Migratory white-without-pressure retinal lesions

[Degenerative lesions of the peripheral retina]

Degenerative lesions of the peripheral retina are present from teenage years onwards and increase with age. These abnormabilities are frequent, some of them being benign while others predispose to retinal tears and detachment. In the latter case, the lesions are rhegmatogenous and may justify prophylactic treatment by laser photocoagulation. We distinguish congenital lesions of the peripheral retina and intraretinal, chorioretinal and vitreoretinal degenerations. The holes and tears observed in 2% of the population consist of round atrophic holes, "horseshoe" tears, oral dialyses and giant tears.

[Which abnormalities can be detected in myopic peripheral retina?]

Vitreoretinal periphery in myopic eyes may present abnormalities whose frequency and severity are correlated with axial elongation of the eye: white-without-pressure, lattice degeneration, pigmentary degeneration, and paving stone degeneration. Sometimes one can find atrophic round holes, retinal breaks, or retinoschisis whose differential diagnosis with slow progressive retinal detachment can be made on the presence of an absolute field defect. The presence of peripheral vitreous strands, pigmentary migrations, holes, associated with extensive liquefaction of the central vitreous body and facial dysmorphy are symptomatic of Stickler syndrome often complicated with bilateral retinal detachments. Congenital hereditary retinoschisis should be raised in the presence of temporal and inferior bullous detachment of a thin inner layer of the retina associated with large multiple holes in a boy with poor vision and cystic macular changes. Examination of peripheral retina should be systematic after the age of 40 in myopic patients to specify the presence of abnormalities predisposing to retinal detachment. It is more important to inform the patient of posterior vitreous detachment or retinal detachment symptoms, a true emergency situation, rather than to suggest regular and repeated consultations in the nonsymptomatic eye.

Sickle cell retinopathy in Jamaican children: further observations from a cohort study

Serial retinal examinations were performed in children aged 5 years and older and fluorescein angiography/angioscopy in children 6 years and older participating in a cohort study of sickle cell disease. There were 1229 patient years of observation among 389 children aged 5-13 years. Peripheral retinal vessel closure was present in approximately 50% of children with SS and SC genotypes at age 6 years and increased to affect 90% of children by age 12 years. A matched pair analysis, comparing groups with minimal and complete closure, indicated that complete closure was associated with significantly lower total haemoglobin and fetal haemoglobin levels and significantly lower weight in SS disease, whereas in SC disease the risk factors appeared to be high mean cell volume and low platelet count. Proliferative retinopathy was rare, occurring only once in an 8-year-old boy with SC disease, despite 592 patient years of observation in children over this age.

Vascular leakage, neovascularization, and vitreous hemorrhage in senile bullous retinoschisis

Retinal detachment is the primary complication of bullous retinoschisis, a benign abnormality of the peripheral retina. We examined three patients (all women, 43, 55, and 56 years old) with typical bullous retinoschisis who had vitreous hemorrhage. In each case, there were sclerotic retinal vessels over the surface of the schisis cavity along with neovascularization above the central portion of the cyst. In one case there was also neovascularization of the peripheral retina in an area distant from the schisis. These findings were confirmed by fluorescein angiography in one case; the other two cases demonstrated similar changes by fluorescein angioscopy. Fluorescein angiography, also demonstrated intraretinal dye leakage from vessels along the posterior extent of the schisis, as well as from an adjacent area of white without pressure.

Ocular manifestations of sickle hemoglobinopathies

The ocular manifestations of sickle cell hemoglobinopathies, while often not severe enough to affect vision, may develop in proliferative stages, resulting in arteriolar-venular anastomoses, neovascular proliferations, vitreous hemorrhage and retinal detachment. The authors review the historical, biochemical, and geographic aspects of the disease, and provide detailed descriptions of findings in theconjunctiva, uvea and fundus, with particular emphasis on the retina. Pathogenesis, histopathologic and clinical appearance, and modes of treatment are discussed.

Peripheral retinal neovascularization in sarcoidosis and sickle cell anemia

A 30-year-old black woman with biopsy-proven sarcoidosis and sickle cell anemia had peripheral retinal neovascularization. Elevated fibrovascular proliferations and distal retinal ischemia with nonperfused ghost vessels passing through the area of neovascularization were found at the temporal periphery. No signs of intraocular inflammation were present. Both diseases occur in black patients and should always be considered in the presence of peripheral retinal neovascularization.