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Purpose: To determine the incidence of diabetic retinopathy (DR) and other ocular findings in previously diagnosed diabetes using telehealth retinal screening with nonmydriatic fundus phot...

PURPOSE To describe a case of frosted branch angiitis after intravitreal ranibizumab injection. METHODS Retrospective chart review. RESULTS A patient with a history of neovascular age-related macular degeneration underwent intravitreal ranibizumab injection and subsequently developed coagulase-negative Staphylococcus endophthalmitis with findings of frosted branch angiitis. CONCLUSION Endophthalmitis presenting as frosted branch angiitis is a rare complication after intravitreal anti-vascular endothelial growth factor injection. Early recognition is critical to optimize outcomes. To our knowledge, this is the second reported case of frosted branch angiitis as a presentation of endophthalmitis with coagulase-negative Staphylococcus.

Objective: The purpose of the study was to determine the predictors of success and evaluate the use of perfluoroperhydrophenanthrene as an intraoperative and postoperative tool in the management of giant retinal tears in a multicentered collaborative study. Design: Multicentered prospective case series. Participants: Twenty-three centers consecutively enrolled 162 eyes of 161 patients with retinal tears 90° or greater in circumferential extent. Intervention: Perfluoroperhydrophenanthrene was used as an intraoperative surgical adjunct in all cases and left after surgery in 16 eyes (9.9%). Main Outcome Measures: Retinal reattachment and visual acuity. Results: Intraoperative reattachment was achieved in 158 eyes (97.5%); 147 eyes (90.7%) remained attached at their most recent follow-up. Seventy-nine eyes (48.8%) experienced an improvement in their visual acuity, 26 eyes (16.0%) remained unchanged, and 57 (35.2%) worsened. Recurrent retinal detachment occurred in 80 patients (49.4%). Other significant postoperative complications included cataract formation in 20 (39.2%) of 51 eyes, macular pucker in 12 (7.4%), corneal decompensation in 10 (6.2%), and hypotony (intraocular pressure equal to or less than 5 mmHg) in 9 (5.6%). A chi-square analysis of preoperative characteristics showed that hypotony ( P = 0.007), macular detachment ( P = 0.020), a history of cataract extraction ( P = 0.003), poor visual acuity ( P = 0.000), giant tear extent greater than 180° ( P = 0.004), and higher grade proliferative vitreoretinopathy ( P = 0.000) all predicted a poor visual outcome. Vitreon (Vitrophage, Inc., Lyons, IL) was left in 16 eyes (9.9%) for an extended postoperative retinal tamponade for between 3 and 1034 days (mean, 87.2 days). The Vitreon was well tolerated, and these eyes experienced a similar outcome and rate of retinal reattachment to the rest of the group. Conclusions: Vitreon is a safe and useful adjunct to pars plana vitrectomy in the management of giant retinal tears and may, additionally, be the perfluorocarbon liquid that can be used most safely as a temporary postoperative tool for extended retinal tamponade, reinforcing its role as a useful adjunct in the management of these complex retinal detachments.

Purpose: The authors determine if specific features of the clinical presentation of acute postoperative endophthalmitis correlate with the microbiologic culture results. Methods: A total of 420 patients who had clinical evidence of endophthalmitis within 6 weeks after cataract surgery or secondary intraocular lens implantation were evaluated as part of a randomized clinical trial. Results of cultures performed on aqueous and vitreous specimens obtained at presentation were categorized as follows: gram-positive coagulase-negative micrococci, "other" gram-positive, gram-negative, and equivocal/no growth. Results: Eleven features of the initial clinical presentation were associated with significant differences in the microbiologic spectrum ( P Conclusions: The presenting characteristics of acute endophthalmitis after cataract surgery may be helpful in predicting the most likely culture results. Such predictions do not appear sufficiently strong to guide the initial empiric choice of intravitreal antibiotics.

