Faculty Bibliography

OBJECTIVE: To identify coexisting ocular diagnoses in a case series of eyes that developed cystoid macular edema (CME) associated with latanoprost therapy. DESIGN: Retrospective observational case series. PARTICIPANTS: Seven eyes of seven patients who developed CME possibly associated with latanoprost treatment were studied. INTERVENTION: When these patients, all of whom were treated with latanoprost in addition to other glaucoma medications, described blurred vision or eye irritation, ocular examination revealed CME, which was confirmed by fluorescein angiography. Latanoprost was discontinued, and in three cases topical corticosteroids and nonsteroidal anti-inflammatory agents were used to treat the CME. MAIN OUTCOME MEASURES: Visual acuity and intraocular pressure were determined before latanoprost use began, during therapy, and after latanoprost use ceased. In these cases, resolution of CME was documented clinically after discontinuing latanoprost. RESULTS: Clinically significant CME developed after 1 to 11 months of latanoprost treatment, with an average decrease of 3 lines in Snellen visual acuity. Intraocular pressure decreased an average of 27.9% during treatment. Cystoid macular edema was confirmed in all cases by fluorescein angiography. In these seven patients, the following coexisting ocular conditions may have placed these eyes at risk for prostaglandin-mediated blood-retinal barrier vascular insufficiency: history of dipivefrin-associated CME, epiretinal membrane, complicated cataract surgery, history of macular edema associated with branch retinal vein occlusion, history of anterior uveitis, and diabetes mellitus. In all cases, the macular edema resolved following discontinuation of latanoprost, in some instances with concomitant use of steroidal and nonsteroidal anti-inflammatory agents. CONCLUSIONS: In this case series of pseudophakic, aphakic, or phakic eyes, the temporal relationships between the use of latanoprost and developing CME, and the resolution of CME following cessation of the drug, suggest an association between latanoprost and CME. In all cases, coexisting ocular conditions associated with an altered blood-retinal barrier were present

Amplitude of accommodation was measured in 121 Hong Kong Chinese subjects between the ages of 11 and 65 years, using the 'push-up' method and the results compared with those previously obtained for Caucasian subjects. The results confirm and quantify clinical experience that Chinese people have lower amplitudes of accommodation than Caucasians. If presbyopia is considered to commence when the amplitude of accommodation declines to less than 5 D, then presbyopia in the Chinese race occurs between the ages of 36 and 40 years. By early in the second decade of life the amplitude of accommodation in the Chinese is already lower than that of Caucasians. This suggests that reduced amplitude of accommodation may be due, at least in part, to factors other than longterm environmental effects

BACKGROUND: Subfoveal choroidal neovascularization (CNV) usually is associated with a poor visual prognosis. Laser photocoagulation of certain subfoveal membranes secondary to age-related macular degeneration (ARMD) appears preferable to observation based on recent Macular Photocoagulation Study (MPS) findings but is associated with decreased vision. The authors explored the use of vitreoretinal surgical techniques as an alternative method of eradicating subfoveal CNV. METHODS: After vitrectomy, a small retinotomy technique was used to extract or disconnect from the choroidal circulation subfoveal CNV in 58 eyes. There were 33 eyes with ARMD, 20 eyes with presumed ocular histoplasmosis, and 5 eyes with miscellaneous etiologies. Five eyes also received subfoveal RPE patches. RESULTS: With limited follow-up, significant improvement in vision (defined as 2 Snellen lines) was achieved in 7 of 22 eyes with ARMD CNV removal (1 eye 20/20), 0 of 4 eyes with ARMD CNV removal and RPE patches, and 1 of 7 eyes with ARMD CNV disconnection. Significant improvement was achieved in 6 of 16 eyes with presumed ocular histoplasmosis removal and 0 of 4 eyes with presumed ocular histoplasmosis CNV disconnection. In 5 eyes with miscellaneous CNV, 2 improved (20/20 and 20/40). CNV recurred in 29%. CONCLUSIONS: Some patients with subfoveal CNV appear to benefit from surgical removal. Only rarely do eyes with ARMD improve. Longer-term follow-up and refined case selection are required before this approach can be widely recommended

The authors reviewed the records of 302 eyes of 185 patients with diffuse diabetic macular edema with or without cystoid macular edema treated with modified grid laser photocoagulation between the years 1981 and 1990. Three years after initial grid treatment, visual acuity was improved in 14.5%, unchanged in 60.9%, and worse in 24.6% of eyes. The average number of treatments per eye was 1.9. These results show that in assessing long-term visual outcome, modified grid laser photocoagulation is an effective modality in maintaining or improving visual acuity in eyes with diffuse diabetic macular edema. The effectiveness demonstrated in this study is without comparison with control subjects with no treatment or comparison with other treatment techniques

Macular ischaemia has a central role in the pathophysiology and prognosis of retinal macular disease. We attempted to quantitate two of its major components as follows: vascular nonperfusion, by measuring the foveal avascular zone (FAZ), using fluorescein angiography; and functional damage, using automated perimetry of the central 30 degrees. Sickle cell disease was chosen for study because it was considered a prototype for a purely ischaemic retinopathy without an exudative component. We found that the FAZ measurement was reproducible and that the patients with maculopathy had statistically larger FAZs than the normal controls (p = 0.016, Wilcoxon rank sum test). In addition, scotomas measured by visual field perimetry were significantly larger in the sickle cell patients with maculopathy than in those without maculopathy. Our results showed that angiography and perimetry of the central 30 degrees were more sensitive tests for the detection of ischaemic macular disease than visual acuity and that macular ischaemia could be quantified by their use