- Email: [email protected]
Evaluation of the peripheral visual field after foveal translocation
REFERENCES
1. Solomon SD, Smith JH, O’Brien J. Ocular manifestations of systemic malignancies. Curr Opinion Ophthalmol 1999;10: 447– 451. 2. Berson EL, Lessell S. Paraneoplastic night blindness with malignant melanoma. Am J Ophthalmol 1988;106:307–311. 3. Milam AH, Saari JC, Jacobson SG, et al. Autoantibodies against retinal bipolar cells in cutaneous melanoma-associated retinopathy. Invest Ophthalmol Vis Sci 1993;34:91–100.
Evaluation of the Peripheral Visual Field After Foveal Translocation Akira Kubota, MD, Masahito Ohji, MD, Shunji Kusaka, MD, Atsushi Hayashi, MD, Jun Hosohata, MD, Takashi Fujikado, MD, and Yasuo Tano, MD PURPOSE:
To evaluate the peripheral visual field after foveal translocation with scleral imbrication or 360degree retinotomy. METHODS: Retrospective, single-center, nonrandomized study. We calculated the rate of preservation of the peripheral visual field using Goldmann perimetry by dividing the width of the postoperative V-4 isopter by the preoperative width and expressing the result as a percentage. RESULTS: In nine eyes that underwent scleral imbrication, the rate of preservation was 100.0% superiorly, 102.6% superotemporally, 99.9% temporally, 97.9% inferotemporally, 96.9% inferiorly, 82.3% inferonasally, 93.7% nasally, and 87.3% superonasally. In 33 eyes that underwent 360-degree retinotomy, it was 89.1%, 87.0%, 81.9%, 78.1%, 86.6%, 90.0%, 89.9%, and 86.8%, respectively. CONCLUSION: After foveal translocation with scleral imbrication, the peripheral visual field was preserved except for slight narrowing nasally; 360-degree retinotomy resulted in preservation of the visual field, except for slight narrowing in all meridians. (Am J Ophthalmol 2001;132:581–584. © 2001 by Elsevier Science Inc. All rights reserved.)
F
OVEAL TRANSLOCATION HAS THE POTENTIAL TO IM-
prove visual function. However, postoperative complications are concerns. Several surgical techniques achieve foveal translocation; foveal translocation with 360-degree retinotomy and foveal translocation with scleral imbrication1,2 are the most Accepted for publication May 2, 2001. From the Department of Ophthalmology, Osaka University Medical School, Suita, Japan. Inquiries to Akira Kubota, MD, Department of Ophthalmology, Osaka University Medical School, 2-2 Yamadaoka, Suita 565-0871, Japan; fax: ⫹81-6-6879-3458; e-mail: [email protected]
VOL. 132, NO. 4
commonly used. A total retinal detachment is created in foveal translocation with 360-degree retinotomy, whereas a retinal detachment temporal to the disk is created in foveal translocation with scleral imbrication. Because visual field narrowing resulting from creation of the retinal detachment is of great concern, we retrospectively evaluated the peripheral visual fields before and after translocation surgery. All patients underwent foveal translocation with 360degree retinotomy or foveal translocation with scleral imbrication at Osaka University Hospital. The charts were retrospectively reviewed. The visual field was measured preoperatively and postoperatively using Goldmann perimetry in nine eyes of nine patients who underwent foveal translocation with scleral imbrication and in 33 eyes of 33 patients who underwent foveal translocation with 360-degree retinotomy. The median patient ages were 59.4 years (range, 46 to 71) and 69.8 years (range, 47 to 82), respectively. The median follow-up period was 18.9 months (range, 4 to 38) and 5.7 months (range, 1 to 12.5), respectively. We evaluated the rate of preservation of the peripheral visual field in eight meridians by dividing the postoperative V-4 isopter with the preoperative width and expressing the result as a percentage. ● CASE 1:
