Macular Degeneration: Maruko I

Koizumi H, Iida T, Saito M, Nagayama D, Maruko I. · Department of Ophthalmology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan. · Graefes Arch Clin Exp Ophthalmol. · Pubmed #17972093 No free full text.

Abstract: PURPOSE: To investigate the association between choroidal perfusion and retinal angiomatous proliferation (RAP). METHODS: We performed indocyanine green angiography (ICGA) on 26 eyes of 13 consecutive patients with RAP, and 17 eyes of 17 age-matched controls without age-related macular degeneration. In eyes with RAP and concurrent pigment epithelial detachments (PEDs), we evaluated ICGA images obtained after the PEDs resolved following treatment. Of the 26 eyes in the study group, five eyes with stage 3 RAP or a disciform scar and two eyes that underwent photodynamic therapy were excluded from further evaluation, leaving 19 eyes (11 eyes with stage 1 or 2 RAP and eight fellow eyes without RAP). RESULTS: Early decreased choroidal filling (EDCF) was observed in nine (81.8%) of 11 eyes with RAP and five (62.5%) of eight fellow eyes without RAP. Late decreased choroidal filling (LDCF) occurred in nine (81.8%) of 11 eyes with RAP and four (50%) of eight fellow eyes without RAP. The incidence of EDCF and LDCF was significantly higher in eyes with RAP than in the control eyes (p < 0.05, p < 0.01, respectively). CONCLUSIONS: Persistent decreased choroidal filling is common in early-stage RAP. Clinicians should be aware of this, especially when considering treatment.

Maruko I, Iida T, Saito M, Nagayama D, Saito K. · Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan. · Am J Ophthalmol. · Pubmed #17509509 No free full text.

Abstract: PURPOSE: To clarify the clinical characteristics of exudative age-related macular degeneration (AMD) in Japanese patients. DESIGN: Retrospective, observational, consecutive case series. METHODS: Two hundred and eighty-nine patients with neovascular AMD were examined. RESULTS: The authors classified the patients into three subtypes of neovascular AMD: polypoidal choroidal vasculopathy (PCV), retinal angiomatous proliferation (RAP), and typical AMD. One hundred and fifty-eight patients (54.7%) were diagnosed with PCV and 102 patients (35.3%) with typical AMD. RAP was observed in 13 patients (4.5%). In 16 patients (5.5%), one eye had PCV and the other eye had typical AMD. Most patients with PCV and typical AMD had unilateral disease (81.6% and 94.1%, respectively) with a male preponderance (77.8% and 71.6%, respectively). Nine of 13 patients with RAP were female (69.2%). Patients with RAP were older (mean, 80.3 years for men and 75.3 years for women) than patients with other subtypes. Serous and hemorrhagic pigment epithelial detachment developed in 69 patients (43.7%) with PCV, 22 patients (21.6%) with typical AMD, and nine patients (69.2%) with RAP. In the patients with unilateral disease in each subtype, large drusen in the unaffected eye were seen in 24.0% with PCV, 30.2% with typical AMD, and 77.8% with RAP. CONCLUSIONS: Neovascular AMD in Japanese patients has different demographic features compared with that in White patients. In Japanese patients, there is a preponderance of PCV, male gender, unilaterality, and absence of drusen in the second eye, with the exception of RAP.

Maruko I, Iida T, Spaide RF, Kishi S. · Department of Ophthalmology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan. · Am J Ophthalmol. · Pubmed #16678528 No free full text.

Abstract: PURPOSE: To report the peripheral abnormalities seen only with indocyanine green angiography in patients with vitelliform macular dystrophy (Best disease, caused by a mutation in the bestrophin gene). DESIGN: Observational case report series. METHODS: Eight eyes of four patients, two with only a central macular lesion and two with multifocal lesions, were studied. Results of indocyanine green angiography were compared with findings from ophthalmoscopy and fluorescein angiography. RESULTS: Throughout the fundus periphery, indocyanine green angiography demonstrated a number of hyperfluorescent spots in all eight eyes. The spots were observed in the midperiphery and the periphery in areas with no abnormality visible by ophthalmoscopy or fluorescein angiography. CONCLUSIONS: Although Best disease generally causes lesions visible in the posterior pole, the extensive distribution of the hyperfluorescent spots is consistent with the wide-ranging abnormalities of the retinal pigment epithelium, Bruch membrane, and the choroid as seen histopathologically.