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Purpose: To investigate whether the prophylactic use of bevacizumab reduces the rate of rubeosis after proton therapy for uveal melanoma and improves the possibility to treat ischemic, reapplicated retina with laser photocoagulation., Design: Comparative retrospective case series., Methods: Uveal melanoma patients with ischemic retinal detachment and treated with proton therapy were included in this institutional study. Twenty-four eyes received prophylactic intravitreal bevacizumab injections and were compared with a control group of 44 eyes without bevacizumab treatment. Bevacizumab injections were performed at the time of tantalum clip insertion and were repeated every 2 months during 6 months, and every 3 months thereafter. Ultra-widefield angiography allowed determination of the extent of retinal ischemia, which was treated with laser photocoagulation after retinal reapplication. Main outcome measures were the time to rubeosis, the time to retinal reattachment, and the time to laser photocoagulation of ischemic retina., Results: Baseline characteristics were balanced between the groups, except for thicker tumors and larger retinal detachments in the bevacizumab group, potentially to the disadvantage of the study group. Nevertheless, bevacizumab prophylaxis significantly reduced the rate of iris rubeosis from 36% to 4% (log-rank test P = .02) and tended to shorten the time to retinal reapplication until laser photocoagulation of the nonperfusion areas could be performed., Conclusions: Prophylactic intravitreal bevacizumab in patients treated with proton therapy for uveal melanoma with ischemic retinal detachment prevented anterior segment neovascularization, until laser photocoagulation to the reapplied retina could be performed., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: To demonstrate the correlation of ultrasound biomicroscopy (UBM) features of iris melanoma with histopathology., Design: Retrospective analysis of medical records., Methods: The medical records of patients that underwent surgery for iris melanoma at the Princess Margaret Hospital, University of Toronto, from June 1990 to October 1998 were reviewed. The clinical features, as well as the UBM findings prior to surgical intervention, were evaluated. The anatomic features noted on UBM were correlated with histopathologic features seen in the surgical specimens., Results: Fourteen cases met the inclusion criteria and were included in the final analysis. The ultrasound acoustic characteristics showed a broad spectrum of findings among iris melanomas. Tumor acoustic parameters correlated well with histologic features, including tumor vascularity, surface plaque, extrascleral extension, ciliary body involvement, and integrity of iris pigment epithelium., Conclusions: UBM is a useful imaging technique for the in vivo assessment of primary iris melanoma and can provide detailed imaging of the tumor's interface with the angle structures. The preoperative assessment of these tumors by UBM may aid the surgeon in choosing the most appropriate technique to ensure total removal., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: To investigate a patient with talc retinopathy who developed macular fibrosis with resultant visual loss., Methods: A 64-year-old intravenous drug abuser was evaluated for bilateral peripheral retinal neovascularization. He admitted to abusing oral methylphenidate intravenously. Funduscopy showed numerous intravascular talc particles in the macular area of both eyes. Over a period of next 4 years, visually significant macular fibrosis gradually developed in both eyes, the left eye more than the right eye., Results: Fluorescein angiography confirmed the presence of bilateral peripheral retinal neovascularization with adjacent areas of ischemic retina. The patient was treated with peripheral laser treatment to the ischemic retina with resultant regression of peripheral retinal neovascularization. Bilateral macular fibrosis accounted for the reduced vision in our patient., Conclusion: Talc retinopathy can be associated with macular fibrosis with resultant visual loss.

