A.M.A. Archives of Ophthalmology

KLIEN, BERTHA

doi: 10.1001/archopht.1958.00940080189001pmid: N/A

Abstract The pluripotential responses of retina, pigment epithelium, and choroid to a variety of pathogens produce a fascinating multiplicity of lesions which modify, often characteristically, the clinical picture of macular disease. The Retina I. Opacities of the Macular Retina. —Any foreign matter deposited within the retinal layers, as a result of either infiltrative, exudative, or proliferative processes, changes its index of refraction and becomes clinically visible as an opacity in the otherwise almost transparent structure. Unless caused by hemorrhage or pigment invasion the opacity is light in color. Three of the four types of whitish opacities occur frequently in the macular region. Lipoid Deposits: Clinically the individual lesion is small, discrete, and of brilliant pure white or yellowish-white color, depending upon the intensity of illumination. There is a tendency for grouping and confluence into arborescent or circinate patterns. They arise in areas of chronic relative anoxia, and in and around References 1. Gissy, C. J.: Ein weiterer Fall von präretinalem Ödem , Ztschr. Augenh. 57:423, 1925. 2. Guist, G.: Über praeretinales Ödem , Ztschr. Augenh. 54:37, 1925. 3. Klien, B.: Macular Lesions of Vascular Origin: II. Functional Vascular Conditions Leading to Damage of the Macula Lutea , Am. J. Ophth. 36:1, 1953. 4. Klien, B.: Macular Lesions of Vascular Origin: I. Organic Vascular Lesions Leading to Damage of the Macula Lutea , Am. J. Ophth. 34: 1279, 1951. 5. Gifford, S. R., and Marquardt, G.: Central Angiospastic Retinopathy , Arch. Ophth. 21:211, 1939.Crossref 6. Falls, H.: Hereditary Congenital Macular Degeneration , Ann. Human Genet. 1:96, 1949. 7. Friedenwald, J. S., and Maumenee, A. E.: Peculiar Macular Lesion with Unaccountably Good Vision , A. M. A. Arch. Ophth. 45:567, 1951.Crossref 8. McFarland, C. B.: Heredodegeneration of the Macula Lutea: A Study of the Clinical and Pathologic Aspects , A. M. A. Arch. Ophth. 53: 224, 1955.Crossref 9. Klien, B.: Late Infantile Amaurotic Idiocy , Am. J. Ophth. 38:470, 1954.

HOLLENHORST, ROBERT W.;STEIN, HAROLD A.

