Macular Degeneration: Priel E

Ehrlich R, Weinberger D, Priel E, Axer-Siegel R. · Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel. · Retina. · Pubmed #18664935 No free full text.

Abstract: OBJECTIVE: To study the effect of intravitreal bevacizumab for the treatment of long-standing exudative age-related macular degeneration (AMD) and low visual acuity. METHODS: Forty-seven patients (48 eyes) aged 57 to 90 years with AMD for 5 months or more and visual acuity of 20/150 or less were treated with one or more injections of bevacizumab 1.25 mg/0.05 mL between December 2005 and March 2007. The files were reviewed for background data, visual acuity, fluorescein angiography, retinal thickness, and complications. RESULTS: Thirty-two eyes were treated previously with photodynamic therapy. Mean duration of symptoms was 17.9 +/- 17.5 months; mean number of bevacizumab injections was 3.41 +/- 2; and mean follow-up was 27 +/- 15 weeks. Snellen visual acuity improved from 20/150 to hand movements (mean logMAR 1.34 +/- 0.29) to 20/50 to counting fingers (mean logMar 1.2 +/- 0.42) (P = 0.003, paired t-test). Visual acuity improved by> or =3 lines in 12 eyes (25%); showed no change in 9 eyes (19%); and deteriorated by > or =3 lines in 4 eyes (8.3%). Visual acuity was at least 20/150 in 16 eyes (33.3%) at the end of follow-up compared with 4 eyes (8.3%) before treatment (P = 0.02, McNemar test). Mean central retinal thickness (measured in 22 eyes) decreased from 324 +/- 121 mum to 264 +/- 65 mum (P = 0.02, paired t-test). CONCLUSIONS: Patients with chronic exudative AMD and low visual acuity may benefit from intravitreal bevacizumab injections.

Axer-Siegel R, Ehrlich R, Avisar I, Kramer M, Rosenblatt I, Priel E, Weinberger D. · Department of Ophthalmology Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel. · Ophthalmic Surg Lasers Imaging. · Pubmed #17152538 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: To report the outcome of combined verteporfin photodynamic therapy (PDT) and intravitreal triamcinolone acetonide (IVTA) for the treatment of choroidal neovascularization (CNV) with serous pigment epithelium detachment (PED) due to age-related macular degeneration (AMD). PATIENTS AND METHODS: The files of all consecutive patients with CNV and serous PED who received PDT and IVTA either primarily (primary treatment group) or following previous unsuccessful PDT (secondary treatment group) were reviewed for visual and angiographic results. RESULTS: Ten patients (11 eyes) were included. Mean number of PDT sessions was 3.18; 8 eyes received one IVTA injection and 3 eyes received two IVTA injections. Thirty-six percent of patients retained their initial visual acuity after a mean follow-up of 15.3 months. Loss of 3 or more Snellen lines was noted in 2 of 3 eyes in the primary treatment group and 5 of 8 eyes in the secondary treatment group. Increased intraocular pressure developed in 3 patients and was controlled by topical medications. CONCLUSIONS: Although combined PDT and IVTA may be considered for CNV with serous PED in patients with poor prognosis with PDT alone, the regimen as administered in this small series was not beneficial. Further studies are required to determine whether alternate sequences, timing, or doses would yield a better outcome.

Axer-Siegel R, Ehrlich R, Rosenblatt I, Kramer M, Priel E, Yassur Y, Weinberger D. · Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel. · Arch Ophthalmol. · Pubmed #15078661 No free full text.

Abstract: OBJECTIVE: To study the visual and angiographic outcome of eyes with neovascular age-related macular degeneration associated with pigment epithelium detachment (PED) treated by photodynamic therapy. METHODS: Review of the medical charts and the fluorescein and indocyanine green angiograms of all consecutive patients with age-related macular degeneration associated with choroidal neovascularization and serous PED of at least 1 disc diameter, who received photodynamic therapy from January 1, 2000, to August 31, 2002. RESULTS: Thirty patients (34 eyes) met the study criteria. Each underwent 1 to 8 treatments (mean, 4); duration of follow-up was 12 to 36 months (mean, 19 months). Nineteen eyes (56%) lost 3 or more Snellen lines of visual acuity, 7 eyes (21%) lost 1 or 2 lines, 6 eyes (18%) maintained their initial acuity, and 2 eyes (6%) gained 1 or 2 lines. Subretinal hemorrhage occurred in 5 eyes and retinal pigment epithelium tears in 4 eyes. In 4 eyes, visual acuity decreased to counting fingers, hand motions, or light perception. CONCLUSIONS: Although 44% of the 34 eyes with age-related macular degeneration and PED lost fewer than 3 Snellen lines in acuity, severe visual loss to counting fingers or less occurred in 4 eyes, 3 of them with choroidal neovascularization inside the PED. Further studies and treatment modalities are required to improve prognosis of neovascular age-related macular degeneration with serous PED.

