Comparison of three permanent intraocular magnets.

A comparison was performed of three small-gauge, permanent, rare-earth, intraocular magnets to assist the posterior segment surgeon with the decision as to which magnet to purchase or to use in different clinical situations. The magnetic force was measured at varying distances from the instrument tip using a 1/8-inch steel ball as the test object. There were small differences in magnetic strength between the three instruments that may have clinical significance in certain situations. Two of the instruments had a retractable magnet within an outer sleeve, allowing for controlled attraction and release of a magnetic foreign body by the surgeon.

A new culture method for infectious endophthalmitis.

We studied the use of blood culture bottles for culturing vitreous specimens obtained during vitrectomy for infectious endophthalmitis. In a retrospective review of 83 cases, blood culture bottles yielded a 91% incidence of positive cultures. A laboratory comparison of direct media inoculation, a membrane filter system, and three blood culture systems was undertaken using inocula of nine organisms in three different concentrations. The blood culture bottle systems became positive at the same time as, or within 24 hours of, the membrane filter system for nearly every organism tested. A prospective clinical comparison was also performed in 14 cases of endophthalmitis, confirming our laboratory findings. The direct inoculation of blood culture bottles may be an acceptable adjunct or alternative to more sophisticated laboratory techniques for vitreous cultures in infectious endophthalmitis.

Retinal macroaneurysms treated with the yellow dye laser.

Retinal macroaneurysms, and their sequelae of retinal hemorrhage, exudate, edema, and serous detachment of the macula, may lead to decreased central visual acuity. We studied twelve patients with retinal macroaneurysms and decreased or threatened central vision who underwent laser photocoagulation of the macroaneurysm using the yellow (577 nm) wavelength of an ophthalmic tunable dye laser. In all cases, the macroaneurysm was "obliterated", with resolution of hemorrhage, exudate, edema, or serous macular detachment; in eight of the twelve cases, the visual acuity improved following treatment. There were no complications due to the photocoagulation.

Posterior tractional retinal breaks complicating branch retinal vein occlusion.

A total of 358 patients with branch retinal vein occlusion (BRVO) were reviewed to examine the relationship between branch retinal vein occlusion with neovascularization elsewhere (NVE), vitreous hemorrhage, and posterior tractional retinal breaks. Twenty-eight of 358 (7.8%) BRVO patients had vitreous hemorrhage. In this group of 28 patients, 24 of the 28 (85.7%) had NVE. Of the 24 BRVO patients with vitreous hemorrhage and NVE, six (21.4%) were found to have posterior tractional retinal breaks adjacent to avulsed neovascular tissue. These data indicate a strong association between BRVO patients with vitreous hemorrhage and posterior tractional retinal breaks due to avulsion of neovascular tissue.

Foveal neovascularization in diabetic retinopathy.

Retinal neovascularization in diabetes mellitus almost always occurs at the optic disc and/or near the major nasal and temporal vascular arcades, sparing the foveal area. We examined seven eyes of seven patients with long-standing insulin-dependent diabetes mellitus who had unilateral foveal retinal neovascularization. The neovascularization originated from the perifoveal capillaries and demonstrated typical leakage on fluorescein angiography.

Purulent anterior segment endophthalmitis following paracentesis.

A 67-year-old man developed a central retinal artery occlusion and was treated with an oral carbonic anhydrase inhibitor, oral glycerin, carbachol rebreathing, and anterior chamber paracentesis. He subsequently developed an anterior segment endophthalmitis. Vigorous medical and surgical management cured the endophthalmitis, but his visual acuity remained at light perception. To the best of our knowledge, this patient represents the first reported case of a culture-positive, anterior segment endophthalmitis following anterior chamber paracentesis.

Treatment of combined traction-rhegmatogenous retinal detachment in the morning glory syndrome.

A 14-year-old boy had a near total retinal detachment associated with the morning glory optic disc anomaly. A tiny slit-like retinal break with adjacent vitreous traction was found within the coloboma, providing communication between the vitreous cavity and the subretinal space. Vitrectomy, fluid-gas exchange, and postoperative confluent Krypton laser photocoagulation around the optic disc resulted in a successful reattachment of the retina. The retina has remained attached for 14 months.

Serratia rubidae endophthalmitis following penetrating ocular injury.

A 10-year-old boy incurred penetrating trauma to his left eye by a small piece of wood. Immediate lens aspiration and repair of his corneal laceration were performed. The patient, however, demonstrated "persistent severe uveitis." On the fourth day following his injury, an uncomplicated pars plana vitrectomy was performed in combination with intracameral injection of gentamicin, cefazolin, and dexamethasone. Cultures of the vitrectomy specimen demonstrated Serratia rubidae. Postvitrectomy treatment with parenteral gentamicin, cefazolin, prednisone, and oral trimethoprimsulfamethoxazole resulted in a complete cure of the endophthalmitis and retention of good visual function. This patient represents the first reported case of Serratia rubidae endophthalmitis.

