Scott M. Steidl

Macular complications associated with posterior staphyloma.

PURPOSE To report macular abnormalities associated with posterior staphyloma in eyes with myopia. METHODS In a retrospective study, we surveyed 116 eyes of 58 patients with myopic refractions. Myopic fundus abnormalities are related to clinically quantified posterior staphyloma formation. RESULTS A posterior staphyloma was present in 88 (75.9%) of 116 eyes with myopic refractions of -3 diopters or more. Best-corrected visual acuity was decreased among eyes in all staphyloma grades. Eyes with the shallowest staphyloma depth (grade 1) displayed the largest drop in visual acuity as well as the greatest frequency of choroidal neovascular membranes and hemorrhages. A linear relationship was observed between staphyloma grade and conus formation (P = .001), retinal pigment epithelial defects (P = .0001), lacquer cracks (P = .0001), and chorioretinal atrophy (P = .001). All these variables were increased in staphylomatous eyes. A significant difference in means by staphyloma grade was observed for myopic refractive error (P = .001), axial length (P = .001), and best-corrected visual acuity (logMAR, P = .0001). CONCLUSIONS There was an unexpected high frequency of choroidal neovascular membranes, hemorrhage, and poor best-corrected visual acuity in the lower staphyloma categories. This suggests that the development of a choroidal neovascular membrane requires relative preservation of the choriocapillaris as present in eyes with less advanced stages of posterior staphyloma formation.

Vitreous hemorrhage in patients with high-risk retinopathy of prematurity

PURPOSE To investigate outcomes in premature infants with high-risk retinopathy of prematurity and secondary vitreous hemorrhage. DESIGN Retrospective chart review. METHODS Patients were selected from a database of infants undergoing retinopathy of prematurity screening from September 1997 to November 1999. Infants with high-risk retinopathy of prematurity (zone I or posterior zone II threshold disease) with and without vitreous hemorrhage were compared. MAIN OUTCOME MEASURES Final stage of retinopathy of prematurity and short-term structural outcome were assessed. Visual acuity and refraction were measured when possible. RESULTS Twenty-two eyes of 11 patients (group 1) had high-risk (posterior zone II or zone I threshold) retinopathy of prematurity without vitreous hemorrhage. Group 1 patients had a 91% favorable short-term structural outcome. Eight eyes of five infants developed vitreous hemorrhage with high-risk retinopathy of prematurity (group 2). Group 2 patients had only a 12.5% favorable short-term structural outcome. Seven of eight (87.5%) progressed to stage IVa or IVb retinopathy of prematurity. Six eyes underwent vitreoretinal surgery after a median duration of hemorrhage of 36 +/- 29 days (4-70 days). Three eyes developed stage V detachments and three progressed to phthisical degeneration. Final visual acuity was no light perception in three eyes. CONCLUSION Vitreous hemorrhage, in association with advanced retinopathy of prematurity, is a poor prognostic sign.

Subretinal organization in stage 5 retinopathy of prematurity

BackgroundThe subretinal organization (SRO) seen in patients who undergo vitrectomy for stage 5 retinopathy of prematurity has not previously been characterized. We report our observations of SRO and correlate its development with previous laser and cryotreatment for neovascular disease.MethodsWe surveyed data from 426 eyes in a retrospective chart review of 263 patients that underwent open-sky vitrectomy for stage 5 retinopathy of prematurity.ResultsOf 426 eyes evaluated, 130 eyes received laser, cryo, or a combination of both treatments. In 44 eyes (10.3%), SRO was observed and considered the cause of incomplete retinal attachment. Three forms of SRO were identified: subretinal bands (63.6%), subretinal plaques (15.9%), and diffuse SRO (18.2%). One patient had both a band and a plaque. SRO developed in 24 eyes after cryotreatment, 3 after laser, and 2 after combination cryo and laser treatment. Fewer untreated eyes than cryotreatment eyes developed SRO (15 of 296 eyes, 5.1%; (P=0.0001). Eyes without laser or cryotreatment had a 5.1% frequency of developing SRO.ConclusionSubretinal organization, a previously uncharacterized entity in retinopathy of prematurity, was most frequently identified in the form of subretinal band formation. SRO was identified in 10.3% of all stage 5 eyes evaluated, and was associated with incomplete retinal reattachment in all cases.