Presumed ocular histoplasmosis syndrome and linear streak lesions

Five cases of subretinal neovascular membranes in the macula associated with punched out chorioretinal scars and linear streaks were seen in five Dutch patients. Clinically the fundus lesions are consistent with those of presumed ocular histoplasmosis syndrome (POHS) seen in the United States of America. Cutaneous serological testing for histoplasmin reactivity was negative in the three patients tested. Of special interest is the presence of linear streaks in association with POHS. They have not been previously described in patients from Europe with this syndrome.

Immune responsiveness to retinal S-antigen and opsin in serpiginous choroiditis and other retinal diseases

The immune responsiveness to bovine retinal S-antigen and opsin has been investigated in some retinal disorders by means of in vitro lymphocyte proliferation, leukocyte migration inhibition and enzyme linked immune sorbent assays (ELISA). Sensitisation to S-antigen was observed in serpiginous choroiditis, but not in acute posterior multifocal placoid pigment epitheliopathy (APMPPE) or retinitis pigmentosa. No significant immune responsiveness was detected to opsin in any of the three diseases. Elevated antibody titers to S-antigen were observed in some individual patients and healthy subjects. However, none of the patient groups exhibited an elevated antibody titer as compared to the control group. Although serpiginous choroiditis and APMPPE share some prominent clinical characteristics, the sensitisation in the former disease may perhaps be attributed to more severe and prolonged damage of the photoreceptor cells and blood-retina barrier. A combination of previous and present results suggests that in immunological investigations of retinitis pigmentosa patients it is more effective to use human than bovine S-antigen as test antigen because a species specific epitope seems to be involved.

A long-term follow-up study of laser coagulation of neovascular membranes in angioid streaks

We treated 30 eyes (24 patients) with angioid streaks and neovascular membranes using light coagulation. Of 30 eyes, 16 showed either ameliorated or unchanged visual acuity. Twelve of the remaining 14 eyes retained a visual acuity of 20/200 or better. In 11 patients, the fellow untreated eye showed central macular degeneration with loss of central vision. The follow-up period ranged from two months to 16 years (mean, 3.4 years).

Clinical evaluation of the Topcon CT10 tonometer

We evaluated the clinical use of the Topcon CT10 non-contact tonometer in our outpatient clinic. Compared to the Goldmann applanation it is useful and reliable in screening glaucoma patients.

X-linked cone dystrophy. An overlooked diagnosis?

The cone dystrophies can be subdivided into 3 functional stages: central cone disease, peripheral cone disease and diffuse cone disease, respectively. In the patient material of our clinic the sex distribution of patients presenting with te diffuse cone disease stage was abnormal: 22 males and 3 females. The authors suggest that the diagnosis X-linked cone dystrophy often is overlooked.

Idiopathic sub-retinal neovascular membranes in the macula (hemorrhagic macular choroidopathy of young adults). Clinical report and effectiveness of laser treatment

Twenty-six patients with idiopathic sub-retinal neovascular membranes (INVMs) located within the posterior pole were examined. Clinical and fluorescein angiographic features of these patients are described. Follow-up ranged from 2 to 96 months (mean 16.5 months). Laser treatment was performed according to the location of the neovascular membrane: 7 out of 9 eyes (77%) increased their final visual acuity or stabilized after Argon blue-green laser photocoagulation (INVMs further than 200 microns from the center of the fovea). Krypton red light laser treatment was performed in 13 eyes with juxta-foveal and sub-foveal INVMs: following treatment 10 eyes (77%) improved by 2 or more Snellen lines or maintained their pre-treatment visual acuity. Because of the fact that the Krypton laser was not yet available, 5 patients were not treated: all of them had sub-foveal (3) or juxta-foveal INVMs (2). The natural history of 4 cases (80%) showed an increase in the final visual acuity in 3 eyes and a steady state in one eye. Pathogenesis and treatment outcome of the disease are finally discussed.

Ligneous conjunctivitis

The case history is given of a woman of 65 (in 1973) with a granulomatous conjunctival inflammation in the right eye and chronic recurrent polyps on the vocal cords. Several times, granulomatous tissue was removed from the conjunctiva of the right eye but the result was recurrences at shorter intervals. Seven years after the onset in the right eye the left eye became affected. Various treatments, both systemic and local, were tried without success. The histological diagnosis of ligneous conjunctivitis was not made until 1981. Treatment with the known remedies for ligneous conjunctivitis was not successful. At the end of 1984 treatment with Imuran (azathioprine) was started. Since that time the patient has been practically free of recurrent granulomatous tissue on the conjunctiva and vocal cords. The treatment of ligneous conjunctivitis with Imuran has not previously been reported in the literature.

