L. Pierro

Echographic Diagnosis of Drusen of the Optic Nerve Head in Patients with Angioid Streaks

A total of 58 patients (116 eyes) with angioid streaks, referred to this department over 2 years (1990-1992), underwent a thorough ophthalmic examination, retinal fluorescein angiography, dermatological visit with skin biopsy, and a series of other examinations (blood and biochemistry, skull X-ray, vascular echo Doppler, abdominal ultrasound) and eye ultrasonography. Fifty patients (100 eyes, 86.2%) had pseudoxanthoma elasticum (PXE). In the whole caselist, 21.6% had drusen compared with 21.0% in the group with PXE. Both these findings are higher than those published elsewhere. Drusen of the optic nerve head were also found in 25% of the 16 eyes (8 patients) with angioid streaks but no PXE. We believe we found a higher prevalence of drusen of the optic nerve head in these patients with angioid streaks because we systematically employed ultrasound.

OCT images and surgery of juvenile Macular retinoschisis.

We describe three cases of X-linked juvenile retinoschisis confined to the posterior pole of the eye, one of which surgically treated. In the first two cases, in vivo optical coherence tomography (OCT) had revealed a cleavage plane in both nerve fiber and outer retinal layers. In the two similar operated eyes of the third case, postoperative OCT had revealed the disappearance of macular schisis in the eye with good recovery of visual function after surgery. On the contrary, it had revealed a persistent splitting of the retina in the other eye, not clinically visible, which explained the poor recovery of visual function after surgery. In cases with progressive worsening of macular involvement in X-linked juvenile retinoschisis, highly accurate surgery may be considered, and the pre- and postsurgical OCT monitor of these patients is indicated.

Clinical variability in keratometry, ultrasound biometry measurements, and emmetropic intraocular lens power calculation.

ABSTRACT We calculated inter‐examiner and intea‐examiner variability in keratometry and ultrasound biometry when performed by two different examiners. The potential effect on intraocular lens power calculation was also considered. Intra‐examiner variability was statistically and clinically significant for axial measurements, particularly in eyes with axial length greater than 24 mm. Thus, variability in biometric examination affected the emmetropic intraocular lens power, especially in myopic eyes.

Ultrasound biomicroscopy following the intraocular use of silicone oil.

We evaluated the ultrasound biomicroscopy findings and the amount and location of silicone oil residue in anterior structures of the eye before and after silicone oil removal. We examined the anterior structures in 40 silicone oil 1000 cs-filled eyes at the end of silicone oil tamponade time (mean silicone oil tamponade duration 5.1 months), and in the same eyes after silicone oil removal. High resolution ultrasound biomicroscopy, 50 MHz transducer, 50 νm of resolution, was used. Silicone oil droplets - often not ophthalmoscopically visible - appeared as highly reflective images with after ringing effect. They were present in the anterior structures of the eye in up to 95% of eyes with silicone oil in the vitreous cavity, and in up to 87.5% after careful silicone oil removal. With ultrasound biomicroscopy it was possible to identify small silicone oil droplets with a typical morphological appearance. Once silicone oil is used in vitreoretinal surgery, its complete removal from the anterior structures of the eye is very difficult to achieve later on.

Prenatal Detection and Early Diagnosis of Hereditary Retinoblastoma in a Family

A couple asked for prenatal testing, the husband being a retinoblastoma survivor. Family history suggested that the tumor predisposing mutation came from his paternal side. DNA analysis indicated that the foetus had not inherited that mutation. Detection of a regressed retinoblastoma in the husbands mother changed the interpretation of the haplotypes obtained, and it was concluded that the foetus had inherited the mutation. Ultrasonography on the 3rd day of extra-uterine life showed a retinal mass in the newborns left eye. Two years later, the couple asked for a new prenatal diagnosis. DNA analysis showed that the foetus had inherited the mutant retinoblastoma haplotype from the father. Fundus examination on the 2nd day of extra-uterine life showed a retinal lesion in the newborns left eye at the posterior pole. This case indicates the necessity of a thorough check on history and an ophthalmological examination of family members.

Reliability of preoperative ultrasonography evaluation for vitreoretinal surgery

To evaluate the present level of reliability of common ultrasonography prior to vitreoretinal surgery, we carried out a prospective study to compare preoperative ultrasonography data with direct intraoperative findings. A total of 228 eyes with different vitreoretinal disorders and opaque or clear media were studied. In the group of 187 eyes with fractional retinal detachment (group I), the percentage of agreement between the ultrasonography data and the surgical fingings ranged from 77.1% to 92.2%, depending on the pathology. In the group of 41 eyes without retinal detachment (group II), agreement ranged from 90.4% to 100%. The most frequent causes of failure of preoperative ultrasonography were incorrect prediction of macular detachment, partial posterior vitreous detachment, posterior vitreoschisis and vitreoretinal adhesions. The main cause of failure was the presence of multiple complicated echos in group I, particularly in fractional diabetic retinal detachment. To achieve maximum benefits from ordinary preoperative ultrasonography, the vitreoretinal surgeon must be fully aware of its present level of reliability and general limitations.

Extraocular Muscle Size Comparison between Normal and Myopic Eyes Using Standardized A Scan Echography

The aim of this study was to establish the range of diameters of extraocular muscles in myopic patients and to obtain the baseline data to follow progression or regression of pathologies involving them. Standardized A scan and B scan ultrasound was used to measure the thickness of straight extraocular muscles at the muscle belly. No statistical differences were seen between right and left eyes. We found no consistent correlation with age or with axial length in the control or in the myopic patients (p>0.05). Diameters in myopic and control eyes were similar. This lack of difference between myopic and control muscle sizes means that we can obtain accurate measurements also from myopic patients.

Capillary and cavernous hemanigoma of the optic disc Echographic and histological findings

Abstract The ultrasonography features of optic disc hemangioma have been described in various reports but the extreme rarity of this ocular tumour makes any univocal interpretation of echographic findings difficult. The two cases of hemangioma of the optic disc described here, one of capillary hemangioma and the other of cavernous hemangioma, presented different echographic patterns. In the capillary hemangioma B‐scan showed a mass lesion with smooth anterior border, acoustic solidity and no choroidal excavation. With A‐scan there was an initial high spike with low/medium internal reflectivity. In the cavernous hemangioma, B‐scan showed an elevated dome‐shaped mass, with an anechoic area inside, and no choroidal excavation. With A‐scan there was a high initial spike and irregular reflectivity. The eyes were enucleated for intractable neovascular glaucoma. Histological examination of the lesion explained the different echographic patterns. Ultrasonography is useful in the differential diagnosis of capillary and cavernous hemangioma.

Ocular involvement in acute lymphoblastic leukemia: an echographic study.

We report a case of acute lymphoblastic leukemia (ALL) with ocular involvement in which bilateral swelling of the optic disk head was noticed. Massive direct infiltration of the optic nerve head by leukemic cells can give rise to a clinical picture identical to that of a true papilledema. Ocular echography allowed a better and more complete interpretation of the optic disk involvement. No echographic description of a leukemic infiltration of the optic nerve head has been reported previously.

Hypertensive choroidopathy: A case report

The authors report a case of exudative retinal detachment of the posterior pole and peripheral choroidal detachment in a patient with renovascular accelerated hypertension. The peculiar clinical situation of this patient was comparable with experimental models of hypertension recently reported in the literature. Both the retinal and the choroidal detachment regressed after blood pressure stabilization with systemic antihypertensive therapy, supporting a choroidal pathogenesis for the chorioretinal lesions.