ABSTRACT
BACKGROUND: Central serous chorioretinopathy is a disorder that typically affects young and middle-aged men. Although extensive information is available pertaining to the clinical features of central serous chorioretinopathy in men, little is known about this condition in women. MATERIALS AND METHODS: The authors reviewed the medical records and photographic files of women who received a diagnosis of central serous chorioretinopathy. The women were divided into three groups for data analysis: idiopathic, exogenous corticosteroid use, and pregnancy. RESULTS: Fifty-one women with active central serous chorioretinopathy were evaluated. These findings in women with idiopathic serous chorioretinopathy were similar to those described in men, with the exception that women tend to be older at the time of onset. Central serous chorioretinopathy in women taking exogenous corticosteroids more likely was characterized by bilateral involvement and subretinal fibrin. Central serous chorioretinopathy in pregnant women typically developed in the third trimester and resolved spontaneously within 1-2 months after delivery. CONCLUSION: Idiopathic central serous chorioretinopathy is similar in women and men, with the exception that women tend to be more older at the time of onset. The finding of exogenous corticosteroid use in a significant number of women in our study provides further support that cortisol may play a role in the development of central serous chorioretinopathy. The mechanism by which cortisol influences the development of central serous chorioretinopathy is unclear.
Subject(s)
Choroid Diseases/pathology , Retinal Diseases/pathology , Adrenal Cortex Hormones/adverse effects , Adult , Aged , Choroid Diseases/chemically induced , Choroid Diseases/physiopathology , Female , Fluorescein Angiography , Fundus Oculi , Humans , Middle Aged , Pregnancy , Pregnancy Complications/chemically induced , Pregnancy Complications/pathology , Pregnancy Complications/physiopathology , Retinal Diseases/chemically induced , Retinal Diseases/physiopathology , Visual AcuityABSTRACT
OBJECTIVE: To determine the natural history and visual prognosis of patients with branch retinal arterial occlusions secondary to multifocal retinitis. METHODS: Cases were reviewed for seven patients who exhibited multifocal retinitis and branch retinal arterial occlusion. The average age of the patients was 27 years (age range, 14 to 19 years). RESULTS: Six patients had systemic illnesses associated with their ocular findings. Four patients were scratched by a cat or exposed to a cat with fleas within 1 month of symptoms. Three of these patients were tested and had positive cat-scratch disease titers. At presentation, five patients complained of a scotoma, and two noted blurred vision. On examination, visual acuity was 20/25 or better in all but one eye. Five patients had vitritis, which was bilateral in three. Four patients exhibited optic nerve edema, which was bilateral in two. White intraretinal infiltrates were present in all patients, and were bilateral in five. The six patients who were examined within 1 week of symptoms had a white retinal infiltrate at the site of vascular occlusion. The retinal findings resolved in 2 to 6 weeks and did not recur. The final visual acuity was 20/20 OU in all patients. CONCLUSIONS: Branch retinal arterial occlusions represent a complication of multifocal retinitis and idiopathic optic nerve edema. The arterial occlusions are probably caused by a focus of retinitis. This self-limited disorder has an excellent visual prognosis and may be related to cat-scratch disease.
Subject(s)
Papilledema/complications , Retinal Artery Occlusion/etiology , Retinitis/complications , Adolescent , Adult , Animals , Anti-Bacterial Agents , Anti-Inflammatory Agents/therapeutic use , Cat-Scratch Disease/drug therapy , Cat-Scratch Disease/etiology , Cats , Drug Therapy, Combination/therapeutic use , Eye Diseases/drug therapy , Eye Diseases/etiology , Female , Fluorescein Angiography , Fundus Oculi , Humans , Male , Optic Disk/pathology , Papilledema/drug therapy , Papilledema/pathology , Prednisone/therapeutic use , Prognosis , Retinal Artery Occlusion/drug therapy , Retinal Artery Occlusion/pathology , Retinitis/drug therapy , Retinitis/pathology , Retrospective Studies , Scotoma/drug therapy , Scotoma/etiology , Visual Acuity , Vitreous Body/pathology , Wounds and Injuries/drug therapy , Wounds and Injuries/etiologyABSTRACT
Ten patients with bilateral nanophthalmos underwent sclerectomies for uveal effusion. Ultrastructural examination of the sclera revealed abnormal collagen in seven patients. Four showed dramatic fraying of the collagen fibrils into fine filaments 2 to 3 nm in diameter. In three of these cases and three other cases without fraying, there were foci of 10- to 35-nm small collagen fibrils, some appearing to arise by splitting of otherwise normal collagen fibrils. In areas of fraying, elastic fibers were absent. All patients had a wider range of collagen diameters than did control subjects. The youngest patient with fraying also had Hallermann-Streiff syndrome. In three patients, no collagen abnormality was found. The clinical feature correlating best with the presence of abnormal collagen was an extremely small eye, since the three patients without collagen abnormality had the largest eyes (range of anteroposterior diameters, 19.2 to 20.3 mm). Nanophthalmos appears to result from several distinct defects.
Subject(s)
Collagen/ultrastructure , Microphthalmos/pathology , Sclera/ultrastructure , Adult , Aged , Child , Female , Humans , Infant , Infant, Newborn , Male , Middle AgedABSTRACT
Classic ocular toxoplasmosis initially involves inner retinal layers and is associated with marked vitreous reaction. We encountered three cases of punctate outer retinal toxoplasmosis, a subset of ocular toxoplasmosis that is characterized by multifocal gray-white lesions at the level of deep retina and retinal pigment epithelium and that is associated with little or no overlying vitreous reaction. Acute lesions may resolve to form fine granular white dots. Recognition of this uncommon presentation of toxoplasmosis is important, since there is some evidence that treatment of toxoplasmosis may be effective.
