Is age-related macular degeneration associated with pinguecula or scleral plaque formation?

PURPOSE: To evaluate whether ocular changes indicating an increased exposure to UV irradiation are associated with the development of age-related macular degeneration (ARMD). METHODS: Using histology, we have investigated a possible association of ocular changes that might be attributed to actinic damage, namely pinguecula and scleral plaque, with findings of both atrophic and disciform ARMD. A total of 74 eyes, could be used for evaluation. RESULTS: Features of ARMD were present in 36 eyes (11 with disciform degeneration and 25 with an atrophic form). A pinguecula was identified in 36 eyes (small in 22 eyes, large in 14 eyes), and a scleral plaque was seen in 5 eyes. While scleral plaque showed an association with ARMD, there was no significant association between pinguecula and ARMD. CONCLUSIONS: Our results support the concept of solar radiation having an effect on the development of ARMD but also indicate that it is a multifactorial disease.     

Does macular hole formation have a hormonal cause?

PURPOSE: To establish the degree of supposed hormonal deficiency in estriadol (E2), gonadotrophins (LH, FSH), growth hormone (GH), insuline-like growth factor 1 (IGF-1) and to assess calcic-phosphatic metabolism in women with idiopathic macula holes as compared to (age-matched) controls. MATERIAL AND METHODS: In 16 female patients aged 65-72, blood E2, LH, FSH, IGF-1 were determined. Serum and 24 h urine excretion calcium and phosphates as well as serum alkaline phosphatase activity were taken as markers of Ca/P metabolism. Bone densitometry was performed in all. RESULTS: Mean actual serum hormone levels were: E2 < 15 pg/ml, LH--31 U/l, FSH--49 U/l, GH--0.1 ng/ml, IGF1--59 ng/ml. The markers of mineral metabolism did not show any abnormality: serum Ca--5.0 mEq/l, P--4.1 mg%, alkaline phosphatase 111 U/l, 24 h urine excretion Ca--121 mg/24 h, P--610 mg/24 h. Mean bone L2-L4 density fell within normal limits: 81% (z = -1.91). CONCLUSIONS: In postmenopausal women with idiopathic macular holes, serum E2, LH, FSH bone metabolic markers and bone density are comparable to those found in women (of the same age group) free of macular holes. Women with macular holes are characterized by lower GH and IGF-1, which prompts further study.     

Retinal pigment epithelium detachment associated with vitreomacular traction syndrome—case report

Purpose To report the unusual association of vitreomacular traction syndrome (VMT) with retinal pigment epithelium (RPE) detachment and describe the outcomes of successful surgery. Methods An 84-year-old man was referred with 6-month history of blurred vision in his RE. Best-corrected visual acuity (BCVA) was “counting fingers.” Slit-lamp examination revealed VMT overlying a RPE detachment. The above findings were confirmed by optical coherence tomography (OCT). Pars plana vitrectomy and internal limiting membrane (ILM) peeling were performed. OCT was carried out at 3, 6, 9, and 11 months postoperatively. Results Eight weeks postoperatively BCVA improved to 6/60. Slit-lamp examination and OCT showed relief of the vitreomacular traction, however the underlying RPE detachment remained unchanged and progressively regressed during the following 11 months. Visual acuity did not improve above 6/36 at the last follow-up visit. Conclusion Retinal pigment epithelium detachment could be associated with VMT. Although the incidence is rare, it may compromise the outcomes of successful surgery.     

Is axial length a risk factor for idiopathic macular hole formation?

Current theories for macular hole formation implicate antero-posterior and tractional forces at the vitreofoveal interface. It is thought that localized perifoveal defects enlarge from centrifugal forces acting about the axis of ocular rotation. If this is true, eyes with longer axial lengths should have an increased incidence of macular holes. The aim of this study was to determine if axial length is a risk factor for macular hole development. The study group comprised 40 patients with refractive errors from hyperopia to myopia with stage 3 and 4 idiopathic macular holes. Controls matched for age, gender and spherical equivalent (SE) were used for statistical comparison. Axial length (AL) was analyzed using SPSS 13.0 statistical software and compared using Student's t test. P < 0.05 was considered significant. SE ranged from -8.88 to +3.63 dioptres in the macular hole group and -8.50 to +3.63 in controls. In the macular hole group, mean AL ± standard deviation was 23.62 ± 1.20 mm (21.81-27.51); in controls, 23.09 ± 1.16 mm (21.31-26.58). Univariate analysis showed that higher AL is associated with macular hole formation. The mean difference in AL was 0.531 mm (95 % confidence interval -0.1596 to -0.9024). Two-tailed t test: P < 0.006. This study showed that increasing ocular AL is significantly associated with macular holes. Dynamic forces at the macula would be greater in these eyes suggesting this may play a causative role in macular hole formation.     

