Faculty Bibliography

Objective: To define the functional deficit that correlates with the inner layer separation and the outer layer detachment that have been observed in optic pit maculopathy and to determine the effect of a gas tamponade that compresses or displaces the two layers. Design: The central visual field before and after a gas tamponade on the posterior pole were charted on a 1-m tangent screen and compared with the changes in the retina observed biomicroscopically and with stereophotography. Setting: The gas operations were done at four hospitals in the New York, NY, area and one in Cleveland, Ohio. The retinal examinations, visual field testing, and stereoscopic photography for eight patients were done at The New York Hospital. The patient who lived in Cleveland was examined and photographed in Cleveland. Participants: Nine patients between the ages of 18 and 46 years with optic pit maculopathy. Intorvention: The patients were operated on by five retinal surgeons with a variety of procedures. Four patients had a vitrectomy and intraocular gas injected. Five patients had gas injected after external compression. Two patients had laser applied in conjunction with the intraocular injection. The gas tamponade was the unifying factor. Results: The dense central scotoma in optic pit maculopathy relates to the outer layer detachment and displacement of it from the posterior pole yields an improvement in visual acuity. The inner layer separation persists centrally after a gas tamponade and continues to provide access for the flow of fluid from the pit. The scotoma that relates to the inner layer separation is mild and consistent with relatively good visual acuity. $$:

A 51 year old man with biopsy proven pulmonary sarcoidosis and skin test positive for tuberculosis presented with features of an amelanotic flat choroidal mass suggestive of choroiditis. The mass enlarged despite corticosteroids and anti-tuberculous medications. A thorough systemic evaluation for possible primary tumor metastatic to the choroid was negative. Further clinical evaluation and magnetic resonance imaging suggested a diffuse primary choroidal malignant melanoma with optic nerve invasion. The eye was enucleated and the mass proved histopathologically to be a mucin secreting adenocarcinoma of unknown origin despite a repeat systemic work-up. The patient died three months after the onset of symptoms and three weeks after enucleation with diffuse metastases from an unknown primary cancer. Magnetic resonance imaging (MRI) is usually helpful in the differentiation of uveal melanoma from uveal metastasis. In this case, however, it suggested the diagnosis of a diffuse choroidal melanoma. The reason for the atypical MRI findings will be discussed

The evaluation of the posterior vitreoretinal interface is important in the study of the natural course and preoperative evaluation of numerous disorders of the retina. The exact status of the posterior vitreous cannot always be reliably determined by ophthalmoscopic examination. The diagnostic value of kinetic contact ultrasonography was investigated to evaluate the status of the posterior vitreous in 70 eyes with clear ocular media. Contact B-scan ultrasound provided an extremely accurate method for evaluating the posterior vitreoretinal interface in 69 of the 70 eyes in this study, when compared with all conventional clinical means of examination including slit-lamp biomicroscopy with the Goldmann contact lens and fundus photography with the El Bayadi-Kajiura lens. Contact B-scan ultrasonography is an important diagnostic adjunct in determining the status of the vitreoretinal interface

A series of young adult patients developed solar retinopathy during sun exposure over a two-day period in a particular region of the United States during March of 1986. Evaluation of the photobiological and geophysical parameters involved in solar retinitis are presented. A multifactorial pathogenesis is proposed. Of interest, a possible increase in terrestrial ultraviolet B radiation secondary to a localized relatively low ozone column during the days involved may have contributed to the retinal damage. Recommendations for protection from solar retinitis are noted

Seventy-six consecutive patients with total rhegmatogenous retinal detachments and severe proliferative vitreoretinopathy underwent combined pars plana vitrectomy, lensectomy, panretinal photocoagulation, perfluoropropane gas (C3F8)/fluid exchange, and scleral buckling. Sixty-two (82%) of the patients had successful, sustained (greater than 12 months) posterior retinal reattachments at last examination. Of these 62 patients, 40 (65%) had complete retinal attachment, with no evidence of regrowth of periretinal membranes or redetachments following the initial procedure. In the remaining 22 cases with successful reattachment of the retina posterior to the equator, partial peripheral retinal detachments were observed. In 16 of the 22 cases, the detachments occurred entirely anterior to the boundary of the previously placed photocoagulation lesions. The posterior retina remained uninvolved, and no further treatment was needed. Reoperation was required in the other six patients to achieve sustained posterior retinal reattachment. Postoperative visual acuity ranged from 20/40 to bare light perception, with 69% of the anatomically successful cases obtaining functional visual acuity (greater than 20/400). Failures were related to reproliferation of fibrous membranes

One hundred fifty-seven patients with subretinal neovascularization (SRN) were treated in a prospective, nonrandomized, consecutive study with the krypton red laser (KRL). The patients were analyzed with respect to age, etiology of the SRN, location of the SRN, and pre- and post-treatment visual acuity in patients with at least three months follow-up. Previous studies have not investigated KRL photocoagulation within the foveal avascular zone (FAZ). The results of this study compare favorably with other large series in which patients with SRN located outside the FAZ were treated with the argon blue-green laser (ABGL)