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We prospectively evaluated a modified version of a previously reported technique of retrobulbar anesthesia for vitreoretinal surgery involving the use of a blunt 19-gauge cannula to directly infuse anesthetic into the retrobulbar space. Using this method, 60 consecutive patients undergoing scleral buckling surgery had effective anesthesia and akinesia, with no complications.

DNA (herpes viruses) and RNA (rubella, rubeola) group viruses are recognized causes of viral retinitis. Severe damage is often the result, not only because the viruses have a cytologic effect but also because the antigens may cause immune complex deposition that results in vasculitis. Most of the viral retinitides are associated with systemic disease; immune-compromised individuals are more susceptible than healthy individuals. A distinct clinical entity, acute retinal necrosis, affects the eye only in healthy individuals and is associated with the herpes family of viruses.

A 30-year-old woman who was being treated with steroids for systemic lupus erythematosus developed a retinopathy originally diagnosed as secondary to her underlying disorder. The progression of the retinopathy eventually made its infectious cause apparent. The relative infrequency of widespread retinopathy in lupus and the lack of ocular inflammation in this disorder are emphasized. The necessity of considering opportunistic infections in immunosuppressed patients is stressed.

Because of its uniqueness, the eye has long been a favored site for immunological study. It is a highly active tissue immunologically, with virtually all types of immune reactions present. This article reviews the ocular immune response, chorioretinal diseases with immunologic features, and immunology of ocular tumors. Immunologic data is discussed as it relates to the pathogenesis, clinical features, and therapy of chorioretinal disease.

We report a 22-year-old Hispanic man with familial congenital nystagmus, iris transillumination, and pigmentary retinal anomalies with subretinal fatty exudates similar to those seen in Coats' disease. Direct treatment of the telangiectatic vessels with cryotherapy caused a subretinal hemorrhage. We therefore recommend surrounding the area of abnormal vessels (posterior to vessels and between vessels and ora serrata) with cryotherapy to reverse the formation of the vascular anomalies.

Macular halos describe a striking clinical finding of bilaterally elevated, doughnut-shaped, white rings around th fovea. This paper presents the third well-documented report of the association of macular halos with Niemann-Pick type B disease, demonstrated by color photographs and subtle fluorescein angiographic findings. The systemic association with Niemann-Pick type B disease was confirmed by bone marrow biopsy and enzyme assay. Of 13 family members examined, only the proposita had macular halos; 10 were found to be carriers by sphingomyelinase assay. Recognition of this pathognomonic eye finding warrants more widespread awareness as a presenting sign of Niemann-Pick type B disease.

We examined the relationship of cilioretinal arteries (CRAs) to juxtapapillary chorioretinal scars, along with the developmental significance of the latter in relation to CRA formation. Both eyes of 360 patients were studied. Sixty-eight (18.9%) of these patients had a CRA in at least one eye, 13 of these 68 (19.1%) had one in both. The CRAs were distributed equally between right and left eyes. Two hundred eight patients (57.8%) had a scar in at least one eye; 157 of these (75.5%) had one in both. The presence of a CRA was significantly associated with the presence of a scar. Since both are common developmental variations, this correlation points to a common embryologic formation mechanism.