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Background: Photodynamic therapy with verteporfin (Visudyne; Novartis, Bülach, Switzerland) has been proposed for the treatment of subfoveal choroidal neovascularization secondary to pathologic myopia. We retrospectively evaluated the effects of verteporfin therapy of subfoveal recurrences of extrafoveal myopic CNV previously treated with thermal laser photocoagulation., Methods: Twelve eyes, previously treated with thermal laser photocoagulation for extrafoveal choroidal neovascularization, received photodynamic therapy with verteporfin for subfoveal recurrence of choroidal new vessels. Thirteen eyes that did not receive photodynamic therapy served as control group. Vision and fluorescein angiography outcomes were analyzed on all study visits (every 3 months) through month 12. Visual acuity was measured in Snellen lines., Results: On average, at the month 12 examination the verteporfin-treated group had gained 2 lines and the untreated group had lost 1 line of vision. Eleven eyes of the verteporfin-treated group compared with nine eyes of the untreated group lost fewer than 3 lines of vision, including four eyes versus none improving at least 1 line of vision., Conclusion: Photodynamic therapy with verteporfin might increase the chance of stabilizing or improving vision in patients with subfoveal recurrences of extrafoveal myopic CNV previously treated with thermal laser photocoagulation. A prospective, randomized study on larger series of patients is mandatory.

Objective: To evaluate visual outcomes following macular translocation with 360 degrees peripheral retinectomy in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration., Methods: In a prospective study, 15 consecutive patients with large subfoveal choroidal neovascularization underwent macular translocation with 360 degrees peripheral retinectomy and silicone oil tamponade. Preoperative and postoperative photographs and fluorescein angiograms were obtained to evaluate lesion size and characteristics and translocation results. Standardized near and distance visual acuity and reading speed were measured preoperatively and 6 and 12 months postoperatively., Main Outcome Measures: Changes in and final levels of near and distance visual acuity and reading speed., Results: Median lesion size was 9 Macular Photocoagulation Study disc areas (range, 4-16 disc areas). In all patients, the fovea was successfully translocated off the subfoveal lesion. The median near visual acuity logMAR score (logarithm of the minimum angle of resolution) improved significantly from 0.54 units to 0.40 units (Snellen equivalent, 20/70 to 20/50; P =.02) at the 6-month follow-up and stabilized at 0.54 (12 months postoperatively; Snellen equivalent, 20/70). Seven (54%) of 13 patients and 7 (58%) of 12 patients achieved reading speeds of 70 words/min or greater at the 6-month and 12-month postoperative visits, respectively. Median preoperative distance visual acuity (20/100) was maintained at both the 6-month and 12-month examinations. No postoperative retinal detachments occurred in this series., Conclusion: Macular translocation with 360 degrees peripheral retinectomy and silicone oil tamponade stabilizes and can sometimes improve near and distance visual acuity and reading speed in patients with vision loss from subfoveal neovascular age-related macular degeneration.

Purpose: To describe a rare manifestation of sarcoidosis., Methods: Case report of a patient with histologically proven sarcoidosis, who developed peripapillary choroidal neovascularisation in the absence of uveitis or optic nerve disease., Results: Oral corticosteroids achieved reduction in the size of the peripapillary choroidal neovascularisation. Laser treatment was effective in treating the remaining peripapillary choroidal neovascularisation, resulting in improvement of visual acuity., Conclusions: Isolated peripapillary choroidal neovascularisation is a previously unreported complication of sarcoidosis. A combination of oral corticosteroids and laser can be successful in treating this type of lesion, thereby preventing permanent visual loss.

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.

We report the case of a 39-year old man who presented with central serous chorioretinopathy. Two months after diagnosis, argon laser photocoagulation was performed. One month later, the patient noticed distortion and a reduction in vision revealing a subretinal neovascularization above the fovea next to the laser scar. The patient underwent surgical extraction of the neovascular membrane and recovered a visual acuity of 20/30. This case report shows a complication of laser treatment of central serous chorioretinopathy and underlines the diagnostic difficulties of this disease and its treatment modalities. The surgical excision, the first reported in this etiology, led to good visual recovery, as is usually observed in young patients operated on for neovascular membrane.

Purpose: Age related macular degeneration (AMD) is the most common cause of legal blindness in the Western world in people over 50 years of age. The most severe visual loss occurs in patients with AMD complicated by choroidal neovascular membranes (CNV). Indocyanine green angiography (ICG) account for visualization in up to 60% of the cases that are classified as occult on fluorescein angiography (up to 70% of the cases). ICG-guided laser photocoagulation of CNV is currently a mater of debate. We conducted a pilot study to determine wether it could be beneficial for patients presenting with occult CNV on fluorescein angiography., Material and Methods: Twenty consecutive patients (20 eyes) with occult CNV in AMD were included. All showed occult CNV on fluorescein angiography and a well defined juxta- or extrafoveal hot spot or plaque hyperfluorescence on ICG. Fibrovascular retinal pigment epithelial detachments were excluded. The patients had serial controls, including fluorescein angiography and ICG, at 15 days, 1, 2, 3, 6, 9 and 12 months after photocoagulation., Results: At the end of follow-up visual acuity (VA) was stable (within +/- 3 lines) compared to the initial one in 80% (16) of the cases. A complete resolution of exudative signs was observed in 75% (15) of the cases., Conclusions: ICG-guided laser photocoagulation of occult CNV in AMD account for better visual acuity than natural course of the disease at 12 months follow-up. However, a prospective randomized clinical trial is warranted to evaluate definitively this treatment approach.

