Polypoidal choroidal vasculopathy is not an uncommon disease in Italy and should be suspected in patients presenting with extramacular lesions and no large drusen in the fellow eye.
Aims-Analysis of the choroidal findings in patients affected by serpiginous choroidopathy (SC). Methods-Thirteen patients (23 eyes; 11 males and two females; age range 50-68 years; mean age 59.1 years) affected by SC were examined with fluorescein angiography (FA) (BrJ Ophthalmol 1996;80:536-540) Serpiginous choroidopathy (SC) usually extends from the optic disc outwards in all directions'-'; initial spreading from the macular area is occasional and at first free of any peripapillar activity (serpiginous maculopathy).4 5SC, known also as geographic helicoid peripapillary choroidopathy' is a chronic, recurrent, progressive, usually bilateral disorder, that extends from the choroid to the retinal pigment epithelium (RPE) and ultimately to the retina. In the acute stage it is common to observe the concomitant expression of new and old lesions. The active lesions are greyish white or yellow in colour, with faint edges and are sometimes associated with a serous detachment of the neuroepithelium and/or less frequently of the RPE.6 SC can be further complicated by choroidal neovascularisation (CNV), usually occurring at the edge of an old lesion, which may represent a further cause of visual impairment in such patients. Other findings include retinal vasculitis,7 generally at the site of an active lesion and venous branch occlusion.8 The healed stage is characterised by well defined, irregularly pigmented atrophic chorioretinal areas. Visual prognosis of SC depends on the extent of foveal involvement.The active lesions are hypofluorescent during the early phases of fluorescein angiography and hyperfluorescent in the late phases with late diffusion. The healed lesions, on the other hand, initially appear as an area ofhypofluorescence, along with clearly visible residual large choroidal vessels, secondary to choriocapillaris and RPE atrophy. As a result of fluorescein spreading from the choriocapillaris and scleral staining, the area of healing becomes hyperfluorescent, with well defined edges.The causes of this disorder are still under investigation. However, there are theories suggesting that either inflammatory"' or vascular factors are involved." 12 Data collected from the limited histopathological studies performed to date 10 13 tend to favour the inflammatory hypothesis; indeed extensive lymphocyte choroidal infiltrates were found at the margin of thelesion, but a coagulation disorder (increase in factor VIII) has been observed in some cases." The distribution of the lesions may suggest a choroidal arterial occlusion and its vascular character would make it possible to unify the two theories.Indocyanine green (ICG) angiography allows a better investigation of the choroidal circulation: ICG has the highest point of absorption and the maximum emission in the near infrared, and so allows us to overcome the screen represented by the RPE and xanthophyll. Good visualisation of the vascular choroidal system (even if there are still limits in the exploration of the choriocapillaris) is due to the fact that 98...
Aim-To evaluate the optical coherence tomographic characteristics of choroidal neovascularisation (CNV) in age related macular degeneration (AMD) and in idiopathic and inflammatory CNV. The use of this technique in the selection of patients for surgery is discussed. Methods-Ocular coherence tomography (OCT), fluorescein, and indocyanine green angiography were performed in 23 patients aVected by AMD complicated by well defined CNV and in 10 patients aVected by inflammatory or idiopathic CNV. The neovascular membrane was surgically removed in five age related CNVs, two inflammatory choroidopathies, and two idiopathic CNVs. Results-In inflammatory and idiopathic CNV, the OCT displayed a neovascularisation on the retinal pigment epithelium (RPE). In three cases the CNV was excised with an improvement of visual acuity equal to or greater than two Snellen lines; in a fourth case, the visual acuity after surgery was unchanged. In the cases of AMD the OCT fell into three diVerent patterns: (A) CNV above the RPE (five cases); (B) focal, irregular thickening of the retinal pigment epithelial band (12 cases); (C) CNV above and below the RPE (six cases). The five pattern A CNV patients underwent the surgical excision of the neovascularisation. In four cases the visual acuity improved by two or more Snellen lines; in the fifth case the visual acuity remained unchanged. Conclusions-The authors suggest that the surgical removal of early age related CNV could be performed in those cases where the OCT shows a neovascular membrane on the RPE, as in idiopathic and inflammatory CNVs. (Br J Ophthalmol 1999;83:438-442) The growth of a choroidal neovascularisation (CNV) is one of the most serious events that can be observed in the macular area. In the past few years, especially since the introduction of submacular surgery, it seems particularly important to evaluate the relation of the CNV not only with the fovea but also with the retinal pigment epithelium (RPE). Particularly, the good visual results of the surgical excision of the CNV in the young, appear to be related to the integrity of the adjacent RPE and to the area of growth over the RPE.1-5 On the contrary, the unsatisfactory visual results observed in the course of age related macular degeneration (AMD) seem to be related to the widespread alteration of the RPE, conditioning a significant loss of RPE cells and choriocapillaris, and with the diVering relation between CNV and RPE.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.