a subfoveal neovascularization secondary to bilateral idiopathic juxtafoveal telangiectasis was treated with PDT plus an intravitreal injection of 4 mg of triamcinolone acetonide. Leakage in the late phase of flu orescein angiography resolved with attenuation of telangiectatic vessels and imp rovement in visual acuity from 20/200 to 20/50. At 9 months post treatment, rec urrent leakage was treated with repeat PDT and intravitreal triamcinolone. One y ear after initial presentation, visual acuity was 20/60 with no leakage on fluor escein. Combined treatment with PDT and intravitreal triamcinolone acetonide res ulted in regression of a subfoveal neovascular membrane and improvement in visua l acuity during the course of follow up.展开更多
To evaluate the disease involvement in a patient with acute zonal occult outer retinopathy (AZOOR). Observational case report. A patient with acute zonal occu lt outer retinopathy was imaged with fundus photography, f...To evaluate the disease involvement in a patient with acute zonal occult outer retinopathy (AZOOR). Observational case report. A patient with acute zonal occu lt outer retinopathy was imaged with fundus photography, fluorescein and indocya nine green angiography, and autofluorescence photography. There was subtle depig mentation in the central portion of the lesion with a drusen like deposit at th e outer border. Fluorescein angiography showed a transmission defect centrally a nd a blocking defect at the border where the drusenoid material accumulated. Aut ofluorescent photography demonstrated that the drusenoid material was intensely autofluorescent, consistent with the presence of lipofuscin, and the central por tion of the lesion showed atrophy of the retinal pigment epithelium. Indocyanine green angiography showed atrophy of the choriocapillaris underlying areas of at rophy of the retinal pigment epithelium. In this case acute zonal occult outer r etinopathy caused an area of retinal pigment epithelium cell death with lipofusc in laden cells at the border of the expanding lesion and associated atrophy of the underlying choriocapillaris.展开更多
PURPOSE: To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) that had areas of retinal pigment epithelial loss. DESIGN: Observational case report. METHODS: A 67-year-old woman with a history ...PURPOSE: To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) that had areas of retinal pigment epithelial loss. DESIGN: Observational case report. METHODS: A 67-year-old woman with a history of uterine cancer presented with 4 months of bilateral visual loss. RESULTS: Although B-scan ultrasonography revealed both small shallow serous retinal and choroidal detachments in the periphery, the choroid was normal in thickness. Fluorescein angiography revealed numerous nummular-shaped areas of transmission defects suggesting retinal pigment epithelium loss. Autofluorescence photography showed complete absence of autofluorescence in these nummular areas, and optical co-herence tomography showed segmental areas with lack of any signal from affected areas of the retinal pigment epithelium, suggesting complete loss of retinal pigment epithelium cells. CONCLUSIONS: Although the fundus findings in BDUMPhave been attributed to the proliferation of uveal melanocytic cells in the outer choroid in previous papers, our patient had nummular areas of loss of the retinal pigment epithelium as the apparent reason for visual decline.展开更多
To analyze the incidence of intraocular pressure (IOP) elevation following int ravitreal triamcinolone injection. Retrospective observational case series. Char ts of patients undergoing intravitreal triamcinolone inje...To analyze the incidence of intraocular pressure (IOP) elevation following int ravitreal triamcinolone injection. Retrospective observational case series. Char ts of patients undergoing intravitreal triamcinolone injection in one clinical p ractice were reviewed. A pressure elevation was defined as a pressure of 24 mm H g or higher during follow up. There were 89 patients with a mean age of 76.4 ye ars. The mean baseline IOP was 14.9 mm Hg with a mean change of 8.0 mm Hg. Thirt y six patients (40.4%) experienced a pressure elevation to 24 mm Hg or higher at a mean of 100.6 days (SD= 83.1 day) after treatment. Of nonglaucomatous patie nts with baseline IOP of 15 mm Hg or above, 60.0%experienced a pressure elevati on, compared with only 22.7%of those with baseline pressures below 15 mm Hg (re lative risk=2.1, P< .01). In glaucoma patients, 6 of 12 (50%) experienced a pre ssure elevation, and this elevation was not correlated with baseline pressure. T hirty two patients (36.0%) received repeat injections, and there was no differ ence in the incidence of procedure elevation in patients receiving multiple inje ctions versus those receiving a single injection. Pressure elevation was control led with topical medications in all patients. IOP elevation after intravitreal t riamcinolone injection is common and may take an extended period of time to mani fest. The proportion of patients who developed a pressure elevation to at least 24 mm Hg was much higher for those with baseline IOP 15 mm Hg or greater.展开更多
