Pupil size influence on the intraocular performance of the multifocal AMO-Array intraocular lens in elderly patients.

PURPOSE: To study the relationship between pupil size and AMO-Array multifocal intraocular lens (MIOL) performance in a population of elderly patients. METHODS: This prospective trial included 62 patients (mean age 76 years; range 70 to 86) undergoing bilateral cataract phacoemulsification and MIOL (AMO-Array SA-40N, Allergan) implantation. Patients were divided into two groups based on preoperative pupil diameter: small pupil group (pupil size of 2.5-2.9 mm; 45 subjects) and large pupil group (pupil size of 3-5 mm; 17 subjects). The analysis included uncorrected (UC) and best-corrected (BC) near and distance visual acuity (VA), spectacle dependence, and photic phenomena complaints (postoperative follow-up 16.6+/-6.2 months; range 11-26 months). RESULTS: Patients in the small pupil group showed postoperatively significantly higher distance UCVA and BCVA, but lower near UCVA compared to those in the large pupil group (Mann-Whitney test, p< or = 0.02). Patients with small pupils also tended to: be more (not statistically significant) spectacle independent for distance (73.3% versus 47.1%) and spectacle-dependent for near vision (55.6% versus 28.4%); report significantly less photic phenomena complaints (37.8% versus 93.1%, chisquare test, p<0.001); and, more satisfied with the surgery (95.5% versus 76.5%). Posterior capsular opacification (PCO) was observed in 19.4% of the patients. CONCLUSIONS: Bilateral AMO-Array MIOL implantation in elderly patients seems to be an effective and safe surgical procedure that improves distance and near UCVA, providing spectacle independence in many cases. The use of these MIOLs, however, can induce photic phenomena and cause PCO. Patients with small preoperative pupils (<3 mm) presented less photic phenomena complaints and expressed a higher visual outcome satisfaction after surgery.

Scleroretinal necrosis after a subconjunctival injection of gentamicin in a patient with a surgically repaired episcleral retinal detachment.

PURPOSE: To describe a case of scleroretinal necrosis after a subconjunctival injection of gentamicin in a patient who had an episcleral retinal detachment that was surgically repaired. METHODS: Case presentation. RESULTS: Thinning of the sclera due to cryosurgery and the induced localized inflammatory response resulting from the surgical procedure, in addition to the effect of the sponge buckle itself, could have played an important role in accumulation and storage of gentamicin under and adjacent to the buckle after injection. The increasingly higher concentration of the drug under the buckle could have induced a greater penetration of gentamicin through the sclera, which could have been the cause of the scleral-chorio-retinal necrosis observed in this patient. CONCLUSIONS: Attention must be given to avoid side effects from subconjunctival injection of gentamicin.

Recurrent RPE microrips in a case of vascularised pigment epithelial detachment.

Microrips of the RPE are an infrequent finding in vascularised pigment epithelial detachments (PEDs). Fluorescein angiography revealed that they are identical to the leaks seen in central serous chorioretinopathy (CSC); it has been hypothesised that both may be caused by hydrostatic forces generating a mechanical disruption of the RPE. We report a case of vascularised PED that was complicated by repeated subretinal haemorrhages and presented recurrent microrips of the RPE, which is a finding never described before according to our knowledge. In this case, a very high protein concentration in the subretinal space, due to prolonged bleeding from the neovascular membrane, might have damaged the RPE and reduced the choroidal suction, as believed for CSC. It might also have increased the intraluminal pressure in the PED, finally determining the passage of fluid through the microrips, which have been hypothesised to be RPE defects. These observations represent further speculation about the pathogenesis and the unique angiographic pattern of the leaks in CSC and of RPE microrips.

Indocyanine green angiography is of value for the diagnosis of chronic central serous chorioretinopathy in elderly patients.

BACKGROUND: Central serous chorioretinopathy is characterized on indocyanine green angiography by areas of transient choroidal hyperfluorescence. These findings are thought to be the consequence of altered permeability of the choroidal vessels. METHODS: The indocyanine green angiograms of 41 patients between 40 and 60 years of age, with central serous chorioretinopathy and of 120 patients above 64 years of age with occult choroidal neovascularization due to age-related macular degeneration were reviewed for the presence of transient indocyanine green leakage. Twelve eyes of 9 patients above 64 years of age with (1) fluorescein leakage of undetermined source corresponding with well-delineated zone(s) of retinal pigmentary changes and (2) transient indocyanine green hyperfluorescence are reported in detail. RESULTS: Transient indocyanine green hyperfluorescence was seen in all eyes with central serous chorioretinopathy, either typical or chronic, and was seldom seen in occult choroidal neovascularization due to age-related macular degeneration. In the series of chronic serous chorioretinopathy in patients above 64 years of age, four classic choroidal neovascular membranes were found in 12 eyes. Most patients presented multizonal transient choroidal hyperfluorescence in both eyes on indocyanine green angiography. CONCLUSION: Transient choroidal hyperfluorescence is suggestive for chronic central serous chorioretinopathy in older patients presenting retinal pigmentary disease with fluorescein leakage of undetermined source. Chronic central serous chorioretinopathy is not uncommonly associated with classic choroidal neovascularization in the elderly.

Retinal neovascularization in a case of macular branch retinal vein occlusion.

BACKGROUND: Retinal neovascularization (RNV) has never been described in cases of macular branch retinal vein occlusion (MBRVO), due to the limited amount of ischemia in this form of retinal vein occlusion. Ischemic areas as wide as 5-10 disc diameters were required by previous studies to count as ischemic cases of central or major branch retinal vein occlusion. CASE REPORT: A 56-year-old woman who had been suffering from MBRVO for 3 years presented at the posterior pole a zone of non-perfusion, extending over 7.5 disc areas, and three small tufts of RNV. RNV regressed after two subsequent laser treatments of the ischemia. Retrohyaloid hemorrhage was observed 2 months after the first treatment. CONCLUSION: Since the average diameter of the non-perfused area was about 2.75 disc diameters, this case demonstrates that small RNVs can appear in less extensive areas of ischemia than is generally believed.

Gorlin's syndrome. Case report.

Gorlin's syndrome (GS) is a hereditary dominant autosomal disease linked to a gene which has a strong discerning and an extremely variable expressiveness. It is an ecto-mesodermic polydysplasia generally characterized by multiple nevoid basal-cell carcinomas, palmo-plantar pits, cysts of cutis and long bones, intracranial ectopic calcification; less frequently it is accompanied by tumors of other organs such as the ovaries, and by brain, neurological and ocular defects. Chalazions and squinting are the most typical ocular complications. We describe a patient with GS detected at an ophthalmology consultancy during which by chance we found multiple peripheral retinal breaks with a partial retinal detachment and retinoschisis.

A 8 months indocyanine angiographic follow-up of a patient with serpiginous choroidopathy.

BACKGROUND: Serpiginous choroidopathy is a rare progressive disorder which affects both the choroid and the retinal pigment epithelium. PURPOSE: To analyze the fluorescein and indocyanine green angiographic evolution in a patient affected by serpiginous choroidopathy with a one year follow-up. METHODS: A patient affected by serpiginous choroidopathy was examined with fluorescein angiography and indocyanine green angiography with a follow-up of 8 months. CONCLUSION: Fluorescein angiography shows clearly the active and healed lesions in serpiginous choroidopathy while indocyanine green angiography seems to be more useful in detecting the extent of the choroidal involvement and may prove to be a useful tool in indicating the direction of future disease extension.