Sanford M. Meyers

A Twin Study of Age-related Macular Degeneration

PURPOSE To determine the importance of genetic factors in age-related macular degeneration by using a twin study to compare the concordance of age-related macular degeneration in monozygotic and dizygotic twin pairs. METHODS We prospectively examined 134 consecutive twin pairs and two triplet sets for age-related macular degeneration. The zygosity was determined by genetic laboratory tests. RESULTS The concordance of age-related macular degeneration was 100% (25 of 25) in monozygotic and 42% (five of 12) in dizygotic twin pairs. The other twins or triplets had no macular changes of age-related macular degeneration. CONCLUSIONS The statistically significant higher concordance of age-related macular degeneration in monozygotic than in dizygotic twin pairs and the clinical heterogeneity of age-related macular degeneration strongly suggest the importance of genetic and nongenetic factors, respectively, in age-related macular degeneration.

Comparison of Pneumatic Retinopexy with Alternative Surgical Techniques

To determine the efficacy of pneumatic retinopexy, the authors conducted a retrospective study of 56 cases of uncomplicated retinal detachments (RDs) treated with this technique (follow-up, 6-18 months). These were compared with 28 similar cases treated with a Lincoff balloon and 78 similar cases treated with a scleral buckle. The long-term success rates for these three groups were 71, 64, and 96%, with the incidence of new breaks being 20, 18, and 1.3% respectively. In aphakic or pseudophakic patients with an absent or ruptured posterior capsule, the success rate for pneumatic retinopexy was only 43%. In phakic and aphakic patients with an intact posterior capsule, the success rate for pneumatic retinopexy improved to 81%. These data suggest that this technique is less effective in aphakic or pseudophakic patients with an absent or ruptured posterior capsule and that careful follow-up to detect new breaks is necessary in all cases. A prospective randomized study is needed to verify these data.

Ocular Findings Associated with Neurofibromatosis Type II

BACKGROUND Neurofibromatosis has been recently acknowledged as consisting of a number of different diseases. Neurofibromatosis (NF) type I and NF type II are the most clearly defined. Type II is characterized by bilateral acoustic neuromas and is rare (its incidence is 1/50,000). The previously reported ocular associations of NF type II are posterior subcapsular cataracts, Lisch nodules, and combined hamartomata of the retinal pigment epithelium and retina. In this study, the authors attempt to define further the ocular manifestations of NF type II. METHODS The authors prospectively examined 9 patients who met the diagnostic criteria for NF type II (age, 18 to 38 years; mean, 25 years). RESULTS Seven of nine patients had epiretinal membranes in the posterior pole. None of these epiretinal membranes were visually significant. In addition, five patients had central posterior cortical cataracts and five had peripheral wedge-shaped cortical cataracts. CONCLUSION The presence of epiretinal membranes in young patients may represent another clinical finding associated with NF type II. Epiretinal membranes, central posterior cataracts, peripheral cortical cataracts, or combined hamartoma of the retinal epithelium and retina in young patients should alert the ophthalmologist to include NF type II in the differential diagnosis in patients with stigmata of NF type II.

Longitudinal Study of New Eye Lesions in Children with Toxoplasmosis Who Were Not Treated During the First Year of Life

