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PURPOSE To describe a patient with a white dot syndrome associated with acute erythema infectiosum. METHODS A patient with a clinical history of erythema infectiosum and multifocal punctate white lesions at the level of the retinal pigment epithelium was followed up for an 8-month interval. Serum was tested for immunoglobulin M (IgM) and IgG antibodies to parvovirus B19 at the time of the initial evaluation and during convalescence using an indirect immunofluorescence antibody technique. Serial photographs and fluorescein angiograms were obtained. RESULTS IgM and IgG antibodies to parvovirus were detected in the serum at the time of initial evaluation; IgM antibodies had disappeared but IgG antibodies persisted in serum obtained at 1-month follow-up. Fundus evaluation revealed clinical disappearance of some lesions, with increased pigmentation of others over the course of follow-up. CONCLUSION The authors have identified an adult patient who presented with a white dot syndrome associated with acute erythema infectiosum documented by serologically proved parvovirus B19 infection.

Over the past decade, a better understanding of the pathogenesis and evolution of idiopathic macular holes has developed. Theories implicating the role of the vitreous in hole formation have led to surgical interventions that have met with surprising success. Recent advances in identifying early lesions, coupled with variations in surgical results based on the hole's preoperative stage, have led some authors to suggest earlier intervention. This report reviews current concepts of macular hole development, focusing on the pathoanatomy, natural history, surgical approach, and surgical outcomes of stage 2 macular holes.

Background: Giant cell arteritis is a common cause of severe visual loss in older individuals. Patients often present to the ophthalmologist having already lost vision in one eye. Detection of early ophthalmoscopic signs that precede irreversible visual loss in giant cell arteritis would allow preventative treatment in an otherwise frequently blinding disease. Methods: Case presentations. Results: Seven patients with mild visual symptoms and results of an ophthalmologic examination significant for cotton-wool spots were found to have giant cell arteritis. On specific questioning, six of seven patients described constitutional symptoms consistent with giant cell arteritis. Six patients had an abnormally elevated Westergren erythrocyte sedimentation rate. Temporal artery biopsy confirmed giant cell arteritis in six patients. The seventh patient received a diagnosis of polymyalgia rheumatica. Prompt treatment with corticosteroids led to preservation of vision and uneventful resolution of the cottonwool spots in all seven patients. Conclusion: Cotton-wool spots are an early ophthalmoscopic finding in giant cell arteritis and can precede severe visual loss. Recognition of the significance of cottonwool spots, use of laboratory studies, and prompt treatment may preserve vision in an otherwise frequently blinding disease.

Purpose: To compare the rates of intraoperative and postoperative complications of external argon laser choroidotomy and needle drainage techniques during scleral buckle procedures for primary retinal detachment. Methods: A group of 175 patients undergoing scleral buckling for primary retinal detachment was randomly assigned to undergo either external argon laser choroidotomy or needle drainage. Complications associated with drainage of subretinal fluid were categorized as retinal break, retinal incarceration, or hemorrhage (dot, ≤ 1 disc diameter “DD”, or > 1 DD), and recorded during surgery and 24 hours after surgery. Results: In the group that underwent laser choroidotomy, 12 (13%) of 92 patients had complications, including 4 dot hemorrhages, 3 hemorrhages 1 DD or smaller, 3 hemorrhages larger than 1 DD, 1 retinal incarceration, and 1 suprachoroidal hemorrhage. In the group that underwent needle drainage, 13 (16%) of 81 patients had complications, including 3 dot hemorrhages, 4 hemorrhages 1 DD or smaller, 5 hemorrhages larger than 1 DD, and 1 suprachoroidal hemorrhage. No significant difference was noted between the two groups in the incidence of complications (P = 0.657). Conclusion: External argon laser choroidotomy and needle choroidotomy are comparable, safe, and effective ways to drain subretinal fluid during scleral buckle surgery.