Objective: This study aimed to report the visual outcome of surgical removal of extensive peripapillary choroidal neovascularization (CNV) due to presumed ocular histoplasmosis syndrome (POHS)., Design: Retrospective review of the records of all patients seen at the Barnes Retina Institute who underwent surgical removal of extensive peripapillary CNV associated with POHS and who had at least 12 months of follow-up., Participants: Seventeen consecutive eyes (in 14 patients) undergoing surgical removal of extensive peripapillary CNV associated with POHS were studied., Intervention: Pars plana vitrectomy and surgical removal of CNV were performed., Main Outcome Measurements: Best-corrected Snellen visual acuity, funduscopic examination, and intravenous fluorescein angiography were obtained before surgery and at regular intervals after surgery., Results: In 14 of 17 eyes, the peripapillary CNV was subfoveal, and in 3 eyes, it was extrafoveal. All three eyes with extrafoveal CNV were not eligible for laser treatment according to Macular Photocoagulation Study guidelines because treatment would have spared less than 1.5 contiguous clock-hours of retina temporal to the optic disc. Follow-up ranged from 17 to 57 months, with a median of 32 months. In eyes with subfoveal CNV, best-corrected preoperative Snellen visual acuity ranged from 20/25 to counting fingers at 2 feet with a median of 20/200, and best-corrected final Snellen visual acuity ranged from 20/25 to 20/200 with a median of 20/40. In 7 (50%) of 14 eyes, a final Snellen acuity of 20/40 or better was achieved, and in all cases except 1, visual acuity improved or did not change with surgery. In the three eyes with extrafoveal CNV, best-corrected preoperative Snellen visual acuity ranged from 20/20 to 20/400 with a median of 20/200, and best-corrected final Snellen visual acuity was 20/20 in all cases. In addition, visual acuity improved with surgery., Conclusions: The data from this small retrospective study suggest that surgical removal may provide visual benefit in selected cases of extensive peripapillary CNV due to POHS.

Objective: To present the cases of two patients with laser-induced iatrogenic subfoveal choroidal neovascular membranes (CNVMs) who underwent surgical removal of the membranes with favorable outcomes., Design: Interventional case reports., Participants: Two patients with iatrogenic subfoveal CNVM. One case developed after laser treatment for macular edema due to branch retinal vein occlusion, and the second case developed after focal laser photocoagulation for diabetic retinopathy., Intervention: Surgical removal by pars plana vitrectomy., Main Outcome Measures: Visual acuity, scotoma, retinal examination with fundus photography, and fluorescein angiography before surgery and during the postoperative period., Results: Both patients underwent surgical removal after progression of the membrane with severe visual loss of 20/200 was noted. At present follow-up, there is a significant improvement in visual acuity and a reduction in the size of the scotoma. No recurrence of CNVM is noted., Conclusion: Both patients with laser-induced iatrogenic subfoveal CNVM achieved a good visual outcome after surgical removal of the membrane. The reasons for a good surgical result are thought to be twofold. First, the origin of the CNVM is extrafoveal at the site of laser application. The chance for foveal cone cell damage during the surgery is reduced. Second, the degree of cellular destruction in iatrogenic CNVM is usually focal without extensive retinal photoreceptor cell and retinal pigment epithelial damage. Therefore, a better chance of postoperative visual recovery is anticipated.

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.

