Epiretinal membranes in sickle cell retinopathy.

We examined the hospital records (including fundus photographs) of 769 patients (1486 eyes) with sickle cell disease from June 1978 to July 1985 for evidence of epiretinal membranes in the macula (51 eyes) or extramacular region (four eyes) of the posterior pole. The incidence of epiretinal membranes, seen in the eyes of patients with hemoglobin SC, SS, and SB+ thalassemia, was 3.7%. Most epiretinal membranes were mild, and visual acuity was 20/40 or better in 78.2% of these eyes. Severe macular pucker was occasionally noted following retinal detachment surgery. One patient with SC disease developed a macular epiretinal membrane that led to a macular hole and eventually to macular and extra-macular retinal detachment. Epiretinal membranes are a relatively common cause of maculopathy in patients with sickle cell disease.

Diffuse unilateral subacute neuroretinitis.

The clinical syndrome of diffuse unilateral subacute neuroretinopathy (DUSN) has been characterised in its early and late stages. Different types of migrating worms in the subretinal and intraretinal space have been described as the cause of the clinical syndrome. We observed a patient with a long history of visual loss, vitritis, and a fundus of abnormal appearance where the worm was noted to migrate to different areas over the course of hours.

Combined internal drainage of subretinal fluid and choroidal detachment.

We describe a surgical technique to perform the intraocular drainage of choroidal hemorrhage with a flute needle. This procedure is performed at the time of the internal subretinal fluid drainage for a traumatic retinal detachment.

Leber's idiopathic stellate neuroretinitis.

Leber's idiopathic stellate neuroretinitis, originally known as Leber's stellate maculopathy, is an uncommon syndrome characterized by unilateral optic disc swelling followed by the development of a macular star due to leakage of capillaries within the optic disc. It is seen in patients 50 years of age or younger and usually resolves spontaneously without visual sequelae. This entity should be recognized and distinguished from more serious diseases causing septic neuroretinitis or papillitis. We present a case which was initially thought to be septic retinitis.

Lensectomy and vitrectomy in the presence of filtering blebs.

We describe a technique for preserving a filtering bleb in glaucoma patients undergoing pars plana lensectomy and vitrectomy. It involves making a conjunctival incision away from the filtering site and injecting the anterior chamber and bleb with (hyaluronic acid) Healon before vitreous surgery is begun.

Calbindins decreased after space flight.

Exposure of the body to microgravity during space flight causes a series of well-documented changes in Ca2+ metabolism, yet the cellular and molecular mechanisms leading to these changes are poorly understood. Calbindins, vitamin D-dependent Ca2+ binding proteins, are believed to have a significant role in maintaining cellular Ca2+ homeostasis. In this study, we used biochemical and immunocytochemical approaches to analyze the expression of calbindin-D28k and calbindin-D9k in kidneys, small intestine, and pancreas of rats flown for 9 d aboard the space shuttle. The effects of microgravity on calbindins in rats from space were compared with synchronous Animal Enclosure Module controls, modeled weightlessness animals (tail suspension), and their controls. Exposure to microgravity resulted in a significant and sustained decrease in calbindin-D28k content in the kidney and calbindin-D9k in the small intestine of flight animals, as measured by enzyme-linked immunosorbent assay (ELISA). Modeled weightlessness animals exhibited a similar decrease in calbindins by ELISA. Immunocytochemistry (ICC) in combination with quantitative computer image analysis was used to measure in situ the expression of calbindins in the kidney and the small intestine, and the expression of insulin in pancreas. There was a large decrease of immunoreactivity in renal distal tubular cell-associated calbindin-D28k and in intestinal absorptive cell-associated calbindin-D9k of space flight and modeled weightlessness animals compared with matched controls. No consistent difference in pancreatic insulin immunoreactivity between space flight, modeled weightlessness, and controls was observed. Regression analysis of results obtained by quantitative ICC and ELISA for space flight, modeled weightlessness animals, and their controls demonstrated a significant correlation. These findings after a short-term exposure to microgravity or modeled weightlessness suggest that a decreased expression of calbindins may contribute to the disorders of Ca2+ metabolism induced by space flight.

Cryptococcal choroiditis.

Two patients with acquired immune deficiency syndrome presented with headaches and fevers. A diagnosis of cryptococcal meningitis was made by lumbar puncture and elevated cryptococcal antigens. Complaints of decreased vision in both patients led to the diagnosis of optic disc edema and cryptococcal choroiditis with yellow-white choroidal infiltrates noted in both eyes of the two patients. Systemic treatment with amphotericin B and 5' flucytosine led to resolution of the choroidal infiltrates. Late visual acuity loss was believed to be secondary to optic atrophy.

