Abnormal electro-oculograms from eyes with a malignant melanoma of the choroid.

Electro-oculograms (EOGs) were recorded from 14 patients with a malignant melanoma of the choroid, nine of which were histologically verified. Twelve of the 14 eyes (86%) with a malignant melanoma of the choroid had an EOG value that was considered borderline. One eye studied had a normal EOG value and a histologically verified malignant melanoma. EOGs were also recorded from a group of eight patients with a choroidal nervus. Five of these eight eyes had normal EOG values, two eyes had borderline EOG values, and one eye had an abnormal EOG value. The EOG value in eyes with a malignant melanoma of the choroid was inversely related to the size of the melanoma. Abnormal EOG values were obtained, however, from eyes lesions occupying only a few square millimeters.

Subretinal new vessels after krypton laser photocoagulation.

The eye of a patient with age-related macular degeneration was treated with krypton laser photocoagulation and later studied histopathologically. Five months after treatment the original membrane was completely obliterated, but a separate new membrane was found, which was fed by the retinal circulation and not by the choroid. The frequency of such recurrences is not known, but they may be related to krypton laser treatment.

Subretinal neovascularization associated with fundus flavimaculatus.

Hemorrhagic disciform degeneration centered in the fovea with serous detachment of the overlying neuroepithelium developed in two patients with fundus flavimaculatus. Fluorescein angiography disclosed the presence of subretinal neovascular membranes. There was no evidence of other diseases associated with subretinal neovascularization. Fundus flavimaculatus must be added to the growing list of diseases associated with subretinal neovascularization.

Retinal ischemia in diabetic retinopathy.

Eight patients with proliferative diabetic retinopathy developed extensive retinal arteriolar and capillary obstruction. Ophthalmoscopy showed many white, thread-like retinal arterioles associated with capillary and venous dilatation. Widespread retinal arteriolar and capillary nonperfusion was demonstrated by fluorescein angiography. Ischemic maculopathy resulted in severe loss of visual acuity in some eyes. The severe degree of retinal ischemia was accompanied by optic disc pallor and neovascularization and a high incidence of rubeosis iridis with neovascular glaucoma. Patients with this variety of diabetic retinopathy have a poor prognosis of retaining useful vision.

Immunocytochemical features of retinoblastoma in an adult.

OBJECTIVE: To describe the clinical course and immunocytochemical characteristics of an unusual intraocular tumor. METHODS: Immunocytochemical analysis of the enucleated eye with an intraocular mass that markedly waxed and waned in size during 1 year of close observation of a 29-year-old woman. RESULTS: Most of the tumor was composed of either dying or rapidly proliferating cells. One area located near the retina consisted mostly of well-differentiated cells in uniform sheets (bacillettes) with lacelike glial processes between the tumor cells. Almost all of the differentiated tumor cells were positive for S antigen. In particular, the dominant cell type stained positively for both antibodies known to be specific for those isoforms of S antigen found only in blue cones and rods but not in red or green cones. Only a few of these cells labeled positively with an anti-rhodopsin antibody. CONCLUSIONS: This is the first case of adult retinoblastoma to be confirmed immunocytochemically. The tumor was unusual because the differentiated regions contained bacillettes composed mostly of blue cones. It is possible that this and other adult retinoblastomas may arise from previously existing retinocytomas.

Clinicopathologic correlations in diabetic retinopathy. II. Clinical and histologic appearances of retinal capillary microaneurysms.

One eye of a 21-year-old patient with proliferative diabetic retinopathy was available for clinicopathologic correlation. The fluorescent spots in a fluorescein angiogram were correlated with the changes in color fundus photographs and with the corresponding histologic findings in a trypsin digest preparation of the retina. A round, regular fluorescent spot was the most reliable diagnostic indicator of retinal capillary microaneurysms, although some microaneurysms appeared as irregular fluorescent spots, tiny fluorescent spots, or dark silhouettes with or without fluorescent halos. Very large fluorescent spots correlated with very large irregular pouches that may represent intraretinal neovascularization. Fluorescein angiography was considerably more sensitive than color fundus photography for the detection of retinal capillary microaneurysms.

Abnormal chloroidal circulation: association with arteriovenous fistula in the cavernous sinus area.

Abnormalities in the choroidal circulation developed in two patients with arteriovenous fistulae in the area of the cavernous sinus. Fluorescein angiography in both patients revealed delayed filling of their choroidal circulation. In the first patient, this was associated with a central serous detachment of the retina secondary to a retinal pigment epithelial defect. In the second patient, a large choroidal detachment and serous retinal detachment, which resolved spontaneously developed. High venous pressure, low mean arterial pressure, and subsequent tissue hypoxia are postulated to be the cause of the altered choroidal circulation. The possibility of occult dural arteriovenous fistulae should be considered in the differential diagnosis in patients with a choroidal detachment, proptosis, and a red eye.

Pars plana vitrectomy. Treatment for tractional macula detachment secondary to proliferative diabetic retinopathy.

Pars plana vitrectomies were performed on 43 eyes with traction macular detachment secondary to proliferative diabetic retinopathy. Anatomic success, as judged by reattachment of the macula, occurred 28 (65%) eyes. Improved visual acuity occurred in 11 (26%) eyes. Severe complications occurring after vitrectomy included moderate to severe rubeosis iridis diabetica (28%), neovascular glaucoma (16%), vitreous hemorrhage (49%), and phthisis bulbi (14%). Eyes that received scatter photocagulation therapy at some time prior to macular detachment had a substantially lower incidence of successful postoperative reattachment of the macula than eyes never treated with photocoagulation.

