Intraocular foreign bodies: management, prognostic factors, and visual outcomes.

OBJECTIVE: To determine prognostic factors and visual outcomes in patients with intraocular foreign bodies (IOFBs). DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Fifty-nine consecutive patients undergoing removal of an IOFB with a minimum of 6 months of follow-up. INTERVENTION: Surgical removal of the IOFB and repair of associated ocular trauma. MAIN OUTCOME MEASURES: Final best corrected visual acuity was the main outcome measured. Ocular findings at presentation were compared with final visual acuity to determine prognostic factors for visual outcome. RESULTS: Final best corrected visual acuity of 20/40 or more was obtained in 42 patients (71%) and ambulatory vision (>5/200) was achieved in 50 patients (85%). Presenting visual acuity was predictive of final visual outcome (P < 0.01). Prognostic factors for a better visual outcome (P < 0.05) included better presenting visual acuity and hammering metal on metal as the mechanism of injury. Prognostic factors for a poor outcome (P < 0.05) included poor presenting visual acuity, the presence of an afferent pupillary defect, and vitreous hemorrhage. CONCLUSIONS: Final visual outcomes were excellent in 71% of patients. Presenting visual acuity was the strongest predictor of final visual outcome in this series. Additional predictive factors included the mechanism of injury, the presence of an afferent pupillary defect, and vitreous hemorrhage.

Anatomic and visual results in asymptomatic clinical rhegmatogenous retinal detachment repaired by scleral buckling.

PURPOSE: To report presenting characteristics as well as anatomic and visual results in asymptomatic clinical rhegmatogenous retinal detachment repaired by scleral buckling. METHODS: Review of 28 eyes of 27 patients with an asymptomatic clinical retinal detachment-defined as a rhegmatogenous retinal detachment with subretinal fluid extending more than 2 disk diameters posterior to the equator-which were repaired by scleral buckling from January 1989 through December 1996 with follow-up of 6 months or longer. RESULTS: With a single scleral buckling procedure, anatomic reattachment of the retina occurred in all eyes; one eye redetached 14 months after the initial surgery secondary to a new retinal break and was successfully reattached. All eyes had best-corrected presenting and final visual acuity of 20/50 or better. Final best-corrected Snellen visual acuity was within 1 line of best-corrected presenting visual acuity in 82% of eyes; three eyes improved more than 1 line of Snellen visual acuity and two eyes lost more than 1 line. CONCLUSION: Anatomic and visual results in asymptomatic clinical rhegmatogenous retinal detachment after scleral buckling surgery are excellent. Strong consideration should be given to repair of these detachments.

The natural history of macular pseudoholes.

PURPOSE: To report the natural history of macular pseudoholes with regard to ophthalmoscopic appearance and visual acuity. METHODS: Thirty-six eyes of 34 patients with macular pseudoholes who were followed up for 1 year or longer were retrospectively evaluated to compare the initial ophthalmoscopic appearance and visual acuity with the most recent follow-up appearance and visual acuity. RESULTS: Mean visual acuity at initial examination was 20/32 (median, 20/30); mean follow-up visual acuity was 20/32 (median, 20/30). Fourteen eyes (39%) had identical initial and final visual acuities, and 30 eyes (83%) had final visual acuity within 2 lines on the visual acuity chart from their initial examination. Four eyes had improved visual acuity of more than 2 lines, and two eyes lost more than 2 lines of visual acuity. Thirty-one eyes had adequate initial and follow-up photographs allowing comparison of macular appearance. Twenty-three (74%) of the 31 eyes showed a definitive change in macular appearance. CONCLUSIONS: Visual acuity in patients with macular pseudoholes tended to remain stable. However, the macular appearance changed in 74% of eyes.

Retinal arterial occlusions in young adults.

PURPOSE: To determine the cause, associated factors, visual results, and systemic morbidity in patients less than 40 years old with retinal arterial occlusions. METHODS: We studied 27 eyes with nontraumatic retinal arterial occlusions in 21 patients less than 40 years old (range, 22 to 38 years; mean, 28 years). RESULTS: Of the 21 patients, branch retinal artery (arteriolar) occlusion occurred in 15 (71%), central retinal artery occlusion occurred in five (24%), and cilioretinal artery occlusion occurred in one (5%). Retinal artery occlusions were bilateral in six patients (29%) and occurred in 14 women (67%). Emboli were identifiable in seven patients (33%). Cardiac valvular disease was the most commonly recognized etiologic agent and was present in four patients (19%). Various associated factors leading to a hypercoagulable state or embolic condition were identified in 19 patients (91%). CONCLUSION: Retinal arterial occlusions in young adults occur via multiple mechanisms. Systemic evaluation allows detection of a risk factor for retinal arterial occlusive disease in most patients.

Progressive outer retinal necrosis secondary to varicella zoster virus in acquired immune deficiency syndrome.