Purpose: To report clinical features and surgical management of neovascular complications associated with rubeosis iridis and peripheral retinal detachment after retinal detachment surgery in nondiabetic patients., Methods: Seven consecutive eyes of seven nondiabetic patients who developed neovascular complications associated with rubeosis iridis and peripheral retinal detachment after scleral buckling and vitrectomy procedures were retrospectively reviewed. None of the eyes had clinical evidence of anterior segment ischemia or retinal vascular disease, but each eye developed rubeosis iridis and neovascular complications., Results: Of the seven eyes with rubeosis iridis and peripheral retinal detachment, six developed recurrent or progressive vitreous hemorrhage, and three developed progressive neovascular glaucoma. Four eyes underwent a revision procedure to repair the peripheral retinal detachment, and anterior proliferative vitreoretinopathy was found in each of these cases. Rubeosis iridis regressed in all three eyes in which surgery resulted in complete reattachment of the retina. In one eye with persistent peripheral retinal detachment and in the three remaining eyes that did not undergo revision surgery, rubeosis iridis persisted and was associated with long-term neovascular complications. Final corrected visual acuity was 20/70 to 20/400 in three eyes with total retinal reattachment and no light perception to hand motions in four eyes with persistent peripheral retinal detachment and rubeosis iridis., Conclusion: Visually significant neovascular complications may occur in eyes that develop rubeosis iridis associated with peripheral retinal detachment after retinal detachment surgery in nondiabetic patients. Successful repair of the peripheral retinal detachment may induce regression of rubeosis iridis, reduce associated complications, and improve the long-term prognosis of these eyes.

Purpose: To determine whether choroidal neovascularization excision causes mechanical damage to the neurosensory retina, retinal pigment epithelium, or choriocapillaris., Methods: Prospectively, 18 eyes of 18 consecutive patients who underwent choroidal neovascularization excision were observed. Preoperatively and postoperatively, the integrity of the choriocapillaris circulation in the pathway of choroidal neovascularization extraction was studied by fluorescein and indocyanine green angiography. Using static scanning laser ophthalmoscope microperimetry, the presence of iatrogenic scotomas that developed postoperatively in the pathway of choroidal neovascularization extraction was also investigated., Results: Postoperatively, a choriocapillaris defect was detected in 17 (94.4%) of 18 cases. In 15 cases (83.3%), the choriocapillaris defect had a clear relationship to the pathway of choroidal neovascularization extraction. Postoperatively, a scotoma was present in 16 (88.9%) of 18 cases. In 14 cases (77.8%), the location of the scotoma had a clear relationship to the pathway of choroidal neovascularization extraction., Conclusion: Surgical excision of choroidal neovascularization leads to severe damage of the choroid and retina in the pathway of the extracted choroidal neovascularization. The injury involves the neurosensory retina, retinal pigment epithelium, and choriocapillaris.

Purpose: To correlate the histologic and clinical classification of type 1 (subretinal pigment epithelium) and type 2 (subsensory retina) choroidal neovascularization., Methods: Ten eyes of 10 patients with surgically excised choroidal neovascularization that were routinely processed and could be histologically classified as having a type 1 or type 2 configuration were studied. The patients were clinically classified as having type 1 or type 2 choroidal neovascularization according to preoperative fundus appearance of both eyes and patient age. The histologic and clinical classifications were made in a masked fashion, and the results were compared., Results: The histologic classification was type 1 and type 2 for three and seven specimens, respectively. The clinical classification matched the histologic classification in nine of 10 cases. Clinical fundus characteristics that distinguished type 2 choroidal neovascularization included a subretinal pigmented halo or pigmented plaque in the area of the choroidal neovascularization and sharply defined borders. Patients with type 1 membranes were on average older (76 years) than patients with type 2 membranes (53 years)., Conclusions: It is generally possible to clinically ascertain by clinical fundus appearance and age of a patient whether subfoveal choroidal neovascularization represents a type 1 or type 2 configuration.

