An atypical case of choroidal osteomas.

BACKGROUND: A choroidal osteoma is a benign choroidal tumor It usually occurs in young, healthy women and is typically unilateral and located in the juxtapapillary region. CASE REPORT: A case of bilateral choroidal osteomas occurring in a 32-year-old woman is reported. The visual symptoms coincided with her third pregnancy. The choroidal osteoma in her right eye was elevated with blurred margins and had signs of subretinal fluid. The lesion in her left eye was flat and dry. Both were located superior temporal to the macula. Fluorescein angiography and indocyanine green angiography showed evidence of subretinal fluid in her right eye. CONCLUSIONS: The atypical features of the osteoma in her right eye include its height, evidence of diffuse leakage of subretinal fluid with no definable neovascular membrane, and its possible growth associated with pregnancy. In addition, the location, indistinct borders, and bilateral presentation are not characteristic clinical features of choroidal osteomas.

Interobserver variability in the estimation of the cup/disk ratio among observers of differing educational background.

BACKGROUND: Accurate assessment of the cup/disk (C/D) ratio is an important skill for eyecare practitioners. Interobserver variability in this estimation has been documented in many studies. This study compares the estimate variation in the C/D ratio as judged by five groups with different educational backgrounds who would provide patient care at a college of optometry. METHODS: Third- and fourth-year students, optometry residents, attending optometrists, and attending ophthalmologists evaluated the C/D ratios of 20 optic nerves using stereoscopic optic nerve photographs. There were five observers in each group, for a total of 25 participants. The results were statistically analyzed with a one-way analysis of variance and the Duncan multiple range test. RESULTS: The one-way analysis of variance showed that a statistically significant difference existed among the five groups. Further analysis with the Duncan multiple range test showed that the attending optometry group was significantly different from the third-year student, fourth-year student, and attending ophthalmology groups. Also, the optometry resident group estimates were significantly different than the fourth-year student and attending ophthalmology group estimates. CONCLUSIONS: There was a statistically significant difference in the estimation of the C/D ratio using stereoscopic disk photographs among five groups that had different educational backgrounds.

Pigmented striae of the anterior lens capsule and age-associated pigment dispersion of variable degree in a group of older African-Americans: an age, race, and gender matched study.

PURPOSE: To investigate pigmented striae of the anterior lens capsule in African-Americans, a potential indicator of significant anterior segment pigment dispersion. METHODS: A group of 40 African-American subjects who exhibited pigmented lens striae (PLS) were identified from a non-referred, primary eye care population in Chicago, IL, USA. These subjects were then compared to an age, race, and gender matched control group relative to refractive error and the presence or absence of diabetes and hypertension. RESULTS: The PLS subjects (mean age = 65.4 +/- 8.8 years, range = 50-87 years) consisted of 36 females and 4 males. PLS were bilateral in 36 (85%) of the 40 subjects. Among the eyes with PLS, 21 (55%) of 38 right eyes and 22 (61%) of 36 left eyes also had significant corneal endothelial pigment dusting, commonly in the shape of a Krukenberg's spindle. Ten (25%) of the PLS subjects had either glaucoma or ocular hypertension (7 bilateral, 3 unilateral). The presence of trabecular meshwork pigment varied from minimal to heavy. The mean +/- SD (range) refractive error of the PLS right eyes was +1.61 +/- 1.43D (-1.50 to +5.00D) and +1.77 +/- 1.37D (-1.00 to +5.00D) for the left eyes. Based on these data, the PLS right eyes were +1.63D (Student's t, p = 0.0001; 95% CI = +0.82 to +2.44D) more hyperopic on average than the control right eyes, and the PLS left eyes were +1.77D (p = 0.0001; 95% CI = +0.92 to +2.63D) more hyperopic on average than the control left eyes. Trend analysis showed a gradually increasing likelihood of PLS with increasing magnitude of hyperopia in both eyes (Mantel-Haenszel chi-square, p = 0.001). Among PLS subjects, 24 (60%) of 40 were hypertensive and 9 (23%) of 40 were diabetic. However, these proportions were not significantly different (two-tailed Fisher's exact test; hypertension: p = 0.30; diabetes: p = 0.70) from the randomly selected controls. CONCLUSIONS: Among our African-American group, which consisted predominately of females >50 years of age, the likelihood of PLS increased with increasing hyperopic refractive error. This finding is consistent with the possibility that PLS may, in some circumstances, indicate a significant pigment dispersal process due to iris-lens rubbing that may be associated with crowding of anterior segment structures. Additional study is warranted to further assess the nature of PLS, their precise relationship with an age-related pigment dispersal process, and their true significance as a risk factor for development of glaucoma.

Asymptomatic unilateral microembolic retinopathy secondary to percutaneous transluminal coronary angioplasty.

BACKGROUND: Percutaneous transluminal coronary angioplasty (PTCA) for the treatment of coronary artery disease has increased in frequency as technological advances have made the procedure more effective and cost-efficient. In spite of the number of procedures that have been performed, ocular complications have rarely been reported. CASE REPORT: A case of asymptomatic unilateral microembolic retinopathy one month after PTCA is presented. Embolic events to the retinal circulation and their relationship to invasive cardiac procedures is discussed. CONCLUSIONS: The embolic ocular complications of PTCA is probably underestimated due to the lack of symptoms from the partial occlusion of the larger retinal arteries and the total occlusion of the remote smaller vessels.

Torpedo maculopathy.

BACKGROUND: Congenital nevi of the retinal pigment epithelium (RPE) may manifest variable degrees of pigmentation. These nevi, which are almost always asymptomatic, can be either solitary or grouped. Torpedo maculopathy is a recently described congenital RPE nevus. METHODS: A review of congenital nevi of the RPE is presented to include torpedo maculopathy. RESULTS: Torpedo maculopathy is a solitary congenital RPE nevus; it is oval, variably pigmented, and located in the temporal macula. Diagnosis of this lesion is made on the basis of its characteristic shape and location. The etiology may be related to alterations in the choroidal vasculature in the macular area during the embryologic development of the eye. Because of the benign nature of the nevus, yearly evaluations are recommended. CONCLUSIONS: Classification of congenital nevi of the RPE is still evolving. As more is learned, a better system of organizing these lesions will be developed.

Differentiation of asymptomatic patients from symptomatic patients by the slope of the forced vergence fixation disparity curve.

Eighty-nine optometry students were divided into an asymptomatic group and a symptomatic group on the basis of a case history. A forced vergence fixation disparity (FD) curve was generated for each subject using a Disparometer (Vision Analysis, Columbus, Ohio). Slopes were calculated for each curve. In addition, each curve was labeled steep or flat based on a previously determined cutoff point of -0.96 min/delta (Sheedy, 1980). Steep curves did not correlate well with symptomatic patients, whereas flat curves did not correlate well with asymptomatic patients. An independent t-test found no significant difference between the two groups.