Objective: To describe the comparative impact of current and preventive treatments on incidence of choroidal neovascularization (CNV) and severe vision loss in patients with bilateral soft drusen (BSD)., Design: Stochastic model., Setting: US population., Patients: Prevalence cohort of white patients 43 years or older with BSD., Interventions: Application of prophylaxis of 10% to 50% efficacy to 1 or both eyes of patients with BSD, application of laser photocoagulation to eligible CNV lesions, or both., Main Outcome Measures: Proportion of patients with BSD after 10 years with unilateral and bilateral CNV and resultant unilateral and bilateral vision loss to visual acuity of 20/200 or worse., Results: The natural history of patients with BSD generated by the model shows that 12.40% of these patients develop either unilateral or bilateral CNV within 10 years of their entry into the BSD prevalence cohort. Bilateral disease occurs in 3.86% of patients with BSD within 10 years. The proportion of patients with BSD becoming legally blind from CNV within 10 years is 2.54% if no treatment is performed. Current laser treatment for CNV decreases the proportion with legal blindness within 10 years to 2.24%. The addition of a preventive treatment of 10% efficacy applied bilaterally to the current laser treatment regimen decreases the proportion with legal blindness to 1.86%; a 25% effective preventive treatment decreases it to 1.34%. Comparatively, preventive treatment of 10% and 25% efficacy given to the fellow eye only after the first eye has developed CNV decreases the proportion of legally blind patients at 10 years only to 2.06% and 1.77%, respectively. All outcomes vary with sex and age at entry into the BSD cohort., Conclusions: Patients with BSD face a 12.40% risk of developing CNV within 10 years. The addition of even a modest (10% effective) bilateral preventive treatment to the current regimen for CNV would more than double the prevention of legal blindness in the BSD population relative to current laser treatment; a preventive treatment of 33% efficacy more than halves the rate of legal blindness caused by CNV. Preventive treatment given to the fellow eye only after the first develops CNV has substantially less impact.

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.

Unlabelled: The surgical removal of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) causes a retinal pigment epithelial defect (RPED) corresponding to the area of diffuse RPE damage. We describe angiographic features of recurrent CNV in AMD after surgical membranectomy in order to elucidate the nature of persistence and recurrence., Methods: After digitalization of the pre- and postoperative fluorescein angiographic images of eight patients with recurrent CNV in AMD we determined the morphology (well or ill-defined) and the area of the CNV and of the subretinal hemorrhage preoperatively and of the recurrent CNV and of the RPE defect postoperatively., Results: The nature of recurrences showed differences between preoperatively well- and ill-defined CNV. Four preoperatively well-defined CNV with surrounding subretinal hemorrhage showed recurrences in the entire area of the preoperative CNV excluding the retinotomy 8-9 weeks postoperatively. Four preoperatively ill-defined CNV with subretinal hemorrhage developed marginal recurrences at the rim of the RPED. There was no background fluorescence in the area of the RPED., Conclusion: The nature of recurrences extending over the entire area of the preoperatively well-defined CNV without loss of background fluorescence only a few weeks after surgical removal of well-defined CNV suggests partial persistence. The removal of the subretinal well-defined CNV could leave sub-RPE parts in locations that preoperatively cannot be visualized angiographically. The marginal recurrence of preoperatively ill-defined CNV weeks to months postoperatively shows angiographic similarities to recurrent CNV after laser coagulation.

Subretinal choroidal neovascularization is an important cause of visual loss in adults. Removal of choroidal neovascular membranes using relatively new techniques of subretinal surgery holds promise for improving or stabilizing vision in some patients. A number of factors have been proposed that may affect the outcome of subretinal surgery for choroidal neovascularization, including the degree of involvement of Bruch's membrane, the location of the neovascular complex relative to the retinal pigment epithelium and Bruch's membrane, the location of the ingrowth site, and the etiology of the membranes. Although the surgical techniques are relatively refined, the indications for removal of choroidal neovascular membranes are still under investigation. This article reviews the recent and past literature and summarizes the authors' specific recommendations regarding present indications for removal of choroidal neovascular membranes.

Objective: To study the histologic and ultrastructural features of surgically excised choroidal neovascularization (CNV) from patients who had undergone submacular surgery., Materials and Methods: Voluntarily submitted surgically excised CNV specimens from a subset of specimens obtained by the Submacular Surgery Trials Research Group between January 1, 1994, and December 31, 1996, were available for this study. The specimens were routinely processed for transmission electron microscopic examination. The largest horizontal and vertical dimensions, cellular and extracellular constituents, and relationship of the CNV to the neurosensory retina and retinal pigment epithelium (RPE) were recorded., Results: Seventy-eight surgical specimens were obtained from 160 patients treated surgically in Submacular Surgery Trials centers. Sixty-one (78%) were from patients with age-related macular degeneration (ARMD) and 17 (22%) were from patients with ocular histoplasmosis syndrome or idiopathic causes (hereafter referred to as the non-ARMD group). The histologic diagnosis was fibrovascular tissue, fibrocellular tissue, or hemorrhage in all cases. Vascular endothelium and RPE were the most common constituents of the CNV. Basal laminar deposit was only present in CNV from patients with ARMD. Age-related macular degeneration specimens were larger (mean +/- SD, 2042 [+/- 1175] x 320 [+/- 185] microm vs 1498 [+/- 792] x 227 [+/- 166] microm) and were more likely to have a sub-RPE (beneath the RPE) component than non-ARMD specimens., Conclusions: All evaluated surgically excised CNV specimens in this study from patients enrolled in the Submacular Surgery Trials consisted of fibrovascular tissue, fibrocellular tissue, or hemorrhage. Surgically excised CNV associated with ARMD in this series was larger and often was located beneath the RPE compared with non-ARMD CNV, although fewer than half of all the specimens could be oriented by topographic relationship to the RPE.

