- Email: [email protected]
Laser and proton radiation to reduce uveal melanoma–associated exudative retinal detachments
Macular retinoschisis in highly myopic eyes. Am J Ophthalmol 2002;133:794 –800. 4. Kadonosono K, Yazama F, Itoh N, et al. Treatment of retinal detachment resulting from myopic macular hole with internal limiting membrane removal. Am J Ophthalmol 2001;131: 203–207.
We complied with federal and state human subject laws. Patients had untreated choroidal melanomas with ⱖ 15% exudative retinal detachments. Tumors overhanging the disk, contiguous to the fovea, or with ⬎ 40% ciliary body involvement were excluded. Eleven patients were treated. Patient characteristics are shown in Table 1. After retrobulbar anesthesia, tumors were treated with confluent 810-nm laser in the first weeks after tantalum ring placement. Laser spots were 3,000-m; tumors ⬍ 3 mm from the fovea, received some 2,000 m spots. Power density was 600 to 900 mW for 1 minute to achieve a gray-white appearance after 45 seconds of treatment. Patients received 56 gray equivalents (GyE) of proton radiation 7 to 14 days later. Forty-five matched historic control subjects, who had received identical 56 GyE of proton radiation and follow-up, were chosen. Patients were examined at 3-month intervals for the first year, 4-month to 5-month intervals for the second year, twice in the third year, and then yearly. Two experimental parameters were assessed: time to subretinal fluid resorption and visual acuity, obtained from automated refractions 1 year after treatment. Visual acuity for statistical analysis was converted using a logarithmic scale. A visual acuity change of 1 log unit reflects a 3-line decrease on the Snellen chart.4 Differences in vision before and 1 year after radiation were compared using a standard two-sample t test. The time to subretinal fluid resorption was compared using Kaplan–Meier survival analysis. The 11 patients receiving proton radiation and laser were younger than the 45 control subjects treated with only protons; all other pretreatment parameters were similar. The mean time to fluid resorption was 192 days in the experimental group vs 263 days in the control group (P ⬍ .04). No patient in the combined treatment group, but 11 patients in the irradiated group, had an exudative detachment throughout follow-up. At 3, 6, 9, 12, and 24 months, a greater percentage of the experimental group had resorption of subretinal fluid (Table 2). Some visits are missing because of subjects’ death4 and enucleation.4 Visual acuity loss at 1 year postradiation was greater in the control group (2.1 vs 1.5 log units), although this was not statistically significant. Exudative retinal detachments dissipated more rapidly when laser-induced hyperthermia was combined with proton radiation. The early visual outcome of the experimental group was not significantly different from historic control subjects. Diminution of subretinal fluid is probably attributable to closure of leaking superficial tumor vessels, because some melanomas were too thick for the laser to penetrate through the entire tumor.5 Laser may be used as an adjuvant to radiation to decrease exudative detachments more rapidly; however, the long-term efficacy remains uncertain.
Laser and Proton Radiation to Reduce Uveal Melanoma–associated Exudative Retinal Detachments Devron H. Char, MD, Riley Bove, BA, and Theodore L. Phillips, MD To assess whether laser-induced hyperthermia with proton irradiation of choroidal melanoma may decrease exudative retinal detachments more rapidly. DESIGN: Case control study. METHODS: Patients treated with laser-induced hyperthermia and proton radiation; results were compared with similar patients treated with only protons. RESULTS: All 11 patients treated with combined laser and proton therapy had resorption of subretinal fluid with a mean duration of retinal detachment of 193 days compared with 263 days in the group treated with only proton therapy (P < .04). At 1 year, visual acuity was similar. CONCLUSIONS: Combined laser radiation more rapidly dissipates exudative detachments than radiation alone. (Am J Ophthalmol 2003;136:180 –182. © 2003 by Elsevier Inc. All rights reserved.) PURPOSE:
C
HARGED PARTICLE RADIATION HAS A LOCAL CON-
trol rate of ⬎ 98%, but significant ocular morbidity can occur.1,2 Innate factors associated with poor visual outcome are age, proximity to the fovea, and nerve and tumor thickness.2–5 Other factors, such as a pretherapy exudative detachment, may be amenable to treatment.2,3 We assessed whether laser would diminish exudative detachment and possibly improve visual outcome in patients undergoing charged particle radiation.
