The effect of complement factor H Y402H polymorphism on the outcome of photodynamic therapy in age-related macular degeneration.

PURPOSE: Photodynamic therapy (PDT) has been widely used in the treatment of age-related macular degeneration (AMD). The complement cascade has an important role in the tissue reactions occurring after PDT. The Y402H polymorphism of the complement factor H (CFH) gene has been identified as a risk factor for AMD. Since CFH is central in the regulation of the complement system the authors wanted to analyze whether the CFH Y402H polymorphism modifies the PDT outcome in AMD. METHODS: A total of 88 patients having been treated with PDT and without further scheduled PDT sessions were analyzed. Depending on the situation at their final PDT session the patients were classified retrospectively as PDT-responders or PDT-nonresponders. All patients were genotyped for the CFH Y402H polymorphism. RESULTS: The proportion of PDT-responders was 18/26 (69.2%) in patients homozygous for the CFH Y402H risk allele, 34/50 (68.0%) in heterozygous, and 7/12 (58.3%) in patients with the normal genotype (p=0.520). The median number of PDT treatments of the PDT-responders was three for all the genotypes. CONCLUSIONS: The dysfunction of the CFH related to the risk of AMD and caused by the Y402H polymorphism does not modify the outcome of PDT. Genotyping for CFH Y402H cannot be used to select patients for this treatment.

Retinoids increase urokinase-type plasminogen activator production by human retinal pigment epithelial cells in culture.

PURPOSE: To examine the effect of two retinoids, all-trans-retinoic acid (tretinoin) and all-trans-9-(4-methoxy-2,3,6- trimethylphenyl)-3,7-dimethyl- 2,4,6,8-nonatetraenoic acid (acitretin) on the production of plasminogen activators and plasminogen activator inhibitors by human retinal pigment epithelial cells in culture. METHODS: Cultures of human retinal pigment epithelial cells were incubated with either of the retinoids at a concentration of 1 microM for 24-72 hours. The media were assayed using solid-phase immunocapture assays and zymography. RESULTS: Both retinoids caused a twofold to sevenfold increase in urokinase-type plasminogen activator in the medium. The effect was seen after 24 hours in culture and was further augmented up to 72 hours. No significant amounts of tissue-type plasminogen activator were detected. The plasminogen activator inhibitor activity was unaffected by the retinoids. Proliferation and morphology of retinal pigment epithelial cells were also unaffected by the retinoids in incubations for up to 72 hours. CONCLUSIONS: Retinoids profoundly affect the extracellular proteolysis of retinal pigment epithelial cells in culture. This effect may be related to the differentiation-inducing activity of retinoids seen in other cell types, often connected with changes in extracellular proteolysis. It is possible that retinoids may modulate dedifferentiation, proliferation, and migration of retinal pigment epithelial cells seen in vitro, as well as in the pathogenesis of retinal disease.

Corneal structure and sensitivity in type 1 diabetes mellitus.

PURPOSE: Corneal wound healing is impaired in diabetic cornea. The purpose of this study was to examine patients with type 1 diabetes mellitus for changes in corneal morphology and to correlate corneal sensitivity, subbasal nerve morphology, and degree of polyneuropathy with each other. METHODS: Forty-four eyes of 23 patients with diabetes and nine control eyes were included. Corneal sensitivity was tested with a Cochet-Bonnet esthesiometer (Luneau, Paris, France), and corneal morphology and epithelial and corneal thickness were determined by in vivo confocal microscopy. The density of subbasal nerves was evaluated by calculating the number of long subbasal nerve fiber bundles per confocal microscopic field. The degree of polyneuropathy was evaluated using the clinical part of the Michigan Neuropathy Screening Instrument (MNSI) classification, and retinopathy was evaluated using fundus photographs. RESULTS: A reduction of long nerve fiber bundles per image was noted to have occurred already in patients with mild to moderate neuropathy, but corneal mechanical sensitivity was reduced only in patients with severe neuropathy. Compared with control subjects the corneal thickness was increased in patients with diabetes without neuropathy. The epithelium of patients with diabetes with severe neuropathy was significantly thinner than that of patients with diabetes without neuropathy. CONCLUSIONS: Confocal microscopy appears to allow early detection of beginning neuropathy, because decreases in nerve fiber bundle counts precede impairment of corneal sensitivity. Apparently, the cornea becomes thicker in a relatively early stage of diabetes but does not further change with the degree of neuropathy. A reduction in neurotrophic stimuli in severe neuropathy may induce a thin epithelium that may lead to recurrent erosions.

