Foveal avascular zone diameter and sickle cell disease.

Patients with sickle cell disease can have a distinct retinopathy in which the posterior pole shows abnormalities, including perifoveolar vascular abnormalities. The foveal avascular zone (FAZ) was examined using fluorescein angiography in patients with sickle cell disease and in healthy normal controls. The longest FAZ diameters of 38 patients (51 eyes) with sickle cell disease were compared with those of the 48 patients (60 eyes) in the control group.

Central retinal vein occlusion associated with drusen of the optic disc.

A 43-year-old man had gradual visual changes OD. Funduscopic examination revealed central retinal vein occlusion OD. Complete ocular examination revealed bilateral drusen of the optic disc, confirmed by b-scan ultrasonography.

Bilateral central retinal vein occlusion as an initial manifestation of pseudotumor cerebri.

Pseudotumor cerebri, or benign intracranial hypertension, is known to produce visual symptoms. Central retinal vein occlusion has been linked with pseudotumor cerebri but rarely as an initial manifestation. We describe a 46-year-old patient--who was obese and mildly hypertensive with bilateral central retinal vein occlusions--who was subsequently diagnosed as having pseudotumor cerebri.

The ocular ischemic syndrome. III. Visual prognosis and the effect of treatment.

The records of fifty-two consecutive patients with the ocular ischemic syndrome seen between 1978 and 1985 were reviewed with the purpose of investigating the visual prognosis and effects of treatment. On initial presentation, 43% of affected eyes had a visual acuity of 20/20-20/50, whereas 37% were counting fingers or worse. By the end of one year, only 24% remained in the 20/20-20/50 group, while 58% were counting fingers or worse.

S-antigen. Identification of human T-cell lymphocyte proliferation sites.

Immune responses to normal retinal proteins, including S-antigen, have been demonstrated in patients with a variety of retinal disorders, as well as in those who have received panretinal laser photocoagulation. T-cell lymphocytes (T cells) have been implicated in the pathogenesis of several ocular inflammatory diseases of possible autoimmune etiology. We used synthetic peptides that correspond to the amino acid sequence of S-antigen in lymphocyte proliferation assays to identify specific sites in the molecule recognized by human T cells.

Quadrantic venous-stasis retinopathy secondary to an embolic branch retinal artery obstruction.

Venous-stasis retinopathy is a term used to describe the posterior segment findings of the ocular ischemic syndrome. These include midperipheral blot retinal hemorrhages, dilated retinal veins, attenuated arterioles, peripheral retinal microaneurysms, macular edema, as well as retinal and optic disc neovascularization. The authors recently evaluated a 71-year-old woman who presented with an asymptomatic calcific embolus in her right infero-temporal branch retinal artery.

The early natural history of subfoveal neovascular membranes in eyes with age-related macular degeneration.

During the course of age-related macular degeneration, the visual prognosis is abruptly changed when the presence of a subretinal neovascular membrane (SRNVM) is established by intravenous fluorescein angiography (IVFA). Patients who have been alerted to this condition may notice distortion on the Amsler grid and report within days of the onset of symptoms. Unfortunately most patients either do not notice the early changes in central vision or incorrectly attribute these symptoms to the development of cataracts and defer proper retinal evaluation for several months.

Choroidal neovascularization in an eye with a macular hole.

We report the case of a 68-year-old woman who initially presented with an idiopathic macular hole OD and atrophic macular degenerative changes and who subsequently developed subretinal neovascularization OU. The subretinal neovascularization evolved through the macular hole OD and decreased visual acuity to counts fingers, but the membrane was successfully treated OS with krypton laser photocoagulation and stabilization of visual acuity at 20/50 over the eight-year postoperative follow-up. This is the first report, to our knowledge, of a membrane developing through a macular hole.

Treatment of Eales' disease with scatter laser photocoagulation.

Eales' disease is an extremely uncommon vasoproliferative retinal disease predominantly affecting otherwise healthy young men. The etiology of this condition is unknown, but its progression and clinical appearance are similar to other vasoproliferative diseases of the retina such as diabetic and sickle cell retinopathies. These similarities make Eales' disease a good prospect for inclusion in a model pattern of retinal ischemic disease and suggest that treatment by panretinal photocoagulation should be effective in this condition.

Progressive capillary nonperfusion in temporal branch retinal vein obstruction.

We studied 31 eyes with nonischemic temporal branch retinal vein obstruction (TBRVO) of six months' duration or less. Each eye had an initial and at least one follow-up fluorescein angiogram according to the clinical course. Five eyes had sufficient additional capillary nonperfusion by angiography to warrant reclassification into the ischemic category.

Temporal branch retinal vein obstruction masquerading as a retinal arterial macroaneurysm: the Bonet sign.

We present the case report of a patient with a hemorrhage at an arteriovenous crossing which was erroneously interpreted as being an arterial macroaneurysm. Shortly thereafter, the typical appearance of a temporal branch retinal vein obstruction was evident indicating that the hemorrhage was an early sign of the venous obstruction. This sign (the Bonet sign) should alert the clinician to this disorder so that the correct diagnosis and recommendations for patient care can be undertaken.

Unilateral proliferative sickle retinopathy: a model for photocoagulation in the proliferative retinopathies.

We present a case report of a patient with unilateral proliferative sickle retinopathy who progressed to intractable vitreous hemorrhage, traction retinal detachment, and severe loss of vision after unsuccessful vitrectomy surgery. The patient's other eye had chronic uveitis resulting in widespread destruction of the retinal tissue, and subsequently the eye did not have any evidence of neovascularization. This observation is consistent with those seen in proliferative diabetic retinopathy where retinal damage from high myopia, trauma, or other cause typically protects that eye from the advanced stages of diabetic retinopathy.

