Argon endophotocoagulation with indirect ophthalmoscopy.

Argon endophotocoagulation may not be possible in some eyes due to the poor view afforded by the operating microscope. This limitation is avoided by viewing through argon filter goggles with the indirect ophthalmoscope while applying treatment with the endophotocoagulation argon laser probe through a pars plana entry site. This method has proved particularly helpful in the gas-filled eye, for treatment over a preexisting scleral buckle, or for a more complete peripheral panretinal photocoagulation.

An improved needle holder for scleral buckling surgery.

A new needle holder was designed to provide the surgeon with a stout-angled jaw and a round locking handle. It is useful for holding large needles commonly used in scleral buckling surgery.

Hemorrhagic peripheral pigment epithelial disease.

Hemorrhage under the retinal pigment epithelium and neurosensory retina occurred in the temporal periphery of ten patients with aging macular degeneration and one patient with histoplasmosis syndrome. The macula was not the source of bleeding. Peripheral subretinal neovascularization, commonly seen histopathologically, may be the cause. The visual recovery was poor, and most patients failed to regain lost vision once peripheral hemorrhage occurred. The differential diagnosis includes retinal detachment, uveal effusion, hemorrhagic retinoschisis, choroidal melanoma, and metastatic tumor.

A simple blue filter for the pocket flashlight.

I devised an easily constructed blue filter for use with a disposable pocket flashlight for detecting fluorescein staining in external disease that can be kept in the pocket and placed on and off the light with ease.

Ocular manifestations of the fetal hydantoin syndrome.

Eleven per cent of infants exposed to hydantoins in utero have a recognizable pattern of abnormalities with serious clinical consequences. This report of a child born to a mother taking diphenylhydantoin emphasized the ocular findings. At birth and subsequent 8-month exam, a girl was noted to have microphthalmus, prominent iris vessels, and an inferior iris and choroidal colobma. Relation of these anomalies to teratogenic properties of diphenylhydantoin is discussed.

Scleral folding: a manifestation of orbital lymphoma.

A 72-year-old man with rapidly progressing, undifferentiated right orbital lymphoma is described. This was manifested by marked exophthalmos and a large inferior scleral fold, both of which responded rapidly to chemotherapy. The usual response of the globe to a localized mass is the development of retinal striae or choroidal folds. This case, however, was unusual in that a large scleral fold developed and resolved without any lasting deficit.

Analysis of monochromatic green argon-laser treatment for age-related macular degeneration.

A retrospective evaluation of 61 consecutive age-related disciform macular degeneration patients who received green argon-laser photocoagulation was done to evaluate the visual results and to search for characteristics of the presenting lesion that correlated with prognosis. For subretinal new vessels within 200 micron of the foveal avascular center, average pretreatment visual acuity was 20/80 and post-treatment 20/200. Twenty-eight percent improved, 36% stabilized, and 36% had worse acuity at last follow-up. Where new vessels were more than 200 micron from the foveal center, 36% improved, 20% stabilized, and 44% had worse acuity. The average pre- and post-treatment visual acuity for this group was 20/80. Overall, 36% required more than one treatment, and associated retinal vascular obliteration was noted in 31%. Hemorrhage over part of the neovascularization, turbid pigment epithelial detachment, and pigment epithelial detachment in the foveal avascular zone were signs that yielded the worst visual prognosis.

Gaze-evoked blindness.

Three patients with orbital lesions had substantial visual loss while maintaining their eye in an eccentric position of gaze (gaze-evoked blindness). The acuity rapidly returned to baseline levels on return to primary position. Two patients had optic nerve sheath meningiomas and one a displaced portion of orbital bone in contact with the globe. Disc abnormalities and/or choroidal folds were present in all three cases. Gaze-evoked blindness is characterized by the presence of an intraconal mass lesion, but proptosis may be subtle or not present at all. Gaze-evoked blindness should be considered in the differential diagnosis of all patients with atypical amaurosis fugax.

Visual prognosis of disciform degeneration in myopia.

A retrospective study was done on a consecutive series of patients presenting to the Moorfields Eye Hospital with visual reduction secondary to angiographically proven subretinal neovascularization associated with myopia (Förster-Fuchs' spot), with a short history of visual loss, and free of other ocular disease. The visual acuity at follow-up was compared to that at presentation, and related to size and location of the neovascular complex, as well as patient age, and duration of follow-up. The results show a generally poor prognosis in that 43% of the patients lost two or more lines of vision, while 60% were less than or equal to 6/60 at last follow-up. As expected there was a direct relationship between visual acuity and the distance of the neovascular tissue from the fovea, and an inverse relationship between acuity and the size of the lesion. There seems to be a short neovascular growth phase, with early visual loss.

Viewing through the asteroids.

Thirty to seventy percent of patients with asteroid hyalosis will also have diabetes. In this group of patients where view of the fundus is essential, it is often difficult or impossible by conventional ophthalmoscopy. We have noted the excellent visualization of fundus detail in asteroid hyalosis on routine fundus fluorescein angiography. The asteroid bodies are "optically removed" from the vitreous with this technique, thus affording a view for diagnosis previously thought impossible without actual vitrectomy. A series of patients, optimal camera filter combination, and a theory for this effect are presented.

Photocoagulation using the Eisner cone.

Thirteen patients with clinical or subclinical retinal detachments were treated with photocoagulation with the aid of a device for scleral depression and the three mirror contact lens. The Eisner cone has proven helpful in achieving clinically white retinal burns at the margins of retinal breaks by displacing subretinal fluid at the time of treatment. Patients selected for treatment had adequate pigmentation for a good photocoagulation response, nearly clear ocular media, and minimal vitreo retinal traction. Extent of retinal detachment was not a determinant, but minimal retinal elevation at break locations proved beneficial. No immediate flattening or adhesion of the retina was seen on release of scleral depression at the time of photocoagulation. White clinical burns remained visible. In 12 of 13 patients the retina was in apposition to the retinal pigment epithelium around the breaks at the first post-treatment examination. The remaining subretinal fluid absorbed in even the most extensive detachment in 2 weeks. One patient with multiple breaks at the equator failed to respond to this technique and required a scleral buckle.