Albert S. Leveille

Bilateral Juxtapapillary Subretinal Neovascularization Associated with Pseudotumor Cerebri

A 32-year-old obese woman with hypertension and a three-year history of pseudotumor cerebri developed bilateral juxtapapillary subretinal neovascular membranes. To our knowledge, this is the first reported case of bilateral subretinal neovascular membranes complicating the course of this disease. The subretinal neovascular membrane in the left eye spontaneously involuted, but because the membrane in the right eye threatened the foveola, the patient underwent argon-laser photocoagulation. The subretinal fluid and hemorrhage progressively resolved, the membrane was replaced by fibrous tissue, and visual acuity improved. The pathogenesis of the subretinal neovascular membranes was presumably secondary to pressure deformity of the border of Bruchs membrane at the optic disk, creating a discontinuity of normal anatomic apposition of the chorioretinal layers. This anatomic dehiscence, coupled with hypoxia created by axonal tissue swelling and resultant impaired vascular perfusion of the tissues, led to the development of subretinal neovascular membranes.

Platelet-Induced Retinal Neovascularization in Leukemia

Retinal changes resembling those of background diabetic or hypertensive retinopathy commonly occur in leukemia, whereas retinal neovascularization is rare. When neovascularization does occur, it is usually the result of hyperviscosity caused by a greatly increased number of circulating leukocytes. A 42-year-old woman with diabetes mellitus developed chronic myelocytic leukemia and peripheral retinal neovascularization. The hyperviscosity leading to the neovascularization was probably caused by an increased number of circulating platelets.

Autosomal dominant central pigment epithelial and choroidal degeneration.

Eight of nine individuals of a four-generation family had autosomal dominant central pigment epithelial and choroidal degeneration, which was not entirely consistent with previously described central retinal and choroidal degenerations. The early loss of the choriocapillaris with a relative sparing of the sensory retinal and pigment epithelial function is similar to central areolar choroidal degeneration. Ophthalmoscopically, however, the disease resembled the dominant progressive foveal degenerations; except that our patients additionally had multiple peripheral yellow-white lesions. An exceptional finding in our patients was the preservation of good visual acuity despite marked atrophy of the choriocapillaris.

STEVENS-JOHNSON SYNDROME ASSOCIATED WITH ADENOVIRUS CONJUNCTIVITIS

An 18-year-old woman developed Stevens-Johnson syndrome six days after the onset of an adenovirus conjunctivitis. Adenovirus serum antibody titers increased from 1:16 to 1:64 during a four-week period, and there was no history of drug ingestion or other infection.

Intraocular Lens Power Formulas

We have developed a FORTRAN digital computer program to evaluate intraocular lens power for any thin lens and combination of corneal curvature and axial length. Partial derivatives of the power with respect to cornea power, axial length, and lens position allow estimation of error in power of the lens. These derivatives are computed along with power of the lens for six far points which may be changed with the program running. The program is written for remote access so that an ordinary telephone and portable terminal provide the ability to compute lens power.

Slit-Lamp Examination of the Bedridden Patient

Slit-lamp examination of bedridden patients is facilitated by using a stretcher with the patient lying prone and holding the head erect.