Objectives To describe three patients with systemic sclerosis (SSc) who developed acute unilateral blindness in the absence of any common etiologic factor for blindness. In one patient, the affected eye required enucleation and was examined histopathologically. Methods Following identification of the first patient with retinal artery occlusion at the Scleroderma Center of Thomas Jefferson University, every patient evaluated at the Center from May 2001 to December 2010 was prospectively assessed for the development of acute unilateral blindness. Two additional cases were identified. Here, we describe the clinical features, laboratory and ancillary examinations of the three patients with SSc who developed acute unilateral blindness and present the histopathological examination of one eye enucleated from one of the patients. Results Clinical and angiographic studies were consistent with acute retinal artery occlusion. The histopathological studies showed severe retinal ischemic atrophy and concentric narrowing and fibrosis of small retinal vessels. Conclusions These findings suggest that acute retinal artery occlusion in these patients is a manifestation of the fibroproliferative vasculopathy characteristic of SSc.

Purpose: To report a newly defined complication of foldable Intraocular lenses (IOLs), namely silicone oil-silicone IOL interaction. This is a complication not generally seen by the implanting cataract surgeon but, rather, at a later stage in a patient's postoperative course, by a vitreoretinal surgeon. Methods: Three clinical case histories, including two explanted silicone IOLs, were submitted for analysis. The submitted silicone lenses were photographed under water, and the nature of the silicone oil coating was documented. Results: In each instance, the silicone coating was manifest as a thick coating with droplet formation on the lens surface that was tenaciously adherent and could not be dislodged by instruments or injection of viscoelastics. Conclusion: The use of silicone IOLs in patients with current vitreoretinal disease or those who are at high risk for future vitreoretinal disease that may require silicone oil as part of the therapy should be reconsidered. The authors recommend that information regarding the existence and significance of this complication be printed on all silicone oil and silicone IOL packages and inserts (if not as a warning, at least as an informative comment regarding the existence of this condition). This is a rare but clinically significant complication that will affect the occasional patient treated with both of these modalities.

The authors report a series of 20 eyes from 20 patients in whom inadvertent perforation of the globe occurred during local anesthesia for ocular surgery. Perforation resulted from retrobulbar anesthesia in 18 eyes and from peribulbar anesthesia in 2 eyes. Nine (45%) of 20 eyes had an axial length greater than or equal to 26.00 mm. Combining this figure with axial length data for the general population and estimates for the risk of globe perforation during local anesthesia yields an approximate incidence of perforation in eyes with axial length greater than or equal to 26.00 mm of 1 in 140 injections. Proliferative vitreoretinopathy (PVR) developed in 8 of the 20 eyes (40%) in this series. Overall, 15 (75%) of the 20 eyes were successfully repaired, and, in five eyes (25%), the final visual acuity was 20/70 or better.

Forty-one patients with a unilateral, macular epiretinal membrane (ERM) underwent pars plana vitrectomy and membrane peeling to improve the visual acuity. The authors retrospectively reviewed the histopathology of the vitrectomy specimen in each instance to determine whether the presence of internal-limiting membrane (ILM) had an adverse effect on visual acuity. Eleven specimens contained long segments of ILM, as determined by light microscopy. With a minimum of 6 months of follow-up, none of these 11 eyes achieved a visual acuity of better than 20/60. Of 30 eyes that did not have ILM present, 41 % achieved a visual acuity of 20/60 or better. Overall, 29% of the eyes in the entire series achieved 20/60 or better visual acuity. The difference between the group with ILM versus that without ILM was statistically significant ( P = 0.01). The presence of long segments of ILM within the histopathologic specimen after vitreous surgery for removal of a macular ERM appears to indicate a less favorable visual outcome.

Posterior 360 degrees retinotomy in conjunction with extensive peripheral retinectomy was necessary for retinal reattachment in 18 eyes. A visual acuity of 20/400 or better was achieved in 22% of the patients; in patients with rubeosis, regression was found in 89%. Of the hypotonus eyes, preoperatively 78% were normotensive postoperatively after removal of anterior proliferative vitreoretinopathy (PVR) covering ciliary epithelium. The major intraoperative complication was hemorrhage, which could be readily controlled. Recurrent retinal detachment (RD) occurred in 39% and reproliferation in 50% of the patients.