Purpose: Submacular surgery is under investigation for the treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration, ocular histoplasmosis syndrome, and other causes. The aims of this study were to determine whether the macular area from which choroidal neovascularization was removed surgically remained functional and whether there was any qualitative difference between eyes with different disease conditions or between eyes of younger and older patients., Methods: Our study included 19 patients (19 eyes) with choroidal neovascularization, seven cases caused by age-related macular degeneration and 12 caused by ocular histoplasmosis syndrome, pathologic myopia, or idiopathic causes. All tests were performed at least 6 months after surgical removal of choroidal neovascularization. All patients underwent fundus perimetry with the scanning laser ophthalmoscope for evaluation of dense and relative scotomas and fixation site., Results: After submacular surgery in 19 patients, 10 patients (one with age-related macular degeneration and nine with pathologic myopia, ocular histoplasmosis syndrome, or an idiopathic cause of choroidal neovascularization) fixated within an area that ophthalmoscopically and angiographically was an area of retinal pigment epithelial disturbance occupied by choroidal neovascularization preoperatively. Of 12 patients without age-related macular degeneration, seven of eight patients younger than 50 years of age compared with two of four patients 50 years or older fixated within the area of retinal pigment epithelial disturbance., Conclusions: Our data suggest that in patients without age-related macular degeneration who undergo submacular surgery, the surgically disturbed area previously occupied by choroidal neovascularization can remain functional postoperatively. Furthermore, occasionally a patient with age-related macular degeneration undergoing submacular surgery still can fixate in the area from which the choroidal neovascularization was removed.

Purpose: To report a surgical method for translocation of the foveal retina in eyes with subfoveal choroidal neovascularization., Methods: In three eyes of three patients, a crescent-shaped, partial-thickness scleral resection was performed near the equator at either the superotemporal or the inferotemporal quadrant. A near-total retinal detachment was created; then the edges of the resected sclera were sutured, causing shortening of the sclera with subsequent reattachment of the retina, resulting in translocation of the fovea to an area overlying nonfoveal retinal pigment epithelium and choroid., Results: In three eyes of three patients, the fovea was surgically translocated to overlie retinal pigment epithelium that preoperatively was not underlying the fovea. In two patients, laser photocoagulation was applied to the choroidal neovascularization that, after translocation of the fovea, was no longer subfoveal, so that the photocoagulation was not associated with immediate visual loss. After a follow-up of 4 to 6 months, the visual acuity had improved in all patients (from 20/126 preoperatively to 20/70 in one patient, from 20/200 preoperatively to 20/70 in the second, and from 20/160 to 20/30 in the third). The patients noted distortion or tilting of the images, which improved over time., Conclusions: Limited foveal translocation may offer a therapeutic modality to preserve or improve vision in cases of subfoveal choroidal neovascularization. Additional follow-up is needed to assess the impact of potential complications associated with the surgical procedure, such as retinal detachment, proliferative vitreoretinopathy, and cataract, as well as the possibility of recurrent choroidal neovascularization.

Purpose: To document the visual outcome after successful foveal translocation with intentional retinal detachment and scleral shortening for the treatment of myopic neovascular maculopathy., Methods: Two severely myopic patients with subfoveal neovascular membranes underwent surgical translocation of the fovea to an area of healthy retinal pigment epithelium by means of scleral shortening and intentional retinal detachment. In the postoperative period, monocular and binocular visual function were studied., Results: In one patient, best-corrected visual acuity improved from 20/150 to 20/20 postoperatively. In the second patient, acuity initially improved from 20/70 to 20/30. In both patients, the fixation point shifted from the site of the neovascular membrane. Oblique astigmatism developed and was managed with hard contact lenses. Diplopia and subjective torsion occurred transiently. Micropsia occurred in one patient. Peripheral fusion assessed by Worth four-dot testing after resolution of diplopia disclosed suppression in the nondominant eye in both cases., Conclusions: Foveal translocation with intentional retinal detachment and scleral shortening was useful in improving visual acuity in two patients with myopic neovascular maculopathy. Diplopia and aniseikonia occurred but resolved over time as suppression developed. This technique is promising for patients with myopic neovascular maculopathy.

