Retinal microincarceration with penetrating diathermy in the management of giant retinal tears.

A technique for repair of giant retinal breaks with detachment involves the performance of lensectomy-sector iridectomy, vitrectomy, and scleral buckling behind the equator. Total fluid-gas exchange is performed while the patient is turned to the prone position on a rotating table. Penetrating diathermy is used to fix the retina and to create retinal microincarceration while air is simultaneously injected into the eye.

Treatment of large von Hippel tumors by eye wall resection.

Two large angiomas (greater than 3 disc diameters) in two patients with von Hippel disease were removed successfully by eye wall resection. The resection of angioma in the first case resulted in improved visual acuity from counting fingers to 20/140, decreased exudates, and cessation of preoperative diffuse retinal capillary leakage observed by fluorescein angiography. The resection in the second case with pre-existing local tractional retinal detachment was tolerated well. The patient retained her preoperative visual acuity of 20/25, and retinal traction was released. Although a complicated surgical procedure, resection of large angiomas offers a good alternative therapy to tumors resistant to cryocoagulation or photocoagulation.

Talc retinopathy in primates: a model of ischemic retinopathy. II. A histopathologic study.

Experiment talc retinopathy was produced in four adult rhesus monkeys by biweekly intravenous injections of talc for 31/2 to ten months and was studied by retinal vascular flat preparations and by light microscopy. Talc particles were lodged in the walls of the precapillary arterioles and capillaries, producing focal occlusion of retinal and choroidal capillaries. The pericyte-endothelial cell ratio was 1:0.77 in the posterior pole and 1:0.53 in the retinal periphery. The horseradish peroxidase study showed leakage of tracer from the retinal vasculature into the extracellular interstitial space, but the barrier of the retinal pigment epithelium was intact. Microinfarcts produced small cystoid spaces in the outer plexiform layer, inner nuclear layer, and ganglion cell layer of the macula. Cytoid bodies and macrophages were scattered in the retina. No retinal or vitreal neovascularization was observed.

A teaching mirror for patient's observations during indirect ophthalmoscopy.

We developed a technique by which patients can observe the central fundus of their own contralateral eye during indirect ophthalmoscopy. This is achieved by adding an angulated mirror to the side of the presently available teaching mirror of the indirect ophthalmoscope. Self-indirect ophthalmoscopy is also feasible when the light source is kept stable.

Scatter retinal photocoagulation for proliferative sickle cell retinopathy.

We treated sea-fan neovascularization in 19 patients (21 eyes) who had proliferative sickle cell retinopathy with localized scatter photocoagulation. We placed burns of light to moderate intensity adjacent to 45 sea fans in a scatter fashion. In general, treatment extended from 1.5 mm posterior to 1.5 mm anterior to the sea fan and one clock hour to each side of each lesion. Flat sea fans responded dramatically to treatment, with complete regression in 24 of 28 lesions. Elevated sea fans (especially large ones) responded less rapidly, with complete regression in only four of 17 lesions. Localized scatter photocoagulation is valuable in treating patients with early proliferative sickle cell retinopathy.

Talc retinopathy in primates. A model of ischemic retinopathy: I. Clinical studies.

Four rhesus monkeys received intravenous injections of talc twice weekly for 3 1/2 to ten months. Within one month, talc particles were visible in fine perifoveal retinal vessels in the posterior pole. Continued deposition of talc could then be seen after subsequent injections. Hemorrhages in the nerve fiber layer, cotton-wool patches, and whitish plaques in the choroid were visible ophthalmoscopically. Fluorescein angiography revealed precapillary arteriolar occlusions, capillary nonperfusion, an abnormal foveal avascular zone, and retinal vascular leakage. Vitreous fluorophotometric findings were abnormal in all five eyes tested, while electroretinograms were normal in two eyes with advanced talc retinopathy. Talc retinopathy in the primate is similar to ischemic retinopathies in humans, including human talc retinopathy, sickle cell retinopathy, and hypertensive retinopathy. Subsequent reports will describe the light microscopic and ultrastructural changes in these eyes using tracer studies with in these eyes using tracer studies with horseradish peroxidase.

Uveal melanoma in association with multiple malignancies. A case report and review.

A 66-year-old man had a pigmented choroidal lesion in his right eye. Over a subsequent period of 8 1/2 years, the lesion showed slight growth. At autopsy, the diagnosis was spindle B melanoma of the choroid without evidence of systemic metastasis. A very unusual feature of this case was the presence in this patient of seven primary malignant tumors and five benign neoplasms. In addition to the choroidal melanoma, these included three distinct pulmonary carcinomas, leiomyosarcoma of the stomach, adenocarcinoma of the sigmoid colon, and basal cell carcinoma. The literature on multiple malignancies in association with uveal melanoma is reviewed.