A 57-year-old woman with myopic choroidal neovascularization in her left eye underwent foveal translocation with scleral imbrication on August 5, 1999. Her preoperative visual acuity was 20/100; 9 months postoperatively, it was 20/60. The peripheral visual field was maintained postoperatively (Figure 1). ● CASE 2:
A 75-year-old man with age-related macular degeneration in his left eye underwent foveal translocation with 360-degree retinotomy on August 17, 1999. His visual acuity improved from 20/40 to 20/30 9 months postoperatively. The peripheral visual field was slightly narrowed postoperatively (Figure 2). After foveal translocation with scleral imbrication, the average rate preservation of the visual field was 100.0% superiorly, 102.6% superotemporally, 99.9% temporally, 97.9% inferotemporally, 96.9% inferiorly, 82.3% inferonasally, 93.7% nasally, and 87.3% superonasally. After foveal translocation with 360-degree retinotomy, the average rate of preservation of the visual field was 89.1% superiorly, 87.0% superotemporally, 81.9% temporally, 78.1% inferotemporally, 86.6% inferiorly, 90.0% inferonasally, 89.9% nasally, and 86.8% superonasally. After foveal translocation with scleral imbrication, the V-4 isopter was narrowed nasally. The temporal peripheral visual field was unaffected. Therefore, the major factor narrowing the visual field is the creation of a retinal detachment temporal to the disk. After foveal translocation with 360-degree retinotomy, the size of the V-4 isopter was slightly narrowed in all
BRIEF REPORTS
581
FIGURE 1. Preoperative (top) and postoperative (bottom) Goldmann perimetry in case 1. After scleral imbrication and foveal translocation, the preservation rate of the peripheral visual field (V-4 isopter) was 106.0% superiorly, 101.9% superonasally, 108.9% nasally, 105.0% inferonasally, 102.8% inferiorly, 103.4% inferotemporally, 108.5% temporally, and 107.8% superotemporally.
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OPHTHALMOLOGY
OCTOBER 2001
FIGURE 2. Preoperative (top) and postoperative (bottom) Goldmann perimetry in case 2. After 360-degree retinotomy and foveal translocation, the preservation rate of the peripheral visual field (V-4 isopter) was 100.0% superiorly, 98.3% superonasally, 105.1% nasally, 88.1% inferonasally, 103.0% inferiorly, 90.4% inferotemporally, 87.6% temporally, and 96.8% superotemporally.
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BRIEF REPORTS
583
meridians. Retinal photocoagulation could cause peripheral visual field loss3,4 in addition to creation of a total retinal detachment and 360-degree retinotomy. After foveal translocation with scleral imbrication, the peripheral visual field was preserved except for slight narrowing nasally; 360-degree retinotomy resulted in preservation of the visual field except for slight narrowing in all meridians. The preservation of the peripheral visual field seems to be clinically acceptable, although surgeons should try to maintain the visual field as much as possible. REFERENCES
1. De Juan E, Loewenstein A, Bressler NM, Alexander J. Translocation of the retina for management of subfoveal choroidal neovascularization. A preliminary report in humans. Am J Ophthalmol 1998;125:635– 646. 2. Machemer R, Steinhorst UH. Retinal separation, retinotomy, and macular relocation. Surgical approach for age-related macular degeneration? Graefe Arch Clin Exp Ophthalmol 1993;231:635– 641. 3. Suzuki R. Effects of panretinal photocoagulation on the retina. Nippon Ganka Gakkai Zasshi 1981;85:1020 –1027. 4. Frank RN. Visual field and electroretinography following extensive photocoagulation. Arch Ophthalmol 1975;93:591– 598.
FIGURE 1. Fundus photograph, left eye, demonstrates subtle sheathed retinal veins mainly in the inferior retina (arrowhead).
Retinal Vasculitis Associated With Chickenpox Ya-Hui Kuo, MD, Yeung Yip, MD, and San-Ni Chen, MD FIGURE 2. Late-phase frame of the fluorescein angiogram, left eye, shows staining of retinal veins without remarkable leakage.
