Atrophic maculopathy associated with hereditary ataxia

Two siblings had atrophic maculopathy associated with hereditary ataxia clinically defined as an olivopontocerebellar degeneration. The macular changes were suggestive of an early bull's-eye maculopathy in one case and of a late atrophic stage of bull's-eye maculopathy in the other. This suggests that concentric annular (bull's-eye) macular dystrophy may occur as part of olivopontocerebellomacular degeneration. Exogenous causes were excluded. The inheritance pattern was autosomal recessive or irregular autosomal dominant. The relationship of these two degenerative disorders is not yet clear. This combination of findings has been, to our knowledge, only rarely described.

Congenital bilateral arterial anastomosis between the choroid and peripheral retina

A healthy 26-year-old woman, had a decrease of vision in her left eye caused by a macular pucker, showed deformed retinal vessels, small exudative detachments of the neuroretina, and retinal exudates and hemorrhages in both fundi peripheral to the equator at the 6-o'clock position. Fluorescein angiography and stereoscopic photographs clearly showed an anastomosis of a recurrent ciliary artery with periphral retinal vessels and localized absence of the choriocapillaris under the detached retina in both eyes. The anastomosis probably developed in the last month of fetal life as the result of a localized absence of Bruch's membrane caused by an incomplete coloboma of the choroid that originated during the second month of gestation.

Argon laser treatment in complications of angioid streaks

Five patients with subretinal neovascular complications of angioid streaks were treated with the argon laser. One patient, additionally had a central retinal vein occlusion with preretinal neovascularization. In four out of five cases we obliterated the subretinal neovascular membranes with ensuing improvement of visual acuity. In a follow-up period of 14 months on the average, the treatment appeared to be successful.

Gyrate atrophy of the choroid and retina with reticular pigmentary dystrophy and ornithine-ketoacid-transaminase deficiency

A 10 year old white girl is presented with gyrate atrophy of the choroid and retina (atrofia gyrata). She also showed reticular pigmentations at the level of the retinal pigment epithelium temporal to both maculas. A generalized hyperornithinaemia was demonstrated in this patient and cultured fibroblasts established the underlying ornithine-keto-acid-transaminase (OKT) deficiency for the first time. Pharmacologic doses of vitamin B6 nor restriction of dietary protein resulted in a significant decrease of the serum ornithine concentration. It is probable that hyperornithinaemia in itself is not the cause of the gyrate atrophy.

Crystalline retinopathy

A 34-year-old woman had crystalline dystrophy of the retina associated with atrophy of the choriocapillaris and pigment epithelium, and pigment clumping in the fundus periphery. Consanguinity of her parents suggested an autosomal recessive inheritance pattern for this type of crystalline retinal dystrophy. The patient did not have corneal crystals. Her electroretinogram was normal, although her electro-oculogram was abnormal.

Retinal dystrophies associated with peripheral retinal vasculopathy

A pair of identical twins with cone-rod dystrophy and 1 patient with dominant retinitis pigmentosa are reported who had a peculiar vascular retinopathy characterised by perivenous accumulation of fluorescein in the temporal periphery. Other retinal dystrophies associated with leaking retinal vessels are discussed.

Rubella retinopathy and subretinal neovascularization

Diseases that primarily affect the pigment epithelium, Bruch's membrane, or the choroid may lead to secondary subretinal neovascularization and its sequelae of hemorrhage and scarring. We studied three cases of presumed congenital rubella retinopathy with congenital deafness, which developed unilateral subretinal neovascularization, hemorrhage, and scarring.

