Branch retinal vein occlusion secondary to hormone replacement therapy in a transgender woman.

PURPOSE: To report a case of branch retinal vein occlusion (BRVO) in a transgender woman having undergone hormone replacement therapy. METHODS: Observational case report. RESULTS: A 44-year-old transgender woman on hormone replacement therapy with transdermal estradiol gel for the past 6 years was referred for sudden loss of vision and metamorphopsia in her left eye (LE) for the past 3 weeks. Best-corrected visual acuity (BCVA) was 20/20 in her right eye (RE) and 20/40 in her LE. Dilated fundus examination showed deep flame-shaped hemorrhages, cotton wool spots, and arteriovenous crossing changes. Spectral-domain optical coherence tomography (SD-OCT, Spectralis; Heidelberg Engineering, Heidelberg, Germany) showed retinal edema in the superonasal perifoveal area. Optical coherence tomography angiography (OCTA PlexElite, Carl Zeiss Meditec, Inc, Dublin, CA) revealed the presence of areas of non-perfusion, disorganization of the capillary network and capillary ectasia and dilation. The patient was treated with 3 monthly intravitreal injections of aflibercept. Three-month follow up revealed complete resolution of the macular edema, with BCVA having improved to 20/20 in the LE. CONCLUSION: As estrogen increases cardiovascular risk when used in hormone replacement therapy, RVO is a complication that must be taken into account by clinicians, especially in transgender women (male-to-female) who are more at risk.

Sutureless intrascleral fixation using a uniquely designed intraocular lens.

We report our experience in the surgical technique of sutureless intrascleral posterior chamber intraocular lens (PC IOL) fixation in patients with insufficient capsular support using a uniquely designed, foldable, acrylic Carlevale IOL. It is specifically designed for sutureless scleral fixation and is equipped with a small plug attached to each of two haptics to anchor the lens to the sclera with a self-retaining mechanism. This surgery does not require creation of a scleral tunnel or transscleral exposure or excessive manipulation of the haptics. The harpoon-like plugs provide great stability to this implant, which can be injected through a 2.2mm incision. The characteristics of this IOL and the relative simplicity of this implantation technique makes it widely applicable in aphakic patients after previous complicated cataract surgery.

Clinical evaluation of the use of infracyanine green staining for internal limiting membrane peeling in epimacular membrane surgery.

PURPOSE: To evaluate the use of infracyanine green (IFCG) staining in idiopathic epiretinal membrane (ERM) surgery. METHODS: A retrospective comparative study of 63 consecutive eyes with ERM operated on with internal limiting membrane (ILM) peeling using or not filtered IFCG diluted (5:1) in glucose 5%. Main outcome measures were best-corrected visual acuity, central visual field perimetry, fluorescein angiography with blue light fundus photograph, optical coherence tomography (OCT), and in seven eyes multifocal electroretinogram (mfERG). RESULTS: A total of 44 eyes underwent surgery with ILM staining using IFCG and 19 eyes without. In the IFCG group, the staining showed that the ILM was removed together with the ERM in 39% of eyes; ILM was still present on the macula after ERM removal in 57% of eyes and removed secondarily. The improvement in vision was slightly better in the IFCG group throughout follow-up but the difference was not significant. On the postoperative blue light photograph, defects in the optic nerve fibre layer were less frequent in the group with IFCG than without (p=0.023), suggesting less peroperative trauma. Two eyes in the group operated without IFCG had recurrence of the ERM including one with a macular hole vs none in the group with IFCG. No difference was observed in the groups as regards central visual field testing, mfERG, OCT, or angiographic data. CONCLUSIONS: Using IFCG for ILM peeling in ERM surgery seemed to reduce significantly the trauma to the optic nerve fiber layer and to prevent ERM recurrence. Deleterious effects were not observed in this study.

[Abnormal retinal artery perfusion and optical coherence tomography angiography]. / Trouble de la perfusion artérielle rétinienne et tomographie en cohérence optique-angiographie.

