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A case of retinal vasculitis is reported, unusual because of its occurrence in a young healthy man, and especially because of the presence of a turn-over of white spots in the mid-peripheral retina, which faded and turned into areas of pigment epithelium changes. The patient presented with anterior uveitis with raised intraocular pressure, and then with vitritis, retinitis in the peripapillary area with involvement of the optic disc, vasculitis with perivascular sheathing and vascular occlusion. Clinical and laboratory investigations remained negative. The lesions regressed with antiviral treatment (Ganciclovir) and steroids. Final visual acuity was 20/400 due to optic disc atrophy and the development of an epimacular membrane. The authors discuss the differential diagnosis of retinal vasculitis related to immunological diseases or viral infection. In conclusion, this case may constitute a mild type of acute retinal necrosis syndrome.

Nd:YAG capsulotomy is currently performed after extracapsular cataract surgery and seems to increase the risk of postoperative retinal detachment. In order to evaluate the incidence of this complication in our experience, we retrospectively studied 144 patients who underwent Nd:YAG laser posterior capsulotomy with at least a six-month follow-up. Six patients out of 144 (4.16%) subsequently developed rhegmatogenous retinal detachment. The average time from extracapsular cataract surgery to YAG capsulotomy was 21 months (11 to 26 months). The average time from capsulotomy to retinal detachment was 3.6 months (1 to 8 months). In 4 out of 6 eyes, at least one risk factor for retinal detachment was present (myopia, lattice degeneration, retinal detachment in the fellow eye). Vitreous cells were observed in 4 patients after capsulotomy. In 2 patients, a prophylactic laser photocoagulation had been previously performed. These retinal detachments were not different from aphakic or pseudophakic detachment, but the examination of retinal periphery was particularly difficult because of the peripheral capsular fibrosis, hiding retinal tears in 4 eyes. Two cases of moderate proliferative vitreoretinopathy were observed. Retinal reattachment surgery was successful in all cases with one procedure. The YAG laser energy required to create a capsulotomy was less than that reported in the literature, and no relationship could be established with the total energy applied. Nd:YAG capsulotomy seems to moderately increase the risk of retinal detachment, especially in myopic patients. The mechanisms of vitreous and retinal damage after Nd:YAG capsulotomy are discussed.

Since 1974 (Gass), many publications have referred to a macular abnormality that is similar to Best's vitelliform dystrophy, but occurs in adults and shows a normal or subnormal electro-oculogram. In our retrospective study, 85 patients with adult macular vitelliform degeneration were included; 31 patients out of 85 have been followed-up for periods ranging from one to ten years. Women (62,3%) were predominantly affected; the median age was 61 years (ranging from 37 to 81 years); family history did not reveal others affected members except in one case (mother and her son affected); electro-oculogram was recorded in 12 patients and was normal (8 patients) or slightly subnormal (4 patients). During follow-up, vitelliform lesions have shown progressive changes over many years, resulting in a round or oval atrophic area in the central retinal pigment epithelium. Visual acuity was fair at presentation but decreased progressively: at presentation, 43% of the eyes had visual acuity better or equal to 0.6; after 1 year, 59%; after 2 years, 28.5%; after 4 years, 20%, and only 8% of those followed-up for 10 years. Impairment of vision was usually related to alteration of the retinal pigment epithelium and macular atrophy, sometimes to subretinal neovascularization (14 eyes of 12 patients out of 157, or 15% of patients), or rarely to macular edema (2 cases). Several aspects of this disease are still controversial: firstly, the problem whether or not the disease represents a single nosological entity; secondarily its dominant inheritance. The analysis of our cases and of those already published seems to show that the macular changes observed are related to a single disease, well-defined by the epidemiology, the clinical aspects, the natural course. The late onset of the disease, the lack of constant familial involvement and the similarity with other retinal degenerative disorders seem to suggest that vitelliform macular lesions may represent a distinct subgroup of age-related macular degeneration, with a possible genetic predisposition.

