Retinal integrity in human babesiosis: a pilot study.

BACKGROUND: Prior case reports and animal studies have reported on potential ophthalmologic complications of babesiosis, but this issue has not previously been addressed in a cohort of patients with babesiosis. This cross-sectional descriptive pilot study evaluated the retinas of patients with acute babesiosis to determine if retinal abnormalities are a feature of the disease. METHODS: We screened all patients admitted to Yale New Haven Hospital with laboratory confirmed babesiosis during the summer of 2023 and obtained informed consent. Patients were interviewed and underwent pupil dilation and a retinal examination using an indirect ophthalmoscope. Demographic and clinical information were obtained by questionnaire and through chart review. RESULTS: Ten patients underwent retinal eye exams with results that were generally unremarkable. No study patients showed any signs of retinal inflammation, infection, retinal bleeding, retinal tears, or abnormal vessel formation that could be attributed to infection. CONCLUSION: This small study did not find evidence of retinopathy in patients with babesiosis. Further studies with larger populations, repeated exams, and long term follow up will further elucidate the potential small vessel complications of human babesiosis.

Serum and vitreous vascular endothelial growth factor levels in diabetic retinopathy.

PURPOSE: To research whether serum vascular endothelial growth factor (VEGF) levels could be used to evaluate diabetic retinopathy (DR) progression and to compare vitreous VEGF levels after injections of intravitreal bevacizumab (IVB), ranibizumab (IVR), and triamcinolone acetonide (IVTA) in proliferative diabetic retinopathy (PDR). METHODS: We enrolled a total of 91 eyes of 89 subjects (70 eyes of 68 diabetics and 21 eyes of 21 non-diabetic controls). The diabetic subjects were divided into three groups as PDR (n = 28), non-proliferative diabetic retinopathy (n = 20), and no-DR (n = 20). Eyes with PDR (n = 31) were injected with IVB (n = 7), IVR (n = 10), or IVTA (n = 6) 3 days before vitrectomy, and eight eyes did not receive an injection. Serum and vitreous samples were collected before vitrectomy and analyzed using ELISA. RESULTS: We found the severity of retinopathy was not correlated with serum VEGF levels (P = .919, ρ = -0.011). Compared with the controls, vitreous VEGF was higher in the PDR (P < .001), whereas serum VEGF did not differ (P = .99). The controls had lower vitreous VEGF than the IVB, IVR, and no-injection subgroups (P = .01, P < .001, and P = .04, respectively). Vitreous VEGF was similar among the injected and no-injection subgroups (P = .17). CONCLUSIONS: Serum VEGF levels may not directly reflect retinopathy progression. Neither IVB, IVR nor IVTA could eliminate vitreous VEGF levels within 3 days before vitrectomy.

EFFECTS OF INTRAVITREAL RANIBIZUMAB AND BEVACIZUMAB ON THE RETINAL VESSEL SIZE IN DIABETIC MACULAR EDEMA.

PURPOSE: The goal of this study was to assess the effects of a single injection of intravitreal ranibizumab (RAN) or bevacizumab (BEV) on the retinal vessel size in eyes with diabetic macular edema. MATERIALS AND METHODS: In total, 32 patients were enrolled in the RAN group, and 30 patients were included in BEV group. Each of these groups was also subdivided into two others groups: a study group and a control group. The study groups were composed of the injected eyes, whereas the noninjected fellow eyes served as the control groups. The patients underwent complete ophthalmic examinations, including optical coherence tomography and fundus fluorescein angiography, and the primary outcome measures included the central retinal artery equivalent, central retinal vein equivalent, and artery-to-vein ratio. RESULTS: In the RAN study group (n = 32), the preinjection mean central retinal artery equivalent (175.42 µm) decreased to 169.01 µm after 1 week, and to 167.47 µm after 1 month (P < 0.001), whereas the baseline central retinal vein equivalent (235.29 µm) decreased initially to 219.90 µm after 1 week, and to 218.36 µm after 1 month (P < 0.001). In the BEV study group (n = 30), the preinjection central retinal artery equivalent (150.21 µm) decreased to 146.25 µm after 1 week, and to 145.89 µm after 1 month (P < 0.001); whereas the baseline central retinal vein equivalent (211.87 µm) decreased initially to 204.59 µm after 1 week and was 205.24 µm after 1 month (P < 0.001). The preinjection artery-to-vein ratio values changed significantly (P = 0.001) after 1 week and after 1 month in the RAN group, but no significant alteration in the artery-to-vein ratio was observed in the BEV group (P = 0.433). In both the RAN (n = 32) and BEV (n = 30) control groups, none of the 3 parameters changed throughout the study period, when compared with the baseline. CONCLUSION: The results of this study showed that both RAN and BEV injections significantly constricted the retinal blood vessel diameters.