INTRODUCTION: To analyze optical coherence tomography angiography (OCT-A) findings in patients with impaired retinal artery perfusion secondary to occlusion of the central retinal artery or its branches, cilioretinal artery occlusion or retinal vein occlusion (RVO). METHODS: In this retrospective observational study of patients with impaired retinal artery perfusion, we recorded the results of clinical examination and multimodal imaging, including fluorescein angiography, spectral-domain (SD)-OCT, and OCT-A (Optovue) of the central 10 degrees with measurement of vascular density. RESULTS: The files of 10 patients were analyzed (5 men, mean age: 63 years), including 3 retinal artery occlusions, 4 cilioretinal artery occlusions, isolated or combined with central retinal vein occlusion (CRVO), and 3 RVO with an arterial component. SD-OCT showed hyper-reflectivity of the inner nuclear layer consistent with paracentral acute middle maculopathy (PAMM) in the acute stage (8 eyes) resulting in retinal atrophy as early as the following month. OCT-A revealed capillary dropout in all patients with various degrees, the deep capillary plexus seemed to be more involved than the superficial plexus. A fern-like pattern was observed on en-face OCT in 4 eyes, outlining venular contours. Vascular density was significantly diminished (whole en-face density in the deep capillary plexus: 50.39 vs. 56.21 in the control group, P=0.001). On fluorescein angiography, reperfusion was observed in half of the eyes. CONCLUSION: OCT-A can be very useful in patients with a transitory arterial occlusion by revealing involvement of the superficial and deep capillary plexus. It may enable a retrospective diagnosis in the case of reperfusion.

[Anti-VEGF therapy in the treatment of anterior segment neovascularization secondary to central retinal vein occlusion]. / Apport des anti-VEGF dans le traitement de la néovascularisation du segment antérieur compliquant les occlusions veineuses rétiniennes.

PURPOSE: To evaluate the benefit of anti-VEGF in the treatment of anterior segment neovascularization (ASNV), a severe complication of ischemic central retinal vein occlusion (CRVO). PATIENTS AND METHODS: This is a retrospective case series of consecutive patients with ASNV secondary to CRVO treated with anti-VEGF. Ophthalmic parameters were recorded for each visit: measurement of best visual acuity (VA), intraocular pressure (IOP), iris examination, gonioscopy and fundus examination, and as necessary, fluorescein angiography and optical coherence tomography. Minimum follow-up was 6 months. RESULTS: Nineteen patients (19 eyes) received intravitreal injections of anti-VEGF in association with panretinal photocoagulation (PRP). In patients who had uncomplicated rubeosis iridis without elevated IOP (n=6), after a mean of 3 injections, VA was stable in 4 patients and improved by two lines in 2 patients. In patients with early neovascular glaucoma (NVG) (n=13), IOP reduction was observed in all eyes within 1 week after injection but increased secondarily after an average of 45 days, although the rubeosis had definitively disappeared, which suggested that the change in IOP was independent of ASNV. After a mean of 6 injections in combination with filtering or cyclodestructive surgery, IOP finally stabilized, but VA decreased in all patients. Three patients (50%) with stage III ASNV progressed to stage IV ASNV in spite of anti-VEGF treatment. CONCLUSION: In all eyes, anti-VEGF treatment stopped neovascularization and helped to control IOP. However, vision was preserved only in the eyes with uncomplicated rubeosis at the time of diagnosis. Since only 32% of eyes were diagnosed at this stage, the authors suggest the prevention of ASNV by careful screening and follow-up of patients at risk, and the performance of PRP in CRVO with extensive retinal non-perfusion prior to the onset of rubeosis.

[Comparison of early management of central retinal vein occlusion with ranibizumab versus hemodilution]. / Comparaison de la prise en charge précoce des occlusions de la veine centrale de la rétine par ranibizumab et/ou hémodilution.

