[Effects of ozone therapy on the functional activity of the retina in patients with involutional central chorioretinal dystrophy]

The retinal electrogenesis was studied in central chorioretinal dystrophy (CCRD) of different stages. The general peculiarities of the ozone-therapy influence on the functional retinal activity typical of any CCRD stage were detected; they comprise: an increasing activity of neurons in the muscular region and a specificity related with the dynamic functional activity of the retinal peripheral segments peculiar of each disease stage. A sharp growth of glial index Cg (b/R12) detected in all patients is indicative of an activated metabolism of Mueller glial cells and of impaired glial-neuron relations in the retina as observed in CCRD. A decreasing Cg, observed after ozone-therapy, is an indirect confirmation of anti-hypoxic effect produced by ozone, which can be regarded as a patho-physiological mechanism of its positive influence on the dynamics of the functional retinal activity. Ozone-therapy is recommended to be implemented with the electroretinography monitoring.

Suprachoroidal seton implantation in refractory glaucoma: a novel surgical technique

PURPOSE

To describe a new surgical technique in which aqueous humor is diverted from the anterior chamber to the suprachoroidal space for the augmentation of uveoscleral outflow in the management of refractory glaucoma.

METHODS

Four painful-blind eyes of four consecutive patients were included in the study. Mean age of patients was 54.7+/- 9.2 years. Preoperative diagnosis was neovascular glaucoma complicating diabetic retinopathy in three cases and chronic angle-closure glaucoma in one case. Mean preoperative intraocular pressure of the patients receiving two medications was 58.5 +/- 9.2 mm Hg. A modified Krupin eye valve with disk was implanted into the suprachoroidal space. The anterior tube part of the Seton device was placed into the anterior chamber through the long scleral tunnel for draining the aqueous humor from the anterior chamber to the suprachoroidal space.

RESULTS

The placement of modified Krupin eye valve with disk to the suprachoroidal space was achieved in all cases. While mean preoperative intraocular pressure was 58.5 +/- 9.2 mm Hg, it was 14.2 +/- 4.7 mm Hg at postoperative one week. It was 13.5 +/- 4.6 mm Hg and 15 +/- 4.9 mm Hg at one and three months respectively. At the last follow-up visit, mean intraocular pressure was 17.25 +/- 5.37 mm Hg ranging from 12 to 24 mm Hg. Choroidal detachment was developed in one case and regressed in six weeks. Rubeosis irides regressed at third month in three cases. None of the eyes developed suprachoroidal hemorrhage, retinal detachment, or phthisis bulbi.

CONCLUSION

The drainage of aqueous humor from the anterior chamber to the suprachoroidal space with the implantation of the glaucoma Seton device is effective in lowering intraocular pressure in refractory glaucoma.

Bilateral combined retinal and choroidal detachment in antineutrophil cytoplasmic antibody-positive scleritis

PURPOSE

To describe a rare complication of scleritis in a patient with positive serum antineutrophil cytoplasmic antibodies (ANCA).

METHODS

We present a case report of a patient who developed bilateral retinal and choroidal detachment associated with ANCA-positive scleritis.

RESULTS

Oral steroids alone were insufficient to maintain sustained remission of ocular inflammation. Clinical relapse of the scleritis was associated with ANCA titres becoming positive again. A combination of cyclophosphamide and steroids was successful in achieving control of the intraocular inflammation over a follow-up period of 18 months.

CONCLUSION

Bilateral combined retinal and choroidal detachment is a potentially blinding complication of ANCA-positive scleritis. Monitoring of ANCA titres is useful in the management of the disease.

Topical fundus pulsation measurement in patients with active central serous chorioretinopathy

OBJECTIVE

To determine regional pulsatile choroidal blood flow using laser interferometry in patients with active central serous chorioretinopathy (CSC).

METHOD

The study compared an equally sized age-, sex-, and refractive error-matched control group of healthy volunteers obtained from the Department of Clinical Pharmacology with 18 consecutive patients who had newly diagnosed active, unilateral CSC obtained from the University of Vienna Eye Clinic, Vienna, Austria.

MAIN OUTCOME MEASURES

Regional fundus pulsation amplitude as assessed using laser interferometry.

