Acute posterior multifocal placoid pigment epitheliopathy and cerebral vasculitis.

Four cases of suspected cerebral vasculitis have been described in association with acute posterior multifocal placoid pigment epitheliopathy, but none was confirmed histopathologically. We describe a patient who developed fatal cerebral vasculitis after placoid pigment epitheliopathy. Histopathologic data revealed a focal granulomatous inflammation of medium-sized arteries in the leptomeninges. Multinucleated giant cells were a conspicuous part of the inflammatory reaction. The cause of both placoid pigment epitheliopathy and cerebral vasculitis remains obscure.

Carbon monoxide retinopathy.

We recently examined three family members with acute carbon monoxide intoxication resulting from a single accidental exposure--a stepfather with a normal fundus, a mother with scattered superficial retinal hemorrhages, and her child with multiple large subinternal limiting membrane hemorrhages, peripapillary hemorrhages, severe venous tortuosity, and disc edema. All three had comparable carboxyhemoglobin levels and no evidence of hypertension, diabetes, or anemia. The different fundus presentations illustrated the variable clinical manifestations of carbon monoxide retinopathy. Early detection could prevent a lethal outcome.

In vivo corneal and conjunctival epithelial nuclear stain.

Epithelium plays a very important structural and functional role in the cornea and conjunctiva. Evaluation of the epithelium is the first step in diagnosing many pathologic states. We have developed a new technique for the in vivo staining of nuclei of corneal and conjunctival epithelium in rabbits and guinea pigs. Several drops of 0.01%, 0.1%, 0.25%, 0.5%, or 1.0% toluidine blue or 1.0% methylene blue were applied to the conjunctival sac to stain epithelial cells. The cells picked up the vital dye within 5 minutes and could be photographed at 30X with the Keeler-Konan wide-field specular microscope. Cells and nuclei were clearly observable. Photographs could be further enlarged to enhance details. Wash out time was rapid and no toxic effects were observed. This technique adds a new dimension to the study of epithelium in normal and pathologic states in experimental animals. This technique may also be applicable to human eyes for discerning such diseases as carcinoma, herpes simplex, or superior limbic keratoconjunctivitis.

Eye disorders: fluorescein angiography.

Fluorescein angiography of the ocular fundus has become a primary diagnostic tool in ophthalmology. It can be of great value in patients with visual loss without ophthalmoscopic abnormality.

Glaucoma. Some practical considerations on a common disease.

Chronic simple glaucoma and acute glaucoma are totally different in pathogenesis, symptoms, and treatment. Chronic simple glaucoma is asymptomatic until late in its course, and only by appropriate screening by primary care physicians can the incidence of irreversible visual loss due to this disease be reduced. The symptoms and signs of acute glaucoma are so characteristic that recognition is usually easy and treatment can be begun early enough to prevent permanent angle damage and secondary glaucoma.

Central retinal artery obstruction in herpes zoster ophthalmicus and cerebral vasculopathy.

We present a case of acute central retinal artery obstruction in association with Herpes zoster ophthalmicus and delayed cerebral vasculopathy. Retinal vascular obstruction is rare in zoster, and its occurrence during postherpetic cerebral vasculopathy has not been reported previously to our knowledge. The syndrome of delayed cerebral vasculopathy is discussed as is its possible relationship to central retinal artery obstruction.

Recognition of carotid stenosis with bilateral simultaneous retinal fluorescein angiography.

In order to study the arm to retina circulation time (ARCT), we simultaneously photographed both fundi in patients with suspected or known carotid artery occlusive disease. Noninvasive carotid artery tests, selective carotid arteriography, or both, were performed on all of the patients. In the 11 patients with arteriographically proven significant carotid stenosis, or with noninvasive carotid tests demonstrating carotid occlusive disease, a triad of fluoroangiographic features (delayed ARCT, disparity of ARCT between eyes, and delayed ciliary circulation at the optic disc) was found. We believe that bilateral simultaneous retinal fluorescein angiography is a sensitive and accurate method for the recognition of patients with carotid artery occlusive disease.

Cilio-optic vein associated with phakomatosis.

This presentation demonstrates the fluorescein angiographic characteristics of the cilio-optic vein. These congenitally enlarged vessels appear at the disc edge and dip into the optic nerve to anastomose with branches of the central retinal vein. Fluorescein angiography shows lamellar filling of the vessels in the early choroidal phase. In one patient, these findings are demonstrated bilaterally with the use of bilateral simultaneous angiography. A second type of communication is presented, a retinociliary vein which drains the retina into the choroidal circulation. In both types presented, a branching hypofluorescent pattern extends from the disc vessel into the choroid. Our patients have evidence of a phakomatosis: neurofibromatosis or Sturge-Weber syndrome. This anomalous disc vessel should not be confused with optociliary shunt, disc neovascularization, cilioretinal artery, or arteriovenous shunt.

Choroideremia in a genotypically normal female. A case report.

A 10-year-old girl demonstrated advanced choroideremia. She had decreased visual acuity, high myopia, and characteristic fundus findings of choroideremia. Her ERG, dark adaptation, visual fields, and fluorescein angiogram were all abnormal; the results were consistent with choroideremia. Her chromosome studies revealed that she was a genotypically normal female. Her parents were examined ophthalmologically and found to be normal.

Fluorescein angiography using ultra-high speed film.

We used a new ultra-high speed black-and-white film, Kodak T-MAX P3200 (ASA 3200), in routine fluorescein angiography on 51 patients and one normal volunteer. The increased film speed permitted a lower flash intensity than with other available films. Photophobia was improved subjectively in 25% of patients who had undergone prior angiography at a higher flash setting. In addition, patient cooperation was improved as evidenced by a decrease in the frequency of photographic artifacts and uninterpretable photographs compared with prior angiograms done using Kodak TRI-X Pan film (ASA 400). T-MAX yielded excellent resolution, but its grain size was slightly greater than that of TRI-X Pan. The use of ultra-high speed film and reduced light intensity may benefit the patient and improve photographic quality in some individuals with photophobia.