1/65. Spontaneous involution of a large retinal arterial macroaneurysm.BACKGROUND: Acquired retinal macroaneurysms are round dilatations of retinal arterioles that occur in the posterior fundus. They tend to rupture before they grow large and cause a visual decrease. The average diameter of macroaneurysms in the previous reports is 281 micrometer. methods: A 63-year-old man complained of a sudden decrease of visual acuity in the left eye. Fundus examination of his left eye revealed a large protruded mass, 2 disc diameters in size, at the first bifurcation of the inferotemporal retinal artery. Preretinal vitreous bleeding and serous retinal detachment were observed around the lesion. indocyanine green (ICG) angiography showed this mass to be continuous with the inferotemporal retinal artery and ICG dye leaked from the retinal artery into the lumen of the mass, with pulsation. RESULTS: Six months later, the large macroaneurysm underwent spontaneous involution. CONCLUSION: As shown in this patient, retinal macroaneurysms may grow extremely large. ICG angiography was useful to diagnose this large retinal arterial macroaneurysm.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
2/65. Polypoidal choroidal vasculopathy masquerading as central serous chorioretinopathy.OBJECTIVE: To differentiate polypoidal choroidal vasculopathy (PCV) from central serous chorioretinopathy (CSC). DESIGN: A retrospective, observational case series. PARTICIPANTS: Thirteen patients originally diagnosed with CSC proved to have PCV after more extensive evaluation and follow-up. methods: A clinical and angiographic review of patients with manifestations of CSC, including macular detachment. MAIN OUTCOME MEASURES: Demographic data, funduscopic examination, and fluorescein and indocyanine green (ICG) angiographic findings. RESULTS: Thirteen patients initially suspected of having CSC were ultimately diagnosed as having PCV. These eyes had exudative macular detachments secondary to a small caliber, polypoidal choroidal vascular abnormality or so-called polypoidal choroidal neovascularization. The clinical manifestations in the fundus varied. They included multiple, variably sized serous pigment epithelial detachments, neurosensory retinal detachment, lipid deposition, patchy atrophy of the pigment epithelium and indistinct staining from decompensation of the posterior blood-retinal barrier on fluorescein angiography. In reality, the suspected PEDs proved to be polypoidal lesions of PCV when imaged with ICG angiography. CONCLUSIONS: The clinical diagnosis of CSC or PCV generally poses little challenge to the experienced retinal specialist. However, in CSC with persistent and/or recurrent exudation, a myriad of retinal pigment epithelial changes may evolve that make it difficult to differentiate these two entities. In such patients, ICG angiography is useful in differentiating CSC from PCV. An accurate clinical diagnosis is important since each of these entities, CSC and PCV, may differ in terms of their risk factors, natural course, and visual prognosis.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
3/65. Acquired tumors arising from congenital hypertrophy of the retinal pigment epithelium.BACKGROUND: Congenital hypertrophy of the retinal pigment epithelium (CHRPE) is widely recognized to be a flat, stationary condition. Although it can show minimal increase in diameter, it has not been known to spawn nodular tumor that is evident ophthalmoscopically. OBJECTIVES: To report 5 cases of CHRPE that gave rise to an elevated lesion and to describe the clinical features of these unusual nodules. methods: Retrospective medical record review. RESULTS: Of 5 patients with a nodular lesion arising from CHRPE, there were 4 women and 1 man, 4 whites and 1 black. Three patients were followed up for typical CHRPE for longer than 10 years before the tumor developed; 2 patients were recognized to have CHRPE and the elevated tumor concurrently. visual acuity was decreased in 3 patients, mainly due to cystoid macular edema. The tumor was located between the equator and ora serrata in all 5 patients. There was no predilection for quadrant of the fundus. The flat part of the lesion was black and had visible lacunae in all 5 patients. The CHRPE ranged in basal diameter from 3 x 3 mm to 13 x 11 mm. The size of the elevated lesion ranged from 2 x 2 x 2 mm to 8 x 8 x 4 mm. The nodular component in all cases was supplied and drained by slightly prominent, nontortuous retinal blood vessels. Yellow retinal exudation occurred adjacent to the nodule in all 5 patients and 1 patient developed a secondary retinal detachment. Two tumors that showed progressive enlargement, increasing exudation, and progressive visual loss were treated with iodine 125-labeled plaque brachytherapy, resulting in deceased tumor size but no improvement in the visual acuity. CONCLUSIONS: Congenital hypertrophy of the retinal pigment epithelium can spawn a nodular growth that slowly enlarges, attains a retinal blood supply, and causes exudative retinopathy and chronic cystoid macular edema. Although no histopathologic evidence is yet available, we believe that the tumor probably represents either an acquired adenoma or a reactive proliferation of the retinal pigment epithelium. The best treatment of these lesions is not yet established.- - - - - - - - - - ranking = 2keywords = size (Clic here for more details about this article) |
