INTRODUCTIONThe purpose of this review is to combine the results of existing literature on the natural history of occult choroidal neovascularisation (CNV) associated with age-related macular degeneration (AMD).

MATERIALS AND METHODSPublished reports evaluating eyes with occult CNV in AMD patients were selected for meta-analysis based on a computerised MEDLINE search. Pooled estimates of the proportions of eyes with a vision loss greater than 2 to 3 (moderate vision loss) or 6 lines (severe vision loss) at 1 year and 2 to 3 years, respectively, or developing a classic component on fluorescein angiography at 1 year were measured.

RESULTSThere is no significant heterogeneity among published rates of visual loss and development of classic CNV. The overall pooled estimates (95% confidence limits) of the proportions of eyes with at least moderate or severe vision loss, respectively, were 59% (53% to 64.5%) and 34% (25% to 43%) at 1 year and 70% (64% to 76%) and 47% (40% to 54%) at 2 to 3 years; the overall pooled estimate of the percentage of eyes developing classic CNV at 1 year was 46% (39% to 54%).

CONCLUSIONA substantial number of patients with occult CNV from AMD will develop at least moderate visual loss at 1 year and severe visual loss within 3 years. However, visual acuity may remain stable in up to 30% of patients. These results may help us to understand the exact role of new therapies and in planning future trials.

Choroidal Neovascularization ; complications ; physiopathology ; Humans ; Macular Degeneration ; complications ; physiopathology ; Vision, Low ; etiology

We analysed a retrospective study of 22 aphakic bullous keratopathy patients (22 eyes) with penetrating keratoplasty for 5 years from January 1987 to December 1991 in the Department of Ophthalmology at St. Mary's Hospital, Catholic University Medical College. The results were as follows; 1. Of the 22 eyes with aphakic bullous keratopathy 16 eyes (72.7%) had previously undergone intracapsular cataract extraction, 6 eyes (27.3%) had extracapsular cataract extraction. 2. The mean time from cataract extraction to aphakic bullous keratopathy to penetrating keratoplasty was 13.8 months. 3. After keratoplasty, the visual acuity of 20 among the 22 transplants (90.9%) were significantly improved compared to the preoperative levels, however that of 2 among the 22 transplants were worse than the preoperative levels. The factors limiting postoperative visual acuity were senile macular degeneration and graft failure. 4. Postoperative complications were glaucoma (2 eyes, 9.1%), cystoid macular edema (1 eye, 4.6%) and graft failure (1 eye, 4.6%).
Cataract Extraction ; Corneal Transplantation ; Glaucoma ; Humans ; Keratoplasty, Penetrating* ; Macular Degeneration ; Macular Edema ; Ophthalmology ; Postoperative Complications ; Retrospective Studies ; Transplants ; Visual Acuity

We analysed a retrospective study of 22 aphakic bullous keratopathy patients (22 eyes) with penetrating keratoplasty for 5 years from January 1987 to December 1991 in the Department of Ophthalmology at St. Mary's Hospital, Catholic University Medical College. The results were as follows; 1. Of the 22 eyes with aphakic bullous keratopathy 16 eyes (72.7%) had previously undergone intracapsular cataract extraction, 6 eyes (27.3%) had extracapsular cataract extraction. 2. The mean time from cataract extraction to aphakic bullous keratopathy to penetrating keratoplasty was 13.8 months. 3. After keratoplasty, the visual acuity of 20 among the 22 transplants (90.9%) were significantly improved compared to the preoperative levels, however that of 2 among the 22 transplants were worse than the preoperative levels. The factors limiting postoperative visual acuity were senile macular degeneration and graft failure. 4. Postoperative complications were glaucoma (2 eyes, 9.1%), cystoid macular edema (1 eye, 4.6%) and graft failure (1 eye, 4.6%).
Cataract Extraction ; Corneal Transplantation ; Glaucoma ; Humans ; Keratoplasty, Penetrating* ; Macular Degeneration ; Macular Edema ; Ophthalmology ; Postoperative Complications ; Retrospective Studies ; Transplants ; Visual Acuity

Total vitrectomy and removal of the posterior hyaloid membrane were done in 7 patients who were diagnosed as macular hole with specific causative factors. The causative factor of 2 patients is high myopia and of remainers is trauma. Of the 7 patients treated by removal of the posterior hyaloid membrane during total vitrectomy, 3 patients showed anatomical and functional success, 2 patients only the anatomical success, and 2 patients failure. The postoperative complications included phthisis bulbi, proliferative vitreoreinopathy, optic atrophy, and macular degeneration, and iatrogenic rhegmatogenous retinal detachment. Two patients of the 3 success cases complained of mild diplopia after operation.
Diplopia ; Humans ; Macular Degeneration ; Membranes* ; Myopia ; Optic Atrophy ; Postoperative Complications ; Retinal Detachment ; Retinal Perforations* ; Vitrectomy*

Humans ; Macular Degeneration ; complications ; drug therapy ; prevention & control ; Risk Factors ; Singapore

INTRODUCTIONUsing artificial means to treat extreme vision impairment has come closer to reality during the past few decades. The goal of this research has been to create an implantable medical device that provides useful vision for those patients who are left with no alternatives. Analogous to the cochlear implants for some forms of hearing loss, these devices could restore useful vision by converting visual information into patterns of electrical stimulation that excite the remaining viable inner retinal neurons in patients with retinitis pigmentosa or age-related macular degeneration.

METHODSData for this review were selected through a comprehensive literature search.

RESULTSAdvances in microtechnology have facilitated the development of a variety of prostheses that can be implanted in the visual cortex, around the optic nerve, or in the eye. Some of these approaches have shown the promise of providing useful visual input to patients with visual impairments.

