Fluorescein and indocyanine green angiographic findings in congenital optic disk pit associated with macular detachment

PURPOSE

To investigate the pattern of congenital optic disk pits associated with maculopathy using indocyanine green angiography (ICG) and fluorescein angiography (FA).

METHODS

Seventeen consecutive patients with unilateral congenital optic disk pit complicated by maculopathy were prospectively enrolled in the study. Complete ophthalmologic examination, color stereophotography, red-free photography, FA, and ICG angiography were performed on all patients during their first examination in our department.

RESULTS

Absolute hypofluorescence of the optic disk pit was noted in all eyes on ICG angiography. On the contrary, all eyes showed early hypofluorescence and late staining of the optic pit on FA. All 17 eyes presented a delineated late hyperfluorescence corresponding to the area of macular elevation on both ICG angiography and FA. The intensity of the hyperfluorescence was milder in cases with long-standing maculopathy.

CONCLUSION

Imaging of congenital optic disk pits associated or not with macular elevation using ICG angiography has not been reported in the literature. The increased hyperfluorescence in the late phases of the macular elevation in the studied eyes could be attributed to leakage of indocyanine or fluorescein dye into the schisis cavity and the subretinal fluid.

Topical 2.0% dorzolamide vs oral acetazolamide for prevention of intraocular pressure rise after neodymium:YAG laser posterior capsulotomy

OBJECTIVE

To compare the efficacy and safety of topical 2.0% dorzolamide hydrochloride with oral acetazolamide in preventing intraocular pressure (IOP) rise following neodymium:YAG (Nd:YAG) laser posterior capsulotomy.

DESIGN

A prospective, randomized, double-masked, placebo-controlled study.

PATIENTS

Two hundred ten patients undergoing Nd:YAG laser posterior capsulotomy.

INTERVENTION

Pretreatment with dorzolamide, acetazolamide, or placebo. Dorzolamide administration as a single drop (1 drop approximately 20 microL) 1 hour before capsulotomy. Acetazolamide administration as a single dose of 125 mg orally 1 hour before capsulotomy.

RESULTS

At first and third hour postoperatively, IOPs and IOP changes from baseline were significantly (P<.001) higher in the placebo group than in the dorzolamide or acetazolamide group. At the same time, IOPs and IOP changes from baseline were similar (P>.50) in the dorzolamide and acetazolamide groups. No patient treated with dorzolamide or acetazolamide experienced an IOP higher than 30 mm Hg after capsulotomy, but 15.7% of patients receiving placebo had an IOP above this level (P<.001). Of patients receiving placebo, 5.7% experienced IOP higher than 35 mm Hg. No serious side effects were recorded in any of the studied patients.

CONCLUSION

Topical 2.0% dorzolamide and oral acetazolamide, given prophylactically as a single administration 1 hour before Nd:YAG laser posterior capsulotomy, have comparable high efficacy and safety in preventing IOP elevation following this procedure.

Ophthalmic dirofilariasis

PURPOSE

To report a rare case of ophthalmic dirofilariasis in a 68-year-old man with sudden, intense pain and itching in the left eye. The nematode was located in the eye and recognized as Dirofilaria repens.

METHODS

Slit-lamp examination disclosed a moving nematelminth under the bulbar conjunctiva of the left eye. The nematode was surgically removed.

RESULTS

The nematelminth surgically removed from the subconjunctival space was identified as D repens on the basis of transverse sections and its macroscopic characteristics.

CONCLUSION

It is important to identify the nematode as D repens, based on both its microscopic and macroscopic characteristics, to avoid treatment with anthelminthic agents. The surgical removal of the worm is the sole recommended treatment.

Treatment of maculopathy associated with optic disk pit by sponge explant

PURPOSE

To evaluate the anatomic and functional outcome in nine patients with optic disk pit maculopathy after the use of the macular buckling procedure.

METHODS

In this prospective study, nine consecutive patients (five women and four men with a mean age of 28 years [range, 14 to 49 years] who had unilateral maculopathy associated with optic disk pit) were treated with macular buckling surgery. A scleral sponge of 7.5 x 5.5 mm was fixed at the posterior pole of the globe corresponding to the macula along the vertical axis of the 12-to-6 o'clock meridian. No additional treatment of any kind (laser, diathermy, or cryotherapy) was used. The correct positioning of the sponge during the operation was monitored by B-scan ultrasonography. Within the first week after surgery, indocyanine green angiography was performed to evaluate the choroidal circulation. During the same period, magnetic resonance imaging of the orbit was performed to determine the sponge position in relation to the optic nerve.