PURPOSE: This study was designed to evaluate and compare the efficacy of early treatment of CRVO with either hemodilution by erythrocytopheresis or intravitreal (IVT) ranibizumab, or both. MATERIAL AND METHODS: A multicentric prospective randomized study including patients with CRVO for less than 1 month was designed. Patients were randomized into 3 treatment groups: hemodilution (HD group), 3 monthly intravitreal injections of ranibizumab followed by PRN treatment (IVT group), or combined treatment (IVT+HD group). A monthly evaluation during a 6-month follow-up included best-corrected visual acuity (BCVA) and macular thickness measurements with OCT. Fluorescein angiography was performed at baseline, month 2 and month 6. Local and systemic tolerability of the different treatments were also compared. RESULTS: Forty-four CRVO patients were included between February 2010 and June 2013: 20 in the IVT group, 13 in the HD group and 11 in the HD+IVT group. The mean duration of CRVO at baseline was 10 days and 16 days at the time of treatment without any significant difference between groups. Retinal ischemia was present at baseline in 40% of eyes in each group. After a 6-month follow-up, no difference between the 3 groups was observed in BCVA (10.5 ETDRS letters, 14.6 and 14.1 in the IVT group, HD group and IVT+HD group respectively, P=0.726) or in macular thickness (398 µ, 440 µ and 379 µ respectively, P=0.465). The time until treatment from CRVO onset, ranging from 1 to 35 days, was not correlated to final outcomes. No significant difference in the mean number of IVT (3.2 in the IVT+HD group vs 3.7 in the IVT group) was observed at 6 months. CONCLUSION: No difference in BCVA nor in macular thickness was seen at M6 between the study groups. The duration of CRVO at the time of the initiation of the treatment was not correlated to better visual outcomes. Therefore, etiologic treatment with HD can still be proposed as a first-line treatment in young patients, which allows delaying or avoiding the IVT treatment and its potential side effects. Anti-VEGF IVT still remains an effective option in every case and can be started one month after the beginning of the CRVO.

[Management of macular edema secondary to retinal vein occlusion]. / Prise en charge de l'œdème maculaire secondaire à une occlusion veineuse rétinienne.

BACKGROUND: In recent years, intravitreal injections have added to the treatment modalities available for macular edema (ME) secondary to retinal vein occlusion (RVO). This article aims to provide an update regarding the management of ME secondary to RVO. METHODS: A work group met in order to analyze the literature available on Embase/PubMed, regarding treatments for venous occlusion that have received market approval and are reimbursed in France. In total, 33 articles were selected. Consensus within the group for recommendations was based on this data from the literature review and clinical experience and was reported in this article. RESULTS: The management of ME secondary to branch retinal vein occlusion (BRVO) or central vein occlusion of the retina (CRVO) differs on a number of points. Methods of best practice were discussed separately for BRVO and CRVO, taking into account various ocular and associated parameters. DISCUSSION: Ranibizumab and dexamethasone implant are the first-line treatments for visual impairment due to ME secondary to RVO. The choice of either of these drugs may take into account various ocular and extraocular parameters. A change of treatment to one or the other or to laser may also be considered during follow-up.

Antiphospholipid antibodies in retinal vascular occlusions. A prospective study of 75 patients.

OBJECTIVE: To assess the prevalence of antiphospholipid antibodies in patients with occlusive retinal vascular disorders. PATIENTS: Seventy-five consecutive patients (44 with central retinal vein occlusions, 24 with branch venous occlusions, five with vasculitis plus branch venous occlusion, and two with arterial occlusions) were screened for antiphospholipid antibodies and compared with a control group composed of outpatients with similar systemic vascular disorders. RESULTS: The antibody assay for one patient was positive for lupus anticoagulant and the antibody assay for three other patients was positive for anticardiolipin antibodies. These four patients had central or branch retinal vein occlusion and presented with several vascular risk factors. Comparison of the retinal vascular occlusion and the control groups showed no difference in the levels of anticardiolipin antibodies or lupus anticoagulant. CONCLUSIONS: Antiphospholipid antibodies did not seem to be a feature of retinal vein occlusion, but in rare cases (5%) they may contribute to the occlusive phenomenon. A systematic screening does not seem to be justified, but it may be valuable to test for antiphospholipid antibodies in patients without conventional risk factors and in patients with clotting screen abnormalities, particularly if associated with lupus-like syndrome or other elements of the primary antiphospholipid syndrome.