PURPOSE To determine the incidence of new chorioretinal lesions in children with toxoplasmosis diagnosed after, and therefore not treated during, their first year. DESIGN Prospective longitudinal cohort study. METHODS Thirty-eight children were evaluated in Chicago between 1981 and 2005 for new chorioretinal lesions. Thirty-eight children and mothers had serum IgG antibody to Toxoplasma gondii. RESULTS Twenty-eight of 38 children had one of the following: diagnosis with serum antibody to T. gondii indicative of chronic infection at age 24 months, central nervous system calcifications, hydrocephalus, illness compatible with congenital toxoplasmosis perinatally but not diagnosed at that time. Twenty-five returned for follow-up during 1981 to 2005. Their mean (range) age at last exam was 10.9 +/- 5.7 (range, 3.5 to 27.2) years and mean follow-up was 5.7 +/- 2.9 years. Eighteen (72%) children developed at least one new lesion. Thirteen (52%) had new central lesions, 11 (44%) had new peripheral lesions, and six (24%) had both. Thirteen (52%) had new lesions diagnosed at age > or =10 years. New lesions were found at more than one visit in four (22%), and bilateral new lesions developed in seven (39%) of 18 children who developed new lesions. Of 10 additional children with eye findings and serologic tests indicative of chronic infection, six returned for follow-up, four (67%) developing new lesions at > or =10 years of age. CONCLUSIONS More than 70% developed new chorioretinal lesions. New lesions were commonly diagnosed after the first decade of life.

Vitrectomy in Eyes with Peripheral Retinal Angioma Associated with Traction Macular Detachment

PURPOSE Peripheral angiomas have been associated with epiretinal membranes and traction retinal detachment. The authors investigated the timing, results, and complications of vitreous surgery to remove the retinal traction and treat the peripheral vascular tumor. METHODS The authors reviewed the results of ten eyes that had undergone vitrectomy for macular pucker and/or traction retinal detachment. These eyes had either preoperative or intraoperative treatment of the peripheral tumor. RESULTS Patients were followed 4 to 95 months. Six eyes had nonfamilial peripheral acquired retinal hemangioma, three had von Hippel angiomas, and one had multiple large peripheral retinal angiomas associated with extensive retinal telangiectasis. Four eyes received cryotherapy and/or laser photocoagulation 2 to 3 months before surgery. In the remaining six eyes, initial treatment to the peripheral angioma was performed at the time of vitreous surgery. At final follow-up, all eyes were attached without retinal traction. Vision improved in all eyes; six (60%) achieved 20/50 or better visual acuity. Complications included recurrent epiretinal membrane (n=3); nonregressed angiomas (n=3); increased nuclear sclerosis (n=2); and retinal detachment (n=1). CONCLUSION Vitreous surgery, when applied to epiretinal membranes or traction retinal detachments associated with peripheral vascular tumors, has a good chance of improving vision. Treatment of the hemangioma, before or during vitrectomy, usually results in tumor regression.

Reoperations and visual results after failed pneumatic retinopexy

A single pneumatic retinopexy (PR) procedure failed to achieve permanent retinal reattachment in 23 (23%) of 101 cases of simple primary retinal detachment (RD). In 12 (16%) of 76 cases that were phakic or had an intact posterior capsule, a single PR failed compared with 11 (44%) of 25 cases without an intact posterior capsule. A total of 27 reoperations including eight repeat PRs (5 of which were successful) was required to achieve permanent retinal reattachment. Comparison of the final visual acuity and change from preoperative to final visual acuity between the initially failed and the successful cases demonstrated that initial failure of PR does not adversely affect the visual outcome. In all cases, the retina remained reattached at latest follow-up.

Toxoplasmosis-associated neovascular lesions treated successfully with ranibizumab and antiparasitic therapy

Joseph D. Benevento, MD1, Rama D. Jager, MD, MBA1, A. Gwendolyn Noble, MD, PhD2, Paul Latkany, MD1,3, William F. Mieler, MD1, Mari Sautter, BA1, Sanford Meyers, MD1, Marilyn Mets, MD2, Michael A. Grassi, MD1, Peter Rabiah, MD1, Kennneth Boyer, MD4, Charles Swisher, MD2, and Rima McLeod, MD1,* other members of the Toxoplasmosis Study Group† 1University of Chicago Pritzker School of Medicine, Chicago, IL 2Children’s Memorial Hospital, Chicago, IL 3St. Luke’s Roosevelt Hospital, The New York Eye & Ear Infirmary, New York, NY 4Rush University Medical Center, Chicago, IL

Recurrent retinal detachment more than 1 year after reattachment.