doi: 10.1001/archopht.1958.00940080201002pmid: 13558785

Abstract The problems of subdural hematoma and subarachnoid hemorrhage in infancy have been thoroughly discussed in recent years in the pediatric, neurologic, and neurosurgical literature. The following analysis of 47 patients seen and followed at the Mayo Clinic during an 11-year interval emphasizes the ophthalmologic manifestations and sequelae. The neurologic abnormalities other than those of ophthalmologic interest have been reported elsewhere.1 Subhyaloid and retinal hemorrhage associated with subdural and subarachnoid bleeding among adults is well known.2-8 The occurrence of such hemorrhage among children with these conditions has been pointed out.9-15 Ingraham and Matson12 reported that intraocular hemorrhage occurred in 21.8% of a large series of infants who had subdural hematomas. Govan and Walsh13 found such hemorrhage in 50% of their infant patients. Statten14 noted retinal hemorrhage in 21 (75%) of 28 infants. Guthkelch15 reported that 20% to 25% of 24 such patients had changes in References 1. Hollenhorst, R. W.; Stein, H. A.; Keith, H. M., and MacCarty, C. S.: Subdural Hematoma, Subdural Hygroma and Subarachnoid Hemorrhage Among Infants and Children , Neurology 7:813-819 ( (Dec.) ) 1957.Crossref 2. MacDonald, A. E.: Ocular Lesions Caused by Intracranial Hemorrhage , Tr. Am. Ophth. Soc. 29:418-432, 1931. 3. Tureen, L. L.: Lesions of the Fundus Associated with Brain Hemorrhage , Arch. Neurol. & Psychiat. 42:664-678 ( (Oct.) ) 1939. 4. Ballantyne, A. J.: The Ocular Manifestations of Spontaneous Subarachnoid Haemorrhage , Brit. J. Ophth. 27:383-414 ( (Sept.) ) 1943. 5. Manschot, W. A.: The Fundus Oculi in Subarachnoid Haemorrhage , Acta ophth. 22:281-299, 1944. 6. Manschot, W. A.: Subarachnoid Hemorrhage: Intraocular Symptoms and Their Pathogenesis , Am. J. Ophth. 38:501-505 ( (Oct.) ) 1954. 7. Timberlake, W. H., and Kubik, C. S.: Follow-Up Report with Clinical and Anatomical Notes on 280 Patients with Subarachnoid Hemorrhage , Tr. Am. Neurol. A. 77:26-28, 1952. 8. Cordes, F. C.: Subhyaloid Hemorrhage Following Subarachnoid Hemorrhage: Report of 2 Cases , Am. J. Ophth. 36:1192-1198 ( (Sept.) ) 1953. 9. Sherwood, D.: Chronic Subdural Hematoma in Infants , Am. J. Dis. Child. 39:980-1021 ( (May) ) 1930. 10. Ingraham, F. D., and Heyl, H. L.: Subdural Hematoma in Infancy and Childhood , J. A. M. A. 112:198-204 ( (Jan. 21) ) 1939. 11. Ingraham, F. D., and Matson, D. D.: Subdural Hematoma in Infancy , J. Pediat. 24:1-37 ( (Jan.) ) 1944. 12. Ingraham, F. D., and Matson, D. D.: Subdural Hematoma in Infancy , in Advances in Pediatrics , New York, Interscience Publishers, Inc., 1949, Vol. 4, pp. 231-263. 13. Govan, C. D., Jr., and Walsh, F. B.: Symptomatology of Subdural Hematoma in Infants and in Adults: Comparative Study, with Particular Reference to the Ocular Signs; An Observation Concerning Pathogenesis of Subdural Hematoma , Arch. Ophth. 37:701-713 ( (June) ) 1947. 14. Statten, T.: Subdural Haematoma in Infancy , Canad. M. A. J. 58:63-65 ( (Jan.) ) 1948. 15. Guthkelch, A. N.: Subdural Effusions in Infancy: Twenty-Four Cases , Brit. M. J. 1:233-239 ( (Jan. 31) ) 1953. 16. Munro, D.: Cerebral Subdural Hematomas: A Study of 310 Verified Cases , New England J. Med. 227:87-95 ( (July 16) ) 1942. 17. Walsh, F. B.: Clinical Neuro-Ophthalmology , Ed. 2, Baltimore, Williams & Wilkins Company, 1957, p. 877.

RONES, BENJAMIN;ZIMMERMAN, LORENZ E.

