Cases reported • Cataract; Lens Opacities; Cataract, Membranous; Pseudoaphakia

1/29. eye injuries associated with paintball guns.

AIMS: This study identifies the various types of ocular injuries sustained after blunt trauma with a paintball fired from a paintball gun. methods: We report two patients who sustained injury to an eye after being shot with a paintball and review similar cases presented in the world literature. The type of injury sustained and the final visual acuity obtained after a paintball hit to the eye are examined. RESULTS: The two boys presented were hit in the eye with a paintball resulting in lens subluxation, hyphema formation, and angle recession. cataract extraction was required in both cases. One boy also had an optic neuropathy and a choroidal rupture. A review of the literature reveals a variety of injuries occur after a paintball hit to the eye. In some of the cases, the damage to the eye has led to loss of vision and at times loss of the eye. CONCLUSIONS: Paintball guns can cause devastating ocular injuries. Wearing protective eye and face gear during this game is essential. We recommend that an anti-fog face mask with a one-piece polycarbonate eye shield be worn by those participating in paintball games.

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ranking = 1
keywords = choroid
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2/29. Complications of ocular paintball injuries in children.

PURPOSE: To evaluate the ocular complications of paintball injuries in children. methods: The clinical course of four children with traumatic ocular paintball injuries was evaluated. All patients underwent a complete ocular examination. Their age, injuries sustained, surgical procedure(s) performed, presence of protective eyewear at the time of injury, and final visual outcome was assessed. The presence of directly related anterior and posterior segment abnormalities were also evaluated. RESULTS: Four boys sustained traumatic paintball injuries. Average patient age was 11.25 years (range: 10-12 years). None of the children were wearing ocular or facial protection at the time of the initial injury. All patients had hyphema and traumatic cataract, and some form of retinal pathology (vitreous hemorrhage, epiretinal membrane, retinal hemorrhage, and choroidal rupture). One child had a partial-thickness corneal laceration that did not require surgical intervention. All other patients underwent ophthalmic surgery. Final visual acuity was 20/30 or better in two patients, and 20/100 or worse in the others. The cause of decreased visual acuity in these children was directly related to macular pathology. CONCLUSION: Ocular injuries resulting from paintball impact are often severe and usually occur when the participants are not wearing eye protection or this protection becomes dislodged. Treatment of these injuries is sometimes limited to an attempt to salvage what remains of useful vision. Unfortunately, most of these sports-related injuries could have been prevented if patients wore adequate eye protection when involved in this sport.

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ranking = 1
keywords = choroid
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3/29. gyrate atrophy of the choroid and retina: clinical, ophthalmologic, and biochemical considerations.

A case of gyrate atrophy of the choroid and retina associated with hyperornithinemia has been subjected to extensive clinical and biochemical investigation. The familial occurrence of the ocular disease and of abnormality of amino acid was unique to this 28-year-old male, being absent in parents and siblings. He presented with progressive visual loss, and was found to have cataracts and large areas of peripheral lacunar atrophy. Clinically there was no other abnormality. However, he was hyperuricemic and has an abnormal EEG. Despite otherwise normal biochemical indices of hepatic, renal, and muscle function; selective catheterization of an artery, the hepatic vein, the renal vein, and a deep forearm vein showed all of these circulatory beds to be producing ornithine according to arteriovenous difference measurements. cerebrospinal fluid and urine contained increased amounts of ornithine. Though electromyography was normal, the muscle biopsy was abnormal. Clinical tests including arginine loading, glucose tolerance testing, and other measurements of blood variables provided inferences as to the metabolic locus of the abnormality. The syndrome is a systemic multiorgan disorder in which the choroid and retina would appear to be target organs and the hyperornithinemia to be of, as yet, undetermined cause and pathogenic significance.

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ranking = 6
keywords = choroid
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4/29. Multifocal choroiditis in patients with familial juvenile systemic granulomatosis.

PURPOSE: To document clinical features of uveitis in patients with familial juvenile systemic granulomatosis. DESIGN: Retrospective chart review. methods: Ophthalmologic examination, medical history, and clinical course in 16 patients from eight families examined at six academic medical centers. RESULTS: Of the 16 patients, 15 had evidence of panuveitis with multifocal choroiditis. One patient had only an anterior uveitis. Ischemic optic neuropathy, presumably due to a small vessel vasculopathy, and retinal vasculopathy each occurred in one patient. Ocular complications were common, including cataracts in 11, glaucoma in six, band keratopathy in six, cystoid macular edema in six, and optic disk edema in six. All 16 patients had polyarthritis, and at least nine had skin rash. Often patients were misdiagnosed initially as having either juvenile rheumatoid arthritis or sarcoidosis. CONCLUSIONS: Familial juvenile systemic granulomatosis is an uncommon genetic disease characterized by polyarthritis and uveitis. panuveitis and multifocal choroiditis often may be present. patients with a diagnosis of juvenile rheumatoid arthritis but having a family history of the disease and multifocal choroiditis should be suspected of having familial juvenile systemic granulomatosis.

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ranking = 7
keywords = choroid
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5/29. diplopia after cataract surgery.

A 69-year-old man developed binocular, vertical diplopia after undergoing cataract extraction in both eyes. He had normal extraocular motility and a 2 prism diopter right hypertropia that was comitant but could not be relieved with overlying prisms. Funduscopy revealed an epiretinal membrane within the macula on the left more than the right. After his metamorphopsia worsened, and his visual acuity decreased to 20/40 in the left eye, he underwent pars plana vitrectomy with removal of the epiretinal membrane and his diplopia resolved. Macular pathology including epiretinal membranes and choroidal neovascular membranes may rarely cause binocular diplopia because of foveal displacement and rivalry between central and peripheral fusional mechanisms.

