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Laser prophylaxis for age-related macular degeneration
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Enrique Peralta, R Joseph O.l.k, Levent Akduman
Choroidal neovascularization formation was similar in treated and observation eyes through 60 months. Visible laser burns had a higher rate of CNV in both treated groups during the first 3 months. Subthreshold lesions took longer to reduce drusen levels and had a higher rate of CNV in unilateral eyes. This increased progression to CNV was significantly higher in treated unilateral eyes that did not respond with reduced drusen levels. We hypothesized that nonresponders may have less healthy RPE and an increased risk for the development of CNV. It is possible that retreatments may help to increase the numbers of eyes responding to laser, but nevertheless these eyes would require further follow-up.
Dermatological emergencies in pregnancy
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Riti Bhatia, Neirita Hazarika, Ruby Bhatia
Nevertheless, it is essential for the treating physician to be aware of potential complications. A multidisciplinary approach should be taken, with regular monitoring of cardiac and renal function, blood pressure, changes in the retina, and any evidence of signs or symptoms that could be the consequence of gastrointestinal bleeding. PXE is not an absolute indication for elective cesarean section. This should be restricted to patients with visual deficits proven by a choroidal neovascularization examination of the eye [37].
How to master MCQs
Published in Chung Nen Chua, Li Wern Voon, Siddhartha Goel, Ophthalmology Fact Fixer, 2017
In photodynamic therapy, a photosensitive dye such as verteporfin is injected which is then taken up by the endothelium of the choroidal neovascularisation. Infra-red laser is used to irradiate these vessels causing damage to the endothelium but sparing the retinal pigment epithelium and the photoreceptors. Only classic choroidal neovascularisation is suitable for treatment; patients with haemorrhage and retinal pigment epithelial detachment are not suitable for treatment.
A clinical perspective on the expanding role of artificial intelligence in age-related macular degeneration
Published in Clinical and Experimental Optometry, 2022
Himeesh Kumar, Kai Lyn Goh, Robyn H Guymer, Zhichao Wu
A recent case vignette study including 81 optometrists in Australia showed that when presented with a case of neovascular AMD, approximately one in six practitioners would have missed the presence of choroidal neovascularisation on multimodal imaging (including colour fundus photographs and optical coherence tomography scans), and approximately one in four of the practitioners would not have referred this case.53 To avoid missing choroidal neovascularisation, Keel et al.54 developed a deep learning algorithm to detect its presence on colour fundus photographs. This system detected 100% of eyes with choroidal neovascularisation and only falsely flagged 7% of colour fundus photographs, when tested on an external cohort. This AI model could thus assist community eye health practitioners in minimising the risk of missing choroidal neovascularisation. Indeed, an AI-based software, used to detect possible neovascular AMD on colour fundus photography (Eyetelligence Assure; Eyetelligence Pty Ltd 2021, Australia) has been recently approved for clinical use in Europe, Australia, and New Zealand to assist clinical decision-making.
Long-term progression of myopic maculopathy in degenerative myopia as imaged by SD-OCT and IR imaging
Published in Clinical and Experimental Optometry, 2022
Georgios Bontzos, Tina Xirou, Anastasia Gkiala, Georgios Smoustopoulos, Ilias Gkizis, Evgenia Kontou, Stamatina A. Kabanarou, Miltiadis Tsilimbaris
The natural history of pathologic myopia has been studied before, mostly using fundus photographs.6,20–26 Progression over a 5 year period is observed in 15.2 − 35% of the population.6,22 Progression typically follows a specific pattern with tessellated fundus leading to diffuse and then patchy atrophy.21 It has been shown that advanced maculopathy tends to progress even faster than preliminary stages.21 Most importantly, choroidal neovascularisation tends to originate from lacquer cracks or adjacent atrophic areas.27,28 Patients with suspicious lesions should be monitored closely to identify early choroidal neovascularisation requiring treatment. SD-OCT combined with (infrared) IR imaging, which is also an excellent method to detect lacquer cracks in vivo,29 can facilitate a regular follow-up of patients, allowing recognition of subtle pathological changes associated with natural progression of degenerative myopia.
Management of inflammatory choroidal neovascular membranes
Published in Expert Review of Ophthalmology, 2021
Rachael Niederer, Asaf Bar, Haya Al-Ani, Lazha Sharief, Shaul Sar, Adi Segal, Sue Lightman, Oren Tomkins-Netzer
Choroidal neovascularization is a significant vision-threatening complication of pathologies that affect the retina and choroid. It is most commonly associated with elderly patients with age-related macular degeneration, though it can also appear in younger patients in relation to high myopia, angioid streaks, or conditions that result in retinal atrophy or scarring [3]. Among patients with uveitis, it can occur either as an early or late complication, mainly of posterior or panuveitis, with a prevalence ranging between 0.11 and 2% [4]. Due to the propensity of CNV to appear in the macular region, it may have a profound and lasting effect on patients’ lives for many years, particularly in bilateral cases [5]. Inflammatory CNV (iCNV) accounts for up to 6% of patients developing moderate or severe vision loss [6].