RESULTS

In all nine eyes, complete disappearance of subretinal and intraretinal fluid in the macula and in the surrounding area was noted. The absorption of the macular fluid started immediately after the operation and was completed after five to six months. No further change of the appearance of the fundus was noted during the follow-up period, which ranged from 18 to 66 months (mean follow-up, 42 months). Six eyes gained four or five lines of visual acuity, and two eyes improved by three lines.

CONCLUSIONS

The macular scleral buckling procedure in optic disk pit maculopathy can yield favorable anatomic and functional results.

Coloboma of the optic disk associated with retinal vascular abnormalities

PURPOSE

We studied a case of congenital optic disk pit and coloboma with associated malformations of the retinal vessels.

METHODS

Slit-lamp biomicroscopy and fluorescein angiography were performed.

RESULTS

Multiple retinal venous anastomoses associated with a congenital coloboma and pit of the optic disk were observed. The retinal vascular anomalies extended from the optic disk to the temporal periphery.

CONCLUSIONS

We consider the coexistence of retinal venous anastomoses with optic disk coloboma and pit to be an extremely rare congenital retinal anomaly.

8 mm bimedial rectus recession in infantile esotropia of 80-90 prism dioptres

Sixteen patients with large angle infantile esotropia with deviations of 80-90 prism dioptres were operated at the age of about 2 years. All patients underwent 8 mm bilateral medial rectus recessions. At the last follow up examination, 6 to 48 months postoperatively (average 16.3 months), successful horizontal alignment was achieved in 12 patients (75%). Four patients (25%) were undercorrected. Clinically significant limitation of adduction or convergence was not observed postoperatively in any of the patients. Consecutive exotropia was not encountered in this series but a longer follow up is probably needed in order to assess its delayed appearance. These results suggest that 8 mm recession of the medial recti is an effective procedure for the correction of large angle infantile esotropia of 80-90 prism dioptres and can be considered as an acceptable alternative to operations on three or four muscles.

The persistence of buckle height in relation to orientation of buckle fixation. An ultrasonographic study

Forty phakic myopic eyes of 40 patients with rhegmatogenous retinal detachment were included in a prospective clinical trial designed to evaluate the changes in buckle height after retinal detachment surgery. The age of the patients ranged between 50 and 75 years. The eyes were divided into two groups (A and B) according to the orientation of sponge fixation. In group A (20 eyes) the sponge fixation was circumferential, while in group B (20 eyes) radial. A-scan ultrasonography was used for the measurements of buckle height 1, 3, 6, 12, and 18 months postoperatively. At all times of measurement, the buckle height presented a statistically significant difference between the patients of group A and B. More specifically, radial fixation produced a significantly lower scleral indentation compared with that produced by circumferential fixation. After a lapse of 18 months, the buckle height in group B retained 41% of its original value compared with that of group A which retained 66%.

Percutaneous anaesthesia with a lignocaine-prilocaine cream (Emla) for eyelid skin surgery

Epicutaneous application of the anaesthetic cream Emla (lignocaine and prilocaine), to induce percutaneous anaesthesia in 38 patients scheduled for eyelid skin surgery is presented. The cream was applied 60 to 90 minutes before operation. In 36 out of the 38 patients (94.8%) no supplementary analgesia was required. The pain during the procedure was rated either as no pain in 29 patients (76.3%), slight pain in five patients (13%), moderate pain in two patients (5.2%), and severe pain in two patients (5.2%). Percutaneous anaesthesia induced by Emla cream is a useful and painless alternative method for analgesia in eyelid skin surgery.

Long-term effectiveness of modified grid laser photocoagulation for diffuse diabetic macular edema

Fifty eyes of 42 patients with background diabetic retinopathy and diffuse macular edema were included in a prospective, randomized, clinical study to determine the long-term visual results of modified grid laser photocoagulation compared with the natural course of the disease. At the end of the three annual follow-up visits there were more eyes with improved visual acuity in the treatment group and more eyes with worse visual acuity in the control group. However, statistical analysis of the data showed that only at the end of the first and the second year was there a significant statistical difference between the two groups. At the end of the third year no statistically significant difference was found. These results suggest that modified grid laser photocoagulation is not an effective procedure for the long-term management of diffuse diabetic macular edema compared with the natural course of the disease.

Optic nerve pit with serous macular detachment resulting in rhegmatogenous retinal detachment

Images

Prophylactic use of acetazolamide to prevent intraocular pressure elevation following Nd-YAG laser posterior capsulotomy

Fifty four eyes of 54 patients undergoing Nd-YAG laser posterior capsulotomy were randomly assigned to pretreatment with either 125 mg of oral acetazolamide (group A) or placebo (group B). During the first 3 hours following capsulotomy, an intraocular pressure (IOP) rise of at least 10 mm Hg was recorded in eight of the 26 eyes of group B (30.8%) and in none of the 28 eyes of group A (p < 0.01). A rise of at least 5 mm Hg was recorded in 16/26 (61.5%) and 4/28 (14.3%) eyes respectively (p < 0.001). Three eyes of group B developed an IOP greater than 35 mm Hg. We found that pretreatment with a low dose of acetazolamide is highly effective in preventing IOP elevation following Nd-YAG laser posterior capsulotomy.