Accepted for publication Dec 17, 2002. InternetAdvance publication at ajo.com Jan 24, 2003. Presented at the 139th meeting of the American Ophthalmological Society, May 17–20, 2003. From the Tumori Foundation CPMC (D.H.C., R.B.), San Francisco, California; Department of Ophthalmology, Stanford University (D.H.C.), Stanford, California; Department of Radiation Oncology, University of California (T.L.P.), San Francisco, California. Supported in part by a grant from the Tumori Foundation, San Francisco. Inquires to Devron H. Char, MD, 45 Castro Street, Suite 309, San Francisco, CA 94114; fax (415) 522-0723; e-mail: [email protected]
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TABLE 1. Comparison of Patient and Tumor Characteristics Radiation ⫹ Laser (11 Patients)
Characteristics
Average age (years) Sex Tumor anterior margin 1. Posterior fundus, posterior to equator 2. Posterior fundus, anterior to equator 3. In ciliary body Tumor posterior margin 1. Posterior fundus, posterior to equator 2. Posterior fundus, anterior to equator 3. In the ciliary body Tumor location Completely posterior to equator Within 3 mm of optic nerve or fovea Largest diameter (mm) Mean Median (min, max) ⬎ 10 mm ⱕ 10 mm Ultrasound thickness (mm) Mean Median (min, max) ⬎ 5 mm ⱕ 5 mm
Radiation Only (45 Patients)
45.4 6 men (55%)
60.5 22 men (48%)
8 (73%) 1 (19%) 2 (18%)
27 (60%) 9 (20%) 9 (20%)
12 (100%)
42 (93%) 1 (2%) 2 (4%)
8 (73%) 5 (45%)
27 (60%) 24 (53%)
12.3 13.5 (8.0, 15.0) 9 (82%) 2 (18%)
12.9 13.0 (6.0, 22.0) 36 (80%) 9 (20%)
6.3 5.7 (3.5, 12.7) 7 (64%) 4 (36%)
6.0 5.4 (1.9, 12.6) 26 (58%) 19 (42%)
TABLE 2. Time to Subretinal Fluid Resorption and Visual Loss at 1 Year
Total days followed Mean Median (min, max) Change in visual acuity at 1 year [log(VA at 1 yr/ 20)/log(2)] - [log(VA pre-tx/20)/log(2)] Mean Median (min, max) Days to resorption (N) Mean Median (min, max) Subretinal fluid resorbed by the 3 M VISIT/ENDPT 6 M VISIT/ENDPT 9 M VISIT/ENDPT 12 M VISIT/ENDPT 2 YR VISIT/ENDPT
Radiation ⫹ Laser (11 Patients)
Radiation Only (45 Patients)
558 396 (182–1221)
1,024 759 (225–2629)
1.547 0.678 (0.000, 6.000) n ⫽ 11 198 104 (41, 590)
2.118 1.585 (⫺2.322, 6.644) n ⫽ 34* 263 234 (34, 634)
6 of 11 (55%) 7 of 10 (70%) 9 of 11 (82%) 10 of 11 (91%) 11 of 11 (100%)
8 of 43 (19%) 16 of 39 (41%) 25 of 40 (63%) 28 of 39 (72%) 34 of 36 (94%)
*There were 11 nonresorbers among the control group. They were followed on average for 498 days (median: 432, range, 172 to 1,282). M ⫽ month; YR ⫽ year; ENDPT ⫽ endpoint.
REFERENCES
1. Char DH. Tumors of the eye and ocular adnexa. Toronto: Decker, 2001:158 –164.
VOL. 136, NO. 1
2. Char DH, Kroll SM, Castro J. Ten-year follow-up of helium ion therapy for uveal melanoma. Am J Ophthalmol 1998;125: 81–89. 3. Kivela T, Eskelin S, Makitie T, Summanen P. Exudative
BRIEF REPORTS
181
retinal detachment from malignant uveal melanoma: predictors and prognostic significance. Invest Ophthalmol Vis Sci 2001;42:2085–2093. 4. Char DH, Kroll S, Quivey JM, Castro J. Long term visual outcome of radiated uveal melanomas in eyes eligible for randomisation to enucleation versus brachytherapy. Br J Ophthalmol 1996;80:117–124. 5. Journee-de Korver JG, Oosterhuis JA, de Wolff-Rouendaal D, Kemmen H. Histopathological findings in human choroidal melanomas after transpupillary thermotherapy. Br J Ophthalmol 1997;81:234 –239.
may experience permanent deterioration of visual function attributable to multiple recurrences. Exposure to corticosteroids have been implicated as potential risk factors in the development of central serous chorioretinopathy.1–3 In vivo models have implicated sympathomimetic agents in the development of the disorder; however, no known clinical cases have been reported until now.4 This is the first observational case series describing three cases of central serous chorioretinopathy in association with the use of two over-the-counter sympathomimetic agents, pseudoephedrine or oxymetazoline (Table 1). We also describe the second known case of the disorder in association with use of 3,4-methylenedioxymethamphetamine (MDMA), an illicit drug with sympathomimetic properties (Table 1).