Comparative Retinal Vessel Size Study of Intravitreal Ranibizumab and Bevacizumab in Eyes with Neovascular Age-Related Macular Degeneration.

PURPOSE: The aim of this paper was to assess and compare the effects of intravitreal ranibizumab and bevacizumab on retinal vessel diameter in eyes with neovascular age-related macular degeneration (AMD). METHODS: Patients with neovascular AMD who underwent intravitreal injection of either ranibizumab or bevacizumab were included. Noninjected fellow eyes served as a control. The main outcome measures were central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and the artery-vein ratio (AVR). RESULTS: In the ranibizumab group, the mean CRAE value decreased significantly at 1 week and 1 month (p = 0.002). The AVR value decreased significantly at 1 month (p = 0.028). CRVE values did not change at 1 week and 1 month (p = 0.083). In the bevacizumab group, the preinjection CRAE, CRVE, and AVR values did not change through the study period (p = 0.128, p = 0.600, and p = 0.734, respectively). CONCLUSION: These results suggest that intravitreal ranibizumab led to significant retinal arteriolar vasoconstriction in eyes with neovascular AMD.

INTRAVITREAL BEVACIZUMAB IN THE TREATMENT OF CHOROIDAL NEOVASCULAR MEMBRANE DUE TO ANGIOID STREAKS.

PURPOSE: To investigate the results of intravitreal bevacizumab for choroidal neovascularization (CNV) secondary to angioid streaks and to assess the factors influencing disease progression. METHODS: Patients treated with intravitreal bevacizumab (1.25 mg/0.05 mL) for CNV secondary to angioid streaks were reviewed retrospectively. In addition to demographic findings, ophthalmologic findings at baseline and during follow-ups were recorded. RESULTS: Twenty-three eyes of 20 patients (mean age, 45.7 years; 7 women) were included in the study. Mean follow-up was 23 months. Mean number of injections was 5.1. Initial and final logMAR visual acuity was not different (0.53 ± 0.33 and 0.60 ± 0.40 logMAR, P = 0.79). At the last examination, patients with final active CNV (N = 14) were younger (mean age, 42 years) than patients with final inactive CNV (N = 9) (mean age, 52 years). The former group required higher number of injections (6.6 vs. 2.8, P = 0.013). Eyes with pseudoxanthoma elasticum (N = 10) needed injections every 4.4 months while the others (N = 13) every 7.2 months (P = 0.072). Pseudoxanthoma elasticum positivity ended up with active membranes in 70% of the cases, composing half of the overall final active CNVs in this study. CONCLUSION: Intravitreal bevacizumab stabilized vision in eyes with CNV and angioid streaks. At younger ages, CNV behaved more aggressively and seemed to be more resistant to treatment.

Ocular complication after trichloroacetic acid peeling: a case report.

UNLABELLED: Chemical peeling is a noninvasive technique currently used more frequently as a cosmetic procedure. Trichloroacetic acid (TCA) is one of the most popular chemical agents used for this purpose Stuzin et al. (Clin Plast Surg 20:9-25, 1993). Although this application commonly is used for the whole face, including the eyelids, the data in the literature referring to ocular complications if TCA leaks into the eye and the injury treatment thereafter are too sparse. The authors therefore report the treatment procedure and follow-up evaluation for a patient who sustained a chemical injury to the eye during rhytidectomy combined with TCA peeling. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Intravitreal slow-releasing dexamethasone implant for idiopathic neuroretinitis.

