444 research outputs found
Laser photocoagulation as treatment of non-exudative age-related macular degeneration: state-of-the-art and future perspectives
No full textPURPOSE: To give an updated review of laser approaches to non-exudative age-related macular degeneration (AMD). METHODS: PubMed and Medline database searches were carried out using the terms "laser" and "photocoagulation" associated with "age-related macular degeneration", and latest publications up to May 2017 have been reviewed. Moreover, the design of an ongoing single-center, non-randomized, phase I-II, pilot study, the PASCAL-GA trial, coordinated by F. Bandello, MD and G. Querques, MD from the IRCCS Ospedale San Raffaele, is described. RESULTS: Either standard or subthreshold laser strategies have been tried to induce regression of distinct phenotypes of AMD, as reticular pseudodrusen (RPD), nascent geographic atrophy (nGA), and drusen-associated geographic atrophy (DAGA), with heterogeneous results. The aim of the PASCAL-GA protocol is to assess if subthreshold laser can restore the retinal pigment epithelium function in eyes with RPD and nGA offering a protective effect against extensive GA. CONCLUSIONS: New-generation medical and surgical approaches, including subthreshold laser photocoagulation, may have some success in downstaging AMD
Ultra-wide-field fluorescein angiography in diabetic retinopathy: a narrative review
No full textAlessandro Rabiolo,1 Mariacristina Parravano,2 Lea Querques,1,2 Maria Vittoria Cicinelli,1 Adriano Carnevali,1,3 Riccardo Sacconi,1,4 Teresa Centoducati,1 Stela Vujosevic,5 Francesco Bandello,1 Giuseppe Querques1 1Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, 2G. B. Bietti Foundation – IRCCS, Rome, 3Department of Ophthalmology, University of “Magna Graecia,” Catanzaro, 4Department of Neurological and Movement Sciences, University of Verona, Verona, 5Department of Neuroscience, Ophthalmology Clinic, University of Padova, Padova, Italy Abstract: Fluorescein angiography (FA) is a useful examination in patients suffering from diabetic retinopathy (DR). Traditional angiograms explore 30°–50° of the retina at once; however, visualization of peripheral retina is fundamental in order to assess nonperfused areas, vascular leakage, microvascular abnormalities, and neovascularizations. In order to expand the field of view, wide-field and ultra-wide-field imaging has been developed allowing to image up to 200° of retinal surface in one single shot. The aim of this narrative review was to provide an overview of the role of the most recent technique of ultra-wide-field fluorescein angiography in DR. Keywords: ischemic index, targeted retinal photocoagulation, diabetic macular edema, diabetic macular ischemia, peripheral vessel leakage, capillary nonperfusio
Choroidal Neovascularization Associated with Extensive Macular Atrophy and Pseudodrusen
No full textPurpose. To describe a case of extensive macular atrophy and pseudodrusen complicated by bilateral choroidal neovascularization (CNV). Methods. A 53-year-old woman showed extensive macular atrophy at the posterior pole associated with disciform scar in the right eye and fibrotic juxtafoveal CNV in the left eye. Results. The patient underwent a complete ophthalmological examination including fundus autofluorescence, fluorescein angiography, and spectral-domain optical coherence tomography, showing a disciform scar at the posterior pole of the right eye and an extensive macular atrophy associated with a fibrotic juxtafoveal CNV. The patient was previously treated with four and seven intravitreal bevacizumab injections, respectively, in the right eye and in the left eye. Molecular analyses of the ABCA4 gene revealed the variant c.1268A<G. Conclusions. Although the natural course of extensive macular atrophy and pseudodrusen usually leads to the enlargement of the macular atrophy, extensive macular atrophy and pseudodrusen can also complicate with bilateral CNV. Intravitreal bevacizumab can help stop the CNV activity
Natural course of adult-onset foveomacular vitelliform dystrophy: a spectral-domain optical coherence tomography analysis.
No full textAbstract
PURPOSE:
To describe the natural course of adult-onset foveomacular vitelliform dystrophy using spectral-domain optical coherence tomography (SD-OCT).
DESIGN:
Retrospective study.
METHODS:
We reviewed the charts of all consecutive patients with adult-onset foveomacular vitelliform dystrophy who underwent SD-OCT at baseline and at least 12 months later (last visit). Main outcome measures were changes of clinical and SD-OCT features over time.
