Choroid plexus cysts (CPCs) are the most commom neuroepithelial cysts, occuring in more than 50% of some autopsy series. They are typically small and asymptomatic and are discovered incidentally in older patients, usually in the trigone of the lateral ventricle. Symptomatic CPCs (usually exceptionally large, 2-8 cm) are rare. The authors report a case of large symptomatic choroid plexus cyst, located in the trigone of the right lateral ventricle in a 26-yr-old man who presented with headache and vomiting. The patient underwent endoscopic removal through a burr hole placed 3 cm from the midline and just behind the hair line. The histological examination of the cyst wall was consistent with choroid epithelium. Despite of postoperative intraventricular hemorrhage and catheter infection, he discharged home without neurologic deficits. The endoscopic fenestration rather than excision should be considered as the first surgical procedure because the goal of treatment is shrinkage of the cyst until normal cerebrospinal fluid flow is restored.
Adult ; Brain Diseases/diagnosis/pathology/*surgery ; *Choroid Plexus ; Cysts/diagnosis/pathology/*surgery ; Endoscopy ; Humans ; Male

A very rare case of multiple primary intracranial tumors is reported. A 41-year-old female patient was referred for surgery with a cerebellopontine angle (CPA) tumor. Medical history and MRI study showed typical findings of a right acoustic neuroma with a hydrocephalus. Neurological, dermatological, and ocular examinations revealed no evidence of neurofibromatosis. During surgery, a red-colored cauliflower like mass was found in the right CPA. The roof of the fourth ventricle could be seen through the lateral recess after removal of the tumor. Another mass, a 1.5-cm sized schwannoma protruding through the right internal auditory meatus, was removed by the transmeatal approach. Although the tumor masses were in contact and compressed against each other, there was a clear demarcation between them. Histological examination confirmed that the first mass was a typical choroid plexus papilloma with fibrovascular core, and that the second was a schwannoma. The patient recovered without any new neurological deficit. Result of a Medline search indicated that this rare combination of multiple primary tumors has not been reported previously.
Adult ; Case Report ; Choroid Plexus Neoplasms/*pathology ; Female ; Human ; Magnetic Resonance Imaging ; Neoplasms, Multiple Primary/*pathology ; Neurilemmoma/*pathology ; Papilloma/*pathology ; Vestibulocochlear Nerve Diseases/*pathology

OBJECTIVE: To determine the effect of photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV). METHODS: Eleven patients (11 eyes) with PCV who were diagnosed by fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optic coherence tomography (OCT) were given PDT. The changes of best corrected visual acuity (BCVA), fundus photography, FFA and ICGA before and after the PDT were compared. Follow-up time varied from 6 to 30 months. RESULTS: One month after the PDT, the BCVA was stable in 3 eyes, increased in 1 line in 3 eyes, increased in 2 lines in 2 eyes, and decreased in 2 lines in 3 eyes. FFA and ICGA showed no leakage in 5 eyes, leakage reduced in 3 eyes, and slight leakage in 3 eyes. At the last follow-up, the BCVA was stable in 5 eyes, increased in 1 line in 2 eyes, increased in 2 lines in 2 eyes, and decreased in 2 lines in 2 eyes. FFA and ICGA showed no leakage in 6 eyes, leakage reduced in 3 eyes, and slight leakage in 2 eyes. No severe systemic or local adverse effect was found during or after the PDT, except that 1 eye had vitreous hemorrhage 2 months after the PDT. CONCLUSION PDT may stop or reduce leakage of the lesion, facilitate the absorption of hemorrhage, edema and exudates, and stabilize or increase the patients' visual acuity. It could be a choice for PCV.
Adult ; Aged ; Choroid ; blood supply ; pathology ; Choroid Diseases ; drug therapy ; Choroidal Neovascularization ; drug therapy ; Female ; Humans ; Male ; Middle Aged ; Peripheral Vascular Diseases ; diagnosis ; drug therapy ; Photochemotherapy ; Photosensitizing Agents ; adverse effects ; therapeutic use ; Porphyrins ; therapeutic use ; Verteporfin ; Visual Acuity

