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.