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Purpose To measure peripheral nonperfusion and describe bilateral vascular abnormalities in patients with Coats disease, emphasizing subtle findings in the contralateral eyes of patients diagnosed with unilateral disease. Methods Clinical records, including retina drawings and fluorescein angiography images obtained under anesthesia, were retrospectively reviewed from consecutive pediatric patients with Coats disease. The main outcome measure was disk diameters of peripheral nonperfusion and proportion of Coats disease patients with bilateral findings. Results Twenty-two of 32 patients with Coats disease had bilateral abnormal peripheral vasculature. In Group 1 (classic Coats disease: presumed unilateral, ocular only disease), 15 of 24 patients had peripheral nonperfusion >2 disk diameters in their contralateral eyes, 5 with telangiectasis and/or microaneurysms. Seven of 8 patients in Group 2 (Coats-like disease: systemic and/or clinically bilateral disease) had bilateral vascular anomalies. Conclusion Bilateral vascular abnormalities are more common in Coats disease than previously reported. This observation supports a systemic and/or genetic association with Coats disease. Patients with Coats disease should have careful evaluation of the periphery of the less affected eye, preferably with fluorescein angiography, to identify vascular changes not visible clinically. Both eyes warrant surveillance over the lifetime of the patient for potential progression to exudative disease that would warrant treatment.

Untreated retinal detachment after laser treatment for acute retinopathy of prematurity (ROP) results in poor visual outcomes in premature infants. Predicting which eyes are at the greatest risk for retinal detachment would therefore allow early intervention and potentially improved visual outcomes. Several groups have studied ROP after laser treatment, including the timing of involution1 and retinal features predictive of progressive stage 4 ROP.2 These studies emphasized the importance of monitoring the tissue between the vascular and avascular retina, which has been clinically defined as a thickened ridge,2,3 adjacent vitreous,1 or fibrovascular organization.1–3 Vitreous state (the presence of haze, hemorrhage, or vitreous organization over the optic nerve) and plus disease predicted both progressive stage 4 ROP and outcome after surgical intervention for retinal detachment. However, the only feature that predicted progressive retinal detachment requiring surgical intervention was clock hour extent of the thickened ridge,2 which is referred to in this study as fibrovascular organization. Because fibrovascular organization was already shown to be a specific and important predictive feature, we were interested in the postmenstrual age (PMA) at diagnosis of fibrovascular organization following laser treatment for ROP to determine possible associations with outcome after surgery for retinal detachment. Fibrovascular organization can be better detected on clinical examination than with wide angle digital imaging. Current technology lacks the resolution to detect subtle fibrovascular organization and higher resolution imaging often requires infants to be imaged under general anesthesia to assure good focus. Fibrovascular organization can be quantified by clock hour extent and may be a practical feature to study in a multicenter clinical trial to determine the features predictive of progressive ROP.

Purpose: To compare anatomic outcomes after lens-sparing vitrectomy (LSV) or scleral buckle (SB) for stage 4 retinopathy of prematurity (ROP). Methods: Nonrandomized, retrospective study of infants consecutively treated for stage 4 ROP by LSV or SB. Outcomes were retinal attachment at 1 month of initial surgery and at the end of follow-up (6 months) and number of procedures to achieve retinal attachment. Exact χ2 methods determined significance, and student’s t-test compared mean postmenstrual age and birthweight between the groups. Results: After one procedure, LSV (72%) was associated with retinal attachment more often than was SB (31%). At the end of follow-up, after one or more procedures, there was no difference in retinal reattachment rate between LSV or SB as the first procedure. There were no differences between the surgical groups by mean postmenstrual age and birthweight or severity of ROP determined by zone, clock hours of ridge elevation, or quadrants of plus disease. Conclusion: This study supports the hypothesis that vitrectomy by LSV stops progressive stage 4 ROP. As an initial procedure, LSV was associated with retinal attachment more often than SB. Future prospective studies can determine the effects of LSV and SB on visual development in progressive stage 4 ROP.

