Macular Degeneration: Spaide RF

Spaide RF, Klancnik JM, Gross NE. · Vitreous-Retina-Macula Consultants of New York and the Manhattan Eye Ear and Throat Hospital, New York, New York 10021, USA. · Retina. · Pubmed #15187655 No free full text.

Abstract: PURPOSE: To evaluate patients who had undergone radial optic neurotomy for central retinal vein occlusion for the presence of retinal choroidal collateral circulation and to correlate these collaterals with changes in macular thickness during follow-up. Radial optic neurotomy is designed to release proposed pressure within the scleral canal. METHODS: Retrospective review of patients undergoing radial optic neurotomy. The patients had a baseline examination including ophthalmoscopy, fluorescein angiography, and optical coherence tomography. At an interval follow-up at approximately 3 months the patients were reevaluated with ophthalmoscopy, optical coherence tomography, and indocyanine green angiography. RESULTS: There were 6 patients, and the mean age was 68.3 years. The mean time from onset of the central retinal vein occlusion to the radial optic neurotomy was 2.3 months. One patient had no collateral vessels, three patients had significant collaterals, and two patients had moderate-caliber collaterals. The mean central macular thickness preoperatively was 1,021 microm and the mean central macular thickness postoperatively was 733 microm. The change in macular thickness was highly correlated with the degree of development of collaterals from the retinal to the choroidal circulation (P = 0.008, Spearman's rho = 0.93). CONCLUSION: Although all patients had a radial optic neurotomy a significant determinant in reduction of macular edema was the presence of retinal-choroidal collateral circulation. This suggests that there may be additional mechanisms, other than simple release of alleged pressure in the scleral canal, for any observed effects from radial optic neurotomy.

Spaide RF. · Vitreous, Retina, Macula Consultants of New York, and the LuEsther T. Mertz Retinal Research Laboratory, New York, New York 10021, USA. · Retina. · Pubmed #15097895 No free full text.

This publication has no abstract.

Spaide RF, Lee JK, Klancnik JK, Gross NE. · Vitreous-Retina-Macula Consultants of New York and the LuEsther T. Mertz Retina Research Laboratory, manhattan Eye, Ear, and Throat Hospital, New York, New York 10021, USA. · Retina. · Pubmed #12824834 No free full text.

Abstract: PURPOSE: To evaluate the incidence of serous retinal detachment (SRD) secondary to a branch retinal vein occlusion (BRVO) by using optical coherence tomography (OCT). METHODS: Fourteen eyes of 14 patients with a BRVO underwent a detailed history, ophthalmoscopic examination, and fluorescein angiographic evaluation. They were also studied with OCT. RESULTS: The 14 patients included eight women and six men with a mean age of 73.6 +/- 10.5 years (range, 55-90 years). Four eyes were found to have cystoid macular edema by fluorescein angiography, whereas 10 cases were detected by OCT. SRD involving any portion of the macula was found in 10 (71.4%) of the 14 eyes, and SRD extending into the fovea was found in six (42.9%) eyes. Two (14.3%) of the 14 patients also showed a subfoveal hemorrhage that appeared to have gravitated inferiorly through the SRD to the dependent portion of the detachment. CONCLUSIONS: That few patients with SRD secondary to a BRVO discovered by ophthalmoscopy have been reported in the literature would suggest that this is an uncommon complication. The authors found with OCT that SRD commonly occurs in BRVO. In addition, subretinal hemorrhage may occur in the context of BRVO, and the authors propose that blood gravitates through the subretinal fluid to settle behind the retina.

Iida T, Yannuzzi LA, Spaide RF, Borodoker N, Carvalho CA, Negrao S. · Department of Ophthalmology, Fukushima Medical University School of Medicine, Japan. · Retina. · Pubmed #12652224 No free full text.

