Concentric microwaves of Henle's fiber layer: in association with cystoid macular edema

Fully developed microwaves of Henle's fiber layer all around a foveolar exhibiting cystoid changes and localized detachment are demonstrated in an eye, that was proptosed and exposed due to advanced basal cell carcinoma. The significance of microwaves in Henle's fiber layer among other reactive changes of the foveal retina is discussed.

Leaky cystoid macular edema attracting vitreous macrophages

A foveola with signs of atrophy and cystoid edema in an eye with a history of contusion, laceration, and hemorrhage exhibits a selective attraction of blood-filled macrophages. This important observation allows for the conclusion that the avascular foveola can leak into the inner eye like a blood vessel and chemotactically attract vitreous macrophages under these conditions.

Three basic types of foveal involvement in choroidal melanomas

Three cases are used to demonstrate the main types of cystoid macular edema, which have been seen to occur in association with choroidal melanomas: 1) direct involvement in cases, where the neoplasm is located under the foveal retina, 2) indirect involvement due to a subfoveal exudate in choroidal melanomas distant to the fovea and 3) indirect foveolar involvement without associated subfoveal tumor or exudate. A recording of the pathology of these three basic reaction patterns of the central retina in choroidal melanomas is considered important. It is emphasized, that combinations of the reactions are common and may result in more complex situations.

Histopathologic study of an unusual form of retinitis pigmentosa

An ultrastructural study was done on a postmortem donor eye from an 84-year-old male with night blindness, pericentral ring scotomas, attenuated retinal arterioles, and intraretinal bone spicule pigmentation distributed around the midperiphery. Unusual findings observed 3 years prior to death were preserved central vision and peripheral visual field and rod and cone electroretinogram amplitudes reduced only about 60% below normal. Ultrastructural examination of the retina revealed apparently normal numbers of cones in the fovea, reduced numbers of rods on the foveal slope, absence of photoreceptors in the midperiphery, and large areas of preserved rods and cones in the far periphery in all quadrants. Other conspicuous findings were the presence of autophagic vacuoles in remaining cones and nonpigmented epithelial cells around some retinal vessels in the midperiphery. Comparison of visual acuities, visual fields, and fundus appearance reported at age 54 and at age 81, combined with ultrastructural observations of the retina at age 84, suggested that this patient's condition was minimally, if at all, progressive over the last 30 years of his life. Classification of this disease as pericentral retinitis pigmentosa is considered.

Foveal pathology in ciliary body melanoma

The histological features of cystoid macular edema in an early stage are demonstrated in the eye of a 54-year-old patient with an active ciliary body melanoma. Separation of the posterior vitreous face and the inner limiting membrane with accumulation of an exudate in the resulting space, petaloid folding of the inner retinal layers, swelling as well as microcystoid degeneration of Henle's fiber layer, and vertical folding of the outer retinal layers with separation of the central cones from the pigment epithelium are observed.

Autosomal dominant foveal hypoplasia and presenile cataracts. A new syndrome

An autosomal dominant syndrome of mild foveal hypoplasia (visual acuity, 20/50), congenital nystagmus, corneal pannus, and presenile cataracts was seen in four patients from a single family. There is variable expressivitly of this trait. The differential diagnosis includes aniridia, ocular albinism, and isolated foveal hypoplasia. Cataract surgery is indicated for affected patients with substantial visual impairment.

Natural course of choroidal neovascular membranes within the foveal avascular zone in senile macular degeneration

We divided 96 eyes (93 patients) with senile macular degeneration and choroidal neovascular membranes into two groups--those with juxtafoveal membranes (1 to 250 mu from the center of the foveal avascular zone) and those with subfoveal membranes (0 mu from the center of the zone). After an average follow-up period of 21 months, one of 38 eyes in the juxtafoveal group (3%) had improved two or more lines on the Snellen chart, three eyes (8%) had remained the same, and 34 eyes (89%) had lost two or more lines on the Snellen chart. Although 35 of the 38 eyes (92%) had had initial visual acuities of 6/30 (20/100) or better, 27 eyes (71%) had become legally blind. Of the 58 eyes in the subfoveal group, 18 (31%) had remained the same or improved and 40 (69%) had lost two or more lines on the Snellen chart; 41 (70%) had final visual acuities of 6/60 (20/20) or worse. Of the 26 eyes in the subfoveal group that had had initial visual acuities of 6/60 (20/100) or better (45%). four (15%) had stayed the same and 22 (85%) had lost two or more lines on the Snellen chart. Fourteen of the 26 eyes (54%) had final visual acuities of 6/60 (20/200) or worse. Exudative maculopathy developed in the second eye in 13% of patients who initially had unilateral choroidal neovascularization after 12 months, in 22% after 24 months, and in 29% after 36 months, using life table analysis.