Telehealth holds the promise of increased adherence to evidenced-based medicine and improved consistency of care. Goals for an ocular telehealth program include preserving vision, reducing vision loss, and providing better access to medicine. Establishing recommendations for an ocular telehealth program may improve clinical outcomes and promote informed and reasonable patient expectations. This document addresses current diabetic retinopathy telehealth clinical and administrative issues and provides recommendations for designing and implementing a diabetic retinopathy ocular telehealth care program. The recommendations also form the basis for evaluating diabetic retinopathy telehealth techniques and technologies. Recommendations in this document are based on careful reviews of current evidence, medical literature and clinical practice. They do not, however, replace sound medical judgment or traditional clinical decision-making. "Telehealth Practice Recommendations for Diabetic Retinopathy" will be annually reviewed and updated to reflect evolving technologies and clinical guidelines.

Purpose To describe a patient whose initial sign of giant cell arteritis was a branch retinal artery occlusion. Methods We examined a 77-year-old woman who developed arteritic anterior ischemie optic neuropathy three weeks after an isolated nonembolic branch retinal artery occlusion occurred in the same eye. Results The diagnosis of giant cell arteritis was confirmed by temporal artery biopsy after the patient was treated with intravenous corticosteroids. Conclusions Although a rare cause of branch retinal vascular occlusion, giant cell arteritis should be considered in the differential diagnosis of a nonembolic branch retinal artery occlusion in elderly patients.

PURPOSE: To report arteriovenous adventitial sheathotomy for treatment of macular edema associated with branch retinal vein occlusion. METHODS: Case reports with review. Five eyes of five patients with best-corrected visual acuity of less than 20/200 secondary to branch retinal vein occlusion had pars plana vitrectomy and arteriovenous adventitial sheathotomy and were followed postoperatively for a mean of 6.5 years (range, 5 to 7 years). RESULTS: In four of five eyes, the best-corrected visual acuity improved to 20/30 to 20/70. In the remaining eye, visual acuity remained at finger counting secondary to macular ischemia. CONCLUSION: Arteriovenous adventitial sheathotomy may be beneficial for select patients with poor vision secondary to branch retinal vein occlusion.

PURPOSE To evaluate the ocular toxicity of intravitreous transforming growth factor-beta 1 (TGF-beta(1)). METHODS Eyes of New Zealand white rabbits were injected intravitreally with TGF-beta(1) in doses of 20, 10, 5, 1 or 0.5 micrograms. Electroretinography and clinical examination were performed before and after the injection. At either 10 or 30 days after injection, the eyes were enucleated and examined histologically. The endothelium of fresh corneas, which had received 20 micrograms TGF-beta(1) or nothing, were checked 5 days after injection. RESULTS Corneal opacity was caused by doses > or = 10 micrograms in 7 of 7 eyes; by doses of 5 micrograms in 3 of 4 eyes; and by doses of 1 microgram in 1 of 4 eyes. Doses > or = 5 micrograms also caused pannus formation in 15 of 16 eyes. Ten days after injection there was some decrease in B-wave amplitude on electroretinography. Thirty days after injection the electroretinographic responses had recovered, except in the eyes injected with 20 micrograms TGF-beta(1), which still showed a decrease in step 1. Histological examination of paraffin sections did not demonstrate significant change. Corneal thickness of the eyes receiving 20 micrograms TGF-beta(1) was twice that of the normal cornea and some corneal endothelial cells lost their hexagonal shape. CONCLUSION TGF-beta(1) injected intravitreally at doses > or = 1 micrograms is toxic to the cornea. Retinal function is only slightly disturbed by 20 micrograms of TGF-beta(1).