Earlier therapeutic effects associated with high dose (2.0?mg) Ranibizumab for treatment of vascularized pigment epithelial detachments in age-related macular degeneration

Summary statement

Intravitreal high dose (2 mg) ranibizumab may lead to quicker resolution of choroidal neovascularization (CNV) and associated retinal pigment epithelial detachment in eyes with exudative age-related macular degeneration, although it may possibly correlate with RPE tears in certain cases.

Purpose

This prospective study compared the outcomes of 0.5 vs 2.0 mg intravitreal ranibizumab injections (RI) for treating vascularized pigment epithelial detachment (vPED) due to age-related macular degeneration.

Methods

Patients with vPED were randomized to receive 2.0 vs 0.5 mg RI monthly for 12 months or for 4 months and then repeated on a pro-re nata basis. Optical coherence tomography, fundus photography, and fluorescein and indocyanine-green angiography were obtained at baseline and subsequent specific intervals. Outcome measures were best-corrected standardized visual acuities, central 1-mm thickness, surface area (SA), greatest linear diameter (GLD), heights (PED and CNV), and amount of subretinal fluid (SRF) and cystoid macular edema (CME).

Results

Both groups yielded reductions of the central 1-mm thickness, PED and CNV SA and PED height and GLD, SRF, and CME. Vision improvement and reduction in SRF and PED height occurred earlier for eyes receiving the 2.0 mg dose. Cataract progression was similar but RPE tears developed more often with the 2.0 mg dose.

Conclusions

There were similar visual and anatomical outcomes at the end of the study; however, the higher dose yielded more rapid reductions and more complete resolution of the PED, although there was possible increased tendency for an RPE tear with the higher dose.     

Rieger anomaly with bilateral choroidal osteoma: coincidence or association?

PURPOSE: To report a case of Rieger anomaly associated with bilateral choroidal osteoma. CASE: An 18-year-old woman presented with corectopia, iridocorneal adhesions, and stromal hypoplasia of the iris, and was diagnosed with Rieger anomaly. RESULTS: Fundus examination revealed bilateral yellowish-orange, placoid degenerative fundus lesions with pseudopod-like edges associated with the areas of retinal pigment epithelium atrophy, indicating choroidal osteoma. Fundus fluorescein angiography showed bilateral early patchy and late diffuse hyperfluorescence. B-scan echography revealed placoid lesion at the posterior ocular coats characterized by localized areas of high ultrasound reflectivity with a corresponding retrobulbar orbital shadowing. This indicated a dense calcium foreign body. In addition, computed tomography of the orbit demonstrated bilateral plate-like thickening with calcification of the choroid that was isodense with the normal skeletal bone. CONCLUSIONS: Although Rieger anomaly is classically known as a disease of the anterior segment of the eye, choroidal osteoma may be a posterior segment finding of the disease that has not previously been reported.     

Retinal pigment epithelial function: a role for CFTR?

In the vertebrate eye, the photoreceptor outer segments and the apical membrane of the retinal pigment epithelium (RPE) are separated by a small extracellular (subretinal) space whose volume and chemical composition varies in the light and dark. Light onset triggers relatively fast (ms) retinal responses and much slower voltage and resistance changes (s to min) at the apical and basolateral membranes of the RPE. Two of these slow RPE responses, the fast oscillation (FO) and the light peak, are measured clinically as part of the electrooculogram (EOG). Both EOG responses are mediated in part by apical and basolateral membranes proteins that form a pathway for the movement of salt and osmotically obliged fluid across the RPE, from retina to choroid. This transport pathway serves to control the volume and chemical composition of the subretinal and choroidal extracellular spaces. In human fetal RPE, we have identified one of these proteins, the cystic fibrosis transmembrane conductance regulator (CFTR) by RT-PCR, immunolocalization, and electrophysiological techniques. Evidence is presented to suggest that the FO component of the EOG is mediated directly or indirectly by CFTR.     

Bilateral rhegmatogenous retinal detachment after external-beam radiotherapy: just a coincidence?

