State anger and prefrontal brain activity: evidence that insult-related relative left-prefrontal activation is associated with experienced anger and aggression.

Research has demonstrated that left-prefrontal cortical activity is associated with positive affect, or approach motivation, and that right-prefrontal cortical activity is associated with negative affect, or withdrawal motivation. In past research, emotional valence (positive-negative) has been confounded with motivational direction (approach-withdrawal), such that, for instance, the only emotions examined were both positive and approach related. Recent research has demonstrated that trait anger, a negative but approach-related emotion, is associated with increased left-prefrontal and decreased right-prefrontal activity, suggesting that prefrontal asymmetrical activity is associated with motivational direction and not emotional valence. The present experiment tested whether state-induced anger is associated with relative left-prefrontal activity and whether this prefrontal activity is also associated with aggression. Results supported these hypotheses.

Foveal drusen resorption one year after perifoveal laser photocoagulation.

"Soft" drusen maculopathy is an important precursor of exudative and atrophic macular degeneration. Resorption of soft drusen at the macula in response to laser photocoagulation has been demonstrated previously. The case described in this article is unique because it documents progression of soft drusen maculopathy prior to laser and shows a better visual and morphologic result than in previous studies. In this case, perifoveal laser photocoagulation caused the complete resorption not only of the treated drusen but also the untreated subfoveal and perifoveal drusen. Foveal morphology was restored, visual acuity improved from 20/40 to 20/20, and metamorphopsia diminished. This uniquely favorable response to photocoagulation may result from the treatment of the drusen maculopathy before atrophic, exudative, or neovascular complications. This result shows the need for establishing indications for this treatment through a prospective clinical study and for investigating its mechanism of action.

Indentation laser photocoagulation of peripheral retinal neovascularization.

The treatment of peripheral retinal neovascularization by laser photocoagulation is an accepted technique. One of its limitations is the difficulty in photocoagulating retinal neovascularization that has become even slightly elevated from the underlying pigment epithelium. The failure to close the neovascular frond and the production of a vitreous hemorrhage are the complications from the direct photocoagulation of elevated neovascularization. The currently accepted method of treating the feeding retinal arteriole and venule, although successful, requires multiple treatment sessions. The use of a scleral indentation funnel at the time of laser photocoagulation permits the direct photocoagulation of elevated neovascularization in some cases. This technique increases the number of neovascular fronds that are amenable to direct laser photocoagulation, improves the rate of success of closure of the neovascularization by photocoagulation, decreases the necessary number of treatment sessions, and decreases the risks from treatment.

Laser photocoagulation with biomicroscopic scleral indentation.

The treatment of peripheral retinal tears by laser photocoagulation is an accepted technique. One of its limitations is its difficulty in use near the ora serrata. The inability to treat the anterior border of a rentinal tear may allow the tear to progress to clinical retinal detachment despite treatment of the tear's posterior and lateral borders. The use of a scleral indentation funnel at the time of laser photocoagulation permits the sealing of all margins of the break. This technique increases the number of retinal tears that can be treated by the laser, and it may improve the rate of success of photocoagulation of peripheral retinal tears.

Diabetic macular edema in juvenile- and adult-onset diabetes.

A retrospective study of 103 patients referred because of diabetic retinopathy graded the degree of maculopathy on the basis of fluorescein angiography. Patients with juvenile-onset diabetes (that is, onset before the age of 40 years), had a higher rate of neovascularization of the disk or retina at early stages of maculopathy than patients with adult-onset diabetes. Greater capillary closure at each degree of maculopathy in the group with juvenile-onset diabetes may explain this difference.

Vitreous base classification of retinal tears: clinical application.

The abundant data about retinal tears has shown that they are prevalent in the general population and that the vast majority of retinal tears do not lead to retinal detachment. What remains to be clarified are the criteria for identifying the few retinal breaks which require prophylactic surgery to prevent their progression to retinal detachment. Numerous reports have identified clinical features which correlate with the risk the retinal detachment. These correlative data offer at best only a suggestion about the need for treatment of any specific retinal break. This paper-demonstrates how the categorization of a retinal tear on the basis of vitreoretinal anatomic detail may be used clinically to make an objective and nonstatistical judgment about the prognosis of any specific retinal break. The application of this new categorization offers an advance in the care of patients with retinal tears.

