Mano Swartz

Macular degeneration associated with age and drusen, an important cause of severe visual loss in older persons, is of unknown cause. The sensory retina and retinal pigment epithelium, which are cell layers in zinc, appear to be prominently involved in the disease process. Because zinc plays a role in the metabolic function of several important enzymes in the chorioretinal complex, we undertook a prospective, randomized, double-masked, placebo-controlled investigation of the effects of oral zinc administration on the visual acuity outcome in 151 subjects with drusen or macular degeneration. Although some eyes in the zinc-treated group lost vision, this group had significantly less visual loss than the placebo group after a follow-up of 12 to 24 months. This is the first controlled oral intervention study to show a positive, if limited, treatment effect in macular degeneration, a major public health problem. Because of the pilot nature of the study and the possible toxic effects and complications of oral zinc administration, widespread use of zinc in macular degeneration is not now warranted.

A 63-year-old female on long-term, high-dose tamoxifen treatment for metastatic breast cancer developed bilateral intraretinal refractile opacities, lesions at the level of the retinal pigment epithelium, and cystoid macular oedema.

The incidence of progression of diabetic retinopathy during pregnancy is unknown and its proper management uncertain. In this study, 55 insulin-dependent diabetic patients under strict glucose control were followed throughout pregnancy with serial retinal examinations by ophthalmoscopy and photographs. Nineteen patients had minimal or background retinopathy and 7 had untreated proliferative changes. Six patients had been treated before pregnancy with photocoagulation for proliferative retinopathy. A positive correlation was found between progressive proliferative diabetic retinopathy and the duration of diabetes mellitus independent of glucose control. During gestation 3 of 19 patients (16%) with minimal or background retinopathy and 6 of 7 patients (86%) with untreated proliferative retinopathy experienced deterioration of their eye disease. In 4 patients with proliferative retinopathy, progression of retinal disease was arrested with photocoagulation during pregnancy. Only 1 of 6 who had received laser treatment prior to pregnancy experienced progression of her retinopathy. These results suggest that photocoagulation prior to pregnancy may protect against rapidly progressive proliferative retinopathy and that aggressive treatment during pregnancy can prevent progression of proliferative retinopathy and visual impairment.