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BACKGROUND: The risk of retinopathy of prematurity (ROP) is associated with low birth weight and low gestational age. For ROP screening examination is recommended in infants weighing < or = 1500 g or of less than 32 weeks' gestational age. METHODS: From 1991 ROP screening was performed in 452 premature infants with either a birth weight < or = 1500 g (n = 303) or a birth weight > 1500 g (n = 149) and who required additional oxygen supplementation or underwent surgery with general anaesthesia before estimated term. RESULTS: Unexpectedly, three infants with birth weights between 2080 and 2325 g and a gestational age of 32 or 33 weeks developed stage 2 or 3 ROP. One of these underwent cryocoagulation. In three infants, preterm birth was induced by sudden placental abruption with severe prenatal blood loss followed by haemorrhagic shock. The umbilical cord packed cell volume was reduced to 0.14-0.19 (normal 0.43-0.63). All three infants underwent surgery with general anaesthesia within the first weeks of life. Of the remaining 449 infants none with a birth weight > 1650 g developed any stage of ROP. CONCLUSION: Severe prenatal blood loss requiring blood transfusions and surgery with general anaesthesia may induce higher stages of ROP even in infants with birth weights exceeding the usual screening criteria.

Pars planta vitrectomy has evolved as an alternative method in the treatment of more complicated rhegmatogenous retinal detachments. We report a series of patients who underwent primary vitrectomy with gas tamponade without the use of additional scleral buckling.A retrospective study of 53 patients with a follow-up of 6-45 months (mean 17.8 months) was carried out. Preoperative findings included unusual, multiple or large breaks, vitreous haemorrhage, proliferative vitreoretinopathy and bullous retinal detachment. Preoperative visual acuity was between light perception and 1.0, with 30% (16/53) of patients with 0.4 or better.Retinal reattachment was achieved in 64% of cases (34/53) with one and in 92% (49/53) with one or more operations. Final visual acuity was between light perception and 1.0, with 41% (22/53) of patients with 0.4 or better. Cataract formation occurred in 86% (37/43) of all patients with a clear lens preoperatively. Macular pucker was noted in 11% (6/53) and postoperative proliferative vitreoretinopathy causing redetachment in 6% (3/53).With primary vitrectomy, a high final anatomical success rate with few intraoperative complications can be achieved in more complicated forms of rhegmatogenous retinal detachment. The major drawback of the procedure is the high incidence of post-operative cataract formation.

1529 Background: The prognosis of intraocular lymphoma (IOL) is poor, and the optimal treatment has not yet been defined. Methods: We evaluated the efficacy and aqueous penetration of intravenous i...

Purpose To perform a detailed morphologic and functional evaluation of Best macular dystrophy (BMD) associated with mutations in the VMD2 gene. Design Retrospective study. Participants The records of 16 patients with BMD and heterozygous VMD2 mutations (group 1) and 5 patients with Best-like lesions with no detectable disease-associated alterations in the VMD2 gene (group 2) were evaluated retrospectively. Methods The data were reviewed regarding visual acuity (VA), color vision, perimetry, autofluorescence of the retinal pigment epithelium (RPE), fluorescein angiography, electro-oculography (EOG), and full-field electroretinography (ERG) and multifocal ERG (mfERG). Main Outcome Measures VMD2 mutations, age at onset of BMD, RPE autofluorescence, EOG, ERG, and mfERG. Results The mean age of the patients in group 1 was 47.1 years (range, 16.7–86.5), and age at onset varied between 5 and 58 years (median, 42.0). Visual acuity ranged between 20/16 and 20/400 (median, 20/40). No association existed between the specific nature of the VMD2 mutation and disease onset or expressivity. Retinal pigment epithelium autofluorescence was increased corresponding to ophthalmoscopically visible yellow material, whereas it was decreased in the atrophic stage of BMD. Electro-oculography light rise was reduced in 18 of 19 eyes. Electroretinography amplitudes were normal in 3 patients and reduced in 6 patients. Multifocal ERG revealed in 10 of 20 eyes a central amplitude reduction and in 7 eyes a generalized one. There were no marked differences in clinical and functional findings between the patients in groups 1 and 2, except that the mean age of the patients in group 2 was higher (64.0 years [range, 45.7–80.6]) and the median VA lower (20/50 [range, 20/32–20/320]). Conclusions The onset of BMD is highly variable and occurred in the majority of patients after the second decade of life. Best-like lesions may develop in older patients without associated VMD2 mutations. Those manifestations may be related to a specific form of age-related macular degeneration. This article contains additional online-only material available at http://www.ophsource.org/periodicals/ophtha.

7525 Background: To define the maximum tolerated dose (MTD) of treosulfan in combination with a fixed dose of gemcitabine and to estimate clinical efficacy in uveal melanoma patients. Preclinical s...

We describe a 49-year-old white man with sympathetic ophthalmia following contact neodymium-YAG laser cyclotherapy. There was no invasive surgery, and no perforating injuries preceded cyclodestructive therapy. The eye had hemorrhagic secondary glaucoma due to Coats' disease. It was treated three times with contact cyclophotocoagulation after cyclocryotherapy failed to lower intraocular pressure. Subsequently, the intraocular pressure slowly decreased and the eye became phthisical 15 months after the last surgery. Intraocular inflammation developed in the fellow eye and sympathetic ophthalmia was suspected. Histologic and immunohistologic study of the enucleated blind eye confirmed this diagnosis.