Purpose: To report a surgical method for retinal translocation as a potential treatment for eyes with subfoveal choroidal neovascularization., Methods: Thirty right eyes of 30 pigmented rabbits were used for this study. The first 15 were used to develop the technique. The complete surgical technique for retinal translocation was performed in the last consecutive 15 rabbits. Intravitreal injection of sulfur hexafluoride was performed to compress and liquefy the vitreous. Two weeks later, we used transscleral subretinal hydrodissection to create a retinal detachment. A scleral resection was then performed near the equator in the superotemporal quadrant. Fundus photographs were taken to record the retinal status before, immediately after, and 1, 3, and 7 days after surgery. Electroretinography was performed in three rabbits 3, 7, and 14 days after retinal translocation. Histologic studies were performed in one rabbit 7 days after retinal translocation., Results: Our results are based on experiments performed in the last consecutive 15 rabbits. One day after surgery, retinal reattachment was observed in 14 of the 15 animals. The remaining animal developed endophthalmitis. A predictable retinal translocation of about 1,000 microm was achieved. Retinal tears were noted on the retinal folds in four cases after 1 week. Electroretinographic studies showed transient reduction in retinal function. Mild morphologic damage to the outer retinal layers was seen histologically. Retinal detachment or proliferative vitreoretinopathy did not develop in any rabbit in the 14 days of follow-up., Conclusions: Limited retinal translocation with repositioning of the central retina was accomplished in rabbits.

Purpose: To determine the effectiveness of Nd:YAG laser membranectomy for reopening blocked glaucoma tube shunts and maintaining the patency over time., Methods: We reviewed retrospectively the records of 13 patients (13 eyes) who, during the period January 1990 through June 1996, underwent Nd:YAG laser membranectomy in an attempt to reopen a blocked glaucoma tube shunt. Intraocular pressure and tube patency were evaluated at each follow-up visit., Results: Nd:YAG laser membranectomy effectively opened the blocked glaucoma tube shunts in 11 (84.6%) of 13 eyes. Two tubes could not be reopened. Reblockage occurred in seven eyes (53.8%) within the first 11 weeks; four tubes (30.8%) remained patent through follow-up periods of 39, 82, 106, and 169 weeks. Postlaser complications were moderate anterior chamber reaction in four eyes (30.8%), hyphema in two eyes (15.4%), corneal edema in two eyes (15.4%), pressure spike in one eye (7.7%), and shallow anterior chamber in one eye (7.7%)., Conclusions: Nd:YAG laser membranectomy is effective in reopening blocked glaucoma tube shunts but is associated with a relatively high rate of subsequent reblockage in the initially successful cases.

Purpose: To describe the presence of optic disk neovascularization in a child with incontinentia pigmenti., Methods: A 6-month-old infant with incontinentia pigmenti developed optic disk neovascularization in addition to vascular abnormalities in the peripheral retina. Panretinal photocoagulation was performed., Result: The optic disk neovascularization regressed after panretinal photocoagulation., Conclusions: Optic disk neovascularization is another notable retinal manifestation of incontinentia pigmenti. When optic disk neovascularization is detected, retinal ablation should be considered as treatment.

Purpose: To determine visual acuity outcome after indocyanine green angiography-guided laser photocoagulation of choroidal neovascularization associated with pigment epithelial detachment in eyes with age-related macular degeneration., Methods: We retrospectively reviewed pretreatment and posttreatment visual acuity after laser photocoagulation to well-demarcated hyperfluorescent areas seen with indocyanine green angiography adjacent to or within pigment epithelial detachments in 20 eyes of 20 patients with age-related macular degeneration and suspected choroidal neovascularization., Results: Visual acuity before and after laser photocoagulation was followed up for 3 to 24 months (median, 9 months). At 3 months after laser photocoagulation, visual acuity had improved 2 or more Snellen lines in two eyes (10%), worsened by 2 or more lines in 10 (50%), and remained unchanged in eight of 20 (40%). By 6 months after laser photocoagulation, visual acuity had improved by 2 or more lines in two eyes (12%), worsened by 2 or more lines in nine (53%), and remained unchanged in six of 17 (35%). At 9 months after laser photocoagulation, visual acuity had improved by 2 or more lines in one eye (9%), worsened by 2 or more lines in nine (82%), and remained unchanged in one of 11 (9%)., Conclusions: Indocyanine green angiography-guided laser photocoagulation may temporarily stabilize visual acuity in some eyes with choroidal neovascularization associated with pigment epithelial detachments, but final visual acuity decreases with time.

