Mary Lou Lewis

FACTORS ASSOCIATED WITH REDUCED VISUAL ACUITY DURING LONG-TERM FOLLOW-UP OF PATIENTS WITH IDIOPATHIC CENTRAL SEROUS CHORIORETINOPATHY

Purpose To investigate factors associated with reduced visual acuity during long-term follow-up of patients with idiopathic central serous chorioretinopathy (ICSC). Methods Retrospective consecutive case series that included patients with ICSC who were younger than 50 years of age at the time of initial examination and were followed up for ≥3 years. Results The mean follow-up for 101 involved eyes of 61 patients was 9.8 years (median, 8.0 years). Eyes were stratified into two groups based on visual acuity at the final examination: Group 1, visual acuity of 20/40 or better; and Group 2, visual acuity of worse than 20/40. Findings identified as potential risk factors for reduced vision at the final follow-up examinations for Group 1 versus Group 2 included the following: macular retinal pigment epithelium atrophy (90.8% versus 96.0%, respectively;P = 0.68); persistent pigment epithelial detachment or persistent subretinal fluid (5.3% versus 28.0%, respectively;P = 0.004); recurrences (39.5% versus 68.0%, respectively;P = 0.020); laser treatment (28.9% versus 32.0%, respectively;P = 0.80); and submacular choroidal neovascularization (0.0 versus 8.0%, respectively;P = 0.059). Conclusions Factors associated with reduced visual acuity during long-term follow-up of patients with ICSC included persistent pigment epithelial detachment and/or subretinal fluid, recurrences, and submacular choroidal neovascularization.

The Acute Retinal Necrosis Syndrome Part 1: Clinical Manifestations

The acute retinal necrosis syndrome is characterized by necrotizing retinitis, vitritis, and retinal vasculitis occurring in otherwise healthy patients. Experience with 11 cases and the review of 30 additional cases in the literature are presented. In this series, 50% of the affected eyes developed retinal detachments, and 64% had a final visual acuity of less than 20/200. The natural history, diagnosis, postulated etiology, and suggestions for management will be discussed.

Variations in the clinical course of submacular hemorrhage

PURPOSE To assess variations in the clinical course of submacular hemorrhages. METHODS We reviewed fundus photography charts taken of patients during a 27-month period. Thirty-one eyes of 31 patients with submacular hemorrhages under the foveal avascular zone were reviewed. RESULTS In 20 of the eyes, the underlying etiology was age-related macular degeneration (ARMD). The other 11 eyes had various underlying conditions, including macroaneurysms (two), presumed ocular histoplasmosis syndrome (two), trauma (one), Valsalvas retinopathy (one), idiopathic central serous choroidopathy (one), diabetic retinopathy (two), central retinal vein occlusion (one), and choroidal rupture (one). Of the eyes with ARMD (mean follow-up, 29 months), eight (40%) of 20 showed an improvement in visual acuity (> or = 2 Snellen lines), six (30%) of 20 had a final visual acuity of 20/80 or better, and three (15%) had a final visual acuity of 20/40 or better (range, 20/25 to 20/80). Of the eyes without ARMD (mean follow-up, 29 months), five (45) of 11 had an improvement in visual acuity and five (45%) of 11 attained a final visual acuity of 20/40 or better (range, 20/20 to 20/40). The best predictive factor for poor final visual acuity was the presence of a subretinal neovascular membrane. CONCLUSIONS Patients with submacular hemorrhage may have spontaneous improvement in visual acuity without surgery. Patients without subretinal neovascular membranes had a better visual improvement rate.

Retinal Detachment Following the Acute Retinal Necrosis Syndrome

Twenty-six patients with the acute retinal necrosis involving 32 eyes have been followed at the Bascom Palmer Eye Institute. Sixteen eyes developed retinal detachment and surgical repair was attempted in thirteen. Ten eyes were successfully reattached. Vitreous surgery was necessary in ten eyes and was performed in eight of the ten successful eyes. The clinical characteristics of the retinal detachments as well as the surgical procedures and results are presented.

