Radiation exposure: a new risk factor for idiopathic perifoveal telangiectasis.

OBJECTIVE: To examine the association between previous radiation exposure and idiopathic perifoveal telangiectasis (IPT). DESIGN: A multicentered, individually matched, case-control study design was used. PARTICIPANTS/CONTROLS: Sixty-five case subjects were matched with 175 control subjects. Individuals with unequivocal evidence of angiographically confirmed IPT were included as cases. Control subjects were matched for center, age, and gender. MAIN OUTCOME MEASURE: The main exposures of interest were a history of therapeutic head or neck irradiation and environmental radiation exposure. METHODS: A standardized questionnaire was administered to case and control subjects. Data were collected for the main exposures of interest as well as pertinent covariates. Conditional logistic regression was used to evaluate therapeutic and environmental radiation as risks for IPT. RESULTS: On univariate analysis, head or neck irradiation was associated with IPT (odds ratios [OR] = 4.15, 95% confidence interval [CI] = 1.30-13.24). While controlling for diabetes and family history of diabetes, IPT was found to be associated with both head or neck irradiation (OR = 4.06, 95% CI = 1.20-13.76) and with environmental irradiation (OR = 6.73, 95% CI = 1.06-42.74). CONCLUSIONS: This study presents a previously unreported association between prior radiation exposure and IPT.

Idiopathic polypoidal choroidal vasculopathy associated with retinal arterial macroaneurysm and hypertensive retinopathy.

BACKGROUND: Idiopathic polypoidal choroidal vasculopathy (IPCV), the posterior uveal bleeding syndrome, and multiple recurrent serosanguineous pigment epithelial detachments in black women are a heterogeneous group of related entities seen in elderly hypertensive females. Similar associations are known for retinal arterial macroaneurysm (RAM). METHODS: This report documents the clinical, fluorescein, and indocyanine green videoangiographic findings of two elderly black female hypertensive patients who presented with IPCV, RAM, and hypertensive retinopathy. RESULTS: Clinical, fluorescein, and indocyanine green videoangiographic analysis of these two patients revealed hypertensive retinopathy, RAM, and anomalous polypoidal vascular networks associated with focal "bead-string" constrictions, terminal vascular loops, and polypoidal and pinpoint choroidal nodules. CONCLUSION: Certain subgroups of IPCV and related entities and RAM may be pathophysiologically related as analogous hypertensive insults to the choroidal and retinal vascular beds.

Use of digitized fluorescein angiogram system to evaluate laser treatment for subretinal neovascularization: technique.

In patients with subretinal neovascular membranes (SRNVM), persistence of the SRNVM after laser treatment is a major cause of decreased visual acuity. Persistence is associated with inadequate initial laser treatment. A technique using a digitized fluorescein angiogram (DFA) system is presented that allows immediate evaluation of the adequacy of laser treatment for SRNVM. This involves overlaying a red-free photograph taken after treatment on a fluorescein angiogram taken before treatment using a digital angiogram system that evaluates the adequacy of treatment. A protocol for augmentation of laser treatment has been developed that will aid in the reduction of persistence after laser treatment of SRNVM.

Surgical intervention for combined retinal-retinal pigment epithelial hamartoma.

A young woman was followed for over 20 years with a macular combined hamartoma of the retina and retinal pigment epithelium. When vision deteriorated due to contracture of an overlying epiretinal membrane, a pars plana vitrectomy with removal of the membrane was performed. Decreased vascular tortuosity and retinal vascular leakage resulted in postoperative improvement of visual acuity. Selected patients with combined retinal and retinal pigment epithelial hamartomas may benefit from removal of epiretinal membranes.

Acute leukemia presenting as a unilateral exudative retinal detachment.

The leukemias commonly involve the eyes and adnexae. It is unusual, however, for leukemia to present with visual complaints. Furthermore, there are only rare case reports of leukemic patients presenting with bilateral exudative retinal detachments. We report a unique case of a boy who presented with visual loss due to a unilateral exudative retinal detachment. A systemic evaluation discovered acute lymphocytic leukemia (ALL). There was rapid settling of the exudative detachment and improvement in vision while the patient received chemotherapy and radiotherapy for the ALL.

Choroidal neovascularization associated with choroidal nevi.

We observed choroidal neovascularization with associated macular detachment in three cases of benign choroidal nevi. Successful obliteration of the neovascular membranes was performed with argon laser photocoagulation with maintenance of good central visual acuity.

Reversible bilateral simultaneous papillitis with no light perception.

This 14-year-old patient with bilateral simultaneous papillitis experienced no light perception in either eye for 24 hours and had a complete recovery of central and peripheral vision 3 weeks later. Fluorescein angiography confirmed the diagnosis. Although her hospital work-up was negative except for a mildly elevated CSF protein, it seems most likely that this was a postviral syndrome based on the bilaterality, rapid recovery of vision, and the age group.

Acute posterior multifocal placoid pigment epitheliopathy associated with an adenovirus type 5 infection.

A 19-year-old black man with acute posterior multifocal placoid pigment epitheliopathy had concurrent positive viral cultures and rising antibodies to adenovirus type 5. This finding, considered together with earlier reports of viral-like syndromes accompanying the disease, supports the implication of a respiratory virus as a possible etiologic factor.

Photocoagulation in venous occlusive disease.

Fifty-one eyes with branch or tributary retinal venous occlusive disease underwent photocoagulation (1970-1973) after certain criteria were met: reduced visual acutity, fluorescein angiographic documentation of vessel permeability changes, and either dye leakage into the macula or neovascularization of the retina, or both. Eighty-four percent of the eyes responded to treatment with an improvement or stabilization in visual acuity, a reduction in collateral vessel caliber and permeability, and reduced dye accumlation in the macular area and increased fluorescein transit time. Photocoagulation is an affective means of reducing macular edema resulting from vascular compensatory changes following venous occlusion and decreases the risk of vitreous hemorrhage from sites of retinal neovascularization.

Photocoagulation of active and inactive lesions of presumed ocular histoplasmosis.

Argon laser photocoagulation was employed in 27 eyes with presumed ocular histoplasmosis. Thirteen eyes with active macular lesions had stable or improved visual results (72%).