doi: 10.1001/archopht.1958.00940080207003pmid: 13558786

Abstract Over the years it has become increasingly evident that tumors of the iris should not be lumped with those of the ciliary body and choroid. They present entirely different problems in clinical diagnosis and surgical management, and there is mounting evidence to support the belief that biologically they may be different tumors. Progress in the study of these tumors has been slow, for they are not common, and a large volume of material with many years of follow-up is necessary for the accumulation of a series of cases from which lessons can be learned. Reese,1 for example, stated that at the Institute of Ophthalmology, in New York. 271 malignant melanomas of the uvea included only 23 that were primary in the iris. More recently, Duke and Dunn2 reviewed the primary tumors of the iris in the pathology laboratory of the Wilmer Institute and were able to report only References 1. This case was reported previously by us.5 2. This case was reported previously by us.5 3. Reese, A. B.: Tumors of the Eye , New York, Paul B. Hoeber, Inc. (medical book department of Harper & Brothers), 1951, pp. 221-222. 4. Duke, J. R., and Dunn, S. N.: Primary Tumors of the Iris , A. M. A. Arch. Ophth. 59:204-214, 1958.Crossref 5. Callender, G. R.; Wilder, H. C., and Ash, J. E.: Five Hundred Melanomas of the Choroid and Ciliary Body Followed 5 Years or Longer , Am. J. Ophth. 25:962-967, 1942. 6. Zentmayer, W.: Primary Sarcoma of the Iris: Removal by Iridectomy; No Recurrence in 3½ Years , Arch. Ophth. 5:219-223, 1931.Crossref 7. Rones, B., and Zimmerman, L. E.: The Production of Heterochromia and Glaucoma by Diffuse Malignant Melanoma of the Iris , Tr. Am. Acad. Ophth. 61:447-463, 1957. 8. Callender, G. R.: Malignant Melanotic Tumors of the Eye: A Study of Histologic Types in 111 Cases , Tr. Am. Acad. Ophth. 36:131-142, 1931. 9. Wilder, H. C.: An Improved Technic for Silver Impregnation of Reticulum Fibers , Am. J. Path. 11:817-821, 1935. 10. Wilder, H. C., and Paul, E. V.: Malignant Melanoma of the Choroid and Ciliary Body: A Study of 2535 Cases , Mil. Surgeon 109:370-378, 1951. 11. Fisher, R. A., and Yates, F.: Statistical Tables for Biological, Agricultural, and Medical Research , Ed. 4, New York, Hafner Publishing Company, Inc., 1953. 12. Zimmerman, L. E., and Rones, B.: Diffuse Malignant Melanoma of the Iris; a Clinicopathologic Study, to be published. 13. Stallard, H. B.: Surgery of Malignant Melanoma of the Iris , Brit. J. Ophth. 35:774-783, 1951.Crossref

HARRIS, JOHN E.;ROWELL, PETER P.;BEAUDREAU, OLIVE

doi: 10.1001/archopht.1958.00940080220004pmid: 13558787

Abstract The germicidal properties of iodine are well known. Indeed, it has been used with good results as an antiseptic for many decades. Its merits for this purpose, recently reviewed by Gershenfeld,1 are numerous. First, it is bactericidal rather than bacteriostatic. Second, such action is rapid and is achieved in comparatively low concentration. Third, unlike most germicides, iodine is essentially equipotent against all bacteria. Fourth, in addition to its bactericidal properties, iodine has well-known activity against spores, fungi, and viruses. Fifth, its tissue toxicity is comparatively low, the toxicity index being less than that of benzalkonium chloride, mercuric chloride, or phenol.1 In spite of its potency and widespread use as a home remedy, iodine finds only limited application in clinical medicine. Most commonly iodine has been used as a skin disinfectant prior to surgery. There is little doubt of its value for this purpose.2,3 However, the use of References 1. A surgical nurse who accidentally splashed this solution in her eye showed no corneal lesion or other evidence of irritation when examined one-half hour afterward. However, contact of this dilution with the conjunctiva should be avoided. When it occurs, immediate irrigation is indicated. 2. This is somewhat higher than the value calculated from the formula provided by the manufacturer. 3. Gershenfeld, L.: Iodine , in Reddish, G. F.: Antiseptics, Disinfectants, Fungicides, and Chemical and Physical Sterilization , Philadelphia, Lea & Febiger, 1957, p. 223. 4. Zintel, H. A.: Asepsis and Antisepsis , S. Clin. North America 36:257-271 ( (April) ) 1957. 5. Medrek, T. F., and Litsky, W.: Surgical Antiseptics , Surg. Gynec. & Obst. 104:209-213, 1957. 6. Thompson, R., Isaacs, M. L., and Khorazo, D.: A Laboratory Study of Some Antiseptics with Reference to Ocular Application , Am. J. Ophth. 20:1087-1098 ( (Nov.) ) 1937. 7. Frisch, A. W., Davies, G. H., and Krippaehne, W.: Skin Degerming Agents with Special Reference to a New Cationic Iodophore, Surg. Gynec. & Obst., to be published. 8. Krippaelme, W., and Frisch, A. W.: Clinical Trial of a New Cationic Iodophore as a Topical Germicide, Surg. Gynec. & Obst., to be published. 9. Lawrence, C. A.: The Effects of Disinfectants on Antibiotic Resistant and Antibiotic Sensitive Strains of Micrococcus Pyogenes, Var. Aureus, to be published. 10. Swan, K. C.: Reactivity of the Ocular Tissues to Wetting Agents , Am. J. Ophth. 27:1118-1122 ( (Oct.) ) 1944. 11. Harris, J. E., and Nordquist, L. T.: The Hydration of the Cornea: I. The Transport of Water from the Cornea , Am. J. Ophth. 40:100-110 (Nov., (Pt. 2) ) 1955. 12. Harris, J. E., and Gruber, L.: The Hydration of The Cornea: III. The Influence of the Epithelium , Am. J. Ophth. 42:330-336 (Oct., (Pt. 2) ) 1956.