Central Serous Chorioretinopathy Associated With Administration of Sympathomimetic Agents John C. Michael, MD, John Pak, MD, PhD, Jose Pulido, MD, MS, and Guillermo de Venecia, MD
● PATIENT 1:
A 43-year-old woman presented with acute visual complaints characterized as “a green circle in the center of vision” and distortion of central vision of the right eye. For allergic rhinitis, she had been ingesting excessive amounts of pseudoephedrine (that is, 45–75 mg every 4 hours). In addition, she acknowledged workrelated stress. Best-corrected visual acuity (BCVA) was 20/25⫺2in the right eye (OD) and 20/15 in the left eye (OS). Ophthalmoscopic and angiographic examination revealed a serous elevation of the neurosensory retina located superotemporal to the fovea in the affected right eye consistent with central serous chorioretinopathy. During a follow-up examination (4 weeks later), she denied further use of pseudoephedrine and, coincidentally, experienced an improvement of BCVA to 20/15 OD but continued to observe a pale greenish circle inferonasal to fixation. Funduscopic examination of the right eye showed evidence of resolution with a shallower and smaller area of serous elevation. Three months later, she presented with dramatically worsening vision, distortion, and an exacerbation of the paracentral “green circle” of the right eye, which coincided with her reuse of pseudoephedrine. Bestcorrected visual acuity decreased to 20/60 OD, and ophthalmoscopic and angiographic examination revealed an enlarged serous elevation with subretinal fibrinous changes within the superotemporal macula and involving the fovea. In the subsequent follow-up, at which time she had discontinued pseudoephedrine for 2 months, her BCVA had returned to 20/15 OD, and funduscopic examination revealed no subretinal fluid but some hard exudate precipitates with mild pigmentary alteration within the macular area.
PURPOSE: To report central serous chorioretinopathy associated with excessive use of compounds with sympathomimetic activity. DESIGN: Observational case series. METHODS: Four patients presented with clinical and fluorescein angiographic evidence of central serous chorioretinopathy. All patients expressed a concomitant psychogenic stress and high-dose ingestion of pseudoephedrine, oxymetazoline, or 3,4-methylenedioxymethamphetamine, all of which possess sympathomimetic properties. RESULTS: In all cases, resolution of central serous chorioretinopathy coincided with cessation of the medication. CONCLUSIONS: Patients afflicted with central serous chorioretinopathy should be notified about its possible association with sympathomimetic medications. (Am J Ophthalmol 2003;136:182–185. © 2003 by Elsevier Inc. All rights reserved.)
