The hallmark lesions of age-related macular degeneration (AMD) are drusen and basal linear deposit which are lipid substances deposited in Bruch membrane or the compartment on the Bruch membrane. There is a prevailing hypothesis that lipid and its oxidized derivant deposited in retina may have important roles in the pathogenesis of AMD. Lipid oxidation products are toxic, may affect the adjacent cells, induce inflammation, and trigger neovascularization.7-ketocholestoral (7KCh), a naturally occurring oxidized form of cholesterol, had been found to be toxic to retinal cells and able to induce chronic inflammation, which may play a critical role in the development of AMD. However the precise mechanism remains to be elucidated. Thus we will make a brief review of 7KCh and its association with AMD.
Objective To investigate the clinical characte ristic of vernier acuity in age-related macular degeneration (AMD) patients. Methods The vernier acuity test soft wear system was developed to detect the 23 cases (39 eyes) of AMD patients. Tweenty-one eyes were atrophic type and 17 eyes were exudative type. Two fixed targets and a movable target are shown on the computer screen. The examinee was asked to adjust the position of the central target and the relationship between it and align them by using a track ball. The computer automatically recorded the deviations of distances between the movable target and the specific one, and then computed and analysed the results of average threshold and variance.Results Both the atrophic and exudative AMD had higher vernier acuity threshold and its variance than normal subjects, and the differences were significant (P＜0.01). The correlation coefficient between visual acuity and vernier acuity threshold was -0.78, and that between visual acuity and threshold variance was -0.80. The results suggest that vernier acuity thre shold and its variance were reliable parameters that reflect the visual acuity in AMD patients.Conclusions The results suggest that vernier acuity threshold and its variance were reliable parameters that reflect the visual acuity in AMD patients.(Chin J Ocul Fundus Dis，2003，19：201-268)
Microparticles are small vesicles that are released by budding of the plasma membrane during cellular activation and apoptotic cell breakdown. A spectrum of cell types can release microparticles including endothelial cells, platelets, macrophages, lymphocytes and tumor cells. Biological effects of microparticles mainly include procoagulant activity, inhibition of inflammation and cancer progression. The present study shows that vitreous microparticles isolated from proliferative diabetic retinopathy (PDR) stimulated endothelial cell proliferation and increased new vessel formation, promoting the pathological neovascularization in PDR patients. Oxidative stress induces the formation of retina pigment epithelium-derived microparticles carrying membrane complement regulatory proteins, which is associated with drusen formation and age related macular degeneration. Microparticles from lymphocyte (LMP) play an important role in anti-angiogenesis by altering the gene expression pattern of angiogenesis-related factors in macrophages. Besides, LMP are important proapoptotic regulators for retinoblastoma cells through reduction of spleen tyrosine kinase expression and upregulation of the p53-p21 pathway which ultimately activates caspase-3. However, how to apply the microparticles in the prevention and treatment of retinal diseases is a major challenge, because the study of the microparticles in the fundus diseases is still limited. Further studies conducted would certainly enhance the application of microparticles in the fundus diseases.
Objective To study the significance of detection the short-term fluctuation (SF) of macular light threshold detected by Octopus-123 automatic perimeter in suspected early age-related macular dege-neration (AMD). Methods SF of macular light sensitivity, Amsler chart and central visual acuity were examined in 51 patients(66 eyes) with suspected early AMD group and in 32 patients (40 eyes) in the control group. Results SF were significantly different in suspected early AMD group and control group. SF was more sensitive than the examination of central visual acuity and Amsler chart. SF was related to the quantity, location and quality of drusen. Conclusion Visual function of some suspected early AMD patients with drusen may be damaged, though the central visual acuity appears normal. (Chin J Ocul Fundus Dis, 2002, 18: 119-120)
Purpose To measure and compare the difference of multifocal electroretinogram in normal subjects and patients with age-related macular degeneration. Methods Seventeen cases(20 eyes)of normal subjects,7 cases(10 eyes)of dry form AMD(age-related macular degeneration),8 cases(8 eyes)of wet-form AMD and 11 cases(11 eyes)of idiopathic macular hole(IMH)were tested with VERIS SciencesTM 4.0 made by EDI company of America.The latencies and average response densities of 6 ring retinal regions in normal subjects were compared with those in various types of age-related maculopathies. Results The N1 and P1 wave latencies of all 6 rings in wet-form AMD and the N1 wave latencies of 3～6 rings in dry-form AMD were delayed statistically.The N1 and P1 wave average response densities of 1～4 rings in and the P1 wave average response densities of 1-6 rings wet-form AMD and the N 1 wave average response densities of 1～5 and the P1 wave average response densties of 1-6 rings in dry-form AMD were decreased statistically.The N1 and P1 wave average response densities of 1～2 and the P1 wave average esponse densities of 1～3 rings were decrease statistically in IMH. Conclusion Multifocal electroretinogram can be used to quantitate the visual function of the affected location in age-related macular degeneration. (Chin J Ocul Fundus Dis,2000,16:224-226)
Objective To analyse the indocyanine green angiographic findings in contralateral eyes of patients with unilateral exudative age-related macular degeneration(AMD). Methods Fundus photograph,fundus fluorescein angiography(FFA) and indocyanine green angiography(ICGA) were performed in a series of 70 patients with unilateral AMD and drusens and pigmentary changes in the macular region in contralateral eyes.The findings of fluoroangiograms were observed and analysed. Results ICGA revealed the characteristics of the contralateral eyes as follows:(1)Drusen could be hypofluorescent,hyperfluorescent or normal fluorescent;(2)14 eyes revealed plaque-like late hyperfluorescent;(3)13 eyes revealed choroidal filling defect;(4)18 eyes revealed pindot-like clusters of late hyperfluorescence. Conclusion ICGA is useful in evaluating the lesions and circulation disturbance of the contralateral eye,and may help to find the risk factors of developing future exudative changes. (Chin J Ocul Fundus Dis, 1999, 15: 216-218)
ObjectiveTo summarize the clinical results and safety of photodynamic therapy (PDT) through 4 years after single and multi-treatments of patients with subfoveal choroidal neovascularization (CNV) caused by age-related macular degeneration(AMD). MethodsClinical data of 73 AMD cases (95 eyes) diagnosed through fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optic coherence tomography (OCT), treated with PDT were reviewed and analyzed in this hospital from June 2000 to June 2004. The changes of best corrected visual acuity (BCVA), fundus pictures, FFA, ICGA and OCT were compared before and after PDT. Follow-up time varied from 3 months to 4 years (mean, 2 years). ResultsThe mean age of 73 patients was 67.8 years old. The BCVA was from CF/10 cm to 1.0. At the final follow up, the BCVA was improved (increase≥2 lines) in 39 eyes (41.1%), stabilized (±1 line) in 51 eyes (53.7 %) and decreased 2 lines in 5 eyes (5.3%). Fundus hemorrhage and exudation reduced after PDT. FFA and ICGA showed CNV complete closure in 58 eyes (61.05%), partial closure in 6 eyes (6.32%), CNV incomplete closure in 22 eyes (23.16% ) and recurrence in 9 eyes (9.47%). After once PDT of 12 eyes with early-stage AMD, the BCVA improved (from 0.6 to 1.5), CNV completely closed, and the OCT showed disappearance of macular edema and neursensory retinal deta chment. No CN V recurred in our four years follow-up observation and the BCVA of the patients remained stable. The mean number of PDT treatment was 1.8 per eye in 95 cases. No serious local or systemic complications were encountered. ConclusionsSingle or multiple sessions of PDT can acheive long-term safety and efficacy. For early-stage AMD patients with minimally classic CNV, PDT can completely make CNV closed and reduce the risk of visual loss.(Chin J Ocul Fundus Dis，2004，20：275-279)
Objective To compare the characteristics of fundus angiograms of central serous chorioretinopathy (CSC) with exudative agerelated macular degeneration (AMD) in patients more than 45. Methods The colorized photographs of ocular fundus, and results of fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) of 32 patients (39 eyes) with CSC and 20 patients (22 eyes) with exudative AMD more than 45 were collected and analyzed retrospectively. Results In 39 eyes with CSC, the results of FFA revealed classic CSC in 11 (28.2％) and diffuse retinal pigment epitheliopathy (DRPE) in 28 (71.8％); the results of ICGA showed localized choroidal delayed filling associated with dilated vessels in 39 (100％) in the early phase, choroidal hyperpermeability in 39 (100％), identifiable hyperfluorescence of leakage from RPE in 16 (41.0％) was observed in the middle phase, and a distinctive silhouetting of the larger choroidal vessels in 5 (12.8％) was detected in the late phase. In 22 eyes with exudative AMD without evident hemorrage, the results of ICGA exhibited focal CNV in 13 (59.1％), plaque CNV in 8 (36.4%), and combination CNV in 1 (4.5%)；choroidal delayed filling around macular region vicariously was found in 5 (22.7％) in the early phase, choroidal hyperpermeability was not observed in the middle phase and silhouetting of the larger choroidal vessels was not showed in the late phase. Conclusions The differences of the ICGA features between CSC and exudative AMD in patients more than 45 include focal or multifocal hyperfluorescence of leakage from RPE, multifocal choroidal hyperpermeability in the middle phase, silhouetting of the larger choroidal vessels in the late phase, and no focal or plaque CNV.