RESULTS

The median age of the patients was 40 years; the male-female ratio was 16:2. Foveal fundus pulsation amplitude was significantly higher in eyes with CSC (mean [SD], 5.5 [1.7] micro m) than in the eyes of the control subjects (4.1 [1.1] micro m; P =.005). In addition, eyes with CSC had a significantly higher variability in fundus pulsation amplitude (mean [SD], 48% [20%]) assessed at different fundus locations around the leak than the controls did (20% [9%]; P<.001).

CONCLUSIONS

To our knowledge, this is the first study that measures topical fundus pulsations in patients who have active, unilateral CSC. These data indicate a generally increased foveal pulsatile choroidal blood flow and an abnormal distribution of fundus pulsation amplitude in the area close to the leak. Whether these findings reinforce the concept that choroidal perfusion abnormalities play a role in the pathogenesis of CSC remains to be established.

Features of abnormal choroidal circulation in central serous chorioretinopathy

AIMS

To evaluate abnormalities in the choroidal circulation in cases of central serous chorioretinopathy (CSC).

METHODS

A complete clinical ophthalmological examination was performed using simultaneous fluorescein and indocyanine green (ICG) angiography with a confocal scanning laser ophthalmoscopy and the digital images analysed in 36 consecutive patients with acute CSC. To quantify the choroidal circulation, the foveal choroidal blood flow was measured in 11 patients using laser Doppler flowmetry.

RESULTS

Fluorescein angiography showed focal leakage from the retinal pigment epithelium in all patients. ICG angiography revealed delays in arterial filling in 27 eyes (75%), and fluorescein angiography showed small hypofluorescent points around the leakage in 27 eyes (75%). Abnormal choroidal hyperfluorescence was observed in 30 eyes (83%). The choroidal blood flow in eyes with CSC was 45% lower than in fellow eyes (p<0.01).

CONCLUSION

Decreased choroidal blood flow in CSC was demonstrated for the first time. The decreased choroidal blood flow might be correlated with the small, localised hypofluorescent areas, which may indicate non-perfused areas of the choriocapillaris that are frequently seen during ICG angiography.

VEGF-TRAP(R1R2) suppresses choroidal neovascularization and VEGF-induced breakdown of the blood-retinal barrier

Vascular endothelial growth factor (VEGF) plays a central role in the development of retinal neovascularization and diabetic macular edema. There is also evidence suggesting that VEGF is an important stimulator for choroidal neovascularization. In this study, we investigated the effect of a specific inhibitor of VEGF, VEGF-TRAP(R1R2), in models for these disease processes. VEGF-TRAP(R1R2) is a fusion protein, which combines ligand binding elements taken from the extracellular domains of VEGF receptors 1 and 2 fused to the Fc portion of IgG1. Subcutaneous injections or a single intravitreous injection of VEGF-TRAP(R1R2) strongly suppressed choroidal neovascularization in mice with laser-induced rupture of Bruch's membrane. Subcutaneous injection of VEGF-TRAP(R1R2) also significantly inhibited subretinal neovascularization in transgenic mice that express VEGF in photoreceptors. In two models of VEGF-induced breakdown of the blood-retinal barrier (BRB), one in which recombinant VEGF is injected into the vitreous cavity and one in which VEGF expression is induced in the retina in transgenic mice, VEGF-TRAP(R1R2) significantly reduced breakdown of the BRB. These data confirm that VEGF is a critical stimulus for the development of choroidal neovascularization and indicate that VEGF-TRAP(R1R2) may provide a new agent for consideration for treatment of patients with choroidal neovascularization and diabetic macular edema.

Multifocal electroretinograms in cases of central areolar choroidal dystrophy

PURPOSE

To study multifocal electroretinograms (mfERG) in patients with early-stage central alveolar choroidal dystrophy (CACD) with well-demarcated atrophic areas.

METHODS

Eight eyes of eight patients with CACD (ages, 47-67 years) and 20 normal control subjects were examined. The first- and second-order kernels (K1 and K2) were extracted from the responses elicited by 61 standard hexagonal elements of a visual response imaging system. The amplitudes and peak times of the focal responses at various retinal eccentricities were studied.