Twenty patients with complicated retinal detachments who were treated with scleral buckling procedures, vitrectomy, and temporary silicone oil filling underwent electrophysiologic tests before and after silicone oil removal. Electroretinographic responses were markedly low or even absent as long as the silicone oil was in the eye but a few days after silicone oil removal the electroretinographic amplitudes had increased in all 20 patients and did not change significantly thereafter. In 12 patients the basic level of the electrooculogram was low as long as the oil was in the eye but was at least twice the previous value in seven patients after oil removal. A light peak of more than 150% occurred in two patients before oil removal and in six after oil removal.

Twenty-seven eyes harboring a choroidal melanoma which could not be treated by other methods were treated with external beam radiation using a linear accelerator. After a mean follow-up period of 15.6 months 3 eyes had to be enucleated. In two eyes fresh tumors developed, which were successfully treated with local beta-radiation. In the remaining 22 eyes the tumor growth was stopped or the tumor regressed. External beam therapy for choroidal melanomas seems to be an effective alternative to enucleation in eyes with tumors not accessible for other methods of treatment and which cannot be enucleated, e.g., single eyes.

We recorded visual-evoked cortical potentials before and after pars plana vitrectomy and intravitreal liquid silicone filling in 30 patients (30 eyes) with complicated retinal detachments without vascular eye disease or glaucoma. The flash- and flicker-evoked cortical potentials increased in amplitude in all cases. Of 21 eyes followed up for more than 50 days, eight had a 30-Hz flicker response before and after surgery. Of 13 eyes with preoperatively reduced flicker-frequency responses, ten (77%) were improved after surgery. The visual-evoked cortical potential parameters did not deteriorate in any of the patients. We concluded that no toxic effect of intravitreal liquid silicone on the optic nerve could be shown by electrophysiologic methods.

The results of treatment of the first 100 patients with uveal melanomas treated with 106-Ruthenium applicators in Essen are presented. The mean follow-up period was 2 years; 80 of the patients presented with choroidal melanomas and 20 with melanomas of the ciliary body. Five of the 100 patients had metastatic disease originating from the primary uveal melanoma. Compared to 60-cobalt therapy, therapeutic results are similar in terms of tumor regression, but the incidence of complications was significantly lower. In 16 patients the eye with the tumor had to be removed, because of tumor growth (12), neovascular glaucoma (3), and vitreous hemorrhage (1). Visual acuity did not decrease in 20% of the cases treated. In the light of our results 106-Ruthenium therapy seems to be a reliable method of tumor treatment in tumors with a maximum prominence not exceeding 8 mm.

A 33-year-old woman underwent bone-marrow transplantation following radiation and chemotherapy for chronic myelocytic leukemia (CML); immunosuppressive therapy was continued for graft-versus-host disease. Five months after successful transplantation, she developed necrotizing retinitis in both eyes with rapid progression over the following weeks. Due to her immunosuppressed state the patient developed pneumonia and died. Postmortem evaluation of the retinal lesions in both eyes disclosed infection by Toxoplasma gondii, which was also found in the brain and myocardium. Multiple viable toxoplasmic cysts were observed at the transition zone from a necrotic to a normal retina. Additionally, cysts of Toxoplasma gondii a normal retina. Additionally, cysts of Toxoplasma gondii were seen in the adjacent intact retina and in areas of necrosis with almost complete absence of retinal or choroidal inflammation. Toxoplasmosis should therefore be considered along with fungi and viruses in the differential diagnosis of necrotizing retinochoroiditis in immunocompromised patients.

We retrospectively analyzed by life table analysis the visual and functional results in 500 eyes that underwent combined vitrectomy and silicone oil for various types of complicated retinal detachments. The cumulative proportion of eyes with attached retina was 77% at six months postoperatively, with a range of 71% for perforating injuries to 85% for posterior holes. The proportion of eyes with a visual acuity of 5/200 or better was 69% at six months, with a range of 56% for perforating injuries to 81% for posterior holes. Sixty-nine eyes had poor visual function despite an attached retina, primarily because of cataract (18 eyes) and preexisting retinal or optic disease (31 eyes). Visual function in eyes with clear optical media and an attached retina was stable over time, except in patients with diabetes. No clinical evidence of retinal toxicity to silicone oil was noted.

On the basis of a series of 500 patients the authors describe the development of silicone oil surgery, the surgical technique, and present-day indications for it, as well as the results that can be achieved with this procedure. The postoperative problems (cataract, glaucoma, and keratopathy) are analyzed and guidelines presented for reducing the complication rate.

The results of local beta ray radiation of 295 eyes containing a uveal melanoma (including 74 melanomas of the anterior choroid and ciliary body) are presented with special respect to the complications of treatment. The most frequent complications were radiation retinopathy and optic neuropathy. Complications known to occur from other radiation methods, such as dry eye syndrome, loss of cilia, and scleral necrosis, did not occur in our series. The incidence of radiation cataract, as compared to the treatment with 60Co plaques, was lower in our series. An average of 700 Gy delivered to the scleral base of the tumor was needed for uveal melanomas which could be destroyed. This radiation dose resulted in a 10% incidence of radiation retinopathy.