We used perfluorophenanthrene as an aid during pars plana vitrectomy in removing lens fragments dislocated posteriorly into the vitreous cavity. We reviewed the records of all patients (nine patients, nine eyes) referred with dislocated lenses who underwent pars plana vitrectomy with perfluorophenanthrene for removal of the lens material at Wills Eye Hospital from July 1, 1991, through Nov. 30, 1991. The lens was dislocated during cataract extraction in eight eyes. One eye had a history of nonpenetrating trauma and lens dislocation. In one eye a retinal tear was noted intraoperatively and treated. Six eyes had postoperative visual acuity of 20/50 or better. In all eyes the lens was removed without further complications. Perfluorocarbon liquids such as perfluorophenanthrene may enhance current techniques by allowing easier and safer removal of displaced lens fragments through the pars plana.

PURPOSE: To report a case of malattia leventinese involving subretinal hemorrhage. METHODS: Case report. RESULTS: Two weeks after initial presentation, the visual acuity of this 34-year-old man decreased to LE: 20/100. Funduscopic evaluation revealed a subretinal hemorrhage involving the center of the foveal in the left eye that was interpreted as secondary to a neovascular membrane on fluorescein angiography. The patient did well after the removal of the submacular material by pars plana vitrectomy. CONCLUSION: Patients with malattia leventinese may occasionally present with submacular hemorrhage. Prompt diagnosis and intervention may enhance the patient’s chance for visual improvement.

Retinopathy of prematurity remains a leading cause of childhood blindness. New technologies and improvements in neonatal care are resulting in a greater survival rate among infants with birth weights of less than 1000 g. A fetus at or beyond 25 weeks’ gestation or with an expected birth weight of 700 g or more currently has a more than 50% chance of survival.1 The International Classification of Retinopathy of Prematurity (ICROP)2 has paved the way for better understanding this potentially blinding condition. Shortly after the ICROP was published, a multicenter trial of cryotherapy for retinopathy of prematurity (CRYO-ROP study) was initiated. The results to date support the efficacy of cryotherapy for reducing the risk of unfavorable ocular outcome from “threshold” ROP. However, significant systemic and ocular complications were reported within the CRYO-ROP study.

The authors report on 11 patients with age-related macular degeneration associated with massive subretinal hemorrhage, who were treated with surgical removal of the hemorrhage and associated fibrosis. Preoperative visual acuity ranged from 20/400 to hand motions. Postoperative visual acuity ranged from 20/200 to light perception with a minimum of 3 months of follow-up. Complications included partial or total retinal detachment in four patients (36%) and cataract in four patients (36%). Four of 11 patients showed some improvement in vision (36%). All four of these patients had surgery within 1 week of the onset of severe visual loss. Although surgical removal of large subretinal hemorrhages is technically feasible, visual recovery is limited, even in uncomplicated cases, by macular degenerative changes.

Cutis marmorata telangiectatica congenita is a rare congenital vascular disorder of the skin, characterized by persistent telangiectasia of the cutaneous blood vessels often associated with cutaneous ulcers. The only previously recognized ophthalmic association with this condition has been rare instances of unilateral congenital open angle glaucoma. The authors report their observations in a child in whom this cutaneous disorder was associated with congenital bilateral total retinal detachments and secondary neovascular glaucoma. The retinal detachments produced bilateral leukocoria simulating retinoblastoma. The cutaneous disorder and the ocular findings were confirmed histopathologically.

Age-related macular degeneration (AMD) remains the leading cause of visual loss in adults older than 65 years. Retinal angiomatous proliferation (RAP) is a newly recognized manifestation of exudative AMD that has a poor natural history and demonstrated resistance to treatment with conventional laser photocoagulation. A novel surgical technique has been developed in this pilot series that shows promise in the treatment of this subtype of neovascular lesions. Through specific surgical lysis of the feeding arteriole and draining venule of an RAP lesion, improvement in visual acuity has been noted. This has been correlated with resolution of intraretinal edema and flattening of associated pigment epithelial detachment, which was confirmed by fluorescein angiography, optical coherence tomography, and high-speed indocyanine green angiography.

