Central retinal vein occlusion (CVO) is a common retinal vascular disorder with potentially blinding complications. However, a simultaneous bilateral affection is not a common entity. One such patient is described here. (+info)
Subacute sclerosing panencephalitis presenting as optic neuritis.
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Subacute sclerosing panencephalitis (SSPE) is a rare progressive neurologic disease affecting both grey and white matter of the brain in children and young adults. One such case which involved the visual system is described here. (+info)
Intravitreal tissue plasminogen activator in submacular haemorrhage.
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Submacular haemorrhage is a major cause of sudden visual loss in age-related macular degeneration (AMD). If left untreated it often results in permanent central visual loss. We present our experience in the use of intravitreal tissue plasminogen activator (tPA) in a 65-year-old male with submacular haemorrhage. (+info)
Computer-assisted quantitation of choroidal neovascularization for clinical trials.
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PURPOSE: To develop a computer-assisted method for the quantitation of choroidal neovascularization (CNV) for the support of clinical trials. METHODS: Fluorescein angiographic images were selected from 5 patients enrolled in a clinical trial for which three follow-up visits were available. Thirty- and 600-second images were digitized at 1000 dots/in and registered (aligned) with polynomial warping algorithms. Custom-developed software allowed for coarse, automated identification of CNV. An easy-to-use graphical user interface facilitated supervision and refinement of the lesion boundaries by a skilled reader based on standard stereoscopic viewing of the fluorescein angiography study. Capabilities for boundary delineation in both early and late phases, and animation to allow for image correlation and evaluation of temporal changes in fluorescence of spatially corresponding pixels, were included. Two metrics for CNV characterization were generated. First, the lesion area based on the lesion boundaries was identified after supervision. Second, an integrated lesion intensity (ILI) reflecting the integrated, normalized lesion hyperfluorescence was calculated. RESULTS: Area and ILI measures were calculated for each of 5 patients for three or more visits. Facile supervision based on the stereoscopic angiogram permitted arbitrarily close concordance with CNV identification using standard methods. Changes in area and ILI measurements between visits correlated closely with clinically observed changes in each case. CONCLUSIONS: Interactive image processing permits efficient, accurate, computer-assisted CNV quantitation that may be useful for the support of clinical trials and preclinical studies. (+info)
PURPOSE: To determine the antiangiogenic effects of peroxisome proliferator-activated receptor (PPAR)-gamma agonists on ocular cells involved in the pathogenesis of choroidal neovascularization (CNV) in vitro and on experimental laser photocoagulation-induced CNV in vivo. METHODS: PPAR-gamma expression in human retinal pigment epithelial (RPE) cells and bovine choroidal endothelial cells (CECs) was determined using an RNase protection assay and Western blot analysis. Two PPAR-gamma ligands, troglitazone (TRO) and rosiglitazone (RSG; 0.1-20 microM), were used to assess effects on RPE and CEC proliferation and migration and CEC tube formation in response to vascular endothelial growth factor (VEGF). The effects of intravitreal injection of TRO on laser photocoagulation-induced CNV lesions in rat eyes (15 experimental, 15 control, nine burns per eye) and cynomolgus monkey eyes (two experimental, two control, seven paramacular burns per eye) was assessed by fluorescein angiography and histologic evaluation. RESULTS. PPAR-gamma1 was expressed in both RPE and CEC. PPAR-gamma ligands significantly inhibited VEGF-induced migration and proliferation in both cell types and tube formation of CEC in a dose-response manner. CNV in rats was markedly inhibited by intravitreous injection of TRO (P < 0.001). Lesions showed significantly less fluorescein leakage and were histologically thinner in the TRO-treated animals. Similar findings were present in the TRO-treated lesions in two monkey eyes. The drug showed no apparent adverse effects in the adjacent retina or in control eyes. CONCLUSIONS: The inhibition of VEGF-induced choroidal angiogenesis in vitro, and CNV in vivo by PPAR-gamma ligands suggests the potential application of these agents in the large group of patients with age-related macular degeneration complicated by CNV. (+info)
Fluorescein diffusion in the human optic disc.