Abstract: PURPOSE: To describe the optical coherence tomography (OCT) and fluorescein angiography findings in the macula of eyes with chronic central serous chorioretinopathy (CSC) and reduced central vision. METHODS: Using OCT, clinical examination, and fluorescein and indocyanine green (ICG) angiography, the authors examined eight eyes of seven patients with CSC, an attached macula, and reduced central vision of 20/200 or worse. All had a history of chronic CSC with resolution of the subretinal fluid in the macular area and poor vision. RESULTS: Patient ages ranged from 55 to 82 years (mean, 66 years). All eight eyes had some parafoveal, patchy RPE atrophy with corresponding transmission hyperfluorescence (window defect) on fluorescein angiography. Five eyes also had a window defect in the foveal area. With OCT, the foveal area revealed variable areas of cystoid change and atrophy in seven of the eight eyes. In four of these eyes, the cystoid changes were not seen on clinical examination or fluorescein angiography. The seven eyes with cystoid changes imaged with OCT had no intraretinal leakage of fluorescein in the foveal region. The authors categorized these eyes as having cystoid macular degeneration (CMD). One other eye had foveal thinning or atrophy without cystoid changes. CONCLUSIONS: Intraretinal cystoid spaces without intraretinal leakage, or CMD, was a common finding in eyes with chronic CSC and reduced central vision after resolution of subretinal fluid. OCT was useful to establish the presence of CMD and foveal atrophy, even when these changes were not clearly evident on clinical examination or fluorescein angiography. Chronic foveal detachment and antecedent intraretinal leakage were proposed to be the mechanisms for the development of the changes. CMD in conjunction with foveal atrophy was an important clinical finding to account for the poor visual outcome in patients with CSC.

Spaide RF. · Vitreous-Retina-Macula Consultants of New York, 519 East 72nd Street, Suite 203, New York, NY 10021, USA. · Ophthalmology. · Pubmed #12578786 No free full text.

Abstract: PURPOSE: To evaluate the autofluorescence images of patients with nonexudative and the fellow eyes with exudative age-related macular degeneration (AMD). DESIGN: Observational case series. PARTICIPANTS: Fifty-four patients seen in the author's practice. METHODS: A fundus camera-based system for autofluorescence photographs was used, and the wavelengths for the excitation (580 nm) and barrier (695 nm) filters were based on known transmission and autofluorescent characteristics of the ocular media. Patients were also photographed with red-free and infrared monochromatic imaging. The mean levels of autofluorescence were compared between patients without (group 1) and those with exudative AMD. Comparisons were made among patients with exudative AMD, examining the autofluorescence pattern in those without retinal vascular contribution to the exudative process (group 2) to those with retinal vascular contribution (group 3). MAIN OUTCOME MEASURES: Mean amounts and patterns of autofluorescence. RESULTS: A total of 54 patients was evaluated; 18 were in each group. The mean age was 75.4 years, and there was no difference in the mean ages among the groups (P = 0.16). There was no correlation of the autofluorescence measurements and the degree of nuclear sclerosis (P = 0.14). Patients with exudative AMD had more autofluorescence in the fellow eye than did eyes of patients without exudative AMD (P = 0.002). Patients in group 3 were more likely to have focal hyperpigmentation, particularly as imaged by infrared light (P = 0.015), and focal areas of intense autofluorescence (P = 0.001) than were patients in group 2. CONCLUSIONS: By use of this method of autofluorescence imaging, it was determined that the fellow eyes of patients with exudative AMD had larger amounts of autofluorescence than did the eyes of patients without a history of exudative AMD. Patients with retinal vascular anastomosis to the vascular proliferation of exudative AMD were much more likely to have focal areas of intense autofluorescence in their fellow eye that corresponded, for the most part, with focal areas of hyperpigmentation best seen by infrared monochromatic fundus photography. Because the amount of fluorescence is directly related to the amount of lipofuscin, which in turn is related to the cumulative amount of oxidative damage, these findings suggest possible explanations for certain patterns of vessel growth seen in exudative AMD.