To examine the laser-tissue interactions for contact transscleral irradiation, argon and CW Nd:YAG light was delivered through a synthetic sapphire crystal which was held in direct conjunctival contact perpendicular to the peripheral retina. The threshold for retinal whitening was 0.5 J in the rabbit, 1.0-1.5 J in the monkey, and 1.0-4.0 J in human eyes. Histologic examination of the acute injury and at 2 days, 1, 3, 6, and 12 weeks, showed coagulative lesions centered around the pigmented layers in the rabbit. While severe chorioretinal disruption and hemorrhage did occur depending on species, energy level, and probe location, no scleral perforation was noted at any setting. These preliminary studies suggest that transscleral contact lasers may be used safely in clinical situations where selective ablation of the peripheral retina or pigmented tissues is the primary objective.

We report the use of a continuous wave Nd:YAG (CW-YAG) laser focused through a sapphire crystal to create a filtering bleb by ab-interno sclerostomy. A 2-mm clear corneal incision was made in each eye of five anesthetized Dutch Belted rabbits, and the 30-mm-long sapphire crystal with a 0.2-mm focal tip was passed across the anterior chamber until it came in contact with the opposite angle. Between two and three pulses of 0.8 J were required to produce a filtering bleb in each of the 10 eyes. The overlying conjunctiva was not damaged; the procedure time was under five minutes. Histological examination revealed a surrounding area of scleral melting that extended an average of 0.06 mm from the sclerostomy. These data suggest that the CW-YAG laser may be useful in performing glaucoma filtering surgery with minimal damage to surrounding ocular tissues.

A 43-year-old woman developed a heterophile-negative infectious mononucleosis syndrome for which no cause was apparent. During her illness she developed subjective changes in the central vision of her right eye and had focal retinal inflammation, which suggested the diagnosis of toxoplasmosis. The clinical course was accompanied by an increased titer to Toxoplasma gondii. Organisms were isolated from lymph node tissue and injected into the peritoneum of mice from which organisms were harvested.

Contact Nd:YAG laser surgery offers a new method of delivering laser energy to a target tissue site. Nd:YAG, a near-infrared laser, can be transmitted through an optical fiber delivery system to a synthetic sapphire probe. This sapphire probe can be used as a surgical scalpel to cut, vaporize, or coagulate tissues. The contact laser scalpel offers many advantages over conventional steel scalpel surgery and the system overcomes many of the limitations encountered with noncontact Nd:YAG lasers. A review of the history, biophysics, and experimental studies is presented. Clinical oculoplastic applications are reviewed.

• Cartilage has been reported to contain a factor that inhibits tumor neovascularization. Rabbit vitreous, another avascular tissue, has also been shown recently to have an inhibitory effect on tumor neovascularization. This report describes our results on the effects of bovine and human vitreous on tumor neovascularization with use of a rabbit cornea model. Inhibition of neovascularization was observed with both bovine and human vitreous in the form of reduced new blood vessel growth over and around the vitreous pellet and subsequent delayed exophytic tumor growth. Stimulation of neovascularization by bovine and human vitreous was also observed as an early, short-lived response.

In 29 experiments, vascular autologous retina from the contralateral rabbit eye was implanted into corneal pockets in New Zealand white rabbits. The implants induced a neovascular growth of limbal vessels that anastomosed with the vessels of the implant in 15 of the cases. Implantation of vascular autologous iris, choroid, optic nerve extraocular muscle, and conjunctiva also induced neovascularization. Avascular peripheral retina, cornea, and scleral implants did not cause a neovascular response, nor did boiled vascular retina, boiled iris, and boiled choroid. Neovascularization from the retinal and iris intracorneal implants was induced by V2 carcinoma.

SUMMARY The SITE instrument appears to combine advantages of other instruments previously described. It meets the proposed objectives of an efficient cutter where tissue is removed at the front end of the tip. It allows the surgeon complete control of the suction and reflux systems. The instrument is of a simple modular design. A fiber optic attachment is available. It is dependable and safe.

