A Case of Severe Retinal Vaso-occlusive Disease in Systemic Lupus Erythematosus

Systemic lupus erythematosus(SLE) is a multisystem disorder in which the various organs are damaged by deposition of autoantibodies and immune complex. Ocular man-ifestations of SLE are involvement of the eyelids, conjunctiva, cornea, episclera, retina and optic nerve. Retinal vascular manifestations are the most common form of ocular manifestation. Most frequently these consist of cotton wool spots, retinal hemorrhage, but occasionally more severe retinal vaso'occlusive disease has been noted. The authors experienced 22 year'old woman who had SLE and severe retinal vaso'occlusive disease. Her left eye was treated with focal photocoagulation and vitrectomy but the visual acuity was F.C. 60 cm due to ischemic state of parafoveal capillary network. Right eye maintain visual acuity of 0.9 by photocoagulation and vitrectomy for vitreous hemorrhage and tractional retinal detachment. As shown in this case, the SLE patients who developed vitreous hemorrhage due to extensive retinal vaso-occlusive disease may have very poor visual prognosis. So periodic ocular examinations and appropriate treatment for vascular occlusion can prevent serious visual loss in SLE.

Rhegmatogenous Retinal Detachment with Spared Macula

We determined the ultimate anatomic success and visual outcome for rhegmatogenous retinal detachment with spared macula, and compared the preoperative findings and success rate with those involving the macula in the 445 eyes treated with scleral buckling for rhegmatogenous retinal detachment and the causes of decrease in visual acuity after operation were evaluated. Seventy-seven (67%) of the 115 eyes with rhegmatogenous retinal detachment with spared macula and 28 (8%) of the 330 eyes with that involving the macula had preoperative visual acuity of 0.3 or better. In comparision to the findings of the eyes with retinal detachment involving the macula, in the eyes with rhegmatogenous retinal detachment with spared macula the extent of retinal detachment was less, the retinal break was located more anteriorly, the demarcation line was less frequently noted, and the incidences of high myopia and lattice degeneration were higher. Postoperatively all 115 eyes with spared macula were anatomically reattached, 99 eyes (86%) had visual acuity of 0.3 or better and success rates were significantly better in comparison to those involving the macula (p<.05). Seventeen eyes had a significant decrease in visual acuity postoperatively, the causes included macular detachment after failure of the first operation, macular pucker, progression of cataract, etc.

Postoperative Amount of Correction for Esotropia

It is ideal to obtain good ocular alignment with the fewest number of procedures for surgical correction of strabismus. But the postoperative result is variable according to investigators due to various factors including the inaccurate preoperative measurement of deviation, surgeon's techniques and experiences as well as anatomic factors such as the size of globe, condition of extraocular muscle and postoperative tissue change. Thus we analyzed the change of deviation after surgical correction on 65 patients with esotropia at Kyung-Pook National University Hospital from January 1987 to December 1990. Of 65 patients, 32 were male, 33 were female and age distribution was from 11 months to 55 years. Preoperative angle of deviation was variable from 20 delta to 80 delta. Thirty five cases were congenital esotropia. 21 cases were acquired esotropia including partially accomodative esotropia and 5 cases were esotropia due to monocular visual disturbances. The change of deviation after surgical correction was 20.9 delta in monocular medial rectus recession group. 35.3 delta in bilateral medial rectus recession group. 42.3 delta in monocular medial rectus recession and lateral rectus resection group and 57 delta in bilateral medial rectus recession and unilateral lateral rectus resection group.

Postoperative Amount of Correction for Esotropia

It is ideal to obtain good ocular alignment with the fewest number of procedures for surgical correction of strabismus. But the postoperative result is variable according to investigators due to various factors including the inaccurate preoperative measurement of deviation, surgeon's techniques and experiences as well as anatomic factors such as the size of globe, condition of extraocular muscle and postoperative tissue change. Thus we analyzed the change of deviation after surgical correction on 65 patients with esotropia at Kyung-Pook National University Hospital from January 1987 to December 1990. Of 65 patients, 32 were male, 33 were female and age distribution was from 11 months to 55 years. Preoperative angle of deviation was variable from 20 delta to 80 delta. Thirty five cases were congenital esotropia. 21 cases were acquired esotropia including partially accomodative esotropia and 5 cases were esotropia due to monocular visual disturbances. The change of deviation after surgical correction was 20.9 delta in monocular medial rectus recession group. 35.3 delta in bilateral medial rectus recession group. 42.3 delta in monocular medial rectus recession and lateral rectus resection group and 57 delta in bilateral medial rectus recession and unilateral lateral rectus resection group.