Fluorescein angiography of the heavily pigmented iris and new dyes for iris angiography.

An inexpensive adapter mounted in front of the objective lens of a fundus camera permits routine fluorescein angiography of the heavily pigmented iris. Angiograms of these patients whose iris pigment was dense enough that standard methods of iris angiography would disclose little or no information were performed with the use of the adapter. For use in the study of the iris vasculature in the research laboratory, three dyes with spectral characteristics different from those of fluorescein allow angiography of the iris at different wavelengths. Angiograms using these dyes were performed on the eye of a cynomolgus monkey. The angiograms were each taken as close as possible to the same time sequence and show dramatically different filling and staining patterns.

Retinal periphlebitis as the initial clinical finding in a patient with Hodgkin's disease.

A 28-year-old woman noted decreased vision in one eye and was found to have bilateral optic disc swelling, periphlebitis, focal chorioretinitis, and vitritis. Subsequent lymph node biopsy revealed nodular sclerosing. Hodgkin's disease, stage II-A. The ocular manifestations of the disease resolved in response to systemic radiation therapy. The relationship of the ophthalmic findings to the systemic disease are discussed.

Retinopathy in juvenile-onset type I diabetes of short duration.

We evaluated the prevalence and severity of diabetic retinopathy in 173 juvenile-onset, type I diabetic subjects and 78 nondiabetic controls of similar age, race, and sex distribution by stereoscopic fundus photography and fluorescein angiography, performed by a standardized protocol and evaluated by five expert, masked observers. The overall prevalence of retinopathy was 18% in the diabetic group and 0% in the controls. Retinopathy prevalence increased with duration of diabetes in the diabetic group, with a prevalence of 1% from 0--4 yr after diagnosis, 25% after 5--9 yr, and 67% 10--16 yr after onset of the systemic disease. There was an independent association with age, with little retinopathy before age 15 and a 48% prevalence in older persons. Retinopathy was also found to be independently associated with the following: diabetic "control," evaluated semiquantitatively but on a masked basis; lens opacities; and frequency of daily insulin injections. Among the 166 diabetic subjects who had both angiography and photography, a retinopathy prevalence of 17% was detected by angiography and 11% by photography. This difference was statistically significant (P = 0.01). This study provides baseline data for use in estimating sample size in controlled trials of therapeutic measures to prevent retinopathy in juvenile diabetic populations. The study also supports the hypothesis that long-term hyperglycemia as well as changes (possibly hormonal in nature) associated with puberty are causally related to diabetic retinopathy.

Management of postoperative and post-traumatic cyclodialysis clefts with argon laser photocoagulation.

Cyclodialysis clefts, which occur following cataract extraction or ocular trauma, occasionally lead to chronic hypotony and loss of vision in the involved eye. In the past, this complication of trauma and surgery has been managed by additional surgical procedures designed to close the cyclodialysis cleft. This report will describe the first patient treated with Argon laser photocoagulation with successful physiologic closure of the cleft with subsequent restoration of both normal intraocular pressure and normal vision. The method of treatment and speculations about the mechanism of cleft closure are discussed.

Retinopathy in juvenile-onset diabetes of short duration.

To study objectively the epidemiology of retinopathy in juvenile-onset diabetes, we performed fundus photography and fluorescein angiography, using the Diabetic Retinopathy Study protocol, on 122 juvenile diabetics and 65 demographically similar non-diabetic subjects as the control group. Photographs and angiograms were masked as to subjects' identities and evaluated independently by five retinal subspecialists. There was no retinopathy in control subjects. In diabetics, prevalence of retinopathy increased with the duration of disease, being 0% after zero to four years, 27% for five to nine years, and 71% for more than ten years. Retinopathy also increased in prevalence with age with a sharp rise after age 15. There is indication that age and duration act independently. Details of our method for establishing the diagnosis of diabetic retinopathy are presented, together with the degree of observer variability in identifying early lesions.

Mooren's ulcer: two cases occurring after cataract extraction and treated with hydrophilic lens.

Two patients developed Mooren's ulcer following cataract extraction. The first case was complicated by ocular trauma 8 years prior to surgery and by vitreous loss at the time of surgery. The second patient underwent cataract extraction without complication. Surgical trauma may have been the inciting factor in the development of these ulcers. Both patients experienced dramatic relief of ocular pain following the application of hydrophilic lenses. There was no apparent alteration in the course of the disease in either case. The use of hydrophilic soft lenses is suggested for symptomatic relief of the severe ocular pain experienced by patients with Mooren's ulcer.

Rhegmatogenous retinal detachment after tributary retinal vein occlusion.

Two patients had rhegmatogenous retinal detachment after tributary retinal vein occlusion. Neovascularization adherent to the posterior hyaloid was avulsed, along with a plug of retinal tissue, as the vitreous body collapsed. Localized retinal detachments resulted. Photocoagulation successfully obliterated the retinal holes and prevented extension of the retinal detachments in both cases.