Fifteen patients (16 eyes) with persistent hyperplastic primary vitreous (PHPV) were followed from one to four years. All but one of the nine eyes in the nonsurgical group showed progressive deterioration. A closed intraocular microsurgical (CIOM) approach posterior to the limbus was used in seven eyes. Three intraoperative complications involving the retina occurred because the retina in these cases inserted directly into the pars plicata and due to the presence of a thick, well-formed vitreous gel. Anterior placement of incisions is recommended to avoid intraoperative complications in small eyes. Early CIOM management is suggested in selected cases of PHPV to prevent progressive deterioration leading to phthisis and to afford reasonable cosmetic improvements.

• During a 17-month period, 33 histologically proved posterior uveal melanomas were prepared for in vitro cultivation in our laboratory. Nine of these remained in culture from five to 12 passages. Four tumors histologically classified as heavily pigmented spindle B cell type remained as pigmented spindle cell tumors in primary culture. During subcultivation one culture lost pigmentation and exhibited mixed cells. Three other tumors, classified histologically as lightly pigmented spindle B cell type, appeared as amelanotic mixed cells in primary culture and grew as epithelioid cells during subcultivation. Two tumors classified as mixed cell type grew as spindle cells in primary culture. One of these last cultures reverted to mixed cell type on subcultivation. One cell culture has shown pigmentary and morphologic changes with variations in carbon dioxide level and media composition.

A contact Nd:YAG laser with a sapphire tip (convex surface 2 mm in diameter) was used to coagulate the retina and ciliary body through the sclera. The laser energy was successfully transmitted through the sclera, producing retinal coagulation and destruction of the ciliary body. A 0.2-mm diameter sapphire tip and Nd:YAG laser were used to perform transvitreal retinal coagulation, retinotomy, and retinochoroidal incision. Minimal hemorrhage occurred when retinochoroidotomy was done. Probe-tissue adhesion occurred but could easily be separated.

Complicated retinal detachments (RDs) were successfully managed in 150 eyes of 170 consecutive patients by one surgeon (JLF) using silicone oil in conjunction with modern pars plana vitrectomy. Long-term postoperative complications were observed between 6 months and 5 years of follow-up. Cataracts developed in all phakic eyes and all corneas with oil-endothelial touch showed band keratopathy within 6 months. Recurrent detachments were noted in 22% of eyes during silicone oil tamponade and occurred in 13% of eyes after the oil had been removed. Other complications associated with the use of oil for vitreous surgery included pupillary block glaucoma (3%), closure of the inferior iridectomy (14%), fibrous epiretinal and subretinal proliferations (15%), pain (5%), and subconjunctival deposits of oil (3%). Without exception, within a period of 1 year the intraocular silicone oil showed some degree of emulsification, suggesting that the physicochemical characteristics of the oil injected may be an important variable in long-term complications.

Serum samples from patients with choroidal malignant melanoma, carcinoma metastatic to the choroid and “normal” controls containing tumor-associated antibodies (TAA) to tissue cultured melanoma cells were examined for the presence of smooth muscle antibody (SMA). Sera found to contain SMA were absorbed with actin or thrombosthenin and reassayed for TAX With this modification, 72% (78% before absorption) of patients with uveal melanoma, 26% (78% before absorption) of patients with carcinoma metastatic to the choroid and 13% (24% before absorption) of “normal” controls were found to have tumor-associated antibodies in their serum.

Eight cases of retinal detachment from giant tears were followed from four months to two years. Patients were treated with a combined procedure, including pars plana vitrectomy, rotation of the patient with air-gas fluid exchange to bring the retina into its normal anatomic position, and trans-scleral retinal sutures, using an external rather than internal approach. Seven of the eight cases were reattached successfully. Methods, materials, and complications are described. Pre- and post-operative information regarding visual acuity and results are listed in tabular form.