PURPOSE This study sought to determine the findings of retinal inflammation on gadolinium-enhanced turbo fluid-attenuated inversion recovery (tFLAIR) images. METHODS Five patients with retinal abnormalities (acquired immunodeficiency syndrome complicated by cytomegalovirus retinitis, two patients; lymphoma complicated by Herpes zoster retinitis, one patient; and diabetic retinopathy, two patients) were identified on routine brain magnetic resonance imaging examinations performed with gadolinium-enhanced tFLAIR; five healthy subjects were retrospectively reviewed for comparison. Retinal signal features and thickness were evaluated comparing gadolinium-enhanced tFLAIR with turbo spin-echo T2-weighted and spin-echo T1-weighted images with and without gadolinium. RESULTS Abnormal retinal thickening and hyperintensity were most conspicuous on gadolinium-enhanced tFLAIR images. Unenhanced T1-weighted images failed to demonstrate any abnormalities. In the enhanced tFLAIR and T1-weighted images, retinal thickness greater than 1.2 mm was abnormal. Abnormal retinal contour and signal was most apparent on the tFLAIR images. CONCLUSIONS Of the sequences studied, gadolinium-enhanced tFLAIR images were found to be the best in identifying incidental retinitis and diabetic retinopathy discovered on routine brain magnetic resonance imaging examinations.

Cat-scratch disease is caused by Bartonella henselae , a pleomorphic gram-negative rod formerly referred to as Rochalimaea henselae . Common ocular sequelae include Parinaud oculoglandular syndrome and neuroretinitis. 1 Acute multifocal retinitis with or without optic nerve edema may also occur, 2 occasionally causing a branch retinal artery occlusion 3 or serous detachment of the neurosensory retina. 4 We describe the use of a recently developed indirect fluorescent antibody test 5 to document systemic B henselae infection in 2 patients with an unusual inflammatory mass of the optic nerve head after a flulike illness and exposure to cats. Report of Cases. Case 1. A 7-year-old girl was seen with profound loss of vision in her left eye 2 months after an acute febrile illness. Her medical history was notable for multiple recent cat scratches. Best-corrected visual acuity was 20/20 OD and no light perception OS. An afferent pupillary defect was present in

A retrospective analysis of thirty-one eyes in thirty patients with neovascular glaucoma (NVG) associated with proliferative diabetic retinopathy or venous occlusive disease was performed. Eyes treated with transconjunctival peripheral panretinal cryotherapy alone, or in combination with limited cyclocryotherapy had improvement or stabilization of visual acuity in 55%, reduction of intraocular pressure in 55%, and stabilization or regression of iris neovascularization in 70% of eyes at 12-14 months post-treatment. Transconjunctival peripheral panretinal cryotherapy alone, or in combination with limited cyclocryotherapy is recommended in the treatment of eyes with NVG and media opacities precluding photocoagulation therapy, or in eyes unresponsive to previous photocoagulation therapy.

• The results of pars plana vitrectomy and membrane peeling for premacular fibroplasia (PMF) were reviewed retrospectively for 88 eyes of 86 patients. Premacular fibroplasia was idiopathic in 61 eyes (69%) and postdetachment in 27 eyes (31%). All patients had a minimum follow-up of 12 months. Visual symptoms of blurring and metamorphopsia were reduced in 75 (85%) study eyes at the end of the follow-up period. Poor visual outcome was significantly related to preoperative cystoid macular edema and pro onged duration of visual blurring. Posterior retinal breaks occurred in three eyes (5%) with idiopathic PMF and five eyes (19%) with postdetachment PMF. Cataract progression was demonstrated in 35 eyes (48%) at 12 months of follow-up and 49 eyes (68%) at 24 months of follow-up, reflecting an incidence of cataract formation that has not been previously reported (to our knowledge) after limited vitrectomy and membrane peeling for PMF.

Treatment of subretinal neovascular membranes associated with choroidal osteomas is described. Early recognition of the membranes, aided by Amsler grid self-assessment, allowed initiation of photocoagulation treatment while the lesions were still extrafoveal. In one patient, initial treatment was performed with the argon green laser and subsequent treatments were applied with the krypton red laser. In two other patients, argon-laser photocoagulation alone was used to destroy subretinal neovascular membranes. Post-treatment evaluations in one patient demonstrated persistence of recurrence of neovascular tissue and allowed for prompt retreatment. Follow-up evaluations have shown that treatment resulted in persistent destruction of the subretinal neovascular membrane in two patients, with stabilization of vision at 20/25- and 20/100, respectively. In one patient, vision has been stable at 20/50 for 6 months; however, a recurrent subretinal neovascular membrane developed, encroaching through the fovea with resultant visual loss of 20/60.