4/65. Detection of HIV-rna in aqueous humor and subretinal fluid in an HIV carrier with rhegmatogenous retinal detachment.BACKGROUND: Although human immunodeficiency virus (HIV)-related ocular complexes are commonly observed in acquired immune deficiency syndrome (AIDS) patients, it has not been previously reported that HIV had already invaded the ocular tissues of HIV carriers. CASE: A 56-year-old woman was diagnosed as having rhegmatogenous retinal detachment with a retinal tear in the 6-o'clock position in her right eye. No signs of ocular manifestations except the retinal detachment were observed. A blood examination revealed that she was already infected with hiv-1, and she was categorized as an HIV carrier. OBSERVATIONS: aqueous humor and subretinal fluid samples were obtained at the time of surgery for rhegmatogenous retinal detachment. Reverse-transcription polymerase chain reaction and Southern blotting at three regions of the HIV, LTR, gag, and env, confirmed the HIV infection in both aqueous humor and subretinal fluid. During the approximately 2-year follow-up after surgery, the patient did not show any signs of retinitis, uveitis, or other ocular manifestations. CONCLUSIONS: This is the first report to reveal that HIV can invade the eye in the early stage of HIV infection. This infection may be related to HIV-related ocular complexes, which suppress the local immunological response.- - - - - - - - - - ranking = 0.55139970361682keywords = sample (Clic here for more details about this article) |
5/65. Erosion and intrusion of silicone rubber scleral buckle. Presentation and management.OBJECTIVE: To describe the clinical presentation and management of erosion and intrusion of silicone rubber implants that are used in scleral buckling procedures for the treatment of retinal detachment. methods: The authors identified four patients from their practices during the last 20 years (1978-1998) who had erosion or intrusion of silicone rubber scleral buckles that were used to manage retinal detachment. Approximately 4400 scleral buckling procedures were performed during this period. A retrospective review of the medical records of all patients was performed. Factors that influenced management decisions concerning the intruding buckle are emphasized. RESULTS: All four patients had myopia. The interval between placement of the scleral buckle and development of intrusion ranged from 1 to 20 years. The buckles were intrascleral in three cases and episcleral in one. Recurrent detachment and vitreous hemorrhage were indications for surgical intervention in three cases. After the surgical removal of buckling elements, visual acuity stabilized in all patients and the retina remained attached in all cases. CONCLUSIONS: Erosion and intrusion of scleral buckle are rare complications of scleral buckling procedures. The intruding buckle may be left intact unless there is significant threat to the integrity of ocular structures, recurrent detachment, or hemorrhage. Manipulation of the encircling band or buckle does not necessarily alter the visual acuity or the status of the retina.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
6/65. herpes simplex virus type 2: a cause of acute retinal necrosis syndrome.PURPOSE: To describe a case of herpes simplex virus type 2 (HSV-2) acute retinal necrosis syndrome (ARN) in a 13-year-old immunocompetent girl. methods: polymerase chain reaction (PCR), cultures, flow cytometry, and cytology were performed on the vitreous sample. RESULTS: Both PCR studies and vitreous cultures revealed HSV-2 as the cause of ARN. flow cytometry showed CD4 , CD8 , and natural killer cells. The visual outcome of the patient was 20/200. CONCLUSION: Successful culture of HSV-2 from the vitreous specimen in a patient with ARN proved HSV-2 to be one of the causes of ARN. The successful culture of HSV-2 has not been previously reported.- - - - - - - - - - ranking = 0.55139970361682keywords = sample (Clic here for more details about this article) |
7/65. Elevated intraocular levels of insulin-like growth factor i in a diabetic patient with acromegaly.Growth factors have become increasingly associated with various events of vitreoretinal disease. In the presence of proliferative retinopathy, elevated levels of insulin growth factor I (IGF-I) have been demonstrated in the vitreous. IGF-I expression itself is regulated by growth hormone, a hormone that is involved in the pathogenesis of acromegaly. In the present paper we report on the detection of very high IGF-levels in the subretinal fluid of a patient with acromegaly who was operated for retinal detachment. With a very sensitive RIA assay we found a four-fold elevation of the serum levels of IGF-I (604 ng/ml) and a high level of IGF-1 in the subretinal fluid (13 ng/ml). It is concluded that acromegaly may lead to an overexpression of IGF-I not only seen as increased concentrations in serum and vitreous, but in the subretinal space as well. This study emphasizes the need for further investigation of growth factor presence in pathological cavities, such as the subretinal space during retinal detachments.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
