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The central endothelia of 48 eye bank corneas from donors ranging in age from 5 weeks to 88 years were photographed using in vitro specular microscopy. Computer-assisted morphometric analysis of the size and shape of endothelial cells was performed, and cell density was calculated. Histologic examination of the corneas after specular microscopy determined endothelial cell counts using x40 objective magnification. The mean endothelial cell counts from five different high-power fields were calculated. Results showed that there is a direct correlation between cell number and specular microscopy cell density (r = .91 and Spearman rank correlation, 0.69; both significant at P less than .01). A nomogram was developed to estimate corneal endothelial cell density from high-power field cell counts of pathologic specimens.

Background: Microwave-stimulated chemical fixation has been used successfully to rapidly prepare nonocular tissue for processing and paraffin embedding., Method: This same technique was adapted to fix whole eyes using a common domestic microwave oven. Histologic sections were compared with sections from globes that were fixed in a traditional manner., Results: Histologic sections and histochemical and immunohistochemical staining of eyes treated with microwave-stimulated chemical fixation in 10% neutral-buffered formalin were comparable in quality to eyes fixed in 10% neutral-buffered formalin at room temperature for 48 hours., Conclusion: Because microwave irradiation accelerates the most time-consuming part of preparing whole eyes for light microscopy, the technique enhances laboratory efficiency. The technique is particularly well suited for ensuring adequate fixation of globes when histologic diagnosis is needed in less than 48 hours.

Fine-needle aspiration biopsy (FNAB) specimens obtained from nine consecutive iris lesions were examined. The lesions included primary malignant melanoma (four cases), metastatic melanoma, metastatic adenocarcinoma, leukemic infiltrate, lymphocytic infiltrate, and epithelial ingrowth. Subsequent histopathologic correlation was performed in all cases. Patient treatment influenced by the results of the FNABs included enucleation (three cases), clinical observation (two cases), external beam irradiation (two cases), resection, and radioactive plaque application. No complications occurred from the FNABs. Fine-needle aspiration biopsy of the iris can be performed with local anesthesia at the slit lamp as an outpatient procedure. In general, FNAB is a safe, effective method of obtaining diagnostic material from primary neoplastic, secondary neoplastic, and degenerative processes involving the iris. Limitations of the procedure include discrepancies in interpretation of the cytologic study and inadequate specimen.

A 29-year-old man with a -22.00-diopter myopia in the right eye underwent a planar, nonfreeze myopic epikeratoplasty and postoperatively developed a central subepithelial opacity. The opacity recurred after two superficial keratectomies; finally, another epikeratoplasty was performed. Light microscopic examination of the original button showed that the epithelium was thickened, collagenous subepithelial fibrocellular tissue was present, and Bowman's layer was focally disrupted. The stroma was edematous and peripherally scarred with scattered keratocytes. Examination by transmission electron microscopy revealed keratocytes lying anterior and posterior to Bowman's layer. The subepithelial fibrocellular tissue corresponded to an area of a break in Bowman's layer and probably originated from the donor stroma. The break in Bowman's layer may have been caused by the microkeratome cuts, but its origin is not certain.

A 20-year-old man was evaluated for an indolent corneal ulcer. Tissue and cultures from a penetrating keratoplasty indicated that the causative agent was Mycobacterium gordonae. This is the third patient reported with M. gordonae keratitis, although there have been numerous reports of nontuberculous mycobacterial keratitis. Nontuberculous mycobacterial keratitis is typically associated with previous trauma. The patient reported here had no known predisposing factor.

A retrospective study was conducted of 308 eyes with pathologic myopia obtained from 202 patients (23 surgical eyes; 285 post mortem eyes) over a 67-year period. Histopathologic findings and percentage of eyes affected, in decreasing order of frequency, were myopic configuration of the optic nerve head, 37.7%; posterior staphyloma, 35.4%; degenerative changes of the vitreous, 35.1%; cobblestone degeneration, 14.3%; myopic degeneration of the retina, 11.4%; retinal detachment, 11.4%; retinal pits, holes, or tears, 8.1%; subretinal neovascularization, 5.2%; lattice degeneration, 4.9%; Fuchs spot, 3.2%; and lacquer cracks, 0.6%. The reasons for enucleation in the surgically obtained eyes included, in decreasing order of frequency: degeneration after retinal detachment; secondary glaucoma; endophthalmitis; postsurgical epithelial ingrowth; expulsive hemorrhage; degeneration after cataract extraction; and presumed intraocular tumor. Clinicopathologic correlations are discussed.

