The nature, causes, and visual outcome of ocular trauma requiring posterior segment surgery at a county hospital.

Fifty consecutive, severe ocular trauma cases with posterior segment involvement underwent vitreoretinal surgery over a 14-month period at a county hospital. Forty-five (90%) of the patients were boys and men, and the mean age was 27 years. The injuries were the result of assaults in 37 cases (74%), industrial accidents in six (12%), accidents involving children at play in six (12%), and child abuse in one (2%). Twenty-five (50%) of the injuries were inflicted by firearms, by knives or sharp objects in ten (20%), by baseball bats in two (4%), by broken glass in two (4%), and unknown in 11 (22%). Twenty-six (52%) were penetrating injuries, of which eight were double perforations. There were ten (20%) intraorbital foreign bodies and three (6%) intraocular foreign bodies. Forty-three (86%) of the cases had initial visual acuities of 20/400 or worse. After a minimum of six months' follow-up, 48.8% improved two or more lines visually, and 69.4% were anatomic successes. Unlike other ocular-trauma studies, where industrial accidents and sports-related injuries were the most common causes of the trauma, assaults with firearms were the most common cause of ocular trauma at this county hospital. The visual and anatomic surgical results, however, were similar to those of other ocular-trauma studies.

Delayed diagnosis of diabetic retinopathy in black and Hispanic patients with diabetes mellitus.

We examined 51 black and 35 Hispanic consecutive patients with noninsulin-dependent diabetes mellitus from similar socioeconomic backgrounds who were evaluated initially for diabetic retinopathy. The mean ages were 58 years for the Hispanics and 53 years for the blacks (P greater than .05). Sixty-five percent of the Hispanics were women, as were 68.6% of the blacks (P greater than .05). The mean duration between the diagnosis of the diabetes mellitus and the initial diagnosis of the retinopathy was 11.5 years for the Hispanics and 12.2 years for the blacks (P = .671). The percentage of patients with severe diabetic retinopathy (preproliferative or proliferative) at the time of initial diagnosis was 42.9% for the Hispanics and 37.3% for the blacks (P greater than .10). Although no significant differences were found between the two groups, the high percentage of patients in both groups (42.9% and 37.3%) with severe diabetic retinopathy at the time of initial presentation suggests that earlier patient referral from primary-care physicians and better patient education about the need for earlier eye examinations should be encouraged in these two groups.

Incidence and characteristics of retinopathy of prematurity in a low-income inner-city population.

The authors have prospectively studied the incidence and nature of retinopathy of prematurity (ROP) in 159 consecutive preterm infants at an institution serving a predominantly black and Hispanic, low-income, inner-city population. Overall, ROP developed in 73 (46%) of the 159 patients. However, ROP developed in 54 (72%) of 75 patients with birth weight under 1200 grams. Significant high-risk factors observed were low birth weight (P less than 0.001), short gestation period (P less than 0.001), and extended supplemental oxygen administration period (P less than 0.001). Other significant factors were the presence of intraventricular hemorrhage (P less than 0.01) and respiratory distress syndrome (P less than 0.01). An additional factor observed to be significant for the development of severe ROP (stages III-V) was sepsis (P less than 0.01). Race and maternal history of substance abuse were not found to be significant factors. The unusually high incidence (72%) of ROP in low birth weight infants found in this study may be due to limited prenatal care and other maternal factors such as inadequate nutrition.

Risk factors associated with branch vs. central retinal vein occlusion.

Records of 145 consecutive central and 214 branch retinal vein occlusion (CRVO and BRVO) patients were reviewed retrospectively to determine the differences in risk factors associated with these two diseases. Mean ages and sex ratios of both groups did not differ significantly. Hypertension and hyperopia were significantly more prevalent in BRVO than in CRVO, and elevated intraocular pressure, elevated erythrocyte sedimentation rate (ESR), and a positive tuberculin skin test were significantly more prevalent in CRVO. We conclude that the causes of the ESR elevation are more significant risk factors for CRVO, and systemic hypertension and hyperopia continue to be the main risk factors for BRVO.

Differences in contributory factors among hemicentral, central, and branch retinal vein occlusions.