We report two cases of choroidal neurofibromatosis, detected with the aid of indocyanine green angiography (ICGA) in patients with neurofibromatosis (NF)-1, otherwise having obscure findings based on ophthalmoscopy and fluoresceine angiography (FA). In case 1, the ophthalmoscopic exam showed diffuse bright or yellowish patched areas with irregular and blunt borders at the posterior pole. The FA showed multiple hyperfluorescent areas at the posterior pole in the early phase, which then showed more hyperfluorescence without leakage or extent in the late phase. The ICGA showed diffuse hypofluorescent areas in both the early and late phases, and the deep choroidal vessels were also visible. In case 2, the fundus showed no abnormal findings, and the FA showed weakly hypofluorescent areas with indefinite borders in both eyes. With the ICGA, these areas were more hypofluorescent and had clear borders. Choroidal involvement in NF-1 seems to occur more than expected. In selected cases, ICGA is a useful tool to be utilized when an ocular examination is conducted in a patient that has no definite findings based on the ophthalmoscope, B-scan, or FA tests.
Child ; Choroid/*pathology ; Choroid Diseases/*diagnosis/etiology ; Coloring Agents/diagnostic use ; Diagnosis, Differential ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Humans ; Indocyanine Green/*diagnostic use ; Male ; Middle Aged ; Neurofibromatosis 1/*complications/diagnosis

PURPOSE: To characterize cross-sectional images of idiopathic polypoidal choroidal vasculopathy (PCV). METHODS: A cross-sectional and retrospective study was performed involving 28 eyes with PCV and 112 eyes with exudative age-related macular degeneration. The frequency and dimensions of the retinal pigment epithelial detachment (RPED) with attenuation of internal reflectivity on optical coherence tomographic (OCT) examination were compared in both diseases. RESULTS: OCT showed the RPED with attenuation of internal reflectivity corresponding to the polypoidal structure in the indocyanine green angiogram in 75% of eyes with PCV, which was significantly more frequent than in eyes with exudative age-related macular degeneration (3.6%). In lesions suspicious of exudative age-related macular degeneration or PCV, the RPED with attenuation of internal reflectivity on OCT images strongly supported PCV diagnosis with a sensitivity of 84% and a specificity of 94%. The base diameter (p=0.010) and base diameter times height (p=0.028) of RPED were smaller in PCV than in exudative age-related macular degeneration. CONCLUSIONS: An RPED with attenuation of internal reflectivity in OCT examination is a highly sensitive and specific finding which characterizes PCV. Recognition of this RPED appearance, as well as the evaluation of its size, aids in the diagnosis of PCV.
*Tomography, Optical Coherence ; Sensitivity and Specificity ; Retrospective Studies ; Middle Aged ; Male ; Macular Degeneration/diagnosis ; Humans ; Fundus Oculi ; Fluorescein Angiography ; Female ; Diagnosis, Differential ; Cross-Sectional Studies ; Choroid Diseases/*pathology ; Choroid/*blood supply ; Aged, 80 and over ; Aged

The whole retina, except for the medullary fiber zone in a rabbit eye, is supplied by choroidal circulation. Therefore, the histopathological changes of the sensory retina due to choroidal circulatory disturbance in rabbits may be comparable to that of the human sensory retina in the case of ophthalmic artery occlusion. This study was carried out to evaluate the histopathological changes of the ischemic retina secondary to the occlusion of choroidal circulation. The experimental occlusion of all posterior ciliary arteries and anterior ciliary arteries in the horizontal rectus muscle of rabbit eyes was performed and the subsequent histopathological changes of the sensory retina were observed by transmission electron microscopy. The morphological changes of the sensory retina following the occlusion of the ciliary arterial system are as follows: severe loss of the inner and outer segments of the photoreceptor, mild to moderate degeneration of the ganglion cells, and excellent preservation of the Muller's cell fibers and the extension of the cytoplasmic villous processes to the cytoplasmic vacuolar spaces of other degenerated cells. These findings indicate that the Muller's fibers in the ischemic condition of retina might contribute to the formation of gliosis or scarring of a damaged retina.
Animals ; Arterial Occlusive Diseases/*complications ; Arteries ; Choroid/*blood supply ; Ciliary Body/*blood supply ; Ischemia/*etiology/pathology ; Rabbits ; Retina/*ultrastructure ; *Retinal Vessels