The authors evaluated the histologic, immunohistochemical, and ultrastructural characteristics of two eyes with retinal hemangioblastoma from patients with von Hippel-Lindau and von Hippel disease. Results of histologic evaluation showed the eyes to have degenerative changes and residual retinal hemangioblastoma. Immunohistochemical stains performed for MAC-387, factor XIIIa, lysozyme, alpha 1 anti-chymotrypsin (histiocyte markers), factor VIII-associated antigen, ulex europeaus (endothelial markers), neuron-specific enolase, chromogranin, neurofilament (neuroectodermal/neural/neuroendocrine markers) and glial fibrillary acid protein (glial marker) showed normal retinal vascular endothelium, neurons, and glial cells to stain where expected. Vascular endothelium in the retinal hemangioblastomas stained for factor VIII and ulex europeaus. Interstitial cells in the stroma of the tumors failed to stain for the histiocyte markers, chromogranin, and neurofilament. The stromal cells stained for glial fibrillary acid protein and neuron specific enolase. Ultrastructural findings in both eyes included endothelial/pericyte-lined vascular channels, elongated stromal cells, and plump, vacuolated stromal cells with ultrastructural features consistent with glial cells. This study supports the concept that retinal hemangioblastoma is composed of a proliferation of capillaries and glial cells.

The histopathologic features of ten consecutive surgically excised subfoveal neovascular membranes from patients with age-related macular degeneration were examined. Ultrastructural features included the following in decreasing order of frequency: endothelium-lined vascular channels, new collagen, fibrocytes, retinal pigment epithelium, erythrocytes, and myofibroblasts. Chronic inflammatory cells were frequently evident and included macrophages, lymphocytes, and plasma cells. Basal laminar deposit or diffuse drusen were observed in six of the membranes. Photoreceptors and Bruch's membrane were each observed in three of the specimens, but were not associated with decreased postoperative visual acuity. Fibrin was observed in eight membranes, either within the stroma of the membrane or in association with subretinal hemorrhage.

The authors reviewed the clinical and histopathologic features of 32 patients with cutaneous malignant melanoma of the eyelid. The lower eyelid was more frequently the site of origin than the upper eyelid (21 patients, 66% of cases). A clinical diagnosis of melanoma was made in only 2 of 13 patients (15%) for whom the clinical diagnosis was listed. Clinical findings of pigmentation, ulceration/hemorrhage, or growth were documented in 25 (78%) patients. The histopathologic classification of the melanomas included nodular (19 patients, 59%), superficial spreading (7 patients, 22%), and lentigo maligna (6 patients, 19%). Associated histopathologic findings included solar elastosis (13 patients, 41%), nevus (12 patients, 38%), and basal cell carcinoma (4 patients, 13%). One of eighteen patients with follow-up data available died of metastatic melanoma.

The peroxidase-antiperoxidase method was used to study ten surgically obtained human optic nerve gliomas (pilocytic astrocytomas). All tissues were formalin fixed and paraffin embedded. Primary antisera included glial fibrillary acidic protein (GFAP), HNK-1 (type 1 astrocyte precursor marker), A2B5 (type 2 astrocyte precursor marker), S-100, vimentin, myelin basic protein (MBP), laminin, keratin, cytokeratin, epithelial membrane antigen (EMA), and neuron-specific enolase (NSE). Neoplastic astrocytes in optic nerve gliomas stained with GFAP, HNK-1, S-100, and vimentin. Oligodendrocytes and myelin sheaths stained for MBP, and NSE stained surviving axons in the tumors. Neoplastic astrocytes did not stain for A2B5, keratin, cytokeratin, EMA, or laminin. These results suggest that human optic nerve gliomas (pilocytic astrocytomas) arise from type 1 astrocytes.

A 46-year-old man underwent excision of a left lower eyelid mass that had enlarged over a 2-month period. Pathologic examination showed the mass to be an eccrine acrospiroma, a benign adnexal tumor that rarely arises in the eyelid. Light microscopic and ultrastructural examination showed two types of cells to comprise the tumor: eosinophilic cells with intracytoplasmic tonofilaments, and clear cells with intracytoplasmic glycogen granules. Immunohistochemical stains were positive for cytokeratins AE 1,3, epithelial membrane antigen, carcinoembryonic antigen, and muscle specific actin in tumor cells.