Purpose To report an unusual case of almost simultaneous bilateral rhegmatogenous retinal detachment in the context of external-beam radiotherapy for a tumor at a non-ocular target site and in the absence of pre-existing ocular pathology.Methods Observational case report with review of corresponding literature.Results A 63-year-old man was referred for bilateral retinal detachment which was associated with many horseshoe tears and proliferative vitreoretinopathy. He had undergone surgery for a carcinoma of the left maxillary sinus 4 months prior to the presentation and had then received external-beam radiotherapy for 3 months. There was no familial history of retinal detachment and/or eye trauma in this hyperopic patient with clear native lenses. No chorioretinal pathology was apparent that could have predisposed the retinas to tearing.Conclusions Simultaneous bilateral retinal detachment is exceptional, especially in a patient with no risk factors. The effect of radiotherapy on the vitreoretinal interface is discussed in the light of existing data and may have been responsible for our patients retinal detachment.This study received no funding, and the authors had no financial or proprietary interest in itLaurent Kodjikian had full access to all available data and takes full responsibility for their integrity and for the accuracy of the analysisStudy previously presented at the meeting of the French Ophthalmologic Society on 10 May 2003 in Paris, France     

Cholesterol and age-related macular degeneration: is there a link?

PURPOSE: To examine the relation among serum cholesterol, apolipoprotein E genotype (APOE), and the risk of early and late age-related macular degeneration (AMD). DESIGN: The Rotterdam Study, a population based prospective cohort study. METHODS: Serum levels of total and high-density lipoprotein (HDL) cholesterol as well as APOE genotype were determined at baseline. Of 3,944 subjects, 400 were diagnosed with incident early and late AMD after a mean follow-up of 5.2 years. RESULTS: Serum HDL, but not total, cholesterol was associated with an increased risk of AMD (odds ratio/SD, 1.20; 95% confidence interval; 1.06-1.35). The association remained unchanged after adjustment for APOE genotype. When stratifying for APOE genotype, the association was strongest in persons with the e 4 allele; an inverse association seemed to be present for e 2 carriers. CONCLUSION: Elevated HDL but not total cholesterol is associated with an increased risk of AMD. Apolipoprotein E genotype does not explain this association but may be an effect modifier.     

Bilateral,symmetric and simultaneous rhegmatogenous retinal detachment. Predisposition or coincidence? A case report

The following is a case report of a 65-year-old patient who had previously been diagnosed with primary open-angle glaucoma and who was experiencing a sudden loss of both visual acuity and of superior visual field in both eyes. In the ophthalmological examination, a bilateral, symmetric rhegmatogenous retinal detachment that affected the inferior quadrants of both eyes was detected. The retinal detachment was caused by a retinal horseshoe break located at the equator of 6 h in each eye. The factors that could determine the predisposition for and/or the coincidence of bilateral and symmetric rhegmatogenous retinal detachment will be discussed.     

Prophylaxis for retinal detachment: evidence or eminence based?

PURPOSE: Prophylactic laser treatment of peripheral retinal lesions to prevent retinal detachment enjoys widespread use. However, clinical and scientific evidence for such treatment only exists for a few particular clinical situations. The aim of the present study was to delineate the current practice patterns for such prophylaxis among some European retinal specialists. METHODS: A postal survey was conducted among all members of BEAVRS (British and Eire Association of Vitreoretinal Surgeons; n = 236), all members of the German Retinological Society (n = 396), and Swiss retinal surgeons (n = 12) using a questionnaire with 6 case scenarios. The retinal specialists were asked to choose between three different options for each case: treat retinal lesion prophylactically, clinical follow-up, and other options. RESULTS: The return rates of the questionnaire were 36% in the United Kingdom, 42% in Germany, and 83% in Switzerland. There was a general tendency to apply laser prophylaxis to peripheral retinal lesions despite the absence of evidence in the medical literature. CONCLUSIONS: Nonevidence-based prophylactic laser treatment of peripheral retinal lesions remains a clinical and economic issue that must be addressed, and more evidence-based data are needed to establish clear clinical guidelines. Swiss retinal specialists are particularly conscientious in sending back a medical questionnaire.     

Is serum cholesterol associated with progression of diabetic retinopathy or macular edema in persons with younger-onset diabetes of long duration?

PURPOSE: To quantitate the relationships of total cholesterol and high-density lipoprotein cholesterol to the incidence and progression of diabetic retinopathy and macular edema 5 years later in those with younger-onset diabetes of long duration. METHODS: Casual serum specimens for lipid values and fundus photography at the time of the lipid determinations were evaluated with regard to retinal lesions in photographs taken 5 years later during the course of a population-based cohort study. RESULTS: Univariable associations were significant for associations of incident retinal lesions with total cholesterol/high-density lipoprotein cholesterol, but multivariable associations considering covariates were not significant. CONCLUSION: Our data suggest that lowering cholesterol by therapeutic means may not be indicated for the sole purpose of decreasing the incidence or progression of these retinal lesions.