Combined hamartomas of the retinal pigment epithelium and retina.

Combined hamartomas of the retinal pigment epithelium (RPE) and retina are rare, benign lesions usually occurring in individuals with no underlying systemic abnormalities. The authors report two cases of combined hamartomas of the RPE and retina. In one case, combined macular hamartomas of the RPE and retina were present in a 5-month-old infant. This is the earliest reported case of bilateral macular involvement. In both patients, multiple cafe-au-lait spots were present, and the diagnosis of neurofibromatosis was considered. The authors suggest that combined hamartomas of the RPE and retina are congenital lesions and may be one of the ophthalmic manifestations of the phakomatoses.

Iatrogenic choroidal neovascularization in sickle cell retinopathy.

Fifteen patients (16 eyes) with proliferative sickle retinopathy treated with argon or xenon arc feeder vessel photocoagulation had chorioretinal (CRN) or choriovitreal (CVN) neovascularization develop. These patients were followed from 2 1/2 to 11 1/2 years with a mean follow-up of 6 years and 8 months. Clinically important late complications of the choroidal neovascularization included vitreous hemorrhage (in three of eight patients with CVN). However, in only two of these three eyes was there any drop in vision related to residual vitreous hemorrhage, and this was limited to loss of only one line of Snellen visual acuity. Therefore, treatment is not usually recommended if CRN or CVN develops after intense photocoagulation. Vitreous fluorophotometry was performed on these patients to examine the breakdown of the blood-retinal barrier. This gave a quantitative measure of fluorescein leakage not obtained with fluorescein angiography. Midvitreous measurements, which are more representative of these peripherally located proliferative lesions than are pre-retinal measurements, suggest that vitreous fluorophotometry may be helpful in differentiating the higher leakage of CVN from the CRN.

Acute retinal necrosis.

Five patients with the acute stages of acute retinal necrosis underwent vitrectomy, with acyclovir in the infusion fluid, and the placement of a 360 degrees scleral buckle after intravenous therapy with acyclovir. Anatomic reattachment was achieved in all patients, and improvement over preoperative visual acuity was obtained in four. Recommendations for the treatment of acute retinal necrosis include a high index of suspicion in healthy patients with retinitis, early diagnosis, early intravenous therapy with acyclovir, early pars plana vitrectomy with the use of intravitreal acyclovir in the infusion fluid, and a 360 degrees scleral buckling procedure.

Alteration of the blood-retinal barrier and vitreous in sickle cell retinopathy.

Nineteen eyes with background sickle cell retinopathy, eleven from patients with SC disease, eight from patients with SS disease, and twelve eyes with proliferative sickle cell retinopathy were examined by direct and indirect ophthalmoscopy, slit-lamp, fluorescein angiography and vitreous fluorophotometry. Calculation of the alteration of the blood-retinal barrier (BRB) and estimation of the diffusion coefficients of fluorescein in the vitreous were performed by fluorophotometry. In background sickle cell retinopathy, the results show a normally functioning BRB in the posterior pole. Abnormally increased fluorescence values to the mid-vitreous (peripheral leakage) were found only in 3 of these 19 eyes, at the two-hour examination (all SC patients). Similarly, mid-vitreous fluorescence values at the two-hour examination were 4.19 +/- 1.52 ng/ml in eyes of patients with SC disease, compared with 2.65 +/- 0.56 ng/ml in eyes of patients with SS disease. All eyes with background sickle cell retinopathy, except one, showed values for the coefficient of diffusion of fluorescein within normal limits, indicating normal vitreous gel structure. In proliferative retinopathy, the mid-vitreous fluorophotometry readings were abnormally increased, correlating well with the extent of the peripheral angiographic changes (neovascularization). The coefficient of diffusion of fluorescein in the vitreous was generally increased in the eyes with proliferative retinopathy (15.0 +/- 8.4 X 10(-4) cm2/min) in comparison with a mean value of 5.4 +/- 1.4 X 10(-4) cm2/min in the eyes with background sickle cell retinopathy, suggesting an alteration of the vitreous structure eyes with proliferative retinopathy. Fluorophotometry is considered a useful tool to follow patients with sickle cell retinopathy by quantitating peripheral retinal vascular leakage.

Sympathetic ophthalmia and subretinal neovascularization.

We report a case of sympathetic ophthalmia with subretinal neovascularization of the macula. The subretinal neovascularization developed after penetrating trauma to the fellow eye. The occurrence of subretinal neovascularization in sympathetic ophthalmia is not surprising since disintegrative changes and breaks in Bruch's membrane have been reported in sympathetic ophthalmia. Subretinal neovascularization has also been reported in Vogt-Koyanagi-Harada syndrome, which is histopathologically similar to sympathetic ophthalmia.