The right eye of a 75-year-old man with a history of cataract extraction, three penetrating keratoplasties, laser trabeculoplasty, two Molteno implants, and an operating microscope-induced retinal phototoxic lesion was studied post mortem. Histopathologic examination of the anterior segment showed evidence of penetrating keratoplasty, cataract surgery, and two Molteno implants with minimal associated tissue response. Ultrastructural examination showed a loose collagenous matrix surrounding the Molteno reservoirs, suggesting aqueous percolation from the reservoirs into the conjunctiva. Posteriorly, in the area of the phototoxic operating microscope-induced lesion, a nodule of retinal pigment epithelial hyperplasia with overlying atrophy of the photoreceptor cell layer of the neurosensory retina was noted. The retina also contained cystoid macular edema and an extensive preretinal membrane that was clinically unexpected.

We studied the immunohistopathologic features of normal lacrimal gland, benign mixed tumor, and malignant mixed tumor of the lacrimal gland. Primary antisera were to keratin, muscle-specific actin, vimentin, and glial fibrillary acid protein. Keratin stained in occasional myoepithelial cells in normal gland, ductal epithelium in normal gland and the tumors, and occasional stromal epithelioid cells in the tumors. Muscle-specific actin stained in myoepithelium and vascular smooth muscle in normal gland and the tumors, and occasional spindle-shaped and clusters of stromal cells in the tumors. Vimentin staining was nonspecific. Glial fibrillary acid protein stained in occasional myoepithelial cells in normal gland and polyhedral stromal cells in benign mixed tumor. Our findings indicate that ductal epithelium develops into the epithelial component, and some cells in the stroma and myoepithelium develop into some cells in the stroma of benign and malignant mixed tumor of the lacrimal gland.

A 64-year-old woman with bilateral corneal and conjunctival crystal deposition was evaluated. A biopsy of her conjunctiva showed intracytoplasmic inclusions of immunoglobulin crystals in fibrocytes, macrophages, and endothelial cells. Serum protein electrophoresis showed elevated kappa and IgA light and heavy chains which corresponded with immunoperoxidase staining results of the conjunctival biopsy. Conjunctival and corneal crystal deposition may be indicative of paraproteinemia, and histopathologic examination of a conjunctival biopsy may be useful in diagnosing this condition.

A 29-year-old man with acquired immune deficiency syndrome (AIDS) was found to have a retinochoroiditis and optic neuritis of his left eye. Results of fundus examination showed inflammatory and hemorrhagic retinal lesions consistent with retinitis due to cytomegalovirus infection. A computed tomographic (CT) scan demonstrated enlargement of the optic nerve. The eye was enucleated and results of histopathologic examination showed retinal necrosis with underlying choroiditis and an optic neuritis. Numerous encysted Toxoplasma gondii organisms were present in the retina and tachyzoites were present in the optic nerve. To the authors' knowledge this is the second histologically documented case of Toxoplasma optic neuritis in a patient with AIDS.

A 59-year-old man who had previously undergone a trabeculectomy in his right eye was examined because of an enlarging pigmented lesion of the inferior portion of the iris. A fine-needle aspiration biopsy of aqueous fluid revealed spindle cells and epithelioid malignant melanoma cells. The eye was enucleated, and subsequent histopathologic examination demonstrated a mixed spindle cell and epithelioid cell melanoma of the inferior portion of the iris with seeding of melanoma cells into the conjunctival filtering bleb via the trabeculectomy site. This case illustrates the usefulness of fine-needle aspiration biopsy in the evaluation of pigmented iris lesions and illustrates that iris melanoma can seed through a trabeculectomy site.