PURPOSE:
To report retinal vasculitis in a young, immunocompetent Asian female adult with chickenpox. METHODS: Interventional case report. A 32-year-old woman had chickenpox 2 weeks before blurred vision in the left eye. The visual acuity was 20/20 for the right eye and 30/50 for the left eye. The left eye presented keratic precipitates, moderate (2ⴙ) cells in the anterior chamber and numerous cells (3ⴙ) in the vitreous. The disk was normal. Perivenous exudation was noted mainly in the inferior retina. The sheathed retinal vessels showed late staining but no remarkable leakage on fluorescein angiography. The right eye was normal. RESULTS: After treatment with acyclovir for 10 days, the visual acuity in the left eye improved to 20/20, and the vasculitis resolved. CONCLUSION: Retinal vasculitis may present as a complication of primary varicella infection in an immunocompetent adult. (Am J Ophthalmol 2001;132:584 –585. © 2001 by Elsevier Science Inc. All rights reserved.)
A
Accepted for publication May 1, 2001. From the Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan. Inquiries to Ya-Hui Kuo, MD, Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Shing St, Guei-Shan Hsian, Taoyuan, Taiwan; fax: 886-3-3287798; e-mail: [email protected]
584
AMERICAN JOURNAL
32-YEAR-OLD
ASIAN
WOMAN
PRESENTED
WITH
blurred vision in the left eye for 1 week and a history of chickenpox 2 weeks before presentation. On examination, the vesicular skin rash had already resolved. Best-corrected visual acuity was 20/20 for the right eye and 30/50 for the left eye. The left eye presented keratic precipitates, moderate (2⫹) cells in the anterior chamber, and numerous (3⫹) cells in the vitreous. The disk was normal. Mild perivenous exudation was noted mainly in the inferior retina (Figure 1). The sheathed retinal vessels showed mild-to-late staining but no remarkable leakage on fluorescein angiography (Figure 2). The right eye was normal. Serologic tests showed venereal disease reaction level (⫺), cytomegalovirus immunoglobulin (IgG) (⫺), herpes simplex virus IgG (⫺), herpes simplex virus IgM (⫺), and antihuman immunodeficiency virus antibody (⫺). Cytomegalovirus IgM and both varicella zoster virus IgG and IgM were (⫹). With the diagnosis of retinal vasculitis associated with chickenpox, acyclovir 200 mg/tab five times a day was prescribed. Topical 0.1% fluorometholone
OF
OPHTHALMOLOGY
OCTOBER 2001
1. Solomon SD, Smith JH, O’Brien J. Ocular manifestations of systemic malignancies. Curr Opinion Ophthalmol 1999;10: 447– 451. 2. Berson EL, Lessell S. Paraneoplastic night blindness with malignant melanoma. Am J Ophthalmol 1988;106:307–311. 3. Milam AH, Saari JC, Jacobson SG, et al. Autoantibodies against retinal bipolar cells in cutaneous melanoma-associated retinopathy. Invest Ophthalmol Vis Sci 1993;34:91–100.
Evaluation of the Peripheral Visual Field After Foveal Translocation Akira Kubota, MD, Masahito Ohji, MD, Shunji Kusaka, MD, Atsushi Hayashi, MD, Jun Hosohata, MD, Takashi Fujikado, MD, and Yasuo Tano, MD PURPOSE:
To evaluate the peripheral visual field after foveal translocation with scleral imbrication or 360degree retinotomy. METHODS: Retrospective, single-center, nonrandomized study. We calculated the rate of preservation of the peripheral visual field using Goldmann perimetry by dividing the width of the postoperative V-4 isopter by the preoperative width and expressing the result as a percentage. RESULTS: In nine eyes that underwent scleral imbrication, the rate of preservation was 100.0% superiorly, 102.6% superotemporally, 99.9% temporally, 97.9% inferotemporally, 96.9% inferiorly, 82.3% inferonasally, 93.7% nasally, and 87.3% superonasally. In 33 eyes that underwent 360-degree retinotomy, it was 89.1%, 87.0%, 81.9%, 78.1%, 86.6%, 90.0%, 89.9%, and 86.8%, respectively. CONCLUSION: After foveal translocation with scleral imbrication, the peripheral visual field was preserved except for slight narrowing nasally; 360-degree retinotomy resulted in preservation of the visual field, except for slight narrowing in all meridians. (Am J Ophthalmol 2001;132:581–584. © 2001 by Elsevier Science Inc. All rights reserved.)