RESULTS:
Forty-six eyes (31 patients, 15 male and 16 female; mean age 74.6 ± 8.2 years) were included. Follow-up was 16.2 ± 6 (range, 12-30) months. Visual acuity (VA) reduced from 0.32 ± 0.22 logMAR at baseline to 0.39 ± 0.28 logMAR at last visit (P=.03). The stage of the disease was vitelliform in 28 eyes (60.8%), pseudohypopyon in 7 eyes (15.2%), vitelliruptive in 11 eyes (23.9%) at baseline; vitelliform in 23 eyes (50%), pseudohypopyon in 5 eyes (10.9%), vitelliruptive in 13 eyes (28.2%), and atrophic in 5 eyes (10.9%) at last visit. Stabilization of the disease stage, inner segment/outer segment (IS/OS) interface status, and lesion reflectivity on SD-OCT determined no VA changes (P>.05), while their worsening determined a reduction of VA (P=.03). In eyes that presented a progression of the disease stage, mean central macular thickness, maximal thickness of the lesion, and maximal width of the lesion showed a significant change (from 404.1 ± 107.6 μm to 246.1 ± 74.0 μm, P = .004; from 277.0 ± 80.8 μm to 105.3 ± 92.3 μm, P=.001; from 2324.2 ± 1250.3 μm to 1751.0 ± 858.3 μm, P = .04, respectively).
CONCLUSIONS:
In adult-onset foveomacular vitelliform dystrophy, progression of the lesion stage (partial/complete resorption of the material) is generally accompanied by IS/OS interface disruption/loss and visual impairment
In Vivo visualization of photoreceptor layer and lipofuscin accumulation in stargardt's disease/fundus flavimaculatus by optical coherence tomography
No full text
Microperimetric Correlations of Autofluorescence and Optical Coherence Tomography Imaging in Dry Age-Related Macular Degeneration.
No full textAbstract
PURPOSE:
To investigate the microperimetric correlations of autofluorescence imaging and optical coherence tomography (OCT) in dry age-related macular degeneration (AMD).
DESIGN:
Retrospective, observational, cross-sectional study.
METHODS:
Consecutive patients with dry AMD underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA), blue fundus autofluorescence (FAF), near-infrared autofluorescence, and spectral-domain (SD)-OCT with integrated microperimetry.
RESULTS:
A total of 58 eyes of 29 patients (21 women; mean age 73 ± 9 years) were included. Mean BCVA was 0.28 ± 0.3 logarithm of the minimal angle of resolution (logMAR). Overall, 2842 points were analyzed as regards FAF and near-infrared autofluorescence patterns, the status of inner segment/outer segment (IS/OS) interface, and retinal sensitivity. We observed a good correlation between the FAF and near-infrared autofluorescence patterns for all the points graded (increased FAF/near-infrared autofluorescence, Pearson rho = 0.6, P = .02; decreased FAF/near-infrared autofluorescence, Pearson rho = 0.7, P = .01; normal FAF/near-infrared autofluorescence, Pearson rho = 0.7, P = .01). Mean retinal sensitivity was significantly reduced in cases of decreased FAF (4.73 ± 2.23 dB) or increased FAF (4.75 ± 2.39 dB) compared with normal FAF (7.44 ± 2.34 dB) (P = .001). Mean retinal sensitivity was significantly reduced in case of decreased near-infrared autofluorescence (3.87 ± 2.28 dB), compared with increased near-infrared autofluorescence (5.76 ± 2.44 dB) (P = .02); mean retinal sensitivity in case of increased near-infrared autofluorescence was significantly reduced compared with normal near-infrared autofluorescence (7.15 ± 2.38 dB) (P = .002). On SD-OCT, there was a high inverse correlation between retinal sensitivity and rate of disruptions in IS/OS interface (Pearson rho = -0.72, P = .001).
CONCLUSION:
A reduced retinal sensitivity consistently correlates with decreased FAF/near-infrared autofluorescence and a disrupted IS/OS interface. Increased near-infrared autofluorescence may represent a useful method for detection of retinal abnormalities early in dry AMD development
Intravitreal ranibizumab for choroidal neovascularization associated with circumscribed choroidal haemangioma.
No full text
Choroidal Neovascularization and Geographic Atrophy are Potential Complications of Early Onset Large Colloid Drusen
No full textThe authors report a case of large colloid drusen (LCD) complicated by choroidal neovascularization (CNV) and geographic atrophy (GA). A 54-year-old man was referred to the authors' department with diagnosis of early onset retinal drusen. Multimodal imaging led to a diagnosis of LCD complicated by GA in the right eye and CNV in the left eye. The patient received a single injection of intravitreal aflibercept (Eylea; Regeneron, Tarrytown, NY) in the left eye. Six months later, best-corrected visual acuity improved to 20/25, and spectral-domain optical coherence tomography still showed absence of subretinal and intraretinal fluid. GA and CNV are possible complications of LCD, and contrary to previous beliefs, it should therefore not be considered as a benign condition. Intravitreal aflibercept could be considered as a useful treatment in cases complicated by CNV
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