We recently reported that fellow eyes of patients with unilateral neovascular AMD have on average foveal cone ERG amplitudes that are normal, but implicit (peak) times that are slower than normal.'0 Since a defect in choroidal filling is apparently common in patients with AMD'-3 and is associated with visual dysfunction,46 we investigated whether this angiographic finding was also related to the slowed foveal ERG seen in the fellow eyes of patients with the unilateral neovascular form. MethodsWe evaluated the fellow eyes of 67 patients (ages 61 to 89) with unilateral neovascular AMD. These patients were part of a larger group with unilateral neovascular AMD who are being followed prospectively with foveal cone ERGs and other tests of cone function to predict who will develop a choroidal neovascular membrane in the fellow eye; demographic characteristics and ocular findings of this larger group have been described previously." Eligibility criteria for the present report included a corrected Snellen visual acuity of 20/60 or better, sufficiently clear media to allow detailed evaluation of the fundus, macular drusen, and no sign of other retinal disease in the study eye.These study eyes had a foveal cone ERG recorded and had angiograms of clear, readable quality throughout the transit. The angiograms were read by two of the authors JCR and ARG), masked with respect to results of foveal cone electroretinography, to identify those angiograms with a prolonged choroidal filling phase; the latter was characterised by a non-uniform fluorescence extending over at least 5 disc diameters of the posterior pole persisting through the onset of the venous phase of the retinal circulation. 1Foveal cone ERGs were elicited with a 40 white stimulus flickering at 42 Hz presented by a hand held, dual beam stimulator ophthalmoscope (Maculoscope, Doran Instruments, Littleton, MA, USA) as previously described.'0 12 Responses were monitored with a contact lens electrode, amplified, filtered, digitised, summed, and quantified by Fourier analysis with respect to amplitude and phase; phase was then converted to implicit time (that is, time interval from stimulus onset to the corresponding cornea positive response peak). AbstractAimsBackgroundBerman-Gund
We reviewed cases of a paraneoplastic syndrome in which uveal melanocytes proliferated and led to blindness. Eighteen cases were derived from the literature, and two were taken from our institution. The average patient age at the time of the diagnosis was 63 years (range, 34-89 years). There were 13 women and 7 men. In approximately half of the cases, the ocular symptoms antedated those of the inciting tumor. Most of the inciting tumors were poorly differentiated carcinomas. The most common tumors were from the female genital tract (ovary and uterus) among the women patients and from the lung among the men. Tumors from the breast were rare (one possible case), and tumors of the prostate were conspicuously absent. All five inciting tumors whose histopathology was reviewed expressed neuron-specific enolase, but none prominently expressed antigens more specific for neuroendocrine carcinomas such as chromogranin or synaptophysin. It is our experience that many general pathologists are not aware of this unique paraneoplastic syndrome. Our report is the first to document a statistically significant association between this syndrome and gynecologic cancers.
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