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The characteristics of the transcapillary transfer of fluorescein dye in the optic disc of healthy individuals has been studied. A diffusible fluorescein dye and a nondiffusible reference substance, indocyanine green (ICG), which was assumed to remain in the capillaries, were injected into the circulatory system. The time courses of the concentrations of the two dyes in the optic disc were determined by simultaneously recording the fluorescence intensity of fluorescein and the infrared absorption by ICG with a fundus reflectometer. The difference between the fluorescein concentration curve and the reference ICG curve is a measure of the accumulation of fluorescein in the disc tissue. Our measurements indicate that fluorescein dye does not diffuse across the capillaries in the optic disc. The accumulation of fluorescein in the disc only starts at about one minute after the injection and seems to be due to diffusion of the dye from the surrounding choroid. The time constant of this diffusion process was found to be approximately one minute. (+info)
Maculopathy in patients with diabetes mellitus type 1 and type 2: associations with risk factors.
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AIM: To examine possible relation between diabetic maculopathy and various risk factors for diabetic complications in patients with diabetes mellitus type 1 and type 2. METHODS: Cross sectional study of two cohorts of diabetic patients, comprising 1796 patients with type 1 diabetes (mean age 47 years, mean duration of diabetes 24 years) and 1563 patients with type 2 diabetes (mean age 62 years, mean duration of diabetes 16 years). Retinopathy levels (R0-RV) and maculopathy were assessed by fluorescence angiography and fundus photography and binocular biomicroscopy. Diabetic neuropathy was assessed by means of computer assisted electrocardiography and by thermal and vibratory sensory examination. Patients were classified as normoalbuminuric (<20 microg/min) or microalbuminuric (20-200 microg/min) according to their albumin excretion rates measured in urine collected overnight. Using univariate analyses, the effects of selected patient characteristics on the presence of maculopathy were evaluated. Multiple logistic regression analyses were performed to determine independent effects of risk variables on diabetic maculopathy. RESULTS: Background retinopathy (RII) was found to be present in 28% of type 1 diabetic patients and in 38% of type 2 diabetic patients. The prevalence of maculopathy in these patients was remarkably high (42% in type 1 and 53% in type 2 diabetic patients). Patients with maculopathy had significantly impaired visual acuity. Multiple logistic correlation analysis revealed that in both types of diabetes maculopathy exhibited independent associations with duration of diabetes and with neuropathy (p <0. 01); in type 1 diabetic patients there were significant associations with age at diabetes onset, serum triglyceride and total cholesterol levels (p <0.05); in type 2 diabetes with serum creatinine levels and with hypertension (p <0.05). CONCLUSIONS: Irrespective of the type of diabetes, diabetic patients with long standing diabetes have a high risk for the development of diabetic maculopathy. Diabetic maculopathy is closely associated with diabetic nephropathy and neuropathy and with several atherosclerotic risk factors which suggests that these factors might have an important role in the pathogenesis of maculopathy. However, prospective trials are necessary to evaluate the predictive value of such factors. The findings of the present cross sectional study reinforce the arguments of previous studies by others for tight control of hypertension and hyperglycaemia. (+info)
The second eye of Japanese patients with unilateral exudative age related macular degeneration.
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AIM: To clarify the incidence of choroidal neovascularisation (CNV) and predisposing findings for development of CNV in the second eye of Japanese patients with unilateral exudative age related macular degeneration (AMD). METHODS: The second eyes of unilaterally affected patients with exudative (neovascular) AMD treated in our clinic during the past 10 years (1988-97) were carefully followed up for more than a year. Evidence of CNV was confirmed by fluorescein and indocyanine green angiography. Macular lesions in patients, in whom CNV developed in the second eye, were retrospectively evaluated from patient records. RESULTS: 170 patients met the criteria. The average follow up period was 47 months (range 12-108 months). All patients were Japanese. CNV developed in the second eye in 12 (7%) of 170 patients, 30.3 months on average after the first examination. Cumulative incidence of developing CNV in the second eye using Kaplan-Meier life table analysis was: 0.6% by 1 year, 5.6% by 3 years, and 12.3% by 5 years, and was relatively low compared with that in white patients. CNV developed most frequently from serous pigment epithelial detachment (PED) in the macula (58%). Soft drusen were not prevalent and risk of developing CNV was not very high (18%). CONCLUSION: It was confirmed that there were some differences in the incidence and predisposing findings for CNV developing in AMD among Japanese and other Asian patients compared with those in white people. It is important to recognise these differences between the two populations to understand the pathogenesis and epidemiology of AMD. (+info)