8/65. Persistent intraschisis hemorrhage simulating choroidal melanoma.BACKGROUND: Intraschisis hemorrhage of dark green color without accompanying vitreous hemorrhage is a rare complication of degenerative retinoschisis-detachment. CASE: A 37-year-old male patient with unilateral intraschisis hemorrhage closely mimicking a choroidal melanoma is described. OBSERVATIONS: ultrasonography and intravenous fluorescein angiography suggested intraschisis hemorrhage. T(1)-weighted magnetic resonance imaging demonstrated a hyperintense lesion compared to the vitreous that did not enhance with contrast agent. Managed by observation, the color of the lesion started to change at the 6th month of follow-up. The hemorrhagic lesion regressed to half size in 40 months following the diagnosis, and disappeared in 62 months. CONCLUSION: Very rarely may an intraschisis hemorrhage secondary to degenerative retinoschisis-detachment simulate a choroidal melanoma. In our patient, careful interpretation of the conventional methods was adequate for the differential diagnosis. The unusual feature of this patient was that the hemorrhage resolved in 5 years, much slower than expected.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
9/65. The management of glaucoma in nanophthalmos.patients with nanophthalmos are prone to develop a chronic painless type of glaucoma in middle age, probably due to the natural increase in the size of the lens which is already relatively too large for the small eye. Although the underlying mechanism is obscure, a slowly progressive "creeping" chronic angle-closure is postulated, but gonioscopic evaluation is difficult due to the shallow anterior chamber, with grade I and slit angles. Response to medical treatment is poor and miotics may even make the condition worse by producing relative pupillary block and by relaxing the lens zonule. Ordinary glaucoma surgery is to be avoided in nanophthalmos because of the fear of postoperative ciliary-block malignant glaucoma. Periopheral iridectomy performed in five eyes at an advanced stage of the chronic angle-closure did not facilitate glaucoma control in three eyes, and in two eyes in which the operation was combined with posterior sclerotomy, the eyes became blind from vitreous hemorrhage. Lenx extraction in five eyes controlled the glaucoma but was followed by choroidal effusion and nonrhegmatogenous retinal detachements in two eyes and blindness in another eye when combined with a posterior sclerotomy. No firm therapeutic recommendations can be made on the basis of the author's experience in the six reported cases. Conventional medical therapy seems ineffectual even when begun early in the glaucoma. Conventional glaucoma surgery must be performed early, before permanent damage to the outflow mechanism occurs but removal of the lens must be anticipated. The surgeon must also remain aware of the high incidence of serious posterior-segment complications which inexplicably follow glaucoma or lens surgery in nanophthalmos, as described by Brockhurst.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
10/65. Prophylactic 360 degrees cryotherapy in fellow eyes of patients with spontaneous giant retinal tears.PURPOSE: To assess the effect of prophylactic 360 degrees peripheral retinal cryotherapy in fellow eyes of patients with spontaneous giant retinal tears (GRTs) on the incidence of retinal detachment. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Forty-eight consecutive patients (31 male, 17 female) with spontaneous GRTs were included. The average age was 41 /- 2 years. The average refraction of the fellow eye was -4.0 /- 0.8 diopters (D). INTERVENTION: patients underwent vitrectomy and silicone oil tamponade in the affected eye and 360 degrees peripheral cryotherapy in the unaffected fellow eye during the same anesthetic. MAIN OUTCOME MEASURE: Attachment of the retina in the fellow eye was determined clinically by indirect ophthalmoscopy. RESULTS: During a mean follow-up of 84 /- 10 months after cryotherapy, one patient (2%) experienced a retinal tear without retinal detachment, and three patients (6%) experienced a retinal detachment in the fellow eye. These occurred 18 /- 9 months after prophylactic treatment and were the result of a small retinal break in two cases and a GRT posterior to the treated area in one case. CONCLUSIONS: Prophylaxis of fellow eyes with 360 degrees cryotherapy appears to be associated with a lower incidence of retinal detachment than that reported in natural history studies. A prospective, randomized clinical trial of such prophylaxis is desirable but would require a sample size of at least 645 patients in each arm of the study, as well as long-term follow-up of at least 5 years to show an unequivocal difference in outcome.- - - - - - - - - - ranking = 1.5513997036168keywords = size, sample (Clic here for more details about this article) |
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