C
ENTRAL SEROUS CHORIORETINOPATHY (CSC) IS A DIS-
order characterized by serous detachments of the macula primarily afflicting young adults. The serous retinal detachments can involve spontaneous resolution with recovery of visual function; however, a subset of patients Accepted for publication Jan 3, 2003. InternetAdvance Publication at ajo.com May 28, 2003. From the Retina Institute of Illinois, P.C., Niles, Illinois (J.C.M.); Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Illinois Eye and Ear Infirmary, Chicago, Illinois (J.Pa., J.Pu.); and Department of Ophthalmology, University of Wisconsin—Madison, Madison, Wisconsin (G.d.V.). This work was supported in part by an unrestricted departmental grant from Research to Prevent Blindness, Inc. (University of Illinois at Chicago) and National Institutes of Health Core Grant EY 01792 (University of Illinois at Chicago). Inquiries to John C. Michael, MD, Retina Institute of Illinois, P.C. 8780 W. Golf Road, Suite 304, Niles, IL 60714; e-mail: johncmichael@ aol.com
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● PATIENT 2: A 32-year-old man presented with a 3- to 4-day history of blurred vision described as a “central spot” of the left eye. He acknowledged ingesting 900 mg of pseudoephedrine during the past 4 days. Examination revealed BCVA of 20/25⫹3 OD and 20/30⫹3OS. Ophthalmoscopic and angiographic examination revealed a central serous detachment of the macula in the affected left eye OF
OPHTHALMOLOGY
JULY 2003
We complied with federal and state human subject laws. Patients had untreated choroidal melanomas with ⱖ 15% exudative retinal detachments. Tumors overhanging the disk, contiguous to the fovea, or with ⬎ 40% ciliary body involvement were excluded. Eleven patients were treated. Patient characteristics are shown in Table 1. After retrobulbar anesthesia, tumors were treated with confluent 810-nm laser in the first weeks after tantalum ring placement. Laser spots were 3,000-m; tumors ⬍ 3 mm from the fovea, received some 2,000 m spots. Power density was 600 to 900 mW for 1 minute to achieve a gray-white appearance after 45 seconds of treatment. Patients received 56 gray equivalents (GyE) of proton radiation 7 to 14 days later. Forty-five matched historic control subjects, who had received identical 56 GyE of proton radiation and follow-up, were chosen. Patients were examined at 3-month intervals for the first year, 4-month to 5-month intervals for the second year, twice in the third year, and then yearly. Two experimental parameters were assessed: time to subretinal fluid resorption and visual acuity, obtained from automated refractions 1 year after treatment. Visual acuity for statistical analysis was converted using a logarithmic scale. A visual acuity change of 1 log unit reflects a 3-line decrease on the Snellen chart.4 Differences in vision before and 1 year after radiation were compared using a standard two-sample t test. The time to subretinal fluid resorption was compared using Kaplan–Meier survival analysis. The 11 patients receiving proton radiation and laser were younger than the 45 control subjects treated with only protons; all other pretreatment parameters were similar. The mean time to fluid resorption was 192 days in the experimental group vs 263 days in the control group (P ⬍ .04). No patient in the combined treatment group, but 11 patients in the irradiated group, had an exudative detachment throughout follow-up. At 3, 6, 9, 12, and 24 months, a greater percentage of the experimental group had resorption of subretinal fluid (Table 2). Some visits are missing because of subjects’ death4 and enucleation.4 Visual acuity loss at 1 year postradiation was greater in the control group (2.1 vs 1.5 log units), although this was not statistically significant. Exudative retinal detachments dissipated more rapidly when laser-induced hyperthermia was combined with proton radiation. The early visual outcome of the experimental group was not significantly different from historic control subjects. Diminution of subretinal fluid is probably attributable to closure of leaking superficial tumor vessels, because some melanomas were too thick for the laser to penetrate through the entire tumor.5 Laser may be used as an adjuvant to radiation to decrease exudative detachments more rapidly; however, the long-term efficacy remains uncertain.
Laser and Proton Radiation to Reduce Uveal Melanoma–associated Exudative Retinal Detachments Devron H. Char, MD, Riley Bove, BA, and Theodore L. Phillips, MD To assess whether laser-induced hyperthermia with proton irradiation of choroidal melanoma may decrease exudative retinal detachments more rapidly. DESIGN: Case control study. METHODS: Patients treated with laser-induced hyperthermia and proton radiation; results were compared with similar patients treated with only protons. RESULTS: All 11 patients treated with combined laser and proton therapy had resorption of subretinal fluid with a mean duration of retinal detachment of 193 days compared with 263 days in the group treated with only proton therapy (P < .04). At 1 year, visual acuity was similar. CONCLUSIONS: Combined laser radiation more rapidly dissipates exudative detachments than radiation alone. (Am J Ophthalmol 2003;136:180 –182. © 2003 by Elsevier Inc. All rights reserved.) PURPOSE:
C
HARGED PARTICLE RADIATION HAS A LOCAL CON-
trol rate of ⬎ 98%, but significant ocular morbidity can occur.1,2 Innate factors associated with poor visual outcome are age, proximity to the fovea, and nerve and tumor thickness.2–5 Other factors, such as a pretherapy exudative detachment, may be amenable to treatment.2,3 We assessed whether laser would diminish exudative detachment and possibly improve visual outcome in patients undergoing charged particle radiation.