Purpose: To determine the relationship between the visual result and perfusion of the subfoveal choriocapillaris after surgical excision of subfoveal neovascularization in presumed ocular histoplasmosis syndrome., Methods: We reviewed the records of 38 eyes of 37 patients with gradable postoperative fluorescein angiograms and color photographs after surgical excision of a subfoveal neovascular membrane in presumed ocular histoplasmosis syndrome. The postoperative photographs and fluorescein angiograms were graded in a masked fashion for the presence of perfusion of the subfoveal choriocapillaris. We used preoperative and postoperative best-corrected visual acuities to determine the correlation between postoperative perfusion of the subfoveal choriocapillaris and both final visual acuity and visual improvement after surgery., Results: After surgery, the subfoveal choriocapillaris was perfused in 24 of the 38 eyes (63%) and nonperfused in 14 (37%). Best-corrected visual acuity improved by at least 2 Snellen lines in 17 of the 24 perfused eyes (71%) and two of the 14 nonperfused eyes (14%) (P = .0089). Best-corrected visual acuity of 20/100 or better was achieved in 18 of the perfused eyes (75%) and four nonperfused eyes (29%) (P = .0076)., Conclusion: Both final visual acuity and improvement in visual acuity were correlated with postoperative perfusion of the subfoveal choriocapillaris in patients with presumed occular histoplasmosis syndrome. Development of techniques to maintain or reestablish perfusion of the subfoveal choriocapillaris after surgery may improve visual outcome in these eyes.

Purpose: We report a case of a submacular surgery complicated by a choroidal neovascular membrane at the retinotomy site., Method: The patient underwent submacular surgery for the removal of an idiopathic choroidal neovascular membrane., Result: Three weeks after surgery, the patient developed a choroidal neovascular membrane at the retinotomy site., Conclusion: A choroidal neovascular membrane can occur at a retinotomy site even without the use of endolaser or endodiathermy. The optimal placement of a retinotomy to prevent or minimize symptomatic visual loss from choroidal neovascular membrane requires further study.

Purpose: To report a surgical procedure for excising subfoveal neovascular membranes and translocating the fovea in an attempt to maintain the function of the sensory retina to preserve central vision, based on the technique of macular relocation., Methods: Three patients with subfoveal neovascular membranes underwent surgery for the creation of a nearly 180-degree retinal flap, removal of neovascular tissue, and reattachment and rotation the retina with translocation of the fovea over functional pigment epithelium., Results: In one patient with age-related macular degeneration, best-corrected visual acuity improved from 20/200 preoperatively to 20/20 postoperatively. A second patient, also with age-related macular degeneration, experienced a worsening of best-corrected visual acuity from 20/700 to 20/ 2,000. In the third patient, with myopic degeneration, best-corrected visual acuity improved from 20/700 to 20/70. Complications included the development of epimacular proliferation in two eyes and retinal detachment and neovascular glaucoma in one eye., Conclusion: The technique of foveal translocation has the potential for restoring central visual function in certain patients with subfoveal neovascular membranes.

Purpose: To treat a patient who had a choroidal neovascular membrane after laser-induced chorioretinal anastomosis for nonischemic central retinal vein occlusion., Methods: A 70-year-old man underwent successful formation of a chorioretinal anastomosis for nonischemic central retinal vein occlusion. He subsequently developed a choroidal neovascular membrane at the site of the chorioretinal anastomosis., Results: The choroidal neovascular membrane at the site of the chorioretinal anastomosis was treated successfully with argon laser photocoagulation. The anastomosis remained functional., Conclusion: We recommend that patients who have undergone laser-induced chorioretinal anastomosis for nonischemic central retinal vein occlusion be followed up closely for choroidal neovascular membrane formation.

