Differences of adrenal stress control mechanisms in subjects with glaucoma and normal subjects. Effect of vasopressin and pyrogen.

Various types of glaucomatous and normal subjects were tested for the adequacy of the stress response of their hypothalamic-pituitary-adrenal axis to pyrogen and vasopressin. With pyrogen, a significant response of elevation of plasma cortisol levels was positively correlated with ocular pressure and changes of the optic disc. Those subjects with increased ocular pressure and optic disc cupping and pallor had greater rises of plasma cortisol levels. With vasopressin, a decreased response of plasma cortisol levels was negatively correlated with the degree of elevated ocular pressure. Those subjects with increased ocular pressure and lower tonographic outflow facilities had smaller rises of plasma cortisol levels. Both tests indicated a disturbance of the hypothalamic-pituitary-adrenal axis in subjects with glaucoma.

Removal of solid silicone rubber exoplants after retinal detachment surgery.

A prospective study of 255 eyes undergoing scleral buckling procedures with solid silicone rubber elements as exoplants disclosed a 1.2% incidence (three of 255 eyes) of buckling element removal after a minimum follow-up period of two years. This rate was lower than that reported in series using solid silicone rubber implants or sponge silicone rubber exoplants.

Posterior vitreous detachment and idiopathic preretinal macular gliosis.

A prospective study of 78 eyes with idiopathic preretinal macular gliosis disclosed that 74 of the 78 (95%) had posterior vitreous detachments at the time of the initial examination. A second prospective study of 34 eyes with acute posterior vitreous detachment showed preretinal macular gliosis in three eyes (9%) initially (zero to seven days) and in 14 eyes (41%) after an 18-month follow-up period. These two studies indicated that posterior vitreous detachment may play a role in the development of idiopathic preretinal macular gliosis.

Reversibility of the early stages of idiopathic macular holes.

Three patients had a history of unilateral acute visual loss accompanied by clinical and fluorescein angiographic findings compatible with foveal sensory retinal detachment secondary to vitreofoveal traction. The reversibility of this early stage of idiopathic macular hole formation in all three eyes was associated with spontaneous release of vitreofoveal traction and with improvement in visual acuity. A localized detachment of the vitreous from the sensory retina in the macula with an associated vitreous condensation overlying the macula was evident in all three cases.

Photocoagulation of nonproliferative exudative diabetic retinopathy.

We conducted a study of 35 patients with exudative diabetic retinopathy who chose to have laser photocoagulation and 35 similar controls who did not. The mean follow-up period was 17 months. A trend toward stabilizing and improving visual acuity was noted in the treated group, but the difference between groups was not significant.

Argon laser photocoagulation of inner wound vascularization after cataract extraction.

A 64-year-old man had vascular ingrowth of a surgical wound resulting in recurrent hyphema and pupillary block glaucoma three years after cataract extraction. Argon laser photocoagulation of an abnormal vessel in the inner lip of the wound resulted in complete clearing of a chronic hyphema, with a four-month follow-up. We used 500-micron laser spots of 2,000 mW and 0.5 seconds' duration to closr the vessels. This approach is recommended for its relative safety and simplicity.

Vitreous hemorrhages and disseminated intravascular coagulation in the newborn.

Of 164 consecutive newborns seen in consultations, three babies had either a preretinal or a vitreous hemorrhage, a rare occurrence. Two of these babies had a mild form of disseminated intravascular coagulation. The hemorrhages cleared within a few months after birth. Each of the three babies was premature, had a respiratory distress syndrome, and was born to a primiparous mother. The possibility of a coagulation defect causing intraocular hemorrhage in newborns should be considered along with the tranditional mechanical theories.

Malignant melanoma of the choroid in neurofibromatosis.

A 60-year-old white woman with generalized neurofibromatosis and multiple melanocytic hamartomas of the iris developed an unusual choroidal mass, with secondary sensory retinal separation in the left eye. Ophthalmoscopically the tumor had a peculiar donut configuration that was caused by a large focus of central necrosis within a spindle B melanoma.

Vitelliform macular dystrophy of late onset.

A family with vitelliform macular dystrophy is presented in which the proband became symptomatic at age 51 rather than during the more typical first or second decade. Elderly patients with vitelliform macular dystrophy may have clinical findings resembling age-related degenerative choroidopathy of the macula.

Natural history of senile disciform macular dystrophy.

Twenty-nine patients with severe visual loss in one eye from disciform macular dystrophy were prospectively studied for the incidence of visual loss in the fellow eye. Four developed such loss in the second eye during a mean period of follow-up of 32 months from the time of onset of visual loss in the first eye, an annual incidence rate of 5.2%. The degree of drusen and retinal pigment epithelial and subretinal pigment epithelial pathology correlated positively with the incidence of visual loss in the fellow eye.

The use of solid soft silicone rubber exoplants in retinal detachment surgery.

A method of retinal detachment surgery utilizing soft solid silicone rubber exoplants is described along with its use in typical cases. Solid silicone rubber, long used as a scleral implant, is a well-tolerated exoplant scleral buckling material which has been found to provide excellent long-term results. The surgical procedure described is relatively short in duration and has a minimum of operative and postoperative complications.

Occlusive microvascular retinopathy with optic disc and retinal neovascularization in acute lymphocytic leukemia.

BACKGROUND: Acute lymphocytic leukemia can be associated with an occlusive microvascular retinopathy. There is a potential for worsening of this occlusive microvascular retinopathy by radiation damage to the retinal vasculature (radiation retinopathy) and by the toxic effects of chemotherapy. METHODS: An 18-year-old woman with T-cell acute lymphocytic leukemia received low-dose irradiation to the brain and subsequent chemotherapy, which included cytosine arabinoside. RESULTS: During the chemotherapy, she developed severe bilateral occlusive microvascular retinopathy that progressed despite extensive panretinal photocoagulation to bilateral optic disc and retinal neovascularization and eventual traction retinal detachment involving the macula. CONCLUSION: The toxic effect of a chemotherapeutic agent such as cytosine arabinoside when combined with radiation retinopathy may be additive, leading to a much more severe ischemic retinal vasculopathy than one would encounter with acute lymphocytic leukemia alone. This must be kept in mind when planning combined radiation and chemotherapy for T-cell acute lymphocytic leukemia.

Optic disk findings in hypervitaminosis A.

Three cases of papilledema secondary to chronic excessive vitamin A intake are presented, and the optic disk changes are documented with intravenous fluorescein angiography. Two of the three patients reported in this study were symptomatic with blurred vision and systemic complaints. The symptoms of blurred vision and systemic complaints disappeared within one week, and papilledema resolved over several months after discontinuance of vitamin A. The fluorescein angiographic changes observed in the optic disk of patients with hypervitaminosis A are similar to those associated with other known causes of papilledema. Since vitamin A is a nonprescription drug, and its indiscriminate use is potentially great, any history of vitamin ingestion should be elicited during the evaluation of papilledema.