Translocation of the macula for management of subfoveal choroidal neovascularization: comparison of results in age-related macular degeneration and degenerative myopia.

PURPOSE: To report the results of limited macular translocation in subfoveal choroidal neovascularization resulting from age-related macular degeneration or degenerative myopia. METHODS: The first consecutive 32 patients (23 age-related macular degeneration eyes and nine myopic eyes) were operated on with the limited macular translocation technique described by de Juan. Before and after surgery, a complete examination included fluorescein and indocyanine-green angiographies and optical coherence tomography. Mean follow-up was 9 months in the age-related macular degeneration group (range, 6 to 14 months) and 10 months in the myopic group (range, 6 to 15 months). RESULTS: The improvement in visual acuity was better in the myopic group than in the age-related macular degeneration group and was correlated with younger age in the myopic group (P <.05). At the end of follow-up, visual acuity improved by 2 lines or more in seven age-related macular degeneration eyes (30%), including four eyes (13%) with an improvement of 6 lines or more, and in six myopic eyes (67%), including two eyes (22%) with an improvement of 6 lines or more. Final visual acuity was unchanged in four age-related macular degeneration eyes (17%) and three myopic eyes (33%), and decreased in 12 age-related macular degeneration eyes (52%). Conversely, the mean foveal displacement was greater in age-related macular degeneration than in myopia (1,105 microm and 685 microm, respectively; P <.05). Main complications were retinal detachment (six eyes), neovascularization at the injection site (two eyes), and recurrence of neovascularization (43% of the age-related macular degeneration group and 11% of the myopic group). CONCLUSIONS: Limited macular translocation allowed a significant improvement in visual acuity in some eyes with subfoveal neovascularization and resulted in a moderate rate of complications. Longer follow-up and additional studies are required to confirm these findings.

A randomized, double-masked study on the treatment of retinal vein occlusion with troxerutin.

Hemorheologic factors probably play a role in the pathogenesis and prognosis of retinal vein occlusion. Accordingly, we designed a prospective, randomized, double-masked study to evaluate the effect of troxerutin, a rheologic drug, on retinal vein occlusion. Fifty-three patients were included, 27 with central retinal vein occlusion and 26 with branch retinal vein occlusion. They were randomly assigned for treatment with either troxerutin or a placebo. All subjects were similar in age, gender, associated diseases, hemorheologic values, and clinical severity of the retinal vein occlusion. At the end of follow-up, members of the troxerutin-treated group, as compared with the placebo group, showed significant improvement in visual acuity (P = .03), macular threshold (P = .01), retinal circulation times (P = .04), and macular edema (P = .05). Furthermore, they had diminished progression of ischemia (P = .05) and decreased red blood cell aggregability (P = .006) when compared with the controls. These encouraging preliminary results obtained with a rheologic treatment attest to the pathogenic role of blood viscosity in retinal vein occlusion and suggest that a large-scale randomized study should be conducted.

Treatment of recent onset central retinal vein occlusion with intravitreal tissue plasminogen activator: a pilot study.

