Frederick H. Reeser

Surgical Results in Ocular Trauma Involving the Posterior Segment

Of 106 eyes with trauma involving the posterior segment, 12 could not be repaired, 74 were treated with vitrectomy, and 20 without vitrectomy. Fifty-five eyes (52%) achieved functional success (defined as a final visual acuity of 6/30 [20/100] or better or as a postoperative improvement in visual acuity from light perception or worse to 6/240 [5/200] or better), 16 (15%) attained anatomic success (attached retinas and generally clear media) but were functional failures, and 35 (33%) were both anatomic and functional failures. The prognosis was better in cases with intraocular foreign bodies and worse in cases with retinal detachments, marked vitreous hemorrhage, and large scleral lacerations. Traumatic involvements of the lens did not appear to affect the prognosis. Prophylactic scleral buckling appeared to lessen the incidence of postoperative retinal detachment. The eyes that underwent vitrectomy within 14 days of the injury had a better final visual outcome than those that underwent later vitrectomy.

Necrotizing vaso-occlusive retinitis.

We studied two adult patients with fulminating, necrotizing vaso-occlusive retinitis, and documented the progressive course of retinal necrosis, vitreoretinal interface contraction, and consequent retinal detachment. The systemic criteria for Behçets disease were present in one patient, and partially fulfilled in the second.

Cystoid Macular Edema after Retinal Detachment Surgery

One hundred eyes in 98 patients were studied by fluorescein angiography and stereo color photography six weeks after successful scleral buckling surgery. Twenty-five percent of 67 phakic eyes and 40% of 33 aphakic eyes demonstrated cystoid macular edema. Older phakic patients were at significantly greater risk to develop cystoid macular edema than younger phakic patients. Seventeen percent of successfully repaired eyes demonstrated distortion of the macula by preretinal membranes; 16 of these 17 eyes showed leakage of fluorescein dye into the surrounding retina sometimes also causing cystoid edema. Either cystoid macular edema or macular distortion was present in 38% of the phakic eyes and 64% of the phakic eyes after successful retinal detachment surgery.

Rhegmatogenous Retinal Detachment Complicating Cytomegalovirus Retinitis

Six eyes in four patients with cytomegalovirus retinitis developed retinal holes and retinal detachment. Holes appeared in areas of necrosis and were typically large and round with shaggy edges. Differentiation from exudative detachment was sometimes difficult because of obscuration of the fundus by vitreous haze. Cryotherapy was successful in closing open breaks without detachment; cryotherapy and exoplant surgery were used effectively to treat the initial detachments. The occurrence of massive periretinal proliferation and late development of new areas of hole formation or retinitis complicated therapy for these detachments.

Astrocytic Hamartoma of the Retina Not Associated with Tuberous Sclerosis

A 6-year-old boy had a peripapillary lesion diagnosed as retinal astrocytic hamartoma, which was not associated with tuberous sclerosis, neurofibromatosis, or intraocular extension of a glioma. The patient was observed for nine years, during which time the lesion grew significantly. Because of this growth and the evidence of proximal optic nerve involvement on computed tomography, radiation therapy was administered with a resultant marked reduction in visual acuity. The eye was subsequently enucleated. The enucleated eye was studied by both light and transmission electron microscopy. The specimen had a retinal astrocytic hamartoma with sparse vascularization and only superficial optic nerve involvement. Additionally, it revealed optic nerve drusen in varying stages of development, significant accumulations of subretinal macrophages, and an almost total loss of retinal outer segments with the preservation of the retinal pigment epithelium.

Unusual ocular presentation of acute toxoplasmosis

Four patients with toxoplasmosis are reported with unusual presenting ocular lesions. One patient had an active lesion that appeared to involve the optic nerve as well as focal toxoplasmosis chorioretinitis at the macula. A second patient had a pale optic nerve in association with the classical chorioretinal scars of toxoplasmosis. The third patient had toxoplasmosis chorioretinitis of the macula with subretinal neovascularisation. The fourth patient had a branch artery occlusion complicating acute retinitis.

Efficacy of Argon Laser Photocoagulation in the Treatment of Circinate Diabetic Retinopathy

We evaluated 115 eyes in 105 diabetic patients with circinate retinopathy and, in most cases, associated macular edema. Of these 115 eyes, 68 were treated with argon laser photocoagulation to leaking vessels, primarily in the center of the circinate ring. Forty-seven eyes that had similar findings but received no treatment were followed up for one year and some patients were followed up for as long as three years. In each year of follow-up the treated eyes did significantly better visually than the untreated eyes. The circinate complex was eliminated in 23 of the 24 treated eyes (96%) followed up for three years, whereas it disappeared in only two of the ten untreated eyes (20%). Complete resolution of macular edema, however, was achieved in only two of the treated eyes (3%) and in none of the untreated eyes. Eyes with initial visual acuities of 6/18 (20/60) or better did significantly better with treatment than eyes treated after visual acuity was less than 6/18 (20/60). The former group was the only one to show a mean improvement in visual acuity.

Vascular Leakage, Neovascularization, and Vitreous Hemorrhage in Senile Bullous Retinoschisis

Retinal detachment is the primary complication of bullous retinoschisis, a benign abnormality of the peripheral retina. We examined three patients (all women, 43, 55, and 56 years old) with typical bullous retinoschisis who had vitreous hemorrhage. In each case, there were sclerotic retinal vessels over the surface of the schisis cavity along with neovascularization above the central portion of the cyst. In one case there was also neovascularization of the peripheral retina in an area distant from the schisis. These findings were confirmed by fluorescein angiography in one case; the other two cases demonstrated similar changes by fluorescein angioscopy. Fluorescein angiography, also demonstrated intraretinal dye leakage from vessels along the posterior extent of the schisis, as well as from an adjacent area of white without pressure.

Retinal Pigment Epithelial Detachments in Posterior Scleritis

A 12-year-old girl developed posterior scleritis and many detachments of the retinal pigment epithelium. Computed axial tomographic findings, reported in posterior scleritis for the first time, disclosed thickening of the posterior sclera. Computed axial tomography appears to be a sensitive test for the diagnosis of posterior scleritis.