文摘Purpose: To examine the 12- month results of a group of patients treated with combined photodynamic therapy (PDT)- with verteporfin and intravitreal triamcinolone acetonide for choroidal neovascularization (CNV) secondary to age- related macular degeneration (AMD). Design: Noncomparative case series. Participants: Twenty- six eyes of 26 patients with CNV secondary to AMD. Thirteen with CNV, without restriction to type, were not treated with prior PDT (newly treated group)- . Thirteen patients with prior PDT therapy who experienced visual loss while being treated with PDT alone comprised the remainder (prior PDT group). Methods: Patients with CNV were treated with PDT, immediately followed by an intravitreal injection of4 mg of triamcinolone acetonide. Visual acuity was measured by Early Treatment Diabetic Retinopathy Study protocol refraction. Need for retreatment was based on fluorescein angiographic evidence of leakage at 3- month follow- up intervals. Main Outcome Measures: Visual acuity and retreatment rate. Results: In the newly treated group, the mean acuity change was an improvement of 2.5 lines (last observation carried forward [LOCF], + 2.4 lines; P=0.011, Wilcoxon signed ranks test, as comparedwith baseline acuity) for patients completing the 12- month follow- up. In the prior PDT group, the mean change was an improvement of + 0.44 lines (LOCF, + 0.31 lines; P=0.53). Retreatment rates were 1.24 for the newly treated group and 1.2 for the prior PDT group over the first year. Ten patients (38.5% ) developed an intraocular pressure (IOP) of >24 mmHg during follow- up, a threshold used to institute pressure reduction therapy. No patient developed endophthalmitis. Conclusion: Although the number of patients in this pilot study was limited, the improvement of acuity and the reduced treatment frequency in these patients suggest that combination therapy with PDT and intravitreal triamcinolone acetonide, particularly when used as first- line therapy, merits further investigation. Elevated IOP seems to be the most frequent early side effect of the treatment.
文摘Purpose: To investigate the autofluorescence characteristics in patients with central serous chorioretinopathy. Design: Observational case series. Participants: Thirty consecutive patients examined in a private referral practice. Methods: Patients were imaged with autofluorescence photography, fundus photography, fluorescein angiography, and optical coherence tomography (OCT). The mean and standard deviation (SD) of the grayscale values from a 100-pixel-diameter circle centered on the fovea were obtained and normalized with the level of autofluorescence of the posterior pole. Results: There were 30 patients, 23 male (76.7%) and 7 female (23.3%), with a median visual acuity (VA) of 20/25 and a range of 20/15 to 20/400. Stepwise linear regression that included individual fixed effects found that normalized central macular autofluorescence (P < 0.001), pigment mottling in the fovea (P=0.045), subfoveal fluid detected by OCT (P=0.033), and the SD of the central macular autofluorescence (P=0.025) produced a highly significant model (R2=0.92, P< 0.001) predicting VA. Increasing levels of autofluorescence were correlated with accumulation of material on the outer surface of the retina as seen by OCT. Decreased central macular autofluorescence, particularly in those eyes with central geographic retinal pigment epithelial atrophy, was associated with poor VA. Conclusions: This study established that autofluorescence changes occurring in central serous chorioretinopathy with explicit patterns can be measured in a noninvasive manner, and this information can be used to estimate the damage induced by central serous chorioretinopathywith a high degree of statistical significance. We hypothesize that the material on the outer surface of the elevated retina may represent accumulation of photoreceptor outer segments secondary to the lack of direct apposition and phagocytosis by the retinal pigment epithelium.