AIMS: To study the effects of intravitreal tissue plasminogen activator (tPA) in recent onset central retinal vein occlusion (CRVO). METHODS: 15 patients with recent onset CRVO (from 1-21 days' duration, mean 8 days) were given 75-100 microg of tPA intravitreally associate with low dose low molecular weight heparin. CRVO was perfused in nine patients and with mild ischaemia not exceeding 100 disc diameters in six patients. Follow up ranged from 5 to 21 months for 14 patients (mean 8 months). Visual acuity measurement, macular threshold (Humphrey perimeter), fluorescein angiography with the scanning laser ophthalmoscope with special emphasis on retinal circulation times, and retinal perfusion were performed at days 0, 1, and 8 and months 1, 3, and 6. RESULTS: Visual acuity was significantly improved on the first day after treatment in only one eye, and decreased transiently in six eyes (40%). Retinal blood velocity was not significantly modified by tPA injection. Retinal ischaemia developed in six eyes (43%), leading to panretinal photocoagulation in five eyes including one with rubeosis iridis. At the end of follow up, visual acuity had improved to 20/30 or better in five eyes (36%), including two with complete recovery; visual acuity was worse than 20/200 in three eyes (28%). No complication of tPA injection was observed. CONCLUSION: Intravitreal tPA treatment for CRVO appears to be simple and safe, but did not significantly modify the course of the occlusion in our patients immediately after treatment. Final visual outcome did not differ significantly from that observed in the natural course of the disease, but final visual acuity seemed to be slightly better. A randomised study is required to determine if intravitreal tPA actually improves visual outcome in CRVO.

Visual function and course of basal laminar drusen combined with vitelliform macular detachment.

Basal laminar drusen (BLD) are small round yellow drusen that are more easily visualised angiographically than biomicroscopically, with a 'stars in the sky' pattern. Patients with BLD are predisposed to macular vitelliform detachment. Little is known about the course of the disease, but the prognosis for retention of useful central vision for patients with BLD is thought to be better than for patients with typical drusen. A retrospective analysis of clinical and angiographic charts of 19 patients with BLD combined with a vitelliform macular detachment was performed to precisely describe their course. In addition, nine patients were re-examined to allow an analysis of their visual function--that is, central visual field, contrast sensitivity, and colour vision. Eyes without choroidal new vessels retained a fair visual acuity (mean final visual acuity 0.5; follow up 4 to 69 months, mean 24 months). In 11 of these eyes visual function assessment disclosed a reduction of contrast sensitivity in high and medium spatial frequencies in nine eyes (81%), a blue-yellow dyschromatopsia in nine eyes (81%), and a mild reduction of foveal threshold in seven eyes (63%). Choroidal neovascularisation (CNV) was observed in 12 eyes (31%) with a poor final outcome (mean final visual acuity 0.1). Two thirds of cases of CNV were observed at the time of presentation; thus this finding may be a bias of a referring centre. However, the high prevalence of CNV suggests the need for a close follow up of patients with BLD.

Full-thickness macular hole and retinal detachment complicating Best's disease.

The unusual association of Best's vitelliform macular dystrophy and a full-thickness macular hole causing retinal detachment is reported. Successful reattachment was achieved with pneumatic retinopexy and postoperative laser photocoagulation. The mechanisms underlying the combination of full-thickness macular hole and retinal detachment in Best's disease remain to be elucidated.

Birdshot retinochoroidopathy: measurement of the posterior fundus spots and macular edema using a retinal thickness analyzer, before and after treatment.

PURPOSE: To measure the retinal thickness in the macular area and at the typical fundus spots in a patient with birdshot retinochoroidopathy, using the retinal thickness analyzer (RTA), a new image analyzer involving laser-slit biomicroscopy, and to quantify the changes after systemic corticosteroid therapy. CASE REPORT: A 54-year-old man with posterior uveitis underwent visual acuity measurement, fluorescein and indocyanine green (ICG) angiographies, optical coherence tomography (OCT) and RTA measurements before and after steroid treatment. RESULTS: The thickness at the birdshot spots measured with RTA remained unchanged after treatment, but the thickness at the fovea decreased in both eyes. Fluorescein and ICG angiographies and OCT showed no change with treatment. CONCLUSIONS: RTA seems a more sensitive method for assessing changes in macula thickness in the course of birdshot retinochoroidopathy and can help document the effect of treatment.

