Aims-To determine the prevalence of polypoidal choroidopathy in consecutive patients presenting with large haemorrhagic and exudative neurosensory retinal and retinal pigment epithelial detachments (PEDs) of over 2 mm in diameter in the absence of drusen. Methods-40 patients were identified over a 5 month period of which 29 had haemorrhagic detachments, and 11 had purely exudative detachments. All had indocyanine green (ICG) angiography, and the presence was sought of large blood vessels in the choroid associated with localised dilated terminals that filled slowly and leaked ICG. Results-In 34 cases (85%) there was an appearance consistent with previous descriptions of idiopathic polypoidal choroidal vasculopathy. Of the six without polypoidal lesions the disorder was attributed to choroidal neovascularisation in four, chorioretinitis in one, and a fibrovascular PED in one. Of those with polypoidal lesions 20 (65%) were female, the mean age was 65.4 years (range 44-88), and 25 (74%) were white, seven (20%) black, and two (6%) east Asian. Eight had a history of hypertension. Visual acuity varied from 6/6 to counting fingers in the involved eye (mean 6/24). Bilateral polypoidal choroidal lesions were demonstrated in 16 patients (47%). The predominant location for these lesions was the macular region in 23 patients (68%). Polypoidal vasculopathy was found in 16 patients (47%) who had a previous diagnosis of age related macular disease (AMD). No patients had evidence of intraocular inflammation. Conclusions-In a largely white patient population a high proportion of patients with haemorrhagic and exudative PEDs has evidence of polypoidal lesions on ICG angiography. (Br J Ophthalmol 2000;84:479-484) In the past, haemorrhagic detachment of the retinal pigment epithelium (PED) has been considered a part of the spectrum of age related macular disease (AMD), occurring as a consequence of age changes at the level of Bruch's membrane. Several mechanisms have been invoked to explain the pathogenesis of a PED, including decreased hydraulic conductivity of Bruch's membrane, choroidal neovascularisation, and excessive exudation from the choroidal blood vessels. 1-3Polypoidal choroidal vasculopathy (PCV) as a cause of recurrent haemorrhagic and exudative PEDs and neurosensory retinal detachments was first described in 1982. 4 In the past, a variety of terms such as "posterior uveal bleeding syndrome" and "multiple recurrent retinal pigment epithelial detachments in black women" have been used to designate this disorder.5 6 It has characteristic morphological features that distinguish it from other exudative maculopathies, which include aneurysmal structures at the termination of a network of dilated choroidal veins associated with recurrent haemorrhage and leakage (Fig 1).The diagnosis of PCV is best made using indocyanine green (ICG) angiography because it permits visualisation of the choroidal vasculature following the initial transit of dye.7 The increasing availability of ICG angiography has permitted a better app...

Background and Purpose-The aim of our study was to evaluate the causes of retinal arterial occlusive disease in African American patients and to compare these etiologies with those observed in Caucasian patients with retinal ischemic symptoms. Methods-We performed a retrospective analysis of a series of consecutive patients evaluated by both the ophthalmology department and the neurology/stroke clinic. Patients had a diagnosis of amaurosis fugax, branch retinal artery occlusion, central retinal artery occlusion, or intra-arterial retinal plaques. Results-Twenty-nine African American patients and 17 Caucasian patients were evaluated. African American patients had a mean age of 61 years (range, 30 to 77 years) and Caucasian patients a mean age of 73 years (range, 56 to 94 years) (Pϭ0.003). There was no statistically significant difference between the 2 groups with respect to visible emboli on funduscopy (Pϭ0.462). After adjusting for age, there was also no difference between the 2 groups with regards to risk factors for arterial occlusive disease such as hypertension, coronary artery disease, hypercholesterolemia, tobacco use, and history of stroke or transient ischemic attacks. Caucasian patients had a 41% incidence (7/17) of high-grade ipsilateral internal carotid artery stenosis, measured by carotid duplex, compared with 3.4% incidence (1/29) in African American patients (Pϭ0.002). Conclusions-There are racial differences in the causes of retinal arterial occlusion. African American patients have a low prevalence of moderate to severe extracranial carotid stenosis, and a high proportion of African American patients have cryptogenic retinal ischemia. In Caucasian patients there is a stronger association between extracranial carotid artery disease and retinal arterial occlusion. (Stroke. 1999;30:1506-1509.)

No abstract

Transpupillary thermotherapy may stabilize visual acuity in a majority of patients with occult subfoveal choroidal neovascularization secondary to ARMD. Proof of therapeutic benefit is best determined by a randomized clinical trial that is currently underway (TTT4CNV).