Chorioretinitis sclopetaria from BB ex memoria.

Chorioretinitis sclopetaria presents a characteristic pattern of choroidal and retinal changes caused by a high velocity projectile passing into the orbit, in close proximity to the globe. While it is unlikely that a patient should completely forget the trauma causing such damage, preserved or compensated visual function may blur the patient's memory of these events over time. Characteristic physical findings help to clarify the antecedent history. Despite the lack of an acknowledged history of ocular trauma or surgery, in our case, the characteristic ocular findings discovered at presentation allowed for recognition of the underlying etiology. Because of good visual function, the patient had completely forgotten about the trauma that occurred 12 years earlier. Strabismus surgery was performed for treatment of the presenting symptomatic diplopia. The pathognomonic findings in chorioretinitis sclopetaria are invaluable in correctly diagnosing this condition, especially when a history of ocular trauma is unavailable.

Irreversible silicone oil adhesion to silicone intraocular lenses. A clinicopathologic analysis.

PURPOSE: To report a newly defined complication of foldable intraocular lenses (IOLs), namely silicone oil-silicone IOL interaction. This is a complication not generally seen by the implanting cataract surgeon but, rather, at a later stage in a patient's postoperative course, by a vitreoretinal surgeon. METHODS: Three clinical case histories, including two explanted silicone IOLs, were submitted for analysis. The submitted silicone lenses were photographed under water, and the nature of the silicone oil coating was documented. RESULTS: In each instance, the silicone coating was manifest as a thick coating with droplet formation on the lens surface that was tenaciously adherent and could not be dislodged by instruments or injection of viscoelastics. CONCLUSION: The use of silicone IOLs in patients with current vitreoretinal disease or those who are at high risk for future vitreoretinal disease that may require silicone oil as part of the therapy should be reconsidered. The authors recommend that information regarding the existence and significance of this complication be printed on all silicone oil and silicone IOL packages and inserts (if not as a warning, at least as an informative comment regarding the existence of this condition). This is a rare but clinically significant complication that will affect the occasional patient treated with both of these modalities.

Cataract extraction in adults with retinopathy of prematurity.

OBJECTIVE: To review the results of lensectomies performed to remove visually significant cataracts in adults with regressed retinopathy of prematurity, with special reference to postoperative vision and retinal complications. METHODS: A chart review of consecutive cases of cataract extraction in eyes with visually significant lens opacities and regressed retinopathy of prematurity was conducted. RESULTS: Fourteen consecutive eyes with retinopathy of prematurity in 10 adult patients were identified as having undergone lensectomy to manage a visually significant cataract. These cataract extractions were performed between June 1970 and February 1993. There were eight women and two men aged 16 to 43 years at the time of lensectomy. A variety of lenticular opacities were noted, the most common of which was nuclear sclerosis. Additionally, the nuclei were frequently much harder than would be expected for the patient's age. Phacoemulsification with implantation of a posterior chamber intraocular lens was the most common technique for cataract extraction. Eight eyes experienced improvement in visual acuity. However, when preoperative visual acuity was less than 20/200, postoperative acuity of 20/60 or better was uncommon. Six eyes were being treated for glaucoma before lensectomy. Glaucoma control was facilitated after lensectomy in six eyes. No combined cataract extraction and filtering procedures were performed. One eye developed a rhegmatogenous retinal detachment 76 months after cataract extraction. The retina was successfully reattached, but the eye suffered a substantial decrease in visual acuity. CONCLUSION: Cataract extraction in adult patients with retinopathy of prematurity may improve visual acuity, facilitate examination and treatment of the posterior segment, and aid in the management of glaucoma. The risk of retinal complications in these patients does not appear to be excessive.