A quantitative in vivo study of retinal thickness before and after laser treatment for macular edema due to retinal vein occlusion.

PURPOSE: To evaluate quantitatively the effect of grid laser photocoagulation in macular edema due to central and branch retinal vein occlusion, using the retinal thickness analyzer. METHODS: Five patients with cystoid and non-cystoid macular edema were studied before and after argon grid laser treatment. All were examined clinically, with fluorescein angiography, and measurement of retinal thickness. Macular thickness was correlated to visual acuity measured on the ETDRS chart. RESULTS: Laser-slit images obtained with the retinal thickness analyzer in patients with macular edema disclosed discrete intraretinal changes after photocoagulation. Biomicroscopy and fluorescein angiography were insensitive to these small changes in the retinal thickness. No patient had any change in visual acuity after three months, but the retinal thickness was greater at this interval. The retinal thickening may be explained by a postoperative inflammatory response or by altered retinal blood flow or, in two of the eyes, by the effect of combined peripheral photocoagulation. CONCLUSIONS: The retinal thickness analyzer offers a refined tool for the diagnosis of subclinical changes of macular edema in retinal vein occlusion and is therefore also useful for assessing the effects of treatment.

Surgical removal of subfoveal choroidal neovascularization: visual outcome and prognostic value of fluorescein angiography and optical coherence tomography.

PURPOSE: To study the functional results of macular surgery and determine pre-operative features associated with better final visual outcome. METHODS: Forty-two consecutive patients underwent surgical removal of subfoveal choroidal neovascularization (CNV), related to age-related macular degeneration (AMD) in 8 eyes, degenerative myopia in 14 eyes, multifocal choroiditis (MFC) in 10 eyes, idiopathic CNV in 6 eyes and other etiologies in 4 eyes. Mean age was 49 years. Pre-operative visual acuity (VA) was 20/200 or less in 30 eyes (71.4%) and never better than 20/40. Fluorescein angiography was analyzed before and after surgery. Pre-operative optical coherence tomographs (OCT) were studied in a masked fashion. Mean follow-up was 12 months (range 4-48 months). RESULTS: Final VA was 20/200 or less in 25 eyes (60%). According to the CNV etiology, the percentage were 87.5%, 80%, 57.1% and 20% respectively in eyes with AMD, MFC, high myopia, and idiopathic or other diseases. Post-operative VA improved in 21 eyes (50%) but subsequently declined in 7% by the final examination. Patients younger than 50 years had better functional results (p=0.006). Lack of retinal pigment epithelium (RPE) changes on pre-operative angiography was correlated with good visual outcome (p<0.001). The OCT study confirmed some features already described and showed some different CNVpatterns: above and usually separated from the RPE, below and not separated from the RPE, and ungradable. Eyes with the first OCT pattern had the best visual outcome. Main complications included 4 (10%) retinal detachments and 9 (21%) recurrences. OCT was also useful to confirm CNV recurrences post-operatively. CONCLUSIONS: CNV surgical excision results vary depending on the underlying disease, the RPE and choriocapillaris function, and the features observed on pre-operative OCT images.

Central retinal vein occlusion and sudden deafness: a possible common pathogenesis.

CASE REPORT: A 31-year-old woman complained of blurred vision in the right eye due to a well-perfused central retinal vein occlusion (CRVO) and two months later, of sudden deafness (SD) in her right ear. Her visual acuity and hearing recovered almost completely within a few months. Medical evaluation disclosed the combination of slight coagulation abnormalities (moderate decrease in protein S, slightly elevated lipoprotein (a)), and elevated fibrinogen, with plasma hyperviscosity. DISCUSSION: The occurrence of CRVO then SD suggests that the same underlying conditions can be considered as risk factors for both diseases and shows up some similarities in the pathogenesis of these acute impairments of microvascular blood flow in the retina and the cochlea.

Macular grid photocoagulation in persistent macular edema due to central retinal vein occlusion.