Accepted for publication Dec 17, 2002. InternetAdvance publication at ajo.com Jan 24, 2003. Presented at the 139th meeting of the American Ophthalmological Society, May 17–20, 2003. From the Tumori Foundation CPMC (D.H.C., R.B.), San Francisco, California; Department of Ophthalmology, Stanford University (D.H.C.), Stanford, California; Department of Radiation Oncology, University of California (T.L.P.), San Francisco, California. Supported in part by a grant from the Tumori Foundation, San Francisco. Inquires to Devron H. Char, MD, 45 Castro Street, Suite 309, San Francisco, CA 94114; fax (415) 522-0723; e-mail: [email protected]
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TABLE 1. Comparison of Patient and Tumor Characteristics Radiation ⫹ Laser (11 Patients)
Characteristics
Average age (years) Sex Tumor anterior margin 1. Posterior fundus, posterior to equator 2. Posterior fundus, anterior to equator 3. In ciliary body Tumor posterior margin 1. Posterior fundus, posterior to equator 2. Posterior fundus, anterior to equator 3. In the ciliary body Tumor location Completely posterior to equator Within 3 mm of optic nerve or fovea Largest diameter (mm) Mean Median (min, max) ⬎ 10 mm ⱕ 10 mm Ultrasound thickness (mm) Mean Median (min, max) ⬎ 5 mm ⱕ 5 mm
Radiation Only (45 Patients)
45.4 6 men (55%)
60.5 22 men (48%)
8 (73%) 1 (19%) 2 (18%)
27 (60%) 9 (20%) 9 (20%)
12 (100%)
42 (93%) 1 (2%) 2 (4%)
8 (73%) 5 (45%)
27 (60%) 24 (53%)
12.3 13.5 (8.0, 15.0) 9 (82%) 2 (18%)
12.9 13.0 (6.0, 22.0) 36 (80%) 9 (20%)
6.3 5.7 (3.5, 12.7) 7 (64%) 4 (36%)
6.0 5.4 (1.9, 12.6) 26 (58%) 19 (42%)
TABLE 2. Time to Subretinal Fluid Resorption and Visual Loss at 1 Year
Total days followed Mean Median (min, max) Change in visual acuity at 1 year [log(VA at 1 yr/ 20)/log(2)] - [log(VA pre-tx/20)/log(2)] Mean Median (min, max) Days to resorption (N) Mean Median (min, max) Subretinal fluid resorbed by the 3 M VISIT/ENDPT 6 M VISIT/ENDPT 9 M VISIT/ENDPT 12 M VISIT/ENDPT 2 YR VISIT/ENDPT
Radiation ⫹ Laser (11 Patients)
Radiation Only (45 Patients)
558 396 (182–1221)
1,024 759 (225–2629)
1.547 0.678 (0.000, 6.000) n ⫽ 11 198 104 (41, 590)
2.118 1.585 (⫺2.322, 6.644) n ⫽ 34* 263 234 (34, 634)
6 of 11 (55%) 7 of 10 (70%) 9 of 11 (82%) 10 of 11 (91%) 11 of 11 (100%)
8 of 43 (19%) 16 of 39 (41%) 25 of 40 (63%) 28 of 39 (72%) 34 of 36 (94%)
*There were 11 nonresorbers among the control group. They were followed on average for 498 days (median: 432, range, 172 to 1,282). M ⫽ month; YR ⫽ year; ENDPT ⫽ endpoint.
REFERENCES
1. Char DH. Tumors of the eye and ocular adnexa. Toronto: Decker, 2001:158 –164.
VOL. 136, NO. 1
2. Char DH, Kroll SM, Castro J. Ten-year follow-up of helium ion therapy for uveal melanoma. Am J Ophthalmol 1998;125: 81–89. 3. Kivela T, Eskelin S, Makitie T, Summanen P. Exudative
BRIEF REPORTS
181
retinal detachment from malignant uveal melanoma: predictors and prognostic significance. Invest Ophthalmol Vis Sci 2001;42:2085–2093. 4. Char DH, Kroll S, Quivey JM, Castro J. Long term visual outcome of radiated uveal melanomas in eyes eligible for randomisation to enucleation versus brachytherapy. Br J Ophthalmol 1996;80:117–124. 5. Journee-de Korver JG, Oosterhuis JA, de Wolff-Rouendaal D, Kemmen H. Histopathological findings in human choroidal melanomas after transpupillary thermotherapy. Br J Ophthalmol 1997;81:234 –239.
may experience permanent deterioration of visual function attributable to multiple recurrences. Exposure to corticosteroids have been implicated as potential risk factors in the development of central serous chorioretinopathy.1–3 In vivo models have implicated sympathomimetic agents in the development of the disorder; however, no known clinical cases have been reported until now.4 This is the first observational case series describing three cases of central serous chorioretinopathy in association with the use of two over-the-counter sympathomimetic agents, pseudoephedrine or oxymetazoline (Table 1). We also describe the second known case of the disorder in association with use of 3,4-methylenedioxymethamphetamine (MDMA), an illicit drug with sympathomimetic properties (Table 1).