Subject(s)
Retinal Diseases/diagnosis , Toxoplasmosis, Ocular/diagnosis , Adolescent , Child , Female , Fluorescein Angiography , Humans , Photoreceptor Cells/pathology , Pigment Epithelium of Eye/pathology , Retinal Diseases/pathology , Toxoplasmosis, Ocular/pathologyABSTRACT
Patients with toxemia of pregnancy may develop permanent alterations of the pigment epithelium that if first discovered in later life may be mistaken for a heredomacular dystrophy, a diffuse tapetoretinal dystrophy or other diseases. These nonprogressive changes are caused by multifocal areas of fibrous platelet occlusion of the choriocapillaris that usually occur just prior to or following delivery and is usually associated with a transient period of exudative retinal detachment. The pattern of pigment epithelial derangement is often sufficiently characteristic to suggest the correct diagnosis.
Subject(s)
Macular Degeneration/diagnosis , Pigment Epithelium of Eye , Pre-Eclampsia , Retinal Detachment/etiology , Adult , Diagnosis, Differential , Female , Fluorescein Angiography , Follow-Up Studies , Humans , Macular Degeneration/genetics , Middle Aged , Pregnancy , Retinal Detachment/diagnosis , Time FactorsABSTRACT
The acute retinal necrosis syndrome is manifested by diffuse uveitis, vitritis, retinal vasculitis, and acute necrotizing retinitis (see Part 1). We studied the histopathology and electron microscopic findings of an eye enucleated from a 67-year-old man with typical acute retinal necrosis. Histology showed profound acute necrosis of the retina, retinal arteritis, and eosinophilic intranuclear inclusions in retinal cells. Electron microscopy demonstrated a herpes group virus in all layers of affected retina. The implications of these findings for antiviral and other treatments are discussed.
Subject(s)
Herpesviridae Infections/complications , Retina/ultrastructure , Retinal Diseases/pathology , Acute Disease , Aged , Humans , Inclusion Bodies/ultrastructure , Male , Microscopy, Electron , Necrosis , Retinal Diseases/etiology , Retinitis/pathology , Syndrome , Uveitis/pathologyABSTRACT
We have produced experimental commotio retinae in 12 owl monkeys by blunt trauma. The ophthalmoscopic and fluorescein angiographic appearance of this contrecoup lesion is identical to the acute traumatic retinal opacity in humans. We examined these eyes by light and electron microscopy from 4 hours to 12 weeks after injury. Immediately after injury, the only abnormality is disruption of the receptor outer segments. From one to six days after trauma, many receptor cells undergo degeneration. The retinal pigment epithelium phagocytoses the degenerating outer segments, occasionally migrating into the retina. There is no extracellular retinal edema. The opacity of commotio retinae seems to represent disrupted receptor cells. Visual loss may result from permanent loss of receptors. The pigment epithelial response to traumatic receptor damage is similar to that observed in experimental retinal detachment and light-induced retinal damage.
Subject(s)
Eye Injuries , Retina/injuries , Retinal Diseases/etiology , Animals , Aotus trivirgatus , Disease Models, Animal , Eye Injuries/diagnosis , Eye Injuries/pathology , Fluorescein Angiography , Photoreceptor Cells/pathology , Retina/pathology , Retinal Diseases/diagnosis , Retinal Diseases/pathology , Time FactorsABSTRACT
A case is describes in which the earliest clinical manifestations of sympathetic uveitis that occurred after trauma and pars plana vitrectomy were confined primarily to the retina, retinal pigment epithelium, and choroid posteriorly, and resembled focal lesions of acute posterior multifocal placoid pigment epitheliopathy. Similar focal lesions were noted on gross examination of the enucleated inciting eye. Histopathological examination revealed that these lesions were caused by focal choroidal granulomas and overlying Dalen-Fuchs nodules. Sympathetic ophthalmia was also noted in four other patients in whom the condition developed after trauma and vitrectomy.
Subject(s)
Eye Injuries/complications , Ophthalmia, Sympathetic , Postoperative Complications , Vitreous Body/surgery , Wounds, Nonpenetrating/complications , Adult , Choroiditis/complications , Eye/pathology , Eye Injuries/surgery , Female , Fluorescein Angiography , Granuloma/complications , Granuloma/etiology , Humans , Male , Middle Aged , Ophthalmia, Sympathetic/diagnosis , Ophthalmia, Sympathetic/etiology , Retinal Degeneration/complications , Retinal Degeneration/etiology , Syndrome , Uveal Diseases/complications , Uveal Diseases/etiology , Wounds, Nonpenetrating/surgeryABSTRACT
A vascular abnormality of the retina of a rhesus monkey was studied with fluorescein angiography, microvascular examination after silicone rubber injection, and histological examination. Fluorescein angiography revealed that this abnormality was an arteriovenous shunt. Microvascular examination showed a vascular abnormality on the sclera and an end-to-end communication of the arteriovenous malformation that was a continuation of abnormally large central retinal vessels observed just before their insertion into the optic nerve in the orbit. Histologic examination proved that the arteriovenous shunt originated from the central retinal vessels in the orbit; that degeneration of the retina and the choroid was extensive near the abnormal vessels; that the abnormal vessels had normal endothelium and adventitia but remarkably widened media; and that the cavernous hamangioma-like structure in the optic disk was clearly distinguishable from a cavernous hamangioma.