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Aim: A pilot study of the feasibility of using dye laser thermotherapy (LTT) at a subcoagulation temperature to occlude newly formed vessels in patients with age related macular degeneration (AMD)., Methods: Choroidal neovascularisation (CNV) in 24 eyes with exudative AMD was treated with a continuous wave yellow laser at 578 nm. Parameters were an exposure time of 2 or 5 seconds, a spot size of 750 or 1000 microm, and a laser power of 100-200 mW. The clinical end point was a greyish discoloration at the treatment site. The effect of thermotherapy was documented by ophthalmoscopic and fluorescein angiographic examination. The follow up after LTT was 4-16 months, mean 5 months., Results: LTT resulted in total occlusion of newly formed vessels in 15 eyes (62.5%). Neovascular outgrowth within 6 weeks and recurrences 2-4 months after LTT were observed, each in three eyes. In six of the nine eyes with occlusion of CNV without recurrence the choriocapillaris remained perfused; in two eyes only the large choroidal vessels remained perfused. In six eyes pigmentary changes were the only ophthalmoscopic and fluorescein angiographic signs of treatment. The effect of LTT is rather unpredictable., Conclusion: CNV in AMD can effectively be treated by yellow dye laser thermotherapy with preservation of choroidal perfusion. The technique requires dosimetric adaptation.

Aim: To investigate the prevalence and the outcome of management of fibrovascular ingrowth (FVI) in eyes undergoing vitreous cavity washout (VCWO) following vitrectomy for diabetic retinopathy., Method: FVI was searched for at VCWO for in 19 consecutive eyes with proliferative diabetic retinopathy undergoing vitreous surgery for recurrent vitreous cavity haemorrhage over an 18 month period; the findings were correlated with the presence or absence of associated sclerotomy vessels externally. Eyes with richly vascularised ingrowths from the pars plana entry sites, as well as eyes with less extensive ingrowths but extensive retinal ablation applied at previous surgery for recurrent haemorrhage, underwent lensectomy and ciliary membrane dissection in addition to extensive retinopexy (n=6). Less severe cases received peripheral laser and cryotherapy only. The outcome of repeat surgery was studied prospectively in the 11 eyes with FVI., Results: 11 of the 19 eyes had a definite FVI from one or more of the original pars plana sclerotomies. In six of 11 eyes with FVI a large external episcleral vessel was present entering the original sclerotomy sites at which ingrowth was found peroperatively, but such sclerotomy vessels were also present in three of eight eyes with no FVI detected on the internal aspect of the sclerotomy. Two patients were lost to follow up and the remaining nine patients with FVI had no further vitreous cavity haemorrhage during initial follow up of 2-5 months., Conclusions: FVI has until now been considered an infrequent occurrence following vitrectomy for diabetic retinopathy. These findings would suggest that it is not uncommon and careful examination of the sclerotomy sites should be undertaken in all cases with recurrent haemorrhage and if FVI is found this should be treated appropriately.

Aims/background: Fluorescein angiography and histopathological findings were correlated in two patients with recurrent choroidal neovascular membranes (CNVs) in an attempt to gain insight into the possible causes of recurrent CNVs and into the healing response after CNV excision., Methods: Two patients with recurrent CNVs underwent repeat excision, and the excised tissue was studied with light and electron microscopy., Results: Incomplete CNV excision probably led to the recurrences. The portion initially excised appears to have been anterior to the RPE in case 1. In both cases, recurrent CNVs contained RPE-like like cells suggesting that native RPE can repopulate the dissection bed. The tissue excised at the second operation contained areas with hyperplastic RPE and fragments of Bruch's membrane (external to the RPE basement membrane) in a matrix of fibrillar collagen and fibrocytes, suggesting that initial removal of the CNV can be followed by an abnormal anatomical arrangement of RPE and scarring of Bruch's membrane., Conclusions: Abnormal resurfacing of the dissection bed by RPE and fibroblasts may underlie, in part, the limited visual outcome often seen after surgical excision of CNVs in age related macular degeneration.

Aims/background: To correlate the histopathology of an excised choroidal neovascular membrane (CNV) with the clinical and angiographic findings in a 32-year-old woman with pseudotumour cerebri and a peripapillary CNV with subfoveal extension., Methods: The patient's visual acuity was assessed by individuals experienced in low vision refraction and who were not members of the surgical team. The CNV was excised via a conventional three port vitrectomy with subretinal dissection. The excised tissue was studied with light and electron microscopy. Preoperative and serial postoperative fluorescein angiograms (FAs) and fundus photographs were obtained to study the dissection bed., Results: One week after surgery, the FA showed mottled subfoveal choriocapillaris perfusion. Three weeks after surgery, this area showed retinal pigment epithelium (RPE) atrophy clinically, and the FA showed choriocapillaris non-perfusion. Six months after surgery, the area of RPE atrophy and the corresponding area of choriocapillaris non-perfusion had expanded. Histologically, the excised CNV disclosed hyperplastic RPE, fibrovascular tissue, and no choriocapillaris. Fragments of RPE basement were present along the external edge of the specimen. The patient's visual acuity did not improve significantly after surgery., Conclusions: Choriocapillaris non-perfusion can develop even in young patients following CNV excision. In this particular case, it is believed that choriocapillaris atrophy was caused by incomplete ingrowth of RPE into the dissection bed following RPE removal with CNV excision. As far as is known, this is the first report describing the results of surgery for CNV secondary to papilloedema associated with pseudotumour cerebri.