Foveal pathology following anterior segment injury

A case of traumatic ocular perforation and aphakia resulting in enucleation after six weeks is used to demonstrate histopathological details of an early stage of a typical foveal involvement with grossly visible petaloid swelling of the central retina, separation of the inner limiting membrane with some exudate, massive swelling and early cystoid degeneration of Henle's fiber layer and a vertical retinal fold of the outer retinal layers extending downward from the foveola. This demonstration is important in view of its possible relationship to the clinical entity of cystoid macular edema.

Fundus photocoagulation with the argon and krypton lasers: a comparative study

Photocoagulation of the monkey fundus with an argon-krypton laser photocoagulator was performed. Lesions produced by argon and krypton wavelengths were compared at various power settings, spot sizes, and exposure durations. At low energy levels argon laser lesions appeared clinically stronger than those produced by the krypton mode. Lesions in the foveal area produced with the argon laser demonstrated more extensive microscopic damage to the inner retinal layers than did those produced with the krypton laser. Histologically, both modalities affected the outer layers of the retina. However, the krypton wavelength affected more of the choriocapillaries and the larger choroidal vessels than the argon wavelengths. Conversely, argon laser coagulation of the retinal vessels damaged the perivascular tissue in the nerve fiber layer more than the krypton laser did. Rupture of Bruch's membrane and choroidal hemorrhage occurred frequently with the krypton laser at low energy levels when a small spot size and a short coagulation time were used. Both complications were less likely to occur with argon burns at similar dosage parameters. By choosing larger spot sizes and longer coagulation times for the krypton laser, these complications were prevented.

Concentric "microwaves" of Henle's fiber layer: associated with horizontal folding

Concentric "microwaves" in Henle's fiber layer are found in a case of extensive horizontal folding in the fundus due to tumor pressure on the globe from behind. In addition to horizontal folding of inner choroid and inner retina between disk and fovea, somewhat irregular vertical folds are found next to the fovea in the inner retinal layers. The concentric waves of Henle's fiber layer are a new observation and they are suspected to be a protective adjustment of the central retina to minimize distortion of the foveola.

Specific changes in the fundus typical for the Sjögren-Larsson syndrome. An ophthalmological study of 35 patients

All Swedish cases with the Sjögren-Larsson syndrome (SLS) i.e. 35 patients were studied. Glistening dots of unknown nature were seen round the foveola. These foveal and parafoveal changes seem to be a cardinal sign of SLS together with congenital ichthyosis, spastic di/tetraplegia and mental deficiency.

Parafoveal retinal telangiectasis. Light and electron microscopy studies

The clinical, histopathological, and ultrastructural features of a case of parafoveal telangiectasis are reported. No telangiectasis of retinal vessels was found. Instead, there was thickening of the wall of the retinal capillaries and narrowing of the calibre of the lumen. Thickening was due to marked proliferation of basement membrane in a multilayered configuration, Cellular debris from degenerated endothelial cells and pericytes, and multimembranous lamellar lipid material were entrapped between layers of basement membrane. Extensive degeneration of pericytes was observed, and occasional areas showed degenerated endothelial cells. These changes were not restricted to the clinical-affected parafoveal area but were also seen to a lesser degree throughout the retina. The changes are interpreted as being due to primary endothelial cell degeneration and regeneration, with successive waves of basement membrane production and secondary degeneration of pericytes.

Peripapillary neovascular membranes in presumed ocular histoplasmosis

We studied 39 eyes with ocular histoplasmosis and peripapillary neovascular membranes for an average of 12 months. On the basis of clinical findings, 19 were selected for treatment with photocoagulation. Of the treated eyes, 12 (63%) had a visual result of 6/12 (20/40) or better. Of the 20 untreated eyes, six were clinically untreatable and 14 were electively followed up. All but one of the eyes electively followed up had a good visual result. Proximity of the neovascular membrane to the fovea was the most important prognostic factor in determining visual outcome. All eyes with membranes less than 1/4 disk diameter from the fovea lost central vision. All membranes greater than one disk diameter had excellent results. The indications for treatment were prolonged serous or hemorrhagic detachment of the fovea, documented progression of the membrane, and possibly, loss of central vision in the fellow eye from peripapillary disease. Residual and recurrent neovascularization were significant treatment complications.

Small unilateral foveal hemorrhages in young adults

We studied nine cases of single, small, intraretinal foveal hemorrhages in one eye each of nine young adults during the last five years. The patients ranged in age from 18 to 47 years and were otherwise healthy. Four patients gave a history of strenuous exercise, most often weight lifting. The visual acuities ranged from 6/6 (20/20) to 6/60 (20/200) and most patients complained of a small central or paracentral scotoma. Fluorescein angiography did not show any retinal or choroidal vascular abnormalities and recovery of visual acuity was excellent in all patients available for follow-up examination during a period of two weeks to six months.