Axer-Siegel R, Ehrlich R, Yassur Y, Rosenblatt I, Kramer M, Priel E, Benjamini Y, Weinberger D. · Department of Ophthalmology, Rabin Medical Center, Beilinson, Petah Tiqva, Israel. · Am J Ophthalmol. · Pubmed #14962414 No free full text.

Abstract: PURPOSE: To evaluate the visual outcome of patients with subfoveal choroidal neovascularization due to age-related macular degeneration, who received photodynamic therapy (PTD) in a clinical setting and to identify potential predictive visual and angiographic factors. DESIGN: Interventional case series. METHODS: The study included 74 patients with subfoveal choroidal neovascularization who underwent PDT from January 2000 to March 2001 and completed at least 1 year follow-up. All patients received verteporfin PDT and were followed clinically, with fluorescein angiography (74 eyes), and with indocyanine green angiography (65 eyes). A review of the medical records and angiograms was performed. RESULTS: Mean follow-up was 15.6 months. Patients received a mean of 3.4 treatments per year. Sixty-six percent lost less than 3 Snellen lines of visual acuity. Three patients (4%) experienced profound visual acuity loss to finger counting. Final visual acuity was positively correlated with lesion size and visual acuity at presentation. Visual outcome was worse in the presence of cystoid macular edema. On indocyanine green angiography, a round hypofluorescent spot was seen at the site of the PDT, with maintenance of medium and large choroidal vessels. CONCLUSION: Smaller lesion size and better visual acuity at presentation were good predictive signs, whereas cystoid macular edema was found to be a poor prognostic sign for visual outcome following PDT.

Axer-Siegel R, Bourla D, Priel E, Yassur Y, Weinberger D. · Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel. · Ophthalmology. · Pubmed #12208724 No free full text.

Abstract: OBJECTIVE: To identify the angiographic features of retinal choroidal anastomoses (RCAs) in patients with newly diagnosed occult choroidal neovascularization (CNV) in the setting of age-related macular degeneration (AMD) and to determine the sequence of flow between the RCA and the CNV. DESIGN: Retrospective cross-sectional study. PARTICIPANTS: The angiograms of 205 eyes of 153 consecutive patients with occult CNV on fluorescein angiography (FA) and focal hot spots on indocyanine green angiography (ICGA) were evaluated retrospectively. METHODS OF TESTING: Red-free photographs and sequential digital fluorescein and indocyanine green angiograms obtained by confocal scanning laser ophthalmoscope (the Heidelberg Retina Angiograph; Heidelberg Engineering GmbH, Dossenheim, Germany). MAIN OUTCOME MEASURES: The angiograms were evaluated for the presence of RCA. The following angiographic characteristics were recorded: number and type of anastomoses, location, distance from fovea, area of CNV, presence of pigment epithelium detachment (PED), cystoid macular edema on FA, and intraretinal leakage on ICGA. The direction of flow between the RCA and the CNV was identified by analyzing high-speed angiograms. RESULTS: Retinal choroidal anastomoses were identified in 57 eyes (28%), in 49 of 154 eyes with PED (32%), and in 8 of 51 eyes without PED (16%). Of 109 anastomoses, 70% were venous and 30% were arterial. Ninety-six percent of the eyes had at least one venous anastomosis, 49% of the eyes had an arterial anastomosis, and 46% of the eyes had both. Cystoid macular edema was seen on FA in 37 eyes (65%), and intraretinal indocyanine green leakage was noted in 52 eyes (91%). Twenty-two eyes that underwent high-speed ICGA were analyzed for the direction of flow. All 15 eyes having arterial and venous anastomoses demonstrated a filling pattern from the retinal arteriole to the CNV, followed by the retinal venule. Seven eyes with venous RCA showed flow sequence from the CNV to the collecting retinal venule. CONCLUSIONS: Our study supports the presence of RCA in the early stages of acute exudative AMD with occult CNV, mainly with serous PED. High-speed angiography helps to identify the filling sequence of the RCA and the CNV, and therefore may guide the clinician in planning treatment strategies.