PURPOSE: To report a case of bilateral bullous exudative retinal detachment in central serous chorioretinopathy (CSC) which was attached by vitrectomy and internal drainage of the subretinal fluid. METHODS: A 47-year-old man affected by bilateral atypical CSC with a bullous retinal detachment with subretinal exudate. A fluorescein angiogram (FAG) showed multiple points of leakage and staining of subretinal fibrosis. A tentative diagnosis of Vogt-Koyanagi-Harada (VKH) syndrome was made and the patient was treated with systemic corticosteroids and immunosuppressive agents. However, the subretinal fluid was not absorbed. He was then treated with vitrectomy and internal drainage of subretinal fluid. RESULTS: The retina was attached successfully in both eyes. Visual acuity improved to 20/50 in his left eye but did not improve in the right eye due to subretinal fibrotic scarring and atropic changes on the macula. CONCLUSIONS: Our case suggests that the surgical management of bullous exudative retinal detachment is safe and necessary.
*Vitrectomy ; Retinal Detachment/etiology/pathology/*surgery ; Middle Aged ; Male ; Humans ; Fundus Oculi ; Follow-Up Studies ; Fluorescein Angiography ; Exudates and Transudates ; Drainage/*methods ; Diagnosis, Differential ; Choroid Diseases/*complications/diagnosis

INTRODUCTIONThis study describes the pathologic changes in the retina of a group of young Asian subjects with myopia worse than -10 diopters spherical equivalent (SE) refraction.

MATERIALS AND METHODSThe study population consists of 20 male subjects undergoing preemployment screening for public service for a 1-year period from 2009 to 2010. A detailed series of visual tests of function, fundus examination and grading, ocular biometry and posterior segment optical coherence tomography were performed for all eyes.

RESULTSA total of 21 eyes with mean SE of -10.88 diopters, [standard deviation (SD) , 1.28 diopters], and mean age of 21.8 years (SD, 1.3 years) were included. Out of 21 eyes, 17 (81.0%) had beta peripapillary atrophy, 10 (47.6%) had clinically detectable optic disc tilt, 1 (4.8%) had positive T-sign and 18 (85.7%) had retinal tessellation, 4 (19.0%) had posterior vitreous detachment and 14 (66.7%) had peripheral retina degeneration. The mean retinal nerve fibre layer (RNFL) thickness was 92.48 mm (SD, 9.99 mm).

CONCLUSIONNone of the 21 highly myopic eyes had features of myopic retinopathy but most of these young males had clinically visible myopia-associated abnormalities of the optic disc, vitreous and peripheral retina. Generally, these eyes had thinner RNFL. Further longitudinal studies are required to investigate if these eyes will eventually develop complications of pathological myopia.

Adolescent ; Adult ; Age of Onset ; Choroid Diseases ; diagnosis ; Fluorescein Angiography ; Humans ; Male ; Myopia ; classification ; pathology ; Nerve Fibers ; pathology ; Ophthalmoscopy ; Optic Atrophy ; diagnosis ; Optic Disk ; pathology ; Optic Nerve Diseases ; diagnosis ; Posterior Eye Segment ; pathology ; Retina ; pathology ; Retinal Degeneration ; diagnosis ; Retinal Diseases ; diagnosis ; Retinal Vessels ; pathology ; Singapore ; Tomography, Optical Coherence ; methods ; Vision Tests ; Visual Acuity ; Vitreous Detachment ; diagnosis ; Young Adult

INTRODUCTIONMushroom-shaped choroidal melanoma is known to be associated with breaks in Bruch's membrane and is more likely to develop when Bruch's membrane is diseased. The study's goal is to determine if diseases causing breaks in Bruch's membrane predispose a choroidal melanoma to develop into a mushroom-shaped melanoma.