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.

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.

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: This study aimed to assess the feasibility of laser photocoagulation of feeder vessels of subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration., Patients and Methods: Of 170 consecutive patients with subfoveal CNV secondary to age-related macular degeneration, feeder vessels were detected in 37 patients by means of indocyanine green videoangiography using a scanning laser ophthalmoscope. Dye laser photocoagulation was applied to extrafoveal feeder vessels, with the fovea spared., Results: Twenty-six (70%) of those 37 patients had complete resolution of exudative manifestations. Persistent or worsened manifestations were seen in 11 patients (30%) because of recurrent CNV or persistent CNV. The visual acuity improved or stabilized in 25 patients (68%). Ten patients (27%) had a final visual acuity of 20/40 or better and six patients (16%) had a final visual acuity of 20/50 to 20/100. Significant factors prognostic of the visual outcome of 20/100 or better were small CNV (2 disc areas or smaller, Fisher's exact probability test, P = 0.041), the absence of white, fibrous tissue in neovascular membranes (Fisher's exact probability test, P = 0.003), and the closest distance of laser burns to the center of the foveal avascular zone (Fisher's exact probability test, P = 0.049). Preoperative visual acuity had a significant positive correlation with final visual acuity (Spearman's rank correlation test, P = 0.0076)., Conclusion: Feeder vessel photocoagulation should be considered as a treatment option for subfoveal CNV secondary to age-related macular degeneration, because no other treatment method has a better visual outcome.

Laser photocoagulation of the entire area of the neovascular lesion is the only proven treatment for subfoveal choroidal neovascularization secondary to age-related macular degeneration with a poor natural history. However, there are some limiting factors such as patient eligibility, a significant decline in visual acuity after treatment, and a very low possibility of a final vision of 20/100 or better. Although no large benefit of other treatment modalities, such as indocyanine green videoangiography-guided laser photocoagulation, surgical removal of neovascular membranes, and radiation therapy, has yet been proven, carefully selected patients may be suitable candidates for such treatments. This article reviews the status of treatment modalities for subfoveal choroidal neovascularization secondary to age-related macular degeneration, including laser photocoagulation of the entire area of the neovascular lesion, and discusses factors prognostic of visual outcome in these treatment options., (Copyright 1998 W.B. Saunders Company.)

Subfoveal choroidal neovascular membrane is a leading cause of legal blindness. Photocoagulation has been effective, but photocoagulation of the fovea causes a decrease in vision immediately after treatment. Surgical removal of the choroidal neovascular membrane is effective for choroidal neovascular membrane in some cases, but it restores useful vision for reading (20/40 or better) in a small number of cases of choroidal neovascular membrane not due to presumed ocular histoplasmosis syndrome. A new treatment for subfoveal choroidal neovascular membrane, foveal translocation, is an innovative procedure in which the fovea is translocated onto healthier retinal pigment epithelium. Three techniques have been developed to relocate the retina, 2 of which (retinotomy and scleral shortening) we performed in 5 cases each. Preliminary results in these 10 cases indicate that foveal translocation provides improvement of visual acuity in 40% of eyes and final visual acuities useful for reading (better than 20/40) in 20% of eyes undergoing translocation with either technique. Further study is essential to refine the amount of translocation needed and to decrease complications of the 2 techniques, including retinal detachment, proliferative vitreoretinopathy, macular pucker, corneal astigmatism, and constricted visual field., (Copyright 1998 W.B. Saunders Company.)

Purpose: To present the clinicopathologic features of the eyes of a patient with age-related macular degeneration (ARMD): the right eye was treated for well-defined extrafoveal choroidal neovascularization (CNV), and the left eye had an untreated disciform scar., Methods: The patient was studied ophthalmoscopically and by fluorescein angiography at the time of presentation and on follow-up examinations up to 54 days after laser treatment, when he died. The posterior portions of both eyes (obtained postmortem), including the macula and optic nerve head, were sectioned serially for light microscopy. Tissue sections from both eyes were removed from glass slides and studied by transmission electron microscopy., Results: Histopathologic study of the right eye disclosed a thin layer of basal laminar deposit throughout the posterior pole. Two defects in Bruch's membrane without CNV were present within the area of laser photocoagulation located superior to the fovea. No CNV was present in the scar. Eleven areas of early CNV were present in the posterior pole. Histopathologic study of the left eye showed a prominent basal laminar deposit throughout the posterior pole. A 2.6 x 2.7 mm disciform scar was present that was located mostly in the subretinal space. Four sources of CNV were present., Conclusions: The clinicopathologic features of a treated eye with well-defined extrafoveal CNV, and the fellow eye with a disciform scar, both associated with ARMD, are presented. Although laser treatment obliterated a choroidal neovascular membrane, 11 additional areas of early, subclinical CNV were present.