Use of argon laser photocoagulation in the treatment of recurrent trichiasis: long-term results

We describe our technique and analyze the long-term results of the use of argon laser photocoagulation in the treatment of 92 eyes with recurrent trichiasis. In spite of an incidence of recurrences of 64.1% which had to undergo a new laser photocoagulation session, the final success rate of the method was impressive (91.3%). The number of misdirected cilia per lid seems to constitute an important factor which affects both the rate of recurrences and the success rate of the procedure.

Long-term study of patients with congenital pit of the optic nerve and persistent macular detachment

During the period 1970-87 we evaluated the changes of the optic disc, peripapillary area, detached macula and visual acuity in 16 cases with congenital pit of the optic nerve and macular detachment. The study revealed in 9 of the 16 cases (56%) an increase of the dimension of the pit or changes in its color, findings which were directly related to the duration of the macular detachment. Chorioretinal scarring, pigment migration, or both, were also noted mainly at the temporal margin of optic disc. In 5/16 cases we found during the follow-up an extension of macular elevation. In altogether 10 out of 16 cases the retinal elevation covered the larger portion of the mid-periphery temporally. In 7/16 cases the final visual acuity remained unchanged, in 9/16 cases deteriorated. The difference, however, in the latter 9 cases between initial and final visual acuity was negligible. During the follow-up period deterioration of the visual fields was also noted.

Cilioretinal arteries in conjunction with a pit of the optic disc

Cilioretinal arteries were noted to accompany pits of the optic disc in 16 of 25 cases (64%). Fourteen of the 16 cases were found to have 2 cilioretinal arteries (86%). The cilioretinal arteries were directly related to the pit of the disc and emerged either from the bottom or the margin of the pit in a proportion of 86%. This finding reinforces the assumption that the optic disc pit belongs to the same spectrum of congenital anomalies which also includes optic disc coloboma, megalopapilla and morning glory syndrome. A fluorescein angiography study showed hyperfluorescence of the pit in 12/16 cases and in particular in all the cases in which both cilioretinal arteries emerged from the pit. Hypofluorescence was noted in 7/9 cases in which the pit was not associated with cilioretinal arteries. Our findings could support the view that hyperfluorescence of the pit, which is not a constant phenomenon, mostly depends on the presence of cilioretinal arteries emerging from the pit.

Central visual field changes after panretinal photocoagulation in proliferative diabetic retinopathy

This study comprises 53 eyes, divided into two groups A and B, with proliferative diabetic retinopathy which were treated with panretinal photocoagulation (PRP). Its purpose is to investigate the alterations in the central 15 degrees and 30 degrees of the visual field and in each quadrant separately. In both groups A and B, PRP covered the periphery and mid-periphery. In group A, it stopped 2 disc diameters (DD) from the upper temporal and lower margin of the fovea including the papillomacular bundle, while in group B, PRP stopped 3 DD from the upper temporal and lower margin of the fovea and 1 DD of the nasal margin of the optic disc. The investigation revealed, in group B after PRP, an improvement of the retinal sensitivity in the central 15 degrees of the visual field (p less than 0.01). In the 30 degrees of the visual field a deterioration after PRP was noted in both groups A and B, the deterioration being however much more prominent in group A. Comparing the results between groups B and A after PRP, a difference in the retinal sensitivity in favour of group B at 15 degrees and 30 degrees of the visual field was found. As regards regression of neovascularization and visual acuity, no statistically significant difference has been observed between the two groups.

A comparative study concerning the treatment of active toxoplasmic retinochoroiditis with argon laser and medication (follow-up 2-9 years)

Thirty-three eyes (i.e. 33 patients) with active toxoplasmic retinochoroiditis were treated and followed up for a 2 to 9 year period. The patients were divided into two groups. The first was treated with laser, while the second received medication. The division into two groups was made in order to discover possible differences between the two groups concerning success rate, time of regression of the lesion recurrences and complications. The study showed the following results: there was no difference as to the rate of overall success between the two groups. The laser produced no result in the cases where the active retinochoroidal lesion was larger than 2 disc diameters. The regression of the active lesion in the laser group was accomplished in 25-50 days, while in the medication group took 50-150 days. Recurrences after treatment were found in both groups. However, the starting point of recurrences differed in each group.