RESULTS

The amplitudes of K1 were reduced in the visibly atrophic areas, and they were also decreased in areas with no visible atrophy. The peak time was slightly delayed in many loci, but the delay was not as long as that in congenital stationary night blindness or diabetic retinopathy. The amplitude of K2 was very small in the central and peripheral areas, but the K2/K1 ratio in both areas was not significantly reduced, compared with that in normal subjects.

CONCLUSIONS

Although the atrophic area was ophthalmoscopically well demarcated in patients with CACD, the abnormality of retinal function extended beyond the borders of the ophthalmoscopic and angiographic lesions. The retinal dysfunction outside the atrophic areas suggests a centrifugal progression of the disease, and abnormal K2 and K1 with preserved K2/K1 ratio are consistent with a presynaptic mechanism for the retinal dysfunction in this disease.

Multifocal electroretinography in central serous chorio-retinopathy and assessment of the reproducibility of the multifocal electroretinography

PURPOSE

To measure and compare the difference of multifocal electroretinography (mERG) in control subjects and patients with central serous chorio-retinopathy (CSCR) and assessing the reproducibility of the multifocal electroretinography.

METHODS

Sixteen cases of control subjects and 12 cases of central serous chorio-retinopathy were tested with the Visual Evoked Response Imaging System science4.2 made by EDI company of America. The results of the left eye of each control subject and patient were used for statistical evaluation by the Mann-Whitney U test. Repeat measurements were performed on 11 control subjects. Wilcoxon technique were used to quantify the reproducibility of the test.

RESULTS

The P1 waveform average response density of 1-3 rings in central serous chorio-retinopathy were decreased statistically. There was no significant difference between repeat measurements on 11 individuals.

CONCLUSION

Multifocal electroretinography can be used to quantify the visual function of the affected area in chorio-retinopathy and showed good agreement in the data distribution for the repeat measurements.

Cystoid macular degeneration in chronic central serous chorioretinopathy

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.

Choroidal effusion and shallowing of the anterior chamber after adjunctive therapy with latanoprost in a trabeculectomized patient with angle closure glaucoma

PURPOSE

Choroidal effusion and anterior chamber loss can occur in a trabeculectomized eye either spontaneously or following aqueous suppressant drug use.

METHODS

A 50 year-old women with complaints of pain in the left eye (LE) was diagnosed as angle closure glaucoma. She was treated medically and underwent bilateral laser iridotomy. Because of high intraocular pressure it was decided to perform trabeculectomy. During the follow up period, the bleb became flat and after 3 months the IOP was again 24 mmHg with timolol maleate 0.5% and dorzolamide twice a day. Latanoprost was added to the therapy of the LE.

RESULTS

12 days later the patient returned with pain and vision loss in her LE. The anterior chamber was diffusely narrow and ophthalmoscopy showed massive choroidal effusion.

CONCLUSION

The possible mechanisms of this complication were discussed.

[The state of diopter and visual acuity in central serous chorioretinopathy]

PURPOSE

To investigate the state of diopter and best corrected visual acuity in active central serous chorioretinopathy (CSC).

METHODS

Twenty-three unilateral active CSC patients (23 eyes) were observed with Integrated Optometry Apparatus. The period of follow-up was from 3 - 12 months (mean, 7.2 months).

RESULTS

Of the 23 patients, 15 eyes (65.2%) of active CSC and 5 fellow eyes (21.7%) showed hyperopic state. There were significant differences in hyperopic state between the active eyes and fellow eyes (P < 0.01). After follow-up, there were only 5 eyes of CSC (21.7%) showed slight hyperopia. There were significant differences in hyperopic state between before and after follow-up of the eyes of CSC (P < 0.01) Among the eyes of the best corrected visual acuities were increased 3 row or above, 90.9% eyes of the best corrected visual acuities were resumed to 1.0.

CONCLUSION

Most of the active CSC demonstrated temporary hyperopic state due to the neuroretinal detachment of macula. The best corrected visual acuities with the Integrated Optometry Apparatus in active CSC are useful in evaluating the final visual acuities of the eyes.