This study has been conducted to assess the sensitivity of indocyanine green angiography (ICGA) in detecting choroidal neovascularization (CNV) in patients with age-related macular degeneration (ARMD) with occult CNV at fluorescein angiography (FA) and to establish their eligibility for laser photocoagulation. Three hundred eighty-three eyes of 355 consecutive patients with occult CNV at FA were studied by ICGA; occult CNV with or without pigment epithelial detachment (PED) were detected as well. Eligibility for laser treatment was established on the basis of the ICGA-guided CNV extension and localization. Out of 157 eyes (41%) with occult CNV and PED, 74 (47.1%) showed focal ICGA CNV, 35 eyes (22.3%) had plaque CNV. Thirty-five eyes with PED (22.3%) appeared serous without CNV, and in 13 eyes (8.3%) no CNV was detectable because of large hemorrhages. Out of the 226 eyes (59%) presenting occult CNV without PED, 94 eyes (41.6%) had plaque CNV, and 58 (25.7%) had focal CNV. In 74 eyes (32.7%), there was no detectable CNV or only an ill-defined ICGA appearance. ARMD with PED is closely associated with focal CNV, while plaque CNV is largely found in exudative ARMD without PED (p < 0.001). Considering all the cases examined by ICGA, CNV was evident in 261 eyes (68%) occult at FA. Extrafoveal CNV laser treatment was recommended for 103 eyes (27%). Our results suggest that ICGA may be useful in the diagnosis and management of ARMD with occult CNV at FA increasing the number of patients eligible for laser treatment.

Purpose: The authors sought to evaluate the progression of presumed choriocapillaris atrophy after surgical excision of a subfoveal choroidal neovascular membrane (CNV) in an 80-year-old man with age-related macular degeneration., Methods: The CNV was excised using a conventional three-port vitrectomy with subretinal dissection. The excised tissue was studied with light and electron microscopy. Preoperative and serial postoperative fluorescein angiograms (FA) and fundus photographs were obtained to study the dissection bed., Results: Seven days after surgery, the FA showed hyperfluorescence in the area previously occupied by the CNV. Six weeks after surgery, this area showed retinal pigment epithelium (RPE) depigmentation, atrophy, or both on clinical examination, and the FA showed presumed choriocapillaris nonperfusion. Seven months after surgery, the area of the RPE depigmentation or atrophy and the corresponding area of presumed choriocapillaris nonperfusion had enlarged. The area of depigmentation or atrophy continued to enlarge for 1 year after surgery. Histologically, the excised CNV specimen disclosed RPE cells but no choriocapillaris., Conclusions: Presumed choriocapillaris nonperfusion after CNV excision may be due to RPE removal at surgery and may progress postoperatively.

This is a retrospective study of 104 patients with a total follow-up between 12 and 48 months (mean follow-up of 24 months), in which the effect of External Beam Radiotherapy with a total dose of 20 Gy (2 Gy fractions) on the visual acuity of eyes affected by subfoveal choroidal neovascularization is evaluated. The evolution of the visual acuity of the irradiated eyes is compared with the evolution of the visual acuity of their fellow eyes which were also affected by choroidal neovascularization but were not treated or treated by laser photocoagulation. This study suggests that the effect of radiotherapy, with a total dose of 20 Gy, on the visual acuity of eyes affected by subfoveal choroidal neovascularization, seems to be not better than the natural course of choroidal neovascularization or the evolution after laser therapy.

Purpose: To evaluate fixation stability and changes in retinal function in patients with laser scar expansion after successful macular photocoagulation for juxtafoveal choroidal neovascularization (CNV)., Methods: A consecutive series of 35 patients was examined in this prospective study. Only patients who had been successfully treated with laser photocoagulation for juxtafoveal CNV and who could be followed over a period of at least 6 months were enrolled. Fixation stability and localized light sensitivity were examined by microperimetry using a scanning laser ophthalmoscope. Visual acuity was measured 2 weeks and 3 and 6 months after the laser treatment. The correlation between changes in the logarithm of the minimum angle of resolution (LogMAR) visual acuity and the distance between fixation and the center of the fovea was evaluated., Results: Of 22 eyes of 20 patients that underwent data analysis, laser scar expansion was observed in 16 (72.7%). Ten (62.5%) of the 16 eyes had relative scotomas corresponding to the expanded laser scars. Mean laser scar expansion ratio was 28.7% in the ARMD group and 109.2% in the myopia group, a statistically significant difference (P < 0.01). The change in LogMAR visual acuity was significantly correlated with the distance of fixation locus from the center of the fovea (r = 0.76)., Conclusions: Laser scars produced by photocoagulation for juxtafoveal CNV may expand and extend into the fovea, causing secondary retinal dysfunction. Scanning laser ophthalmoscopic assessment may be useful in evaluating fixation stability and subclinical changes in retinal function surrounding the laser scars before visual disturbance appears.

