Perifoveal vascular leakage and macular oedema after intracapsular cataract extraction.
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Perifoveal capillary leakage of fluorescein was demonstrated in 60 per cent of 50 eyes when angiography was performed two weeks after cataract extraction. Repeat angiography six weeks postoperatively in 17 eyes demonstrated persistence of already established leakage in 11 of 12 eyes and no new leakage in five eyes previously negative. Cystoid macular oedema with visual acuity of less than 20/40 six weeks postoperatively occurred in five eyes (10 per cent). Eyes of patients with vascular disease and those patients of 60 years or older were found to have altered vascular permeability significantly more frequently. Inflammation was no more severe or prevalent in those patients who demonstrated leakage and no inflammation was clinically apparent in 10 of 11 eyes demonstrating dye leakage six weeks postoperatively. We conclude that the constitutional factors of age and vascular disease are of prime importance in causing altered vascular permeability in the early postoperative period after cataract extraction; factors causing sustained leakage with reduction of visual acuity were not demonstrated. (+info)
The use of internal limiting membrane maculorrhexis in treatment of idiopathic macular holes.
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The purpose of this study was to assess surgical results of internal limiting membrane (ILM) maculorrhexis in macular hole surgery. This study is a part of continuing prospective clinical trial of our team of researchers. Thirteen eyes of 13 patients with idiopathic macular hole underwent vitrectomy with the removal of posterior cortical vitreous, peeling of the macular ILM, and intraocular gas tamponade, followed by postoperative face-down positioning. The excised specimens were evaluated with transmission electron microscopy. Complete closure of the hole was observed in all 13 eyes (100% anatomic success rate). Visual improvement of 2 or more lines on ETDRS visual acuity chart was achieved in 11 (85%) of the 13 eyes. Six (54.5%) eyes attained visual acuity of 20/50 or better. Electron microscopy showed ILM in the removed specimens. ILM maculorrhexis is a promising new surgical approach to close idiopathic macular holes but requires further investigation and long-term evaluation. (+info)
Quantitative assessment of macular thickness in normal subjects and patients with diabetic retinopathy by scanning retinal thickness analyser.
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AIMS: To evaluate the scanning retinal thickness analyser (RTA), a novel non-invasive imaging instrument, in diagnosing and quantitatively characterising diabetic macular oedema, and to investigate the relation between central macula thickness measured by RTA and other clinical examinations. METHODS: Central macular thickness was measured using the RTA in 40 normal subjects and 60 patients with diabetic retinopathy. The reproducibility of the retinal thickness measurements was evaluated by calculating the mean of the inter- and intrasession variations. Central macular thickness was correlated with the results of visual acuity measurements, biomicroscopy, and fluorescein angiography. RESULTS: Intra- and intersession reproducibility of the RTA in normal subjects was plus or minus 5.2% (16 microns) and plus or minus 6.1% (19 microns), respectively. The mean central macular thickness was 182 (SD 16) microns in normal subjects, 283 (116) microns in diabetic eyes without clinically significant macular oedema (CSMO), and 564 (168) microns in diabetic eyes with CSMO. Central macular thickness was significantly greater (p < 0.001) in eyes with diabetic retinopathy than in normal subjects, even when macular thickening did not meet the standard for CSMO (p = 0.019) measured by biomicroscopy. Although greater fluorescein leakage at the macula results in greater central macular thickness, only eyes with diffuse leakage had statistically significant macular thickening compared with normal subjects (p = 0.022). Central macular thickness measured with the RTA was significantly correlated with the logarithmic converted visual acuity (r2 = 0.76) in diabetic eyes. CONCLUSION: Scanning RTA, which has good reproducibility, might be useful to quantitatively detect and monitor macular thickening in diabetic retinopathy. Central macular thickness was highly correlated with logarithmic converted visual acuity in diabetic macular oedema. (+info)
Natural history of diabetic macular streak exudates: evidence from a screening programme.
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BACKGROUND/AIMS: Diabetic retinopathy screening guidelines recommend referral to an ophthalmologist if there is exudate within one disc diameter of the fovea. Many of these patients, however, have resolution of small amounts of exudate without treatment. This study aimed to assess whether patients with minimal streak or dot exudates within one disc diameter of the fovea can be monitored in a screening programme without compromising visual acuity. METHODS: A retrospective review of records and Polaroid photographs obtained by one screening centre over a 10 year period was performed. Outcomes measured were referral rates, alteration of Snellen visual acuity, and the need for macular photocoagulation treatment. RESULTS: 55 patients (74 eyes) fulfilled entry criteria (37 streak and 37 dot exudates). Mean follow up was 56.1 months (range 12-127 months). Twenty five patients (30 eyes) were referred to an ophthalmologist. 13 eyes (17.6%) required macular photocoagulation treatment. Four eyes (5.4%) lost two or more lines of Snellen acuity over the follow up period (three from macular oedema and one from macular ischaemia). There was no relation between the presence or resolution of minimal exudate and visual loss (p>0.2). CONCLUSION: It is appropriate to monitor eyes with streak or dot macular exudates at 6-9 monthly intervals in a screening programme. (+info)
Macular vasculopathy and its evolution in incontinentia pigmenti.
