A bidirectional, turbulent, delaying, centripetal, suction filter.

The physiologic functions of the outer retina and the pathophysiology of drusen-related macular failure are best explained by attributing the properties of a bidirectional, turbulent, delaying, centripetal, suction filter to Bruch's membrane.

Misdiagnosis of iridocyclitis.

Flare cells, and hypotony do not always signify uveitis, but may also be presenting symptoms of a retinal detachment. Unexpected, unusually good intraocular pressure control in a difficult case of glaucoma is less often a cause for rejoicing and more often a result of a retinal detachment.

Posterior decompensation syndrome: macular failure versus senile macular degeneration.

Macular cone death in adults is caused by failure of the system that carries away the retinal biologic wastes. This failure may be termed the posterior decompensation syndrome, a name intended to convey the dynamic concept of imbalance between formation and elimination of waste. Because of centripetal fluid flow in the subretinal space, a disproportionate amount of drusen-like debris accumulates upon the surface of the lamina vitrea at the posterior pole. Recognition of this concept is the key to prevention of macular failure by reducing the amount of waste generated from the peripheral retina or its transport to the macula.

Centripetal subretinal flow.

An unfamiliar concept, the presence of centripetal flow in the subretinal space, is proposed as explaining the maculopathy of Coats's and von Hippel-Lindau's syndromes. If this flow exists, our recognition of it will contribute to understanding the etiology of other posterior-pole disorders, and possibly to their treatment as well. The obvious and important posterior-pole disorder to which this is applicable is macular degeneration, especially diskiform macular degeneration. Laser treatments designed to reduce the amount of peripheral retinal biologic waste production should reduce the work load of the macular disposal system, thereby prolonging its useful life.

Host tolerance of homologous fascia lata in retinal detachment surgery.

The use of homologous fascia lata in ocular surgery has been frequently questioned in regard to its host tolerance. Our electron microscopic examination of homologous fascia lata grafts up to 19 years old, which had been implanted as scleral buckling elements, showed no gross or microscopic histologic changes. Late infection, migration, and erosion were virtually nonexistent in comparison with other series using synthetic buckling materials. Therefore, homologous fascia lata is ideally tolerated and the most perfect scleral buckling material currently available.

Ophthalmoscopic changes in a patient with Wilson's disease during long-term penicillamine therapy.

The development of retinal pigment epithelial defects in a young patient with Wilson's disease after long-term penicillamine therapy is described. It is hypothesized that decreased copper availability secondary to penicillamine therapy may result in defective elastin within the lamina of Bruch with resultant defects in the overlying retinal pigment epithelium.