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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.

Objective: To investigate the therapeutic effect of surgical removal of subfoveal neovascular membrane with vitrectomy in treatment of age-related macular degeneration., Methods: 30 patients (30 eyes) with the macular degeneration were selected. The duration of the disease was limited less than 2 years and the size of the neovascular membrane was limited to

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 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.

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.

Background and Objective: To analyze the application of the Macular Photocoagulation Study eligibility criteria for laser photocoagulation of choroidal neovascularization, in view of the expansion of these criteria in recent years., Patients and Methods: The authors prospectively analyzed 50 eyes of 47 consecutive patients with exudative age-related macular degeneration (AMD) to determine their suitability for treatment., Results: Fifteen eyes (30%) were found to be suitable for laser photocoagulation. Patients eligible for treatment were more likely to have experienced visual symptoms for a months or less (P = .006), to have a visual acuity of 20/200 or better (P = .009), and to be younger in age (P = .02). Visual symptoms experienced for a month or less were more prevalent in extrafoveal exudative lesions compared with the subfoveal type (P = .01), Conclusions: Despite recent advances, laser photocoagulation still can be applied only to a minority of the patients with neovascular AMD. Prompt ocular examination following the onset of visual symptoms is essential.

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.

Modern vitreoretinal surgery is now one of the most effective tools for treating posterior segment diseases. In the last several years, there has been a surge of interest in submacular surgery which allows removal of submacular choroidal neovascular membranes and haematomas. Various aspects of this rapidly emerging modality of surgery are discussed in this review.

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.

Objectives: To determine the effects of macular scatter ("grid") laser photocoagulation compared with observation on the visual function of eyes with subfoveal choroidal neovascularization (CNV) that has poorly demarcated boundaries and to provide preliminary data for the evaluation of the feasibility and design of a larger, definitive trial., Design: Randomized pilot clinical trial., Setting: Two tertiary care retinal referral practices., Patients: Symptomatic individuals with subfoveal CNV secondary to age-related macular degeneration in whom fluorescein angiography showed occult CNV with poorly demarcated boundaries; classic CNV was allowed but did not need to be present for entry into the study., Main Outcome Measure: Change in visual acuity from baseline to specified time periods., Results: Fifty-two eyes were assigned to observation. Fifty-one eyes were assigned randomly to treatment consisting of macular scatter ("grid") laser photocoagulation to the area of CNV. The treatment protocol for 8 of these eyes also included confluent laser photocoagulation to areas of classic CNV. The average visual acuity decrease from baseline was greater in the treated than in the observed group. The difference between these groups was greatest within the first year after study enrollment. At 24 months, slightly more than 40% of the eyes in each group had lost 6 or more lines of visual acuity. Similar results were noted for the subgroup of eyes initially with angiographic features of occult CNV but no classic CNV., Conclusions: These short-term study results suggest that macular scatter ("grid") laser treatment is not beneficial and is possibly harmful compared with observation for symptomatic subfoveal CNV with poorly demarcated boundaries in age-related macular degeneration. With or without treatment, a significant proportion of these patients are at risk of severe visual loss within 2 years of seeking treatment, even when the eye initially has occult CNV and no classic CNV.

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.

Background: Subretinal choroidal neovascular membranes in persons younger than 55 years old are commonly idiopathic or associated with the ocular histoplasmosis syndrome. There have been a few reports describing the histopathologic features of these membranes. Studies have shown that idiopathic membranes have the same morphologic features as membranes in age-related macular degeneration except for the absence of basal laminar deposits., Method: The authors studied a clinicopathologic case of a macular lesion associated with two peripheral hypopigmented spots in a healthy 30-year-old woman., Results: The clinical and fluorescein angiographic findings in this patient were characteristic of submacular neovascular membranes, except that the edge of the lesion remained distinct in the late phase of the fluorescein angiogram. Results of histopathologic examination of the surgically excised membrane showed a well-circumscribed granuloma containing some eosinophils. Attenuated vascular spaces were present within the hard tubercle. Special stains for micro-organisms were negative. The patient had no evidence of a systemic inflammatory disease., Conclusions: A visible edge despite intense staining in the late phases of a fluorescein angiogram may suggest the possibility of subretinal granulomatous inflammation in a lesion that otherwise appears like a neovascular membrane. The clinical distinction between this pattern of subretinal neovascularization and a typical idiopathic membrane may be important because subretinal granulomatous inflammation could respond to treatment with systemic corticosteroids.