F
OVEAL TRANSLOCATION HAS THE POTENTIAL TO IM-
prove visual function. However, postoperative complications are concerns. Several surgical techniques achieve foveal translocation; foveal translocation with 360-degree retinotomy and foveal translocation with scleral imbrication1,2 are the most Accepted for publication May 2, 2001. From the Department of Ophthalmology, Osaka University Medical School, Suita, Japan. Inquiries to Akira Kubota, MD, Department of Ophthalmology, Osaka University Medical School, 2-2 Yamadaoka, Suita 565-0871, Japan; fax: ⫹81-6-6879-3458; e-mail: [email protected]
VOL. 132, NO. 4
commonly used. A total retinal detachment is created in foveal translocation with 360-degree retinotomy, whereas a retinal detachment temporal to the disk is created in foveal translocation with scleral imbrication. Because visual field narrowing resulting from creation of the retinal detachment is of great concern, we retrospectively evaluated the peripheral visual fields before and after translocation surgery. All patients underwent foveal translocation with 360degree retinotomy or foveal translocation with scleral imbrication at Osaka University Hospital. The charts were retrospectively reviewed. The visual field was measured preoperatively and postoperatively using Goldmann perimetry in nine eyes of nine patients who underwent foveal translocation with scleral imbrication and in 33 eyes of 33 patients who underwent foveal translocation with 360-degree retinotomy. The median patient ages were 59.4 years (range, 46 to 71) and 69.8 years (range, 47 to 82), respectively. The median follow-up period was 18.9 months (range, 4 to 38) and 5.7 months (range, 1 to 12.5), respectively. We evaluated the rate of preservation of the peripheral visual field in eight meridians by dividing the postoperative V-4 isopter with the preoperative width and expressing the result as a percentage. ● CASE 1:
A 57-year-old woman with myopic choroidal neovascularization in her left eye underwent foveal translocation with scleral imbrication on August 5, 1999. Her preoperative visual acuity was 20/100; 9 months postoperatively, it was 20/60. The peripheral visual field was maintained postoperatively (Figure 1). ● CASE 2:
A 75-year-old man with age-related macular degeneration in his left eye underwent foveal translocation with 360-degree retinotomy on August 17, 1999. His visual acuity improved from 20/40 to 20/30 9 months postoperatively. The peripheral visual field was slightly narrowed postoperatively (Figure 2). After foveal translocation with scleral imbrication, the average rate preservation of the visual field was 100.0% superiorly, 102.6% superotemporally, 99.9% temporally, 97.9% inferotemporally, 96.9% inferiorly, 82.3% inferonasally, 93.7% nasally, and 87.3% superonasally. After foveal translocation with 360-degree retinotomy, the average rate of preservation of the visual field was 89.1% superiorly, 87.0% superotemporally, 81.9% temporally, 78.1% inferotemporally, 86.6% inferiorly, 90.0% inferonasally, 89.9% nasally, and 86.8% superonasally. After foveal translocation with scleral imbrication, the V-4 isopter was narrowed nasally. The temporal peripheral visual field was unaffected. Therefore, the major factor narrowing the visual field is the creation of a retinal detachment temporal to the disk. After foveal translocation with 360-degree retinotomy, the size of the V-4 isopter was slightly narrowed in all
BRIEF REPORTS
581
FIGURE 1. Preoperative (top) and postoperative (bottom) Goldmann perimetry in case 1. After scleral imbrication and foveal translocation, the preservation rate of the peripheral visual field (V-4 isopter) was 106.0% superiorly, 101.9% superonasally, 108.9% nasally, 105.0% inferonasally, 102.8% inferiorly, 103.4% inferotemporally, 108.5% temporally, and 107.8% superotemporally.
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OPHTHALMOLOGY
OCTOBER 2001
FIGURE 2. Preoperative (top) and postoperative (bottom) Goldmann perimetry in case 2. After 360-degree retinotomy and foveal translocation, the preservation rate of the peripheral visual field (V-4 isopter) was 100.0% superiorly, 98.3% superonasally, 105.1% nasally, 88.1% inferonasally, 103.0% inferiorly, 90.4% inferotemporally, 87.6% temporally, and 96.8% superotemporally.
