Central retinal artery obstruction in herpes zoster ophthalmicus and cerebral vasculopathy.

We present a case of acute central retinal artery obstruction in association with Herpes zoster ophthalmicus and delayed cerebral vasculopathy. Retinal vascular obstruction is rare in zoster, and its occurrence during postherpetic cerebral vasculopathy has not been reported previously to our knowledge. The syndrome of delayed cerebral vasculopathy is discussed as is its possible relationship to central retinal artery obstruction.

Fluorescein angiography using ultra-high speed film.

We used a new ultra-high speed black-and-white film, Kodak T-MAX P3200 (ASA 3200), in routine fluorescein angiography on 51 patients and one normal volunteer. The increased film speed permitted a lower flash intensity than with other available films. Photophobia was improved subjectively in 25% of patients who had undergone prior angiography at a higher flash setting. In addition, patient cooperation was improved as evidenced by a decrease in the frequency of photographic artifacts and uninterpretable photographs compared with prior angiograms done using Kodak TRI-X Pan film (ASA 400). T-MAX yielded excellent resolution, but its grain size was slightly greater than that of TRI-X Pan. The use of ultra-high speed film and reduced light intensity may benefit the patient and improve photographic quality in some individuals with photophobia.

Cell density dependency of vitreous fibrosis induced by monocytes and lymphocytes.

The possible roles of monocytes and lymphocytes in vitreous fibrosis were examined by injecting various numbers of the peripheral cell types into the rabbit vitreous. Our results indicated that the degree of vitreous fibrosis and the presence of traction retinal detachment corresponded to the number of cells injected. It was suggested that these findings are probably similar to vitreous membrane formation and retinal detachment in various clinical ocular diseases or inflammations in humans.

Acute posterior multifocal placoid pigment epitheliopathy and cerebral vasculitis.

Four cases of suspected cerebral vasculitis have been described in association with acute posterior multifocal placoid pigment epitheliopathy, but none was confirmed histopathologically. We describe a patient who developed fatal cerebral vasculitis after placoid pigment epitheliopathy. Histopathologic data revealed a focal granulomatous inflammation of medium-sized arteries in the leptomeninges. Multinucleated giant cells were a conspicuous part of the inflammatory reaction. The cause of both placoid pigment epitheliopathy and cerebral vasculitis remains obscure.

Choroideremia in a genotypically normal female. A case report.

A 10-year-old girl demonstrated advanced choroideremia. She had decreased visual acuity, high myopia, and characteristic fundus findings of choroideremia. Her ERG, dark adaptation, visual fields, and fluorescein angiogram were all abnormal; the results were consistent with choroideremia. Her chromosome studies revealed that she was a genotypically normal female. Her parents were examined ophthalmologically and found to be normal.

Hemorrhagic valsalva retinopathy in Leber's optic neuropathy.

A patient with acute Leber's optic neuropathy had a large splinter retinal hemorrhage noted after he had strained to install fire hydrants. The hemorrhage occurred at a site of peripapillary telangiectasia, which is a feature of this condition. The pathogenesis of the process is discussed.

In vivo corneal and conjunctival epithelial nuclear stain.

Epithelium plays a very important structural and functional role in the cornea and conjunctiva. Evaluation of the epithelium is the first step in diagnosing many pathologic states. We have developed a new technique for the in vivo staining of nuclei of corneal and conjunctival epithelium in rabbits and guinea pigs. Several drops of 0.01%, 0.1%, 0.25%, 0.5%, or 1.0% toluidine blue or 1.0% methylene blue were applied to the conjunctival sac to stain epithelial cells. The cells picked up the vital dye within 5 minutes and could be photographed at 30X with the Keeler-Konan wide-field specular microscope. Cells and nuclei were clearly observable. Photographs could be further enlarged to enhance details. Wash out time was rapid and no toxic effects were observed. This technique adds a new dimension to the study of epithelium in normal and pathologic states in experimental animals. This technique may also be applicable to human eyes for discerning such diseases as carcinoma, herpes simplex, or superior limbic keratoconjunctivitis.

Carbon monoxide retinopathy.

We recently examined three family members with acute carbon monoxide intoxication resulting from a single accidental exposure--a stepfather with a normal fundus, a mother with scattered superficial retinal hemorrhages, and her child with multiple large subinternal limiting membrane hemorrhages, peripapillary hemorrhages, severe venous tortuosity, and disc edema. All three had comparable carboxyhemoglobin levels and no evidence of hypertension, diabetes, or anemia. The different fundus presentations illustrated the variable clinical manifestations of carbon monoxide retinopathy. Early detection could prevent a lethal outcome.

Change in vitreous collagen after penetrating injury.

