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

Objective: To define the functional deficit that correlates with the inner layer separation and the outer layer detachment that have been observed in optic pit maculopathy and to determine the effect of a gas tamponade that compresses or displaces the two layers. Design: The central visual field before and after a gas tamponade on the posterior pole were charted on a 1-m tangent screen and compared with the changes in the retina observed biomicroscopically and with stereophotography. Setting: The gas operations were done at four hospitals in the New York, NY, area and one in Cleveland, Ohio. The retinal examinations, visual field testing, and stereoscopic photography for eight patients were done at The New York Hospital. The patient who lived in Cleveland was examined and photographed in Cleveland. Participants: Nine patients between the ages of 18 and 46 years with optic pit maculopathy. Intorvention: The patients were operated on by five retinal surgeons with a variety of procedures. Four patients had a vitrectomy and intraocular gas injected. Five patients had gas injected after external compression. Two patients had laser applied in conjunction with the intraocular injection. The gas tamponade was the unifying factor. Results: The dense central scotoma in optic pit maculopathy relates to the outer layer detachment and displacement of it from the posterior pole yields an improvement in visual acuity. The inner layer separation persists centrally after a gas tamponade and continues to provide access for the flow of fluid from the pit. The scotoma that relates to the inner layer separation is mild and consistent with relatively good visual acuity. $$:

We evaluated the hypothesis that higher serum levels of micronutrients with antioxidant capabilities may be associated with a decreased risk of neovascular age-related macular degeneration by comparing serum levels of carotenoids, vitamins C and E, and selenium in 421 patients with neovascular age-related macular degeneration and 615 controls. Subjects were classified by blood level of the micronutrient (low, medium, and high). Persons with carotenoid levels in the medium and high groups, compared with those in the low group, had markedly reduced risks of neovascular age-related macular degeneration, with the levels of risk reduced to one half and one third, respectively. Although no statistically significant protective effect was found for vitamin C or E or selenium individually, an antioxidant index that combined all four micronutrient measurements showed statistically significant reductions of risk with increasing levels of the index. Although these results suggest that higher blood levels of micronutrients with antioxidant potential, in particular, carotenoids, maybe associated with a decreased risk of the most visually disabling form of age-related macular degeneration, it would be premature to translate these findings into nutritional recommendations

The objective of our clinic-based case-control study was to identify risk factors for branch retinal vein occlusion. Between 1986 and 1990 data were obtained at five clinical centers from 270 patients with branch retinal vein occlusion and 1,142 controls. Data were collected from interviews, clinical examinations, and laboratory analyses of blood specimens. An increased risk of branch retinal vein occlusion was found in persons with a history of systemic hypertension, a history of cardiovascular disease, an increased body mass index at 20 years of age, a history of glaucoma, and higher serum levels of alpha2-globulin. Risk of branch retinal vein occlusion decreased with higher levels of alcohol consumption and high-density lipoprotein cholesterol. The data suggest a cardiovascular risk profile for patients with branch retinal vein occlusion and indicate that 50% of patients with branch retinal vein occlusion may be attributable to hypertension. Our findings support current public health recommendations to diagnose and treat hypertension, reduce weight, increase physical activity, and maximize serum high-density lipoprotein levels. $$: