Macular Degeneration: Chandra SR

Klein ML, Ferris FL, Armstrong J, Hwang TS, Chew EY, Bressler SB, Chandra SR, Anonymous00008. · Devers Eye Institute, Legacy Good Samaritan Hospital and Medical Center, Portland, Oregon, USA. · Ophthalmology. · Pubmed #17981333 No free full text.

Abstract: PURPOSE: To determine specific retinal precursor lesions and sequence of events preceding the onset of geographic atrophy (GA) in eyes with age-related macular degeneration (AMD). DESIGN: Retrospective review. PARTICIPANTS: All participants in the Age-Related Eye Disease Study (AREDS) at 2 clinical centers (Devers Eye Institute, Portland, Oregon, and University of Wisconsin, Madison, Wisconsin) in whom GA initially appeared in at least one eye a minimum of 4 years after the baseline study visit. METHODS: All stereoscopic fundus photographs taken before the appearance of GA in the involved (study) eye were reviewed. Fundus features at the site of future GA were graded and recorded. Three graders reviewed photographs, with independent grading and adjudication by mutual agreement. Features graded included drusen (classified by size and confluence), focal hyperpigmentation, hypopigmentation, and refractile deposits. The time between first appearance of these features and initial appearance of GA was recorded. MAIN OUTCOME MEASURE: Appearance of GA. RESULTS: Of all AREDS participants at the 2 sites, 95 eyes of 77 developed GA at least 4 years after entrance into the study. Average time from baseline to initial appearance of GA was 6.6 years (range, 4-11). Drusen were found in 100% of eyes at the site of later developing GA, drusen >125 mum in diameter in 96% of eyes, confluent drusen in 94%, hyperpigmentation in 96%, drusen > 250 mum in 83%, hypopigmentation in 82%, and refractile deposits in 23%. Time from lesion appearance to onset of GA varied by lesion type, ranging from 5.9 years for drusen confluence to 2.5 years for hypopigmentation or refractile deposits. Lesions generally followed a uniform sequence of appearance. CONCLUSIONS: By focusing on the location of initial GA appearance and then retrospectively analyzing prior photographs, we were able to identify specific precursor lesions and the most common sequence of events leading to GA formation in eyes with AMD. The progression was usually characterized by large drusen formation and development of hyperpigmentation, followed by regression of drusen, appearance of hypopigmentation, and ultimately development of GA, sometimes preceded by the appearance of refractile deposits.

Handwerger BA, Blodi BA, Chandra SR, Olsen TW, Stevens TS. · Department of Ophthalmology and Visual Science, University of Wisconsin, Madison, USA. · Arch Ophthalmol. · Pubmed #11146723 No free full text.

Abstract: OBJECTIVE: To investigate the safety and efficacy of low-dose intravitreal tissue plasminogen activator (tPA) and an expansile gas bubble in displacing submacular hemorrhage in patients with age-related macular degeneration (ARMD). PATIENTS AND METHODS: We reviewed retrospectively the medical records of 14 consecutive patients with ARMD from 1 academic center who received low-dose intravitreal tPA (18-50 microg) and expansile gas (0.3-0.4 mL of perfluoropropane) for thrombolysis and displacement of submacular hemorrhage. After the procedure, patients maintained face-down positioning for 1 to 3 days. MAIN OUTCOME MEASURES: Displacement of blood from the fovea, early and final visual acuity, and toxicity of tPA. RESULTS: Submacular blood was completely displaced from the fovea in 10 (71%) of the 14 patients and partially displaced in 3 (21%). In 1 patient, no displacement occurred. Early (<2 months) postoperative visual acuity improved by 2 or more lines in 8 patients (57%). With a mean follow-up of 7.7 months, 2 (15%) of 13 patients maintained 2 or more lines of improvement and 69% (9 patients) maintained preoperative visual acuity. No clinical evidence of retinal toxicity was seen at this low-dose of tPA. CONCLUSIONS: Doses of intravitreal tPA ranging from 18 to 50 microg and an expansile gas bubble are safe and effective in displacing submacular hemorrhage in patients with ARMD. Final visual acuity was limited by the underlying presence of end-stage ARMD.