[Treatment of central serous chorioretinopathy with beta blockers]

On a group of 13 eyes the authors evaluate their experience with medicamentous treatment of central serous chorioretinopathy. For treatment they used the non-selective beta-blocker Trimepranol, 2 x 5 mg/day. They found that in 11 eyes, in 84.6% cases, adherence of the ablated neuroepithelium of the macula occurred latest within four months of treatment, in two eyes (15.4%) this therapeutic dose did not lead to remission of the disease even after four months of treatment and the condition was evaluated as failure of treatment. The authors conclude that a therapeutic dose of Trimepranol of 2 x 5 mg/day is not a reliable therapeutic solution of central serous chorioretinopathy.

[Visual prognosis in polypoidal choroidal vasculopathy associated with subretinal hematoma]

PURPOSE

Although it is reported that the prognosis for polypoidal choroidal vasculopathy(PCV) is better than that for age-related macular degeneration, visual acuity is not always good in eyes with subfoveal hemorrhage. We evaluated the factors that may affect the visual prognosis after subfoveal hematoma associated with PCV.

SUBJECT

We examined retrospectively the records of 37 eyes in 34 patients that were diagnosed as PCV by indocyanine green angiography from January 1998 to July 2000 at Kyoto University Hospital. Among the 37 eyes, we chose 15 eyes in 15 patients that had subfoveal hematoma of more than 1 disk diameter, and evaluated the area of hematoma, period required for absorption of the hematoma, association of choroidal neovascularization(CNV), treatment, and visual acuity change.

RESULTS

The area and the absorption period of the hematoma did not correlate with the visual prognosis. Association of CNV strongly influenced the visual outcome after the absorption of subretinal hemorrhage. Four eyes with CNV received various treatments, but no restoration of visual acuity was observed.

CONCLUSION

CNV association mostly affected the prognosis of PCV with hematoma. Early detection of CNV appeared important to predict visual prognosis.

Peripheral nervous system in gyrate atrophy of the choroid and retina with hyperornithinemia

OBJECTIVE

To evaluate peripheral nervous system involvement in gyrate atrophy of the choroid and retina with hyperornithinemia (GA).

BACKGROUND

GA is an inborn error of amino acid metabolism caused by mutations in the enzyme ornithine aminotransferase. Patients with GA have hyperornithinemia, progressive centripetal loss of vision, minor CNS abnormalities, and type II muscle fiber atrophy with accumulation of tubular aggregates. The authors previously showed that muscle and brain creatine stores are depleted in the patients with GA.

METHODS

The authors searched evidence of peripheral nervous involvement in 40 patients with GA (mean age 31.6 +/- 16.3 years; range 5 to 74 years) by using neurography, quantitative sensory threshold testing, and evoked potential testing.

RESULTS

Neurography revealed abnormalities in 21 (53%) of the patients. The abnormalities associated with the severity of the ophthalmologic changes and the age of the patients. With quantitative sensory threshold testing, abnormal large-fiber function was found in seven (18%) and abnormal small-fiber function was found in four (10%) patients. Somatosensory evoked potential and brainstem auditory evoked potential responses were abolished in five patients.

CONCLUSIONS

These findings of peripheral nervous system involvement in GA suggest that GA is a systemic disease affecting not only CNS but also the peripheral nervous system.

Localized retinal dysfunction in central serous chorioretinopathy as measured using the multifocal electroretinogram

PURPOSE

To determine the extent of electrophysiologic dysfunction in patients with central serous chorioretinopathy (CSC).

DESIGN

Prospective observational case series.

PARTICIPANTS

Six patients with unilateral CSC (mean age, 40 years) were recruited into the study.

METHODS

Six patients with CSC underwent multifocal electroretinogram (mfERG) testing on both their clinically affected and opposite uninvolved eyes using the VERIS System, with a stimulus array of 103 scaled hexagons. The first positive peak responses were analyzed within six concentric ring annuli centered on the fovea. Amplitudes and implicit times were compared with those of an age-similar control group.

MAIN OUTCOME MEASURES

Local electroretinographic response amplitudes and implicit times within the central 40 degrees with the mfERG.

RESULTS

All the clinically uninvolved eyes showed mfERG amplitudes and implicit times within the normal range throughout the central 40 degrees of the retina. All six eyes with CSC showed reduced amplitudes and/or delayed implicit times that were limited to the regions of the macula in which clinical changes associated with CSC were apparent.

