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PURPOSE: We studied reversible loss of light perception after vitreoretinal surgery to show that functional vision can return in some patients. METHODS: We reviewed the medical records of seven patients who had postoperative reversible loss of light perception in the eye that underwent vitreoretinal surgery. Differences in the postoperative courses and interventions were studied. RESULTS: Five of the seven patients had diabetes mellitus but none had hypertension. The indications for vitreoretinal surgery were severe proliferative diabetic retinopathy in five patients and retinal detachment with advanced proliferative vitreoretinopathy in two patients. Seven patients had reversible loss of light perception within the first three postoperative days. Six of the seven patients had an intraocular pressure greater than 26 mm Hg at the time the eye had no light perception. Decreasing the intraocular pressure was associated with return of light perception in five of seven patients. Return of useful vision was gradual. Four of seven patients had a visual acuity of 20/400 or better one month after surgery, and all seven had a visual acuity of 20/400 or better three months after surgery. Visual acuity in four eyes improved further to 20/70 or better at six months or more after surgery. CONCLUSION: Reversible loss of light perception after vitreoretinal surgery does occur in some patients. Monitoring vision and intraocular pressure is important because prompt treatment may assist in the recovery of functional vision.

A complication of vitrectomy (removal of a portion of the vitreous, a jelly-like substance located behind the lens of the eye) may be the formation of intraocular fibrin (a stringy insoluble protein, and product of the clotting process). Formation of a fibrin membrane on the pupil may cause a form of glaucoma, and fibrin in the vitreous or on the retina can contract, causing retinal detachment. The incidence and risk factors for postvitrectomy intraocular fibrin formation have not been determined. To determine the incidence of this complication and identify patients at risk, 194 patients undergoing vitrectomy were studied. Indications for vitrectomy included retinal detachment, proliferative disease, vitreous hemorrhage, macular pucker, and trauma. Intraocular fibrin formation occurred in 62 patients (32 percent); of these, 24 patients developed severe fibrin formation. Preoperative factors found to be predictive of severe fibrin formation were: severe flare in the anterior chamber (in front of the iris), an indication of breakdown of the blood-aqueous barrier: a scleral buckle from previous retinal detachment surgery; and poor vision preoperatively. An anterior epiretinal membrane dissection during surgery was also associated with fibrin formation. These results may be helpful in determining methods of preventing postvitrectomy fibrin formation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objective: To characterize an unusual clinical entity resembling acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and serpiginous choroiditis but with an atypical clinical course. Patients: We describe 6 patients, aged 17 through, 51 years, exhibiting this unusual entity who were seen at 6 different centers from 1984 to 1997. Results: The acute retinal lesions in this series were similar to those of APMPPE or serpiginous choroiditis, both clinically and on fluorescein and indocyanine green angiography. However, the clinical course, number of lesions, and location of these lesions were atypical. These patients had evidence of numerous posterior and peripheral retinal lesions predating or occurring simultaneously with macular involvement. Older, healing pigmented lesions were often accompanied by the appearance of new active white placoid lesions. Additionally, these cases all demonstrated prolonged periods of activity resulting in the appearance of more than 50 and sometimes hundreds of lesions scattered throughout the fundus. Growth of subacute lesions and the appearance of new legions continued for 5 to 24 months after initial examination, and relapses were common. Conclusions: This entity has clinical features similar to APMPPE and Serpiginous choroiditis but has a prolonged progressive clinical course and widespread distribution of lesions. It may represent a variant of serpiginous choroiditis or may be a new entity. We call it relentless placoid chorioretinitis. Arch Ophthalmol, 2000;118:931-938