We present the clinicopathologic features of the eye of a patient with age-related macular degeneration who underwent submacular membranectomy and had retention of good visual acuity for almost 4 years despite recurrent choroidal neovascularization treated with krypton laser photocoagulation and mild expansion of the laser lesion with time. Histopathologic study of the surgically removed membrane from the right eye disclosed a thin fibrovascular membrane lined by retinal pigment epithelium on one surface. Microscopic examination of the right eye obtained post mortem disclosed a 2.75-mm (horizontal) x 2.1-mm (vertical) retinal pigment epithelium defect with overlying photoreceptor cell atrophy centered on the temporal parafoveal area, and a 0.6 x 0.1-mm subretinal pigment epithelium fibrovascular membrane with an area of retinal pigment epithelial hyperplasia and vascularization from the retina 0.4 mm temporal to the fovea. Basal laminar deposit was present in the region of the fovea and nasal parafoveal area.

Purpose: Submacular surgery for choroidal neovascularization (CNV) is under investigation in the treatment of age-related macular degeneration (AMD) and the presumed ocular histoplasmosis syndrome. Four case studies are presented to demonstrate scanning laser ophthalmoscope (SLO) testing in the pre- and postsurgical evaluation of visual function in patients with subfoveal CNV secondary to AMD, presumed ocular histoplasmosis syndrome, and submacular hemorrhage secondary to AMD., Methods: Patients underwent a visual assessment pre- and 6 months postoperatively, consisting of low vision visual acuity measurement, SLO macular perimetry of dense and relative scotomas, and analysis of the preferred retinal locus for fixation (PRL) location and ability., Results: Visual acuity, dense and relative scotoma size and location, and PRL location were compared; and relationships between anatomic and functional changes were observed. Decreases in scotoma size and improvement in PRL location and ability usually corresponded with improved visual acuity. Preoperative scotoma and PRL location guided retinotomy site selection., Conclusion: Scanning laser ophthalmoscope macular perimetry and PRL testing may be useful adjuncts in the visual assessment of submacular surgery and may advance under-standing of the effects of submacular surgery on visual function. In addition, this testing may be used to plan location of surgical interventions for macular diseases.

The introduction of laser photocoagulation for the treatment of macular disease has enabled many patients to retain visual acuity and retard additional deterioration of vision. Treatable maculopathy can occur as the result of choroidal neovascular development, idiopathic central serous choroidopathy, and retinal vascular disease. Variations in the treatment of these maculopathies include type of laser used, spot size, duration of treatment, burn pattern, and intensity of the burn. The cause of the maculopathy determines the type of laser photocoagulation that is most appropriate. While some forms of treatment leave characteristic scars, others leave hardly a trace. Use of fluorescein angiography, and in some cases indocyanine green angiography, is essential in the determination of the appropriate laser treatment modality.

Purpose: To determine whether pars plana vitrectomy combined with tissue plasminogen activator for evacuation of submacular hemorrhage results in improved visual acuity., Methods: Retrospective review of 18 patients who received a subretinal injection of tissue plasminogen activator during a pars plana vitrectomy to evacuate dense submacular hemorrhages., Results: Diagnoses included age-related macular degeneration (16 patients), ruptured macroaneurysm (1 patient), and penetrating ocular trauma (1 patient). Preoperative visual acuity ranged from 20/200 to counting fingers (median visual acuity, counting fingers). Follow-up ranged from 10 to 104 weeks (median, 33 weeks). Best postoperative visual acuity ranged from 20/30 to counting fingers (median, 20/300). Best postoperative visual acuity improved two or more lines in 11 (61%) of 18 eyes, remained unchanged in 4 (22%) of 18 eyes, and decreased two or more lines in 3 (17%) of 18 eyes (P = 0.10, Wilcoxon sign-rank test). Final visual acuity ranged from 20/40 to light perception (median, counting fingers). Final visual acuity improved two or more lines in 5 (28%) of 18 eyes, remained unchanged in 6 (33%) of 18 eyes, and decreased two or more lines in 7 (39%) of 18 eyes (P = 0.53, Wilcoxon sign-rank test)., Conclusions: Pars plana vitrectomy to evacuate massive subretinal hemorrhage can improve visual acuity, but final visual acuity is limited by the underlying disease.