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PURPOSE: To describe macular vasculopathy in incontinentia pigmenti. METHODS: Twelve baby girls with incontinentia pigmenti were examined under general anesthesia by fluorescein angiography of the macula. Nine eyes of 9 patients had sufficient detail to allow evaluation of capillary changes. Angiography was initiated as early as 3 months of age and was repeated in 7 eyes at 3- to 12-month intervals. Changes in capillary patterns were identified. RESULTS: Irregularly enlarged or distorted foveal avascular zones were noted in all 9 maculas. Sparseness of the perifoveolar capillary bed was a characteristic finding. Sequential macular angiography demonstrated non-progressive (stable) capillary closure in 2 eyes; progressive closure in another macula; progressive closure plus addition or reopening of macular capillaries in 3 eyes; and central retinal artery occlusion, with cherry-red spot formation, in 1 eye at 12 days of age. In addition, progressive tractional detachment of the macula occurred in 2 of these eyes, and progressive macular neovascularization occurred in 1 eye. CONCLUSIONS: Macular ischemia is characteristic of incontinentia pigmenti and is often progressive. It is the initiating event of a typical vasculopathy, characterized by capillary remodelling and, occasionally, by neovascularization and tractional detachment of the retina. (+info)
The etiology and treatment of macular detachment associated with optic nerve pits and related anomalies.
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PURPOSE: Up to two thirds of patients with optic disc pits develop a sight-limiting maculopathy. There is confusion regarding the etiology and nature of the maculopathy in these cases. We present 7 cases of serous macular detachment occurring in association with optic pits or related cavitary anomalies and identify a rhegmatogenous etiology. METHODS: We reviewed the records of 7 patients with optic nerve anomalies and macular detachment. Patients were treated with observation, barricade laser, vitrectomy, and/or gas tamponade. RESULTS: Seven patients were noted to have serous macular detachment associated with an optic nerve pit or other cavitary anomaly. A hole or tear in the diaphanous tissue overlying the optic pit was identified in all cases. None of the patients had a posterior vitreous detachment. Two were treated with photocoagulation only, and 5 underwent pars plana vitrectomy with fluid-gas exchange with or without photocoagulation. Pretreatment visual acuity ranged from 20/30 to 6/200. Posttreatment acuity ranged from 20/25 to 20/100. Five of 7 eyes had final acuities of 20/30 or better, and all treated eyes improved. CONCLUSIONS: A tear in the diaphanous tissue overlying the optic nerve pit is responsible for the development of serous macular detachment and is consistent with findings in similar conditions, such as retinal detachment in association with chorioretinal coloboma. These tears may be quite subtle, and careful biomicroscopic examination is required to appreciate them. The treatment of this condition remains controversial. However, because of the relatively poor prognosis, we believe treatment should include the formation of a barricade to fluid movement as well as sealing and relief of traction from the hole. The value of laser treatment may be increased by the early identification of a defect in the diaphanous membrane prior to the development of macular detachment. Consideration of prophylactic laser might then reduce the need for later, more invasive measures, and improve the prognosis. (+info)
The spectral sensitivity of the human short-wavelength sensitive cones derived from thresholds and color matches.
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We used two methods to estimate short-wave (S) cone spectral sensitivity. Firstly, we measured S-cone thresholds centrally and peripherally in five trichromats, and in three blue-cone monochromats, who lack functioning middle-wave (M) and long-wave (L) cones. Secondly, we analyzed standard color-matching data. Both methods yielded equivalent results, on the basis of which we propose new S-cone spectral sensitivity functions. At short and middle-wavelengths, our measurements are consistent with the color matching data of Stiles and Burch (1955, Optica Acta, 2, 168-181; 1959, Optica Acta, 6, 1-26), and other psychophysically measured functions, such as pi 3 (Stiles, 1953, Coloquio sobre problemas opticos de la vision, 1, 65-103). At longer wavelengths, S-cone sensitivity has previously been over-estimated. (+info)
A practical method for measuring macular pigment optical density.
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PURPOSE: Increasing evidence indicates that the macular pigments (MP) protect the central retina and may retard macular disease. For that reason, a practical method for measuring MP that does not require elaborate optics and can be applied to diverse populations by operators with a modest amount of experience was developed and validated. METHODS: A small tabletop device based on light-emitting diodes (LEDs) as the light source with electronic controls was constructed. Macular pigment was measured with the tabletop device with a 1 degrees test stimulus at 460 nm using heterochromatic flicker photometry, and the results were compared with measurements using a traditional three-channel Maxwellian view system with a xenon-arc source. RESULTS: Macular pigment density of 30 subjects (age range, 16-60 years) was measured with both stimulus systems. Macular pigment measured with the LED tabletop device in free view was highly correlated with MP measured in Maxwellian view (y = -0.03 + 1.06x, r = +0.95). The average absolute difference between the two techniques was 0.04 (SD, 0.03). The new technique was not significantly affected by variations in lens optical density, pupil size, or small head movements. CONCLUSIONS: Psychophysical measurement of MP provides a unique opportunity to make repeated noninvasive assessment of the concentration of a protective nutrient in the retina. The availability of this new device should make this measurement technology accessible to a wide variety of investigators for application to diverse populations. (+info)