Ocular involvement in tumoral calcinosis.

We report a 32-year-old male who presented with blurring of vision in the right eye since 1.5 years. He had history of swelling over the extensor surfaces of large joints which were migratory in nature. Few of them spontaneously subsided following suppuration of chalky white discharges except over the gluteal region. Ophthalmological examination revealed visual acuity of counting fi ngers (CF) at 1 m in the right eye and perilimbal conjunctival calcifi c deposits and retinal angiod streaks in both eyes. There was choroidal neovascular membrane with subretinal hemorrhage in right eye, confirmed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). B scan ultrasonography and simultaneous vector A scan detected calcifi cation of the subretinal neovascular membrane and the adjoining sclera.

Ultrastructural Features of Surgically Excised Idiopathic Subretinal Neovascular Membrane

Subretinal neovascular membrane is the direct cause of visual impairment in various macular lesions. The aim of this study is to understand the pathophysiology of subretinal neovascular membrane by ultrastructural study. Six cases of surgically excised idopathic subretinal neovascular membrane were examined ultrastructurally. The vascular channels, which were lined by endothelial cells and surrounded by pericyte or retinal pigment epithelium, were the main feature of subretinal neovascular membrane. Other cellular components were retinal pigment epithelium, myofibroblast containing melanosome, chronic inflammatory cells including macrophages, histiocytes, plasma cells and lymphocytes, fibrocytes and outer segments of photoreceptor cells. Considereing that the development of subretianl neovascular membrane is similar to the wound healing process, it is suggested that pathophysiology of subretinal neovascular membrane may be a process of abnormal wound healing.

Clinical Results of Subretinal Neovascular Membrane in Adults under 50 years of age

We studied 28 eyes presenting with subretinal neovascular membrane by means of clinical evaluation and fluorescein angiography. Each patient was an adult under 50 years of age. None of the patients were treated with laser photocoagulation or operation. The patients included 7 males(9 eyes) and 17 females(19 eyes). Idiopathic subretinal neovascular membrane was noted in 71.4% and myopic subretinal neovascular membrane in 28.6%. Visual acuity at the first visit was from finger count to 20/25. Visual acuity of 19 eyes(67.9%) was above 20/100. In 62.5% of the cases, the size of the lesion was less than half the diameter of the disc. Subfoveal type was noted in 75.0%. Visual acuity was maintained or improved in 75.0% and decreased in 25.0%. The subretinal neovscular membranes in patients who were under 50 years of age were mostly small and idiopathic, and located at the subfovea. These patients had good visual acuity compared to patients with subretinal neovascular membrane secondary to age-related macular degeneration.

Central Serous Retinopathy in Old Age

Central serous retinopathy is a serous detachment of sensory retina in macular area resulting from retinal pigment epithelial defect. It usually affects adult between 25 and 50 years of age. Central serous retinopathy which occured in 50 years of age or older can be readily mistaken for senile macular degeneration with subretinal neovascularization, Two diseases must be differentiated because of different progress and treatment. Thirteen patients were 50 years of age or older among 172 patients with central serous retinopathy, There were 3 eyes with retinal pigment epithelial atrophy but there were no eyes with soft drusen, geographic atrophy and subretinal neovascular membrane. Subretinal neovascular membrane was not seen during follow up period also. Seven eyes received conservative treatment and 6 eyes received argon laser photocoagulation. Visual acuity of all patients improved to more than 20/50 after treatment and visual prognosis is not different with that of young adult.

Choroidal Osteoma: Two Cases Report

Choroidal osteoma, a benign tumor and involving one eye frequently, occurred around optic disc in usually healthy young women, In our cases, the ophthalmoscopic examination revealed a sharply circumscribed, slightly elevated, orange-red subretinal lesion with irregular geographic borders and the tumors became depigmented and yellow-white with time. Diffuse and mottled depigmentation of the overlying pigment epithelium was occurred and the tufts of branching blood vessels were scattered on the tumor suface. In case 1, the tumor size was enlarged with pregnancy. In case 2, the tumor size was progressively enlarged with time in right eye and new lesion was developed in left eye, which had been normal at the first visit. The causes of visual disturbance were degeneration of retinal pigment epithelium and sensory retina in case 1 and right eye of case 2, and submacular neovascular membrane in left eye of case 2.