Background: Lacquer cracks are breaks in the retinal pigment epithelial-Bruch's membrane-choriocapillaris complex and are manifestations of pathologic myopia. Progressive posterior segment elongation, uveal scleral thinning, and retinal pigment epithelial degeneration are thought to create a predisposition for crack formation in these eyes. In turn, choroidal neovascularization (CNV) may develop within the cracks to produce disciform scarring of the macula. This study examined lacquer cracks as a possible consequence of laser photocoagulation of CNV., Methods: From the files of two retinal referral practices, five patients were located in whom lacquer cracks developed or expanded after laser photocoagulation for macular CNV in pathologic myopia. The mean age of the patients was 54.8 years. Four patients were treated with krypton red laser and one with an argon laser. Laser settings were available for only one of the patients., Results: After laser photocoagulation, lacquer cracks were noted to expand in one or two directions from the laser scar between 10 days and 3 months of the treatment. The cracks also served as a pathway for progressive or recurrent neovascularization., Conclusions: Although lacquer cracks occur spontaneously in pathologic myopia, expansion, elongation, or simple development of a crack may occur as a result of laser photocoagulation of CNV. The new cracks also serve as a potential risk for recurrent neovascularization. This potential adverse complication should be considered in the management of CNV in pathologic myopia with laser treatment.

Objective: The purpose of the study is to determine whether the 810-nm diode wavelength using a rectangular waveform is clinically effective in the treatment of choroidal neovascularization from age-related macular degeneration and to determine whether macular edema secondary to branch vein occlusion or diabetic retinopathy can be effectively treated with this laser using the micropulse waveform., Design: Review of consecutive nonrandomized patients whose eyes were treated with the diode laser over a 30-month period., Participants: Fifty-three patients with an initial presentation of choroidal neovascularization located subfoveally (77%), extrafoveally (17%), and juxtafoveally (6%); 14 patients with macular edema from a branch vein occlusion; and 59 patients with diabetic macular edema, 40 of which were treated for the first time., Intervention: Ablative rectangular wave laser photocoagulation was applied to the choroidal neovascular membranes and very light threshold treatment was applied in a macular grid to treat retinal edema. Microaneurysms were not targeted., Main Outcome Measures: Anatomic resolution of macular edema or choroidal neovascularization and visual acuity., Results: Sixty percent of eyes treated for choroidal neovascularization had no persistence or recurrence at 6 months, and 72% achieved visual stabilization. In 8% of eyes, some localized bleeding occurred during photocoagulation. Clinical resolution of macular edema from branch vein occlusion occurred by 6 months in 92% of eyes, and 77% had stabilization of visual acuity. At 6 months, 76% of newly treated patients with diabetic macular edema and 67% of previously treated patients had clinical resolution of their edema. Vision was improved or stabilized in 91% and 73% of newly treated and retreated patients at 6 months, respectively., Conclusions: The micropulsed 810-nm diode laser is clinically effective in the treatment of macular edema from venous occlusion and diabetic retinopathy, and the rectangular (normal) mode diode laser can be used in many eyes with choroidal neovascularization.

Objective: To determine whether lysing subretinal fibrin with tissue plasminogen activator (t-PA) before excising subfoveal choroidal neovascularization improves visual acuity in patients with age-related macular degeneration., Design: Randomized, double-masked trial., Participants: Eighty eyes of 80 patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration were studied., Intervention: Each eye underwent pars plana vitrectomy and received a subretinal injection of t-PA or balanced salt solution (BSS) before the neovascular membrane was excised. Preoperative and postoperative protocol refraction, ophthalmic examination, color photography, and fluorescein angiography were performed in all 80 eyes., Main Outcome Measures: Visual acuity and fluorescein angiographic evidence of leakage after 1 year., Results: Visual acuity did not differ between the t-PA group (n = 40) and the BSS group (n = 40), and median best-corrected visual acuity was 20/320 for both groups (P = 0.38). Changes in visual acuity from baseline were also equal, with a median loss of 1 line in each group (P = 0.78). Patients whose initial visual acuity was 20/250 or less were more likely to improve by 2 or more lines (P = 0.01) and less likely to lose 2 or more lines (P < 0.001). Patients with choroidal neovascularization of at least 4 disc areas were more likely to improve by 2 or more lines (P = 0.02) and less likely to lose 2 or more lines (P < 0.001). After 1 year, choroidal neovascularization was present in seven of the t-PA eyes and in eight of the BSS eyes (P = 0.78)., Conclusions: With current surgical techniques, the use of t-PA before surgical excision of subfoveal choroidal neovascularization is of no visual or anatomic benefit to patients with age-related macular degeneration.

