Photocoagulation using the Eisner cone.

Thirteen patients with clinical or subclinical retinal detachments were treated with photocoagulation with the aid of a device for scleral depression and the three mirror contact lens. The Eisner cone has proven helpful in achieving clinically white retinal burns at the margins of retinal breaks by displacing subretinal fluid at the time of treatment. Patients selected for treatment had adequate pigmentation for a good photocoagulation response, nearly clear ocular media, and minimal vitreo retinal traction. Extent of retinal detachment was not a determinant, but minimal retinal elevation at break locations proved beneficial. No immediate flattening or adhesion of the retina was seen on release of scleral depression at the time of photocoagulation. White clinical burns remained visible. In 12 of 13 patients the retina was in apposition to the retinal pigment epithelium around the breaks at the first post-treatment examination. The remaining subretinal fluid absorbed in even the most extensive detachment in 2 weeks. One patient with multiple breaks at the equator failed to respond to this technique and required a scleral buckle.

Hemorrhagic peripheral pigment epithelial disease.

Hemorrhage under the retinal pigment epithelium and neurosensory retina occurred in the temporal periphery of ten patients with aging macular degeneration and one patient with histoplasmosis syndrome. The macula was not the source of bleeding. Peripheral subretinal neovascularization, commonly seen histopathologically, may be the cause. The visual recovery was poor, and most patients failed to regain lost vision once peripheral hemorrhage occurred. The differential diagnosis includes retinal detachment, uveal effusion, hemorrhagic retinoschisis, choroidal melanoma, and metastatic tumor.

Prevention of ocular gunshot injuries using polycarbonate lenses.

Two patients lost three eyes, and one his life, secondary to ocular gunshot wounds. In both patients, the pellets gained entry into the central nervous system through the eye and orbital bones despite only superficial wounds to other areas of the body. These tragic injuries prompted a study of polycarbonate lenses to determine their effectiveness in preventing small caliber ocular gunshot wounds. This investigation determined that 3.0 mm and the 2.2 mm polycarbonate lenses could prevent such injuries at distances greater than 15 yards. In comparing the two lenses, it was found that the 3.0 mm lens sustained less damage at 70 degrees F, but the 2.2 mm lens was more resistant to penetration at 32 degrees F. Since most hunting is done in the fall and winter months, the brittle nature of the thicker lens is significant. Polyamide sports frames with a posterior rim were also tested and found to prevent posterior lenticular expulsion at 15 yards. Standard acetate frames were shown to be ineffective in this regard at 30 yards.

Secondary syphilitic uveitis.

A patient with secondary syphilis had positive serum and cerebrospinal fluid findings. Fluorescent-antibody darkfield testing demonstrated spirochetes (Treponema pallidum) in the aqueous. There were clinical signs of secondary syphilis, including palmar skin lesions and frontal balding, and bilateral nasal altitudinal visual field loss. The discrete, waxy, yellow-white retinal lesions became increasingly pigmented and later migrated anteriorly into the vitreous chamber. The patient was treated with large amounts of penicillin (total dosage, 440 million units) and probenecid. Visual acuity improved to R.E. : 6/9 (20/30) and L.E.: 6/12 (20/40) and the inflammatory reaction disappeared. A second aqueous tap eight weeks after therapy ended showed no spirochetes by fluorescent-antibody testing.

Viewing through the asteroids.

Thirty to seventy percent of patients with asteroid hyalosis will also have diabetes. In this group of patients where view of the fundus is essential, it is often difficult or impossible by conventional ophthalmoscopy. We have noted the excellent visualization of fundus detail in asteroid hyalosis on routine fundus fluorescein angiography. The asteroid bodies are "optically removed" from the vitreous with this technique, thus affording a view for diagnosis previously thought impossible without actual vitrectomy. A series of patients, optimal camera filter combination, and a theory for this effect are presented.