Weinberger D, Lichter H, Goldenberg-Cohen N, Priel E, Bahar I, Yassur Y, Axer-Siegel R. · Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel. · Retina. · Pubmed #12172105 No free full text.

Abstract: PURPOSE: To evaluate alterations in the retinal vasculature overlying pigment epithelial detachments (PED) in exudative age-related macular degeneration (ARMD) using indocyanine green and fluorescein angiography. METHODS: Forty-one patients (41 eyes) with a clinical diagnosis of exudative ARMD with PED underwent simultaneous fluorescein and indocyanine green angiography, also under high (10 degrees ) magnification. Vascular abnormalities in the retina were compared between patients with vascularized (n = 34, group 1) and nonvascularized (n = 7, group 2) PED on indocyanine green angiography and correlated with the size of the PED and the presence of serous retinal detachment. RESULTS: In all, 67 vascular abnormalities were found by indocyanine green angiography and only 22 by fluorescein angiography; this finding was statistically significant (P < 0.0001). The finding of retinal vasculopathy (32 patients in group 1 and two patients in group 2) was directly correlated with the presence of choroidal neovascularizations (P = 0.002). There was also a direct correlation between the presence of choroidal neovascularization and size of the PED (P = 0.03). The number of retinal vascular findings was not significantly correlated with serous elevation of the retina. CONCLUSIONS: Retinal vasculopathies may be observed in eyes with PED and are detectable by indocyanine green and fluorescein angiography.

Kramer M, Mimouni K, Priel E, Yassur Y, Weinberger D. · Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel. · Am J Ophthalmol. · Pubmed #10764859 No free full text.

Abstract: PURPOSE: To compare fluorescein angiography and indocyanine green angiography for imaging of choroidal neovascularization located under subretinal hemorrhage, in age-related macular degeneration. METHODS: In a retrospective study, 30 eyes of 30 consecutive patients with hemorrhagic age-related macular degeneration were evaluated with fluorescein angiography and indocyanine green angiography. In each eye, areas of macular hemorrhage, choroidal neovascularization, and total lesion (hemorrhage plus choroidal neovascularization) were measured, and the choroidal neovascularization was categorized as classic, occult, or mixed on fluorescein angiography, and as hot spot, plaque, or combined lesion on indocyanine green angiography. Results of the two techniques were compared for the ability to identify a laser-treatable lesion. RESULTS: Fluorescein angiography showed fluorescence in most cases (28, 93.3%). In 23 cases (76.6%), the fluorescence pattern was compatible with occult choroidal neovascularization. Indocyanine green angiography revealed defined patterns of fluorescence in 27 cases (90%): 12 hot spots, seven plaques, and eight combined hot spots and plaques. Twenty lesions (66.6%) detected by indocyanine green angiography were considered eligible for laser therapy. Nine of them (45%) were extrafoveal. CONCLUSIONS: Indocyanine green angiography is beneficial for imaging choroidal neovascularization located under subretinal hemorrhage. Choroidal neovascularization demonstrated on indocyanine green angiography may be considered eligible for laser treatment. Therefore, indocyanine green angiography should be considered in cases of hemorrhagic age-related macular degeneration.

Axer-Siegel R, Lichter H, Rosenblatt I, Priel E, Yassur Y, Weinberger D. · Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel. · Am J Ophthalmol. · Pubmed #10511028 No free full text.

Abstract: PURPOSE: To describe the indocyanine green angiographic pattern of retinal pigment epithelium tears in the setting of age-related macular degeneration compared with the fluorescein angiographic features. METHODS: Twelve consecutive patients (12 eyes) with a retinal pigment epithelium tear underwent simultaneous indocyanine green angiography and fluorescein angiography with the confocal scanning laser ophthalmoscope. The findings for the two modes were compared. RESULTS: Choroidal neovascular membrane was evident beneath the rolled retinal pigment epithelium on indocyanine green angiograms in 11(92%) of 12 eyes: a focal neovascular membrane was apparent in five (42%) of 12 eyes, whereas a plaque neovascular membrane was seen in six (50%) of 12 eyes. In comparison, fluorescein angiography demonstrated late leakage as a result of occult choroidal neovascular membrane in nine (82%) of 11 eyes but no well-defined choroidal neovascular membrane. CONCLUSIONS: Indocyanine green angiography is superior to fluorescein angiography for imaging choroidal neovascularization in cases of retinal pigment epithelium tear and may serve as an important adjunct to indocyanine green-guided laser treatment in selected cases.