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Objectives: To determine the effects of macular scatter ("grid") laser photocoagulation compared with observation on the visual function of eyes with subfoveal choroidal neovascularization (CNV) that has poorly demarcated boundaries and to provide preliminary data for the evaluation of the feasibility and design of a larger, definitive trial. Design: Randomized pilot clinical trial. Setting: Two tertiary care retinal referral practices. Patients: Symptomatic individuals with subfoveal CNV secondary to age-related macular degeneration in whom fluorescein angiography showed occult CNV with poorly demarcated boundaries; classic CNV was allowed but did not need to be present for entry into the study. Main Outcome Measure: Change in visual acuity from baseline to specified time periods. Results: Fifty-two eyes were assigned to observation. Fifty-one eyes were assigned randomly to treatment consisting of macular scatter ("grid") laser photocoagulation to the area of CNV. The treatment protocol for 8 of these eyes also included confluent laser photocoagulation to areas of classic CNV. The average visual acuity decrease from baseline was greater in the treated than in the observed group. The difference between these groups was greatest within the first year after study enrollment. At 24 months, slightly more than 40% of the eyes in each group had lost 6 or more lines of visual acuity. Similar results were noted for the subgroup of eyes initially with angiographic features of occult CNV but no classic CNV. Conclusions: These short-term study results suggest that macular scatter ("grid") laser treatment is not beneficial and is possibly harmful compared with observation for symptomatic subfoveal CNV with poorly demarcated boundaries in age-related macular degeneration. With or without treatment, a significant proportion of these patients are at risk of severe visual loss within 2 years of seeking treatment, even when the eye initially has occult CNV and no classic CNV.

AIDS and the Eye by Drs Stenson and Friedberg is a concise, wellillustrated, and well-referenced "mini-text," with 7 short chapters on the subject of human immunodeficiency virus infection and how it affects the eye and the orbit. Its brevity stimulates the reader to pick it up. The first chapter gives a concise but encompassing discussion that reviews important aspects of human immunodeficiency virus infectious activity. The second chapter discusses prevention of infection and summarizes current recommendations by the Centers for Disease Control and Prevention, the Occupational Safety and Health Administration, and the American Academy of Ophthalmology. Ophthalmic involvement is covered in the next 4 chapters, which review manifestations of the acquired immunodeficiency syndrome in the anterior segment, retina, choroid, orbit, and the eyeassociated neurologic system. The final chapter covers systemic manifestations of acquired immunodeficiency syndrome. For the reader who wants more, the references are generous but pertinent. Also noteworthy

Since ultrasound was first used in ophthalmologic practice in 1956, there have been at least nine publications that could be called text-books on the subject. This one is the most recent and, although comprehensive, is quite readable. The book quickly lets us know that the term echography is the most precise name for the field of study created by the evaluation of reflections of sound energy in the ultrasonic range. These reflections are displayed in various modes, including the time-intensity display known as the A mode and the two-dimensional intensity-space display known as the B mode. The book has three major sections. The first briefly and simply (perhaps too simply for some readers) reviews the principles of physics that underlie the science of echography. The second section deals with echography of the globe, devoting an initial chapter to a careful description of a systematic method of doing and recording an

• One hundred twenty-five retinochoroidal photocoagulation burns, produced by a transpupillary diode laser (810 nm) in six eyes of three cynomolgus monkeys, were evaluated by clinicopathologic correlation for up to 9 weeks after laser treatment. Diode burns of clinical grade 2 strength were comparable to those described for argon laser. However, diode burns of clinical grade 3 strength produced choroidal changes more intense than those described for argon laser. Where present underneath photocoagulation sites, ciliary nerves in choroid or sclera consistently showed scarring. Prospective randomized controlled clinical trials to document possible clinical equivalence or superiority of diode treatment have not yet been performed. Potential clinical advantages of the diode laser include its weight, size, durability, price, absence of visible flash, and its ability to produce burns that profoundly affect the choroid.

• In 14 patients, preretinal membranes, causing retinal traction and severe visual impairment, were removed by vitrectomy and evaluated by light and electron microscopy using myosin subfragment-1 to stain actin filaments. Eight membranes were of vascular origin, six of nonvascular origin. All but one contained bundles of oriented actin filaments within a number of their nonvascular stroma cells, suggesting that the contractile protein action may have been involved in their clinically observed contraction.

• A 36-year-old man developed blurred vision and a cough five months after traveling to an area from where a large out-break of acute blastomycosis had been reported. Examination revealed a left choroidal lesion in the macular region, skin lesions on the right calf, and a left lung apical infiltrate. Histopathologic examination of the skin lesion demonstrated a granulomatous inflammation and broad-based, budding yeast characteristic ofBlastomyces dermatitidis. Amphotericin B therapy produced a rapid resolution of both choroidal and pulmonary lesions. During a six-month follow-up, there was no evidence of recurrence.

Abnormalities in the fine vasculature of the macular and perimacular regions occurred in 7 of 35 consecutive patients with sickling hemoglobinopathies (4 sickle cell anemia, 2 sickle cell hemoglobin C disease, 1 sickle thalassemia). Microaneurysm-like dots, dark and enlarged segments of terminal arterioles, and hairpin-shaped venular loops were visible ophthalmoscopically. Pathologic avascular zones and changes in the normal architecture of both the foveal avascular zone and the surrounding capillary bed were visible only on fluorescein angiography. Four of the seven patients had some loss of central visual functions. These abnormalities are similar to changes described In the retinal periphery of patients with sickling disorders and can be explained by the same pathogenic mechanisms. They, therefore, represent a clinical disease that we have called sickling maculopathy.

One possible explanation for the rarity of ocular herpesvirus infections in newborn infants may be the universal application of Crede prophylaxis. To test this hypothesis, a clinically used silver nitrate preparation was instilled in the eyes of rabbits 20 minutes after an ocular inoculation with a strain of type 1 or a strain of type 2 herpesvirus (HSV). With the strain of type 1 HSV, silver nitrate prevented infection with smaller inocula (3,000 plaqueforming units [PFU]), but not with a larger dose (30,000 PFU). With the strain of herpes type 2 there was not prevention of disease with either concentration of inoculum (1,000 and 10,000 PFU). The practical importance of silver nitrate prophylaxis on herpetic infection in the newborn may be small.