Clinically successful contact transscleral krypton laser cyclophotocoagulation. Long-term histopathologic and immunohistochemical autopsy findings.

OBJECTIVE: To report long-term histopathologic findings 10 months after contact transscleral krypton cyclophotocoagulation. METHODS: The tissue response in a successfully treated eye was analyzed by light microscopy and a panel of 11 antibodies to epithelial, mesenchymal, and inflammatory cells. RESULTS: A 75-year-old man with uncontrolled angle recession glaucoma was treated with transscleral contact krypton cyclophotocoagulation (17 burns, 3.5 J each) 10 months before his death. The intraocular pressure fell from 28 to 17 mm Hg 6 months after therapy. Confluent scars straddled the posterior pars plicata and the anterior pars plana. The ciliary processes were destroyed, but the sclera and zonules were intact. Vimentin and cytokeratin 8 and 18 persisted in the degenerated ciliary epithelium. The inner connective-tissue layer and the ciliary muscle had atrophied, as shown with antibodies to the HNK-1 epitope, desmin, and alpha-smooth-muscle actin. Macrophages with phagocytized pigment and single T cells were present instead. No unusual inflammatory infiltrate was present in the choroid of either eye. CONCLUSIONS: Clinically effective ablation of ciliary processes is achieved with contact krypton laser. Little chronic inflammation and no signs of sympathetic ophthalmia were present. Atrophy of the ciliary muscle may reduce accommodative capacity in younger patients undergoing cyclophotocoagulation.

Peripheral retinal angiomalike lesion and macular pucker.

We interpreted clinical data on five eyes with preretinal macular fibrosis (macular pucker) in association with a solitary angiomalike lesion in the peripheral retina. One angioma was associated with von Hippel-Lindau disease, and the others were regarded as acquired sporadic angiomas occurring in otherwise healthy persons. Regression of the vascular mass occurred as a result of transscleral cryopexy in four eyes and by argon laser in one eye. After treatment, the macular pucker was stabilized, but regression of the preretinal membrane did not occur. The visual acuity improved after cryotherapy in one eye, and in two eyes visual improvement occurred after vitrectomy and membrane removal.

Experimental retinal and ciliary body photocoagulation using a new 670-nm diode laser.

PURPOSE: Evaluation of ocular tissue reactions to 670-nm diode laser. METHODS: Twelve eyes of 12 pigmented rabbits were used. Transscleral contact laser delivery of a new 670-nm diode laser was used to produce retinal laser lesions in four rabbits; endolaser application of this laser produced photocoagulation of the retina in another four rabbits; and ciliary body lesions were produced by transscleral application of this laser in a third group of four rabbits. The rabbits were killed either 2 days or 1, 3, or 6 weeks later; lesions were evaluated by gross examination and histology. RESULTS: The mildest visible retinal lesions were produced by transscleral contact application at 0.2 J (2 seconds, 100 mW); explosive lesions began at 0.6 J. The mildest visible lesions were produced by endolaser application at 50 mW (spot size, 0.5 mm); intensive reactions started to occur at 300 mW, but no explosive lesions were produced below 600 mW. With contact transscleral application, substantial ciliary body reactions occurred at 0.5 and 1.0 J. Histologic examination disclosed destruction of the outer retina, pigment epithelium, and parts of the choroid in mild lesions, and of all retinal layers in the intense lesions. CONCLUSIONS: In this experimental study, the 670-nm diode laser appears to be a promising modality for laser photocoagulation of the retina and ciliary body.

Disappearance and formation rates of microaneurysms in early diabetic retinopathy.

