Grid laser photocoagulation on decompensated retinal pigment epithelium: adjunct to treatment of choroidal neovascularization

Decompensated retinal pigment epithelium is believed to be the prime risk factor for development of exudative maculopathy and choroidal neovascularization. Simulataneous treatment of both choroidal neovascularization and decompensated retinal pigment epithelium has not been reported previously. Over a six-year period, we used argon laser photocoagulation to treat 78 eyes with age-related macular degeneration that had juxtafoveal choroidal neovascularization and decompensated retinal pigment epithelium. With fluorescein angiography, decompensated retinal pigment epithelium was characterized by late diffuse leakage around the macula, seen in addition to the typical leakage from choroidal neovascularization, either well or poorly defined. The choroidal neovascularization received standard laser treatment, and grid laser treatment was applied to the decompensated retinal pigment epithelium as well. Follow-up of 36 months or more was observed in 38 eyes; 27 [71%] of these eyes still had visual acuity of 20/200 or better at 36 months, and 11 [29%] had visual acuity less than 20/200. We suggest that whenever a juxtafoveal neovascular membrane is accompanied by decompensated retinal pigment epithelium in an eye with age-related macular degeneration, the treatment protocol should include grid pattern photocoagulation to the decompensated retinal pigment epithelium, in addition to the traditional treatment of choroidal neovascularization

Retinal toxicity of amiodarone

Amiodarone, a benzofuran derivative, is one of the most effective cardiac anti-arrhythmic agents. We describe a patient in whom changes in the retinal pigment epithelium developed, most likely as a result of prolonged amiodarone treatment. We suggest that patients taking high doses of amiodarone for extended periods of time have fundus examinations regularly as well as fluorescein angiography if retinal changes are suspected, or if visual complaints arise. Amiodarone, a benzofuran derivative, is described as perhaps the most effective single anti-arrhythmic drug for the treatment of refractory supraventricular and ventricular cardiac arrhythmias. Some ocular complications, such as corneal microdeposits, have been recognized for many years, and optic neuropathy caused by amiodarone was recently described as well. We describe a patient in whom changes in the retinal pigment epithelium [RPE] developed, most likely as a result of prolonged treatment with amiodarone

Detection of diabetic retinopathy: a tracer evaluating health services for non-insulin dependent diabetes mellitus patients

A tracer, sometimes called "a clinical indicator", is a measure that can be used as a guide to monitor and evaluate the quality of patient care. It is not a direct measurement, nor does it cover all aspects of services given. However, it is an index that identifies and evaluates issues that warrant greater attention. A tracer is a well-defined and frequently occurring problem for which there is an accepted treatment. Diabetic retinopathy is such a problem. We postulated that it could serve as a tracer to evaluate services provided to patients with non-insulin dependent diabetes mellitus [NIDDM] in terms of complications, prevention, and awareness of the condition. In a project to screen for diabetic retinopathy in the population of residents in a desert community, we used part of the findings of this large study as a potential tracer to evaluate the above mentioned variables. Diabetic retinopathy fulfilled the technical prerequisites to serve as a tracer for rating overall patient care in diabetes mellitus. Our study demonstrated that diabetic retinopathy can effectively and conveniently serve as a tracer to evaluate health care given to diabetics. We found that diabetic retinopathy is a common, yet under diagnosed, complication among patients with NIDDM