CONCLUSIONWhile the development of various retinal prostheses have shown promise in limited clinical trials, there are distinct advantages and disadvantages for each type of prosthesis. This review will focus primarily on the Epiretinal Intraocular Retinal Prosthesis, studied by our group, but will also briefly review other modalities: the subretinal prosthesis, cortical prosthesis, and optic nerve prosthesis.

Electric Stimulation Therapy ; Electrodes, Implanted ; Humans ; Macular Degeneration ; complications ; Prosthesis Implantation ; Retinitis Pigmentosa ; complications ; Vision Disorders ; etiology ; rehabilitation

A retrospective study was performed in 180 eyes (173 patients) with rhegmatogenous retinal detachment which underwent primary scleral buckling operations. One hundred and sixteen patients (67.1 %) were men. The most common age group was the seventh decade (34 patients, 19.6%). Moderate- to high- degree myopia were the most numerous (65 eyes, 38.0%) as the associated ocular findings and the peripheral retinal degenerations were next (44 eyes. 257%). One hundred and fifty eyes had retinal breaks preoperatively, 129 eyes (76.8%) had breaks distributed in the superior and/or inferior temporal quadrants, 84 eyes (56.0%) had breaks located in the equator and 82 eyes (54.7%) had atrophic holes. Among 180 eyes studied, 141 eyes (78.3%) achieved retinal reattachment by primary scleral buckling operations. Preoperative and/or postoperative proliferative vitreoretinopathy as causes of failure were presented in 18 eyes. Ten eyes had intraocular hemorrhage as intraoperative complications and the other 10 eyes developed cataract as postoperative ones. Fourty-seven eyes (33.3%) had corrected visual acuity below 0.1 in spite of successful retinal reattachment and 23 eyes had macular degenerations as the most common causes of poor vision.
Cataract ; Hemorrhage ; Humans ; Intraoperative Complications ; Macular Degeneration ; Male ; Myopia ; Retinal Degeneration ; Retinal Detachment* ; Retinal Perforations ; Retinaldehyde* ; Retrospective Studies ; Scleral Buckling ; Visual Acuity ; Vitreoretinopathy, Proliferative

We studied the ultrastructural features of four consecutive subfoveal neovascularmembranes (SFNM) associated with age-related macular degeneration. Cellular components of the membranes included retinal pigment epithelial (RPE) cells, endothelium-lined vascular channels, macrophages, myofibroblasts, fibrocytes, glial cells, erythrocytes, and lymphocytes. Extracellular interstitial constituents included collagen fibrils, basal laminar deposits, fibrin and young elastic fibrils. These findings show that SFNMs consist of various cells originating from surrounding tissues and vessels. Among these RPE cells and macrophages are the main cellular components and in conjunction with various extracellular matrix, especially collagen, may play an important role in the formation and maintenance of the membranes.
Basement Membrane/surgery/ultrastructure ; Humans ; Macular Degeneration/complications ; Microscopy, Electron ; Retina/*ultrastructure ; Retinal Neovascularization/etiology/*pathology/surgery

Submacular hemorrhage from various causes induces the irreversible damage to the retina, leading to poor visual outcome. Surgery for removal of submacular hemorrhage was performed but the general results were not satisfactory in spite of better surgical technique. We took this study to identify the effectiveness and safety of intravitreal injection of tissue plasminogen activator(tPA) and SF6 for displacement of submacular hemorrahge. Thirteen patients who have submacular hemorrhage had undergone intravitreal injection of tPA and SF6 and positioned face down for about 1 week. Postoperative complication, best corrected visual acuity, final visual acuity, amount of displacement related to the duration of submacular hemorrhage and causal diseases were checked retrospectively. The average age of the patients was 64. Six eyes(46.2%) improved visual acuity by 2 lines or more, and 2 eyes(15.4%) lost visual acuity 2 lines or more. Complications included vitreous hemorrhage in 2 eyes, increased intraocular pressure in 2 eyes. Causes were trauma in 3 eyes and age-related macular degeneration in 10 eyes. The final visual results after 5 months or longer were related with macular lesion. Complete displacement was achieved in 10 eyes, partial displacement in 4 eyes at 1 month. The authors concluded that brief prone position after intravitreal injection of tPA and SF6 is rapid and effective method for displacement of submacular hemorrhage.
Hemorrhage* ; Humans ; Intraocular Pressure ; Intravitreal Injections* ; Macular Degeneration ; Plasminogen ; Postoperative Complications ; Prone Position ; Retina ; Retrospective Studies ; Visual Acuity ; Vitreous Hemorrhage

PURPOSE: This study was undertaken to evaluate the clinical results of pars plana vitrectomy on posterior segment complications in posterior uveitis. METHODS: We reviewed the records of 20 eyes of 19 uveitis patients who were followed up for 6 months or more after vitrectomy. RESULTS: The mean follow-up period was 20 months. Final visual acuity improved in 10 eyes (50%), was maintained in 6 (30%), and decreased in 4 (20%). The mean improvement of vision was 1.6 lines (p=0.019). Detached retina was reattached in 8 (80%) among the 10 eyes with primary surgery. Postoperative complications were cataract (7 eyes), macular degeneration (2 eyes), retinal detachment (2 eyes), and recurrence (1 eye). CONCLUSIONS: These results suggest that pars plana vitrectomy may be a safe and effective treatment for posterior segment complications in posterior uveitis, but that early and complete vitrectomy should be considered for a better visual prognosis.
Cataract ; Follow-Up Studies ; Humans ; Macular Degeneration ; Postoperative Complications ; Prognosis ; Recurrence ; Retina ; Retinal Detachment ; Uveitis ; Uveitis, Posterior* ; Visual Acuity ; Vitrectomy*