Background and Objective: Submacular membranectomy has been proposed as a treatment option for subfoveal choroidal neovascular membranes (CNVMs). The authors reviewed the visual outcomes of patients who underwent surgical removal of subfoveal CNVMs caused by age-related macular degeneration (ARMD)., Patients and Methods: Thirty-eight patients (38 eyes) were retrospectively reviewed. Selection criteria included: (1) the presence of a well-demarcated subfoveal CNVM on fluorescein angiography; (2) best-corrected Snellen visual acuity reduced to the level of 20/200 or worse; and (3) no other eye disease that could compromise visual acuity. Pars plana vitrectomy, retinotomy, and membrane removal were performed to remove the subfoveal choroidal neovascular complex with minimal disruption of the surrounding tissues. A significant change was defined as a two-line difference from best-corrected preoperative visual acuity on the Snellen chart., Results: At 3 months postoperatively, 7 (18.4%) of the 38 eyes had improved, 8 (21.1%) of the eyes had worsened, and 23 (60.5%) of the eyes had remained unchanged. The final visual acuity improved in 8 (21.1%) of the eyes, worsened in 11 (28.9%) of the eyes, and remained unchanged in 19 (50%) of the eyes. The average follow-up time was 632 days., Conclusions: The authors employed a minimally invasive approach to the removal of CNVMs in ARMD. Nevertheless, the resultant visual acuity was often unsatisfactory. Therefore, the authors recommend not operating on ARMD-associated subfoveal CNVMs with the current technology.

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.

Unlabelled: This retrospective study was designed to help clarify the visual prognosis during long-term follow-up (5-10 years) of myopic choroidal neovascularization (CNV) with and without laser treatment in a referral population., Patients and Methods: A group of 50 consecutive non-treated eyes and a group of 50 consecutive treated eyes were selected retrospectively. Inclusion criteria were: fluorescein angiographic documentation of CNV not involving the center of the fovea, visual acuity (VA) > or = 20/200, age less than 60, onset of symptoms < or = 6 months and at least five years of follow-up. The mean decrease in VA in non-treated and treated eyes during the follow-up was analysed on the basis of subgroups with the same initial VA., Results: Considering both groups (100 eyes) at presentation, 89% of CNV spared the center of the fovea but were located in the foveolar area (< 200 microns) and only 11% were extrafoveal (> or = 200 microns). In the natural history group, after five years all CNV involved the center of the fovea and mean VA was 20/160. In the treated group, at the end of the five year follow-up and after one or more laser session, 64% of eyes had a dry scar and mean VA was 20/74. Nevertheless there was a very high rate of recurrences (72%) and at the end of follow-up 36% of treated eyes had a subfoveal recurrence with a mean decrease in VA to 20/154. The difference between the mean decrease in VA of the treated and non-treated groups was statistically significant at two years. At five years (100 eyes), the difference persisted only for eyes with initial VA better than > or = 20/40 (P < 0.05). At eight years (76 eyes) and ten years (24 eyes), this difference was no longer significant., Comments: This study confirms that CNV accompanying degenerative myopia has an extremely poor prognosis. Nevertheless analysis of final VA in both groups suggests that eyes with high initial VA gain more from treatment.

Objective: To determine the visual results, recurrence rates, and postoperative complications of surgical removal of subfoveal choroidal neovascularization (CNV) in patients with the presumed ocular histoplasmosis syndrome., Design: A consecutive surgical series of 63 eyes of 62 patients with subfoveal CNV and the presumed ocular histoplasmosis syndrome with longer than 6 months of follow-up., Setting: Tertiary care university medical center., Methods: Patients underwent surgical removal of subfoveal CNV using vitreoretinal surgical techniques. The anatomical and functional results of surgery were analyzed., Results: The median age of the patients was 42 years (range, 16-68 years), and the median follow-up time was 24 months (range, 6-48 months). Visual acuity improved by 2 or more Snellen lines in 22 (35%) of the 63 eyes, was unchanged in 28 (44%) of the eyes, and worsened in 13 (21%) of the eyes. Eleven (17%) of the 63 eyes improved to a visual acuity of 20/50 or better. Eyes with an initial visual acuity of 20/200 or worse had a better prognosis for improved vision (ie, 26 [41%] of the eyes) than those with an initial visual acuity of 20/100 or better (ie, 5 [8%] of the eyes). Recurrence of the subfoveal CNV occurred in 24 (38%) of the 63 eyes and was more common in those eyes that received preoperative laser photocoagulation (ie, 15 [47%] of the eyes). The median time to recurrence was 5 months after surgery. Post-operative complications included macular striae in 4 (6%) of the 63 eyes, rhegmatogenous retinal detachment in 2 (3%) of the eyes, retinal tear in 1 (1.6%) of the eyes, and progression of cataract in 19 (30%) of the eyes., Conclusions: Surgical excision of subfoveal CNV may be an effective therapeutic modality in patients with the presumed ocular histoplasmosis syndrome that offers the possibility of improving central vision in many patients. Factors possibly associated with a favorable visual prognosis include younger patient age and the absence of previous laser photocoagulation.

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.

