Edwin E. Boldrey

Risk of Retinal Tears in Patients with Vitreous Floaters

A total of 589 patients (369 women and 220 men, 123 of whom were less than 40 years old and 52 of whom were more than 70 years old) with photopsia, vitreous floaters, or both participated in a prospective study designed to identify patients at particularly high risk for retinal tears. The patients were graded on a number of factors before undergoing peripheral retinal examinations. Computer analysis showed that the following factors had the strongest associations (P less than .001) with retinal tears: visual symptoms of diffuse dots (62 of 120 patients, or 51.7%), many vitreous cells (graded 2+ or worse) (61 of 94 patients, or 64.9%), and grossly visible vitreous or preretinal blood (51 of 56 patients, or 91.1%). Of the 176 eyes that had at least one of these three conditions, 93 (52.8%) had retinal tears compared to 16 of the remaining 413 eyes (3.9%). Although other factors correlated with retinal tears to some degree, the associations were not strong enough to help select the high-risk group.

Retinal Burns Occurring at Cataract Extraction

Paramacular changes presumably induced by operating microscope light have been described previously in six patients who had undergone extracapsular cataract extraction with posterior chamber lens implantation. Twelve additional patients are reported, including pseudophakes and nonpseudophakes, macular and paramacular burns, and no visual loss and severe visual loss. Burns occurred in spite of filters and light barriers used in some cases. Light sources were tungsten bulb or halogen/fiberoptic. Three cases had essentially normal preoperative angiography. Currently recommended safety measures have not eliminated this complication.

Retinal Injury Due to Industrial Laser Burns

Ocular industrial lasers burns in seven patients were analyzed as to cause, severity, and type of injury. Ocular damage ranged from minimal retinal burns to extensive areas of damage with commotio retinae and vitreous hemorrhage. Visual loss ranged from complete recovery without residual defect to a profound decrease in central acuity. The kinds of lasers causing these injuries were neodymium YAG, argon, krypton, and rhodamine dye. Severity of injury was related to several factors. Some degree of carelessness was involved in all injuries.

Retinal Neovascularization and Ocular Toxoplasmosis

Retinal neovascularization, a rare complication of ocular toxoplasmosis, is a source of vitreous hemorrhage. We examined three patients (all women, 70, 36, and 19 years old) with inactive toxoplasmosis scars associated with occlusion of a retinal arteriole or venule passing through the scar, capillary nonperfusion, and adjacent retinal neovascularization. In two patients photocoagulation of the ischemic areas produced a cessation of hemorrhage and the disappearance of neovascularization. In the third case, the neovascular frond was avulsed from its supplying retinal arteriole without treatment.

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.

Vitreous Cells as an Indicator of Retinal Tears in Asymptomatic or Not Recently Symptomatic Eyes

PURPOSE To define the relationship between vitreous cells and retinal tears in eyes without recent flashes or floaters. METHODS Five hundred eighty-five consecutive patients who complained of light flashes, floaters, or both in one eye had their asymptomatic or not recently symptomatic fellow eye examined prospectively for vitreous cells and retinal tears. RESULTS Of these fellow eyes with 2+ or more vitreous cells (10 or more cells per 1-mm slit-lamp field), 31.6% (6/19) had one or more tears vs 1.6% (9/566) of those with 1+ or fewer cells (less than nine cells per 1-mm slit-lamp field) (P = .0001). CONCLUSIONS A substantial number of vitreous cells, even in an eye with no recent symptoms, is correlated with the presence of a retinal tear. Additionally, a retinal tear may exist in an eye with 1+ or fewer cells.

A Modified Contact Lens for Far Peripheral Retinal Evaluation in Pseudophakes

Abstract It can be difficult to see the far peripheral retina clearly in pseudophakic eyes. This type of lens induces marginal astigmatism. However, most of the blur can be eliminated by attaching an appropriately oriented -6.00-diopter (D) cylindric lens to the front surface of a modified three-mirror contact lens. This new contact lens can be used for both examination and laser treatment.

A Modified Vitreous Scissors

A new vitreous scissor combines an immobile shaft and hook with a sliding cutting blade; the blade is angled to trap the vitreous band while it is being cut. A tweezer-action handle is used. This scissors cuts dense membranes while producing only minimal traction on the retina.