Complement is present in ocular fluids, but the molecular mechanism(s) restricting its activation to exogenous targets and not to autologous ocular cells are currently unknown. To clarify how this control is achieved, monoclonal antibody (mAb)-based techniques were used to examine the eye, the lacrimal gland, and ocular fluids for the decay-accelerating factor (DAF), a membrane regulatory protein which protects blood cells from autologous complement activation on their surfaces. Immunohistochemical staining of tissue sections revealed DAF antigen on corneal and conjunctival epithelia, corneal endothelium, trabecular meshwork, and retina, as well as on lacrimal gland acinar cells and in adjacent lumens. By flow cytometry, cultures of conjunctival epithelium exhibited the highest DAF levels and levels on corneal epithelium greater than corneal endothelium greater than conjunctival fibroblasts. Biosynthetic labeling of corneal endothelium yielded de novo DAF protein with an apparent molecular weight (Mr) of 75 kD, approximating that of blood cell DAF protein, and digestions of conjunctival epithelium with phosphatidylinositol-specific phospholipase C (PI-PLC), an enzyme which cleaves glycoinositolphospholipid membrane anchors, released approximately 70% of the ocular surface DAF protein similar to leukocyte surface DAF protein. Quantitations of DAF by radioimmunometric assay employing mAbs against two DAF epitopes revealed 325 ng/ml (n = 12), 4.8 ng/ml (n = 10), and 22.0 ng/ml (n = 8) of soluble DAF antigen in tears, aqueous humor, and vitreous humor, respectively. Western blot analyses of the tear DAF antigen revealed two DAF forms, one with an apparent Mr of 72 kD resembling membrane DAF forms in other sites, and a second with an apparent Mr of 100 kD, which is previously undescribed. Since DAF activity is essential physiologically in protecting blood cells from autologous complement attack, the identification of DAF on the ocular surface, intraocularly, in the lacrimal gland, and in tears suggests that DAF-mediated control of complement activation is also required in these locations.

An 80-year-old man was evaluated for an epibulbar tumor on a phthisical eye. The initial biopsy diagnosis of the epibulbar tumor was poorly differentiated neoplasm. Exenteration of the phthisical eye and orbital contents showed an extensive pleomorphic adenocarcinoma of the nonpigmented epithelium of the ciliary body with extraocular extension. There was evidence of hyaluronic acid secretion and immunohistochemical staining was strong for vimentin, focal for epithelial membrane antigen and S-100 protein, and weak for neuron-specific-enolase. Electron microscopy demonstrated desmosomes between tumor cells, areas of thick, multilaminar basement membrane production surrounding individual tumor cells, and occasional intracytoplasmic intermediate filaments.

Syringoma, a benign sweat gland tumor which may occur in the eyelid, commonly presents as multiple lesions in young women. We had an unusual case of a sclerosing syringoma found as a single lesion in the lower eyelid of a man.

Two patients with infectious crystalline keratopathy associated with topical anesthetic abuse are described. No previously reported predisposing factors existed, including topical corticosteroid use during active Herpes simplex or Acanthamoeba keratitis, or following penetrating keratoplasty. Cultures from corneal biopsies of both patients grew Streptococcus viridans. Both infections resulted in corneal scarring with vascularization. Ultimately, corneal transplantation was performed in one case.

A 76-year-old man with bilateral corneal infiltrates secondary to a monoclonal gammopathy of undetermined significance (MGUS) is described. The corneal changes simulated a remote lattice dystrophy. Although the clinical presentation of corneal opacities secondary to paraproteinemic conditions is somewhat variable, this patient's corneas lacked the common crystalline appearance of immunoglobulin deposits. This patient demonstrates an atypical clinical presentation of corneal infiltration secondary to a paraproteinemia.

Cerebro-ocular dysplasia-muscular dystrophy (COD-MD) syndrome is a rare disorder encompassing a triad of brain, eye, and muscle abnormalities. The principal central nervous system features are cerebral and cerebellar agyria-micropolygyria, cortical disorganization, glial-mesodermal proliferation within the leptomeninges, neuronal heterotopias, hypoplasia of nerve tracts, hydrocephalus, and, occasionally, encephalocele. Ocular abnormalities include microphthalmia, cataract, immature anterior chamber angle, retinal dysplasia with or without retinal detachment, persistent hyperplastic primary vitreous, optic nerve hypoplasia, and coloboma. Skeletal muscle findings include fiber splitting, variable fiber size, and endomysial fibrosis. Recent evidence has shown that COD-MD syndrome may be identical to the Walker-Warburg (also known as Warburg) syndrome. Fukuyama congenital muscular dystrophy is similar to the COD-MD and Walker-Warburg syndromes, although the ocular manifestations are less severe. We report the histopathologic findings in two siblings with multiple features of COD-MD syndrome.