AIM: Macular edema is still the main cause of poor visual prognosis in central retinal vein occlusion (CRVO). This study was designed to establish whether grid photocoagulation is effective in the management of this disorder. METHODS: The records of 16 patients who had undergone macular grid photocoagulation for persistent macular edema due to CRVO were reviewed retrospectively. Pre-treatment visual acuity ranged from 20/400 to 20/40, and laser treatment was done six months or more after the onset of the disease. RESULTS: Biomicroscopy and fluorescein angiography showed the improvement or disappearance of macular edema in 14/16 patients (87.5%). Improved visual acuity was observed in eight (50%) and no improvement or reduced vision in the other eight (50%). A poorer prognosis was statistically correlated with older age (p < 0.03), macular ischemia (p < 0.001), foveal avascular zone larger than 1/2 disc diameter (p < 0.05) and pigmentary clumps in the foveal area (p < 0.05). Laser treatment was ineffective for most patients with systemic vascular risk factors and pre-treatment visual acuity below 20/200. CONCLUSION: Macular grid photocoagulation may be effective for drying up, or at least reducing, macular edema due to CRVO and some improvement of vision can be expected in half the cases.

[Macular vitelliform degeneration in adults. Retrospective study of a series of 85 patients]. / Dégénérescence maculaire vitelliforme de l'adulte. Etude rétrospective d'une série de 85 patients.

Since 1974 (Gass), many publications have referred to a macular abnormality that is similar to Best's vitelliform dystrophy, but occurs in adults and shows a normal or subnormal electro-oculogram. In our retrospective study, 85 patients with adult macular vitelliform degeneration were included; 31 patients out of 85 have been followed-up for periods ranging from one to ten years. Women (62,3%) were predominantly affected; the median age was 61 years (ranging from 37 to 81 years); family history did not reveal others affected members except in one case (mother and her son affected); electro-oculogram was recorded in 12 patients and was normal (8 patients) or slightly subnormal (4 patients). During follow-up, vitelliform lesions have shown progressive changes over many years, resulting in a round or oval atrophic area in the central retinal pigment epithelium. Visual acuity was fair at presentation but decreased progressively: at presentation, 43% of the eyes had visual acuity better or equal to 0.6; after 1 year, 59%; after 2 years, 28.5%; after 4 years, 20%, and only 8% of those followed-up for 10 years. Impairment of vision was usually related to alteration of the retinal pigment epithelium and macular atrophy, sometimes to subretinal neovascularization (14 eyes of 12 patients out of 157, or 15% of patients), or rarely to macular edema (2 cases). Several aspects of this disease are still controversial: firstly, the problem whether or not the disease represents a single nosological entity; secondarily its dominant inheritance. The analysis of our cases and of those already published seems to show that the macular changes observed are related to a single disease, well-defined by the epidemiology, the clinical aspects, the natural course. The late onset of the disease, the lack of constant familial involvement and the similarity with other retinal degenerative disorders seem to suggest that vitelliform macular lesions may represent a distinct subgroup of age-related macular degeneration, with a possible genetic predisposition.

[Viral vasculitis and disseminated white spots]. / Vascularite virale et taches blanches disséminées.

A case of retinal vasculitis is reported, unusual because of its occurrence in a young healthy man, and especially because of the presence of a turn-over of white spots in the mid-peripheral retina, which faded and turned into areas of pigment epithelium changes. The patient presented with anterior uveitis with raised intraocular pressure, and then with vitritis, retinitis in the peripapillary area with involvement of the optic disc, vasculitis with perivascular sheathing and vascular occlusion. Clinical and laboratory investigations remained negative. The lesions regressed with antiviral treatment (Ganciclovir) and steroids. Final visual acuity was 20/400 due to optic disc atrophy and the development of an epimacular membrane. The authors discuss the differential diagnosis of retinal vasculitis related to immunological diseases or viral infection. In conclusion, this case may constitute a mild type of acute retinal necrosis syndrome.