Three patients are described who presented with blood-induced glaucoma. The cause of the vitreous hemorrhage was different for each patient, and included branch vein occlusion, diabetic retinopathy, and cataract extraction. The clinical findings common to all three cases consisted of degenerated red blood cells in the anterior chamber and vitreous cavity, a broken anterior vitreous face, open angles, and the absence of rubeosis iridis. Pars plana vitrectomy and anterior chamber Irrigation resulted in normalization of intraocular pressure in each patient. RETINA 1:255–257, 1981

• We have devised a method whereby an inexpensive, disposable tuberculin syringe may be used as a flute syringe with retrograde flushing capability. This syringe is particularly useful in vitreous surgery and alleviates problems that occur with commercially available instruments of this type.

• A man was admitted to the hospital with a penetrating injury to the eye caused by a fishhook. One of the current techniques for removing cutaneously embedded hooks was used to remove it. This technique, in conjunction with detachment surgery, resulted in the successful restoration of vision in our patient. To our knowledge, this is the first report of the successful removal of a fishhook that penetrated the retina and lay within the vitreous of the eye.

• Supplemental photocoagulation on the buckle appears to be a useful therapeutic modality in selected cases of persistent retinal detachment. In a retrospective review, 71 (63%) of 113 eyes were successfully treated with photocoagulation, thus avoiding the need for surgical revision. Median response time between treatment and postoperative subretinal fluid absorption in the successfully treated eyes was two days, with the majority responding within one day. The one favorable prognostic factor was the use of a soft silicone segmental sponge. Unfavorable prognostic factors included the following: contour of subretinal fluid (combined, ie, both anterior and posterior to the buckle); excessive amount of subretinal fluid; inadequate support of break(s); multiple drainages at first operation; rolled edge in association with a giant break; and residual vitreous traction on the break. Postoperative photocoagulation alone on the buckle did not appear to influence the rate of development of premacular fibroplasia or proliferative vitreoretinopathy.

• This report describes the method of electrocoaptation, a sutureless technique for closure of the conjunctiva, in 75 patients who underwent primary scleral buckling or vitrectomy procedures. The technique is safe, rapid, easily performed, and results in a secure wound that heals well.

• Exploding glass bottles filled with carbonated beverages cause serious ocular injuries that have not received adequate attention in ophthalmic publications. All three patients described in this article had corneal lacerations and traumatic cataracts developed. One patient was left with an inoperable retinal detachment. Beverage bottles may explode with normal handling and without provocation. Manufacturing standards have just taken effect that may help to eliminate defective bottles. The addition of plastic sleeves to beverage bottles and the use of plastic shatterproof bottles also reduce the hazard of explosions and high velocity fragments. It is advisable to avoid subjecting beverage bottles to undue heat and agitation and to direct the cap away from the face when opening the bottle.

• Bilateral retinal and preretinal hemorrhages with an acute and permanent partial loss of visual acuity developed in a 60-year-old man after an oxygen myelogram. In order to increase the contrast of the myelogram, a greater volume of oxygen was injected in the subarachnoid space than the volume of CSF that was removed. It is believed that the hemorrhages and visual loss were secondary to the sudden increase in CSF pressure caused by the excess volume of oxygen injected.

Congenital rubella syndrome (CRS) has been a nationally notifiable disease since 1965; however, reporting has been quantitatively poor. To improve surveillance, a National Registry for Congenital Rubella Syndrome was established in 1969. Since then, the Registry has received 133 case report forms from 28 states and the District of Columbia. Analysis of these reports shows that peaks of CRS births occurred seven to nine months after the peak incidence of rubella in 1969 and 1970. Estimates of the number of babies born with CRS per year far exceed the actual number of -reported cases. Since the ultimate goal of rubella immunization programs is the prevention of congenital rubella syndrome, improved surveillance of CRS is of prime importance in the overall rubella immunization effort.