An update on multiple recurrent serosanguineous retinal pigment epithelial detachments in black women.

A unique clinical entity of multiple recurrent serosanguineous retinal pigment epithelial detachments in three black women was first described by the authors in 1985. Nine patients with this entity have now been observed, all of whom have developed a vitreous hemorrhage in at least one eye. Vitreous hemorrhage was the initial clinical presentation in seven eyes and developed 63.5 months after initial presentation in another patient who eventually sustained bilateral vitreous hemorrhages. Ultrasonographic examination in this entity often shows a characteristic pattern of irregular choroidal thickening and retinal elevation, which may aid in the diagnosis when the presentation is that of a vitreous hemorrhage of unknown origin. Vitrectomy has been performed in three cases, two of these retaining clear media during subsequent follow-up. Postvitrectomy vision correlated with the extent of macular involvement by the underlying disease. Eight patients had a history of, or evidence of, hypertension. Although choroidal neovascular membranes are a potential cause, the definitive etiology is not known.

Valsalva maculopathy due to a retinal arterial macroaneurysm.

The term Valsalva retinopathy refers to hemorrhage in and around the macula in response to a sudden rise in intrathoracic or intra-abdominal pressure. The increased intravenous pressure is felt to be transmitted to the retinal circulation with resulting retinal capillary rupture. Fluorescein angiography is generally normal following resolution of the hemorrhage. We have followed the evolution of an arterial macroaneurysm that presented initially as a case of Valsalva maculopathy.

The drainage of subretinal fluid: a randomized controlled clinical trial.

A randomized controlled clinical trial was conducted on a series of 120 consecutive cases of rhegmatogenous retinal detachment. One group of 60 eyes, randomly selected, was managed with a scleral buckling operation that included the drainage of subretinal fluid. The other group of 60 had a similar operation without drainage. A new method for evaluating complications, the "Complications Score," was devised. The score was higher (P = 0.005) for the drainage group, but this did not decrease the final anatomic or visual results. Eighty-seven percent of the drainage group was reattached with one operation, a figure not significantly different from the 83% reattached in the nondrainage group. The final cure rate after reoperations was 97% for both groups. The best corrected visual acuity, measured six months after operation, was not significantly different for the two groups. This study concludes that equally good results can be obtained with either a drainage or nondrainage operation.

Lesions simulating serous detachment of the pigment epithelium. Occurrence after retinal detachment surgery.

Serous detachment of the retinal pigment epithelium (RPE) has been previously described in association with disorders of the underlying choroid and Bruch's membrane but has not been reported after retinal reattachment surgery. We have observed, for at least 16 months, three cases that clinically appeared to be RPE detachments after scleral buckling. In each case the lesions exhibited the typical biomicroscopic features of focal serous detachment of the RPE. However, the failure to show the typical fluorescein pooling has prompted us to regard these lesions as focal pockets of turbid subretinal fluid that simulate RPE detachments.

Adjustable length infusion needle for Ocutome vitrectomy.

We devised an adjustable length infusion needle for Ocutome vitrectomy. Visualization of the tip of the infusion terminal is not necessary and the risk of infusion into the uvea is eliminated.