Exudative age-related macular degeneration or Best vitelliform macular dystrophy?--A case report

PURPOSE: To report a case of Best vitelliform macular dystrophy referred to the Department Ophthalmology in Krakow with a diagnosis of exudative age-related macular degeneration (AMD). MATERIALS AND METHODS: 70-years old man was diagnosed in our clinic because of a two years history of slow, progressive visual acuity worsening in both eyes with the presence of metamorphopsia. The basic ophthalmic examination was performed with additional diagnostic methods including: colour vision test (Panel D-15), Amsler grid test, contrast sensitivity test (Pelli-Robson chart), fluorescein angiography (FA), indocyanine green angiography (ICGA), electroretinogram (ERG), electrooculogram (EOG) and optical coherence tomography (OCT). RESULTS: Visual acuity in the right eye was: 0.16 and in the left: 0.25. Amsler grid test revealed the presence of bilateral mild etamorphopsia with the relative central scotoma. Pelli-Robson test showed decreased contrast sensitivity perception in both eyes; PO > LO. On fundoscopy in macula of both eyes the symmetrical round, elevated lesions of 1.5 dd with the meniscus of subretinal creamy-yellow masses were present. The early frames of FA showed the presence of round lesions with distinct borders, unchanged in size and shape throught the examination, hypofluorescent in the lower and hyperfluorescent in the upper half of the lesions. Late frames of FA revealed the irregular hyperfluorescence also in lower aspects of the lesions. ICGA showed: round hypofluorescent lesions with isofluorescence in the upper part of the lesions. ERG--revealed no pathology, EOG--showed decreased light response and depressed Arden ratio in both eyes. OCT demonstrated hiperreflectivity of the retinal pigment epithelium with elevation of retina and deletion of the foveolar depression in both eyes. CONCLUSIONS: Based on the results of performed tests the diagnosis of the Best vitelliform macular dystrophy was established. In some cases various pathologies involving the macula may mimic the exudative AMD. The basic ophthalmic examination supported by additional diagnostic methods allow to establish the definitive diagnosis in most cases of macular disorders.     

Electro-oculographic findings after 360° retinotomy and macular translocation for subfoveal choroidal neovascularisation in age-related macular degeneration

Purpose To evaluate potential electro-oculographic changes after 360° retinotomy and macular translocation for subfoveal choroidal neovascularisation in patients with age-related macular degeneration (AMD) in a randomised comparative (self-controlled) trial.Methods A consecutive series of 30 patients suffering from subfoveal choroidal neovascularisation secondary to age-related macular degeneration underwent 360° retinotomy and macular translocation. The EOG served as the main parameter of the study and was recorded 1 day prior to the translocation surgery and no earlier than 21 days after the silicone oil removal.Results Postoperatively, a statistically significant decrease in mean dark trough by 64% was found for treated eyes (P<0.001). The mean dark trough of the fellow eye remained stable after surgery (P=0.33). The postoperative difference between the treated und untreated eyes proved to be statistically significant (P<0.001). The Arden ratio remained stable in the treated and untreated eyes with mean values of 204% (P=0.81) and 213% (P=0.18), respectively. A significant correlation between the reduction of the dark trough and the visual acuity at the 1-year follow-up was found.Conclusions A persistent decrease in the corneofundal potential is associated with 360° retinotomy and macular translocation for exudative AMD. This indicates a substantial postoperative malfunction of retinal pigment epithelial cells and an impaired photoreceptor regeneration. The impeded recovery of the RPE-photoreceptor complex can be interpreted as the result of the surgical trauma on the basis of prediseased RPE. A severe postoperative decrease in dark trough forecasts an incomplete recovery of visual acuity.     

‘Toy' laser macular burns in children

Purpose

Laser ‘toys'' can be purchased online and imported with relative ease; the variety of such devices is a potential public safety concern. We describe five children with maculopathy following exposure to laser ‘toys''.

Methods

Case series of maculopathy following exposure to laser ‘toys''.

