Combined electrophysiological assessment of the visual system in central serous retinopathy.

Six subjects suffering from idiopathic central serous retinopathy were examined during the acute phase using a battery of neurophysiological tests. The records (using skin electrodes) included the electro-oculogram (EOG), the white light electroretinogram (ERG) during various stages of dark and light adaptation, and the flash and pattern reversal visual evoked potentials. Results obtained from the affected eye were compared with those from the healthy eye. The values of the healthy eye were not significantly different from our normal control group. The EOGs of the affected eyes were not significantly different from those of the healthy eyes. The 'a' wave of the ERG during light adaptation was significantly (P less than 0.05) smaller in the affected eye. The amplitudes of the other components and the latencies of all components were not affected. The latency of the PR-VEP of the affected eye in all subjects was prolonged in comparison with the unaffected eye. In 3 subjects the latency was prolonged by more than 2 S.D.s compared with our control group. The amplitude of the PR-VEP in 5 of our 6 subjects was slightly but significantly (P less than 0.02) smaller in the affected eye. There was no correlation between amplitude and latency changes.

Static perimetric and Amsler chart changes in patients with idiopathic central serous retinopathy.

Macular disturbances in patients with active idiopathic central serous retinopathy can be readily documented by performing Amsler charting or static perimetry, but, as uncertainty exists as to which examination technique is superior for detecting disturbances after a detachment has settled, a study was performed in which patients were investigated by the two methods during the acute, resolving and resolved stages of the disease. All of the patients assessed in the acute phase showed abnormal responses to both forms of examination, but after the oedema fluid absorbed 63% of cases retained abnormal static profiles whereas 81% recorded defects on Amsler charting. Disturbances of retinal function were most apparent on static perimetry testing if the meridian studied corresponded to that intersecting the site at which the focal breakdown of the choroidoretinal barrier had developed and the fovea. The incidence of retinal changes was found to be greater in patients where the oedema resolved slowly.

Photostress recovery times in cases of central serous retinopathy.

Photostress recovery times were measured in 50 normal individuals in the age group 20-50 years and in 27 patients who had developed central serous retinopathy. A flash generator of a commercially available fundus camera was used to provide the appropriate stimulus. The results showed that photostress recovery times were grossly abnormal in patients with central serous retinopathy for the first few weeks after the onset of symptoms, but gradually returned to normal values by 5 months and remained so thereafter. In a few patients during the recovery phase a transient paradoxical response was noted, whereby the photostress recovery times became less than in the unaffected control eye.It appears that the use of a fundus camera to provide photostress stimulus has merit because the light source is subject only to slight variation in intensity, standardization of responses is possible and the technique can be employed on patients about to have fluorescein angiographic studies for diagnostic or documentation purposes.

Chorioretinitis sclopetaria.

Chorioretinitis sclopetaria occurs as a result of missiles penetrating into the orbit and grazing, but not perforating, the sclera. Localized destruction of both the retina and choroid develops adjacent to the impact site and these structures are subsequently replaced by a connective tissue response. Extensive damage is produced in the retinal circulation, which is not confined to the zones containing connective tissue plaques. Residual field defects are found to relate more closely to areas of retinal capillary non-filling than to the while scarred areas.

Indirect choroidal tears at the posterior pole: a fluorescein angiographic and perimetric study.

Retinal fluorescein angiographic and visual field studies were performed on 10 patients who had developed indireect choroidal tears, these procedures being repeated at intervals until the retinal disturbances stabilised. Fluorographic investigations revealed that a transient breakdown of the choroidoretinal barrier to fluorescein dye could be detected in cases investigated within 4 days of injury, and also that the late complication of neovascularisation, producing a serous maculopathy, may resolve and good central vision be retained without recourse to photocoagulation therapy. Patients who had visual field examinations performed within a few days of trauma were noted to have dense central scotomata, but some recovery occurred in most cases, although to a variable degree. Field defects away from fixation corresponded to an extent with areas of post-traumatic pigmentary retinopathy, but in some portions of retina with normal background appearances sensitivity was also noted to be reduced. Scotomata corresponding specifically to choroidal tears or nerve fibre bundle defects were not recorded. Improvement of visual acuity may be expected, except in cases where a choroidal tear has involved the fovea or progressive choroidal neovascularisation led to permanent macular damage.