文摘To report combined treatment of photodynamic therapy (PDT) with verteporfin an d intravitreal triamcinolone acetonide injection for subfoveal neovascularizatio n secondary to bilateral idiopathic juxtafoveal telangiectasis. Interventional c ase report. A patient with a subfoveal neovascularization secondary to bilateral idiopathic juxtafoveal telangiectasis was treated with PDT plus an intravitreal injection of 4 mg of triamcinolone acetonide. Leakage in the late phase of flu orescein angiography resolved with attenuation of telangiectatic vessels and imp rovement in visual acuity from 20/200 to 20/50. At 9 months post treatment, rec urrent leakage was treated with repeat PDT and intravitreal triamcinolone. One y ear after initial presentation, visual acuity was 20/60 with no leakage on fluor escein. Combined treatment with PDT and intravitreal triamcinolone acetonide res ulted in regression of a subfoveal neovascular membrane and improvement in visua l acuity during the course of follow up.
文摘To evaluate the disease involvement in a patient with acute zonal occult outer retinopathy (AZOOR). Observational case report. A patient with acute zonal occu lt outer retinopathy was imaged with fundus photography, fluorescein and indocya nine green angiography, and autofluorescence photography. There was subtle depig mentation in the central portion of the lesion with a drusen like deposit at th e outer border. Fluorescein angiography showed a transmission defect centrally a nd a blocking defect at the border where the drusenoid material accumulated. Aut ofluorescent photography demonstrated that the drusenoid material was intensely autofluorescent, consistent with the presence of lipofuscin, and the central por tion of the lesion showed atrophy of the retinal pigment epithelium. Indocyanine green angiography showed atrophy of the choriocapillaris underlying areas of at rophy of the retinal pigment epithelium. In this case acute zonal occult outer r etinopathy caused an area of retinal pigment epithelium cell death with lipofusc in laden cells at the border of the expanding lesion and associated atrophy of the underlying choriocapillaris.
文摘PURPOSE: To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) that had areas of retinal pigment epithelial loss. DESIGN: Observational case report. METHODS: A 67-year-old woman with a history of uterine cancer presented with 4 months of bilateral visual loss. RESULTS: Although B-scan ultrasonography revealed both small shallow serous retinal and choroidal detachments in the periphery, the choroid was normal in thickness. Fluorescein angiography revealed numerous nummular-shaped areas of transmission defects suggesting retinal pigment epithelium loss. Autofluorescence photography showed complete absence of autofluorescence in these nummular areas, and optical co-herence tomography showed segmental areas with lack of any signal from affected areas of the retinal pigment epithelium, suggesting complete loss of retinal pigment epithelium cells. CONCLUSIONS: Although the fundus findings in BDUMPhave been attributed to the proliferation of uveal melanocytic cells in the outer choroid in previous papers, our patient had nummular areas of loss of the retinal pigment epithelium as the apparent reason for visual decline.
文摘To analyze the incidence of intraocular pressure (IOP) elevation following int ravitreal triamcinolone injection. Retrospective observational case series. Char ts of patients undergoing intravitreal triamcinolone injection in one clinical p ractice were reviewed. A pressure elevation was defined as a pressure of 24 mm H g or higher during follow up. There were 89 patients with a mean age of 76.4 ye ars. The mean baseline IOP was 14.9 mm Hg with a mean change of 8.0 mm Hg. Thirt y six patients (40.4%) experienced a pressure elevation to 24 mm Hg or higher at a mean of 100.6 days (SD= 83.1 day) after treatment. Of nonglaucomatous patie nts with baseline IOP of 15 mm Hg or above, 60.0%experienced a pressure elevati on, compared with only 22.7%of those with baseline pressures below 15 mm Hg (re lative risk=2.1, P< .01). In glaucoma patients, 6 of 12 (50%) experienced a pre ssure elevation, and this elevation was not correlated with baseline pressure. T hirty two patients (36.0%) received repeat injections, and there was no differ ence in the incidence of procedure elevation in patients receiving multiple inje ctions versus those receiving a single injection. Pressure elevation was control led with topical medications in all patients. IOP elevation after intravitreal t riamcinolone injection is common and may take an extended period of time to mani fest. The proportion of patients who developed a pressure elevation to at least 24 mm Hg was much higher for those with baseline IOP 15 mm Hg or greater.
