Long-term follow-up with optical coherence tomography and microperimetry in eyes with metamorphopsia after macula-off retinal detachment repair.

PURPOSE: to report the long-term sequential morphological and functional results in eyes with metamorphopsia after retinal detachment (RD) repair. PATIENTS AND METHODS: in six eyes of six patients aged 58.7 ± 11.0 years with metamorphopsia after successful buckling surgery for macula-off RD, best-corrected visual acuity (BCVA), fundus biomicroscopy, Amsler grid test, time-domain optical coherence tomography (TD-OCT) and central 12° microperimetry (MP-1) were performed at months 1, 3, 6, 12, and 18. At 5 to 6 years after surgery all patients underwent also spectral domain (SD)-OCT. RESULTS: three eyes slowly recovered pre-RD BCVA. In the remaining three eyes-with good final BCVA-the interrupted junction line between photoreceptor cell inner and outer segments (IS/OS) was progressively less evident after RD surgery; and the external limiting membrane was preserved on SD-OCT examination. In all eyes post-operative metamorphopsia faded with time, but fully disappeared in 6 years only in two eyes without photoreceptor abnormalities. One of the two eyes with subretinal fluid up to 6 months and IS/OS disruption had central dense scotoma with relatively unstable fixation on MP-1 and persistent metamorphopsia. Macular sensitivity (MS) increased from 9.7 ± 7.1 at month 1 to 13.5 ± 5.6 dB at the final check, and was weakly (r=0.33) correlated with post-operative BCVA and OCT abnormalities. CONCLUSION: long-standing metamorphopsia can occur after successful macula-off RD repair even without detectable photoreceptor disruption on OCT. Post-operative BCVA recovery weakly correlates with increasing MS, and late restoration of the photoreceptor layer may be observed.

Recurrent eyelid basal cell carcinoma with sclerochoroidal infiltration: echographic findings.

In an 82-year-old woman with a recurrent right lid basal cell carcinoma infiltrating the upper temporal orbit, a solid yellowish lesion was found ophthalmoscopically in the superotemporal periphery of the right eye. On standardized echography examination, the 2.5-mm elevated subretinal lesion was medium to high reflective with irregular structure, whereas the adjacent orbital mass was medium to low reflective and the sclera was thinned with at least one passage between the orbital and ocular lesions. To our knowledge, this is the first echographic report of sclerochoroidal infiltration from a lid basal cell carcinoma.

First report of centroblastic lymphoma in a human immunodeficiency virus-positive patient with a rare congenital coagulation disorder (factor X Friuli).

The association of lymphoma and human immunodeficiency virus (HIV) seropositivity in a patient with a rare congenital clotting disorder (Factor X Friuli) is reported. The propositus was a previously asymptomatic HIV-positive 46-year-old man who suddenly presented a rapidly evolving right exophthalmos due to a centroblastic lymphoma, as the presenting symptom of full-blown AIDS. The clinical picture was characterized by unusual site of presentation, advanced stage and fatal course over a short period of time, despite therapy. Bone marrow, but not lymph node or parenchymal involvement, was present. Central nervous system involvement, with an unusual diffuse and massive pattern, and the B-cell origin of the lesion were demonstrated at autopsy. Few reports exist so far about the association of malignancy and HIV in patients with congenital coagulation disorders and this is the first report about a defect other than classic hemophilia.

Optic neuropathies: diagnostic role of standardized echography.

While large excavation, elevation and drusen of the optic disc are best detected with contact B-scan examination, standardized A-scan echography is needed to investigate properly and to differentiate optic nerve disease. Increased subarachnoidal fluid within the retrobulbar optic nerve, optic nerve atrophy and optic nerve tumors (glioma and meningioma) can be evidenced with standardized echography. Techniques and examples of ultrasound diagnosis of optic nerve disease are presented and discussed.

Ischemic optic neuropathies.

Primary or secondary impairment of blood supply to the optic nerve results in a spectrum of ischemic optic neuropathies with multiple etiopathogenesis. Among these the clinical features of traumatic and radiation optic neuropathy are outlined. Diagnostic criteria, associated conditions, risk factors and functional prognosis of anterior ischemic optic neuropathy are reviewed and discussed in the light of the contribution of recent literature.

Anterior ischemic optic neuropathy and aging.

The records of 293 patients admitted to Padua University Eye Clinic with diagnosis of optic neuropathy were reviewed. Age and sex distribution of different types of optic neuropathies were analyzed. 84 patients (28.7%) with a mean age of 61.9 years had anterior ischemic optic neuropathy (AION). The mean follow up of these patients was 3 years. In less than 30% of patients stabilized visual acuity of the first affected eye was better than 20/200; however, patients younger than 65 showed a significantly (p less than 0.01) better visual acuity than patients older than 64. Involvement of the second eye was found in 26 patients with AION (30.9%), of whom only five were considered idiopathic. The latency before controlateral eye involvement was significantly (p less than 0.05) shorter in patients over 64 years of age than in the younger group. Commonly known associated conditions such as giant cell arteritis (3.6%), arterial hypertension (34.5%), diabetes mellitus (10.7%), both arterial hypertension and diabetes (8.3%), migraine (7.2%) or intracapsular cataract extraction (1.2%) were considered. The frequency of a number of risk factors was found out in patients with arterial hypertension and/or diabetes and in patients with idiopathic AION. Symptoms or signs of ischemic cardiopathy and/or peripheral nonarteritic vascular disease, TIAs prior to AION onset, elevated plasma cholesterol or triglyceride levels, excessive smoking were considered. These risk factors were not found in 11.1% of diabetic patients with AION, in 37.9% of hypertensives, in 14.2% of both diabetic and hypertensive patients and in 31% of patients with idiopathic AION. Our data seem to indicate that the onset of AION may be influenced more strongly from these risk factors than aging.

