Posterior Pole Lesions Research Articles

Clinical characteristics, visual acuity outcomes, and factors associated with loss of vision among patients with active ocular toxoplasmosis: A retrospective study in a Thai tertiary center.

Ocular toxoplasmosis (OT) is the most common cause of infectious uveitis worldwide, including Thailand. This study describes the clinical presentation, visual acuity (VA) outcomes, and factors associated with VA loss in patients with active OT following antiparasitic treatment. A retrospective chart review of patients with active OT treated with antiparasitic drugs between 2010 and 2020 was performed. Outcome measures included clinical characteristics, interval VA, and predictive factors associated with loss of VA ≤ 20/50 at 6 months post-treatment. Ninety-two patients (95 eyes) were enrolled. The median follow-up time was 10.9 months (IQR 4.9-31.8 months). The median age at presentation was 35.9 years, 51% were male, and 92.4% had unilateral OT. Eleven patients (12%) were immunocompromised (HIV infection, eight patients; receiving immunosuppressive agents, three patients). Patients mainly presented with primary retinitis without previous scar (62%), posterior pole lesion (56%), and lesion size of ≤ 2-disc area (75%). Immunocompromised patients showed a significantly larger size of retinitis than immunocompetent patients. Oral trimethoprim/sulfamethoxazole monotherapy was the primary short-term antiparasitic drug prescribed (85%). At the final visit, 21% of all affected eyes suffered VA ≤ 20/200. The cumulative incidence of recurrent OT at three years was 33.9% (95% CI, 19.7%-54.2%). Immunocompromised patients [adjusted odds ratio (aOR) 4.9, p = 0.041], macular lesion (aOR 5.4, p = 0.032), and initial VA ≤ 20/200 (aOR 9.1, p = 0.014) were predictive of having VA ≤ 20/50 at 6 months post-treatment. Ocular toxoplasmosis mainly presents as unilateral primary retinitis within the posterior pole. Severe VA loss was observed in one-fifth of eyes following treatment with lesion resolution. Immunocompromised patients, eyes with macular lesions, and poor initial VA were associated with poor VA outcomes.

OVERVIEW OF OCULAR TOXOPLASMOSIS IN DR KARIADI HOSPITAL SEMARANG: A 5-YEAR RETROSPECTIVE STUDY

Abstract
 Introduction & Objectives : Ocular toxoplasmosis is the most common infectious etiology of posterior uveitis. The aim of this study is to describe the clinical characteristics of ocular toxoplasmosis in Dr. Kariadi Hospital, Semarang.
 Methods : A retrospective review of out-patient medical records of ocular toxoplasmosis at Dr. Kariadi Hospital Semarang from January 2018 to December 2022 was done. All toxoplasmic uveitis were included, whereas incomplete medical records and loss of follow-up were excluded. The clinical characteristics of patients were recorded and analyzed.
 Results : During 5 years a total of 160 patients were recruited of which 123 fulfilled the criteria, consisting of47 males (38.2%) and 76 females (61.8%), mostly were acquired infection (97.6%) with immunocompetent status (75.6%), and affected unilateral eye (65%). The predominant age was 26-45 years old (82.1%). Primary infection (70.7%) was greater than recurrent infection (10.6%) in which recurrence affects 46-65 years old (72.7%). Visual acuity at the initial presentation was <6/18-6/60 (26.2%), and the final follow-up increased to ≥6/18 (33.1%). Posterior uveitis (35.1%) with posterior pole lesion (66%) was a common clinical sign found. Medications given were trimethoprim-sulfamethoxazole (51,25%), and corticosteroid (27.5%) as an adjuvant. The complication detected was cataract (13%).
 Conclusion : Ocular toxoplasmosis was mostly found in immunocompetent female patients, acquired, unilateral, and in the posterior pole. A good response was found by trimethoprim-sulfamethoxazole and corticosteroid medications.

GAMBARAN UMUM TOKSOPLASMOSIS OKULER DI RUMAH SAKIT DR KARIADI SEMARANG

Introduction: Ocular toxoplasmosis is the most common infectious etiology of posterior uveitis. The aim of this study is to describe the clinical characteristics of ocular toxoplasmosis in Dr. Kariadi Hospital, Semarang. Methods: A retrospective review of out-patient medical records of ocular toxoplasmosis at Dr. Kariadi Hospital Semarang from January 2018 to December 2022 was done. All toxoplasmic uveitis were included, whereas incomplete medical records and loss of follow-up were excluded. The clinical characteristics of patients were recorded and analyzed. Results: During 5 years a total of 160 patients were recruited of which 123 fulfilled the criteria, consisting of 47 males (38.2%) and 76 females (61.8%), mostly were acquired infection (97.6%) with immunocompetent status (75.6%), and affected unilateral eye (65%). The predominant age was 26-45 years old (41.5%). Primary infection (70.7%) was greater than recurrent infection (8.9%) in which recurrence affects 46-65 years old (72.7%). Visual acuity at the initial presentation was <6/18-6/60 (26.2%), and the final follow-up increased to ?6/18 (33.1%). Posterior uveitis (35.1%) with posterior pole lesion (66%) was a common clinical sign found. Medications given were trimethoprim-sulfamethoxazole (51,3%), and corticosteroid (27.5%) as an adjuvant. The complication detected was cataract (13%). Conclusion: Ocular toxoplasmosis was mostly found in immunocompetent male patients, acquired, unilateral, and in the posterior pole. A good response was found by trimethoprim-sulfamethoxazole and corticosteroid medications.

Does PLEX® Elite 9000 OCT Identify and Characterize Most Posterior Pole Lesions in Highly Myopic Patients?

High myopia (HM) is defined as an axial length (AL) ≥ 26 mm that may result in various pathologies that constitute pathologic myopia (PM). The PLEX® Elite 9000 (Carl Zeiss AC, Jena, Germany) is a new swept-source optical coherence tomography (SS-OCT) underdevelopment that allows wider, deeper and more detailed posterior-segment visualization; it can acquire ultra-wide OCT angiography (OCTA) or new ultra-wide high-density scans in one image. We assessed the technology's ability to identify/characterize/quantify staphylomas and posterior pole lesions or image biomarkers in highly myopic Spanish patients and estimate the technology's potential to detect macular pathology. The instrument acquired 6 × 6 OCTA, 12 × 12 or 6 × 6 OCT cubes, and at least two high-definition spotlight single scans. A hundred consecutive patients (179 eyes; age, 51.4 ± 16.8 years; AL, 28.8 ± 2.33 mm) were recruited in one center for this prospective observational study. Six eyes were excluded because images were not acquired. The most common alterations were perforating scleral vessels (88.8%), classifiable staphyloma (68.7%), vascular folds (43%), extrafoveal retinoschisis (24%), dome-shaped macula (15.6%), and more uncommonly, scleral dehiscence (4.46%), intrachoroidal cavitation (3.35%), and macular pit (2.2%). The retinal thickness of these patients decreased, and the foveal avascular zone increased in the superficial plexus compared with normal eyes. SS-OCT is a novel potent tool that can detect most main posterior pole complications in PM and may provide us with a better understanding of the associated pathologies; some pathologies were identifiable only with this new kind of equipment, such as perforating scleral vessels, which seem to be the most common finding and not so frequently related to choroidal neovascularization, as previously reported.

Multimodal Imaging of Severe Oxalate Retinopathy in a 20-Month-Old Boy

Primary hyperoxaluria type 1 (PH1) is a rare disease due to alanine glyoxylate aminotransferase enzyme deficiency caused by mutations in AGXT gene. Increased oxalate causes crystalline deposits in the eye particularly in conjunctiva, cornea, iris, retina, and choroid. A 20-month-old boy was referred with a diagnosis of infantile PH1. There were numerous yellowish crystalline deposits at the posterior pole and hyperpigmented lesions were detected around the macula. Enhanced depth imaging optical coherence tomography (EDI-OCT) revealed dome-shaped retinal pigment epithelium elevations, subretinal and intraretinal hyperreflective material and also choroidal hyperreflective lesions. To the best of our knowledge, this is the first case to document choroidal deposition by EDI-OCT at such an early period of life. [Ophthalmic Surg Lasers Imaging Retina 2022;53:697-700.].

Choroidal haemangioma and its multimodal diagnosis: A case report

AbstractPurpose: To describe the clinical manifestations and diagnosis of choroidal haemangioma with the aid of different multimodal images, as well as its usefulness for making a differential diagnosis.Methods: A case of a patient who comes due to blurred vision is described, who underwent different complementary tests of multimodal images: optical coherence tomography (OCT), fluorescein angiography (FA), indocyanine green angiography (ICGA), autofluorescence (AF), ultrasound eye exam and retinography to achieve the accurate diagnosis.Results: We present the case of a 50‐year‐old patient who debuted with recently‐onset blurred vision in the left eye (LE). In the eye fundus of LE, a yellow‐orange temporal‐inferior lesion of 3 disc diameter (DD) with neurosensory detachment of 4 DD that affects the fovea is observed. An OCT is performed that shows a choroidal mass associated with subretinal and intraretinal fluid with hyperrefringent points, the B‐scan ultrasound shows a hyperechoic lesion in the posterior pole, and both ICGA and FA reveal a hyperfluorescent pattern in all its phases, being the choroidal vessels of better visualization in the latter phase (without double vascularization pattern). AF shows hyperautofluorescence. After the definitive diagnosis of choroidal haemangioma, he was referred for treatment with Argon laser with favourable results.Conclusions: Choroidal haemangioma is a rare benign vascular tumour that occurs in middle‐aged adults and can be circumscribed (CCH) or diffuse depending on its extension. For the diagnosis of intraocular tumours it is very important to make a good differential diagnosis with the help of multimodal images: OCT, FA, ICGA, AF, Ultrasound and retinography; in order to differentiate it from similar posterior pole lesions with worse prognosis. CCH itself is benign and asymptomatic, and its treatment consists of observation; but it can present inflammatory signs with subretinal fluid and affect the macular area and therefore a more invasive treatment is indicated.References.1. Singh AD, Kaiser PK, Sears JE. Choroidal hemangioma. Ophthalmol Clin North Am. 2005;18(1):151–61, ix.2. Berry M, Lucas LJH. Circumscribed choroidal hemangioma: A case report and literature review. J Optom. 2017;10(2):79–83.

Recurrent and De Novo Toxoplasmosis Retinochoroiditis following Coronavirus Disease 2019 Infection or Vaccination.

This study reports three cases of toxoplasmosis retinochoroiditis following coronavirus disease 2019 (COVID-19) infection or vaccination from the national Canadian COVID-19 Eye Registry between December 2020 and September 2021. A 56-year-old male presented 15 days after a positive COVID-19 test with toxoplasmosis retinochoroiditis. He later relapsed 8 days following a first Pfizer-BioNTech vaccine dose. Two patients presented with toxoplasmosis retinochoroiditis following COVID-19 vaccination: A 58-year-old female presenting 4 days following a first Pfizer-BioNTech vaccine dose with anterior uveitis and a posterior pole lesion discovered 3 months later and a 39-year-old female presenting 17 days after a first Moderna vaccine dose. Resolution was achieved with oral clindamycin, oral trimethoprim/sulfamethoxazole, and topical prednisolone acetate 1%. Patients were offered prophylactic trimethoprim/sulfamethoxazole for subsequent doses without relapse. Following COVID-19 infection or vaccination, patients may be at risk for toxoplasmosis retinochoroiditis. Prophylactic antibiotics for future doses may be offered to patients with known ocular toxoplasmosis to prevent recurrence.

Endoscopic Ultrasonography-Guided Fine Needle Aspiration of Kidney Masses

Scan the quick response (QR) code to the left with your mobile device to watch this article's video abstract and others. Don't have a QR code reader? Get one by searching 'QR Scanner' in your mobile device's app store. clinical management strategy is based on imaging features. A solid, contrast-enhancing renal mass seen on CT or MRI is considered malignant until proven otherwise, and operative resection is undertaken in appropriate candi- dates. A histologic diagnosis remains necessary in selected patients, such as those with radiographically indetermi- nate lesions, in those considering partial nephrectomy, and to confirm malignancy in patients unfi tf or surgery. Tissue diagnosis is critical to discern appropriate treat- ment in this subgroup. Renal biopsies are usually per- formed percutaneously under transabdominal ultrasound (US) or CT guidance. Percutaneous fine needle aspiration (FNA) can discriminate benign from malignant neoplasms in 91% of cases with histologic classification of tumor type possible in 87% of tumors. 2 Nondiagnostic/inade- quate specimens are largely owing to sampling error and occur in about 30% of cases. Data from case reports and series suggest endoscopic ultrasound (EUS)-guided FNA may provide an additional diagnostic technique for tissue acquisition of renal mass lesions.

Visual Outcome in Ocular Toxoplasmosis: A Case Series of 30 Patients from Ghana

Purpose: To determine visual outcome (low vision and blindness) in patients with inactive ocular toxoplasmosis. Methods: This study employed a cross sectional design involving a series of 30 patients with inactive toxoplasmic ocular lesions. Ophthalmic assessment including best corrected visual acuity (BCVA) measurement, slit lamp biomicroscopy, and dilated fundus examination by indirect ophthalmoscopy was performed on all participants. Ocular toxoplasmosis was diagnosed based on characteristic retinal lesions in addition to a positive serologic testing using commercial ELISA kits. Visual impairment (VI) was determined based on the International Classification of Diseases. Results: Their ages ranged from 16-59 years (mean age of 34.2 ± 14.19), with 19 (63.3%) males and 11 (36.7%) females. There were 33 infected eyes in all (3 patients had bilateral cases). The most common complaint (77%) was blurred vision in the infected eyes. 11 (33%) eyes had mild or no visual impairment (VI category 1), 22 (67%) eyes had low vision (VA<6/18), and 11 (33%) eyes were blind (VA<3/60). Posterior pole (p<0.001) and larger retinal lesions (p=0.04) were the major causes of visual impairment. However, there was no association between visual impairment and the number of lesions occurring in the infected eyes (χ2=3.52, p=0.11). Older patient age was significantly associated with: posterior pole lesions (0.003), larger retinal lesion sizes (p=0.001) and multiple lesions (p=0.001). Only three cases each of strabismus and bilateral involvement suggest that acquired infection is more common in this Ghanaian population. Conclusion: Low vision and blindness were common in Toxoplasma eye infection in our Ghanaian population and that posterior pole and larger retinal lesions rather than multiple lesions were the major causes of reduced vision.

Managing fetuses at high risk of retinoblastoma: lesion detection on screening MRI.

This study aimed to describe tumour identification on magnetic resonance imaging (MRI) in a 35-week fetus with familial retinoblastoma (RB) and report the use of prenatal ultrasound (US) and MRI screening in the management of fetuses at high risk of RB. This is a retrospective review of the prenatal course and immediate postnatal findings in all children considered at high risk of RB who had prenatal imaging with both US and MRI at our institution over a 5-year period. Five patients met the inclusion criteria. No lesions were identified on US in any patients. Fetal MRI identified bilateral posterior pole lesions in one patient at 35 weeks' gestation. Of the four remaining patients, three developed lesions by 5 weeks of age. Only one fetus was delivered early following detection of RB. We present the first reported case of RB detected in a high-risk fetus on screening MRI at 35 weeks' gestation. A protocol for screening this population using both imaging modalities is presented.

Inflammatory choroidal neovascularization

Purpose and Methods:Choroidal neovascularization (CNV) can be a severe sight-threatening sequela, which can be secondary to both infectious and noninfectious uveitis. This review summarizes the different diseases associated with CNV, highlighting new treatment modalities and the possible strategies, which could be applied for the therapy of this occurrence. Results:Since CNV can often originate from posterior pole lesions and can be hard to identify, an accurate examination is mandatory in order to identify the correct diagnosis. In the majority of cases, fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) enable the determination of the clinical characteristics of the CNV. An infectious disease should be looked for to include a suitable therapy when available. The treatment strategy for CNV secondary to noninfectious uveal inflammations should be directed at controlling the inflammatory process. Systemic corticosteroids with or without immunosuppressive agents are indicated even when the CNV occurs with apparently inactive uveitis: Chronic subclinical inflammation can be the basis for the pathogenesis of CNV. Additional therapies aimed directly at the neovascular process, such as the intravitreal anti-Vascular Endothelial Growth Factor (VEGF) agents, are recommended particularly when the therapy shows an insufficient response.Conclusion:CNV secondary to uveitis is a severe sequela leading to significant visual impairment. ICGA is mandatory in order to obtain relevant information about the choroidal status. Several therapeutic options have been considered, but no guidelines are provided at the moment. Moreover, the current data are still only based on case reports or small series. For such reasons, further trials are mandatory to validate the preliminary available results.

Follow up of a slowly growing melanocytic lesion during 12 years

Abstract Purpose We report an atypical case of a very slowly growing and rather flat pigmented lesion in the posterior pole. Methods A women 53 years old at presentation, was followed during more than 12 years for a posterior pole lesion. Periodical fundoscopy, fluoangiography, ICG angiography and ultrasounds were performed. After enucleation in 2008, the definitive diagnosis was made after histopathologic examination. Results Visual decrease because of macular oedema in the left eye was the reason for referral. Fundus examination and fluo‐angiography revealed a slowly enlarging subretinal lesion with abnormal pigmentation and leakage with signs of chronic neurosensory detachment; ultrasound examination showed a cystic lesion with macular oedema. The lesion increased very slowly in thickness until a maximum of 1.5mm. Finally a chronic retinal detachment caused an intractable neovascular glaucoma and necessitated enucleation in 2008. Histopathology showed a diffuse proliferation of small spindled melanocytes with bland, uniform nuclei lacking mitotic activity with some small nests of larger, haevely pigmented epitheloid melanocytes with nuclear pleimorphism, embedded in collageneous matrix. The cell proliferation marker Ki67 showed only rare tumor cells with immunoreactive nuclei,indicating a very low fraction of cycling tumor cells. Other immunohistochemical markers are currently performed in order to elucidate the biological behaviour. Conclusion This case shows a unusually slowly growing lesion with classical histological features of melanoma and suggests the existence of a type of ocular melanoma of extremely low grade malignancy. Further phenotypical profiling is warranted in order to understand the cause of this "benign" behaviour.

Clinical Experience with Trimethoprim - Sulfamethoxazole and Prednisolone in the Treatment of Ocular Toxoplasmosis with Zone -1 Posterior Pole and Peri-papillary Lesions

To evaluate the efficacy of trimethoprim- sulfamethoxazole and oral prednisolone in the treatment of ocular toxoplasmosis with zone-1 posterior pole and peri-papillary lesions. Retrospective evaluation of records of patients in our tertiary care referral hospitals. 22 eyes of 21 patients with active toxoplasma retino-choroiditis in zone -1 posterior pole and peri-papillary areas were included in the study. One patient developed active lesion in the fellow eye after 6 months which regressed after re-institution of the treatment. There were 11 females and 10 males. Age varied between 18–52 (mean age 29 ± 8.8) years. The follow-up period varied between 4- 46 (mean 15 ± 11) months. All patients showed resolution of retino-choroiditis and improvement of visual acuity between 1-9 lines (mean 4.18 lines± 2.3).The mean lesion size pre-treatment was 0.89 disc diameters±0.3 and post-treatment was 0.70 disc diameters±0.28. The mean time taken for the sharpening of lesion borders was 2.3 ± 0.4 (range 2–3) weeks. No complications reported with the medication. The combination of trimethoprim-sulfamethoxazole and prednisolone is quite effective in treating the patients with active vision threatening posterior pole and peri-papillary toxoplasmosis lesions.

Clinical Experience with Trimethoprim - Sulfamethoxazole and Prednisolone in the Treatment of Ocular Toxoplasmosis with Zone -1 Posterior Pole and Peri-papillary Lesions “Arabic abstracts”

Clinical Experience with Trimethoprim - Sulfamethoxazole and Prednisolone in the Treatment of Ocular Toxoplasmosis with Zone -1 Posterior Pole and Peri-papillary Lesions “Arabic abstracts”

Optical coherence tomography of a subretinal granuloma in simultaneous visceral and ocular larva migrans.

Ocular toxocariasis is usually a unilateral posterior uveitis in otherwise asymptomatic children. The authors report the rare occurrence of presumed ocular toxocariasis presenting as a juxtapapillary lesion in a 52-year-old woman with systemic manifestations of visceral larva migrans. A 52-year-old woman presented with blurred vision in her right eye for 2 months. She shared her bedroom with two puppies. Best-corrected visual acuity was 20/20 in both eyes; slit-lamp examination was unremarkable. Funduscopy revealed a whitish, elevated, juxtapapillary retinochoroidal lesion of approximately one disk diameter size with macular star formation. She also developed severe respiratory distress and diarrhea. An intense eosinophilia was detected. Investigation included a liver biopsy positive for Toxocara antigens upon staining with chromogen 3,3'-diaminobenzidin and anti-Toxocara immunoglobulin G >10,240 (enzyme-linked immunosorbent assay). Treatment with albendazole and corticosteroids was implemented. Third generation optical coherence tomography (Stratus Tomographer, Model 3,000, Carl Zeiss Ophthalmic Systems, Inc., Dublin, CA) (OCT) of the macular area was unremarkable, except for a slight increase in retinal thickness as it approached the inflammatory lesion. Two months after treatment, there was a hypopigmented scar with localized condensed vitreous opacities. The OCT demonstrated traction along the vitreoretinal interface as the inflammation waned. A conservative approach was maintained as visual acuity remained stable. OCT imaging may offer a practical means of locating and staging posterior pole lesions due to ocular toxocariasis.

Risk of Visual Impairment in Children with Congenital Toxoplasmic Retinochoroiditis

Reliable information is needed to counsel parents of children with congenital toxoplasmosis regarding the long-term risk of visual impairment resulting from ocular toxoplasmosis. Prospective cohort study of children with congenital toxoplasmosis identified by prenatal or neonatal screening. After three years of age, ophthalmologists reported the site of retinochoroidal lesions and visual acuity and parents reported visual impairment. An ophthalmologist predicted the child's vision based on the last retinal diagram. Selection biases were minimized by prospective enrollment and data collection, high rates of follow-up, and exclusion of referred cases. Two hundred and eighty-one of 284 infected children who underwent ophthalmic examinations were followed up to a median age of 4.8 years. One in six children (49/281; 17%) had at least one retinochoroidal lesion, two-thirds of whom (32/49; 65%) had a lesion at the posterior pole. In children with retinochoroiditis who had visual acuity measured after 3 years of age, 94% (31/33) had normal vision in the best eye (6/12 Snellen or better), as did 91% of those with a posterior pole lesion (21/23). Analyses based on affected eyes showed that 42% (29/69) had a posterior pole lesion, of which just more than half (15/29, 52%) had normal vision, as did 84% (16/19) of eyes with a peripheral lesion alone. Vision predicted by the ophthalmologist was moderately sensitive (59%) but overestimated impairment associated with posterior pole lesions. Of 44 children with information on acuity, four (9%) had bilateral visual impairment worse than 6/12 Snellen. Severe bilateral impairment occurred in 9% of children with congenital toxoplasmic retinochoroiditis. Half the children with a posterior pole lesion and one in six of those with peripheral lesions alone were visually impaired in the affected eye.

Peripheral and posterior pole retinal lesions in association with high myopia: a cross-sectional community-based study in Hong Kong

To evaluate the prevalence and factors associated with posterior pole and peripheral retinal lesions in Chinese subjects with high myopia. Three hundred and thirty-seven asymptomatic adults with high myopia of refractive error <or=-6 D were examined in a cross-sectional community-based study. All subjects underwent cycloplegic refraction, ultrasound biometry and dilated fundal examination. Statistical analysis was performed to assess factors associated with the presence of posterior pole and peripheral retinal lesions. The mean age of the 337 subjects was 36.0 years and the mean spherical equivalent refractive error was -10.2 D. Thirty-eight eyes (11.3%, 95% CI=8.1-15.2%) were found to have one or more posterior pole lesions and subjects with posterior pole lesion had significantly older age, longer axial length and higher degree of myopia (all P<0.001) compared with subjects without posterior pole lesion. After controlling for axial length, both the severity of refractive error and older age were significantly associated with the presence of posterior pole lesion (both P<0.001). For peripheral retinal lesions, 189 eyes (56.1%, 95% CI=50.6-61.5%) were found to have one or more peripheral retinal lesions. The presence of peripheral retinal lesion was associated with younger age and higher degree of refractive error (P=0.046 and 0.002, respectively). Posterior pole and peripheral retinal degenerative lesions were found in a considerable proportion of subjects with high myopia. As some of these retinal lesions might predispose to visual impairment, highly myopic individuals should be educated on the symptoms of various eye conditions and seek care immediately if symptoms arise.

Acute Posterior Multifocal Placoid Pigment Epitheliopathy After Acute Group A Streptococcal Infection

We studied a case of acute posterior multifocal placoid pigment epitheliopathy in a 40-year-old man who had had an acute febrile illness. The medical record was reviewed for clinical manifestations, course of disease, and laboratory findings, including results of fluorescein and indocyanine green angiography. The patient had the typical clinical course of acute posterior multifocal placoid pigment epitheliopathy with spontaneous resolution of posterior pole lesions and improvement in visual acuity from 20/60 to 20/20. The laboratory evaluation was remarkable for a rise in the anti-DNAse B antibody titer between initial and convalescent-phase serum samples, providing evidence of recent group A streptococcal infection. Although acute posterior multifocal placoid pigment epitheliopathy is often attributed to a postviral condition, this syndrome may also develop after an acute group A streptococcal infection.

Pigmentary irregularities and optic disc edema after heart transplantation.

To determine the prevalence of chorioretinal lesions and optic disc edema after heart transplantation and to study potential associations. One hundred one patients who had undergone heart transplantation at one institution and 19 patients prior to heart transplantation underwent ophthalmological examination, including fundus photography. The prevalence of fundus lesions was then compared between the two groups. With a standardized protocol, the presence of optic disc edema, chorioretinal hyperpigmentation and depigmentation, retinal hemorrhages, cotton-wool lesions, and arteriovenous nicking was graded on color transparencies. The prevalence of optic disc edema and hypopigmentations was significantly higher among the transplant recipients than among the patients prior to heart transplantation (31% vs 5%, P = .01, and 55% vs 11%, P < .001, respectively). Hyperpigmentation was only present in patients after transplantation (15% vs 0%, P = .06). Heart transplant recipients showed an increased risk of hyperpigmentations after 2.5 years. Acute rejection episodes were not associated with posterior pole lesions. Common posterior pole lesions after heart transplantation are optic disc edema and pigmentary changes. Although visual acuity does not seem severely impaired, further longitudinal study is necessary to evaluate the long-term significance of these lesions.

Cone Pigments in Acute Posterior Multifocal Placoid Pigment Epitheliopathy

We measured cone pigment density and kinetics with a reflection retinal densitometer during the evolution and resolution of posterior pole lesions in a 17-year-old patient with acute posterior multifocal placoid pigment epitheliopathy. Three weeks after onset, density was markedly reduced and regeneration complex and nonexponential. Pigment density increased, and kinetics returned to normal as the disease resolved.