Vitrectomy for epiretinal membranes: visual outcome and prognostic criteria.

The treatment of choice for epiretinal membranes (ERM) causing marked retinal distortion and substantial visual impairment remains vitreoretinal surgery. The purpose of this study was to evaluate the results of surgery performed in our department and to investigate the prognostic value of different factors such as preoperative best-corrected visual acuity (BCVA), pre-existing cystoid macular edema (CME), intra-operative peeling of the internal limiting membrane (ILM), age and duration of symptoms. Eighty-eight consecutive eyes of 88 patients were operated on for ERM from July 1998 to June 2000. Both idiopathic and secondary cases were included. In all cases the ERM was successfully removed from the fovea. Mean BCVA after surgery increased from Snellen 0.2 (hand motion (HM) - 0.6) to Snellen 0.5 (HM - 1.0) (p<0.0001). Our results confirm the efficacy of surgical removal of the ERM in improving the visual acuity. Although not statistically significant, mean postoperative BCVA was slightly better in the group without pre-existing CME (p>0.05) and in the group where peeling of the ILM was performed (p>0.05). The data suggest that early surgery is likely to decrease the risk of developing irreversible macular damage (p<0.05). Because accelerated nuclear sclerosis with visual impairment is a common phenomenon after vitrectomy, one might consider performing a phaco-emulsification at the same time, especially in the elderly.

Subconjunctival Loa Loa worm: case report.

A 38-year old Ghanaian suddenly had the sensation of a foreign body in his right eye. Slit-lamp examination revealed a transparent worm underneath the conjunctiva. With topical anesthesia, the complete worm, 3.5 cm long, was removed surgically. A microbiological analysis at the Institute of Tropical Medicine confirmed the diagnosis of Loa Loa. Laboratory tests showed negative blood eosinophilia, positive blood film examination for microfilariae and positive results for filarial serology. The postoperative treatment consisted of progressive doses of di-ethyl-carbamazine (50-->100-->200 mg/d). A subconjunctival Loa Loa worm is rare in Belgium and usually occurs in immigrants or travellers returning from Tropical (Equatorial) West and Central Africa. Our patient visited Nigeria in 1985 and Ivory Coast in 1986. Those regions are highly endemic for Loa Loa.

Familial spastic paraplegia and maculopathy with juxtafoveolar retinal telangiectasis and subretinal neovascularization.

PURPOSE: To describe a previously unreported condition involving familial spastic paraplegia and a peculiar type of maculopathy. METHODS: Two pairs of siblings were studied. All four cases underwent serial clinical examinations, fundus photography, and fluorescein angiography. Two siblings had extensive investigations. RESULTS: Characteristics of the four cases include spastic paraplegia diagnosed in the first decade of life and visual loss at about age 9 due to a maculopathy with an abnormal vascular complex. In the early stages, parafoveal dilatation of the capillary network was noted. The later stages were characterized by cystic macular degeneration, and seven of eight eyes developed fibrovascular scars with retinochoroidal anastomoses, pigment migration, and atrophic changes. In two siblings, electro-oculographic findings were subnormal, whereas results of electroretinography, magnetic resonance imaging of the brain and spinal cord, and metabolic and karyotype studies were normal. These siblings were an Indonesian girl and boy; the other siblings were white males. There was no consanguinity of the parents and family history was unremarkable. CONCLUSIONS: This study suggests that the two pairs of siblings have an identical familial and probably recessive disorder with neurodegenerative changes that have caused paraplegia and a peculiar maculopathy associated with anomalous retinal vascular complexes, retinochoroidal anastomoses, and subretinal neovascularization.

Ocular ischemic syndrome: two case reports of bilateral involvement.

The ocular ischemic syndrome is characterised by ocular symptoms and signs secondary to severe carotid artery obstruction. In this paper, two cases of bilateral ocular involvement are presented. The first case was caused by severe bilateral carotid stenosis and the second by bilateral occlusion of the carotid artery.

Multifocal choroiditis with panuveitis and punctate inner choroidopathy: a mini review.

Multifocal choroiditis and punctate inner choroidopathy cause scattered acute chorioretinal lesions in the fundus. Secondary choroidal neovascularization and, more rarely, diffuse subretinal fibrosis without obvious neovascularization are associated with both syndromes and cause severe visual loss. Both disorders are of unknown etiology and have many similarities. It is our purpose to present four such cases with emphasis on their fluorescein and indocyanine green angiographic appearance. We review shortly the literature on the subject.

Dark choroid in cone-rod dystrophy.

An unusual pattern of dark choroid in an eight-year-old girl is described. The ophthalmoscopic, fluorescein angiographic and functional changes were indicative of progressive cone-rod dystrophy.

Acute macular neuroretinopathy after shock.

Acute macular neuroretinopathy is a rare disease that has been described mainly in women taking hormonal contraceptives. An association either with a viral illness or with the parenteral use of sympathomimetics was sometimes found. We describe its occurrence in a 22-year-old female following an anaphylactic shock after a bee sting, and in a 26-year-old female following a pregnancy complicated with vena cava syndrome and delivery by caesarean section. A combination of factors including hypoperfusion, Valsalva stress, estrogen-induced hematological and rheological changes, and alpha-adrenergic stimulation apparently provoked this clinical manifestation.