Purpose: Surgical removal of epiretinal membranes generally leads to anatomic and functional improvement. Main complications include cataract, retinal breaks and detachment. We describe the onset of a juxtafoveal choroidal neovascularization 2 years after surgery of an epiretinal membrane., Methods: The neovascular membrane was treated by argon laser photocoagulation., Results: Complete obliteration of the neovascularization was obtained resulting in functional improvement., Conclusions: Although rare, choroidal neovascularization as a complication of epiretinal membrane surgery must be suspected in case of poor visual outcome or relapse of symptoms.

Objectives: To verify and quantify previously reported risk factors for development of choroidal neovascularization (CNV) in the fellow eye of patients with 1 eye affected with CNV secondary to age-related macular degeneration, to examine the value of characteristics of the pericentral macula in the quantification of risk for developing CNV, and to explore whether the presence of occult CNV in the first eye affects the development of CNV in the fellow eye., Design, Patients, and Setting: Follow-up study of fellow eyes of 670 patients enrolled in multicenter, randomized clinical trials of laser photocoagulation of juxtafoveal or subfoveal CNV., Main Outcome Measure: Development of CNV., Results: Three characteristics of the central macula of the fellow eye and 1 systemic factor were associated independently with an increased risk of developing CNV: the presence of 5 or more drusen (relative risk, 2.1; 95% confidence interval, 1.3-3.5), focal hyperpigmentation (relative risk, 2.0; 95% confidence interval, 1.4-2.9), 1 or more large drusen (relative risk, 1.5; 95% confidence interval 1.0-2.2), and definite systemic hypertension (relative risk, 1.7; 95% confidence interval, 1.2-2.4). Estimated 5-year incidence rates ranged from 7% for the subgroup with no risk factors to 87% for the subgroup with all 4 risk factors. Characteristics of the pericentral macula were not strongly associated with the development of CNV. The presence of occult CNV in the first eye affected had no influence on the development of CNV or on the type of CNV in the fellow eye., Conclusions: The prognosis of the fellow eye is affected strongly by characteristics of its central macula and by systemic hypertension. These factors should be considered when counseling patients with unilateral neovascular age-related macular degeneration and when targeting patients for preventive interventions.

The authors applied experience from studies conducted abroad pertaining to the diagnosis, follow-up and laser treatment of the classic choroidal neovascularization (CNV) in patients with age-related macular degeneration. The group comprises 12 patients with CNV with an extrafoveolar localization who were treated by laser photocoagulation and another 12 patients investigated on account of CNV with a juxta and subfoveal localization. In the group of treated patients vision improved or became stabilized in 9 patients (75%), in the group of untreated patients it did not change in 3 (25%), the mean follow-up period being 11 and 13 months resp. The assembled results correspond with those published in the literature.

Background: Occult choroidal neovascularization (CNV), poorly defined on fluorescein angiography, is present in the majority of patients with exudative complications of age-related macular degeneration. For patients who present with this type of subfoveal CNV but who have useful visual acuity, no form of treatment is of proven benefit. Accordingly, a pilot randomized trial of indirect laser treatment was performed. The rationale of this treatment was to inhibit the CNV through laser-induced effects on the retinal pigment epithelium., Methods: Patients with occult subfoveal CNV without retinal pigment epithelial detachment and with visual acuity of 20/200 or better were randomized to treatment or control groups. A grid of laser burns was applied to the macula beyond the area of serous retinal detachment and of angiographically defined occult CNV., Results: After an average follow-up of 38 months, there was no difference in mean final visual acuity (0.12 treated, 0.14 control) or clinical outcome between treated and untreated groups. Fluorescein angiography showed gradual enlargement in the occult CNV in 58% of eyes in both groups. A decrease in visual acuity to worse than 20/200 (54% of treated, 50% of control eyes) was associated with ingrowth of well-delineated CNV (6 treated, 7 control eyes) or progression to a fibroglial or atrophic scar (11 treated, 8 control eyes)., Conclusions: No benefit was demonstrated for scatter photocoagulation of the macula in patients with age-related macular degeneration and occult subfoveal CNV with initially good visual acuity. There were, however, no complications related to 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: To investigate the efficacy of the surgical removal of subfoveal choroidal neovascularization in patients with type 2A idiopathic juxtafoveolar retinal telangiectasis., Methods: Two patients with bilateral acquired idiopathic juxtafoveolar retinal telangiectasis and a subfoveal choroidal neovascular membrane underwent surgical excision of the membrane using standard subretinal surgical techniques., Results: In both cases, surgical removal of the neovascular membrane was complicated by an intimate adherence of the membrane with the overlying neurosensory retina in an area of retinochoroidal anastomosis. A retinal dehiscence occurred in both instances at the time of surgery. Postoperative visual outcome was poor., Conclusion: The retinochoroidal anastomoses often visualized in cases of subretinal neovascularization complicating bilateral acquired IJFRT could indicate that there is a fairly marked adherence of the neovascular membrane to the neurosensory retina. Attempts at surgical removal of subretinal membranes in this disease entity with current techniques may be contraindicated.