Aims-To determine the prevalence of polypoidal choroidopathy in consecutive patients presenting with large haemorrhagic and exudative neurosensory retinal and retinal pigment epithelial detachments (PEDs) of over 2 mm in diameter in the absence of drusen. Methods-40 patients were identified over a 5 month period of which 29 had haemorrhagic detachments, and 11 had purely exudative detachments. All had indocyanine green (ICG) angiography, and the presence was sought of large blood vessels in the choroid associated with localised dilated terminals that filled slowly and leaked ICG. Results-In 34 cases (85%) there was an appearance consistent with previous descriptions of idiopathic polypoidal choroidal vasculopathy. Of the six without polypoidal lesions the disorder was attributed to choroidal neovascularisation in four, chorioretinitis in one, and a fibrovascular PED in one. Of those with polypoidal lesions 20 (65%) were female, the mean age was 65.4 years (range 44-88), and 25 (74%) were white, seven (20%) black, and two (6%) east Asian. Eight had a history of hypertension. Visual acuity varied from 6/6 to counting fingers in the involved eye (mean 6/24). Bilateral polypoidal choroidal lesions were demonstrated in 16 patients (47%). The predominant location for these lesions was the macular region in 23 patients (68%). Polypoidal vasculopathy was found in 16 patients (47%) who had a previous diagnosis of age related macular disease (AMD). No patients had evidence of intraocular inflammation. Conclusions-In a largely white patient population a high proportion of patients with haemorrhagic and exudative PEDs has evidence of polypoidal lesions on ICG angiography. (Br J Ophthalmol 2000;84:479-484) In the past, haemorrhagic detachment of the retinal pigment epithelium (PED) has been considered a part of the spectrum of age related macular disease (AMD), occurring as a consequence of age changes at the level of Bruch's membrane. Several mechanisms have been invoked to explain the pathogenesis of a PED, including decreased hydraulic conductivity of Bruch's membrane, choroidal neovascularisation, and excessive exudation from the choroidal blood vessels. 1-3Polypoidal choroidal vasculopathy (PCV) as a cause of recurrent haemorrhagic and exudative PEDs and neurosensory retinal detachments was first described in 1982. 4 In the past, a variety of terms such as "posterior uveal bleeding syndrome" and "multiple recurrent retinal pigment epithelial detachments in black women" have been used to designate this disorder.5 6 It has characteristic morphological features that distinguish it from other exudative maculopathies, which include aneurysmal structures at the termination of a network of dilated choroidal veins associated with recurrent haemorrhage and leakage (Fig 1).The diagnosis of PCV is best made using indocyanine green (ICG) angiography because it permits visualisation of the choroidal vasculature following the initial transit of dye.7 The increasing availability of ICG angiography has permitted a better app...

The micropulse laser is a new development in laser therapy. Micropulsing is frequent short pulses of subthreshold intensity applied to retinal lesions. It has been shown to be effective in diabetic macular edema, branch vein occlusion, and drusen. Although the initial landmark studies showed it to be effective, the exact parameters have not been established. This article illustrates the current state of its use.

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Differential diagnosis included Behcet's disease, sarcoidosis, systemic lupus erythematosus, viral retinitis, and Eales disease. He did not have any systemic signs and symptoms such as oral aphtha, genital lesions, and skin lesions. The absence of these systemic symptoms and laboratory results indicative of autoimmune diseases excluded many of the aforementioned diseases, especially Behcet's disease. Viral retinitis will yield more severe exudates than preretinal or vitreous haemorrhage. It is uncommon in Eales disease that anterior uveitis and dense vitritis exist as seen in our case. 4 This patient and his father have HLA-B27, which is possessed only in 0.8% of the Japanese population. 1 His father had a past history of unknown uveitis. It is quite possible that his disease was also related to the haplotype of HLA-B27. Furthermore, HLA-B27 AAU occurs in B27positive members of the patients' families (approximately 10%) more frequently than in B27-positive healthy controls (1-2%). 5 Posterior segment involvement in HLA-B27-associated uveitis occurs somewhere between 4 and 17.4% in Caucasians. 2,6 Benitez del Castillo reported that the blood-aqueous barrier had been broken when HLA-B27-positive acute anterior uveitis was in active stage. 7 However, these cases usually have good responses to corticosteroid or immunosuppressive therapy. HLA-B27-associated uveitis in Japanese have also good visual prognoses. 8 However, there was no report of PVR despite intensive therapy. Our case, thus, verifies the fact that severe and refractory inflammation can happen in HLA-B27associated uveitis that could lead to the development of PVR in a short period.

The influence of diabetic dysregulation on refraction was analysed by a short-term and a long-term approach. a) Out of 15 patients admitted due to high blood sugars and followed over weeks, 11 showed refractive fluctuation of 1-6.5 D, in either direction-often with excess hypermetropia, while 4 appeared refractively stable. In those with refractive change a transient increase of lens thickness was suggested from ultrasound measurements. b) Diabetes control was evaluated retrospectively in 74 adult diabetics, mainly based on repeated 24 h urine glucose determinations over a 6-year period. As a group, those with low myopia did not score worse than those who had stayed emmetropic. Among the myopes, diabetes duration was longer in the subgroup where diabetes preceded myopia onset. - All considered, we found no support for dysregulation per se as an underlying factor behind the 'diabetic myopia' previously reported from our clinic.