The aim of this study was to compare the efficacy of various dye laser wavelengths in different forms of retinopathies. The study material consisted of 292 eyes of 210 diabetic retinopathy patients treated with dye laser photocoagulation between 1990 and 1992. All the patients were followed for at least 6 months after photocoagulation. Non-proliferative changes (maculopathy and/or preproliferative retinopathy) were present in 135 (46.3%) and proliferative retinopathy in 157 (53.7%) of the eyes undergoing photocoagulation. Of the 157 eyes with proliferative retinopathy, 60 (20.5%) had disc neovascularization, 71 (24.3%) had retinal neovascularization and 26 (8.9%) had retinitis proliferans. Yellow dye laser (580 nm) was applied in 92 (31.5%) eyes, red dye laser (630 nm) in 120 (41.1%) eyes and both yellow and red dye lasers in 80 (27.4%) eyes. There was no significant difference between the different wavelength groups with regard to visual acuity changes before and after treatment (p < 0.01). Overall, the visual acuity was maintained in 56.2% and improved in 25.0% of the eyes. After panretinal photocoagulation, disc neovascularization regressed partially or completely in 47 (78.3%) of the eyes. There was no significant difference among the various laser wavelengths with regard to treatment efficacy judged by the disappearance or regression of disc neovascularization (p < 0.01). All retinal neovascularizations regressed completely with laser treatment, but in 7 eyes (9.9%) new retinal neovascularizations in previously untreated areas developed. Dye laser has not resulted in any complications. It requires lower power settings compared to argon laser and thus facilitates photocoagulation. Another advantage of dye laser is the ability to use yellow and red wavelengths sequentially.

Objective: To determine the percent of cases with all primary forms of exudative age-related macular degeneration that are eligible for treatment by the Macular Photocoagulation Study (MPS) guidelines in a retina clinic serving both as a primary care center and as a referral center., Design: Fluorescein angiograms of patients with age-related macular degeneration examined at the Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, during a 5-year period (1985 to 1990) were randomly selected and reviewed. Angiograms showing all forms of exudative age-related macular degeneration were eligible. The first 100 eligible angiograms identified constituted the study series and were classified into four groups: active choroidal neovascularization (CNV), pigment epithelium detachment, hemorrhage, and disciform scars. The active CNVs were further divided into three subgroups: classic (well defined), occult (poorly defined), and combined. Eligibility for laser treatment was determined exclusively with use of the published MPS recommendations for treatment of extrafoveal, juxtafoveal, and subfoveal membranes., Results: There were 10 cases in the pigment epithelium detachment group, 11 cases in the hemorrhagic group, and 16 cases with disciform scars. All of these 37 cases were ineligible for treatment by MPS guidelines. Sixty-three eyes had active membranes; 37 were classic CNVs (eight extrafoveal, seven juxtafoveal, and 22 subfoveal). All extrafoveal and juxtafoveal CNVs were found to be eligible for laser treatment. Eleven membranes of the subfoveal group were larger than 2 disc areas, a size for which the MPS did not demonstrate benefit from laser treatment. There were 19 membranes in the strictly occult CNV subgroup, all of them untreatable by MPS criteria. Seven cases had both occult and classic CNV, and all were larger than 3.5 disc areas and therefore ineligible for treatment. Overall, 26 cases were eligible for treatment by strict MPS criteria; these constitute 26% of the whole series and 41% of the active CNV cases in the series., Conclusions: Our results indicate that the MPS guidelines for laser treatment are applicable only to a minority of the cases with exudative age-related macular degeneration presenting to our clinic. Further studies should be conducted to identify additional treatment modalities for this common eye disease.

Background: Submacular membranectomy has been suggested as an alternative treatment for subfoveal choroidal neovascularization (CNV). Clinicopathologic features of the right eye of a 59-year-old man with recurrent subfoveal CNV who underwent submacular membranectomy after two unsuccessful laser photocoagulation treatments are reported., Methods: The surgically excised subfoveal membrane was sectioned serially and evaluated by light microscopy. The globes were obtained postmortem and serial sectioned through the macula and optic nerve head for light microscopy. Ultrastructural study of a tissue section in the center of the lesion was performed., Results: Histopathologic study of the surgically excised membrane disclosed a thin two-component fibrovascular membrane with the larger component internal to residual retinal pigment epithelium and basal laminar deposit. Photoreceptor outer segments were present on the internal surface of the membrane near one margin. Light and electron microscopic study of the postmortem globe revealed a very thin subfoveal subretinal pigment epithelial fibrovascular membrane with loss of photoreceptor cell layer in a central 0.5 mm area, loss of outer segments, reduction of inner segments, and thinning of the outer nuclear layer in the remainder of the lesion. There was moderate retinal pigment epithelial attenuation and mild basal laminar and basal linear deposits., Conclusion: Submacular membranectomy for recurrent subfoveal CNV secondary to age-related macular degeneration after two unsuccessful laser photocoagulation treatments appeared to be effective with repopulation of two thirds of the area of membranectomy by extension of attenuated retinal pigment epithelium from adjacent areas. There was, however, persistence or recurrence of CNV, moderate atrophy of the overlying retina with total loss of the photoreceptor cells over the central 0.5 mm of the membrane, and moderate loss of the photoreceptor cells over the remaining area.