Fernandes LH, Freund KB, Yannuzzi LA, Spaide RF, Huang SJ, Slakter JS, Sorenson JA. · LuEsther T Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY 10021, USA. · Retina. · Pubmed #12441720 No free full text.

Abstract: PURPOSE: To clarify the frequency and nature of ICG angiographic "hot spots" seen in patients with neovascular age-related macular degeneration (ARMD). METHODS: A consecutive series of newly diagnosed patients with neovascular ARMD and fluorescein angiographic evidence of occult choroidal neovascularization (occult CNV) was imaged with ICG angiography. Eyes with ICG angiographic "hot spots" were identified and further classified. A hot spot was defined as any area of abnormal hyperfluorescence, in the mid to late stages of ICG angiography, measuring less than 1 disk area in size. RESULTS: From a total of 190 patients (220 eyes) with neovascular ARMD, 30 patients and 34 eyes (16%) with hot spots were identified. Hot spots were noted to be of three distinct patterns: polypoidal choroidal neovascularization (polypoidal CNV) in 21 of 34 eyes, or 62%; retinal angiomatous proliferation (RAP) in 11 of 34 eyes, or 30%; and focal occult CNV in 2 of 34 eyes, or 8%. CONCLUSIONS: A focal area of intense hyperfluorescence or so-called hot spot seen on ICG angiography in neovascular ARMD is due to one of three possible forms of neovascularization: most frequently polypoidal CNV, less commonly RAP, and infrequently nonspecific, focal occult CNV. Since neovascular ARMD may be caused by different types of neovascularization, each with distinct clinical manifestations, natural course, visual prognosis, and response to treatment, it is important to identify the precise nature of hot spots to establish an accurate diagnosis and, when appropriate, a specific form of management.

Kaga T, Fonseca RA, Dantas MA, Spaide RF. · LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, USA. · Retina. · Pubmed #11321145 No free full text.

This publication has no abstract.

Slakter JS, Yannuzzi LA, Schneider U, Sorenson JA, Ciardella A, Guyer DR, Spaide RF, Freund KB, Orlock DA. · Vitreous-Retina-Macula Consultants of New York, New York 10021, USA. · Ophthalmology. · Pubmed #10768338 No free full text.

Abstract: OBJECTIVE: This study was designed to identify the incidence of retinal choroidal anastomoses in patients with occult choroidal neovascularization (CNV) and focal hot spots on indocyanine green (ICG) angiography, to identify the clinical and angiographic features that would assist in their identification, and to determine if the presence of these anastomotic lesions affect the outcome of laser therapy. DESIGN: Combined prospective and retrospective cross-sectional study. PARTICIPANTS: One hundred fifty consecutive patients with newly diagnosed occult CNV secondary to exudative age-related macular degeneration and focal hot spots on ICG angiography were evaluated prospectively. In addition, a retrospective review was performed on 79 eyes previously reported to have undergone laser photocoagulation treatment with ICG guidance. METHODS AND TESTING: In all cases, stereo color and red-free photographs, and stereo fluorescein and digital ICG angiograms were obtained for evaluation. MAIN OUTCOME MEASURES: Images obtained by all four techniques were evaluated for the presence of a retinal choroidal anastomosis. Associated clinical and angiographic findings were noted. In the retrospective review, the success rate of laser treatment was correlated with the presence or absence of a retinal choroidal anastomosis. RESULTS: Of the 150 eyes evaluated prospectively, 31 (21%) were found to have a retinal choroidal anastomosis. Retinal choroidal anastomoses were found in 27% of patients with associated serous pigment epithelial detachment (PED), whereas 13% were found in those without an associated elevation of the retinal pigment epithelium. Seventy-one percent of eyes had multiple anastomotic connections. Ninety percent of eyes had at least one retinal vein involved in the anastomotic connection. Clinical evidence of preretinal and intraretinal hemorrhage and cystic edema coupled with angiographic evidence of intraretinal dye leakage were key features of retinal choroidal anastomoses. In the retrospective review, seven patients were found to have retinal choroidal anastomoses with associated serous PED and demonstrated a very low (14%) success rate for laser treatment. CONCLUSIONS: Retinal choroidal anastomoses can present as a primary manifestation of the exudative process in age-related macular degeneration. They may be seen in eyes with and without detachment of the retinal pigment epithelium. Specific clinical and angiographic features have been identified that can aid in the diagnosis of these vascular anomalies. Their presence represents a poor prognostic sign for successful ICG-guided laser treatment.