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ranking = 1
keywords = choroid
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6/29. Posterior capsule opacity and choroidal neovascularization in patients with age-related macular degeneration.

BACKGROUND AND OBJECTIVE: To present a series of 3 patients with the dry form of age-related macular degeneration (AMD) in whom choroidal neovascularization (CNV) was observed following neodymium: yttrium-aluminum-garnet (Nd:YAG) capsulotomy. patients AND methods: Three consecutive patients aged 80 to 87 years (average = 83.7 years) with hard drusen or retinal pigment epithelial changes underwent uneventful cataract extraction between 6 months and 20 years before undergoing Nd:YAG capsulotomy for posterior capsule opacity. The patients were examined for retinal changes before laser treatment and at regular intervals after treatment. RESULTS: All patients developed CNV between 12 days and 1 month after capsulotomy that caused a decrease in the visual acuity from 20/20-20/40 to 20/200--counting fingers at 4 feet. The fellow eye did not show a substantial change in AMD over a year of follow-up. Two of the fellow eyes had disciform scar due to CNV before the cataract surgery, and these patients remained legally blind. CONCLUSIONS: The development of CNV after Nd:YAG capsulotomy suggests a temporal association between the two and calls for further study. Because posterior capsule opacity may mask CNV, patients with dry AMD and posterior capsule opacity who experience decreased visual acuity or glare may undergo indocyanine green angiography before it is decided to perform Nd:YAG capsulotomy.

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ranking = 5
keywords = choroid
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7/29. New method of surgical repair for 360-degree cyclodialysis.

A 44-year-old man suffered traumatic 360-degree cyclodialysis in the left eye complicated by persistent hypotony, disc edema, maculopathy, and cataract. Treatment was removal of the cataract with phacoemulsification followed by insertion of a capsular tension ring with 2-point scleral suture fixation with polypropylene in the ciliary sulcus. A foldable acrylic posterior chamber intraocular lens was implanted in the capsular bag through the 4.1 mm corneal tunnel incision. The intraocular pressure responded well with resolution of hypotony, choroidal detachment, disc edema, and maculopathy. Ultrasound biomicroscopy showed complete closure of the cyclodialysis cleft.

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ranking = 1
keywords = choroid
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8/29. Presymptomatic diagnosis of bronchogenic carcinoma associated with bilateral diffuse uveal melanocytic proliferation.

A 62-year-old man presented with bilateral diffuse uveal melanocytic proliferations (BDUMP) and painful flexor contractures of the fingers of both hands. All these features were considered paraneoplastic but extensive and repeated investigations revealed no underlying malignancy. Oral steroids and orbital radiotherapy were ineffective. The diagnosis was confirmed by trans-scleral biopsy of the right choroid. Rapidly progressive cataracts were treated by phacoemulsification. Severe exudative retinal detachment with rubeosis and neovascular glaucoma in the left eye were treated successfully by partial choroidectomy. Fifteen months after presentation, investigations detected a 22 mm, poorly differentiated adenocarcinoma, which was resected without complication. The ocular tumours in both eyes regressed, without improvement in vision of light perception, and the palmar fasciitis also improved. The patient remained free of tumour recurrence until sudden death from myocardial infarction five years after he first presented.

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ranking = 2
keywords = choroid
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9/29. choroidal neovascularization in highly myopic eyes after cataract surgery.

PURPOSE: To determine the incidence and characteristics of choroidal neovascularization (CNV) in patients with high myopia (>or=8 diopters) who underwent cataract surgery in the Department of ophthalmology, tokyo Medical and Dental University, or the Ohno Eye Clinic, tokyo, between September 1991 and March 2000. methods: The medical records of 35 patients (48 eyes) who underwent cataract surgery with phacoemulsification and intraocular lens implantation were studied retrospectively. The development of CNV over a 4-year follow-up period, and its characteristics were determined. All of the eyes had received a comprehensive ophthalmological examination, including best-corrected visual acuity measurements, anterior segment biomicroscopy, and a dilated fundus examination by stereoscopic observation. RESULTS: CNV was found in six eyes (12.5%) of six patients. The mean interval between cataract surgery and the development of CNV was 34+/-17 months (range, 12-48 months). The CNV was subfoveal in all cases. The mean logarithm of the minimum angle of resolution (logMAR) after cataract surgery and before the appearance of CNV was 0.23+/-0.24, and 0.93+/-0.41 after the CNV appeared. This decrease was statistically significant (P=0.0008, paired Student t test). Subfoveal CNV developed more frequently in eyes when the fellow eye showed evidence of CNV preoperatively (40.0%) than in eyes when the fellow eye exhibited no evidence of CNV (9.3%). CONCLUSIONS: CNV developed in 12.5% of patients with high myopia after cataract surgery. CNV tended to develop more frequently when the fellow eye had CNV.

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ranking = 1
keywords = choroid
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10/29. Low dose ocular irradiation for diffuse choroidal hemangiomas associated with bullous nonrhegmatogenous retinal detachment.

The authors describe five eyes in four patients with diffuse choroidal hemangiomas associated with progressive serous nonrhegmatogenous retinal detachment that were treated with low dose external beam ocular irradiation (1,250 to 2,000 cGy in multiple fractions). The subretinal fluid reabsorbed completely within 3 to 12 months of treatment in every case and there has been no reaccumulation in any case to date (median follow-up 14 months). Two of the patients have developed a focal posterior subcapsular radiation cataract in the treated eye (at 19 months and 66 months, respectively, after irradiation), but none of the patients has thus far developed radiation retinopathy. The authors discuss the potential benefits and risks of this form of treatment for choroidal hemangiomas with bullous retinal detachment.

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ranking = 6
keywords = choroid
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