Types of avulsed retinal vessels associated with rhegmatogenous retinal detachment: treatment and results

We performed a prospective study of 87 cases with avulsed retinal vessels in conjunction with tears and rhegmatogenous retinal detachment. The postoperative follow-up period ranged from 6 months to 5 years. The avulsed vessels were classified according to their location (peripheral or central) as well as with respect to their form (5 types). The surgical procedure comprised the fixation of an episcleral sponge implant (high indentation), cryoapplication, and, if necessary, laser coagulation or endodiathermy at a later stage. The postoperative condition of the avulsed vessel mainly depended on its location, the type of avulsion, and the buckle height.

[Diminution of myopia following operation of macular hole-induced retinal detachment]

This paper presents an assessment of the diminution of myopia in 25 eyes after surgery according to the technique of G. P. Theodossiadis for retinal detachment due to a macular hole. The procedure consists in the stretching and fixation of a silicone sponge at the posterior pole and dispenses entirely with either cryocoagulation or light coagulation. The sponge is stretched and fixed to the sclera at both ends (12 and 6 o'clock), far from the posterior pole. The scleral protrusion thus obtained in the macular area leads to a considerable diminution of the high myopia usually present in such cases. The reduction of myopia is proportionate to the degree of protrusion of the scleral buckle, which in turn depends on the stretching of the sponge and on the amount of subretinal fluid released.

Determination of chromium and caesium in human cataractous lenses

The concentration of chromium and caesium in totally opaque (mature) cataractous lenses has been determined by instrumental neutron activation analysis and gamma spectrometry. The presence of these trace-elements in the human lens has to our knowledge not been investigated so far. Both elements under study are of known biological importance. Chromium is an essential trace-element necessary for the maintenance of normal glucose metabolism. Moreover it is considered to rank among those elements, the increased level of which contributes to environmental pollution. Caesium is a biologically important trace-element due to its relationship with potassium, as has been demonstrated in a variety of biochemical and physiological processes. The concentration of these elements was determined in cataractous lenses from fifty-one patients with senile cataract and has been correlated with age and sex.

Treatment of retinal detachment due to macular holes without chorio-retinal lesions. A seven-year follow-up study

For the treatment of retinal detachment arising from macular holes we do not apply cryotherapy, light-coagulation, or diathermy in the area of the macula. Our method involves merely the fixation of a silastic sponge of 14-17 mm length and 7.5 mm diameter at the posterior part of the eyeball corresponding to macula and along the meridian of 12-6 o'clock axis. The sponge is stretched and then fixed at both ends to the sclera away from the posterior pole. The stretching and fixation of the sponge creates the proper indentation which closes the macular hole. By avoiding energy application we obtain better visual acuity. The present paper describes the results we have had in the last 7 years exclusively using this technique.

Choroidal neovascularization after cryoapplication

After sealing peripheral retinal tears in retinal detachment surgery by means of cryoapplications, neovascularization appeared, stemming from the choroidal circulation. This complication was noted in three cases of retinal detachment with tears in an area of latticelike degeneration. The neovascularization, clearly originating from the choroid, extended into the vitreous cavity through the chorioretinal scar created by the cryoapplication. Repeated attempts to destroy the neovascularization with argon laser applications proved unsuccessful. In the 4--6-year follow-up of the cases recurrent hemorrhages were observed. The etiology of the neovascularization remains unknown, but it is probably related to the presence of subretinal pigment epithelium neovascularization encountered in a high percentage of adults in the retinal periphery. The choroidal neovascularization described provides evidence that, in addition to xenon arc and argon laser applications, cryoapplication on the retina can also cause this rare complication.

Evolution of Leber's miliary aneurysms: a clinicopathological study

The clinical course is described of two genuine cases of the disease of Leber's miliary aneurysms that developed into Coats' disease. Following the issue of the disease in a painful and blind eye, the cases were examined histopathologically. In the first case the transformation into Coats' disease, and subsequently into a painful eye, took six years, in the second case four years. This histopathological examination revealed vascular formations of the superficial corneal stroma of the periphery in the second case. In respect of the retina the presence of neovascularization was observed. Pathological vessels of varying width were also found in the deeper retinal layers. The presence of cholesterol clefts should be regarded rather as a consequence of the chronicity of the case than as being a characteristic feature of the condition.

Macular pigment deposits in rhegmatogenous retinal detachment

This is a study of 20 cases of macular migration after operation for retinal detachment. The frequency of pigment deposits on the macula among the total number of operated detachments was 6.4%. The evolution of pigment migration depened on the form and type of the deposits. In some cases the pigment diminished or disappeared. In 6 of the 20 eyes with pigment migration puckering of the macula occurred 4 months or more after surgery. The improvement in visual acuity 6 months and more after operation was relatively less in the group with pigment deposits than in the group without pigment. In the former group static perimetry showed defects corresponding to the pigment migration.