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.

Forty eyes with age-related macular degeneration and a choroidal neovascular membrane involving the entire foveal avascular zone were enrolled in a pilot study to evaluate an unconventional photocoagulation technique that was postulated to stimulate inhibitors of neovascularization. Eighteen (45%) eyes were treated with extrafoveal scatter macular photocoagulation, and 22 (55%) eyes were treated with this type of photocoagulation and focal extrafoveal ablation of the choroidal neovascular membrane. The eyes were followed for at least 1 year and up to 4 years (average, 2.4 years). One to 7 months after treatment, approximately 45% of the membranes treated with each technique did not leak fluorescein during angiography. The absence of leakage was associated with better visual acuity, but this difference was not statistically significant. At the beginning of the study, the visual acuity was 20/200 or better in 32 eyes (80%) and 20/80 or better in 11 (28%). At the conclusion of the study, the visual acuity was 20/200 or better in 21 eyes (53%) and 20/80 or better in 7 (18%). After treatment, 24 eyes (60%) had the same or better (plus or minus two lines) visual acuities. Compared with eyes in natural history studies, those treated with scatter macular photocoagulation had less visual loss from baseline but did not recover acuity of 20/100 or better more frequently. There was no difference in results between these two methods of treatment.

The destruction of senile neovascular membranes in the central avascular region of the macula by argon laser is difficult and associated with complications. Yellow pigment in this region absorbs the blue component of the conventional argon laser radiation. In this study, the authors used lasers of different wavelengths: red krypton and green argon. Optical and electron microscopic studies on nonhuman primates were performed at 1 hour and 6 weeks. Maximum damage was seen at the level of the internal choroid with krypton laser and at the level of the pigment epithelium with green argon laser. A clinical and angiographic study showed that the destruction of the juxtafoveal neovascular membranes by both lasers was possible. Our clinical experience suggests that the red krypton laser offers a better alternative for treatment of neovascular membranes located near the foveola than the green argon laser.

In a group of 182 patients of under 50 years of age with subretinal neovascularization, the syndrome of hemorrhagic macular choroidopathy of the young adult was identified in 30 cases. This syndrome is characterized by the occurrence of a juxtafoveolar idiopathic neovascular membrane in an eye normal in all other respects. The natural course of this lesion is the production of a fibroglial scar leading to a mean final visual acuity of 0.15. The syndrome remains unilateral in 75 p. cent of cases, as shown by a mean follow-up of 23.9 months. Photocoagulation of these new vessels is possible, and in a group of 19 eyes it allowed conservation of a mean acuity of 0.6. This syndrome differs from ocular histoplasmosis where widespread uni- or bilateral involvement of the pigment epithelium and choriocapillaris is found. Hemorrhagic macular choroidopathy can also be distinguished from choroiditis associated with hemorrhages. The existence or the sequellae of uveitis, even when associated with subretinal new vessels arising from an atrophic chorioretinal scar, establishes the correct diagnosis. The etiology of hemorrhagic macular choroidopathy is unknown. It is possible that multiple etiologic agents might be responsible for different clinical syndromes in relation to endemic factors.

The authors reviewed four cases of iatrogenic subretinal neovascularization after focal argon green photocoagulation for clinically significant diabetic macular edema. An inappropriate combination of small spot size with a high-power setting is the common feature in each case of iatrogenic subretinal neovascularization. Close follow-up with fluorescein angiography is used to identify iatrogenic subretinal neovascularization at an early, treatable stage. All four patients responded favorably to laser photocoagulation of the subretinal neovascular membrane.

Untreated subfoveal choroidal neovascularization (SFCN) often progresses to destroy much central visual function. In this study, laser photocoagulation which included the entire foveal avascular zone was applied to SFCN in the second eye of 13 consecutive patients. Each patient had untreated SFCN in their first eye with visual acuity less than or equal to 20/400. Each second eye had SFCN of recent onset which was less than or equal to 1 disc diameter (DD) in size and visual acuity less than or equal to 20/200. In 10 of 13 (76.9%) treated eyes, SFCN was eliminated for 3 to 30 months. These eyes all retained strikingly better visual fields (Amsler or automated) than their fellow untreated eyes, markedly better subjective vision, and Snellen visual acuities of 20/70 to 20/400. Foveal photocoagulation may be useful in selected cases of SFCN with small neovascular nets and poor visual acuity.