Visual loss and foveal lesions in Usher's syndrome

Forty-eight patients with Usher's syndrome were assess for the degree of visual loss, extent of lens opacities, and presence of foveal lesions. Twenty-one patients (44%) showed either atrophic or cystic-appearing bilateral foveal changes. Despite having foveal lesions and variable degrees of lens opacities most patients maintained central visual acuity of 20/60 or better until their middle 30s.

Repair and late degeneration of the primate foveola after injury by argon laser

Each foveola of nine rhesus monkey eyes was subjected to a single, mild, calibrated exposure from an argon laser (1 to 1.4 mW for 10 to 20 min). Observations from ophthalmoscopy, fundus photography, and fluorescein angiography were correlated with light and electron microscopic studies. The ophthalmoscopic changes consisted of initial whitening and subsequent but persistent depigmentation of the foveola. Fluorescein angiography showed a pattern consistent with "window defect" of the retinal pigment epithelium (RPE). In the first 6 months after injury, the pathologic changes consisted of initial vacuolar changes of the RPE, followed by persistent hypopigmentation and slow development of membranous bodies or lipoidal degeneration in these cells. Initial alteration and subsequent incomplete reformation of cone outer segments were also noted. In animals sacrificed 3 to 4 years after injury, separation of RPE from Bruch's membrane, with production of various abnormal basement membranes and intercellular cystoid changes in the overlying retina, was observed. The morphologic observations suggest that although the mildly injured epithelial cells may recover, they may develop functional incompetence at a later date, resulting in serous detachment of RPE and foveal (macular) edema.

Foveal hypoplasia and bilateral 360-degree peripheral retinal rosettes

A 24-year-old woman had bilateral pendular nystagmus, foveal hypoplasia, 360-degree peripheral retinal rosettes, and hypoplastic ora serrata of nongenetic origin. Kinetic perimetry revealed a generalized constriction of the field. Flicker perimetry revealed general depression of the critical flicker frequencies in the entire field. A slight increase of the threshold for light sensitivity after dark adaptation was noted from 10 to 30 degrees. Haidinger brush phenomenon was abnormal. Color vision was normal. The electroretinogram revealed mild abnormalities in the photopic flicker response. The visual-evoked response, recorded by local macular stimulation, was abnormal. The relationship of foveal hypoplasia to peripheral retinal rosettes in this case may have been caused by an intercurrent infection during the late stages of embryogenesis.

Foveo-macular retinitis, solar retinopathy, and trauma

Three patients are described with foveal lesions resembling minute holes following trauma. The similarity of the lesions to foveomacular retinitis and solar retinopathy suggests that all these conditions produce a similar, localised neuroretinal lesion with sparing of the pigment epithelium. Loss of the photoreceptors at the fovea would be expected to produce a lesion resembling a small retinal hole.

X-linked ocular albinism in Blacks. Ocular albinism cum pigmento

X-linked ocular albinism can be an unsuspected cause of congenital nystagmus in blacks. In this study, eight of ten black ocular albinos from two kindreds had nonalbinotic, moderately pigmented fundi and no transillumination of the iris. We refer to this paradoxical condition as "ocular albinism cum pigmento." The only constant ophthalmoscopic feature was a foveal hypoplasia. Biopsy of clinically normal skin to demonstrate giant pigment granules is the most accurate means of diagnosis.

[Niemann-Pick disease type B: An enzymatically confirmed case with unexpected retinal involvement (author's transl)]

In a 6-year-old girl with normal to outstanding intelligence Niemann-Pick disease was diagnosed by the demonstration of an about 90% deficient sphingomyelinase activity. Abnormalities of the eye fundi are described which are comparable to but quantitatively deviate from the classic cherry-red spot as known from neurolipidoses. The brownish-red foveola was surrounded by a relatively thin opaque ring around which punctate white deposits (lipids?) could be detected. The absence of any other neurologic symptom was in contrast iwth an extreme hepatosplenomegaly, foam cells in the bone marrow, lung infiltration, underweight, and undergrowth. Therefore, the case was classed with the type B of Niemann-Pick disease, although the common definition of this type excludes cerebral as well as oculoneural involvement. In the literature only one comparable case could be found which, however, had not been enzymatically confirmed. In the future the definition of type B of Niemann-Pick disease should include the possibility of oculoneural involvement.

Familial foveal retinoschisis associated with a rod-cone dystrophy

A brother and sister born of a consanguinous marriage had bilateral foveal retinoschisis and a generalized rod-cone dysfunction. This was associated with nyctalopia, hyperopia, minimal vitreous opacities in the sister, a paramacular tapetal sheen reflex, normal retinal vessels, an abnormal electroretinogram, and a normal electro-oculogram in the less affected brother. Foveal retinoschisis is not pathognomonic for x-chromosome-linked juvenile retinoschisis. It may be seen as a manifestation of a macular dystrophy or associated with a generalized tapetoretinal dystrophy.