Idiopathic reactive hyperplasia of the retinal pigment epithelium.

OBJECTIVES: To present and discuss 2 patients with acquired peripapillary pigmented lesions. METHODS: We reviewed the patients' clinical records and histopathologic findings. RESULTS: The first patient was diagnosed with a pigmented papillary lesion that was followed up for 38 years. The second patient was a child with neurofibromatosis type 1 who developed a pigmented peripapillary lesion following excision of an optic nerve glioma. Histologic findings in both cases demonstrated hyperplasia of the retinal pigment epithelium with associated findings. CONCLUSIONS: The lesions presented an idiopathic reactive hyperplasia of the retinal pigment epithelium. The clinical and histopathologic findings resemble findings reported with the combined hamartoma. We suggest that such lesions are reactive in nature, rather than hamartomatous.

Unplanned extracapsular cataract extraction in postvitrectomy eyes.

A 70-year-old man, a 59-year-old woman, and a 57-year-old woman underwent pars plana vitrectomy. In all three cases, cataracts developed in the eyes that had been operated on. During cataract extraction, which included massage of the globe after retrobulbar anesthesia and a conventional ab externo incision, loss of lens material into the vitreous cavity occurred in all three postvitrectomy eyes.

Postvitrectomy keratopathy.

Twenty-six of 75 eyes undergoing pars plana vitrectomy developed significant corneal complications requiring treatment. Slow or nonhealing epithelial abrasions, recurrent corneal erosion, and microcystoid and striate keratitis were among the most frequent problems. Significant predisposing factors included diabetes, surgical trauma such as epithelial debridement and prolonged operative time, aphakia, and postoperative glaucoma or hyphema. Corneal complications may be minimized with careful preoperative and operative precautions.

Diabetic papillopathy.

A 13-year-old girl and a 20-year-old man with juvenile-onset diabetes mellitus developed transient bilateral optic disk edema with minimal impairment of optic nerve function and with minimal diabetic retinopathy. This conditions, termed diabetic papillopathy appears to be a local optic disk vasculopathy, and generally resolves without treatment. Diabetic papillopathy should not be mistaken for papilledema or for the optic disk neovascularization of diabetic retinopathy.

Scleral buckling procedure for retinal detachments secondary to proliferative diabetic retinopathy.

Ninety-two patients (99 eyes) underwent scleral buckling procedures for retinal detachment associated with proliferative diabetic retinopathy. Fifty-three procedures were for rhegmatogenous retinal detachment and 46 for tractional retinal detachment. The average follow-up period was 38 months. Anatomic success was assessed in terms of closure of retinal breaks (59/69, 86%), macular reattachment (42/90, 46%), and reduction in extent of retinal detachment postoperatively as compared to preoperatively (62/99, 63%). The visual acuity was better postoperatively in 33/99 (34%) of the eyes; 58/99 (58%) of the eyes maintained finger counting visual acuity. Improvement in visual acuity was more frequent in eyes with rhegmatogenous detachment (23/53, 43%) than in those with traction detachment (10/46, 22%). Although improvement is generally limited, some patients are markedly benefitted by scleral buckling procedures.

A review of linguistic factors associated with early childhood stuttering.

This paper summarizes recent thinking on several aspects of early childhood stuttering. The concept of fluency is examined, and a review of research that traces the acquisition of fluency in young children and its relationship to language acquisition is presented. Other topics considered are the relationship of normal childhood nonfluencies to early stuttering, stuttering as it relates to language acquisition, and psycholinguistic influences on stuttering in young children.

Perception of stress contrasts in semantic and nonsemantic contexts by children.

Using 140 subjects (20 children each from kindergarten through the sixth grade), this study followed the developmental trends of children on two tasks involving the perception of stress contrasts. Task I consisted of discriminating whether two syllables in bisyllabic nonsense words have the same or different stress patterns. Task II consisted of sentence pairs, for half of which the first sentence in each pair provided appropriate lexical as well as stress patterns for the second sentence. The first sentence in the remaining sentence pairs provided the appropriate lexical context but an inappropriate stress context for the second sentence. Subjects were to evaluate whether members of each sentence pair sound "good together' or "not good together.' Results yielded remarkable lawfulness in the developmental trends for both tasks, and were discussed in terms of children's perception of stress contrasts in semantic vs. nonsemantic conditions.

Pars plana vitrectomy. Vitrectomy in diabetic retinopathy.

In spite of the rather high rate of complications, it is clear that in selected cases of proliferative diabetic retinopathy with massive long-standing vitreous hemorrhage, significant improvement can be accomplished by pars plana vitrectomy. However, the number of eyes recovering 20/40 vision or better remains small (7% in our series at 9 to 15 months postvitrectomy), and consideration needs to be given to means to improve these figures. Whether vitrectomy at an earlier stage of the retinopathy can accomplish this is the subject of an upcoming cooperative study under the sponsorship of the National Eye Institute.

A method for recording vitreoretinal relationships.

A method for recording vitreoretinal relationships is described. The system includes designations for the extent and height of posterior hyaloid detachment and for sites of abnormal vitreoretinal adhesions. The method may be used for preoperative evaluation of eyes prior to vitrectomy surgery or for the follow-up of patients with vitreoretinal disease.