Radial optic neurotomy for central retinal vein occlusion: a retrospective pilot study of 11 consecutive cases.

PURPOSE: Retinal vascular occlusive disease is the second leading cause of permanent retinal blindness. The etiology of central retinal vein occlusion (CRVO) is not well understood. The anatomy of the optic disk including the cribriform plate and scleral ring may contribute to the development of retinal vaso-oclussive diseases. Neurovascular compression within the confined space at this location may play a pathoetiologic role in CRVO. The authors performed radial optic neurotomy in patients with CRVO to relax this space and relieve pressure on the central retinal vein. METHODS: Radial optic neurotomy (RON) was performed on 11 consecutive patients with severe, hemorrhagic CRVO with visual acuities of 20/400 or less. A microvitreoretinal blade was used to relax the scleral ring, cribriform plate, and adjacent sclera of the optic disk. Reperfusion of the retina was achieved via decompressing the central retinal vein. RESULTS: Radial optic neurotomy was performed successfully in all 11 patients. There were no complications noted with this procedure. All patients had clinical improvement as determined by fundus examination, photography, and fluorescein angiography. Postoperative visual acuities were equal or improved in 82% of patients. Eight of the patients (73%) had rapid improvement of visual acuity with an average gain of five lines of vision. CONCLUSIONS: Surgical decompression of CRVO via RON is a technically feasible and initially safe procedure that is associated with rapid reperfusion of the retina. Resolution of the intraretinal hemorrhage, edema, and ischemia may improve the visual prognosis in patients with this common retinal disorder.

A comparison of cryotherapy versus diode laser retinopexy in 100 consecutive infants treated for threshold retinopathy of prematurity.

PURPOSE: The purpose of this paper is to present a series of patients who were treated for threshold retinopathy of prematurity with either cryotherapy or diode laser. Complications and unfavorable outcomes during the first year after treatment will be compared for the two procedures. METHODS: The clinical courses of a consecutive series of 100 infants (192 eyes) were reviewed. All infants had their threshold status confirmed by a second examiner. Infants were treated with cryotherapy through 1993 and with diode laser thereafter. One hundred two eyes of 54 patients were treated with cryotherapy. Ninety eyes of 46 patients were treated with laser retinopexy. Two of the patients who were treated with laser (4 eyes) did not survive to the 3-month follow-up visit, and their results are not included here. The two groups of infants were comparable in their birth weight, adjusted gestational age at treatment, and severity of disease as determined by zone and sectors of stage 3 retinopathy of prematurity. RESULTS: Unfavorable outcome (total retinal detachment) was seen in 25.4% of eyes treated with cryotherapy (26 of 102), as compared with 15% of eyes treated with laser (13 of 86). Two cataracts were seen in our patients: one patient 22 weeks after cryotherapy, and the other 7 months after diode laser. CONCLUSIONS: No statistically significant difference was found in the rate of retinal detachments in the two groups (X2 = 3.05; P = .08).

Opportunistic infections of the retina and posterior segment.

Opportunistic infections of the retina are becoming a more frequent diagnostic and therapeutic challenge as immunosuppressed patients become more common. Viral, fungal, protozoan, and bacterial agents may be encountered. Diagnostic and therapeutic considerations, illustrated by case histories, are presented in this article. Viral infections are characterized by progressive exudation and hemorrhagic necrosis in a segmental distribution corresponding to the retinal vasculature. Protozoan, fungal, and bacterial infections may demonstrate more focal lesions with greater vitreous involvement. Diagnosis is established by clinical examination of body fluids. Antimicrobial drugs alone or combined with vitrectomy are effective therapy for fungal, bacterial, and protozoan infections. Antiviral drugs have yielded more disappointing results in the management of viral retinitis.

Incidence of misdiagnosed and unsuspected choroidal melanomas. A 50-year experience.

The eye pathology files at Ohio State University, Columbus, were examined for a 50-year period to determine the percentage of misdiagnosis of uveal melanomas in three separate time periods (1931 through 1959, 1960 through 1969, and 1970 through 1981) and the percentage of unsuspected melanomas during these same periods. Of 395 eyes enucleated for choroidal melanoma, 369 had clear media. Histologic examination of these eyes showed that 13 (3.5%) did not contain a melanoma. The incidence of misdiagnosis decreased from 10.9% in 1931 through 1959 to 1.7% in 1960 through 1981. Of 411 choroidal melanomas present on histologic examination, 37 (9%) were unsuspected. All had opaque media. This percentage, when categorized by the aforementioned periods, decreased from 19.6% to 13.3% to 2.4%, respectively. These results confirm the reliability of indirect ophthalmoscopy, widely used since the 1960s, in the diagnosis of melanoma in the presence of clear media and the reliability of ultrasonography, used since 1970, in the diagnosis of melanoma in eyes with opaque media.

Bilateral retinal metastases from cutaneous malignant melanoma.

To our knowledge, only nine cases of retinal metastases from a primary cutaneous melanoma have been reported in the literature. A 44-year-old man had bilateral retinal metastases and choroidal metastasis documented clinically with color photography and fluorescein angiography. When ocular metastases occur, they usually are preceded by a known diagnosis of the skin lesion, usually of the superficial spreading type, with dermal invasion and widespread visceral and CNS involvement.

Chemotherapy for treatment of choroidal metastases from breast carcinoma.

Of 15 patients with choroidal metastases from breast carcinoma, eight were treated with radiation therapy and six with chemotherapy. One patient received both. Although five of the six patients receiving chemotherapy died after an average follow-up period of 12 months, these patients generally had more widespread disease and a worse prognosis originally. Chemotherapy proved to be as effective as radiation therapy for this tumor.