Atypical sector pigmentary dystrophy

The authors describe a family with atypical sector shaped pigmentary dystrophy in two generations with transmission from father to son. A review of the literature is given.

Evolution of benign concentric annular macular dystrophy

In 1974, Deutman described a family with an autosomal dominantly inherited macular dystrophy that he termed "benign concentric annular macular (bull's-eye) dystrophy." Ten years later, we performed a follow-up examination. Some patients complained of deterioration of visual acuity, night vision, and color vision. The macular dystrophy had progressed. The fundus periphery was more involved and in two patients there were bone corpuscle-like pigmentations. Electrophysiologic examination showed increased photoreceptor dysfunction with equal involvement of the rod and cone system. The patients had an acquired type III blue-yellow color vision defect with pseudoprotanomaly.

Rips of the retinal pigmentepithelium

A rip or rupture of the detached retinal pigment epithelium (RPE) with subsequent retraction of that layer is an often misdiagnosed affection of the posterior pole of the eye. The histologic appearance of this entity has to our knowledge not yet been published, but the fundus aspect and fluorescein angiography show that the focal absence of the pigmentepithelial layer is very likely. A rip is only seen in older age and it always appears in a detached RPE that often exists in combination with other features of a senile macular degeneration. Mostly the rip arises spontaneously but it may develop sometimes directly after laser coagulation of the detached RPE.

Iris angiography after cataract extraction and the effect of indomethacin eyedrops

To test the efficacy of topical indomethacin eye drops in preventing cystoid macular edema (CME) postcataract extraction, iris fluorescein and fundus fluorescein angiography were performed in two series of eyes that underwent intracapsular cataract extraction; 25 control eyes and another 25 eyes receiving indomethacin eye drops. In the latter group, 1% indomethacin eye drops were given three times a day, from 1 day preoperatively to 4 weeks postoperatively. In these two groups, there was a statistically significant difference in the findings on iris fluorescein angiography in the early and late period. There appeared to be a correlation between the degree of dye leakage on iris fluorescein angiography and the occurrence of CME. Fundus examination showed 6-9 weeks postoperatively perifoveal vascular leakage in 28% of the control group and in 8% of the indomethacin group. The results show from this study support the theory that prostaglandin form an etiological factor of CME.

Pigment dispersion syndrome and pigmented pattern dystrophy of retinal pigment epithelium

The 2 rare entities, pigmentary dispersion syndrome and pigmented pattern dystrophy of the retinal pigment epithelium, were found in a young male patient. Visual function was undisturbed.

Acute multifocal ischaemic choroidopathy and the choriocapillaris

Acute multifocal ischaemic choroidopathy (AMIC) seems to be a better name than acute posterior multifocal placoid pigment epitheliopathy (A.P.M.P.P.E.). Fluorescein angiography indicates obstruction of the precapillary choroidal arterioles leading to non perfused choriocapillaris lobules and focal swelling of the retinal pigment epithelium at the site of the lesions. Furthermore in many fluorescein angiograms of human patients the specific mosaic pattern of the choriocapillaris can be observed, which was described in monkeys by Hayreh & Baines (7). The choroid has, indeed, an endarterial system. The special conditions in which a well-defined appearance of the choriocapillaris occurs are listed.

Visual disturbances during pregnancy caused by central serous choroidopathy

Three patients had during pregnancy visual disturbances caused by central serous choroidopathy. One of them had a central scotoma in her first and second pregnancy. The 2 other patients had a central scotoma in their first pregnancy. Symptoms disappeared spontaneously after delivery. Except for the ocular abnormalities the pregnancies were without complications. The complaints can be misinterpreted as pregnancy-related optic neuritis or compressive optic neuropathy, but careful biomicroscopy of the ocular fundus should avoid superfluous diagnostic and therapeutic measures.

Rift Valley fever retinitis

A 57-year-old Dutch woman, who had lived and worked in Tanzania for 26 years, developed serious, progressive bilateral retinitis after suffering from a fever of unknown origin. Fundus abnormalities in both eyes suggested that the woman had been infected with Rift Valley fever virus. Serologic studies confirmed this suspicion. White macular lesions accompanied to extensive vasculitis appear to be specific for Rift Valley fever retinitis.