Purpose: To study the clinical histories and courses of six patients with choroidal neovascularization secondary to endogenous Candida albicans chorioretinitis., Methods: The medical records, fundus photographs, and fluorescein angiograms of six patients who developed C. albicans chorioretinitis secondary to candidemia and who subsequently developed choroidal neovascularization in one or both eyes were reviewed., Results: The six patients ranged in age from 18 to 79 years. Four were women and two men; all but one showed evidence of bilateral chorioretinal scarring secondary to C. albicans chorioretinitis. All patients had been treated successfully with systemic antifungal therapy (amphotericin B). Two weeks to two years after the chorioretinitis, choroidal neovascularization developed in one eye (four cases) or both eyes (two cases). The neovascularization on initial examination was subfoveal in four eyes, extrafoveal in three eyes, and juxtafoveal in one eye. Laser photocoagulation was used in four of the eight involved eyes. In these cases, the active choroidal neovascularization was brought under control. In one eye, the patient had submacular surgery for excision of the choroidal neovascular membrane. Final visual acuities ranged from 20/20 to 20/200 in treated eyes and from 20/50 to 20/400 in untreated eyes., Conclusion: Choroidal neovascularization is a potential cause of late visual loss in patients who have had C. albicans sepsis and endogenous C. albicans chorioretinitis. Eyes that have chorioretinal scarring from C. albicans chorioretinitis should be watched for the development of choroidal neovascularization. Laser photocoagulation or perhaps surgical excision of the neovascular complex may be of benefit in selected cases.

Purpose: We sought to identify specific fluorescein angiographic patterns that may have led to the diagnosis of questionable recurrent choroidal neovascularization. We evaluated follow-up information to determine whether any specific angiographic patterns could be used to identify patients at high risk for definite recurrence., Methods: We identified fluorescein angiograms graded as questionable for recurrent choroidal neovascularization that were taken from a previous prospective study involving 401 consecutive follow-up visits of patients treated with photocoagulation for choroidal neovascularization. We reviewed these angiograms to identify specific angiographic patterns that might have led to the classification of questionable recurrent choroidal neovascularization. Angiograms from visits subsequent to a questionable recurrence were reviewed to determine which patterns, if any, were associated with an increased risk for a definite recurrence to develop later., Results: Forty-four eyes (44 patients) with questionable recurrences (of which 40 had at least four months of follow-up) were categorized into six angiographic patterns. The three most common patterns included the following: (1) focal staining along the edge of the laser lesion (20 cases, 15 subsequently recurred); (2) blocked fluorescence from subretinal hemorrhage not documented at the previous visit (eight cases, five subsequently recurred); (3) speckled hyperfluorescence noted beyond the edge of the laser lesion (eight cases, six subsequently recurred)., Conclusions: Questionable recurrent choroidal neovascularization may be identified by specific angiographic patterns. Focal staining along the edge of the laser lesion and speckled hyperfluorescence were the patterns that were most likely to progress to definite recurrence.

Surgical excision of subfoveal neovascular membranes may result in recovery of excellent visual acuity in patients with presumed ocular histoplasmosis but not in patients with age-related macular degeneration. To provide an explanation for this discrepancy, I analyzed the clinical and histopathologic findings in five patients with presumed ocular histoplasmosis. These findings provide evidence that the new vessels arising in the choroid in these patients usually grow within the subsensory retinal space and not in the subpigment epithelial space, as occurs in patients with age-related macular degeneration. In presumed ocular histoplasmosis, the new vessels are partly engulfed by a monolayer of proliferating retinal pigment epithelium. Surgical excision of this membrane permits reapproximation of the retinal receptors and native pigment epithelium and may be associated with remarkable return of visual acuity.