WILSON, WARREN A.;DONNELL, GEORGE N.

doi: 10.1001/archopht.1958.00940080229005pmid: 13558788

Abstract Galactosemia is an inborn error of carbohydrate metabolism first described by von Reuss1 a half a century ago. Sporadic reports of the disorder are found in the literature since that time, and during the past decade, probably because of earlier recognition and diagnosis, such reports have appeared with increasing frequency. The occurrence of cataracts is one of the common features of the disease, and it is the purpose of this paper to give a longrange follow-up of the eye findings in a relatively large group of cases. Clinical Findings Clinically, infants with galactosemia appear normal at birth, but signs and symptoms appear within a few days or weeks at most. Presenting symptoms are usually vomiting, lethargy, fever, and failure to gain weight. Icterus, ascites, peripheral edema, hepatomegaly, and splenomegaly are among the physical findings.2 Cataracts and mental retardation may be recognized as early as 4 to 8 weeks References 1. von Reuss, A.: Zuckerausscheidung im Säuglingsalter , Wien. med. Wchnschr. 58:799-803, 1908. 2. Donnell, G. N., and Lanz, S. H.: Galactosemia: Report of 4 Cases , Pediatrics 7:503-515 ( (April) ) 1951. 3. Haworth, J. C., and MacDonald, M. S.: Reducing Sugars in the Urine and Blood of Premature Babies , Arch. Dis. Childhood 32:417-421 ( (Oct.) ) 1957.Crossref 4. Holzel, A.; Komrower, G. M., and Schwarz, V.: Galactosemia , Am. J. Med. 22:703-711 ( (May) ) 1957.Crossref 5. Isselbacher, K. J.: Clinical and Biochemical Observations in Galactosemia , Am. J. Clin. Nutrition 5:527-532 ( (Sept.-Oct.) ) 1957. 6. Kalckar, H. M.; Anderson, E. P., and Isselbacher, K. J.: Galactosemia, a Congenital Defect in a Nucleotide Transferase , Biochim et biophys. acta 20:262-268 ( (April) ) 1956.Crossref 7. Isselbacher, K. J.; Anderson, E. P.; Kurahashi, K., and Kalckar, H. M.: Congenital Galactosemia, a Single Enzymatic Block in Galactose Metabolism , Science 123:635-637 ( (April 13) ) 1956.Crossref 8. Holzel, A., and Komrower, G. M.: Study of Genetics of Galactosemia , Arch. Dis. Childhood 30:155-159 ( (April) ) 1955.Crossref 9. Mitchell, H. S., and Dodge, W. M.: Cataracts in Rats Fed on High Lactose Rations , J. Nutrition 9:37-49 ( (Jan.) ) 1935. 10. Donnell, G.: Unpublished data. 11. Mitchell, H. S., and Cook, G. M.: Galactose Cataract in Rats: Factors Influencing Progressive and Regressive Changes , Arch. Oph. 19:22-23 ( (Jan.) ) 1938.Crossref 12. Bray, P. T.; Isaac, R. J., and Watkins, A. G.: Galactosaemia , Arch. Dis. Childhood 27: 341-350 ( (Aug.) ) 1952.Crossref 13. McAuley, F. D.: Cataracts in Galactosaemia , Brit. J. Ophth. 37:655-660 ( (Nov.) ) 1953.Crossref 14. Johnson, J.: Cataracts in Galactosemia , Am. J. Ophth. 36:1380-1385 ( (Oct.) ) 1953. 15. Reiter, C., and Mortimer, A. L.: Galactose Cataracts , Am. J. Ophth. 35:69-75 ( (Jan.) ) 1952. 16. Turnbull, D. C.: Galactosemic Cataracts , Am. J. Ophth. 42:602-606 (Oct., (Pt. 1) ) 1956. 17. Ritter, J. A., and Cannon, E. J.: Galactosemia with Cataracts: Report of a Case with Notes on Physiopathology , New England J. Med. 252: 747-752 ( (May 5) ) 1955.Crossref