Results

Five children were seen in our Ophthalmic Unit with macular injuries following exposure to laser ‘toys''. Clinically, three children had an acute vitelliform-like maculopathy which resolved to leave sub-foveal retinal pigment epithelium changes with reduced vision. One case was complicated by a choroidal neovascular membrane.

Conclusion

Laser ‘toys'', which resemble laser pointers, are increasingly available over the internet. Such ‘toys'' may not meet safety standards. Retinal injury in childhood following exposure to laser ‘toys'' is a public safety concern.     

Formation of idiopathic macular hole—reappraisal

Purpose  

The study is intended to examine the development of macular hole in idiopathic conditions.     

Assessment of reading behavior with an infrared eye tracker after 360° macular translocation for age-related macular degeneration

PURPOSE. Macular translocation (MT360) is complex surgery used to restore reading in exudative age-related macular degeneration (AMD). MT360 involves retinal rotation and subsequent oculomotor globe counterrotation and is not without significant surgical risk. This study attempts to gauge the optimal potential of MT360 in restoring reading ability and describe the quality and extent of recovery. METHODS. The six best outcomes were examined from a consecutive series of 23 MT360 cases. Reading behavior and fixation characteristics were examined with an infrared eye tracker. Results were compared to age-matched normal subjects and patients with untreated exudative and nonexudative AMD. Retinal sensitivity was examined with microperimetry to establish threshold visual function. RESULTS. MT360 produced significant improvements in visual function over untreated disease and approximated normal function for reading speed and fixation quality. Relative to the comparative groups, eye tracking revealed the MT360 cohort generated a greater number of horizontal and vertical saccades, of longer latency and reduced velocity. In contrast, saccadic behavior when reading (forward and regressive saccades) closely matched normal function. Microperimetry revealed a reduction in the central scotoma with three patients recovering normal foveal sensitivity. CONCLUSIONS. Near normal reading function is recovered despite profound surgical disruption to the anatomy (retinal/oculomotor). MT360 restores foveal function sufficient to produce a single stable locus of fixation, with marked reduction of the central scotoma. Despite the limitations on saccadic function, the quality of reading saccadic behavior is maintained with good reading ability. Oculomotor surgery appears not to limit reading ability, and the results of retinal surgery approximate normal macular function.     

Timothy Olsen:epidemiology of age-related macular degeneration

Introduction Timothy Olsen (Figure 1),MD,is former chair and director of Emory Eye Center.He is a member of the Vitreoretinal Surgery & Disease service where his clinical expertise focuses on macular diseases,age-related macular degeneration (AMD) and macular surgery.     

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.     

‘Idiopathic’ preretinal macular fibrosis in young individuals

In order to evaluate possible etiological factors and the natural course of diopathic preretinal fibrosis in young persons, nine consecutive patients with macular pucker diagnosed under the age of 50 years were examined. There were six women and three men with the mean age of 27.2 years (range 15–50) and the mean follow-up of 4.5 years (range 1.5–10). The initial visual acuity varied from 0.25 to 1.0. The preretinal membrane was either central or paramacular. In two eyes the process was probably congenital (retinal hamartoma), one was postinflammatory (retinal vasculitis), and one was associated with sclerosis of the anomalous macular arterioles. In the others no causative factors were discovered. In seven of the nine eyes both the visual acuity and the fibrotic process remained stable, in one eye the vision improved, and in one eye deteriorated. It seems that most young persons with idiopathic preretinal fibrosis of the macula can be followed up without surgical removal of the membrane.     

Does the cilioretinal artery affect age-related macular degeneration?

PURPOSE: The aim of this study was to investigate the influence of the cilioretinal artery (CRA) on eyes with age-related macular degeneration (AMD). METHODS: One hundred and seventy-five eyes with AMD and 170 eyes without AMD as a control were included in the study. The prevalence of a CRA was compared between the control subjects and the patients with AMD. RESULTS: A CRA was established in 20.6 % of eyes that did not have AMD. 12.5 % of eyes with AMD had a CRA (p = 0.045). A CRA was observed in 13.6 % of eyes with wet AMD, in 10.5 % of eyes with dry AMD and in 19.2 % of eyes with drusen. CONCLUSION: The presence of CRA may have protective effects against the development of AMD.