Prediction of visual outcome after retinal detachment surgery using the Lotmar visometer.

AIM: To evaluate whether an achromatic interferometer, the Lotmar visometer, is useful in predicting postoperative visual outcome in patients with primary rhegmatogenous retinal detachment (RD) involving the macula. METHODS: This prospective study included 40 eyes of 40 non-consecutive patients with macula-off RD. The eyes were phakic or pseudophakic, had a clear optical media, and had a measurable potential vision on preoperative visometric examination. Preoperative variables included Snellen visual acuity, duration of macular detachment, extent of RD, and visometric potential acuity. Reattachment surgery consisted of radial scleral buckling in 33 patients, circumferential scleral buckling and encircling in seven patients, and subretinal fluid drainage in 10 patients. Retinal breaks were treated with cryotherapy or laser photocoagulation. Patients were followed up for at least 6 months after uncomplicated surgery. Best corrected visual acuity measured at any time during follow up was correlated with the preoperative variables. RESULTS: Preoperative visual acuity was less than 20/200 in 37 (93%) of 40 patients. Potential visual acuity of 20/200 or better was measured using the Lotmar visometer in 37 patients (93%). Postoperative visual acuity was correlated significantly with duration of macular detachment (r=0.55; p<0.001), and extent of RD approached statistical significance (r=0.31; p=0.05). There was a higher correlation between postoperative visual acuity and the visometric measurements (r=0.61; p<0.001). CONCLUSIONS: The Lotmar visometer may be a valuable method to estimate visual outcome after uncomplicated scleral buckling surgery in patients with RD involving the macula.

An unusual case: bilateral orbital varices.

PURPOSE: To present a rare case of bilateral orbital varices. METHODS: An 18-year-old man showing bilateral orbital masses on magnetic resonance (MR) imaging was examined with color Doppler ultrasonography (US), computed tomography (CT) and digital subtraction venography. RESULTS: The presenting symptoms of the patient were pain and fullness in both orbits induced by bending forward. Ocular examination was normal with the exception of a two millimeter proptosis of both eyes during Valsalva maneuver. MR imaging demonstrated bilateral retrobulbar masses, but was not diagnostic. The comparison of CT images obtained before and after Valsalva maneuver revealed the diagnosis of orbital varices. Color Doppler US and orbital venography demonstrated a large venous connection between the lesions and systemic circulation. CONCLUSION: Clinical presentation of orbital varices is unusual. Different radiological methods may be necessary for the confirmation of the diagnosis and demonstration of the anatomic and the dynamic features of the lesions.

Radiation therapy in exudative age-related macular degeneration.

It has been suggested that ionizing radiation at doses relatively safe to the optic nerve and retina exert an inhibitory and occlusive effect on the endothelial proliferation of choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD). The encouraging results of early studies in preservation or improvement of visual acuity and regression of the CNV gave rise to many clinical trials in different centers. Disparate radiation doses, dose fractions, type and rate of radiation administration have been used to determine the efficacy of radiotherapy in AMD. Conflicting treatment responses have been reported by different centers. Some studies provided evidence of beneficial treatment outcome in AMD, and others could not show any efficacy of ionizing radiation in the visual and morphological evolution of the disease. Data from the literature and our experience indicate that radiotherapy can be effective in regressing the leakage of the CNV in AMD. However, despite treatment visual deterioration continues and new CNV lesions develop. The observation of morphological progression in the disease process might be related to an unfavorable effect of radiation on the pathogenesis of AMD.

Ocular findings in familial adenomatous polyposis.

BACKGROUND: Retinal pigment epithelium (RPE) lesions are predictive congenital phenotypic markers for familial adenomatous polyposis (FAP). This prospective screening study aims at assessing the incidence and significance of these lesions in FAP patients and their family members. METHODS: Sixty-two members from three families including five patients with the diagnosis of FAP have been ophthalmologically surveyed. All RPE lesions were documented with fundus photography and fluorescein angiography was performed in 13 subjects. Sigmoidoscopy and/or radiological examination were performed annually in 9 family members with typical RPE lesions during 4 years to allow early diagnosis of FAP. RESULTS: Typical RPE lesions were present in five FAP patients and 15 family members. Telangiectatic dilatations in the retinal periphery with small dot-like hemorrhages were detected in 6 subjects from 3 families These lesions were particularly evident on fluorescein angiography. Annual colon analysis showed polyps in 3 out of 9 subjects who were positive for RPE lesions. CONCLUSION: RPE lesions are valuable as a clinical marker in predicting FAP. The co-existing peripheral vascular alterations which have not been reported before, are probably related to FAP.