Central Serous Chorioretinopathy Associated With Administration of Sympathomimetic Agents John C. Michael, MD, John Pak, MD, PhD, Jose Pulido, MD, MS, and Guillermo de Venecia, MD
● PATIENT 1:
A 43-year-old woman presented with acute visual complaints characterized as “a green circle in the center of vision” and distortion of central vision of the right eye. For allergic rhinitis, she had been ingesting excessive amounts of pseudoephedrine (that is, 45–75 mg every 4 hours). In addition, she acknowledged workrelated stress. Best-corrected visual acuity (BCVA) was 20/25⫺2in the right eye (OD) and 20/15 in the left eye (OS). Ophthalmoscopic and angiographic examination revealed a serous elevation of the neurosensory retina located superotemporal to the fovea in the affected right eye consistent with central serous chorioretinopathy. During a follow-up examination (4 weeks later), she denied further use of pseudoephedrine and, coincidentally, experienced an improvement of BCVA to 20/15 OD but continued to observe a pale greenish circle inferonasal to fixation. Funduscopic examination of the right eye showed evidence of resolution with a shallower and smaller area of serous elevation. Three months later, she presented with dramatically worsening vision, distortion, and an exacerbation of the paracentral “green circle” of the right eye, which coincided with her reuse of pseudoephedrine. Bestcorrected visual acuity decreased to 20/60 OD, and ophthalmoscopic and angiographic examination revealed an enlarged serous elevation with subretinal fibrinous changes within the superotemporal macula and involving the fovea. In the subsequent follow-up, at which time she had discontinued pseudoephedrine for 2 months, her BCVA had returned to 20/15 OD, and funduscopic examination revealed no subretinal fluid but some hard exudate precipitates with mild pigmentary alteration within the macular area.
PURPOSE: To report central serous chorioretinopathy associated with excessive use of compounds with sympathomimetic activity. DESIGN: Observational case series. METHODS: Four patients presented with clinical and fluorescein angiographic evidence of central serous chorioretinopathy. All patients expressed a concomitant psychogenic stress and high-dose ingestion of pseudoephedrine, oxymetazoline, or 3,4-methylenedioxymethamphetamine, all of which possess sympathomimetic properties. RESULTS: In all cases, resolution of central serous chorioretinopathy coincided with cessation of the medication. CONCLUSIONS: Patients afflicted with central serous chorioretinopathy should be notified about its possible association with sympathomimetic medications. (Am J Ophthalmol 2003;136:182–185. © 2003 by Elsevier Inc. All rights reserved.)
C
ENTRAL SEROUS CHORIORETINOPATHY (CSC) IS A DIS-
order characterized by serous detachments of the macula primarily afflicting young adults. The serous retinal detachments can involve spontaneous resolution with recovery of visual function; however, a subset of patients Accepted for publication Jan 3, 2003. InternetAdvance Publication at ajo.com May 28, 2003. From the Retina Institute of Illinois, P.C., Niles, Illinois (J.C.M.); Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Illinois Eye and Ear Infirmary, Chicago, Illinois (J.Pa., J.Pu.); and Department of Ophthalmology, University of Wisconsin—Madison, Madison, Wisconsin (G.d.V.). This work was supported in part by an unrestricted departmental grant from Research to Prevent Blindness, Inc. (University of Illinois at Chicago) and National Institutes of Health Core Grant EY 01792 (University of Illinois at Chicago). Inquiries to John C. Michael, MD, Retina Institute of Illinois, P.C. 8780 W. Golf Road, Suite 304, Niles, IL 60714; e-mail: johncmichael@ aol.com
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AMERICAN JOURNAL
● PATIENT 2: A 32-year-old man presented with a 3- to 4-day history of blurred vision described as a “central spot” of the left eye. He acknowledged ingesting 900 mg of pseudoephedrine during the past 4 days. Examination revealed BCVA of 20/25⫹3 OD and 20/30⫹3OS. Ophthalmoscopic and angiographic examination revealed a central serous detachment of the macula in the affected left eye OF
OPHTHALMOLOGY
JULY 2003