L-Ornithine-ketoacid-transaminase deficiency in cultured fibroblasts of a patient with hyperornithinaemia and gyrate atrophy of the choroid and retina

L-Ornithine-ketoacid-transaminase deficiency was established in cultured fibroblasts obtained from a patient with hyperornithinaemia (mean ornithine level in serum approximately 100 mumol/l) and gyrate atrophy of the choroid and retina. The deficiency was found both the L-ornithine concentrations of 3.0 mM (about twice the KM value) and 12 mM, indicating that the enzymic defect was not due to a decreased affinity for this substrate. The reliability of the colorimetric assay of ornithine-ketoacid-transaminase activity was established radiochemically. Performance of the radiochemical assay revealed the presence of an impurity in the substrate DL-[2-14C]ornithine - HCl being a strong inhibitor of the enzyme. The passage level and the subcultivation time of the fibroblasts did not influence the enzymic activity.

Peripheral cone disease

Peripheral cone disease is characterized by an absent cone function as measured by the ERG but a normal or slightly affected colour vision. The authors examined 20 cases. The most striking fact was the high incidence of myopia and the presence of nystagmus; on the basis of this finding the authors suggest that at least some cases of peripheral cone disease are due to myopic choroido-retinal degeneration (in French: "choroïdose myopique").

Retinal functions in dominant cystoid macular dystrophy (DCMD)

Dominant cystoid macular dystrophy (DCMD) occurred in 28 members of 5 unrelated families. The disease is characterized by cystoid macular oedema and leakage from retinal capillaries in the posterior pole. Colour vision examination reveals a type I red-green defect with concomitant blue-yellow defectiveness; the latter may be caused by the leaking capillaries. The ERG is normal. The EOG is subnormal. Darkadaptation curves are often slightly disturbed. There are frequently also aspecific pigmentary alterations in the peripheral fundus.

Dominantly inherited cystoid macular edema

An apparently autosomal-dominant macular dystrophy occurred in three pedigrees with the presenting signs of typical cystoid macular edema due to leaking perimacular capillaries. Other striking features were retinal capillary leakage all over the posterior pole of the eye, whitish punctate deposits in the vitreous body, a normal electroretinogram, a subnormal electro-oculogram, and moderate to high hyperopia. In later or more advanced stages the macula developed a central zone of "beaten bronze" atrophy. Strabismus occurred frequently.

Serpiginous (geographic) choroiditis

The rare pathological condition of serpiginous choroiditis is discussed on the basis of four observations. The authors discuss the different views advanced in the literature in regard to the aetiology. They advance arguments in favor of an inflammatory pathogenesis. The problems of the differential diagnosis are also considered in some detail.

Acute macular neuroretinopathy

An unrecognized acute macular affection occurred in four women, 24 to 35 years old, using oral contraceptives who complained of a sudden decrease of visual acuity or paracentral scotomas. Three patients had bilateral lesions and one patient had unilateral lesions. These lesions consisted of darkish brown-red, wedge-shaped dots in the macula pointing to the fovea. These dots were located mostly on the nasal side to the macula. Biomicroscoby showed these lesions were located in the superficial layers of the retina. The retinal vessels, pigment epithelium, and optic disk showed no distinct pathologic features. Fluorescein angiography, performed repeatedly, showed some questionably dilated perimacular capillaries without leakage in two cases. Static perimetry delineated dense paracentral scotomas. Recovery was slow or absent, confirmed py perimetric observation. Ophthalmoscopic, fluorescein angiography, and perimetric details excluded an affection of the pigment epithelium, the nerve fiber layer, and the optic disk. Since the affection appears to be localized superficially in the retina, we called this specific entity acute macular neuroretinopathy.

[Diagnosis and treatment of macular lesions in multifocal chorioiditis (presumed histoplasmosis) (author's transl)]

The authors describe the clinical picture of "presumed histoplasmosis" with the typical disciform mascular lesion which is found in a increasing number of Dutch patients. Although systemic histoplasmosis is not endemic in the Netherlands, the authors feel they are dealing with the same entity. The therapy is elucidated, especially (Argon laser) photocoagulation of favourably situated subretinal neovascularisations. The importance of adequate coagulation technique and frequent (fluographic) follow-up studies in view of possible complications is stressed.