Erythrocyte aggregation is one of the principal determinants of blood viscosity at low shear rates (low flow). Anatomical and hemodynamical characteristics make retinal venous circulation particularly dependent on hemorheological factors. Erythrocyte aggregation and other laboratory parameters (haematocrit, fibrinogen, plasma proteins, clotting) were measured in 85 patients presenting with retinal vein occlusion and 64 controls matched for age, sex and vascular risk factors (hypertension, diabetes, smoking). Statistical analysis of the results demonstrated a significant difference between the retinal vein occlusion group an the control group for erythrocyte aggregation (p less than 0.001 for the aggregation index at 10 sec and for the threshold of dissociation). The fibrinogen level, haematocrit and plasma proteins (albumin, IgA, IgG, IgM, total proteins, 2-macroglobulin) were similar in the two groups. No statistically significant difference for erythrocyte aggregation was observed between occlusions of the venous branch and occlusions of the central retinal vein or between ischaemic and non-ischaemic forms. These results suggest that raised erythrocyte aggregation mainly explains the increase in blood viscosity previously demonstrated, and could play a role in the constitution of retinal vein occlusion.

The seven patients described where suffering from simultaneous occlusion of the central retinal vein and cilioretinal artery. All underwent complete ocular examination including fluorescein angiography and visual field assessment, and general investigation with special emphasis on blood and vascular disorders. All patients had been observed for at least one year. Their age ranged from 35 to 60 years (mean: 46 years); fundus examination showed a common pattern consisting of mild edematous central retinal vein occlusion with few hemorrhages as well as a large area of retinal infarction due to cilioretinal artery occlusion. Despite the presence of this large infarcted area, this cases were very different from the ischemic forms of central retinal vein occlusion since in all cases perfusion of the retinal capillaries in the cilioretinal area recovered in a few days. In 4 of 7 cases, fluorescein angiography also disclosed sectorial hypoperfusion of the optic disc at the acute stage. Recovery of venous occlusion occurred in 3 to 14 weeks and the visual acuity outcome was fairly good, as in 5 of the 7 patients, visual acuity reached at last 0.5. No embolic disease was detected but 3 patients had severe migraine. The pathogenesis of this condition remains unclear. Although cilioretinal infarction is usually thought to be secondary to central retinal vein occlusion, the possible role of primary occlusion of the cilioretinal artery is considered.

Benign intracranial hypertension with papilloedema developed in a 18-year-old woman following Minocycline administration. Tetracycline therapy was prescribed for acne vulgaris. One month after the beginning of the treatment, she presented with headache, nausea and vomiting; there were no visual symptoms. Visual acuity and visual field were normal, fundus examination showed bilateral papilloedema. After Minocycline was discontinued and steroid therapy was administrated, symptoms rapidly resolved and papilloedema disappeared. Minocycline is known to penetrate into the central nervous system more effectively and to have a greater lipoid solubility than the other antibiotics of the same group. However the pathogenesis of benign intracranial hypertension after Minocycline therapy remains unknown.

Erythrocyte aggregation (EAg) is one of the principal determinants of blood viscosity at low shearing rates (slow flow). The retinal venous circulation, characterised by a slow circulatory rate and a high resistance to flow, creates a favourable environment for the formation of erythrocyte aggregates. EAg and other laboratory parameters (haematocrit, fibrinogen, plasma proteins, clotting) were measured in 64 patients presenting with retinal vein occlusion (RVO) and 64 controls matched for age, sex, risk factors (HT, diabetes, smoking) and concomitant vascular disease. Statistical analysis of the results demonstrated a significant difference between the RVO group and the control group for fibrinogen (p = 0.03) and erythrocyte aggregation (p = 0.00003 for the aggregation index at 10 sec and p = 0.0002 for the threshold of partial dissociation). The rise in the fibrinogen level alone cannot explain the increased erythrocyte aggregation. These results demonstrate that the increased EAg largely explains the hyperviscosity reported by other authors and suggest that it plays an important role in the pathogenesis of RVO.

Fourteen patients (26 eyes) suffering from idiopathic retinal periphlebitis were followed during a mean time of 6 years (2 to 11 years). At the first examination, five eyes presented with irreversible loss of vision (tractional retinal detachment, neovascular glaucoma). At the end of follow-up, the visual acuity was inferior to 0.1 in 6 eyes, between 0.1 and 0.5 in 7 eyes, superior to 0.6 in 13 eyes. In 70% of cases, initial visual acuity was maintained or ameliorated. New vessels were present in association with significant capillary closure in 18 eyes (70%). Cystoid macular edema appeared in 7 eyes (27%). Steroid therapy, or immunosuppressants in few cases, were usefull to suppress intraocular inflammation. Laser photocoagulation was performed in 18 eyes in order to prevent or reduce ocular neovascularization; beneficial results were obtained in 13 eyes.