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BRIEF REPORTS
583
meridians. Retinal photocoagulation could cause peripheral visual field loss3,4 in addition to creation of a total retinal detachment and 360-degree retinotomy. After foveal translocation with scleral imbrication, the peripheral visual field was preserved except for slight narrowing nasally; 360-degree retinotomy resulted in preservation of the visual field except for slight narrowing in all meridians. The preservation of the peripheral visual field seems to be clinically acceptable, although surgeons should try to maintain the visual field as much as possible. REFERENCES
1. De Juan E, Loewenstein A, Bressler NM, Alexander J. Translocation of the retina for management of subfoveal choroidal neovascularization. A preliminary report in humans. Am J Ophthalmol 1998;125:635– 646. 2. Machemer R, Steinhorst UH. Retinal separation, retinotomy, and macular relocation. Surgical approach for age-related macular degeneration? Graefe Arch Clin Exp Ophthalmol 1993;231:635– 641. 3. Suzuki R. Effects of panretinal photocoagulation on the retina. Nippon Ganka Gakkai Zasshi 1981;85:1020 –1027. 4. Frank RN. Visual field and electroretinography following extensive photocoagulation. Arch Ophthalmol 1975;93:591– 598.
FIGURE 1. Fundus photograph, left eye, demonstrates subtle sheathed retinal veins mainly in the inferior retina (arrowhead).
Retinal Vasculitis Associated With Chickenpox Ya-Hui Kuo, MD, Yeung Yip, MD, and San-Ni Chen, MD FIGURE 2. Late-phase frame of the fluorescein angiogram, left eye, shows staining of retinal veins without remarkable leakage.
PURPOSE:
To report retinal vasculitis in a young, immunocompetent Asian female adult with chickenpox. METHODS: Interventional case report. A 32-year-old woman had chickenpox 2 weeks before blurred vision in the left eye. The visual acuity was 20/20 for the right eye and 30/50 for the left eye. The left eye presented keratic precipitates, moderate (2ⴙ) cells in the anterior chamber and numerous cells (3ⴙ) in the vitreous. The disk was normal. Perivenous exudation was noted mainly in the inferior retina. The sheathed retinal vessels showed late staining but no remarkable leakage on fluorescein angiography. The right eye was normal. RESULTS: After treatment with acyclovir for 10 days, the visual acuity in the left eye improved to 20/20, and the vasculitis resolved. CONCLUSION: Retinal vasculitis may present as a complication of primary varicella infection in an immunocompetent adult. (Am J Ophthalmol 2001;132:584 –585. © 2001 by Elsevier Science Inc. All rights reserved.)
A
Accepted for publication May 1, 2001. From the Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan. Inquiries to Ya-Hui Kuo, MD, Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Shing St, Guei-Shan Hsian, Taoyuan, Taiwan; fax: 886-3-3287798; e-mail: [email protected]
584
AMERICAN JOURNAL
32-YEAR-OLD
ASIAN
WOMAN
PRESENTED
WITH
blurred vision in the left eye for 1 week and a history of chickenpox 2 weeks before presentation. On examination, the vesicular skin rash had already resolved. Best-corrected visual acuity was 20/20 for the right eye and 30/50 for the left eye. The left eye presented keratic precipitates, moderate (2⫹) cells in the anterior chamber, and numerous (3⫹) cells in the vitreous. The disk was normal. Mild perivenous exudation was noted mainly in the inferior retina (Figure 1). The sheathed retinal vessels showed mild-to-late staining but no remarkable leakage on fluorescein angiography (Figure 2). The right eye was normal. Serologic tests showed venereal disease reaction level (⫺), cytomegalovirus immunoglobulin (IgG) (⫺), herpes simplex virus IgG (⫺), herpes simplex virus IgM (⫺), and antihuman immunodeficiency virus antibody (⫺). Cytomegalovirus IgM and both varicella zoster virus IgG and IgM were (⫹). With the diagnosis of retinal vasculitis associated with chickenpox, acyclovir 200 mg/tab five times a day was prescribed. Topical 0.1% fluorometholone
OF
OPHTHALMOLOGY
OCTOBER 2001