In eyes that develop progressive stage 4 retinopathy of prematurity (ROP) after laser treatment for threshold ROP,1,2 vitreoretinal surgery is considered to prevent or repair retinal detachment.3–7 For the best visual potential, surgery should achieve retinal attachment, be performed before macular detachment,4 and spare the lens to permit visual rehabilitation in the phakic eye.3,7 However, surgical complications of cataract,8 aphakia, and peripheral retinal breaks have vision-threatening consequences, including profound amblyopia and inoperable retinal detachment,5 which are unique to the developing infant compared with the adult. In addition, because approximately 70% of eyes treated for threshold ROP1,2 and some eyes with stage 4A ROP do not progress,9 recognition of retinal features predictive of progression of stage 4 ROP may facilitate early treatment of eyes at risk for vision loss and also minimize treatment of some low-risk eyes. We performed this study to determine the characteristics predictive of progression of stage 4 ROP in infants who had been adequately treated for threshold ROP. We abstracted features from retinal drawings made at the time of examinations performed within 1 week of developing partial retinal detachment (stage 4A ROP) or 2 weeks after laser treatment in eyes that showed regression of disease. We developed a generalized estimating equation (GEE) model that accounted for within-subject variability of the eyes10 to determine predictive features of progressive stage 4 ROP in eyes after laser treatment for threshold ROP.

Purpose To present ocular features associated with surgical outcomes in infants with stages 4 and 5 retinopathy of prematurity (ROP). Methods Twenty-two infants (35 eyes) were referred for vitreoretinal surgery for stages 4 and 5 ROP. The following ocular features recorded before the development of retinal detachment requiring surgical intervention were analyzed: clock hour extent of ridge elevation, vitreous state, plus disease, prominent iris vessels, neovascularization, and the presence of exudates. Surgical procedures included scleral buckle, lensectomy-vitrectomy, and lens-sparing vitrectomy. Univariate and multivariate analyses were used to determine features associated with failure to achieve retinal reattachment as the main outcome variable. Results Of the 35 eyes that underwent at least one surgical procedure, nine had successful retinal reattachment after the first surgery, and 18 achieved it at the end of follow-up. After accounting for the correlation between the eyes, features significantly associated with surgical failure after the first surgery were vitreous haze, hemorrhage, or organization; plus disease; and neovascularization. The presence of exudates was significantly associated with a successful outcome. When eyes were analyzed by stage at the first procedure, vitreous organization and plus disease were associated with failed retinal reattachment in stage 4 eyes, whereas at least 6 clock hours of ridge elevation and plus disease were significant in stage 5 eyes. The need to perform a lensectomy-vitrectomy was associated with a poor surgical outcome. Neither stage nor number of procedures performed was associated with the development of phthisis. Conclusions Vitreous haze, neovascularization, and plus disease are associated with a poor surgical outcome in eyes that progress after treatment for threshold ROP requiring surgical intervention for retinal detachment. When eyes were divided by stage of ROP at first surgery, plus disease remained a significant variable associated with failed retinal reattachment. Close observation of eyes after laser treatment for threshold ROP is necessary. If neovascularization and plus disease persist and progression of ROP is noted, additional laser should be considered before surgery for retinal detachment. Additional studies with a larger patient sample will be necessary to further define ocular features associated with surgical outcome for ROP.

PURPOSE To detect and localize exudative lesions in exudative age-related macular degeneration and to compare images obtained from infrared scanning laser tomography and video displays of digitized color slides in detection and localization of exudation. METHODS In a prospective study, 11 eyes of 11 patients with exudative age-related macular degeneration were studied. From 32 images with infrared scanning laser tomography, confocal images were chosen in the following focal planes: anterior to the retina, the retinal surface, and the deep retina. Using the fluorescein angiogram as a standard, three retinal specialists rank-ordered the ability to discern the lesion in these confocal images, the summary of confocal images, and video displays of digitized color slides that were adjusted to the same resolution as that of the confocal images (approximately 23 microm per pixel). RESULTS For choroidal neovascularization, both the retinal surface image and the summary image were rated superior to video displays of digitized color slides (P < 0.004). The confocal images were ranked in the following fashion: best, retinal surface; next, deep retina; and then, anterior to the retina (P < 0.01). For pigment epithelial detachment, all three confocal images and summary images were superior to video displays of digitized color slides (P < 0.002). There were no significant differences among the confocal images (P = 0.95). CONCLUSION Infrared confocal imaging was superior to video displays of digitized color slides for visualization of both pigment epithelial detachment and choroidal neovascularization. This technique could have an impact on epidemiologic studies.