INTRODUCTION: The purpose of this report is to describe a successful management of idiopathic neuroretinitis with intravitreal dexamethasone implant. METHOD: Interventional case report. CLINICAL CASE: A 34-year-old man with an acute painless unilateral vision loss, optic disc swelling, and a macular edema was diagnosed as idiopathic neuroretinitis, and he underwent 0.7 mg dexamethasone intravitreous implant injection. Macular edema responded quickly and visual acuity improved from 20/50 to 20/25 within 2 weeks and to 20/20 within a month. One month after the injection, optic disc edema disappeared. No recurrence occurred and visual acuity was stable at 20/20 during 3 years of follow-up. CONCLUSION: Idiopathic neuroretinitis can be treated with intravitreal dexamethasone implant.

Exploration of fluoroquinolone-induced retinal pigment epithelium layer changes in the pathogenesis of macular degeneration.

PURPOSE: Fluoroquinolone toxicity studies in animals (cats, rabbits and mice) showed that acute retinal degenerations appear clinically related to phototoxicity. The aim of this study was to evaluate the association between the administration of oral fluoroquinolone and the onset of clinically or subclinically detectable acute retinal degeneration in humans. MATERIAL AND METHODS: This study included patients that received oral fluoroquinolone treatment (ciprofloxacin, levofloxacin or moxifloxacin) for variable systemic diseases diagnosed by the Department of Urology and Infectious Diseases (study group, n=76), and age and sex matched otherwise healthy subjects (control group, n=50). All the subjects underwent a detailed ophthalmologic examination including tests for visual acuity, intraocular pressures, color vision, photostress recovery time and contrast sensitivity measurements, central foveal thickness, subfoveal choroidal thickness, ganglion cell complex thickness and 10/2 Humphrey visual field test. Color fundus and fundus autofluorescence photographs were also obtained. Examinations and tests were repeated at 1st week and 1st month in the study group. RESULTS: There was no statistically significant difference among visual acuity, intraocular pressure, photostress recovery time, color vision, contrast sensitivity measurements, central foveal thickness, subfoveal choroidal thickness, average ganglion cell complex thickness, superior ganglion cell complex thickness, inferior ganglion cell complex thickness, focal loss volume, global loss volume, mean deviation, pattern standard deviation values in treatment group at baseline, 1st week and 1st month (p > 0.05, for the comparison of each parameters). There was not any alteration among color fundus and fundus autofluorescence photographs obtained at baseline, 1st week and 1st month in treatment group. All parameters within the study and control groups were similar throughout the study period (p > 0.05, for the comparison of each parameter). CONCLUSION: This study evaluated the association between the administration of oral fluoroquinolone and the onset of acute retinal degeneration. Preliminary results of this study showed that use of oral fluoroquinolone had no detectable impact on retinal degeneration at acute phase.

Idiopathic and secondary epiretinal membranes: do they differ in terms of morphology? An optical coherence tomography-based study.

PURPOSE: The purpose of this study was to define the morphologic differences in idiopathic and secondary epiretinal membranes (ERMs) using a time domain optical coherence tomography. METHODS: The medical records and optical coherence tomography images of 293 eyes of 236 consecutive patients diagnosed to have ERM were evaluated retrospectively. Demographic features, best-corrected visual acuities, central macular thickness, membrane attachment patterns, macular changes, and the presence of posterior retinal detachment at the time of diagnosis were compared between the groups (idiopathic group, n = 125 eyes; secondary group, n = 168 eyes). RESULTS: The mean age was higher among idiopathic ERMs (67 ± 9 vs. 62 ± 10 years, P = 0.001). In the secondary group, best-corrected visual acuity was estimated to be worse (P < 0.001) and central macular thickness higher (P = 0.02) than the idiopathic group. In both groups, ERMs were mostly diagnosed at Grade 1 level. Diffuse attachment was more common in both of the groups. Among macular changes, only cystoid macular degeneration differed significantly between the groups (P = 0.0001). CONCLUSION: Idiopathic and secondary ERMs were estimated to differ significantly at the time of diagnosis in terms of age, visual acuities, macular thickness, presence of cystoid macular degeneration, and posterior vitreous detachment. These parameters may assist the retinal surgeon in the treatment process of ERM.

Intraocular Pressure Change and Sustained Intraocular Pressure Elevation After Pars Plana Vitrectomy.