UIHLEIN, ALFRED;RUCKER, C. WILBUR

doi: 10.1001/archopht.1958.00940080239006pmid: 13558789

Abstract Visual failure more often than not is due to a disorder of the globe and falls within the realm of the ophthalmologist. However, a lesion that involves the optic pathways may occasionally be responsible for acute loss of vision and at times is overlooked because a thorough medical examination was not conducted when the patient first consulted his physician.1-3 Ideally, if irreparaable visual loss is to be prevented, the cause should be determined. This requires a thorough medical examination, which should include ophthalmologic investigation, the plotting of accurate visual fields, roentgenographic examination of the skull, and a complete neurologic examination. In the more difficult diagnostic problems, ancillary tests may be required if the condition of the patient can tolerate these procedures. The records of 310 patients who came to the Mayo Clinic because of unilateral loss of vision were studied in 1953.4 Lesions involving the retrobulbar portion of References 1. List, C. F.; Williams, J. R., and Balyeat, G. W.: Vascular Lesions in Pituitary Adenomas , J. Neurosurg. 9:177-187 ( (March) ) 1952.Crossref 2. Norlen, G., and Falconer, M. A.: Diagnosis and Treatment of Intracranial Saccular Aneurysms , Proc. Roy. Soc. Med. 45:291-302 ( (May) ) 1952. 3. Uihlein, A.; Balfour, W. M., and Donovan, P. F.: Acute Hemorrhage into Pituitary Adenomas , J. Neurosurg. 14:140-151 ( (March) ) 1957.Crossref 4. Uihlein, A., and Weyand, R. D.: Meningiomas of Anterior Clinoid Process as Cause of Unilateral Loss of Vision: Surgical Considerations , A. M. A. Arch. Ophth. 49:261-270 ( (March) ) 1953. 5. Mooney, Alan: Some Neuro-Ophthalmological Problems , Brit. J. Ophth. 42:129-156 ( (March) ) 1958.Crossref

