Primary intraocular (retinal) lymphoma after ocular toxoplasmosis.

PURPOSE: Toxoplasmosis gondii is a common worldwide parasite that presents in the eye with focal retinochoriditis and vitritis. Although it is rare, ocular toxoplasmosis has been linked to primary intraocular (retinal) lymphoma, which is mostly a diffuse large B-cell lymphoma. METHODS: An elderly female patient was treated for recurrent ocular toxoplasmosis, and because of progressive vitritis, a diagnostic vitrectomy was performed. Shortly afterward, she developed multiple brain lesions. Pathologic examinations of the vitreous specimen and cerebral tissues were conducted, including tests for T. gondii, Epstein-Barr virus, and cytomegalovirus DNA. RESULTS: The patient initially responded to antitoxoplasmosis treatment but continued to have persistent vitritis. She was diagnosed with primary intraocular lymphoma, and a repeated magnetic resonance imaging revealed cerebral lesions. Brain biopsy confirmed lymphoma. T. gondii DNA was found in malignant vitreous cells but was absent in the nonmalignant vitreous cells and brain lymphoma cells. The cytomegalovirus and Epstein-Barr virus genes were not found in any of the lymphoma cells. CONCLUSION: T. gondii may have played a role in lymphoproliferation and primary intraocular lymphoma development.

A model of spectral filtering to reduce photochemical damage in age-related macular degeneration.

BACKGROUND/PURPOSE: Cumulative sunlight exposure and cataract surgery are reported risk factors for advanced age-related macular degeneration (AMD). Laboratory studies suggest that accumulation and photochemical reactions of A2E (N-retinylidene-N-retinylethanolamine) and its epoxides, components of lipofuscin, are important in AMD. To relate this data to the clinical setting, we modeled the effects of macular irradiance and spectral filtering on production of A2E and reactive oxygen intermediates (ROIs) in pseudophakic eyes with a clear or "yellow" intraocular lens (IOL) and in phakic eyes. METHODS: We calculated relative changes of macular irradiance as a function of light (390 to 700 nm) intensity, pupil size, age, and lens status, and modeled resulting all-trans-retinal concentration and rates of production of A2E-related photochemicals and photon-induced ROIs in rods and retinal pigment epithelium (RPE). We compared these photoproducts following cataract surgery and IOL implantation with and without spectral sunglasses to normal age-related nuclear sclerotic lens changes. RESULTS: Following cataract and IOL surgery, all-trans-retinal and lipofuscin photochemistry would theoretically increase average generation of 1) A2E-related photochemicals, 2) ROI in rods and 3) ROI in RPE, respectively, 2.6-, 15- and 6.6-fold with a clear IOL, and 2.1-, 4.1- and 2.6 fold with a yellow IOL, but decrease approximately 30-, approximately 20- and 4-fold with a vermillion filter sunglass and clear IOL compared to an average 70 year old phakic eye. CONCLUSION: Sunglasses that strongly decrease both deep blue light and rod photobleaching, while preserving photopic sensitivity and color perception, would provide upstream protection from potential photochemical damage in subjects at risk for AMD progression after cataract surgery.

Recurrent retinal detachment more than 1 year after reattachment.

PURPOSE: Little information exists regarding recurrent retinal detachment after 1 or more years of complete retinal reattachment. To better understand this uncommon problem, we evaluated late recurrent retinal detachments in relation to the contemporary classification of proliferative vitreoretinopathy (PVR). DESIGN: Retrospective consecutive noncomparative case series. PARTICIPANTS: Nine patients (10 eyes) with late recurrent retinal detachment after 1 or more years of complete reattachment. METHODS: We retrospectively analyzed the clinical and operative records of one surgeon over a 9-year period to identify late recurrent retinal detachments that occurred 1 or more years after complete retinal reattachment. The study group was derived from a total of 453 consecutive cases of rhegmatogenous retinal detachment repair not associated with proliferative diabetic retinopathy, uveitis, or penetrating ocular trauma. MAIN OUTCOME MEASURES: Late recurrent retinal detachments after 1 or more years of complete retinal reattachment. RESULTS: The study group consisted of 10 eyes (2.2% of total) in nine patients. Redetachment occurred from 12 to 126 months (average, 46.8 months) after the initial detachment surgery. Late recurrent retinal detachments were associated with new retinal breaks (five eyes), reopening of old breaks (three eyes), or both (two eyes). In all, 13 open breaks were identified, nine of which were on or anterior to the scleral buckle. Eight eyes had grade C PVR, including four eyes with anterior PVR, three eyes with posterior PVR, and one eye with both anterior and posterior PVR. The retina was reattached after additional vitreoretinal surgery in eight eyes of seven patients; two patients (two eyes) declined reoperation. Visual acuity improved in seven of eight eyes after repair of the late recurrent retinal detachment. Postoperative follow-up after late recurrent detachment repair ranged from 69 to 140 months (average, 101.7 months, or 8.5 years). CONCLUSIONS: Vitreous base traction seems to be an important factor in late recurrent retinal detachments occurring 1 or more years after complete retinal reattachment, and the associated PVR was probably a secondary phenomenon and not a causative factor in most cases. Reoperation for such late recurrent retinal detachments can successfully reattach the retina and improve visual acuity in most cases.