Ariah Schwartz

The Classification of Retinal Detachment with Proliferative Vitreoretinopathy

The term proliferative vitreoretinopathy (PVR) is proposed as a designation for the clinical condition previously known variously as massive vitreous retraction, massive preretinal retraction, or massive periretinal proliferation. This is an abnormality in which rhegmatogenous retinal detachment is complicated by proliferation of membranes on both surfaces of the detached retina and on the posterior surface of the detached vitreous gel. The new classification subdivides PVR into four stages: A, minimal; B, moderate; C, marked; and D, massive. The extent of the fixed retinal folds is subdivided to indicate the number of involved quadrants. The degree of retinal shrinkage into a funnel-like configuration is subdivided into three grades.

Classification of Proliferative Vitreoretinopathy Used in the Silicone Study

The Silicone Study is a multicenter randomized clinical trial that compares a long-acting gas with silicone oil for the surgical treatment of proliferative vitreoretinopathy (PVR). As part of the study, a topographic classification of PVR has been developed that is based on the characteristic patterns of retinal distortion produced by the contraction of proliferative membranes on the retina or within the vitreous base. This classification is used to document the extent and anatomic distribution of PVR present preoperatively and to help standardize the surgical treatment. Experience has shown that this classification facilitates the identification of these membranes and their systematic dissection, and the authors therefore suggest that it be used to augment the Retina Society classification of PVR.

Ocular Metastases from Systemic Melanoma

We studied two patients, a 72-year-old man and a 27-year-old woman, with metastatic melanoma documented by cytologic examination of the ocular fluids. Neither patient had a clinically detectable ocular mass. Fine-needle aspiration with cytologic examination may be useful in the diagnosis of metastatic ocular melanoma.

Enlargement of Congenital Hypertrophy of the Retinal Pigment Epithelium

Photographs taken several years apart showed enlargement of areas of congenital hypertrophy of the retinal pigment epithelium in two patients. Slow growth of these lesions may be more common than has been thought, and should not be taken as evidence of malignancy.

Aniseikonia, metamorphopsia and perceived entoptic pattern: some effects of a macular epiretinal membrane, and the subsequent spontaneous separation of the membrane

Following cryo surgery for retinal hole repair, visual effects in the senior authors eyes were caused by an epiretinal membrane. Subjectively, metamorphopsia was noted, and entoptically perceived radial striae were observed centred near fixation. After subsequent cataract surgery, metamorphopsia was not detectable. Several months later, the centre of the striate entoptic pattern was observed to be centred several degrees from fixation. Concurrently, loss of contrast in the central visual field was noted. In time, both the entoptic pattern and the contrast effects became less visible (contrast improved much faster). The epiretinal membrane had spontaneously separated from the fovea. Repeated measurements of aniseikonia were obtained before cataract surgery, and after cataract surgery both prior to, and after the separation of the epiretinal membrane. Inferences are drawn.

Photographic Documentation and Grading of PVR

In 1983, the Retina Society devised a grading system for proliferative vitreoretinopathy (PVR) in hopes that a standardized grading system would make it possible to compare techniques and results of treatment for PVR from different surgeons.1 The system defines PVR as grade “A” if there is pigment proliferation in the vitreous, grade “B” if there are partial thickness retinal wrinkles and rolled edges on retinal breaks due to pre-retinal membrane contraction, grade “C” if periretinal membrane contraction produces full-thickness retinal folds involving 9 clock hours of the retina or less, and grade “D” if more than 9 clock hours of the retina are involved by such fixed folds. The “C” category is subdivided according to the number of clock hours of the retina involved by fixed folds (C-l, 1–3 clock hours; C-2, 4–6 clock hours; C-3, 7-9 clock hours). The D category is subdivided according to the degree of “funnelling” the fixed folds produce around the optic nerve (D-l, a wide open funnel; D-2, a narrow funnel defined as having its “mouth” less than 45°; and D-3, a closed funnel, such that the disc is entirely hidden at the apex of the funnel).