CONCLUSIONS

We observed electroretinographic changes only in the clinically affected eyes, and these were limited to regions with ophthalmoscopically apparent fundus changes. Our findings do not support the conclusion that functional impairment, as measured by the mfERG, in eyes with CSC extends beyond clinically observed fundus changes. We did not observe abnormal mfERG responses in the clinically normal eyes of such patients.

Clinical features and natural history of the acute idiopathic enlarged blind spot syndrome

OBJECTIVE

To study the clinical pattern and natural history of patients with the symptom of an enlarged blind spot.

DESIGN

A retrospective case series. Twenty-one patients were collected from a neuro-ophthalmologic practice during the period January 14, 1983, to July 1, 1996, and four consecutive patients were added from three vitreoretinal practices during the period April 14, 1986, to June 7, 1999.

PARTICIPANTS

Twenty-six eyes of 25 patients were studied at onset and at repeat visits from 1 year and 7 months to 15 years and 6 months later.

METHODS

The first visit was composed of a complete neuro-ophthalmologic examination with fundus photos and fluorescein angiography in 12 of the 26 eyes. Follow-up examination consisted of an interval history, ophthalmologic examination, visual fields, fundus photographs, fluorescein angiograms in eight eyes, indocyanine green angiograms in seven eyes, and multifocal electroretinograms (mfERG) in both eyes of seven patients.

MAIN OUTCOME MEASURES

The major outcome measures were onset and long-term visual field characteristics, disc and peripapillary features, association with other chorioretinal diseases, and mfERG features.

RESULTS

Twenty-one eyes had clinical features of chorioretinal syndromes, which are usually associated with an enlarged blind spot. Five eyes were examined too late after onset to expect such features. The visual field defect regressed in all but 12 eyes but never to an unequivocally normal-sized blind spot. Four of the 12 had chorioretinal scarring that corresponded to the permanent field defect. Twenty-one of 26 eyes had peripapillary scarring. The peripapillary scarring appeared the same no matter what the associated chorioretinal disease or type or size of field defect was. mfERG testing of seven patients at follow-up revealed first-order and second-order abnormalities long after clinical recovery, abnormalities that were bilateral even when the clinical signs had been unilateral.

CONCLUSIONS

If an eye with an enlarged blind spot is examined within 2 weeks of onset, signs of a chorioretinal disease will usually be present. Beyond that period, signs such as disc congestion, disc staining, peripapillary retinitis, foveal changes, and peripheral retinal spots may not be present. Although the patient usually becomes asymptomatic, the blind spot is slightly and permanently enlarged, and there is usually peripapillary disc scarring. mfERG testing indicates that retinal damage is more widespread, bilateral, and permanent than the visual field and clinical features would indicate. Chorioretinal syndromes that are associated with a temporal field defect have some features in common and others that are distinctive.

Use of the multifocal electroretinogram in the evaluation of a patient with central areolar choroidal dystrophy

PURPOSE

To assess the multifocal electroretinogram and full-field electroretinogram findings in a patient with advanced central areolar choroidal dystrophy.

DESIGN

Observational case report.

METHODS

A 53-year-old man with central areolar choroidal dystrophy underwent multifocal electroretinogram and full-field electroretinogram testing.

RESULTS

The multifocal electroretinogram demonstrated relative preservation of foveal function compared with the severely depressed retinal function of the perifoveal macula corresponding to the location of the retinal and retinal pigment epithelium atrophy. The full-field electroretinogram was normal for both photopic and scotopic responses.

CONCLUSION

Despite a normal full-field electroretinogram, the multifocal electroretinogram demonstrated significant macular dysfunction with relative preservation of foveal function in a patient with central areolar choroidal dystrophy.

[Relationship between constitutional type of systemic hemodynamics and formation of peripheral vitreo-chorioretinal dystrophies during pregnancy]

Dynamic observations of 86 pregnant women with peripheral vitreochorioretinal dystrophies (PVCRD) (121 eyes) showed that the condition progressed during pregnancy in 33.8% cases. Decrease of ocular hemodynamics and scleral rigidity were characteristic of pregnancy, being particularly pronounced in OPH gestosis. The highest incidence of PVCRD progress was observed in pregnant women with the hypokinetic type of systemic hemodynamics, being 30% in normal pregnancy and reaching 48% in OPH gestosis vs. 8.3 and 16.6 and 16.6 and 22.7% in the hyper- and eukinetic types, respectively.

