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Two men with recent history of lightining strike were referred to our hospital. Both patients complained of metamorphosia in one eye and reduced visual acuity. Funduscopy revealed target-like alterations at the fovea. Fluorescein angiography showed window defects of the central retinal pigment epithelium in both patients. One patient developed an anterior subcapsular cataract. If the eye is part of the current-circuit, the melanin granules of the iris, pigment epithelium, and choroid might act as a resistor. The resulting accumulation of heat may lead to damage of the surrounding tissues.

Purpose: To evaluate whether oxidative tissue damage and inflammatory reactions occur in epiretinal membranes of eyes suffering from proliferative diabetic retinopathy (PDR), proliferative vitreoretinopathy (PVR), and macular pucker (MP)., Methods: Epiretinal membranes were removed during surgery and frozen at -80 degrees C (PDR, n = 26; PVR, n = 24; MP, n = 15), and oxidative tissue damage and inflammatory activity (MPO) of the membrane tissue were determined. The values are expressed as means of thiobarbituric acid-reactive substances (TBARS, nmol/mg) and MPO (units/mg)., Results: Both TBARS and MPO activity were significantly elevated (P < 0.05) in membranes of eyes suffering from PVR and PDR compared to MP. The myeloperoxidase activity in PDR membranes was significantly increased (P < 0.05) compared to PVR., Conclusions: Inflammatory cells and oxidative metabolites lead to oxidative reactions in PDR and PVR. The proliferation of membrane tissue may be enhanced through products of the lipoxygenase pathway, which is active in inflammatory cells and leads to oxidative tissue damage. Chemoattraction of leukocytes by oxidative metabolites renders the process self-progagating. Since patients suffering from MP have an intact vitreous body with an intact antioxidative system, this reaction occurs to a lesser degree, resulting in less membrane-growth activity. The cell-growth-enhancing properties of inflammatory cells should be further investigated in PDR and PVR with regard to new therapeutic interventions.

We analyzed 133 consecutive cases of primary retinal detachment treated by pneumatic retinopexy (PR). The postoperative follow-up period was at least 6 months (mean, 16.7 months; maximum, 36 months). In all, 97 cases (72.9%) were successfully treated by a single PR. In 19 cases (14.3%) primary reattachment was not achieved. In another 17 cases (12.8%) redetachment occurred. Redetachment was never observed later than 6 months following PR. It was caused by missed or new retinal tears in 8 eyes (6.0%) and by proliferative vitreoretinopathy in 7 eyes (5.3%). A final reattachment rate of 98.5% was achieved. Preoperative factors suggesting primary failure or redetachment were (1) extensive retinal detachment (P < 0.01), (2) pseudo- or aphakia (P = 0.01), (3) the retinal status of the fellow eye (P < 0.05), and (4) poor visual acuity in cases of attached macula (P < 0.01). In cases with preoperatively detached macula, visual acuity (VA) recovered considerably better following PR than following conventional buckling procedures. As compared with cases of successful PR, recovery of VA in all eyes requiring reoperation was significantly reduced. It was, however, still equivalent to the VA of eyes treated by scleral buckling. Surgical success is influenced by preoperative factors such as pseudo- or aphakia, extensive retinal detachment, poor initial VA in cases of attached macula, or the state of the fellow eye. These factors have to be taken into consideration in decisions for or against PR. The anatomical and functional outcome proves the value of this technique in the treatment of primary rhegmatogenous retinal detachment.

A 31-year-old white patient was referred with a recent history of decreased visual acuity in his left eye. A raised, greyish-white lesion close to the optic nerve was the only ophthalmological finding. Upon systemic work-up a chest X-ray revealed enlarged pulmonary lymph nodes. A biopsy obtained during bronchoscopy led to the diagnosis of sarcoidosis. No other manifestation was noted. Following systemic steroid treatment the lesion regressed and visual acuity improved. Granulomatous inflammatory diseases have to be ruled out in cases of prominent greyish-white fundus lesions.

The refractive error of 186 eyes with choroidal neovascularization (CNV) secondary to age-related macular degeneration (ARMD) was determined. It was found that the risk for the development of this form of ARMD increased with increasing degrees of hyperopia. The 96 patients afflicted with bilateral CNV were significantly older than the unilaterally affected patients (P = 0.027). Abnormal choroidal perfusion was identified in 66.4% of the fluorescein angiograms. These findings support the concept that hyperopic shortening in eyes afflicted with ARMD might cause secondary changes in the choroidal vasculature, predisposing them to choroidal neovascularization.

The injection of oxidative metabolites such as lipid peroxides (LPO) into the vitreous cavity led to tissue damage demonstrable by a dose-dependent increase in intravitreal and intralental LPO levels, which are expressed as thiobarbituric-acid-reactive substances (TBARS). This process was accompanied by an inflammatory response as indicated by the occurrence of leukocyte-derived myeloperoxidase (MPO) in the vitreous body. Intramuscular injections of vitamin E were very effective in reducing both TBARS and MPO activity, whereas vitamin C had a moderate effect on TBARS only. The injection of a combination of the two vitamins was no more effective than treatment with vitamin E alone.