BETTMAN, JEROME W.;FELLOWS, VICTOR;CHAO, PETER;JOHNSON, JOHN PRATT

doi: 10.1001/archopht.1958.00940080246007pmid: 13558790

Abstract Tonography has become a recognized test in clinical ophthalmology and the source of much experimental and scientific information. It is simply a method of pushing fluid out of the eye by a given weight in a given time. The problem discussed in this paper is What fluid?—Is it entirely aqueous or partly aqueous and partly blood? The fact that the application of a tonometer to an eye for a period of time caused the pressure to drop was known to Schiøtz and his early followers. Wegner1 concluded that the drop in tension was primarily due to displacement of blood from the uveal system. Bailliart2 felt that the fall in tension was from the modification of the choroidal vascular system, which allowed itself to be flattened. Subsequent investigators have supplied ample proof that external pressure in the form of tonometry displaces aqueous from the eye, but the role of References 1. Wegner, W.: Massagewirkung und Stauungsversuche am normalen und glaukomatösen Auge , Ztschr. Augenh. 55:381, 1925. 2. Bailliart, P.: On Tonometry , Tr. Ophth. Soc. U. Kingdom 51:412, 1931. 3. Kronfeld, P. C.: Tonography , A. M. A. Arch. Ophth. 48:393 ( (Oct.) ) 1952.Crossref 4. Grant, W. M.: Tonographic Method for Measuring the Facility and Rate of Aqueous Flow in Human Eyes , Arch. Ophth. 44:204 ( (Aug.) ) 1950.Crossref 5. Becker, B., and Friedenwald, J. S.: Clinical Aqueous Outflow , A. M. A. Arch. Ophth. 50:557 ( (Nov.) ) 1953.Crossref 6. Mansheim, B. J.: Aqueous Outflow Measurements by Continuous Tonometry in Some Unusual Forms of Glaucoma , A. M. A. Arch. Ophth. 50: 580 ( (Nov.) ) 1953.Crossref 7. Streiff, E.: L'Ophtalmodynamometrie de Bailliart: Sa valeur et sa précision , Docum. ophth. 7-8:27, 1954. 8. Duke-Elder, W. S.: The Ocular Circulation: Its Normal Pressure Relationships and Their Physiological Significance , Brit. J. Ophth. 10:513 ( (Oct.) ) 1926.Crossref 9. Wessely, K.: Experimentelle Untersuchungen über den Augendruck, sowie über qualitative und quantitative Beeinflussung des intraokularen Flüssigkeitswechsels , Arch. Augenh. 60:97, 1908-1911. 10. Adler, F. H.; Landis, E. M., and Jackson, C. L.: The Tonic Effect of the Sympathetic on the Ocular Blood Vessels , Arch. Ophth. 53:239 ( (May) ) 1924. 11. Bárány, E.: The Influence of Intra-Ocular Pressure on the Rate of Drainage of Aqueous Humour , Brit. J. Ophth. 31:160, 1947.Crossref 12. Colle, J.; Duke-Elder, P. M., and Duke-Elder, W. S.: Studies on the Intra-Ocular Pressure: Action of Drugs on Vascular and Muscular Factors Controlling Intra-Ocular Pressure , J. Physiol. 71:1 ( (Jan.) ) 1931. 13. Becker, B., and Christensen, R.: Beta Hypophamine (Vasopressin): Its Effect Upon Intraocular Pressure and Aqueous Flow in Normal and Glaucomatous Eyes , A. M. A. Arch. Ophth. 56:1 ( (July) ) 1956.Crossref 14. Ridley, F.: The Drainage Path of the Aqueous Humour , Tr. Ophth. Soc. U. Kingdom 50:268-309, 1930. 15. Bettman, J. W., and Fellows, V. G.: Factors Influencing the Blood Volume of the Choroid and Retina , Tr. Am. Acad. Ophth. 60:791-803 ( (Nov.-Dec.) ) 1956. 16. Bettman, J., and Fellows, V.: A Technique for the Determination of Blood Volume Changes , Am. J. Ophth. 42:161-166 (Oct., (Pt. 2) ) 1956. 17. Friedenwald, J. S.: Standardization of Tonometers: Decennial Report by the Committee on Standardization of Tonometers , American Academy of Ophthalmology and Otolaryngology, 1954, p. 105. 18. Moses, R., and Becker, B.: Clinical Tonography: The Scleral Rigidity Correction , Am. J. Ophth. 45:196 ( (Feb.) ) 1958. 19. Michaelson, I. C.: Retinal Circulation in Man and Animals , Springfield, Ill., Charles C Thomas, Publisher, 1954. 20. Friedenwald, J. S., in discussion on Grant, W. M.: Clinical Measurements of Aqueous Outflow , A. M. A. Arch. Ophth. 46:113 ( (Aug.) ) 1951.Crossref 21. McBain, E.: Tonometer Calibration: Determination of Pt Formula by Use of Strain Gauge and Recording Potentiometer on Enucleated Normal Human Eyes , A. M. A. Arch. Ophth. 57: 520 ( (April) ) 1957.Crossref 22. Friedenwald, J.: Some Problems in the Calibration of Tonometers , Am. J. Ophth. 31:935 ( (Aug.) ) 1948. 23. Koch, F. L. P.: Ophthalmodynamometry , Arch. Ophth. 34:234 ( (Sept.) ) 1945.Crossref 24. Svien, H. J., and Hollenhorst, R. W.: Pressure in Retinal Arteries After Ligation or Occlusion of the Carotid Artery , Proc. Staff Meet. Mayo Clin. 31:684 ( (Dec. 26) ) 1956.