OBJECTIVES: The aim of this study was to investigate the incidence and influential factors of changes in intraocular pressure (IOP) and sustained IOP elevation (SIOPE) after an uncomplicated pars plana vitrectomy (PPV). METHODS: In all, 41 eyes of 41 patients who underwent PPV due to the presence of epiretinal membrane, macular hole, or vitreomacular traction syndrome were included in the study. In the vitrectomized eye, an elevated IOP of ≥21 mmHg or an increase of ≥6 mmHg from the preoperative IOP on 2 or more postprocedure visits or the addition of a new IOP-lowering medication during follow-up was defined as sustained IOP elevation. The results of procedures performed with a 20-G instrument and a 23-G instrument were compared. RESULTS: The mean postoperative IOP was significantly higher than the preoperative IOP in vitrectomized eyes (preoperative IOP: 15.2±3.1 mmHg; postoperative 1st month: 17.4±5.8 mmHg, p=0.018; 6th month: 17.3±2.6 mmHg, p=0.02; 12th month: 16.7±2.6 mmHg, p=0.020). While no significant difference in IOP was detected between the vitrectomized and fellow eyes preoperatively, the IOP was significantly higher in the vitrectomized eyes in the 1st, 6th, and 12th months (p=0.040, p <0.001, p <0.001, respectively). SIOPE was detected in 15 vitrectomized eyes (37%) and 1 fellow eye (2%). The postoperative first day IOP was significantly lower in the vitrectomized eyes (11.1±6.1 vs 15.4±2mmHg; p<0.001) and significantly lower in the 23-G group than the 20-G group (9.3±5.2 vs 15.7±5.8; p=0.001). CONCLUSION: IOP may rise significantly in comparison with the fellow eye or the preoperative IOP, even after an uncomplicated PPV. SIOPE and preoperative IOP values should be taken into consideration in addition to cross-sectional IOP findings in the evaluation of PPV.

Pneumatic displacement of acute submacular hemorrhage with and without the use of tissue plasminogen activator.

PURPOSE: To evaluate the efficacy of C(3)F(8) gas-assisted pneumatic displacement in the treatment of massive submacular hemorrhage, with and without the use of tissue plasminogen activator (tPA). METHODS: Twenty-one eyes of 21 patients with recently developed (up to 10 days) dense submacular hemorrhage underwent intravitreal injection of pure C(3)F(8) gas (0.4-0.5 mL) followed by face-down positioning for pneumatic displacement. Seven of them received additional intravitreal injection of 25-50 microg tPA. The primary etiology of submacular hemorrhage was age-related macular degeneration (n=16), myopic choroidal neovascularization (n=2), retinal arterial macroaneurysm (n=2), and trauma (n=1). Visual acuity and displacement of hemorrhage were the main outcome measures. RESULTS: Follow-up period was 6-12 months. Effective displacement of hemorrhage was obtained in 20 of 21 patients within 7 days. Final median Snellen visual acuity (0.18) was found significantly improved compared to baseline (0.03) (p<0.001). Visual acuity improvement was similar in both groups (p=0.72). CONCLUSIONS: Intravitreal injection of C(3)F(8) effectively displaced thick submacular hemorrhage and improved visual acuity independently from primary cause. Additional tPA use in this study had no impact on the final outcomes.

Pars plana vitrectomy results of exogenous endophthalmitis in children.

PURPOSE: To identify the etiology, culture results, pars plana vitrectomy results, complications, and visual outcome of exogenous endophthalmitis in children. METHODS: Seven eyes of 7 consecutive pediatric patients who were treated and followed up for exogenous endophthalmitis between February 2006 and June 2008 were included in this study. The etiology of endophthalmos was penetrating eye injuries in 4 eyes and intraocular surgery in 3 eyes. Combined pars plana vitrectomy and intravitreal vancomycin plus ceftazidime injection were performed on all 7 eyes. Anterior chamber fluid and vitreous cultures were taken from all eyes. The patient files were inspected retrospectively. RESULTS: Mean follow-up time was 10.3 months (4-16 months). Mean age of the patients was 8.5 years (3-14 years). At baseline, visual acuity values of the patients were light perception (n=2), hand movements (n=4), and counting fingers from 1 meter (n=1). At final examination, visual acuity improved in 5 eyes, stayed the same in 1 eye, and decreased in 1 eye. Positive culture results were obtained in 3 eyes: alpha hemolytic Streptococcus (n=2) and coagulase-negative Staphylococcus (n=1). Complications seen after vitreoretinal surgery were transient ocular hypertension, emulsification of silicone oil, phthisis bulbi, and secondary retinal detachment. CONCLUSIONS: Early pars plana vitrectomy and intravitreal vancomycin plus ceftazidime injection improved anatomic and functional success in pediatric eyes with exogenous endophthalmitis.