We successfully used a semiconductor diode laser to deliver endophotocoagulation burns to the retina of a rabbit. The diode laser employed emits light at a wavelength of 817 nm (near infrared). It has a power output of up to 1.0 W in the continuous-wave mode, equivalent to the capability of current argon laser endophotocoagulators. A standard, commercially available fiberoptic endophotocoagulation probe was used to deliver the laser burns. We used power settings ranging from 300 m W to 400 m W and exposure times of 0.1 to 0.2 seconds to produce chorioretinal bums that appeared clinically and histopathologically indistinguishable from those induced with conventional wavelengths. This new laser system has the decided advantages over traditional endophotocoagulators of being much smaller, less costly, and requiring no water cooling, without sacrificing power output or ease of delivery.

Adequate pupillary dilation is essential to dissect and excise peripheral fractional proliferative tissue during vitreous surgery. Most surgical dilating procedures involve an incision or excision of iris tissue, that is either inadequate or irreversible. We describe a modification of a previously devised technique for stretching the pupil that ensures an excellent view of the peripheral retina. The technique has been used in aphakic and pseudophakic eyes in over 50 cases with no postoperative morbidity or problems with glare or poor cosmesis.

• Aliquots of normal human plasma that had been incubated with tritiated fluorescein were examined for radioactive binding to proteins. Samples were fractionated by polyacrylamide gel electrophoresis (PAGE) and gel filtration. Aliquots removed between zero time and two hours showed no specific radioactive binding peaks by either method. Tritiated fluorescein ran well ahead of all proteins at all times on PAGE and well after the protein eluted from a fractionating column (Sephadex G-75). Ten minutes after intravenous injections, PAGE of plasma from three patients undergoing fluorescein angiography with nonradioactive dye showed the only fluorescent band migrating ahead of all protein bands. These methods failed to demonstrate specific binding of tritiated fluorescein to normal human plasma proteins. We conclude that during angiography, fluorescein exists in plasma as an unbound molecule or is so weakly associated with plasma proteins as to be undetectable by the methods used.

Visualization is a critical factor in determining the success or failure of vitreoretinal procedures. One frequent problem during ocular surgery, especially during lengthy procedures, is corneal epithelial clouding. This may occur despite constant irrigation with physiologic balanced salt solution. Using a surface contact lens in pars plana vitrectomy may add to corneal epithelial damage and further exacerbate corneal clouding.

• Fluorescein angiographic sequences from 31 patients with angioid streaks were evaluated. In contrast to previous reports, the streaks usually showed an early central zone of hypofluorescence. We postulated that the hypofluorescence was due to a break in Bruch membrane, causing a separation of the choriocapillaris. This resulted in an area of nonperfusion. Adjacent light-colored areas were hyperfluorescent, possibly due to abnormal retinal pigment epithelium, thickened Bruch membrane, and patent choriocapillaris. The hypofluorescence of the paired red-brown spots may have resulted from an increased pigment density. The intermittent hypofluorescent spots comprising the area of peau d'orange were thought due to focal dehiscences in Bruch membrane and the choriocapillaris. The hyperfluorescent isolated focal lesions may have resulted from an abnormal thickening of Bruch membrane and a patent choriocapillaris.

• The tumor-associated antibody (TAA) levels in two patients with choroidal melanomas who were undergoing xenon arc photocoagulation therapy were determined by indirect immunofluorescence with allogeneic tumor cells. The TAA titers rapidly increased after each photocoagulation session and then fell to previous levels. Even after 11 months, TAA levels rose after as many as five photocoagulation therapy sessions. Variations in the TAA titers probably occurred as an immune response to the release of sequestered tumor-associated antigens after the initial photocoagulation or necrosis following the reduction of the tumor's blood supply. The persistence of changes in the TAA level after many photocoagulation sessions and spanning nearly a year suggests that even though the tumor appears clinically resolved, sequestered tumor-associated antigens have remained in the area.

• The indirect immunofluorescent and indirect immunoperoxidase methods to detect tumor-associated antibodies (TAAs) in the plasma of patients with ocular melanomas were examined with commercially available conjugates. Testing indicated comparable titers and staining between the two techniques using snap-frozen uveal melanoma cells. With the indirect immunoperoxidase method it was found that 78% (57) of 73 patients with uveal melanoma had TAAs, while 24% (25) of 106 control subjects were positive for TAAs ( P Tumor-associated antibodies have not been correlated to various prognostic indicators, but serial testing after therapy may show the biologic meaning of such antibodies in patients with ocular melanoma.