Hemicentral retinal vein occlusion (HRVO) is an anatomic variant of central retinal vein occlusion (CRVO) and thus different from branch retinal vein occlusion (BRVO). Therefore, the risk factors for HRVO should be similar to those of CRVO and different from those of BRVO. To test this, the authors compared 15 demographic and clinical variables of 28 HRVO patients with those of 117 CRVO and 214 BRVO patients. Mean age of onset and sex ratio were not significantly different among the groups. Elevated erythrocyte sedimentation rate (ESR) (P = 0.019) and elevated intraocular pressure (IOP) (P = 0.025) were significantly more prevalent in the HRVO than the BRVO group. In addition, when the authors compared CRVO with BRVO, elevated ESR (P = 0.003), elevated IOP (P = 0.015), and positive purified protein derivative (PPD) (P = 0.003) were significantly more prevalent in the CRVO than the BRVO group, whereas hypertension (P = 0.03) and hyperopia (P = 0.008) were significantly more prevalent in the BRVO group. However, of the variables tested between HRVO and CRVO patients, no significant differences were found.

Secondary causes of premacular fibrosis.

The records of 187 consecutive patients (206 eyes) with a diagnosis of secondary premacular fibrosis were reviewed. The mean patient age was 63.2 years; 96 (51.3%) patients were men. The most common surgical causes in 175 eyes were cataract extraction with or without implant, 73 (41.7%); scleral buckle, 33 (18.9%); both cataract extraction with implant and scleral buckle (in separate surgical sessions), 20 (11.4%); argon laser procedures, 17 (9.7%); and retinal cryopexy, 14 (8.0%). The most common nonsurgical causes in 31 eyes were blunt ocular trauma, 12 (38.7%); uveitis, 9 (29.0%); and retinal vein occlusion, 5 (16.1%). Initial visual acuity was 20/100 or better in 120 of the 206 eyes (58.3%). After a minimum follow-up period of 6 months (mean, 44.2 months), 72 of 101 eyes (71.3%) had stable or improved visual acuity without surgical intervention. Of 32 eyes that underwent vitrectomy with membrane stripping, 25 of 26 eyes (96.2%) followed for a mean period of 24 months (minimum, 6 months) had stable or improved visual acuity. Of 157 eyes that did not undergo vitrectomy, 143 (91.1%) had partial or complete posterior detachment. Fifty-eight of 148 eyes (39.2%) had angiographic cystoid macular edema; however, vitreous traction at the macula was not a significant cause of cystoid macular edema (CME) in these eyes.(ABSTRACT TRUNCATED AT 250 WORDS)

A review of 324 cases of idiopathic premacular gliosis.

We reviewed the records of 324 patients (395 eyes) seen between 1973 and 1987 with a diagnosis of idiopathic premacular gliosis. Mean age of onset was 64.6 years, 189 (58.3%) were women, and all but six patients were white. Initial visual acuity was 20/40 or better in 214 eyes (54.2%), 20/50 to 20/100 in 136 eyes (34.4%), and poorer than 20/100 in 45 eyes (11.4%). Follow-up examinations were made in 214 eyes. After a mean follow-up period of 33.6 months, 106 (49.5%) of the 214 eyes maintained a visual acuity within one line of initial visual acuity, 28 (13.1%) were more than one line better, and 80 (37.4%) were poorer. Partial or complete posterior vitreous detachment was present in 303 (84.9%) of the 357 eyes undergoing vitreous study; 43 (14.2%) of these 303 eyes had partial vitreous detachment with vitreous adhesion to the macula. Cystoid macular edema was present on angiography in 77 (20.6%) of 373 eyes undergoing fluorescein angiography; 20 (26.0%) of these 77 eyes had partial posterior vitreous detachment with vitreous adhesion to the macula, whereas only 23 (7.8%) of the 296 eyes without cystoid macular edema had such vitreous adhesion (P less than .001). Other findings were myopia in 116 of 367 eyes (31.6%) (103, or 88.8%, of the myopic eyes had posterior vitreous detachment), and increased intraocular pressure in 56 of 324 eyes (17.3%).

Factors associated with retinal-vein occlusion in Hispanics.

Sixty-eight foreign-born Hispanic patients with angiography-proven retinal-vein occlusion (RVO) and 50 age-, sex-, and race-matched controls were evaluated for systemic disease. Thirty of the RVO patients had central retinal-vein occlusion, and 38 had branch retinal-vein occlusion. Hypertension, the most commonly associated factor, was present in 66.2% of the RVO patients in contrast to 18% of the controls (P less than .001). Other factors which were more common in the RVO population included open-angle glaucoma (19.1% vs 8%), diabetes mellitus (16.2% vs 12%), and atherosclerotic heart disease (14.7% vs 10%); these, however, were not statistically significant (P greater than .05). Hyperlipidemia was present in 12% of the controls and 10.3% of the RVO group (P greater than .50). This is in direct contrast to reports of nonHispanic populations where hyperlipidemia has been reported to be present in up to 60% of RVO patients.