Focal inner retinal hemorrhages in patients with drusen - An early sign of occult choroidal neovascularization and chorioretinal anastomosis

被引:129
作者
Gass, JDM
Agarwal, A
Lavina, AM
Tawansy, KA
机构
[1] Vanderbilt Univ, Sch Med, Vanderbilt Eye Ctr, Dept Ophthalmol, Nashville, TN 37232 USA
[2] Univ British Columbia, Dept Ophthalmol, Vancouver, BC V5Z 1M9, Canada
[3] Childrens Hosp, Dept Ophthalmol, Los Angeles, CA 90027 USA
来源
RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES | 2003年 / 23卷 / 06期
关键词
age-related macular degeneration; occult chorioretinal vascular anastomosis; occult choroidal neovascularization; retinal pigment epithelium detachment; drusen; laser photocoagulation; superficial retinal hemorrhage; type 1 subretinal pigment epithelial; choroidal neovascularization; type 2 subsensory retinal choroidal neovascularization;
D O I
10.1097/00006982-200312000-00001
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
Purpose: To present evidence that superficial retinal hemorrhage in the macula of patients with age-related macular degeneration (ARMD) may be an early sign of occult chorioretinal anastomosis (OCRA) and type 1 occult choroidal neovascularization (OCNV). Methods: Retrospective follow-up study of 16 patients presenting with a small focal area of superficial retinal hemorrhages and drusen in the juxtafoveolar area in 24 eyes. Results: OCRA and OCNV occurred in an older subset of patients with ARMD (mean age, 75 years). Of 22 eyes with the early stages of chorioretinal anastomosis (CRA), 18 had evidence of a piggyback neovascular complex, with the smaller subsensory retinal type 2 complex lying anterior to the larger subretinal pigment epithelial type 1 complex. At initial presentation, three patients had OCRA and OCNV bilaterally, and three patients had large disciform cicatricial lesions with overt CRA in the fellow eye. Nine patients had one or more laser photocoagulation treatments for early stages of CRA. Only one patient maintained visual acuity of better than 20/200 for >1 year. At the last follow-up, 24 of 26 eyes with CRA had visual acuity of 20/200 or less. Conclusion: Superficial retinal hemorrhage in the paracentral area of patients with drusen is the earliest sign of OCRA and OCNV. Fluorescein angiography and indocyanine green angiography are important in detecting the dual nature of the subretinal neovascular network. Photocoagulation and photodynamic treatment is usually unsuccessful in preserving central vision.
引用
收藏
页码:741 / 751
页数:11
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