Electrophysiological findings in anterior ischemic optic neuropathy.

Electroretinograms (ERG), oscillatory potentials (OP) and pattern reversal visual evoked potentials (VEP) were performed in nine patients (mean age 66 years) with unilateral long-standing anterior ischemic optic neuropathy (AION) and in an age matched control group. Normal ERGs but bilateral impaired OPs were observed in virtually all AION affected patients. Regardless of visual acuity, VEP amplitude reduction was found in all eyes with AION and in controlateral eyes of patients with associated systemic conditions such as diabetes mellitus, arterial hypertension and atherosclerosis. A normal latency of VEP was found bilaterally in AION affected patients; however no correlation between VEP latency and visual acuity or fields could be established. Our results seem to indicate moderate ischemic damage to the retina and to the axons of the optic pathways in patients with AION.

Optic nerve hypoplasia associated with pupillary light-near dissociation, spastic paraparesis and other non-ocular anomalies.

We report a case of bilateral optic nerve hypoplasia in a patient with pupillary light-near dissociation, spastic paraparesis with deep hyperreflexia, mild distal hypotrophy especially of lower limbs, bilateral pes cavus and signs of motor peripheral neuropathy. Other associated signs were rhinolalia, hypotrophy and fasciculations of the tongue and cardiomyopathy. We differentiate the condition from a number of hereditary ataxias and paraplegias. The clinical features of Strümpell-Lorrain spastic paraplegia and amyotrophic lateral sclerosis seem to resemble most closely that of our patient.

Aqueous prostaglandin E2 and intraocular pressure after argon laser trabeculoplasty in glaucoma patients pretreated with topical piroxicam.

Intracameral injection of prostaglandin E2 causes an increase in intraocular pressure (IOP) in rabbits, cats, and monkeys. Arachidonic acid administered topically in rabbits and monkeys also increases IOP. The effect of prostaglandin E2 on IOP in human eyes is unclear. We performed paracentesis of the anterior chamber one hour after 180 degrees argon laser trabeculoplasty in cases of primary open-angle glaucoma. This laser treatment may increase IOP, but no correlation was found between post-operative IOP changes and PGE2 levels. PGE2 was significantly lower in ten eyes pretreated with topical piroxicam, a prostaglandin biosynthesis inhibitor (7 +/- 6 pg/ml), than in ten untreated eyes (443 +/- 232 pg/ml) and five controls. No significant difference was found between post-operative IOP in eyes pretreated and untreated with piroxicam. The low levels of PGE2 in the aqueous humour of eyes pretreated with piroxicam indirectly demonstrated the transcorneal penetration of the topically-administered drug, and the effectiveness of piroxicam in inhibiting the ocular synthesis of PGE2.

Diabetic optic neuropathies: clinical features.

Optic disc neovascularization, anterior and posterior ischemic optic neuropathy (AION and PION), diabetic papillopathy and Wolfram's syndrome are known conditions affecting the optic nerve in diabetics. Analysis of frequencies of AION in diabetes and two cases with and without background diabetic retinopathy are reported. The literature concerning the pathogenesis of diabetic papillopathy and its clinical similarity to optic disc vasculitis are briefly discussed.

Echography of optic disc related pathology in diabetic retinopathy.

Combined A- and B-scan examination of eyes with diabetic retinopathy and opaque media provides information about the presence and density of vitreous hemorrhages, can detect membranes inserting into the optic disc or the retina and differentiate them from retinal detachment. Absolute and relative indications for echographic examination are listed and some echograms concerning vitreous hemorrhage, proliferating membranes and traction retinal detachment are presented. The value of both A-scan standardized echography and contact B-scan technique for previtrectomy evaluation is stressed.

A critical analysis of the long-term results of trabeculectomy.

We analyzed the long-term results of trabeculectomy in a homogeneous group of 90 eyes (75 patients) followed up one to five years after surgery. The effect on intraocular pressure was considered stable after one year; complete success was achieved in 69 (71%) of cases with a further in 8 (9%) partial success in eight (9%). The pressure-lowering effect was closely related to the presence of a filtering bleb. The main complication was the late appearance of lens opacities, although these seemed less frequent than after other antiglaucoma operations. Lens opacities were particularly frequent in hypotonic eyes and may depend upon the process of aqueous humor filtration itself.