AIM: To analyse the formation and disappearance rates of individual microaneurysms in mild background retinopathy. METHODS: Three fluorescein angiograms were taken at 1 year intervals during a 2 year follow up from 24 type 1 diabetics with mild background retinopathy. Microaneurysms were identified and localised twice from each angiogram using a computerised system for retrieval of the coordinates for each microaneurysm. Microaneurysms identified similarly in both sessions were then processed further to obtain rates of microaneurysm formation and disappearance, and microaneurysm count changes. RESULTS: In the whole material the total number of microaneurysms increased from 298 to 436 from baseline to 2 years. During the 2 year follow up 395 new microaneurysms formed and 258 microaneurysms disappeared. Of the microaneurysms present at baseline 174 (58%) were still present at the 1 year and 142 (48%) at the 2 year follow up. In patients with good glucose control (HbA1c < or = 7.5 mmol) microaneurysm formation showed a trend of being decreased whereas microaneurysm disappearance did not correlate with glucose control. CONCLUSION: Background diabetic retinopathy is a dynamic process. A significant proportion of microaneurysms present disappear within 2 years. This is compensated for by formation of new microaneurysms, the resultant net changes in microaneurysm counts being small. Microaneurysm formation and disappearance rates are new variables of diabetic retinopathy and may prove to be more sensitive indicators of the progression patterns of background diabetic retinopathy than microaneurysm count changes.

Correlation between Octopus perimetry and fluorescein angiography after strontium-90 plaque brachytherapy for subfoveal exudative age related macular degeneration.

AIM: To evaluate the correlation between the central visual field and changes in fluorescein angiography and fundus photography in patients treated with strontium plaque radiotherapy for subfoveal exudative age related macular degeneration (AMD). METHODS: Octopus program 34 automated static perimetry, fluorescein angiography, and colour fundus photography were performed on 19 patients at baseline and at 12 months after strontium-90 plaque therapy. A schematic picture outlining the areas of hyperfluorescent neovascular membranes and subretinal blood was drawn of a projected 30 degrees fundus fluorescein angiogram. This drawing was superimposed on the size adjusted Octopus visual field. The changes in retinal sensitivity were calculated and related to angiographic changes. RESULTS: Three of the 19 patients had a reliability factor (RF) > 15% and were excluded from further analysis. In the remaining 16 patients the mean defect (MD) and loss variance (LV) values remained unchanged in patients showing regression of the choroidal neovascular membrane (CNVM) to irradiation at 12 months. MD was 7.7 (SD 1.7) at baseline and 7.6 (1.9) at 12 months (p = 0.86), and LV was 32.6 (13.9) at baseline and 32.4 (15.7) at 12 months (p = 0.94). However, in patients with progression of the CNVM at 12 months, both the MD and LV increased significantly during the 12 month follow up (MD from 7.3 (2.9) to 13.1 (3.6) (p = 0.05) and LV from 31.0 (22.9) to 71.8 (24.1) (p = 0.017)). When comparing the mean retinal sensitivity in the area of the primary CNVM (including classic, occult, and haemorrhagic components), the results were analogous: in patients with a regression of the CNVM after irradiation the mean sensitivity remained almost unchanged. It was 10.3 (6.4) dB at baseline and 9.4 (7.3) dB at 12 months (p = 0.58). In five out of 11 patients (45%) with regression of the CNVM, the mean retinal sensitivity even improved by 2.0-5.0 dB in the area of the original lesion during follow up. Instead, in patients showing progression of the CNVM at 12 months, there was a significant loss in mean retinal sensitivity--from 9.9 (4.6) dB at baseline to 1.0 (1.1) dB at 12 months (p = 0.019). The mean retinal sensitivity in the area of the irradiated but clinically normal retina during follow up was not significantly altered (21.5 dB at baseline, 19.7 dB at 12 months (p = 0.10)). CONCLUSIONS: Regression of subfoveal choroidal membranes in AMD after focal strontium irradiation is connected with stabilisation or even improvement of retinal sensitivity in central visual field measured by automated perimetry. Strontium plaque irradiation does not change the sensitivity in clinically normal paramacular retina during a 12 month follow up.

Radiation related complications after ruthenium plaque radiotherapy of uveal melanoma.