Acute posterior multifocal placoid pigment epitheliopathy associated with cerebral vasculitis and homonymous hemianopia.

An 18-year-old man developed acute posterior multifocal placoid pigment epitheliopathy and homonymous hemianopia. Cerebral angiography showed cerebral vasculitis probably with occipital infarction. To the best of our knowledge, this is the first reported case with such concomitant visual defects. Other published reports suggest that such cerebral vasculitis may not be unusual in acute posterior multifocal placoid pigment epitheliopathy.

Amelanotic small flat lesions of the choroid.

On routine examination, three patients demonstrated yellow-white lesions in the posterior third of the fundus. These lesions have a subtle but unique appearance. They are in the choroid and have definite borders, minimal or no elevation, a lack of secondary changes in the overlying pigment epithelium or neuroepithelium, and no pigment within the lesion or at its borders. Ophthalmoscopic and fluorescein angiographic data permit discussion of the differential diagnosis of these lesions. They may represent amelanotic nevi of the choroid.

Conjunctival adnexal cysts and dermoids.

Of 128 cysts diagnosed clinically and pathologically as epidermoids and dermoids, 12 lesions were discovered that were lined by nonkeratinizing squamous epithelium with variable numbers of admixed goblet cells. Five lesions did not contain any adnexal structures in their walls and were designated as simple conjunctival cysts; seven lesions additionally displayed appendages in their walls and were diagnosed as conjunctival dermoids. Clinically, this group of 12 cysts differed from classic epidermoids and dermoids by their overwhelming superomedial location and absence of associated osseous defects. It is proposed that these nonkeratinizing cysts represent sequestrations of conjunctival-type epithelium, analogous to the displacements of keratinizing surface epidermis that are most commonly responsible for the production of classic epidermoids and dermoids. It is possible to confuse conjunctival cysts and dermoids with mucoceles.

Lymphoid lesions of the conjunctiva: relation of histopathology to clinical outcome.

A retrospective clinicopathologic study of 40 patients with lymphoid lesions of the conjunctiva demonstrated the validity of current histologic criteria in predicting clinical outcome. Overall histologic architecture as well as cytologic detail must be used to differentiate benign reactive lymphoid hyperplasia from lymphoma. Lesions verified clinically as being malignant had obvious malignant cytologic features. Clinical signs of surface follicularity, multifocality, and minimal elevation suggest benignancy. All the benign lesions, on histopathologic examination, were either follicular in architecture or composed of mature lymphocytes, and were generally restricted to the substantia propria. Bilaterality and clinical recurrence do not necessarily imply a malignant disease.

Clinical manifestations of brawny scleritis.

We studied four patients with posterior brawny scleritis. Two underwent enucleation for suspected melanoma, and in the other two, the correct diagnosis was made and effective therapy begun. Of seven other eyes with brawny scleritis from other sources, five were enucleated after diagnosis of choroidal melanoma and one for suspected intraocular tumor. This experience and other previous reports indicate the high incidence of diagnostic confusion regarding brawny scleritis. We therefore emphasized clinical symptoms and signs of brawny scleritis: inflammation, tenderness or pain of the globe, history of collagen vascular disease, proptosis, bilaterality, and retinal and choroidal detachment. A preserved normal choroidal vascular pattern over an elevated subretinal mass may be indicative of posterior brawny scleritis. Scleral biopsy is useful for tissue diagnosis. Radioactive phosphorus uptake tests and ultrasonography may erroneously indicate choroidal melanoma and lead to enucleation of a potentially salvageable globe.

Spontaneous lens rupture following pars plana vitrectomy.

This paper presenta a case of pars plana vitrectomy with spontaneous posterior lens capsule rupture 7 weeks after surgery and 1 week after discontinuation of cycloplegia. The diagnosis, treatment, sequelae, and etiology of this spontaneous lens rupture receive discussion. The accommodative mechanism in the postvitrectomy eye may explain the cause of lens rupture and suggest methods of prophylaxis.