Malattia leventinese presenting with subretinal neovascular membrane and hemorrhage.

PURPOSE: To report a case of malattia leventinese involving subretinal hemorrhage. METHODS: Case report. RESULTS: Two weeks after initial presentation, the visual acuity of this 34-year-old man decreased to LE: 20/100. Funduscopic evaluation revealed a subretinal hemorrhage involving the center of the foveal in the left eye that was interpreted as secondary to a neovascular membrane on fluorescein angiography. The patient did well after the removal of the submacular material by pars plana vitrectomy. CONCLUSION: Patients with malattia leventinese may occasionally present with submacular hemorrhage. Prompt diagnosis and intervention may enhance the patient's chance for visual improvement.

Pseudophakic retinal detachments. Anatomic and visual results.

Retinal reattachment rates and visual results were analyzed in 227 consecutive primary pseudophakic rhegmatogenous retinal detachments. The overall anatomic reattachment rate was 90%, with no significant difference between the anterior chamber (AC) and posterior chamber intraocular lens groups. Visual results were significantly worse in the AC lens group (P less than 0.05). Negative prognostic indicators for reattachment included age greater than 65 years, poorer preoperative vision, larger extent of the retinal detachment, inability to identify a retinal break, longer duration of symptoms before presentation, and grades C or D proliferative vitreoretinopathy (P less than 0.05). In addition to the above factors, eyes with AC reaction, AC lenses, and macular detachment had a poorer visual prognosis.

Lipemic diabetic retinopathy.

A study group of eight patients with diabetic retinopathy and marked accumulation of hard exudates in the fundi is described. There was a significant increase in serum triglyceride levels (P less than 0.05) in the study group as compared to a control group of 23 consecutive patients with diabetic retinopathy. This exudative disorder is visually disabling and is associated with legal blindness in 50% of eyes. The authors believe that the term most appropriate to describe such a severe type of exudative response is lipemic diabetic retinopathy.

Congenital retinal macrovessels.

The clinical and fluorescein angiographic features of seven patients with unilateral, large retinal vessels supplying or draining the macular region, both inferior and superior to the horizontal raphe, are described. All patients had good vision, although two patients also had a concomitant foveolar cyst in the involved eye. Four of the seven eyes had small perifoveolar arteriovenous communications, while three eyes did not. Four eyes also showed abnormal areas of retinal capillary nonperfusion. In addition, delayed drainage of dye from the enlarged vessels was a commonly encountered feature. It is suggested that these congenital anomalies be referred to as retinal macrovessels.

Management of intraretinal foreign bodies.

Closed posterior intraocular microsurgery with vitreous instruments and bimanual surgical techniques have markedly altered the management of intraocular foreign bodies (IOFB). This paper presents an approach to 14 metallic intraretinal foreign bodies (IRFB) that could not be removed by conventional methods. In all cases, posterior vitrectomy was required to visualize the foreign body or to facilitate its removal through a pars plana incision with intraocular forceps under microscopic visualization. Although successful removal of the intraretinal foreign body was possible in all 14 patients, central visual acuity of 20/400 or better was obtainable in only 40% of this series. An important observation in these patients was a tendency to macular pucker from subsequent epiretinal membrane formation and retinal detachment with massive periretinal proliferation (MPP), which occurred in 90% of these eyes. Despite an obviously enhanced ability to remove foreign bodies from the retina, made possible by vitreous instruments and surgical techniques, the magnitude of the secondary complications in this variety of ocular trauma suggests a poor visual prognosis for such injuries.

Vitrectomy and cystoid macular edema.

Twenty-two patients who underwent vitrectomy surgery for chronic cystoid macular edema (CME) were evaluated. These patients all had uneventful intracapsular cataract extraction, but CME with vitreous adhesions to the cataract incision later developed. Vitrectomy was performed to remove the vitreous from the anterior segment structures in each case. Nineteen of the 22 patients showed improved visual acuities within six months, and all but two had complete resolutions of the CME by one year. These two patients did show marked improvements of visual acuity. The majority of patients younger than 65 years of age had final visual acuities of 20/50 or better, whereas the majority of those older than 65 years had less than 20/50. The results were not influenced by the duration or the pattern of the CME prior to vitrectomy. A prospective study to determine the value of vitrectomy in this type of patient is suggested.

An alternative method of gas-fluid exchange through the limbus in giant tears and other complicated retinal detachments.

An alternative method of gas-fluid exchange through the limbus in patients with giant tears and complicated retinal detachments is presented. The indications for the combined surgery of scleral buckle, vitrectomy, and gas-fluid exchange are suggested. The results of this type of surgery in 5 patients with giatn retinal tears, and in 12 patients with complicated retinal detachments, are reported. Most failures were caused by massive periretinal proliferation.

Lipofuscin pigment over benign and malignant choroidal tumors.

This study has shown that lipofuscin pigment may accumulate in RPE cells and macrophages over several types of benign and malignant choroidal tumors. The color of the pigment, however, varies with the nature and color of the underlying lesion. On the surface of deeply pigmented tumors the lipofuscin pigment may produce an orange color, whereas over amelanotic lesions it may appear brown or reddish-brown. On the surface of vascular tumors, such as choroidal hemangiomas, the lipofuscin is almost invisible ophthalmoscopically but may be demonstrated with fluorescein angiography. Although the presence of such pigment accumulation is suggestive of a malignant melanoma, it is not diagnostic and may occur over benign simulating lesions as well.

B-scan ultrasonography in the diagnosis of atypical retinoblastomas.

Contact B- scan ultrasonography (Bronson-Turner unit) was performed on fourteen patients with retinoblastoma. In ten cases, the patient presented with leukocoria, and ultrasonography was helpful in confirming the clinical diagnosis. In four atypical cases contact B-scan ultrasonography was instrumental in making the diagnosis. The ultrasonographic pattern for retinoblastoma is characteristic but not pathognomic. There is a solid intraocular echo corresponding to the tumor and within it are numerous dense focal echoes which persist at lower sensitivities, suggesting calcification. Calcification was demonstrated ultrasonographically and confirmed histologically in all four of these atypical cases, but routine skull x-rays failed to demonstrate calcium in three of the four children. Contact B- scan ultrasonography is a safe and simple procedure which may provide valuable diagnostic information in children with suspected retinoblastoma.

Intraocular microsurgery: I. New instrumentation (SITE).

The SITE instrument appears to combine advantages of other instruments previously described. It meets the proposed objectives of an efficient cutter where tissue is removed at the front end of the tip. It allows the surgeon complete control of the suction and reflux systems. The instrument is of a simple modular dsign. A fiber optic attachment is available. It is dependable and safe.

Hemangiomas of the optic disc.

Seven cases of hemangioma of the optic disc are presented. A survey of the literature is summarized and the differential diagnosis and appropriate management discussed.