The risk of missing angle neovascularization by omitting screening gonioscopy in acute central retinal vein occlusion.

OBJECTIVE: The purpose of the study was to determine whether angle neovascularization can occur without pupillary margin neovascularization in central retinal vein occlusion (CRVO). DESIGN: The study design was a prospective study of the main question and a retrospective study of ancillary issues. PARTICIPANTS: The authors examined 105 eyes of 100 patients with CRVO having clinical evidence of ischemia between July 1, 1986, and March 18, 1996. INTERVENTION: The authors looked for iris and angle neovascularization with both undilated slit-lamp biomicroscopy and Zeiss four-mirror gonioscopy. MAIN OUTCOME MEASURES: The presence of anterior segment neovascularization was measured. RESULTS: Of 34 eyes developing anterior segment neovascularization, 4 (12%) developed angle neovascularization without pupillary margin neovascularization over a mean follow-up of 2.2 +/- 2.4 standard deviation years. CONCLUSIONS: Angle neovascularization can occur without pupillary margin involvement in CRVO, implying the necessity of screening gonioscopy and supporting the Central Vein Occlusion Study conclusion (based on a photographic technique not used clinically).

The effect of patient characteristics on response to focal laser treatment for diabetic macular edema.

PURPOSE: The purpose of the study was to determine which patient characteristics influence response to focal photocoagulation for clinically significant diabetic macular edema (CSME). METHODS: A retrospective chart review was performed of 547 eyes from 361 patients who were observed for at least 1 year (mean, 2.6 +/- standard deviation 1.7 years) after surgery. Preoperative patient characteristics were tested for their significance in predicting outcome using multiple regression analysis. RESULTS: Increasing patient age has a negative effect on visual outcome (P = 0.0179). Patients with diet-controlled diabetes show improvement in mean vision, whereas patients whose diabetes is controlled with insulin, oral agents, or both show declines, and these differences are significant (P < 0.0001). Neither cataract surgery before or after focal photocoagulation nor simultaneous panretinal photocoagulation for patients having concomitant high-risk proliferative retinopathy had a significant effect on outcome. CONCLUSIONS: Younger patients with CSME and those with diet-controlled diabetes can be given more favorable prognoses. Patients with CSME and high-risk proliferative disease can have cost-effective simultaneous focal and panretinal photocoagulation without adversely affecting visual outcome.