The authors describe in seven eyes of four patients a form of serpiginous choroiditis beginning in the macula without initial peripapillary activity. Eyes with macular serpiginous choroiditis often had a poor visual prognosis and sometimes developed subretinal neovascularization. Fluorescein angiography of the acute lesions showed hypofluorescence; some cases were thus initially diagnosed as having choroidal ischemia. Fluorescein angiography in one eye, however, suggested that at least some of the hypofluorescence seen acutely in eyes with serpiginous choroiditis is secondary to blocked fluorescence from "opaque" retinal pigment epithelium.

The authors present a randomized study of 27 eyes affected by pathological myopia with macular subretinal neovascularization which were treated with a tunable dye laser. The effectiveness of three different wavelengths (577, 590 and 620 nm) in the direct treatment of subretinal neovascularizations was evaluated in 3 groups of 9 patients each. Statistical analysis of both visual and anatomical results did not show significant differences among the three wavelengths used.

The histology of macular photocoagulation is reviewed. This information may be helpful in selecting the best available laser for retinal vascular and choroidal disorders in the macular region, as providing an experimental method to better understand the effects of photocoagulation on retinal disease processes.

Twenty-six patients with idiopathic sub-retinal neovascular membranes (INVMs) located within the posterior pole were examined. Clinical and fluorescein angiographic features of these patients are described. Follow-up ranged from 2 to 96 months (mean 16.5 months). Laser treatment was performed according to the location of the neovascular membrane: 7 out of 9 eyes (77%) increased their final visual acuity or stabilized after Argon blue-green laser photocoagulation (INVMs further than 200 microns from the center of the fovea). Krypton red light laser treatment was performed in 13 eyes with juxta-foveal and sub-foveal INVMs: following treatment 10 eyes (77%) improved by 2 or more Snellen lines or maintained their pre-treatment visual acuity. Because of the fact that the Krypton laser was not yet available, 5 patients were not treated: all of them had sub-foveal (3) or juxta-foveal INVMs (2). The natural history of 4 cases (80%) showed an increase in the final visual acuity in 3 eyes and a steady state in one eye. Pathogenesis and treatment outcome of the disease are finally discussed.

Laser treatment of a subretinal neovascular membrane associated with a unilateral choroidal osteoma in a 28-year-old woman is described. To our knowledge, this is the first reported use of krypton red laser photocoagulation for the initial treatment of a subfoveal neovascular membrane in this setting. Early recognition of the membrane allowed treatment prior to involvement of the central fovea. Follow-up has shown obliteration of the membrane without recurrence and 20/20 vision. We emphasize recognition of this unusual tumor, self-monitoring with an Amsler grid, and early treatment of subretinal neovascularization in this high risk group of young patients.

In two patients, a detachment of the macula occurred following a branch retinal vein occlusion. Vitreoretinal relationships were investigated and documented by biomicroscopic photography. Both eyes showed partial posterior vitreous detachment with dense adhesions to a preretinal membrane at the macula. Vitreous contraction and traction appeared to be responsible for the detachment.

Photofield mapping is a useful method for classifying subretinal neovascularization based on its area and location. Careful central field mapping is performed to delineate scotomata during evaluation of patients with subretinal new vessels. A photofield map is then constructed by projecting 35 mm fundus photographs and angiograms onto an appropriately-oriented central visual field map. The composite map (photofield) documents the location and relationship of scotomata, subretinal neovascularization, foveal avascular zone, and retinal blood vessels. The areas of subretinal neovascularization and scotomata are measured in square millimeters with a planimeter. The distance between their closest edge and the center of the foveal avascular zone is measured in millimeters. This method permits quantitative comparison of results with different photocoagulation protocols and instrumentation. Such comparative analysis may help improve the technique and instrumentation used in laser photocoagulation of subretinal neovascularization.

A serous hemorrhagic maculopathy with a subretinal neovascular membrane appears in about 70% of cases of angioid streaks. In this study a series of 60 eyes (31 patients) was reviewed. In 13 eyes macular subretinal neovascularizations were photocoagulated with blue-green argon laser, green argon laser, dye laser (rhodamine 6G) at 590 nm and red krypton laser. The authors present and discuss the results obtained and suggest that photocoagulation of subretinal new vessels not involving the fovea can be worth performing.