Retinal detachment after radial keratotomy.

We report the case of a 43-year old woman who developed retinal detachment (RD) after radial keratotomy (RK) for the correction of a 7 D myopia. Further flattening in the corneal topography with a decrease in myopia was noted following RD surgery. Although no cause-effect relationship between RK and RD can be stated, it is imperative to inform the patients that RK only corrects the refractive aspect of myopia.

Tuberous sclerosis: ocular findings and their correlation with cranial computed tomography.

In this study, cases with tuberous sclerosis (TS) with positive cranial computed tomography (CT) findings are ophthalmologically examined. Investigations revealed retinal hamartomas in all patients. The ocular findings and their correlation with cranial CT findings are presented.

Treatment of chronic macular oedema with low dosage acetazolamide.

In this study, 46 eyes of 40 patients exhibiting chronic macular oedema have been treated with 125 mg Acetazolamide. The eyes with pseudophakia and the eyes with retinitis pigmentosa obtained considerable beneficial help from this treatment. Our findings indicate that Acetazolamide may offer the clinician an alternative approach in the treatment of central vision threatening chronic macular oedema.

Retinal abnormalities in Alport's syndrome.

The ophthalmological findings in 13 patients with Alport's syndrome are reported. Special attention was given to the retina and retinal functions. Flecked retinopathy was present in 12 out of the 13 cases. Two cases showed tortuosity of the retinal vessels. Retinal function tests showed no significant abnormalities. This study suggests that in Alport's syndrome, retinal lesions are more common than has been reported until now.

A long-term follow-up study of laser coagulation of neovascular membranes in angioid streaks.

We treated 30 eyes (24 patients) with angioid streaks and neovascular membranes using light coagulation. Of 30 eyes, 16 showed either ameliorated or unchanged visual acuity. Twelve of the remaining 14 eyes retained a visual acuity of 20/200 or better. In 11 patients, the fellow untreated eye showed central macular degeneration with loss of central vision. The follow-up period ranged from two months to 16 years (mean, 3.4 years).

A clinical review of Stargardt's disease and/or fundus flavimaculatus with follow-up.

Out of 49 patients diagnosed as having Stargardt's disease that have been clinically reviewed, 22 of these cases have been followed for a period up to 13 years. The cases have been studied in three subgroups, according to their fundus appearance. Patients from group I were those whose lesions were confined to the macula, showing no flecks in the retina. In group II the macular lesion was surrounded by perimacular flecks and in group III fundus flavimaculatus flecks were seen, diffusely scattered in the posterior pole. It appears that the prognosis of group I is better than the other groups, where surrounding flecks are seen in addition to the macular lesion. The follow-up indicates that the disease evolves with a rather large spectrum of expressivity. Assessment of a predictive factor for the evolution of the disease is not yet possible. However, the observation of a dark choroid appears to be strongly suggestive for a further centrifugal progression of the disease.

Pseudophakic glaucoma.

Pseudophakia by itself does not cause ocular hypertension. Pseudophakic glaucoma should be defined as glaucoma that would not be present in an eye if it were not pseudophakic. Ocular hypertension was noted in 15 (9%) of 166 pseudophakic eyes. Only 5 eyes (3%) had ocular hypertension requiring treatment. Three of these eyes (1.8%) had permanent ocular hypertension resulting in chronic pseudophakic glaucoma. This study shows that pseudophakic glaucoma is no more frequent than aphakic glaucoma. Secondary glaucoma in pseudophakic eyes is not always related to the presence of the lens. Pupillary block glaucoma and UGH syndrome are directly related to the lens. Secondary glaucoma by ghost cells and by pigment-dispersion are also in some cases directly related to the lens.