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Unusual Epithelial Downgrowth Complicating Retinal Surgery
750
AMERICAN JOURNAL OF OPHTHALMOLOGY
edema is an excellent example. Systemic corticosteroids are probably helpful in some of these cases, but they must be used before macrocystic spaces have de veloped and they may be needed for pro longed periods of time. If there is a sheet of vitreous to the wound, that should be delt with surgically; corticosteroids alone will not solve the problem. Furthermore, no rationale exists for photocoagulation in the treatment of aphakic inflam matory cystoid macula edema, because photocoagulation itself can increase capillary leakage, and the offending perifoveal capillaries should not be photocoagulated. On the other hand, argon laser treat ment of branch venular occlusion may be helpful in some cases. Acute posterior vitreous detachment can cause cystoid macular edema in phakic or aphakic pa tients. If a piece of internal limiting mem brane is torn from the posterior pole, the integrity of the retinal capillaries can be disturbed. A mild vitritis may occur sec ondarily. Systemic corticosteroids may be useful in some of these cases; however, the final visual results are seldom as good as with aphakic inflammatory cystoid macular edema patients treated with cor ticosteroids. The relationship between intraopera tive and postoperative hypotomy and cys toid macular edema is not known. How ever, it may help to explain that a large percentage of patients show fluorescein leakage after cataract surgery but only a few of these have reduction in visual acuity. It seems prudent to keep the time during which the eye is open to a mini mum and to re-establish intraocular pres sure with balanced salt solution after clo sure. The possibility that a drug used intraocularly or postoperatively could cause cystoid macular edema has not been in vestigated, except for epinephrine. I won der if repeated use of Neosynephrine
NOVEMBER, 1977
postoperatively could have a similar ef fect in some patients. The last point is that careful slit-lamp biomicroscopy is at least as important as fluorescein angiography in the under standing and treatment of this condition. I hope that further studies will contin ue to elucidate the causes and treatment of this frustrating condition. RICHARD R. JAMISON, M.D.
Rochester, New York REFERENCE 1. Henry, M. M., Henry, L. M., and Henry, L.: A possible cause of chronic cystic maculopathy. Ann. Ophthalmol. 9:455, 1977.
Unusual Epithelial Downgrowth Complicating Retinal Surgery Editor: In the excellent article, "Intrusion of scierai implant associated with conjunctival epithelial ingrowth" (Am. J. Ophthal mol. 83:504, 1977), by Nicholas J. Colosi and Myron Yanoff, the authors state: "To our knowledge this is the first example of intraocular epithelial ingrowth occurring after a silicone scierai buckling procedure for treatment of a retinal detachment." The present letter is written to claim priority for the description of this type of epithelial growth covering the inner sur face of the retina and occurring as a complication of a silicone scierai buck ling operation.1 It is important to empha size that proliferation of conjunctival epi thelium on the retina is irritating and that the involved eye had to be enucleated in both cases. I am happy to see another report of this serious and unusual surgical complication. J. REIMER WOLTER, M.D.
Ann Arbor, Michigan REFERENCE 1. Wolter, J. R.: Unusual epithelial downgrowth, complicating retinal surgery and ocular eviscera tion. Am. J. Ophthalmol. 60:679, 1965.
AMERICAN JOURNAL OF OPHTHALMOLOGY
edema is an excellent example. Systemic corticosteroids are probably helpful in some of these cases, but they must be used before macrocystic spaces have de veloped and they may be needed for pro longed periods of time. If there is a sheet of vitreous to the wound, that should be delt with surgically; corticosteroids alone will not solve the problem. Furthermore, no rationale exists for photocoagulation in the treatment of aphakic inflam matory cystoid macula edema, because photocoagulation itself can increase capillary leakage, and the offending perifoveal capillaries should not be photocoagulated. On the other hand, argon laser treat ment of branch venular occlusion may be helpful in some cases. Acute posterior vitreous detachment can cause cystoid macular edema in phakic or aphakic pa tients. If a piece of internal limiting mem brane is torn from the posterior pole, the integrity of the retinal capillaries can be disturbed. A mild vitritis may occur sec ondarily. Systemic corticosteroids may be useful in some of these cases; however, the final visual results are seldom as good as with aphakic inflammatory cystoid macular edema patients treated with cor ticosteroids. The relationship between intraopera tive and postoperative hypotomy and cys toid macular edema is not known. How ever, it may help to explain that a large percentage of patients show fluorescein leakage after cataract surgery but only a few of these have reduction in visual acuity. It seems prudent to keep the time during which the eye is open to a mini mum and to re-establish intraocular pres sure with balanced salt solution after clo sure. The possibility that a drug used intraocularly or postoperatively could cause cystoid macular edema has not been in vestigated, except for epinephrine. I won der if repeated use of Neosynephrine
NOVEMBER, 1977
postoperatively could have a similar ef fect in some patients. The last point is that careful slit-lamp biomicroscopy is at least as important as fluorescein angiography in the under standing and treatment of this condition. I hope that further studies will contin ue to elucidate the causes and treatment of this frustrating condition. RICHARD R. JAMISON, M.D.
Rochester, New York REFERENCE 1. Henry, M. M., Henry, L. M., and Henry, L.: A possible cause of chronic cystic maculopathy. Ann. Ophthalmol. 9:455, 1977.
Unusual Epithelial Downgrowth Complicating Retinal Surgery Editor: In the excellent article, "Intrusion of scierai implant associated with conjunctival epithelial ingrowth" (Am. J. Ophthal mol. 83:504, 1977), by Nicholas J. Colosi and Myron Yanoff, the authors state: "To our knowledge this is the first example of intraocular epithelial ingrowth occurring after a silicone scierai buckling procedure for treatment of a retinal detachment." The present letter is written to claim priority for the description of this type of epithelial growth covering the inner sur face of the retina and occurring as a complication of a silicone scierai buck ling operation.1 It is important to empha size that proliferation of conjunctival epi thelium on the retina is irritating and that the involved eye had to be enucleated in both cases. I am happy to see another report of this serious and unusual surgical complication. J. REIMER WOLTER, M.D.
Ann Arbor, Michigan REFERENCE 1. Wolter, J. R.: Unusual epithelial downgrowth, complicating retinal surgery and ocular eviscera tion. Am. J. Ophthalmol. 60:679, 1965.