Intraocular lens implantation following expulsive choroidal hemorrhage.

Uncomplicated posterior chamber intraocular lens implantation was performed in two eyes that had been salvaged after expulsive choroidal hemorrhage during a previous cataract operation and in one eye after loss of the fellow eye from expulsive choroidal hemorrhage. The procedure was performed in a 72-year-old woman three weeks after and in an 81-year-old man four months after the successful management of expulsive choroidal hemorrhage. A third patient, an 84-year-old woman, had posterior chamber intraocular lens implantation in her remaining eye six years after the loss of other eye. All three patients had a final visual acuity of 20/40 or better after a follow-up period of six months to four years.

Argon laser phototherapy of phthiriasis palpebrarum.

Argon laser phototherapy is an alternative new, quick, and effective method of treating phthiriasis palpebrarum in one sitting. A beam at a setting of 200-microns size, 0.1 second time, and 200 mW power is employed to destroy individual adult parasites and nits. The only drawbacks are an occasional but tolerable stinging and the slicing of the eyelash stems carrying the nit. The eyelashes regain their normal length within a few days.

Argon laser treatment of trichiasis.

This paper presents the application of argon laser in the treatment of trichiasis. The technique involves the destruction of the follicles of the abnormal cilia. A beam of 50- to 200-micron spot size, 0.1- to 0.2 second time, and 1,000 to 1,200 mW power is used under local anesthesia. This method proved safe, convenient, precise, and effective in 11 cases. The technique is most suitable when a few fine cilia are involved, but repeated treatment may be required for more and thicker eyelashes. The follow-up period in this study varied from a minimum of four months to a maximum of nine months.

Intraocular and extraocular colobomatous cysts in adults.

A 29-year-old woman had a colobomatous multiloculated cystic left eyeball. None of the normal structures of the globe were discernable by clinical examination. The cyst had been present since birth and had not grown in size since early childhood. Another patient, a man of 73, had an intraocular colobomatous cyst occupying the temporal half of the large choroidal bridge coloboma in his left eye. This cyst was partially filled with shimmering crystalline fluid. This patient had bilateral open-angle glaucoma which had caused advanced damage to the optic nerve in the structurally normal right eye. It is interesting that glaucoma did not affect the left eye with choroidal coloboma and intraocular colobomatous cyst, which had normal vision. The author thinks that ectatic sclera in the area of coloboma might have protected the eye from elevated intraocular pressure.

Biomicroscopy and argon laser photocystotomy of free-floating vitreous cysts.

Laser photocystotomy is a new technique that employs a 200 mu beam of argon laser at a setting of 0.1 second and 500 mW to accomplish cystotomy of symptomatic free-floating vitreous cysts. It was successful in treating this type of cyst in the right eye of a 23-year-old man. The paper also includes the first photographic documentation of the biomicroscopic features of a free-floating vitreous cyst.

Changes in the contralateral eye in uncomplicated persistent hyperplastic primary vitreous in adults.

In two adults (a 62-year-old man and a 71-year-old woman) uncomplicated full-blown unilateral persistent hyperplastic primary vitreous was diagnosed on the basis of characteristic clinical features and ultrasonography. In the contralateral uninvolved eyes, we found open-angle glaucoma, anomalous blood vessels along the entire circumference of the anterior chamber angle, band keratopathy, and heterochromia iridis. The axial length of one involved eye was about 0.85 mm larger than that of the uninvolved eye.

Leaf-shaped lesions of ocular fundus and white eyelashes in tuberous sclerosis.

A 5-year-old white girl with tuberous sclerosis had, in addition to bilateral retinal hamartomas, two hypopigmented leaf-shaped areas in the right fundus. These areas may be akin to the well known ash-leaf white cutaneous macules of tuberous sclerosis. Also, poliosis circumscripta was present in the left upper eyelid. Both findings may be rare associated signs of tuberous sclerosis.

Familial chorioretinal vascular anastomoses and congenital cataracts.

Familial congenital chorioretinal venous anastomoses in the area of the optic disc in a mother and her daughter are reported. The anomaly was accompanied, in both patients, by bilateral congenital cataracts, bilateral myopic astigmatism with amblyopia, and bilateral abnormal optic discs with corresponding visual field defects. The author postulates that all these ocular anomalies might have been transmitted by the same pleiotropic gene; however, he could not determine the exact mode of transmission of this syndrome. The chorioretinal venous anastomoses include vena vorticosa vaginalis (an accessory vortex vein draining into the pial plexus of the optic nerve sheath) in the mother and optico-ciliary vein in the daughter. The mother also had a dramatic posterior vortex vein that was located between the optic disc and the macula.

Ocular melanocytosis and angioid streaks.

Unilateral angioid streaks of the ocular fundus with homolateral ocular melanocytosis in a 49-year-old white woman are reported. The findings are substantiated by fluorescein angiography. The local changes related to ocular melanocytosis probably precipitated the formation of angioid streaks in the genetically predisposed patient. Two greyish-yellow patches were also found on ophthalmoscopy of the involved eye. One of these, located in the paramacular region, exhibited definite progression, and transformed into a disciform lesion without implicating the macula. The presence of these likely precursors of angioid streaks about the macula is more ominous. A comment about the relationship between melanocytosis, angioid streaks, and phakomatoses is added.

Intraepithelial epithelioma (Bowen's disease) of conjunctiva and chronic lymphocytic leukemia.

Occurrence of intraepithelial epithelioma (Bowen's disease) of the conjunctiva in a 54-year-old white man with chronic lymphocytic leukemia and bilateral labiopalatine clefting is discussed. The lesion developed slowly during 3 years following mechanical trauma to the eye. The interrelationship between trauma, Bowen's disease, and chronic lymphocytic leukemia remains obscure. It is postulated that an altered immunologic status might be responsible for neoplastic changes in the posttraumatic healing process. Intractable lesions in a patient with abnormal immunologic system or with an already proven malignancy should be studied by excisional biopsy.

Congenital toxoplasmosis: chances of occurrence in subsequent siblings.

Occurrence of congenital toxoplasmosis in subsequent siblings after the birth of an affected child is discussed. Toxoplasmic retinochoroiditis was found in 3 surviving siblings. The diagnosis was made by the typical fundus lesions in children, intracranial calcification in one child, and significant positive titer for toxoplasmic antibodies in all the children and the mother, who was asymptomatic. Serology for syphilis, skin tests for histoplasmosis and tuberculosis, blood studies with sedimentation rate, and chest roentgenograms were all negative in mother and all 3 children. The view that transmission of infection from mother to the fetus may result from a chronically infested uterine wall is supported and is thought to be the probable cause in the cases reported here. After the birth of one child with congenital toxoplasmosis, the parents may be reassured about the favorable prognosis of subsequent pregnancies with some reservation. However, it appears unwise to categorically refute the repetition of congenital toxoplasmosis in siblings. It is also suggested that because of possible danger of reactivation, the healed toxoplasmic chorioretinal lesions should be properly monitored if the patient is to be given corticosteroids for any other reason.