Decreases in the Foveolar Choroidal Circulation Precede the Appearance of Choroidal Neovascularization (CNV) in Age Related Macular Degeneration (AMD)
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Age related macular degeneration (AMD) is the major cause of irreversible blindness in elderly patients worldwide. The pathogenesis of this disease has been investigated from genetic,1histological,2 and haemodynamic perspectives.3-6 AMD is classified as non-exudative—the dry type, or exudative neovascular—the wet type.7 8Choroidal neovascularisation (CNV) in the macula causes severe visual impairment in AMD. Several angiogenic factors (vascular endothelial growth factor (VEGF) and basic fibroblast growth factor), which are induced by hypoxia and ischaemia, may play a part in the development of CNV.9-11 Choroidal haemodynamics are important for CNV development in AMD.
Chen and colleagues report abnormal choroidal blood flow in asymmetric exudative AMD by measuring pulsatile ocular blood flow (POBF) using an OBF tonometer in 37 patients with asymmetric exudative AMD in this issue of the BJO (p 1411). Their results demonstrated that POBF was significantly higher in eyes with CNV than in the contralateral eyes with drusen. Eyes with disciform scars had lower POBF than the contralateral eyes with drusen. …
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The refractive error of 186 eyes with choroidal neovascularization (CNV) secondary to age-related macular degeneration (ARMD) was determined. It was found that the risk for the development of this form of ARMD increased with increasing degrees of hyperopia. The 96 patients afflicted with bilateral CNV were significantly older than the unilaterally affected patients (P = 0.027). Abnormal choroidal perfusion was identified in 66.4% of the fluorescein angiograms. These findings support the concept that hyperopic shortening in eyes afflicted with ARMD might cause secondary changes in the choroidal vasculature, predisposing them to choroidal neovascularization.
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Purpose: Focal choroidal excavation (CE) is an unusual concavity in the choroid without posterior staphyloma or scleral ectasia and with pathogenesis is still unknown. In this article we present a case of de novo progressive focal choroidal excavation associated with exudative age-related macular degeneration (AMD). Methods: This study was designed as a descriptive case report based on clinical and imaging data collected during patient’s observation and follow-ups. Results: A 67-year-old man with systemic hypertension and hypercholesterolemia, with a previous diagnosis of bilateral AMD complicated by already treated macular neovascularization, underwent our attention to perform follow-up visits. Over the 5-year follow-up, the left eye remained stable, requiring no further treatments and disclosing a BCVA of 0.0 LogMAR. On the contrary, the right eye showed several exudation recurrences, requiring further anti-VEGF injections. Structural OCT detected the progressive development of a focal CE, which gradually enlarged converting into a large CE. Structural OCT examinations reported even growing defects of the Bruch’s membrane. Despite the evident progression of the CE, BCVA disclosed stable values over the 5-years follow-up (1.0 LogMAR), with a worsening of metamorphopsia. Conclusion: Large CE may be a complication of neovascular AMD. Bruch’s membrane abnormalities, including thickness and reflectivity changes, detectable on structural OCT, can be considered early biomarkers of potentially developing CE.
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Long term survival of patient with invasive aspergillosis involving orbit, paranasal sinus, and central nervous system Aspergillus infections of the paranasal sinuses are classified as invasive or non-invasive. 1 The vast majority are non-invasive with a good prognosis; however, the invasive type behaves as a malignant neoplasm with bone destruction, orbital and intracranial extensions, and a high mortality rate. [2]][4] We present one patient with invasive paranasal aspergillosis that extended into the orbit and cranial cavities, and who has survived for 9 years and 1 month.www.bjophthalmol.com
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To evaluate the association between subfoveal choroidal thickness and the visual outcome in eyes with type 1 choroidal neovascularization (CNV) due to neovascular age-related macular degeneration (nAMD).This was a retrospective, longitudinal, cross-sectional study including patients diagnosed with nAMD type 1 lesions managed with intravitreal injections of ranibizumab in a PRN strategy during 24 months. Retrospective chart review of patients with type 1 CNV recording the visual acuity, number of intravitreal injections, multimodal imaging data, and follow-up period was performed. Subfoveal choroidal thickness was measured using enhanced depth imaging scans obtained with spectral-domain optical coherence tomography.Twenty-five eyes of 21 patients were included. The mean baseline logMAR best-corrected visual acuity was 0.52 (+0.35) (median 0.5; range 0.1-1; interquartile range (IQR) 0.3-0.8) and improved to 0.39 (+0.39) (median 0.4; range 0.1-1; IQR 0.2-0.5) by the end of the follow-up (p = 0.038). Subfoveal choroidal thickness was 202.8 (+60.3) μm (median 218; range 81-285; IQR 146-258). Statistical mixed effects model demonstrated an association between rate of improvement of visual acuity with subfoveal choroidal thickness after 24 months (p<0.001) (95% confidence interval 0.0002-0.0001 logMAR month μm); higher thickness values were correlated with better visual acuity.Thicker subfoveal choroid was associated with better visual outcomes in patients with type 1 CNV due to nAMD following a strict PRN regimen with intravitreal ranibizumab at 24 months of follow-up.
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