Vitrectomy for Retinal Detachment Associated With Acute Retinal Necrosis

Six patients with retinal detachment associated with the acute retinal necrosis syndrome were treated by the combination of vitrectomy, gas injection, and laser photocoagulation. The retinas were successfully reattached in each patient with one operation. Five of the patients achieved a visual acuity of 20/200 or better, and three had a visual acuity of 20/40 or better.

Visual results and complications after retinal reattachment in the acute retinal necrosis syndrome. The influence of operative technique.

The authors compare the complications and visual results encountered in a consecutive series of 16 eyes undergoing retinal reattachment surgery for retinal detachment associated with the acute retinal necrosis syndrome. Eight eyes were treated with scleral buckling, vitrectomy, and cryotherapy with or without gas injection. Eight consecutive eyes (with one exception) were treated by the combination of vitrectomy, gas injection and laser photocoagulation with or without primary lensectomy and not subjected to scleral buckling as a primary procedure. The final reattachment rate was 93.8% (15 of 16 eyes) with no significant difference between the primary scleral buckle group (87.5%) and the non-buckle group (100%). Retinal reoperation and complication rates were higher in the primary buckle group and final visual acuities better in the non-buckle group despite comparable preoperative characteristics.

Follow-up Study of Presumed Ocular Histoplasmosis Syndrome

One hundred and sixty-two patients with presumed ocular histoplasmosis syndrome were evaluated. New macular scars not present on initial angiogram developed in 9% of eyes. The risk of developing a symptomatic macular lesion in eyes with asymptomatic macular scars was 23%. In eyes with peripapillary scarring, 3.8% developed a peripapillary neovascular membrane. Follow-up was 5.5 years. When the neovascular membrane was touching or outside the foveal avascular zone, the difference between photocoagulated and control eyes was not statistically significant. When only adequately photocoagulated eyes (20) were compared with control eyes (40), the difference was statistically significant (P = 0.04).

Interferon alfa-2a in the treatment of exudative age-related macular degeneration

Nineteen patiens (20 eyes) with the exudative form of macular degeneration were treated with parenteral interferon alfa-2a. Fifteen patients (16 eyes) had adequate follow-up for evaluation of outcome of the exudative macular lesion. The average follow-up was 8 months (range 5-11 months). Color photographs and fluorescein angiograms were evaluated independently by two masked readers for change in size, presence of fibrosis, and leakage of the neovascular lesion. During the follow-up, none of the exudative lesions resolved: one lesion became smaller, four remained the same, nine enlarged, and two could not be graded based on the photographs. Visual acuity remained 20/40 or better in four eyes. The proportion of eyes with visual acuity of 20/200 or worse increased from 35% at the initial visit to 59 % at the final visit. Ten patients experienced significant but reversible side effects, including weight loss, depression, and/or hematopoietic suppression. The data from these cases do not support any significant treatment benefit from interferon alfa-2a at the doses used in exudative macular degeneration.

Iris fluorescein angiography in diabetic vitrectomy patients

Preoperative iris fluorescein angiograms (IFA) and ophthalmic records of 34 diabetic patients who underwent vitrectomy were reviewed. Of 24 patients without clinically apparent rubeosis, 23 showed evidence of iris microvascular abnormalities or rubeosis on IFA. Patients with rubeosis (Grades III and IV) on IFA had a 63% incidence of postoperative neovascular glaucoma, thus isolating them as a high risk group. The visual outcome of patients developing neovascular glaucoma was poor. Präoperative Fluoreszeinangiogramme der Iris von 34 Diabetikern, an denen eine Vitrektomie durchgeführt wurde, wurden mit dem postoperativen Verlauf verglichen. 23 von 24 Patienten, bei denen klinisch keine Rubeosis festgestellt wurde, zeigten Gefäßveränderungen im Angiogramm. Patienten mit eindeutiger Rubeosis im Angiogramm (Grad III and IV) bekamen in 63% der Fälle ein Sekundärglaukom. Sie gehören damit in eine hohe Risikogruppe. Der postoperative Visus bei den Patienten mit Glaukom war schlecht.