The multifocal electroretinogram in central serous chorioretinopathy

PURPOSE

To compare multifocal electroretinograms (ERGs) in control subjects and patients with central serous chorioretinopathy (CSC).

METHOD

Eighteen eyes of control subjects and 15 eyes affected by CSC were tested with a VERIS Sciences 4.0 system. The average response densities and latencies of six annular retinal regions in control subjects were compared with those with CSC.

RESULTS

The N1, P1 average response densities of the first and second annuli were decreased and the N1, P1 latencies of first to third rings were delayed in CSC.

CONCLUSION

The multifocal ERG can be used to evaluate retinal dysfunction in CSC.

Multifocal electroretinogram in patients with central serous chorioretinopathy

PURPOSE

To assess local retinal function of macula in patients with central serous chorioretinopathy (CSC).

METHODS

Multifocal electroretinograms (ERGs) were recorded in 5 patients with unilateral CSC and 20 normal subjects. The waveforms from the central retina within 5 degrees of visual angle were analyzed. The first negative trough was designated as N1, the first positive peak as P1, and the second trough as N2.

RESULTS

The multifocal ERG amplitudes were significantly reduced at the first attack of CSC in all patients compared with the values in the normal controls, for P1-N1 (P <.01) and for P1-N2 (P <.01). Multifocal ERG latencies of the patients significantly increased compared with normal controls, for P1 (P <.01) and N2 (P <.01). After the resolution of retinal detachment, although the multifocal ERG amplitudes increased markedly, they did not improve to the normal level during the follow-up period (4-23 months).

CONCLUSIONS

Persistent functional impairment of the retina was found by multifocal ERGs in patients with CSC after the resolution of subretinal fluid. A topographical analysis of the multifocal ERG is useful in the clinical observation of CSC.

Polypoidal choroidal vasculopathy: natural history

PURPOSE

The present study was performed to clarify the long-term natural history of polypoidal choroidal vasculopathy (PCV).

DESIGN

Prospective, consecutive observational case series.

METHODS

Fourteen eyes of 12 consecutive patients with PCV were prospectively followed in our clinic for at least 2 years without any treatment after a first visit to the clinic between February 1996 and November 1998. All patients underwent complete ophthalmologic examination, color fundus photography, and fluorescein and indocyanine green (ICG) angiography at regular intervals. Inclusion criteria were as follows: eyes had serous and/or hemorrhagic pigment epithelium detachment (PED) and retinal detachment in the posterior pole, and ICG angiography revealed a branching vascular network with polypoidal dilations at the terminals of the network. Exclusion criteria were as follows: other diseases such as exudative age-related macular degeneration, high myopia, angioid streaks, and presumed ocular histoplasmosis syndrome, and patients who previously underwent any ocular surgery.

RESULTS

Patients were followed for mean of 39.9 months (range, 24-54 months). PCV was present in 10 (83%) men and two women and in the elderly (mean age 68.1 years), usually unilateral (83%) with vascular lesions located at the macula (93%). The PCV manifested in two patterns, exudative and hemorrhagic. In the exudative pattern, serous PED and retinal detachment were predominant at the macula. The hemorrhagic pattern was characterized by hemorrhagic PED and subretinal hemorrhage at the macula. ICG angiography revealed polypoidal choroidal neovascularization that was changeable in appearance and repeatedly grew and spontaneously regressed, but the vascular network persisted. In some eyes, a collection of small aneurysmal dilations of vessels resembling a cluster of grapes appeared and all of them had marked bleeding and leakage and worse outcome.

CONCLUSION

Polypoidal choroidal vasculopathy is a long persistent chronic disease and the patients had a variable course. Fifty percent of the patients had a favorable course. In the remaining half of the patients, the disorder persisted for a long time with occasional repeated bleeding and leakage, resulting in macular degeneration and visual loss. Eyes with a cluster of grapes-like polypoidal dilatations of the vessels had a high risk for severe visual loss.