LEMOINE, A. N.;ROBISON, J. T.;CALKINS, LARRY L.

doi: 10.1001/archopht.1958.00940080253008pmid: 13558791

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract It is our purpose in this paper to describe a technique of scleral shortening with incarceration of a hinged roll of sclera. This procedure was evolved to obtain the advantages of a reduced scleral arc and a large and long-lasting choroidal fold without introducing a foreign body such as a plastic tube. From 1954 to 1958 we have operated on 97 cases, using the following method. To obtain adequate scleral exposure a conjunctival incision is made 10 to 12 mm. from the limbus. If the area to be operated on is confined to one quadrant, an episcleral traction suture is used; if there is more than one quadrant requiring surgery or if the optimum area for operation straddles a muscle, this rectus muscle is detached and a traction suture is placed through its tendon stump on the sclera. The location and extent of the scleral incisions will of course be

SCHWARTZ, ARIAH

doi: 10.1001/archopht.1958.00940080255009pmid: 13558792

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Introduction Although a great deal has been written and spoken about the importance of ophthalmoscopy in the diagnosis of retinal detachments, practically all of this discussion relates to the preoperative examination. The importance of adequate postoperative examination can be emphasized when it is realized that 30% to 40% of primary retinal detachment operations are failures. It is possible to achieve cures in 50% of these initial failures if reoperations are properly planned and executed, bringing the final percentage of cures to 80% to 85%.Postoperative ophthalmoscopy is more difficult than preoperative examination for several reasons: 1. In the early stages, the visibility of the fundus is poor because of the increased haze of the media, mainly in the cornea and vitreous. 2. Important new factors, which require interpretation, have been introduced, namely, the diathermized fundus areas and the possible presence of the roll of a scleral resection.It is generally

SHIPMAN, JAMES S.

doi: 10.1001/archopht.1958.00940080263010pmid: N/A

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract In 1956 at the Academy of Ophthalmology and Otolaryngology Rolett presented a movie film entitled "Scleral Shortening: A New and Simplified Method of Use in Retinal Detachment." I saw this and was stimulated to try a modification of this operation. In my modification two incisions are made instead of one through the outer three-fourths of the sclera, with an island of full thickness of sclera between these. I wish to recommend this to you as a procedure for cases requiring more than the ordinary retinopexy but not such an extensive procedure as a resection of the sclera with insertion of a polyethylene tube. The technique is as follows: The incision in the bulbar conjunctiva is made far enough away from the limbus to allow it to be reflected over the cornea as an apron-like flap to protect the cornea during the operative procedure. The anterior edge of the conjunctival incision