The ocular ischemic syndrome. II. Mortality and systemic morbidity.

The cases of 52 consecutive persons with ocular ischemic syndrome (ocular symptoms and signs attributable to severe carotid artery obstruction) were studied. Followup disclosed a five year mortality of 40%. In comparison, an age and sex matched control group from the Framingham study had a five year mortality of 11%.

An eye disorder caused by chronic cardiovascular disease.

Retinal vein occlusion is a serious ophthalmologic condition that requires prompt diagnosis and treatment to avoid permanent vision loss. With acute onset of central vein occlusion, vision loss is sudden, unilateral, and painless. Vision loss from branch vein occlusion is typically less severe.

Branch retinal-artery obstruction: a review of 201 eyes.

A study of 187 patients (201 eyes) with branch retinal-artery occlusion (BRAO) was done to determine the etiology, natural history, and treatment of this disorder. On follow-up, almost 90% of the patients had visual acuity of 20/40 or better. The rest had poor visual acuities initially.

Quantification of progressive diabetic macular nonperfusion.

We used the IS-2000 Image Analyzer to estimate the extent of progressive diabetic macular nonperfusion in a patient by means of an automatic clustering algorithm applied to digitized fluorescein angiograms of the patient's macula taken over time. This method may provide an objective and reproducible quantification of progressive macular nonperfusion.

Central retinal-artery occlusion in proliferative sickle-cell retinopathy after retrobulbar injection.

Central retinal-artery obstruction (CRAO) is a devastating complication after retrobulbar anesthesia, a procedure which was previously recommended routinely to immobilize the eye and reduce discomfort during laser surgery. Recent developments in treatment technique, involving scatter laser applications given over several sessions with smaller spot sizes and shorter durations, have virtually eliminated the need for retrobulbar injections and the risks of retrobulbar hemorrhage, which can cause increased intraocular pressure and culminate in closure of the arterial circulation. We present the case of a patient with proliferative sickle retinopathy who sustained such a complication after direct photocoagulation treatment of sea-fans elsewhere and offer alternative treatment techniques which we have used for the past ten years that eliminate this hazard.

Dynamic amaurosis fugax secondary to compression of vertebral artery.

Transient unilateral loss of vision can be a manifestation of ipsilateral carotid disease; whereas transient visual impairment affecting both eyes simultaneously suggests vertebral basilar-artery insufficiency. We present such a case where the symptoms were related to head position. Congenital anomalies of the vertebral arteries were found on four-vessel cervical angiography.

Resolved incomplete central retinal-artery obstruction simulating ischemic optic neuropathy.

To our knowledge, this is the first reported case of an embolic three-fourths central retinal-artery obstruction with isolated sparing of the superior temporal branch artery. Multiple nonfoveolar-sparing cilioretinal arteries were also present. As a result of the unusual obstruction distribution, ischemic optic neuropathy was simulated after a five-month interval.

The ocular ischemic syndrome. Clinical, fluorescein angiographic and carotid angiographic features.

The records of 43 consecutive patients (51 eyes) with the ocular ischemic syndrome (ocular symptoms and signs attributable to severe carotid artery obstruction) were studied in a retrospective fashion. Men comprised 67% of the group and the mean age at presentation was 64.5 years.

Subretinal neovascular membranes associated with choroidal nonperfusion and retinal ischemia.

This is the first well-documented case of co-existent underlying choroidal nonperfusion in an eye with a subretinal neovascular membrane that was subsequently treated with krypton red laser photocoagulation by the senior author (LEM). The possible role of chronic macular ischemia secondary to choroidal circulatory impairment is discussed in relationship to other well-established risk factors. Perhaps treatment to improve macular oxygenation would be a reasonable alternative to eradication of the neovascularization by direct laser photocoagulation.

Panretinal photocoagulation for radiation-induced ocular ischemia.

We present preliminary findings on the effectiveness of panretinal photocoagulation in preventing neovascular glaucoma in eyes with radiation-induced ocular ischemia. Our study group consisted of 20 patients who developed radiation-induced ocular ischemia following cobalt-60 plaque radiotherapy for a choroidal or ciliary body melanoma. Eleven of the 20 patients were treated by panretinal photocoagulation shortly after the diagnosis of ocular ischemia, but nine patients were left untreated.

Ocular ischemic syndrome: long-term ocular complications.

Acute retinal arterial occlusive events in the eye are generally easily recognized and the association with embolic material, often from ulcerative lesion of the ipsilateral carotid vessels, usually can be established by noninvasive imaging techniques. In contrast, chronic retinal and choroidal circulatory impairments from ophthalmic artery insufficiency is usually due to high-grade, hemodynamically-significant carotid occlusive disease which can be difficult to recognize because of the diverse clinical features and presentations. We present herein the experience of the senior author (LEM) in the diagnosis and management of these complex cases.

Review of choroidal osteoma: successful krypton red laser photocoagulation of an associated subretinal neovascular membrane involving the fovea.

Laser treatment of a subretinal neovascular membrane associated with a unilateral choroidal osteoma in a 28-year-old woman is described. To our knowledge, this is the first reported use of krypton red laser photocoagulation for the initial treatment of a subfoveal neovascular membrane in this setting. Early recognition of the membrane allowed treatment prior to involvement of the central fovea.