Photodynamic therapy for iatrogenic CNV due to laser photocoagulation in central serous chorioretinopathy.

The authors report the result of photodynamic therapy for iatrogenic choroidal neovascularization from focal argon laser photocoagulation in a case with central serous chorioretinopathy. A 45-year-old woman who developed choroidal neovascularization after focal argon laser photocoagulation for chronic central serous chorioretinopathy was treated with ocular photodynamic therapy with verteporfin. Choroidal neovascularization became inactive clinically a month after photodynamic therapy. Fluorescein angiography and optical coherence tomography demonstrated the resolved choroidal neovascularization. Baseline visual acuity improved from 20/40 to 20/20 after photodynamic therapy. The patient's condition remained stable 2 years postoperatively. Photodynamic therapy was beneficial for the outcome of iatrogenic choroidal neovascularization that developed after laser treatment for longstanding central serous chorioretinopathy.

Comparison of conventional and torsional mode (OZil) phacoemulsification: randomized prospective clinical study.

PURPOSE: To compare the amount of intraoperative energy used during conventional and torsional phacoemulsification surgery and investigate the changes in corneal endothelial cell density. METHODS: In this study, a total of 100 eyes in patients with age-related cataract (mean age 68.9 years) were included. Patients were randomly allocated into conventional (group 1) or torsional (OZil, group 2) phacoemulsification. Mean nuclear grade made according to Lens Opacities Classification System II was not different in the 2 groups. Total ultrasound time (USTT), cumulative dissipated energy (CDE), and the percent of total equivalent power in position 3 (%USTEPiP3) were compared between the 2 groups. RESULTS: There were 47 eyes in group 1 and 53 eyes in group 2. Patient age and sex were matched between the 2 groups (p=0.49, p=0.08). Mean USTT was 1.6+/-1.1 minutes (m) in group 1 and 1.5 +/- 0.9 m in group 2 (p=0.55). Average CDE was 29.9+/-16.9 in group 1 and 25.2+/-19.1 in group 2 (p=0.20).Mean %USTEPiP3 was 27.0%+/-8.5% in group 1; however, it was 22.4%+/-6.6% in group 2 (p=0.003). At the first postoperative day, mean corneal edema was graded as 0.25+/-0.5 in group 1 and 0.18 +/- 0.4 in group 2 (p=0.47). At the first postoperative week, it was found to be 0.02+/-0.15 in group 1 and 0.03+/-0.27 in group 2 (p=0.71). ECD loss was 6.7%+/-3.3% in group 1 and 4.2%+/-5.7% in group 2 (p=0.56). CONCLUSION: No statistically significant difference was found between conventional and torsional phacoemulsification with respect to USTT and CDE. Torsional mode led to a significant reduction in US power in footswitch position 3. Torsional mode also appears to be associated with less loss of ECD.

Corneal ablation with new 193 nm solid-state laser: preliminary experiments.

PURPOSE: To assess the ability of a newly developed 193 nm solid-state laser to ablate the cornea. SETTING: Osaka University, Osaka, Japan. METHODS: A prototype laser engine was developed by combining a 1547 nm laser diode, fiber amplifiers, and 5 stages of a frequency-conversion system using CsLiB6O10 crystals as the last stage. Poly(methyl methacrylate) (PMMA) plates were exposed to the prototype laser beam to determine the relationship between the fluence and ablation rate. Laser irradiation of porcine corneas was performed to induce morphological changes, and the quality of the lesions was determined by light and scanning electron microscopy. RESULTS: The relationship between the fluence and ablation rate of the 193 nm solid-state laser was comparable to that of the argon-fluoride excimer laser. Light and scanning electron microscopy of the porcine corneas showed that the linear and square lesions had sharp, clean edges. CONCLUSIONS: Smooth ablations of PMMA plates and porcine corneas were obtained by the laser. Further investigations must be conducted to determine whether this laser can be an alternative laser source for keratorefractive surgery.

Retinal Vascular Caliber Changes After Topical Nepafenac Treatment for Diabetic Macular Edema.