Aim: To assess the centre of fixation before laser photocoagulation of well defined juxtafoveal or extrafoveal choroidal neovascularisation (CNV) secondary to age related macular degeneration (AMD), and to better predict visual function after treatment using scanning laser ophthalmoscope (SLO) fundus perimetry., Methods: 19 consecutive eyes with juxtafoveal or extrafoveal CNV were examined by fundus perimetry before and after laser treatment with documentation of the fixation point using the SLO. The stability of fixation was defined as standard deviation around the mean fixation point. Overlays of fluorescein angiographic pictures and fundus perimetry were obtained using image analysis software., Results: Fundus perimetry allowed accurate determination of the centre of fixation. Overlays demonstrated the precise geographic relation of the angiographically detectable foveal margin of the CNV and the centre of fixation. Thereby, prediction of the visual outcome with regard to reading ability was facilitated. Stability of fixation did not change significantly after treatment., Conclusions: Fundus perimetry using the SLO was helpful in patients who underwent laser treatment for juxtafoveal or extrafoveal CNV secondary to AMD and may aid the pretreatment counselling of such patients.

The clinical course in 50 eyes was analysed after pars plana vitrectomy for progressive diabetic fibrovascular proliferations. Patients were assigned to pars plana vitrectomy if progression of proliferations occurred despite a photocoagulation treatment with a mean number of 3500 burns and additional peripheral cryoablation. All cases had visual impairment because of fibrovascular tissue covering the macula without detachment of the macula. Flat proliferations were present in all eyes without retinal elevation, vitreous detachment, or vitreous haemorrhage. The follow up intervals ranged from 13 months to 39 months (mean interval 24 months). Twelve months postoperatively, 36 eyes (72%) showed improved visual acuity, five eyes (10%) were worse, and nine eyes (18%) were unchanged. Thirty two eyes (64%) achieved a final visual acuity of 0.2 or better, and 45 eyes (90%) gained 0.05 or better. In only two eyes could reproliferation be observed. The postoperative course indicates that pars plana vitrectomy for diabetic fibrovascular proliferations covering the macula can preserve socially useful visual acuity of at least 0.05 in most cases.

Nine eyes with parafoveal choroidal neovascular membranes due to age-related macular degeneration or angioid streaks were treated with a diode laser and were followed up to 40 weeks (mean 26 weeks). Angiographically proved closure of the membrane was achieved in seven eyes. Four lesions needed a second treatment for growth of subretinal neovascular tissue. Post-treatment visual acuity ranged from 6/9 to 6/60. Two eyes developed subfoveal membranes resulting in poor visual acuity. The morphology of the diode laser lesions differed from that of the argon green laser and was more similar to that of the krypton laser, producing a 'black hole' on the fluorescein positive print. In one particular eye fluorescein angiography revealed subfoveal choroidal non-perfusion next to the site of the diode lesion suggesting choroidal vascular closure.

A case of a macular idiopathic choriovitreal membrane is described which developed in a diabetic man. On initial examination the patient was found to have a pigment epithelial detachment with a choroidal neovascular membrane (CNVM) in the right eye. Two months after the first visit the CNVM was seen to have penetrated the retina and presented as a choriovitreal membrane. Panretinal photocoagulation was applied after which the choriovitreal membrane demonstrated fibrotic involution. This case is unusual in that the choriovitreal membrane developed in the absence of a choroidal or retinal pigment epithelial disease process that may be associated with a CNVM as well as in the absence of previous macular laser treatment.

The effect of scatter photocoagulation on the perfusion of iatrogenic choriovitreal neovascularisation (CVN) has been assessed by a randomised trial in 35 CVN lesions in 18 eyes with proliferative sickle retinopathy. No difference in size or vascularity of CVN lesions was apparent between the nine treated and nine control eyes over a median follow-up of 42 months. Scatter photocoagulation by the stated protocol was not effective in the treatment of CVN.

Established neovascular glaucoma in the presence of clear media can be treated by panphotocoagulation followed by drainage surgery. Three cases are described, and the advantages of this procedure as opposed to others available are discussed. Photocoagulation must be performed early before the development of opaque ocular media obscures the retina.

The authors report the occurrence of occlusive retinal arterial disease and retinal neovascularisation in a 44-year-old woman with systemic lupus erythematosus (SLE). Two days after uncomplicated panretinal photocoagulation the patient developed an acute anterior segment ischaemic syndrome. To our knowledge this complication has not been reported in any other patient following laser photocoagulation or in association with SLE.

A group of 20 patients (28 eyes) with proliferative retinopathy who required extensive argon laser photocoagulation to induce regression of new vessels is presented. The mean number of burns applied to each eye was 7225, with a maximum of 11,513. These were delivered in a mean of nine sessions over a mean period of 22.9 months. Twenty-five eyes (89%) had a final visual acuity of 6/18 or better. The remaining three eyes (11%) had severely reduced vision attributable to complications of proliferative diabetic retinopathy (traction retinal detachment involving the macula in two eyes and ischaemic maculopathy and a persistent vitreous haemorrhage in the third). Large amounts of confluent argon laser photocoagulation may be necessary for the elimination of new vessels in some patients, and it is our view that laser photocoagulation should be continued until regression of new vessels occurs. This is compatible with the retention of functional vision and good visual acuity.