We removed a trematode of the species Philophthalmus from under the left upper eyelid of a 66-year-old man who had follicular conjunctivitis for three weeks. After removal of the parasite, the conjunctivitis resolved.

Glycosidases, which cleave sugar molecules from complex glycopolymers, have been previously quantified in normal human cornea in our laboratory. Data quantifying glycosidases in macular corneal dystrophy are lacking. Tissue obtained at keratoplasty from patients with macular dystrophy and normal corneas obtained from eye bank eyes were used to determine levels of glycosidase activity. A fluorometric technique was employed using 4-methyl-umbelliferyl-glycosides as substrates. The corneal tissues were homogenized, centrifuged, and the supernatants assayed for enzyme activity. Specific activities (mumol/mg protein/hour) were determined and Km and Vmax values were obtained for all but one enzyme. Activity of alpha-galactosidase was significantly lower in cornea tissue and keratocytes from macular corneal dystrophy compared to normal.

A 33-year-old man with acquired immune deficiency syndrome (AIDS) was found to have bilateral cytomegalovirus (CMV) retinitis with concomitant unilateral optic neuritis. The patient died and postmortem examination of both eyes disclosed CMV inclusions in all layers of the involved retinas including the retinal pigment epithelium (RPE). Also found were CMV inclusions in the optic nerve of his left eye. Immunohistochemical stains for glial fibrillary acid protein demonstrated that glial cells were infected in the optic nerve.

We retrospectively studied eight eyes of seven patients sustaining indirect choroidal rupture secondary to blunt trauma. Clinical and fluorescein angiographic findings were reviewed. The ruptures were single in five eyes and multiple in three eyes. Four eyes contained macular ruptures, and three eyes contained extramacular ruptures. Peripapillary ruptures were noted in three eyes. Three eyes developed subretinal neovascularization as a complication. Location of the rupture but not visual acuity at presentation was predictive of visual outcome. All ruptures were concentric with the optic nerve and vertically oriented, consistent with a break in Bruch's membrane and an associated tethering effect by the optic nerve.

A 28-year-old woman was evaluated for a firm subcutaneous nodule of the left upper eyelid. Results from the examination showed multiple red to brown subcutaneous nodules on her upper extremities and thorax. An excisional biopsy specimen showed the nodules to be cutaneous involvement of acute monocytic leukemia. Acute monocytic leukemia should be considered in the differential diagnosis of a subcutaneous nodule in the eyelid.

The authors examined an eye obtained post-mortem from a patient with chronic granulomatous disease of childhood and clinically apparent chorioretinal scars. Histologic examination disclosed numerous chorioretinal scars with associated retinal pigment epithelial changes and glial proliferation. Special stains for bacteria and fungi were negative. Additional findings were scattered pigment-containing macrophages found in the patient's spleen, liver, lymph nodes, bone marrow, lungs, kidney, thymus, choroid, and retina. The significance of the pigmented macrophages is unknown, however they may represent an abortive macrophage response to infectious agents.

Diagnostic accuracy of computed axial tomography (CT) of the eye and orbit is limited by resolving power and interpretation. Indiscriminate use of the scan is limited by radiation exposure and cost of the modality. The use of CT should be reserved in the ophthalmologist's supply of diagnostic modalities and be used as part of an orderly, logic scheme of diagnostic testing. The scheme proposed advises ordering a B-mode ultrasound before CT.

Pseudotumor of the orbit is an uncommon entity in children. Three patients under 20 years of age with biopsy-proved orbital pseudotumor are presented. A three-month-old infant, to our knowledge the youngest patient reported with orbital pseudotumor, had a history similar to those of previously reported cases, whereas the two older patients differed from previously reported cases of childhood pseudotumor in that they lacked constitutional symptoms and orbital pain. Two of the patients were successfully treated with systemic steroids. In one patient, radiation therapy was required to reduce the mass.