AIMS/BACKGROUND: To analyse radiation related complications and secondary enucleation after irradiation of malignant uveal melanoma with ruthenium-106 plaques. METHODS: A series of 100 consecutive eyes irradiated in 1981-91 was analysed using the life table method and the Cox proportional hazards model. The median apical and scleral tumour dose was 100 Gy (range 15-200 Gy) and 1000 Gy (range 200-1200 Gy), respectively. The median follow up time was 2.8 and 2.0 years (range 1 month to 10 years) for anterior and posterior segment complications, respectively. RESULTS: The 3 and 5 year probabilities of being without radiation cataract were 73% and 63%, without neovascular glaucoma 91% and 81%, without vitreous haemorrhage 83% and 74%, without radiation maculopathy 85% and 70%, and without radiation optic neuropathy 90% and 88%, respectively. The risk of radiation cataract was highest with large tumour size (T1 + T2 v T3, p = 0.0027; height < or = 5 v > 5 mm, p = 0.029; largest basal diameter (LBD) < or = 15 v > 15 mm, p < 0.0001) and location of anterior tumour margin anterior v posterior to the equator (p = 0.0003); the risk of neovascular glaucoma with large size (T1 + T2 v T3, p = 0.039; LBD < or = 15 mm v 15 mm, p = 0.021); and the risk of maculopathy and optic neuropathy with proximity of the posterior tumour margin to the fovea and the optic disc (< or = 1.5 v > 1.5 mm; p = 0.030 and p = 0.0004, respectively). In Cox's multivariate analysis the strongest risk indicator for radiation cataract (RR 1.5, 95% CI 1.4-1.6) and vitreous haemorrhage (RR 1.6, 95% CI 1.4-1.8) was the height of the tumour; for neovascular glaucoma the TNM class (RR 6.2, 95% CI 2.7-13.8); for radiation maculopathy location of posterior tumour margin within 2 mm from the fovea (RR 3.4, 95% CI 2.0-6.0); and for radiation optic neuropathy location of tumour margin within 1 DD of the optic disc (RR 6.1, 95% CI 3.0-12.4). The 3 and 5 year probabilities of avoiding enucleation were 92% and 85%, respectively. Ten eyes were enucleated--six because of recurrent tumour growth, three because of treatment complications, and one because of mistakenly suspected extraocular growth. CONCLUSION: The results suggest that the frequency of radiation related complications after ruthenium brachytherapy of uveal melanoma is acceptable, in particular as regard irradiation of small and medium sized tumours for which ruthenium therapy generally is recommended.

Retinal breaks before and after neodymium:YAG posterior capsulotomy.

PURPOSE: To determine the frequency of asymptomatic retinal breaks before and after neodymium:YAG (Nd:YAG) laser posterior capsulotomy. SETTING: Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. METHODS: Of 350 consecutive patients referred for their first laser Nd:YAG posterior capsulotomy, 235 eligible eyes were enrolled and 220 eyes completed the study. A vitreoretinal surgeon looked for retinal breaks using binocular indirect ophthalmoscopy with scleral indentation. The eyes were examined 1 week before and 1 hour and 1 month after the posterior capsulotomy. The number, type, and location of retinal breaks were recorded. RESULTS: The median age of eligible patients who did not participate in the study was higher than that of enrolled patients (79.6 versus 74.4 years; P =.0005). The mean axial length, median time from cataract surgery, and the course of cataract surgery were comparable in both groups. Before the posterior capsulotomy, an untreated retinal break was diagnosed in 4 of the 235 eyes (1.7%; 95% confidence interval [CI] 0 to 4) scheduled for surgery and an undiagnosed retinal detachment was present in 2 additional eyes (0.9%; 95% CI 0 to 3). An asymptomatic retinal break was also present in 4 fellow eyes (1.7%, 95% CI 0 to 4). No new breaks developed during Nd:YAG posterior capsulotomy using a median total energy of 51 mJ (range 10 to 901 mJ) and a median number of 22 applications (range 4 to 341 applications) and resulting in an opening with a median largest diameter of 3.4 mm (range 2.0 to 4.6 mm). In 1 treated eye (0.4%; 95% CI 0 to 2), a new retinal break had developed by 1 month postoperatively. CONCLUSIONS: The observed 2.1% frequency of asymptomatic retinal breaks that had escaped the attention of the referring ophthalmologist or had developed by 1 month after Nd:YAG posterior capsulotomy can be contrasted with the 0.5% to 2.0% frequency of retinal detachment reported in the literature. However, it is not known which proportion of such asymptomatic breaks, if any, will progress to detachment after Nd:YAG laser posterior capsulotomy.

Transscleral contact krypton laser cyclophotocoagulation for treatment of posttraumatic glaucoma.