PURPOSE: To assess changes in retinal vascular caliber in response to short-term use of nepafenac eye drops in patients with mild diabetic macular edema. MATERIALS AND METHODS: Thirty-four patients with previously untreated bilateral mild diabetic macular edema were included in this prospective study. For each participant, one eye was randomly assigned to nepafenac treatment (0.1%, three times/day) and the other eye was left untreated throughout the study. Using digital fundus photographs, retinal vascular calibers were calculated and compared in treated and untreated eyes at the baseline, week 1, and week 6. RESULTS: Baseline vessel diameters did not differ in treated and fellow eyes (p > 0.05). Over the 6 weeks of the study, significant vasoconstriction of the retinal arteriolar caliber was observed at weeks 1 (p < 0.05) and 6 (p < 0.05), while an unchanged retinal venular caliber was noted between the treated and untreated eyes (p > 0.44). Significant macular thickness difference was only observed at week 6 (p = 0.002). CONCLUSIONS: Topical nepafenac has a significant narrowing effect on the retinal arteriolar diameter and a significant reductive effect on central macular thickness in eyes with mild diabetic retinopathy.

Diabetic vitrectomy: influence of lens status upon anatomic and visual outcomes.

OBJECTIVE: To determine the effect of lens status upon the anatomic and visual results in primary diabetic vitrectomy. DESIGN: Retrospective, comparative, consecutive case series. PARTICIPANTS: One hundred two eyes of 85 patients with proliferative diabetic retinopathy and its complications that underwent primary vitrectomy. METHODS: The eyes that remained phakic after vitrectomy were compared with the eyes that were either aphakic or pseudophakic (nonphakic) postoperatively. MAIN OUTCOME MEASURES: Intraoperative and postoperative complications, vitreoretinal reoperation rate, and ultimate anatomic and visual success with at least 6 months' follow-up. RESULTS: Preoperatively, 72 eyes were phakic, and 30 were aphakic (n = 1) or pseudophakic (n = 29). During vitrectomy, 1 eye underwent lensectomy and 12 eyes underwent phacoemulsification with lens implantation. Postoperatively, 59 eyes were phakic and 43 eyes were nonphakic. The vitreoretinal reoperation rate was significantly higher (P = 0.04) for the phakic group (28.8%) than for the nonphakic group (11.6%). Rubeosis iridis developed in 3 phakic eyes and no nonphakic eyes (P = 0.26). Intraoperative complications were similar in the phakic and nonphakic groups (P = 0.40). Postoperative complications such as rhegmatogenous retinal detachment (P = 0.39), nonclearing vitreous hemorrhage (P = 0.07), and anterior chamber complications (P = 0.60) were also similar. Visual acuity improved by at least 0.2 logarithm of the minimum angle of resolution units in 76.2% of the phakic eyes and 86.0% of the nonphakic eyes (P = 0.22). CONCLUSIONS: Eyes that were phakic after primary diabetic vitrectomy had a significantly higher subsequent vitreoretinal reoperation rate when compared with nonphakic eyes, suggesting that diabetic eyes are less likely to require additional vitreoretinal surgery if they are rendered nonphakic before or during vitrectomy.

Pheochromocytoma presenting with bithalamic infarction, dementia, and increased intraocular pressure.

The authors describe a case of pheochromocytoma presenting with bithalamic infarction, dementia, and elevated intraocular pressure. The patient received glaucoma treatment to suppress high intraocular pressure in addition to antihypertensive and antidiabetic medication for his complaints. Bilateral fundus examination and visual field defects revealed glaucoma-like changes. Adrenelectomy improved all complaints and all medications were stopped. Intraocular pressure and visual field changes improved. Pheochromocytoma presenting with bithalamic infarction, dementia, and increased IOP in the same patient is unusual. Adrenelectomy can improve dementia, increased IOP, and glaucoma-like changes in such cases.

Spontaneous separation of epiretinal membrane in a child with Stargardt macular dystrophy.

We demonstrate optical coherence tomography findings of spontaneous separation of an epiretinal membrane associated with Stargardt macular dystrophy in a child. A period of observation seems appropriate in eyes with an epiretinal membrane associated with Stargardt's disease, as the membrane may show spontaneous release and the macular area may improve.