The benefit of laser photocoagulation to choroidal neovascularization secondary to angioid streaks remains controversial. To further expand our knowledge, we reviewed the records of 20 patients (24 eyes) with classic (well-defined) choroidal neovascularization secondary to angioid streaks, who were treated with laser between 1982 and 1991 at the Retinal Vascular Center of the Wilmer Institute. The choroidal neovascularization was extrafoveal in 18 (75%), juxtafoveal in two, subfoveal in three, and indeterminate in one eye. Seventeen of the 24 fellow eyes (71%) had a disciform scar or choroidal neovascularization, or both. Follow-up ranged from three months to nine years (mean, 3.5 years; median, two years). Lines of visual acuity change averaged -2.5 at three, -2.6 at six, -2.4 at 12, and -4.8 lines at 24 months. Choroidal neovascularization persisted in five of 24 eyes and recurred in nine of the remaining 19 eyes at risk. When the fellow eye had choroidal neovascularization, scar, or both, at the time of treatment, the rate of persistence or recurrence was 65% vs 33% if the fellow eye had no choroidal neovascularization, scar, or both. An average of four lines of visual acuity was lost when fellow eyes had choroidal neovascularization, scar, or both, vs one line when the fellow eye had no choroidal neovascularization or scar. Laser photocoagulation of choroidal neovascularization in patients with angioid streaks can result in closure of the choroidal neovascularization and stabilization of visual acuity.

The development of subfoveal choroidal neovascularization is a major cause of visual loss in age-related macular degeneration and other disorders of the retinal pigment epithelium-Bruch's membrane complex. We designed a new subretinal laser delivery system and used it to treat subfoveal neovascular membranes in three eyes with age-related macular degeneration. Preoperative visual acuities were 20/200, 20/80, and 20/300, respectively. With a mean follow-up of seven months, postoperative visual acuities were 20/80, 20/400, and 20/300, respectively. One eye developed recurrent neovascularization, which was adequately treated with slit lamp-delivered laser photocoagulation. Another eye continued to lose visual acuity because of progressive atrophy of the retinal pigment epithelium. Although ablation of choroidal neovascular membranes was possible with this technique, visual results were disappointing, probably because of damage of the underlying retinal pigment epithelium and choriocapillaris.

The neovascular variant of age-related macular degeneration is amenable to laser photocoagulation treatment within well-defined guidelines established by clinical trials. However, only a limited number of patients meet eligibility criteria for this form of treatment, principally because of the ill-defined, or occult nature, of the choroidal neovascularization commonly seen. Previous studies have estimated that one half of patients with neovascular age-related macular degeneration have occult neovascularization at initial manifestation of the disease. We examined the initial findings of 67 patients with newly diagnosed unilateral neovascular age-related macular degeneration. Eighty-seven percent of these patients (58 of 67) had disease that did not meet Macular Photocoagulation Study Group guidelines for laser photocoagulation treatment. As so few patients are eligible for laser photocoagulation, further research into new techniques of diagnosis and treatment for this disorder is warranted.

We studied the results of surgical excision of ten consecutive subfoveal choroidal neovascular membranes in ten patients with age-related macular degeneration. The criteria for surgical eligibility included the following: (1) a clearly identifiable subfoveal membrane occupying the entire foveal avascular zone, (2) a visual acuity of 20/200 or worse, (3) minimal subretinal hemorrhage, and (4) an associated exudative macular detachment. Six of the ten patients showed visual improvement at one-month and three-month follow-up visits and seven showed visual improvement by the six-month examination. All ten maculae remained attached without recurrence of subfoveal neovascular membranes throughout the follow-up period. These results suggested that surgical excision is a viable alternative to laser photocoagulation in patients with subfoveal neovascularization in age-related macular degeneration.

We studied retrospectively 55 eyes with juxtapapillary choroidal neovascularization in 42 patients over the age of 50 years. In all but four lesions, the choroidal neovascularization was undetected, causing the choroidal new vessel complexes to be ill defined, discontinuous, and show irregular dye leakage on fluorescein angiography. Growth of the lesion was unpredictable. Visual loss occurred in eight of 16 eyes during the first six months of follow-up. Recurrent neovascularization after photocoagulation originated in some patients from outside the pretreatment subretinal complex. Of the 15 patients with bilateral involvement, 13 had juxtapapillary lesions. Fellow eyes in patients with unilateral juxtapapillary lesions showed no predisposing abnormality at or near the nerve head. The prevalence, density, and fluorescein angiographic characteristics of drusen were different from those in age- and sex-matched patients with macular neovascularization.