PURPOSE: To evaluate the usefulness of the krypton laser for transscleral contact cyclophotocoagulation in the treatment of posttraumatic glaucoma. PATIENTS AND METHODS: A total of 18 eyes of 18 patients with therapy-resistant posttraumatic glaucoma treated with krypton laser cyclophotocoagulation from 1991 to 1996 were included in this review. The krypton laser was delivered by a fiberoptic probe with simultaneous compression of the sclera. The energy used was 3 to 5 J per application at the tip of the probe, with an exposure time of 10 seconds. The treatment covered 90 to 360 degrees of the ciliary body with approximately 10 applications per quadrant. RESULTS: With one or more cyclophotocoagulation treatments, the intraocular pressure decreased from the baseline mean (+/- standard deviation) of 32.6 +/- 12.8 mm Hg to 23.6 +/- 10.3 mm Hg (n = 17) at 1 month, to 21.8 +/- 7.5 mm Hg (n = 13) at 3 months, to 22.5 +/- 7.6 mm Hg (n = 13) at 6 months, and to 19.6 +/- 10.5 mm Hg (n = 18) at the last control visit (mean, 19.4 months; range, 3 weeks to 73 months) after cyclophotocoagulation but no other glaucoma procedure. At baseline, 17 (94%) of 18 patients were taking glaucoma medication, as were 15 (83%) of 18 patients at the last control visit. One (6%) case of phthisis occurred. CONCLUSIONS: Krypton laser cyclophotocoagulation is an effective and reasonably well tolerated means of lowering intraocular pressure in posttraumatic glaucoma. Because of the refractory nature of the disease, repeated treatments may be needed.

Tissue-type plasminogen activator in subretinal fluid.

The plasminogen activation system is quantitatively the major mechanism of extracellular proteolysis. To evaluate its role in retinal detachment, plasmin and plasminogen activators were measured in subretinal fluid (SRF) from 12 eyes of twelve patients. Plasmin was detected in 5 eyes (mean 6.26 micrograms/ml, SD = 3.7 micrograms/ml). Tissue-type plasminogen activator was present in 5 eyes (mean activity 0.33 IU/ml, SD = 0.24 IU/ml) but the activity did not associate with the plasmin activity in all of the SRF samples. Urokinase-type plasminogen activator was not detected in SRF. We conclude that the plasmin system has been activated in SRF in some eyes with retinal detachment with tissue-type plasminogen activator as the predominant activator. Plasmin in SRF may enhance dispersion of pigment epithelial cells into the subretinal space and the vitreous, a phenomenon seen frequently in eyes with retinal detachment.

Grading choroidal neovascular membrane regression after strontium plaque radiotherapy; masked subjective evaluation vs planimetry.

PURPOSE: To analyze angiographic changes in choroidal neovascular membranes (CNVM) after strontium-plaque (90Sr) irradiation for exudative age-related macular degeneration (AMD) using masked measurement of the CNVM areas and a masked subjective comparison of CNVM size and leakage. METHODS: We studied the baseline, 3, 6, and 12-month angiograms of 19 eyes treated with 90Sr-plaque irradiation for exudative AMD. The area of CNVM-related hyperfluorescence was measured quantitatively, and the angiograms were subjectively evaluated by a masked grader. RESULTS: In 7 of the 19 eyes the CNVM-related hyperfluorescence was too scattered to be analyzed by planimetry but masked subjective grading correlated with the clinical response to irradiation. In the remaining 12 eyes, the CNVM decreased in size in 67% of the eyes and showed leakage in 67%. Planimetry and subjective assessment of the size and leakage of the CNVMs similarly reflected the regression after irradiation. CONCLUSIONS: CNVM size and leakage frequently diminish after 90Sr-plaque irradiation. Quantitative measurement of the CNVM areas, or a grading system based on masked subjective assessment, give similar results for evaluating these changes. Masked subjective grading can be used even in cases where the CNVM is too scattered to be outlined for planimetry.

Visual outcome of eyes with malignant melanoma of the uvea after ruthenium plaque radiotherapy.

