Macular Hole as a Risk Factor of Choroidal Detachment in Rhegmatogenous Retinal Detachment

PURPOSE: Choroidal detachment (CD) associated with rhegmatogenous retinal detachment (RRD) is a rare, but serious condition, which makes the prognosis worse. Previously reported risk factors for CD in RRD patients include high myopia, aphakia, pseudophakia, and advanced age. However, macular hole has not been discussed as an important factor in increasing the risk of CD in RRD patients. The purpose of this study was to evaluate macular hole as a risk factor for CD in eyes evidencing RRD. METHODS: The medical records of 480 patients with primary RRD were reviewed. We compared the CD incidence among the RRD patients in accordance with the presence or absence of macular holes. The relationship between gender, age, presence of systemic disease, refractive errors, lens status, intraocular pressure and the development of CD were also analyzed. RESULTS: The incidence (4/21 eyes, 19.0%) of CD in the RRD with macular hole was significantly higher than that (7/459 eyes, 1.5%) observed in the RRD without macular hole (p=0.010). The preoperative intraocular pressure (mean+/-SD; 2.5+/-1.3 mmHg) in the RRD with CD and macular hole was significantly lower than that (7.4+/-4.4 mmHg) observed in the cases of RRD with CD without macular hole (p=0.035). The eyes complicated by CD evidenced a higher prevalence of diabetes mellitus (p=0.024) than was observed in the eyes without CD. CONCLUSIONS: The retinal detachment combined with macular hole creates a predisposition toward the development of profound hypotony and CD.

Ultrastructure of the Optic Neuritis Induced by Herpes Simplex Virus-1 Injection in Rabbits

PURPOSE: This study was performed to investigate the ultrastructural changes of the optic nerve after intravitreal injection of herpes simplex virus-1. METHODS: Herpes simplex virus was separated from the culture media after observing the cytopathic effect on cultured vero cells. Viruses were then injected on the optic nerve head of 21 rabbit eyes. Eyes were enucleated at 1, 2, 3, 5, 7, 10, and 14 days after injection of herpes simplex virus and examined under the electron microscope. RESULTS: The intranuclear inclusion body was noted in eyes examined at 2 days after injection. The histopathological changes were perivascular infiltration of inflammatory cells, cytoskeletal degeneration of large diameter of myelinated nerve, demyelination of axonal nerve fiber, and the accumulation of mitochondria within axonal nerve fiber. CONCLUSIONS: These results suggest that optic neuritis may be induced by herpes simplex virus. The accumulation of mitochondria may be related to the interruption of the axonal transport through the axonal nerve fibers of optic nerve.

Junctional scotoma in giant cerebral aneurysm

A brain lesion located at the lateral side of the sella turcica can produce a junctional scotoma by compressing the ipsilateral optic nerve and the contralateral inferonasal nerve fiber. This study reports a female patient with a junctional scotoma caused by a cerebral aneurysm. At the initial visit, she complained of visual disturbance in both eyes and the right optic disc was atrophied. The visual field showed right blindness and left superotemporal quadrantopsia. A brain CT indicated an approximately 3 cm sized brain mass located superolateral to the sella turcica. The brain MRI showed the lesion to be more like an aneurysm than a pituitary adenoma. Therefore, 4 vessels angiography was done, and this lesion was confirmed to be a sellar variant of an aneurysm located at the right carotid siphon. Like a tumor of the optic chiasm, a cerebral aneurysm can cause visual disturbance and visual field defects. Therefore, an early differential diagnosis is important because the prognosis and treatment of an aneurysm differ.