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PURPOSE: The purpose of this article is to analyze cross-sectional images of a subretinal macular lesion, using optical coherence tomography (OCT) in eyes with adult-onset foveomacular vitelliform dystrophy (AOFVD), to compare thickness of the neurosensory retina over the lesion with best-corrected visual acuity (BCVA) of each eye, and to compare OCT tomograms of AOFVD patients with OCT of Best disease. DESIGN: Observational case series. METHODS: This is a retrospective study which took place in a clinical practice. Forty-three patients (72 eyes) with AOFVD and 12 patients (24 eyes) with Best's disease were studied. The observation procedures used were biomicroscopic fundus examination, fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). The main outcome measures were a description of the typical picture of AOFVD in OCT tomograms, the relationship between the neurosensory retinal thickness over the lesion, the BCVA expressed in decimal terms, and a comparison with description of OCT in Best disease. RESULTS: Of the 43 patients affected by AOFVD, 29 had bilateral macular lesions. Fluorescein angiography showed a central hypofluorescent spot surrounded by an irregular hyperfluorescent ring in 65 of the 72 eyes. Indocyanine green angiography demonstrated a central nonfluorescent spot and a hyperfluorescent area surrounding the central spot in 22 of 27 eyes examined. In all 72 eyes of 43 patients, OCT showed a well-defined central region of thickening in the reflective band representing the retinal pigment epithelium (RPE). The relationship between the thickness of neurosensory retina over the lesion and BCVA was significant ( P = .001, r 2 = 0.61). Optical coherence tomography in all 24 eyes with Best disease showed a well-defined central serous retinal detachment. CONCLUSION: In the 72 eyes with AOFVD, FA and ICGA presented different features. Instead, OCT tomograms showed a well-defined subretinal thickening of the RPE in all the eyes. The lack of difference in OCT patterns between cases with or without the hypofluorescent spot on angiography was useful for confirming the diagnosis of AOFVD. Moreover, a reduced visual acuity was evident in patients with a thinner neurosensory retinal layer over AOFVD lesion. Finally, OCT images were also useful for distinguishing AOFVD from Best disease.

Purpose To report the incidence of back pain after photodynamic therapy, which suggests methods for prevention that are related to its pathogenesis. Design Retrospective case series. Methods We retrospectively observed 548 patients who had undergone photodynamic therapy with verteporfin. Results Of 548 patients at the first treatment, 14 patients (2.6%) experienced pain during the infusion. Eleven patients were being treated for age-related macular degeneration; their mean age was 81 years, which significantly differed from the mean age of the overall age-related macular degeneration group ( P = .003). The pain was mild in eight patients, moderate in four patients, and severe in two patients, with dyspnea and precordial pain. Five of the 14 patients had further courses of photodynamic therapy. After being treated prophylactically 60 minutes before photodynamic therapy, only one patient reported further mild pain. Conclusions The biologic mechanisms of back pain may involve a high level of circulating thromboxanes that are induced by the liposomal composition of verteporfin. Prevention may include hydration, nonsteroidal anti-inflammatory drugs, and halving the infusion rate.