BACKGROUND AND OBJECTIVE: To analyze the overall visual outcome in 100 consecutive eyes with malignant uveal melanoma irradiated with ruthenium-106 plaques between 1981 and 1991. PATIENTS AND METHODS: The follow-up ranged from 4 months to 10.1 years (median 3.0 years). Scattergrams of equal follow-up periods, life-table survival analysis, and Cox's proportional hazards analysis were used to analyze visual outcome. RESULTS: VA increased for some time in 14 eyes. By 3 years, VA of at least 20/70, 20/200, counting fingers, and light perception were retained in 27%, 41%, 67% and 82% of eyes, respectively. Macular pathology cause loss of reading vision; neovascular glaucoma or enucleation caused loss of light perception. In univariate analysis, large tumor size (height > 5 mm or TNM class T3) predicted visual loss of all VA levels. For the loss of light perception, the tumor's largest basal diameter > 15 mm reached significance. In Cox's multivariate analysis tumor height > 5 mm was the only significant independent risk indicator for loss of VA levels 20/70 and 20/200. For the level CF, largest basal tumor diameter also reached significance, but location of the tumor within 1 disc diameter of the optic disc, either alone or in addition to the fovea, had the greatest risk ratio (6.3, 95% CI 4.1-9.8). For losing light perception, large TNM size (T3) was the strongest risk indicator (risk ratio 10.0; 95% CI 4.5-22.5), followed by proximity of the tumor to the optic disc (risk ratio 4.3, 95% CI 2.4-7.8). CONCLUSION: Ruthenium brachytherapy may retain vision in an eye with a malignant melanoma of the uvea for a considerable period of time. The data presented are useful in patient counseling and allow comparison to subsequent series.

Inflammatory markers and retinopathy in pregnancies complicated with type I diabetes.

AIM: The relation of maternal cytokine levels to retinopathy progression during diabetic pregnancy is a less studied subject. Therefore, we investigated levels of systemic proinflammatory markers, C-reactive peptide (CRP), interleukin-6 (IL-6) and circulating vascular cell adhesion molecule-1 (VCAM-1) during pregnancy and postpartum in relation to the progression of diabetic retinopathy (DR). METHODS: A prospective follow-up study of 39 pregnant women with Type I diabetes and eight nondiabetic pregnant women was performed. DR was graded from fundus photographs. Plasma levels of systemic proinflammatory markers were measured by immunofluorometric assay (CRP) and by enzyme-linked immunosorbent assay (IL-6 and VCAM-1) in the first, second (diabetics only), third trimester of pregnancy, and 3 and 6 months postpartum (diabetics only). RESULTS: Our diabetic women had good glycaemic control (HbA1c 6.9 +/- 0.8). The levels of IL-6, VCAM-1, and CRP did not differ between diabetic and nondiabetic women throughout pregnancy and postpartum (repeated measures ANOVA between the groups). An association between CRP and progression of retinopathy was observed in diabetic women (P = 0.037). Additional evidence of inter-relationship could be revealed as CRP was higher in those diabetic women with worse glycaemic control (HbA1c) (P = 0.038). CONCLUSIONS: During pregnancy and postpartum, levels of proinflammatory factors (IL-6, CRP, VCAM-1) seem to be generally similar in Type I diabetic women compared to nondiabetic controls. However, CRP levels were higher in those diabetic women with progression of retinopathy and in those with worse glycaemic control.

Reduction of plasma renin substrate after parturition; role of renin.

Plasma renin substrate concentration, renin activity, serum sex hormone binding globulin and total protein concentration were measured sequentially in 10 women after elective caesarean section. Plasma renin substrate concentration decreased from 5406 +/- 000 micrograms AI/l (mean +/- SD) at term to 2369 +/- 726 micrograms AI/l 6 days post partum. Plasma renin activity decreased from 6.2 +/- 3.3 micrograms AI/l/h at term to 4.2 +/- 4.0 micrograms AI/l/h 6 days after delivery. Serum sex hormone binding globulin decreased more slowly than plasma renin substrate concentration. Clearance of plasma renin substrate based on plasma renin activity was calculated. This consumption by renin could explain only 12% of the decrement in plasma renin substrate concentration at the steepest part of the plasma renin substrate disappearance curve. It is concluded that metabolic clearance of plasma renin substrate may be much greater than that calculated from plasma renin activity.

Multiple evanescent white dot syndrome.

Multiple small infiltrates deep in the retina were found in three previously healthy patients aged 21-28 years in association with a mild non-specific acute infection. In two patients the lesions were uniocular, in one patient both eyes were affected. Both posterior pole and midperiphery were involved. In two cases the optic disk was slightly swollen. Due to macular lesions the visual acuity on admission varied from 0.1 (6/60) to 0.6 (6/10). On fluorescein angiograms the lesions were initially hypofluorescent and later slightly hyperfluorescent. No causative agents were discovered. All lesions resolved in 4-8 weeks without treatment, leaving faint pigment dispersion or, more commonly, no visible scars, and the visual acuity recovered to 1.0 (6/6).