PURPOSE Little information exists regarding recurrent retinal detachment after 1 or more years of complete retinal reattachment. To better understand this uncommon problem, we evaluated late recurrent retinal detachments in relation to the contemporary classification of proliferative vitreoretinopathy (PVR). DESIGN Retrospective consecutive noncomparative case series. PARTICIPANTS Nine patients (10 eyes) with late recurrent retinal detachment after 1 or more years of complete reattachment. METHODS We retrospectively analyzed the clinical and operative records of one surgeon over a 9-year period to identify late recurrent retinal detachments that occurred 1 or more years after complete retinal reattachment. The study group was derived from a total of 453 consecutive cases of rhegmatogenous retinal detachment repair not associated with proliferative diabetic retinopathy, uveitis, or penetrating ocular trauma. MAIN OUTCOME MEASURES Late recurrent retinal detachments after 1 or more years of complete retinal reattachment. RESULTS The study group consisted of 10 eyes (2.2% of total) in nine patients. Redetachment occurred from 12 to 126 months (average, 46.8 months) after the initial detachment surgery. Late recurrent retinal detachments were associated with new retinal breaks (five eyes), reopening of old breaks (three eyes), or both (two eyes). In all, 13 open breaks were identified, nine of which were on or anterior to the scleral buckle. Eight eyes had grade C PVR, including four eyes with anterior PVR, three eyes with posterior PVR, and one eye with both anterior and posterior PVR. The retina was reattached after additional vitreoretinal surgery in eight eyes of seven patients; two patients (two eyes) declined reoperation. Visual acuity improved in seven of eight eyes after repair of the late recurrent retinal detachment. Postoperative follow-up after late recurrent detachment repair ranged from 69 to 140 months (average, 101.7 months, or 8.5 years). CONCLUSIONS Vitreous base traction seems to be an important factor in late recurrent retinal detachments occurring 1 or more years after complete retinal reattachment, and the associated PVR was probably a secondary phenomenon and not a causative factor in most cases. Reoperation for such late recurrent retinal detachments can successfully reattach the retina and improve visual acuity in most cases.

Coagulase-negative Staphylococcus Endophthalmitis After Cataract Surgery With Intraocular Vancomycin

PURPOSE We studied a case of postoperative coagulase-negative Staphylococcus endophthalmitis in a 79-year-old man who had undergone cataract extraction in which vancomycin had been used intraoperatively in the infusion fluid. METHODS The medical records were reviewed for the clinical history, ocular findings, and the vitreous and anterior chamber culture results. RESULTS Acute, postoperative coagulase-negative Staphylococcus endophthalmitis developed in the patient in whom vancomycin had been used intraoperatively in the infusion fluid. CONCLUSIONS Restraint is urged in the prophylactic use of vancomycin in the infusion fluids.

Indocyanine green angiography in the diagnosis of retinal arterial macroaneurysms associated with submacular and preretinal hemorrhages: a case series

PURPOSE To report the use of indocyanine green angiography in the diagnosis of retinal arterial macroaneurysms associated with preretinal and subretinal hemorrhage. METHODS Retrospective case series. Indocyanine green angiograms of five consecutive patients with dense preretinal, intraretinal, and subretinal hemorrhages in which the cause of hemorrhage was still in question after clinical evaluation and fluorescein angiography. RESULTS In five eyes of five patients, indocyanine green angiography demonstrated acquired retinal arterial macroaneurysms as the cause of hemorrhage. Each diagnosis was confirmed after the hemorrhages spontaneously resolved or were surgically removed. CONCLUSIONS Indocyanine green angiography is useful in the diagnosis of acquired retinal arterial macroaneurysms when fluorescein angiography is inconclusive because of preretinal, intraretinal, or subretinal hemorrhage. Establishing the diagnosis of retinal arterial macroaneurysm can influence the management of patients with submacular and premacular hemorrhage.