We examined two eyes from two noninsulin-dependent diabetic patients that developed vitreous hemorrhage secondary to retinal neovascularization after branch retinal arterial obstruction. Although there was no ophthalmoscopic evidence of diabetic retinopathy, diabetes mellitus may have predisposed the retinas to a neovascular response, which was precipitated by the arterial obstruction.

A 32-year-old man with atypical retinitis pigmentosa developed bilateral neovascularization of the optic disk. One year after the diagnosis, vitreous hemorrhage occurred in one eye. Panretinal photocoagulation of this eye resulted in some regression of the neovascularization.

We studied the ultrastructural characteristics of 23 vascularized preretinal membranes removed from 22 eyes during pars plana vitrectomy for proliferative diabetic retinopathy. Traction detachment of the macula was the most frequent reason for surgery (15 of 22 eyes), followed by nonclearing vitreous hemorrhage (seven of 22 eyes). Vessels found in the membranes were studied by serial sectioning and categorized as having either developing, mature, or regressing characteristics. Developing vessels were seen in ten of 23 membranes (43%), mature vessels in 19 of 23 membranes (83%), and regressing vessels in 13 of 23 membranes (57%). Endothelial fenestrations and cell separations were rare. With three-dimensional reconstruction, we found that new vessels often extended cytoplasmic processes into the extracellular matrix and that lumina were present even at the distalmost tips of the vessels. Solid cords of endothelial cells were not seen. We concluded that in proliferative diabetic retinopathy, new vessels develop by a process of focal extracellular matrix degradation, generalized and exuberant extracellular matrix production, cytoplasmic microvillus extension into the extracellular matrix, and active lumen formation.

During a ten-year period, we treated 241 eyes by transscleral ruby laser cyclocoagulation. Each eye had a minimum follow-up of six months. The average was 24 months and the range was six to 92 months. Using a criterion for success of intraocular pressure between 5 and 22 mm Hg, we achieved an overall success rate of 62% (150 of 241 eyes). This success rate varied from 86% for aphakic open-angle glaucoma (32 of 37 eyes) to 53% for neovascular glaucoma (72 of 135 eyes). Most eyes with useful vision preoperatively maintained these levels. Chronic hypotony (41 eyes) and phthisis (17 eyes) were the most frequent complications, although phthisis was common only in the neovascular glaucoma group (13 eyes). The visual results are more favorable and the need for retreatment and postoperative medications is less than with cyclocryotherapy, and postoperative discomfort is considerably reduced.

We treated 12 eyes with advanced neovascular glaucoma with a modification of drainage implant surgery. All 12 eyes had rubeosis iridis and severe pain and nine had undergone previous glaucoma surgery. After follow-up periods of two to 24 months (mean, 11.3 months), nine of 12 eyes had intraocular pressures of less than 24 mm Hg (mean preoperative value, 49.5 +/- 8.2 mm Hg; mean postoperative value, 22.2 +/- 12.9 mm Hg). Surgery was unsuccessful in three eyes, in two because the anterior chamber remained flat postoperatively and in one because a large hyphema blocked the tube 15 months postoperatively. Our procedure, which uses a Y-shaped Teflon tube, is easy to perform, is well tolerated by the eye, and is associated with a low risk of serious complications.

We treated 30 eyes (24 patients) with angioid streaks and neovascular membranes using light coagulation. Of 30 eyes, 16 showed either ameliorated or unchanged visual acuity. Twelve of the remaining 14 eyes retained a visual acuity of 20/200 or better. In 11 patients, the fellow untreated eye showed central macular degeneration with loss of central vision. The follow-up period ranged from two months to 16 years (mean, 3.4 years).