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Occlusion of the Central Retinal Vein: Reply
119
CORRESPONDENCE
VOL. 91, NO. 1
2. Yannuzzi, L. A., Gitter, K. A., and Schatz, H. : The Macula. A Comprehensive Text and Atlas. New York, Williams and Wilkins, 1979, pp. 134-142. 3. Gass, J. D. M.: Lamellar macular hole. A complication of cystoid macular edema after cataract extraction. A clinicopathologic case report. Trans. Am. Ophthalmol. Soc. 73:231, 1975. 4. Appen, R. E., de Venecia, G., and Ferwerda, J.: Optic disk vasculitis. Am. J. Ophthalmol. 90:352, 1980.
Reply We appreciate Dr. Schatz bringing a point of semantics to our attention. The anomalous vessels we described appear to be collateral vessels which function to shunt (verb) or divert blood to an alter nate route. We propose that this shunting is via anomalous optic disk capillaries that serve as collaterals. Our findings concur with Dr. Schatz's observation that cystoid maculopathy is a major cause of decreased visual acuity in young individuals with occlusion of the central retinal vein. Our retrospective study involved a relatively small number of patients who were not managed by a definitive treatment protocol. We were unable to provide statistical conclusions about final visual acuity with respect to the use of warfarin, corticosteroids, or o t h e r agents. A controlled d o u b l e masked prospective study is needed to confirm Dr. Schatz's observation that sys temic corticosteroids lessen the severity of cystoid maculopathy associated with occlu sion of the central retinal vein. IRA A. PRILUCK, D E N N I S M. ROBERTSON, ROBERT W. H O L L E N H O R S T ,
Rochester,
M.D. M.D. M.D.
Minnesota
Extended-Wear Contact Lenses After Corneal Grafts Editor: In his article, "The effect of extendedwear aphakic hydrophilic contact lenses
after penetrating keratoplasty" (Am. J. Ophthalmol. 90:331, 1980), M. A. Lemp elucidated a significant problem that should be given serious consideration. Six aphakic keratoplasty patients whom I fitted with hydrophilic contact lenses (Hydrocurve 11-55) at various intervals after keratoplasty developed superficial vascularization of the cornea and mild stromal edema. One patient spontane ously developed an endothelial graft re jection; another patient developed a small Staphylococcus aureus corneal ul cer and the inflammation touched off an endothelial graft rejection. In 90 patients with simple surgical aphakia whom I fitted with extendedwear Hydrocurve 11-55 and Hydrocurve II contact lenses there was less vascular ization and stromal edema than in these post-keratoplasty patients. The grafted cornea appears to respond poorly to extended-wear hydrophilic con tact lenses and I strongly agree with Dr. Lemp that "alternative methods of cor recting visual acuity be considered in patients with aphakia who have received corneal grafts." J O H N J. P U R C E L L , J R . ,
St. Louis,
M.D.
Missouri
Reply Editor: I was very interested in Dr. Purcell's letter relating problems he experienced in post-keratoplasty patients fitted with extended-wear hydrophilic lenses. This confirmation of my finding further strengthens the caution which I urged for clinicians in fitting extended-wear lenses in patients with grafts. It should be remembered that currently available extended-wear lenses with a high water content, that is, 70% to 80%, can provide minimal oxygen requirements for normal corneal epithelium. Contact lenses
CORRESPONDENCE
VOL. 91, NO. 1
2. Yannuzzi, L. A., Gitter, K. A., and Schatz, H. : The Macula. A Comprehensive Text and Atlas. New York, Williams and Wilkins, 1979, pp. 134-142. 3. Gass, J. D. M.: Lamellar macular hole. A complication of cystoid macular edema after cataract extraction. A clinicopathologic case report. Trans. Am. Ophthalmol. Soc. 73:231, 1975. 4. Appen, R. E., de Venecia, G., and Ferwerda, J.: Optic disk vasculitis. Am. J. Ophthalmol. 90:352, 1980.
Reply We appreciate Dr. Schatz bringing a point of semantics to our attention. The anomalous vessels we described appear to be collateral vessels which function to shunt (verb) or divert blood to an alter nate route. We propose that this shunting is via anomalous optic disk capillaries that serve as collaterals. Our findings concur with Dr. Schatz's observation that cystoid maculopathy is a major cause of decreased visual acuity in young individuals with occlusion of the central retinal vein. Our retrospective study involved a relatively small number of patients who were not managed by a definitive treatment protocol. We were unable to provide statistical conclusions about final visual acuity with respect to the use of warfarin, corticosteroids, or o t h e r agents. A controlled d o u b l e masked prospective study is needed to confirm Dr. Schatz's observation that sys temic corticosteroids lessen the severity of cystoid maculopathy associated with occlu sion of the central retinal vein. IRA A. PRILUCK, D E N N I S M. ROBERTSON, ROBERT W. H O L L E N H O R S T ,
Rochester,
M.D. M.D. M.D.
Minnesota
Extended-Wear Contact Lenses After Corneal Grafts Editor: In his article, "The effect of extendedwear aphakic hydrophilic contact lenses
after penetrating keratoplasty" (Am. J. Ophthalmol. 90:331, 1980), M. A. Lemp elucidated a significant problem that should be given serious consideration. Six aphakic keratoplasty patients whom I fitted with hydrophilic contact lenses (Hydrocurve 11-55) at various intervals after keratoplasty developed superficial vascularization of the cornea and mild stromal edema. One patient spontane ously developed an endothelial graft re jection; another patient developed a small Staphylococcus aureus corneal ul cer and the inflammation touched off an endothelial graft rejection. In 90 patients with simple surgical aphakia whom I fitted with extendedwear Hydrocurve 11-55 and Hydrocurve II contact lenses there was less vascular ization and stromal edema than in these post-keratoplasty patients. The grafted cornea appears to respond poorly to extended-wear hydrophilic con tact lenses and I strongly agree with Dr. Lemp that "alternative methods of cor recting visual acuity be considered in patients with aphakia who have received corneal grafts." J O H N J. P U R C E L L , J R . ,
St. Louis,
M.D.
Missouri
Reply Editor: I was very interested in Dr. Purcell's letter relating problems he experienced in post-keratoplasty patients fitted with extended-wear hydrophilic lenses. This confirmation of my finding further strengthens the caution which I urged for clinicians in fitting extended-wear lenses in patients with grafts. It should be remembered that currently available extended-wear lenses with a high water content, that is, 70% to 80%, can provide minimal oxygen requirements for normal corneal epithelium. Contact lenses