Transactions. Section on Ophthalmology. American Academy of Ophthalmology and Otolaryngology最新文献

The incidence, pathogenesis, and treatment of diabetic maculopathy are discussed. A plea is made for earlier, more discrete treatment that may improve the chances of prolonging sharp central vision.

The percentages of retinal detachment surgical cure rates determined in this study should not be regarded too literally. At least ten preoperative factors have been described which, acting in isolated fashion, are associated with decreased rates of retinal reattachment. Among these factors are visual acuity of 20/60 or less, myopia, preretinal membrane formation, alphakia, pars plana detachment, reoperation, age over 80 years, vitreous membranes, giant tear, and choroidal detachment. Usually there are several influential factors acting simultaneously. The behavior patterns of combinations of predictive factors have not been determined. In addition, there are undoubtedly some factors which are insignificant when acting alone but which have an adverse influence when arranged in certain combinations. More sophisticated analysis would be required to confirm this hypothesis.

Four cases of exudative retinal detachment associated with retrolental fibroplasia are presented. The exudation appears to be secondary to leakage from neovascularization as well as vitreous traction on normal retinal vessels. The range in age of onset was between 13 and 17 years, with three of the four cases occurring in patients 23 years of age or younger. Treatment is directed at eliminating the abnormal vasculature which, in our experience, has been accomplished best by an encircling scleral-buckling procedure. One patient, however, required vitrectomy because of the severe vitreous membranes and traction which were present.

Choroidal neovascularization is the major complication of several macular diseases. Criteria for the selection of patients for consideration of photocoagulation treatment are presented. The distance of the foveal edge of the choroidal new vessel membrane to the center of the fovea is the most important criterion in considering the patient for photocoagulation. Photocoagulation is not considered unless the edge of the new vessel membrane is at least one fourth disc diameter (375micron) from the center of the fovea. Randomized controlled studies are required to document the role of photocoagulation therapy for choroidal neovascularization.

Cystoid macular edema was commonly observed in retinitis pigmentosa and documented, fluorangiographically, in 70% (41) of 58 consecutive patients. Macular fluorescence representing the intraretinal accumulation of dye from leaking perifoveal capillaries was best seen by simultaneous projection of early- and late-phase angiograms. This facilitated visualization of dim cystoid staining amid mottled and sometimes confusing hyperfluorescence in the posterior pole. Patients of many different ages demonstrated cystoid macular edema and there was no predominant involvement of any particular age group. Although visual acuity was affected in the majority of patients with cystoid macular edema, 25% had 20/25 or better due, perhaps, to sparing of the fovea. Bone corpuscular pigmentation appeared frequently with cystoid macular edema and we were, therefore, unable to corroborate previous opinions that depicted cystoid macular edema as part of a presumed atypical nonpigmented form of retinitis pigmentosa.