Following controlled ocular penetrating injuries in rabbits, autologous blood was injected into the vitreous. All animals were examined with ultrasonography, ophthalmoscopy and photography. After 3 weeks the animals were sacrificed and serial histologic sections were made on the enucleated globes. Fibroblasts and collagen were found in the vitreous. In additional eyes, the altered vitreous was removed and examined by gel electrophoresis following limited pepsin digestion. Type I collagen was an important component of vitreous fibrosis. In contrast, only type II collagen was detected in normal vitreous. The collagen formation after hemorrhagic injury may follow a similar process of wound healing in other tissues.

Ophthalmodynamometry reveals retinal embolus.

Suction ophthalmodynamometry made an otherwise invisible retinal embolus appear by attenuating the overlying blood column. Observation of the entire posterior pole while the intraocular pressure is at diastole could enhance our ability to detect retinal emboli.

Recognition of carotid stenosis with bilateral simultaneous retinal fluorescein angiography.

In order to study the arm to retina circulation time (ARCT), we simultaneously photographed both fundi in patients with suspected or known carotid artery occlusive disease. Noninvasive carotid artery tests, selective carotid arteriography, or both, were performed on all of the patients. In the 11 patients with arteriographically proven significant carotid stenosis, or with noninvasive carotid tests demonstrating carotid occlusive disease, a triad of fluoroangiographic features (delayed ARCT, disparity of ARCT between eyes, and delayed ciliary circulation at the optic disc) was found. We believe that bilateral simultaneous retinal fluorescein angiography is a sensitive and accurate method for the recognition of patients with carotid artery occlusive disease.

Short posterior ciliary artery insufficiency with hyperthermia (Uhthoff's symptom).

Transient visual blurring with heart or exercise (Uhthoff's symptom) is associated with multiple sclerosis. To our knowledge, this is the first report of its occurrence in cases of documented vascular disease. Two patients had insufficiency of the short posterior ciliary circulation. In one it was caused by a carotid occlusion and in the other by cranial (giant-cell, temporal) arteritis. The monocular blurring may have occurred during periods of relative arterial hypotension.

Cilio-optic vein associated with phakomatosis.

This presentation demonstrates the fluorescein angiographic characteristics of the cilio-optic vein. These congenitally enlarged vessels appear at the disc edge and dip into the optic nerve to anastomose with branches of the central retinal vein. Fluorescein angiography shows lamellar filling of the vessels in the early choroidal phase. In one patient, these findings are demonstrated bilaterally with the use of bilateral simultaneous angiography. A second type of communication is presented, a retinociliary vein which drains the retina into the choroidal circulation. In both types presented, a branching hypofluorescent pattern extends from the disc vessel into the choroid. Our patients have evidence of a phakomatosis: neurofibromatosis or Sturge-Weber syndrome. This anomalous disc vessel should not be confused with optociliary shunt, disc neovascularization, cilioretinal artery, or arteriovenous shunt.

Choroidal vascular changes in toxemia of pregnancy.

Twenty-seven patients with toxemia of pregnancy were examined during a postpartum period of two days to eight months. Five of these manifested abnormal photographic and angiographic findings including disk and retinal edema, retinal striae, deep retinal yellow-white focal lesions, choroidal nonfilling, leakage of dye from the optic disk and deep retinal lesions, and retinal pigment epithelial window defects. The location and configuration of the leakage correlated with the defects seen on color photography. The normal retinal, and predominantly abnormal choroidal vascular patterns provide evidence implicating choroidal vascular insufficiency as the primary basis for secondary retinal detachments seen in toxemia of pregnancy.

The inhibition of corneal vascularization with aortic extracts in rabbits.

A low molecular weight fraction of bovine aortic extract inhibited corneal vascularization and edema in rabbits when administered either subconjunctivally or topically as long as 48 hours after injury. The extract also appeared to enhance the regression of newly formed corneal vessels. Topical administration for as long as two months had no deleterious ocular side effects. Tissue culture experiments showed that analagous fractions prepared from bovine vitreous inhibit endothelial cell growth. The major growth inhibitor of corneal neovascularization was not the Kunitz bovine protease inhibitor.

Fluorescein angiography in pigmented iris tumors.

Three pigmented iris tumors were studied with fluorescein angiography. Two malignant melanomas leaked dye very early in the arterial phase, while blockage of fluorescence was noted in one melanocytoma. The angiographic appearance of these three lesions was consistent with that, which would be anticipated, based on knowledge of similar lesions in the fundus of the eye. We recommend that fluorescein angiography be performed for all pigmented iris tumors as part of the diagnostic evaluation.

Endogenous intraocular Nocardia asteroides in Hodgkin's disease.

A 60-year-old man receiving antituberculous and corticosteroid therapy for a granulomatous disease of uncertain etiology was found to have a chorioretinal mass in his right eye. Fluorescein angiography showed blockage of fluorescence by the mass and late leakage. Autopsy findings were compatible with Hodgkin's disease with disseminated nocardiosis caused by Nocardia asteroides. Organisms typical of Nocardia were found in the choroid and subretinal space. The patient's history, ophthalmic examination, and fluorescein angiographic findings suggested a type of chorioretinal involvement.