A total of 2,455 conjunctival lesions in adults (over 15 years old) obtained during a 61-year period were reviewed and histopathologically classified as congenital, acquired epithelial, acquired subepithelial, pigmented, inflammatory/degenerative, and miscellaneous. The most common lesions in decreasing order of frequency were: pterygium, nevus, dysplasia, nonspecific nongranulomatous inflammation, and epithelial inclusion cyst. The most common conjunctival malignancy in adults was squamous cell carcinoma, followed by melanoma, and pagetoid change associated with sebaceous gland carcinoma. Squamous cell carcinomas arise from progressive stages of mild, moderate, and severe dysplasia. These tumors have a low malignant potential but may behave more aggressively in the spindle cell and mucoepidermoid variants. Melanomas arise de novo, from nevi or, most commonly, from acquired melanosis and have an associated 14-32% mortality rate by metastatic spread. Sebaceous carcinomas are often initially clinically misdiagnosed, involve the conjunctiva by pagetoid spread, and can have a low rate of metastasis and death if diagnosed early and excised with frozen-section monitoring of the surgical margins.

Bilateral serous retinal detachments are rare complications of thrombotic thrombocytopenic purpura (TTP). We report the case of a 28-year-old woman with chronic relapsing TTP with bilateral serous retinal detachments, which resolved after prompt aggressive medical therapy. Unlike several previous reports, the retinal detachments in our patient were unrelated to systemic hypertension.

Two patients with hemangiopericytoma of the conjunctiva are reported. The first patient, a 40-year-old woman with a six-month history of a conjunctival mass, presented with a lesion confined to the conjunctiva. The second patient, a 43-year-old man, presented with a one-year history of a conjunctival mass. Excisional biopsy and histopathologic examination showed both lesions to be a hemangiopericytoma; an uncommon tumor of the conjunctiva.

We report an unusual case of extensive sulfur and calcium deposition in the cornea after retinal detachment surgery, vitrectomy, and use of topical sulfacetamide. There were no signs of anterior segment ischemia and intraocular silicone oil was not used. Light and electron microscopic examination and x-ray energy dispersive analysis are described. A possible mechanism for the pathogenesis of this condition is presented.

Corneal buttons from two patients with failed epikeratoplasties requiring penetrating keratoplasty were examined by light and transmission electron microscopy. Penetrating keratoplasty was performed for lenticule scarring in the first case (adult aphakia) and inadequate best corrected visual acuity in the second case (keratoconus). Findings included decreased lenticule keratocytes and electron-dense, fibrillogranular material associated with either lenticule or recipient keratocytes in both corneas and defects in Bowman's layer in one cornea. In addition, light and electron microscopic evidence consistent with recipient keratocyte migration into the lenticule was demonstrated in one case. These findings were compared with three previous cases.

The inheritance of Bardet-Biedl syndrome is thought to be autosomal recessive. Of the approximately 500 case reports in the literature, three patients were found to have sex chromosome aneuploidy. The authors describe two siblings with Bardet-Biedl syndrome, one of whom has a unique sex chromosome aneuploidy with mosaicism, including deletion of the short arm of the X chromosome (45,X/46,X,del(X)(p21)). The possible significance of sex chromosome aneuploidy and the Bardet-Biedl syndrome is discussed.

The authors report a patient with nonsimultaneous choroidal and cutaneous melanomas. The patient did not display the dysplastic nevus syndrome phenotype, and there was a negative family history for cutaneous or uveal melanomas. This sporadic case might suggest a common etiologic factor in the pathogenesis of multicentric malignant melanomas.

Recent studies utilizing electron microscopy and immunohistochemistry have added to the understanding of the pathology of progressive supranuclear palsy. This article reviews the neuropathologic findings of progressive supranuclear palsy and includes two new case reports. Findings in the patients reported here include extensive neuronal loss with reactive gliosis in deep subcortical gray matter such as globus pallidus, subthalamic nuclei, substantia nigra, red nucleus, dentate nucleus, and inferior olives. Neurofibrillary tangles were also noted in thalamus, hypothalamus, striatum, nucleus basalis, locus ceruleus, basis pontis nuclei, midbrain, pontine, and medullary reticular formation as well as in various cranial nerve nuclei.

A 76-year-old myopic woman who had undergone bilateral extracapsular cataract extractions and received posterior intraocular lens implants underwent two sessions of krypton laser photocoagulation for subretinal neovascularization secondary to age-related macular degeneration in her right eye. The patient expired and histopathologic examination of her treated eye showed a posterior chamber intraocular lens with both haptics in the ciliary sulcus, areas of macular degeneration, evidence of krypton laser photocoagulation including a full-thickness retinal scar, and an area of clinically unsuspected subretinal neovascularization.