BACKGROUND: A syndrome consisting of rapidly progressive outer retinitis in patients with suppressed immune systems has been described. The etiologic agent appears to be a member of the herpes virus family. METHODS: A 41-year-old man with acquired immune deficiency syndrome (AIDS) developed bilateral outer retinitis and choroiditis, which progressed despite antiviral treatment. A transscleral eye wall biopsy specimen and whole globe were submitted for microbiologic and histologic study. RESULTS: Polymerase chain reaction of a transscleral eye wall biopsy specimen and of the enucleated specimen determined the etiologic agent to be varicella zoster virus (VZV). Histologic studies demonstrated intranuclear inclusions consistent with viral particles in choroidal cells. CONCLUSION: Our study revealed intranuclear inclusions in choroidal cells, a previously undocumented finding in progressive outer retinal necrosis. Polymerase chain reaction was very useful in identifying the causative agent.

Acquired immunodeficiency syndrome-related primary intraocular lymphoma.

A 37-year-old man with acquired immunodeficiency syndrome and cytomegalovirus retinitis developed primary intraocular and central nervous system lymphoma. Intraocular involvement was documented before death with vitrectomy. Autopsy demonstrated the presence of cytomegalovirus retinitis in the right eye and lymphoma in both eyes and the brain. We believe this is the first report of autopsy-confirmed primary intraocular lymphoma in a patient with the acquired immunodeficiency syndrome.

Vitreoretinal surgical technique for transplanting retinal pigment epithelium in rabbit retina.

Transplantation of retinal pigment epithelial (RPE) cells has been proposed as a potential remedial procedure for previously untreatable retinal diseases. In this study, a vitreoretinal surgical technique was used to transplant pigmented RPE cells obtained from pigmented rabbits into the subretinal space of New Zealand White rabbits. At the time the animals were sacrificed, the retina was re-attached in all but 4 of the 24 experimental eyes. Histologically, by one week the transplanted RPE cells had formed a monolayer in patchy areas beneath the attached retina. By electron microscopy, RPE cells with prominent melanin granules were found attached to Bruch's membrane. Three weeks after transplantation, grafted RPE cells had formed apical microvilli and tight junctions with adjacent cells. The nucleus of the cells containing pigment had become oval, and their contact with Bruch's membrane appeared to be composed of bsal infoldings that were well formed. Our findings demonstrated the functional appearance of the transplanted RPE cells.

Posterior chamber intraocular lens implantation combined with lensectomy-vitrectomy and intraretinal foreign-body removal.

Two patients with intraretinal foreign bodies and traumatic cataracts were treated with pars plana lensectomy, vitrectomy, and removal of the foreign body. In each case, it was technically possible to preserve the anterior capsule despite small but obvious rents caused by the foreign body. This allowed support for the placement of a posterior chamber intraocular lens at the time of the initial repair. Posterior chamber intraocular lens implantation may be a useful adjunctive step in the treatment of selected patients with intraocular foreign bodies.

Cutaneous malignant melanoma metastatic to the choroid.

Cutaneous malignant melanoma metastatic to the eye is a well-documented occurrence in the ophthalmic literature. Typically, ocular metastatic disease occurs concomitantly with or following the documentation of disseminated metastases. We present the clinical and histopathologic findings in a 62-year-old man whose first manifestation of metastatic cutaneous melanoma was his choroidal lesion.

Surgical removal of massive subretinal hemorrhage associated with age-related macular degeneration.

The authors report on 11 patients with age-related macular degeneration associated with massive subretinal hemorrhage, who were treated with surgical removal of the hemorrhage and associated fibrosis. Preoperative visual acuity ranged from 20/400 to hand motions. Postoperative visual acuity ranged from 20/200 to light perception with a minimum of 3 months of follow-up. Complications included partial or total retinal detachment in four patients (36%) and cataract in four patients (36%). Four of 11 patients showed some improvement in vision (36%). All four of these patients had surgery within 1 week of the onset of severe visual loss. Although surgical removal of large subretinal hemorrhages is technically feasible, visual recovery is limited, even in uncomplicated cases, by macular degenerative changes.

Protein S deficiency and bilateral branch retinal artery occlusion.

A macular branch retinal artery occlusion developed in the right eye of a 25-year-old woman when she was 38 weeks pregnant. She subsequently presented 5 days postpartum with a branch retinal artery occlusion in her left eye. Although her initial work-up did not reveal a source for her occlusions, subsequent studies have documented a deficiency of protein S.

The use of intravitreal air in selected retinal detachments.

Statistically controlled studies substantiating the current widespread acceptance of intravitreal air injection as an adjunct to traditional or standard scleral buckling techniques in the repair of rhegmatogenous retinal detachment are unavailable. The surgical success rate of a prospectively chosen group of patients who received intravitreal air was compared with that of a retrospectively chosen but comparable group of patients who did not receive air injection in their detachment repair. The 100% retinal reattachment rate in the air group at six weeks was found to be statistically significant for comparable configurations of retinal detachment and superiorly located breaks in patients without significant proliferative vitreoretinopathy.