Fernandes LH, Scassellati-Sforzolini B, Spaide RF. · LuEsther T. Mertz Retina Research Laboratory, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA. · Am J Ophthalmol. · Pubmed #10704572 No free full text.

Abstract: PURPOSE: To describe the occurrence of visual hallucinations in a patient with Charles Bonnet syndrome associated with estrogen intake. METHOD: Case report. RESULTS: An 84-year-old woman with poor visual acuity secondary to bilateral, nonexudative, age-related macular degeneration had nonthreatening visual hallucinations 2 weeks after starting oral estrogen for osteoporosis. The estrogen was stopped, and the hallucinations subsided. The patient was given estrogen twice more and each time the hallucinations recurred. CONCLUSION: We report a case of Charles Bonnet syndrome associated with estrogen intake in an 84-year-old woman. Estrogen may have promoted release phenomena and triggered the hallucinatory episodes in our patient.

Spaide RF, Leys A, Herrmann-Delemazure B, Stalmans P, Tittl M, Yannuzzi LA, Burke KM, Fisher YL, Freund KB, Guyer DR, Slakter JS, Sorenson JA. · NY LuEsther T. Mertz Retinal Research Laboratory, Manhattan Eye, Ear & Throat Hospital, New York, New York 10021, USA. · Ophthalmology. · Pubmed #10599654 No free full text.

Abstract: PURPOSE: To characterize a newly discovered choroidal vascular abnormality in patients who have received radiation therapy for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration. DESIGN: Two-center cross-sectional study. PARTICIPANTS: In the United States, there were 95 patients who were treated with 10 or 12 Gy of external beam photons. In Belgium, 98 patients were treated with 20 Gy. These patients were examined retrospectively for the presence of a specific CNV abnormality. RESULTS: During the follow-up period, an unusual vascular growth pattern was identified in 12 patients (12.6%) of those treated in the United States and in 7 (7.1%) of those treated in Belgium. These patients developed round or oval vascular blebs along the outer border of their neovascular lesions. These blebs profusely leaked fluorescein dye and could be imaged best by indocyanine green angiography. Patients with these blebs appeared to have a marked propensity for loss of visual acuity. CONCLUSION: An unusual pattern of new vessel growth occurred in 19 of the 193 patients with CNV treated with radiation. This new entity, termed radiation-associated choroidal neovasculopathy, is a recognizable disorder that appears to have a particularly poor prognosis.

Yannuzzi LA, Wong DW, Sforzolini BS, Goldbaum M, Tang KC, Spaide RF, Freund KB, Slakter JS, Guyer DR, Sorenson JA, Fisher Y, Maberley D, Orlock DA. · Manhattan Eye, Ear and Throat Hospital, New York, NY, USA. · Arch Ophthalmol. · Pubmed #10565519 No free full text.