Twenty-two patients who underwent vitrectomy surgery for chronic cystoid macular edema (CME) were evaluated. These patients all had uneventful intracapsular cataract extraction, but CME with vitreous adhesions to the cataract incision later developed. Vitrectomy was performed to remove the vitreous from the anterior segment structures in each case. Nineteen of the 22 patients showed improved visual acuities within six months, and all but two had complete resolutions of the CME by one year. These two patients did show marked improvements of visual acuity. The majority of patients younger than 65 years of age had final visual acuities of 20/50 or better, whereas the majority of those older than 65 years had less than 20/50. The results were not influenced by the duration or the pattern of the CME prior to vitrectomy. A prospective study to determine the value of vitrectomy in this type of patient is suggested.

Nineteen eyes on which pars plana vitrectomy was performed were studied with fluorescein angiography. The degree of background diabetic retinopathy before and after surgical treatment appeared unchanged. The degree of proliferative retinopathy not only was less after surgical treatment, but continued to show regression with time.

It is not by chance that light energy has been utilized therapeutically in ophthalmology for over four decades. The human eye has evolved into a complex sense organ that can convert minimal amounts of light into a chemical reaction to begin the visual process. Its anatomic structure is designed to focus light energy onto the photoreceptor cells of the retina and adjacent retinal pigment epithelium (RPE). The intensity of light reaching these structures is critically controlled by the lids and pupil. Too much light focused on the retina and the retinal pigment epithelium (RPE) can cause damage resulting in a chorioretinal scar. Clinically, light-induced chorioretinal lesions can be seen in patients after an eclipse of the sun,1 arc welding,2 and during exposure to microscope light source during cataract surgery.3

Closed posterior intraocular microsurgery with vitreous instruments and bimanual surgical techniques have markedly altered the management of intraocular foreign bodies (IOFB). This paper presents an approach to 14 metallic intraretinal foreign bodies (IRFB) that could not be removed by conventional methods. In all cases, posterior vitrectomy was required to visualize the foreign body or to facilitate its removal through a pars plana incision with intraocular forceps under microscopic visualization. Although successful removal of the intraretinal foreign body was possible in all 14 patients, central visual acuity of 20/400 or better was obtainable in only 40% of this series., An important observation in these patients was a tendency to macular pucker from subsequent epiretinal membrane formation and retinal detachment with massive periretinal proliferation (MPP), which occurred in 90% of these eyes. Despite an obviously enhanced ability to remove foreign bodies from the retina, made possible by vitreous instruments and surgical techniques, the magnitude of the secondary complications in this variety of ocular trauma suggests a poor visual prognosis for such injuries.

A series of 12 patients (13 eyes) with neovascular glaucoma in association with arterial obstructive disease is presented. Appropriately characterized as having an ocular ischemic syndrome, the anterior segment findings in each included aqueous flare and rubeosis iridis. Posterior segment manifestations included midperipheral intraretinal hemorrhages (venous stasis retinopathy), narrowed retinal arteries, often a cherry red spot, and neovascularization of the disc and/or retina. Most eyes with the ocular ischemic syndrome have either ipsilateral common carotid artery obstruction or severe bilateral obstruction of the internal carotid arteries.

• The aqueous humor and serum samples of patients with presumed ocular toxocariasis were examined by an enzyme-linked immunosorbent assay (ELISA) for antibody to the embryonated egg antigen. Using a single dilution (1:8), higher amounts of antibody have been found in the aqueous humor than in the serum samples. Antibody was not found in the serum or aqueous humor of patients with retinoblastoma, Coats' disease, uveal malignant melanoma, or central retinal artery obstruction. While two patients with presumed ocular toxocariasis had normal serum levels of antibody, the aqueous humor ELISA titers were greatly elevated, supporting the clinical diagnosis and suggesting localized antibody production.