MATERIALS AND METHODSA retrospective review of cases of choroidal melanoma seen at our institution was carried out to determine if mushroom-shaped melanomas are more common than dome-shaped tumours in patients with macular abnormalities involving a loss of Bruch's membrane integrity. Forty-nine eyes of 48 patients were included in this retrospective study. A dome-shaped or mushroom-shaped configuration was assigned to each tumour. Macular degeneration, macular drusen, retinal pigment epithelial (RPE) stippling, macular oedema, choroidal neovascularisation (CNV), angioid streaks, disciform scars, lacquer cracks, and myopia greater than -3.00 D, were considered to constitute evidence of potential Bruch's membrane breaks and were determined in both eyes. A chi-square evaluation was used to compare the proportion of eyes with macular abnormalities in the 2 tumour configuration groups.

RESULTSThe tumour was dome-shaped in 40 eyes (82%) and mushroom-shaped in 9 eyes (18%). Macular abnormalities, indicative of loss of Bruch's membrane integrity, were seen in 21 (53%) of 40 eyes with dome-shaped melanomas and 5 (56%) of 9 eyes with mushroom-shaped melanomas. The proportion of eyes with macular abnormalities was not statistically different between the dome-shaped and mushroom-shaped tumours, as assessed by chi-square analysis (P = 0.87).

CONCLUSIONSBruch's membrane disease does not influence the differentiation of choroidal melanoma into mushroom-shaped or dome-shaped tumour growth patterns.

Adult ; Aged ; Aged, 80 and over ; Bruch Membrane ; abnormalities ; Chi-Square Distribution ; Choroid Neoplasms ; epidemiology ; pathology ; Comorbidity ; Female ; Humans ; Male ; Melanoma ; epidemiology ; pathology ; Middle Aged ; Retinal Diseases ; epidemiology ; Retrospective Studies ; Visual Acuity

PURPOSE: To compare the effectiveness of intravitreal injections of bevacizumab and ranibizumab in patients with treatment-naive polypoidal choroidal vasculopathy (PCV). METHODS: Records from 106 consecutive patients who received intraviteral bevacizumab (n = 58, 1.25 mg) or ranibizumab (n = 52, 0.5 mg) for treatment of PCV were retrospectively reviewed. After three initial monthly loading injections, injection was performed as needed. The main outcome measures included best-corrected visual acuity (BCVA), foveal central thickness (FCT) as assessed by spectral domain optical coherence tomography, and the changes in polypoidal lesions based on an indocyanine green angiography. RESULTS: The average number of injections was 3.31 +/- 1.25 in the bevacizumab group and 3.44 +/- 0.92 in the ranibizumab group. Mean logarithm of the minimum angle of resolution of BCVA from baseline to 6 months after injection improved by 0.17 in the bevacizumab group (p = 0.03) and by 0.19 in the ranibizumab group (p = 0.01). Average FCT decreased from 322 +/- 62.48 microm to 274 +/- 40.77 microm in the bevacizumab group (p = 0.02) and from 338 +/- 50.79 microm to 286 +/- 36.93 microm in the ranibizumab group (p = 0.02). Polyp regression rate was 20.7% (12 of 58 eyes) in the bevacizumab group and 21.2% (11 of 52 eyes) in the ranibizumab group. There was no statistically significant difference between groups in BCVA improvement achieved, FCT improvement achieved, and polyp regression rate between groups. CONCLUSIONS: Intravitreal injections of bevacizumab and ranibizumab have similar effects in stabilizing of visual acuity, macular edema, and regression of polypoidal complex in PCV eyes over the short term.
Angiogenesis Inhibitors/administration & dosage ; Antibodies, Monoclonal, Humanized/*administration & dosage ; Choroid/*blood supply ; Choroid Diseases/diagnosis/*drug therapy/physiopathology ; Dose-Response Relationship, Drug ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fovea Centralis/pathology ; Fundus Oculi ; Humans ; Intravitreal Injections ; Male ; Middle Aged ; Peripheral Vascular Diseases/diagnosis/*drug therapy/physiopathology ; Retrospective Studies ; Time Factors ; Tomography, Optical Coherence ; Treatment Outcome ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity