RETINAL DETACHMENT REPAIR

 Above is a montaged Optomap image of a left eye that has undergone retinal detachment surgery with the placement of a scleral buckle.  There is an large artifactual shadow on the left side but the ring shadow over the macula is from a posterior subcapsular cataract that has developed subsequent to the surgery. 

 This is an autofluorescence picture of the same eye.  It clearly delineates the boundaries of the orginal retinal detachment in the nasal retina, barely sparing the macula.  The patient's vision is 20/25, even with the cataract present. 

CONGENITAL HYPERTROPHY OF THE RETINAL PIGMENT EPITHELIUM (CHRPE)

VITREOMACULAR TRACTION

Above is a scan that demonstrates the vitreomacular traction progression over a two and a half year period of time.  The patient's visual acuity is still 20/25. 

WEDGE DEFECT REVEALS NERVE FIBER LOSS

A 69 year old man presented with a history of cataract surgery for a routine eye examination with no complaints.  His visual acuity was 20/20 in each eye.  He has minimal optic nerve cupping and 15mmHg intraocular pressure in each eye.  There would normally be no suspicion of  glaucoma given this data. 

An Optomap image of the right fundus revealed a suspicious looking wedge defect superiorly.

An optical coherence tomography revealed an interesting dip in the retinal nerve fiber layer in the same area as the wedge defect.  The macular ganglion cell scan showed no thinning.  To treat or not to treat?

STARGARDT'S MACULAR DYSTROPHY

Stargardt disease is an inherited disorder of the retina. For most people, vision loss progresses slowly over time to 20/200 or worse. (Normal vision is 20/20).

People with the disease might notice gray, black, or hazy spots in the center of their vision, or that it takes longer than usual for their eyes to adjust when moving from light to dark environments. Their eyes may be more sensitive to bright light. Some people also develop color blindness later in the disease.

Autosomal recessive mutations account for about 95 percent of Stargardt disease. 

Currently, there is no treatment for Stargardt disease. Some doctors encourage people with Stargardt disease to wear dark glasses and hats when out in bright light to reduce the buildup of lipofuscin. Cigarette smoking and second hand smoke should be avoided. Supplements containing more than the recommended daily allowance of vitamin A should be avoided. There is no need to worry about getting too much vitamin A through food.

Stem cell-based therapies are showing promise for Stargardt disease in clinical trials. A U.S. company called Advanced Cell Technology (ACT) is conducting a trial of retinal pigment epithelium (RPE) cells for AMD and Stargardt disease. 

Below are photos of the macula of a 60 year old female with Stargardt's Disease.  Fortunately, her visual acuity has stabilized at 20/40.  Autofluorescence images are included.  

LONGSTANDING MACULAR HOLE

The photo above is autofluorescence in each eye.  The left shows hyperautofluorescence in the  are of the macular hole.  

 Here is the color photo of the macular hole in the left eye. 

Here is the Optical Coherence Tomography (OCT) retina map demonstrating the full thickness hole. 

COMMOTIO RETINAE WITH VITREOUS HEMORRHAGE

This is the superior retina of a young man who got hit in the eye with a soccer ball.  The young man see's 20/20 still, since the macula is uninvolved.  We will look for eventual resolution over weeks to months, while monitoring closely for retinal tears, holes, or detachments. 

 The white area is commotio retinae, in a sense it's a bruised retina.  You can see retinal hemorrhages and the darker spots are actually vitreous hemorrhages.  There does not appear to be a retinal tear, either with the Optomap image or with a dilated eye exam. 

The second picture is 9 days after the first photo.  The dark areas are actually blood in the vitreous, which was present at the first visit, but the commotio retinae is mostly resolved.

CONGENITAL HYPERTROPHY OF THE RETINAL PIGMENT EPITHELIUM (CHRPE)