Abstract: OBJECTIVE: To determine the nature and frequency of polypoidal choroidal vasculopathy (PCV) in a series of patients suspected of having neovascularized age-related macular degeneration (AMD). METHODS: A prospective analysis of 167 consecutive, newly diagnosed patients aged 55 years or older with presumed neovascularized AMD was performed. All patients were examined with fundus biomicroscopy as well as fluorescein and indocyanine green angiography. RESULTS: Choroidal neovascularization secondary to AMD was diagnosed in 154 (92.2%) of 167 patients; 13 (7.8%) patients had PCV. The patients affected by PCV were younger than those with AMD (P = .01). Peripapillary choroidal neovascularization was seen in 3 (1.9%) of 154 patients with AMD and 3 (23.1%) of 13 patients with PCV (P = .006). Significant drusen were present in 63 (70%) of 90 fellow eyes with unilateral AMD compared with only 1 (16.7%) of 6 eyes with PCV (P = .02). Only 5 patients with AMD (3.2%) were nonwhite compared with 3 patients with PCV (23.1%) (P = .02). CONCLUSIONS: A measurable number of elderly patients with findings suggestive of neovascularized AMD and serosanguineous macular manifestations will instead have PCV. Polypoidal choroidal vasculopathy can occur in any sex or race, but is more commonly seen in the peripapillary area, without associated drusen, and in nonwhite patients. It is important to differentiate AMD from PCV because there are significant differences in the demographic risk profile, natural course, visual prognosis, and management of these patients.

Spaide RF, Ho-Spaide WC, Browne RW, Armstrong D. · LuEsther T. Mertz Retina Research Laboratory, Manhattan Eye, Ear, and Throat Hospital, New York, USA. · Retina. · Pubmed #10213241 No free full text.

Abstract: PURPOSE: To determine if peroxidized lipids occur in Bruch's membrane isolates and to characterize the type present in human necropsy specimens. METHODS: Bruch's membrane isolates from eye bank eyes obtained from 13 white donors were homogenized. Measurement of peroxidized lipids was done with the fluorometric thiobarbituric acid assay and high pressure liquid chromatography. RESULTS: Bruch's membrane isolate homogenates contained native unsaturated fatty acids and peroxidized lipids in a ratio of about 200:1. The amount of thiobarbituric acid reacting substances increased exponentially with age. The peroxidized lipids identified in Bruch's membrane isolates were derived from long chain polyunsaturated fatty acids, particularly docosahexaenoic acid and linolenic acid, which are normally found in the photoreceptor outer segments. CONCLUSIONS: Lipids are known to accumulate in Bruch's membrane, an acellular layer with no known intrinsic mechanisms to combat lipid peroxidation. In related studies, lipid peroxides have been shown to induce neovascularization by inducing expression of a cascade of angiogenic cytokines. This is the first study to show that lipid peroxides, biological molecules that have the potential to incite new vessel growth, occur in Bruch's membrane. The increase in amount of peroxidized lipids with age, combined with their vasogenic potential, suggests that peroxidized lipids may play a role in the etiology of age-related macular degeneration, particularly choroidal neovascularization.

Spaide RF. · No affiliation provided · Ophthalmology. · Pubmed #18675704 No free full text.

This publication has no abstract.

Singerman LJ, Brucker AJ, Jampol LM, Lim JI, Rosenfeld P, Schachat AP, Spaide RF. · Retina Associates of Cleveland, Cleveland, OH, USA. · Retina. · Pubmed #16208185 No free full text.

Abstract: Several recent developments may provide an opportunity to improve outcome in individuals who develop neovascular age-related maculopathy (age-related macular degeneration [ARMD]). Concurrent with progress in isolating clinically relevant subtypes of neovascular ARMD, several therapies have been introduced that show promise for halting progression of this disorder. However, data from controlled clinical trials to test the relative efficacy of different management strategies across these subtypes of disease presentation remain limited. In addition, strategies to control ARMD may evolve quickly as more is learned about how specific molecular events, such as cell-mediated inflammation and angiogenesis, contribute to disease expression. A roundtable of investigators was convened to discuss and summarize recent progress in the treatment of ARMD. Case studies were then presented to provide an opportunity for experts to reveal their specific thought processes in the approach to neovascular ARMD based on their own interpretation of current clinical data and empirical experience.