Faculty Bibliography

PURPOSE: To describe the occurrence of visual hallucinations in a patient with Charles Bonnet syndrome associated with estrogen intake. METHOD: Case report. RESULTS: An 84-year-old woman with poor visual acuity secondary to bilateral, nonexudative, age-related macular degeneration had nonthreatening visual hallucinations 2 weeks after starting oral estrogen for osteoporosis. The estrogen was stopped, and the hallucinations subsided. The patient was given estrogen twice more and each time the hallucinations recurred. CONCLUSION: We report a case of Charles Bonnet syndrome associated with estrogen intake in an 84-year-old woman. Estrogen may have promoted release phenomena and triggered the hallucinatory episodes in our patient

PURPOSE: To characterize a newly discovered choroidal vascular abnormality in patients who have received radiation therapy for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration. DESIGN: Two-center cross-sectional study. PARTICIPANTS: In the United States, there were 95 patients who were treated with 10 or 12 Gy of external beam photons. In Belgium, 98 patients were treated with 20 Gy. These patients were examined retrospectively for the presence of a specific CNV abnormality. RESULTS: During the follow-up period, an unusual vascular growth pattern was identified in 12 patients (12.6%) of those treated in the United States and in 7 (7.1%) of those treated in Belgium. These patients developed round or oval vascular blebs along the outer border of their neovascular lesions. These blebs profusely leaked fluorescein dye and could be imaged best by indocyanine green angiography. Patients with these blebs appeared to have a marked propensity for loss of visual acuity. CONCLUSION: An unusual pattern of new vessel growth occurred in 19 of the 193 patients with CNV treated with radiation. This new entity, termed radiation-associated choroidal neovasculopathy, is a recognizable disorder that appears to have a particularly poor prognosis

OBJECTIVE: To determine the nature and frequency of polypoidal choroidal vasculopathy (PCV) in a series of patients suspected of having neovascularized age-related macular degeneration (AMD). METHODS: A prospective analysis of 167 consecutive, newly diagnosed patients aged 55 years or older with presumed neovascularized AMD was performed. All patients were examined with fundus biomicroscopy as well as fluorescein and indocyanine green angiography. RESULTS: Choroidal neovascularization secondary to AMD was diagnosed in 154 (92.2%) of 167 patients; 13 (7.8%) patients had PCV. The patients affected by PCV were younger than those with AMD (P = .01). Peripapillary choroidal neovascularization was seen in 3 (1.9%) of 154 patients with AMD and 3 (23.1%) of 13 patients with PCV (P = .006). Significant drusen were present in 63 (70%) of 90 fellow eyes with unilateral AMD compared with only 1 (16.7%) of 6 eyes with PCV (P = .02). Only 5 patients with AMD (3.2%) were nonwhite compared with 3 patients with PCV (23.1%) (P = .02). CONCLUSIONS: A measurable number of elderly patients with findings suggestive of neovascularized AMD and serosanguineous macular manifestations will instead have PCV. Polypoidal choroidal vasculopathy can occur in any sex or race, but is more commonly seen in the peripapillary area, without associated drusen, and in nonwhite patients. It is important to differentiate AMD from PCV because there are significant differences in the demographic risk profile, natural course, visual prognosis, and management of these patients

PURPOSE: To determine systemic factors associated with central serous chorioretinopathy. METHODS: In a retrospective study, 230 consecutive patients with central serous chorioretinopathy examined in a referral setting were compared with a historical gender-matched and age-matched control group of 230 patients with ocular findings who were examined in the same referral setting. RESULTS: The median age of the patients was 49.8 years, and of the control subjects, 50.0 years. The male-female ratio for both groups was 2.7:1. Patients with central serous chorioretinopathy were more likely to use psychopharmacologic medications (odds ratio = 2.6; 95% confidence interval = 1.30 to 5.19; P = .0049) and corticosteroids (odds ratio = 3.17; 95% confidence interval = 1.30 to 7.70; P = .0067) and were more likely to have hypertension (odds ratio = 2.25; 95% confidence interval = 1.39 to 3.63; P = .0008) than were the control subjects. CONCLUSIONS: This study identified psychopharmacologic medication use, corticosteroid use, and hypertension as factors associated with central serous chorioretinopathy. These findings reinforce the concept that stress and adaptations to stress play a role in this disorder. The findings of possible associations between central serous chorioretinopathy and both hypertension and corticosteroid usage suggest that these modifiable factors may influence morbidity of central serous chorioretinopathy

Choroidal neovascularization (CNV) is the most common cause of legal blindness in older adults in the United States. The most common cause for CNV in this age group is age-related macular degeneration, a condition manifesting with drusen (particularly soft drusen) and pigmentary alterations in the macular region. CNV can occur in younger people (< 50 years), who usually do not have conspicuous drusen or pigmentary abnormalities. In this age group CNV may occur as a secondary manifestation of many inherited and acquired conditions such as angioid streaks, high myopia, trauma, choroidal tumors, familial macular dystrophies, and inflammatory retinochoroidopathies. Occasionally, CNV in young people has no apparent antecedent cause, and these cases are termed 'idiopathic CNV.' This review examines the common reasons for CNV in young adults, with reference to some of the older literature as well as to recently published papers