Objective To compare the characteristics of the ocular fundus of exudative age-related macular degeneration (AMD) with polypoidal choroidal vasculopathy (PCV). Methods The photographs of ocular fundus of 123 patients (137 eyes) with exudative AMD and 42 patients (48 eyes) with PCV diagnosed by fundus photography, fundus fluorescein angiography (FFA), and indocyanine green angiography (ICGA) were retrospectively analyzed. Results In 137 eyes with exudative AMD, 16 eyes (11.7%) had classic neovascularization (CNV), 121 (88.3%) had occult CNV. In the eyes with occult CNV, 42 eyes (34.7%) had hot spots, 74 eyes (61.2%) showed plaque hyperfluorescences and 2 eyes (1.7%) had hot spots with PCV in ICGA. In 48 eyes with PCV, 7 eyes (14.6%) had subretinal reddish-orange lesions, 2 eyes (4.2%) of the polypoidal dilations with branching vascular network were detected with FFA, 36 eyes (75.0%) demonstrated polypoidal dilations with branching vascular network, and 12 eyes (25.0%) showed scattered polypoidal dilations without identifiable continuous branching vascular network, 16 eyes (33.3%) had the polypoidal dilations resembling a cluster of grapes, and 32 eyes (66.3%) showed the polypoidal dilations as several solitary round aneurismal dilations. The polypoidal dilations showed either a washout of the dye from the polyp with staining of its walls or staining of the dye in the late phase of ICGA. Conclusions The different features of exudative AMD and PCV in the ICGA, and the PCV with subretinal reddish-orange lesions are useful in the differentiate diagnosis of the both diseases. (Chin J Ocul Fundus Dis，2004，20：307-309)
ObjectiveTo observe and classify the characteristics of optical coherence tomography (OCT) for several common diseases which could lead to submacular choroidal neovascularization (CNV), and to provide the warrant to make the differential diagnosis and treatment of CNV.MethodsThe data of OCT of 165 patients (187 eyes) with CNV due to AMD, CEC, high myopia and ICNV diagnosed by fundus photography and fundus fluorescein angiography (FFA) were retrospectively analyzed, and the images of OCT were classified considering the results of FFA, and the characteristics of different types of the images were sumerized.ResultsWell-defined fusiform thickening of retinal pigment epithelial (RPE) and choriocapillary layer in CNV with well-defined border (60 eyes), dispersed backscattering increase in poorly-defined CNV (101 eyes), optic darkspace beneath RPE layer in serous detachment of RPE layer (19 eyes), quickly decreased high backscattering region under RPE layer in hemorrhagic detachment of RPE layer (11 eyes), slight to moderate backscattering region between RPE layer in fibrovascular detachment of RPE layer (10 eyes), and detachment of neurepithelial layer from RPE layer with the optic darkspace between the layers in detachment of neurepithelial layer (45 eyes) were observed.ConclusionsThe images of OCT for the common diseases which could lead to submacular choroidal neovascularization may be divided into 6 types. Analyzing the characteristics of images of OCT is helpful in differential diagnosis and treatment of CNV. (Chin J Ocul Fundus Dis, 2005,21:69-73)