Faculty Bibliography

The presence of subretinal exudation in a patient with neurosensory detachment of the macula frequently suggests the diagnosis of choroidal neovascularisation. A retrospective chart review of newly diagnosed cases of central serous chorioretinopathy revealed 11 patients, seven men and four non-pregnant women, who had plaques of subretinal exudate, which presumably were fibrin. Each of these patients had a solitary plaque that ranged in size from 300 to 1500 microns in diameter. These patients had no signs or a clinical course suggestive of choroidal neovascularisation. In each case the subretinal plaque was overlying an exuberant leak in the retinal pigment epithelium. The exudate was generally present at the initial examination, and usually showed dissolution before or coincident with the resolution of the neurosensory detachment. After resolution of the central serous chorioretinopathy, patients were left with subtle alterations in the retinal pigment epithelium in the areas of the subretinal plaque. These findings are important for two reasons. Firstly, the presence of subretinal exudation does not necessarily rule out the diagnosis of central serous chorioretinopathy. Secondly, pathophysiological theories of central serous chorioretinopathy must explain how the plaques are deposited behind the retina

Of 141 patients who had clinically significant cystoid macular edema (CME) following cataract surgery, 42 had a visual acuity of 20/200 or worse. Logistic regression demonstrated that of all the systemic and ocular factors studied, the best predictors of visual acuity of 20/200 or worse were the presence of iris in the wounds (odds ratio = 2.86, P = .011) and a fluorescein angiogram grade of 4 (odds ratio = 2.91, P = .0076). Entering into the logistic regression variables such as integrity of the posterior capsule, iritis, vitreous in the wound, or type of intraocular lens did not significantly improve the ability of the model to predict which patients would have poor visual acuity. This study suggests that iris incarceration in the wound may have a more important association with poor vision in patients with chronic postsurgical CME than previously thought

We describe six patients with exudative age-related macular degeneration who had retinal pigment epithelial detachments with associated overlying neurosensory detachments. During fluorescein angiography, each patient demonstrated a solitary, intense, central serouslike leak at the edge of the retinal pigment epithelial detachment with passage of fluorescein into the subretinal space. In patients in whom the location of associated choroidal neovascularization was evident, the leakage site was remote to the area of neovascularization. Our observations suggest that these leaks result from small retinal epithelial rips, which we termed 'microrips,' that differ from conventionally described retinal pigment epithelial rips in clinical course and response to laser treatment. We hypothesize that the mechanisms and forces that generate these microrips are different from those producing conventionally described retinal pigment epithelial rips

We examined three patients with acquired immunodeficiency syndrome who had frosted branch angiitis associated with small patches of cytomegalovirus retinitis. Each patient had a low CD4-helper T-lymphocyte count and a T-lymphocyte helper-suppressor ratio of less than 0.1. Treatment with intravenous anticytomegalovirus antibiotics caused the vascular sheathing to resolve within two weeks in all three patients, but each patient continued to have a smoldering retinitis. Retinal biopsy in one of the patients demonstrated virions whose morphologic characteristics were consistent with cytomegalovirus on electron microscopy and the identity of which was confirmed by immunohistochemistry. Although frosted branch angiitis in otherwise healthy patients responds to corticosteroids, similar treatment with corticosteroids for frosted branch angiitis associated with cytomegalovirus retinitis in patients with AIDS does not seem to be indicated. Before corticosteroid treatment is started for a patient with the clinical signs and symptoms of frosted branch angiitis, careful medical examination of the patient is necessary

Posterior scleritis was diagnosed in four adolescent boys. These patients represented a distinct subgroup of patients with posterior scleritis that differed from the adult variant by gender, lack of systemic disease, and absence of the associated ocular findings often seen in the adult variant of the disorder. The four patients had diminished visual acuity, ocular pain, and exudative retinal detachments at initial examination. Fluorescein angiography demonstrated multiple pinpoint leaks at the level of the retinal pigment epithelium in three patients with late-phase patchy staining of a mass-like lesion in one patient. B-scan ultrasonography demonstrated choroidal and scleral thickening with increased acoustic density of the choroid in all patients. Systemic evaluation of these patients disclosed no underlying disease. Clinical signs and symptoms resolved in three of the patients after treatment with low-dose, orally administered corticosteroid or noncorticosteroid anti-inflammatory medication. High systemic doses of corticosteroid in combination with noncorticosteroid anti-inflammatory medication and local corticosteroid therapy was required to induce remission in one patient. All patients recovered good visual acuity

A 24-year-old Caucasian female presented with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and associated infiltration round some of the larger choroidal blood vessels. This infiltration dissipated as the patient's clinical condition improved and did not induce any permanent alteration of the overlying retinal pigment epithelium. We suggest that the infiltration round the choroidal vessels was due to a choroidal vasculitis. The finding of choroidal inflammation in this case lends support to the hypothesis that choroidal vasculitis is an underlying pathological process in APMPPE. $$:

A 24-year-old Caucasian female presented with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and associated infiltration round some of the larger choroidal blood vessels. This infiltration dissipated as the patient's clinical condition improved and did not induce any permanent alteration of the overlying retinal pigment epithelium. We suggest that the infiltration round the choroidal vessels was due to a choroidal vasculitis. The finding of choroidal inflammation in this case lends support to the hypothesis that choroidal vasculitis is an underlying pathotogical process in APMPPE. $$: