Faculty Bibliography

Eleven patients, 40 to 71 years old, had a choroidal vasculopathy that led to hemorrhagic and exudative macular degeneration. The patients had peculiar polypoidal, subretinal, vascular lesions associated with serious and hemorrhagic detachments of the retinal pigment epithelium. This macular disorder, which we have named idiopathic polypoidal choroidal vasculopathy (IPCV), appears to represent a distinct entity that differs clinically and demographically from age-related macular degeneration (AMD) and other macular diseases associated with subretinal neovascularization. Recognition of this condition is important because it may have specific risk factors, natural course, and management considerations that differ from those of age-related macular degeneration

Seventy-six consecutive patients with total rhegmatogenous retinal detachments and severe proliferative vitreoretinopathy underwent combined pars plana vitrectomy, lensectomy, panretinal photocoagulation, perfluoropropane gas (C3F8)/fluid exchange, and scleral buckling. Sixty-two (82%) of the patients had successful, sustained (greater than 12 months) posterior retinal reattachments at last examination. Of these 62 patients, 40 (65%) had complete retinal attachment, with no evidence of regrowth of periretinal membranes or redetachments following the initial procedure. In the remaining 22 cases with successful reattachment of the retina posterior to the equator, partial peripheral retinal detachments were observed. In 16 of the 22 cases, the detachments occurred entirely anterior to the boundary of the previously placed photocoagulation lesions. The posterior retina remained uninvolved, and no further treatment was needed. Reoperation was required in the other six patients to achieve sustained posterior retinal reattachment. Postoperative visual acuity ranged from 20/40 to bare light perception, with 69% of the anatomically successful cases obtaining functional visual acuity (greater than 20/400). Failures were related to reproliferation of fibrous membranes

In cooperation with the New York State Athletic Commission, 74 boxers applying for a new or yearly renewal license were sequentially referred over a 2-year period for a complete dilated ocular examination at the Sports Vision Institute of the Manhattan Eye, Ear and Throat Hospital. At least one ocular injury was found in 66% of boxers. Vision-threatening injuries, defined as significant damage to the angle, lens, macula, or peripheral retina occurred in 58% of boxers. Nineteen percent of boxers had angle abnormalities. Nineteen percent of boxers had pathologic cataracts, over 70% of these were posterior subcapsular. Six boxers had macular lesions. A total of 24% of boxers had retinal tears. Standardized photographs were used to distinguish pathologic cataracts from congenital opacities and pathologic retinal tears from atrophic holes. Attempts were made to identify risk factors in boxing that might be predictive for ocular injury. Variables included age, weight division, left- or right-handedness, total number of losses, and total number of bouts. Significant correlations were found between the total number of bouts and the total number of losses, and the presence of retinal tears. College varsity athletes were selected as controls. Significant differences were found between boxers and controls for the total number of injuries, total vision-threatening injuries, and the number of retinal tears. A series of recommendations are proposed to aide in the early detection and prevention of serious ocular injuries

Endophthalmitis remains a dreaded complication of intraocular surgery and penetrating eye trauma. Subconjunctival, topical, and systemic antibiotics have been largely ineffective in the treatment of endophthalmitis, whereas intravitreal antibiotics have proved efficacious. Methicillin-resistant Staphylococcus epidermidis has become an important pathogen in many infections, including endophthalmitis. Toxicity, clearance, and efficacy of intravitreal vancomycin were evaluated in the treatment of experimental methicillin-resistant S. epidermidis endophthalmitis. No evidence of retinal toxicity was found and therapeutic levels were demonstrated six days after injection. The treated rabbit eyes showed a marked beneficial effect when compared to the untreated eyes. If experience confirms the safety of intravitreal vancomycin in human eyes, vancomycin should be considered the drug of choice for methicillin-resistant S. epidermidis endophthalmitis.

A retrospective analysis of a consecutive series of patients treated with krypton red laser (KRL) photocoagulation for subretinal neovascularization (SRN) secondary to drusen-related macular degeneration (DMD) was carried out to investigate the frequency and nature of recurrent neovascularization (recurrence). A classification of various types of recurrences based on the clinical and fluorescein angiographic features and the onset of their appearance in the postoperative course was used in this study. Patient, fundus, and membrane variables were examined in search of relevant high risk factors predisposing to recurrences. The membrane's proximity to the fovea and its relative lack of pigmentation were individual factors which were associated with a high risk of recurrence (P less than 0.05 for distance and P = 0.005 for color). Multivariate analysis also indicated that a greater distance from the fovea (P less than 0.05) and a darker color (P = 0.002) were favorable features to the primary membrane, reducing the probability of a recurrence. Overall, 39% of the patients experienced recurrences (23% of the patients had treatable recurrences and 16% had non-treatable recurrences extending under the center of the fovea). The membranes recurred predominantly at the margin of the photocoagulation burn. The recurrences were also noted relatively early in the postoperative course, 65% within two months after photocoagulation of the primary membrane. The fluorescein angiographic and clinical nature of these membranes and the visual effect of retreatment are also discussed in the paper