Archives of Ophthalmology

Abramson, David H.

1990 Archives of Ophthalmology

doi: 10.1001/archopht.1990.01070130016001pmid: 2244821

Abstract To the Editor. —I read the article by Tamboli et al1 with interest. I commend the authors for attempting to study the incidence of retinoblastoma in the United States, and although I think most of their conclusions are correct, they and the reader must be aware of significant problems with their approach. Their incidence figures, and those in an earlier report by Pendergrass and Davis,2 utilize the Surveillance, Epidemiology, and End Results (SEER) program for analysis. This is an appropriate way to study cancer in the United States in general but a poor way to study retinoblastoma in particular. They have studied a total of 220 cases from nine population areas in this country during an 11-year period. Because retinoblastoma treatment is concentrated in the hands of a relatively small number of groups in this country, they missed the data from New York, NY, and Philadelphia, Pa, which References 1. Tamboli A, Podgor MJ, Horm JW. The incidence of retinoblastoma in the United States: 1974 through 1985 . Arch Ophthalmol . 1990;108:128-132.Crossref 2. Pendergrass TW, Davis S. Incidence of retinoblastoma in the United States . Arch Ophthalmol . 1980;98:1204-1210.Crossref

Tamboli, Ashlesha;Podgor, Marvin J.;Horm, John W.

1990 Archives of Ophthalmology

doi: 10.1001/archopht.1990.01070130016002

Abstract In Reply. —Dr Abramson seems concerned that some cases of retinoblastoma may be missed by the SEER program due to referrals to major treatment centers in New York and Philadelphia. Indeed, disease incidence estimates require complete ascertainment of cases among defined populations at risk. The residents in each registry constitute the populations at risk in the SEER database. Because of the geographic location of several of the registries, it seems unlikely that many children with retinoblastoma would be referred out of these registries. Furthermore, the homogeneity of incidence rates across all registries suggests that only a few cases of retinoblastoma occurring in the SEER areas may not be recorded in the registries. Therefore, we believe that there is nearly complete ascertainment of the number of retinoblastoma cases in these populations, and one may thus estimate incidence.In addition to incidence estimation, a population-based data collection system such as SEER may References 1. Abramson DH, Ellsworth RM, Grumbach N, Kitchin FD. Retinoblastoma: survival, age at detection and comparison 1914-1958,1958-1983 . J Pediatr Ophthalmol Strabismus . 1985;22:246-250.

Larkin, Frank

1990 Archives of Ophthalmology

doi: 10.1001/archopht.1990.01070130017005pmid: 2244823

Abstract To the Editor. —I read with interest the article by Wakefield and colleagues in the February 1990 issue of the Archives.1 This well-conducted study found evidence of previous Yersinia infection in 12 of 28 consecutive patients with anterior uveitis.Cafferkey, Eustace, and I2 previously reported serologic evidence of this infection in 13 of 54 patients with anterior uveitis who were surveyed. Wakefield and colleagues did not refer to our work and I am writing to provide the reference for interested readers.In serologic testing, we used tube saline agglutination tests, and not the enzyme-linked immunosorbent assay method used by Wakefield and colleagues. However, the similar results emphasize that this condition may be widely undiagnosed in patients with acute anterior uveitis References 1. Wakefield D, Stahlberg TH, Toivanen A, Granfors K, Tennant C. Serologic evidence of Yersinia infection in patients with anterior uveitis . Arch Ophthalmol . 1990;108:219-221.Crossref 2. Larkin DFP, Cafferkey MT, Eustace P. Yersinia-induced uveitis in Ireland . Br J Ophthalmol . 1988;72:938-941.Crossref

Campochiaro, Peter A.;Conway, Brian P.;Hackett, Sean F.

1990 Archives of Ophthalmology

doi: 10.1001/archopht.1990.01070130017004

Abstract In Reply. —Pneumatic retinopexy has several potential advantages for the management of some retinal detachments.1,2 It involves much less manipulation than a scleral buckle and does not require a conjunctival incision; it therefore (1) eliminates the need to go to the operating room, (2) speeds rehabilitation and visual recovery, (3) decreases the likelihood of muscle imbalance, (4) eliminates surgically induced refractive error, and (5) eliminates conjunctival and episcleral scarring that can complicate future surgical procedures. Initially it was used for a select group of detachments with superior breaks not more than 1 clock hour apart, but enthusiasm generated by the above advantages has prompted some surgeons to expand their indications.As experience with the techique has grown, so has the list of potential disadvantages, which now includes (1) the development of new retinal breaks, (2) the development of folds through the macula, (3) detachment of a previously attached macula, References 1. Hilton GF, Kelly NE, Salzano TC, Tornombe PE, Wells JW, Wendel RT. Pneumatic retinopexy: a collaborative report of the first 100 cases . Ophthalmology . 1987;94:307-314.Crossref 2. Tornombe PE, Hilton GF, The Retinal Detachment Study Group. Pneumatic retinopexy: a multicenter randomized controlled clinical trial comparing pneumatic retinopexy with scleral buckling . Ophthalmology . 1989;96:772-784.Crossref 3. Chew JC, Robertson JE, Coonan P, et al. Results and complications of pneumatic retinopexy . Ophthalmology . 1988;95:601-608.Crossref 4. Hackett SF, Conway BP, Campochiaro PA. Subretinal fluid stimulation of retinal pigment epithelial cell migration and proliferation is dependent on certain features of the detachment or its treatment . Arch Ophthalmol . 1989;107:391-394.Crossref 5. Cowley M, Conway BP, Campochiaro PA, Kaiser D, Gaskin H. Clinical risk factors for proliferative vitreoretinopathy . Arch Ophthalmol . 1989;107:1147-1151.Crossref

Griffiths, Philip G.;Richardson, John

1990 Archives of Ophthalmology

doi: 10.1001/archopht.1990.01070130017003pmid: 2244822

Abstract To the Editor. —The article by Hackett et al1 in the March 1989 issue of the Archives has serious implications for the technique of pneumatic retinopexy. With this technique, an expanding gas bubble causes retinal flattening by a combination of the surface tension of the bubble, preventing recruitment of fluid from the vitreous cavity through the retinal hole, and the bubble squeezing subretinal fluid through the open break. The latter is sometimes deliberately encouraged by performing "steamroller maneuvers." As a result of subretinal fluid being squeezed through the break, a marked increase in vitreous flare and pigment cells can be observed.2 On one occasion, we have observed pigment cells being squeezed through an open break using the slit lamp with a 90-diopter lens.This dumping of subretinal fluid into the vitreous cavity is unique to pneumatic retinopexy; in conventional retinal detachment surgery, the subretinal fluid becomes isolated from the References 1. Hackett SF, Conway BP, Campochiaro PA. Subretinal fluid stimulation of retinal pigment epithelial cell migration and proliferation is dependent on certain features of the detachment or its treatment . Arch Ophthalmol . 1989;107:391-394.Crossref 2. Griffiths PG, Richardson J. Pneumatic retinopexy in the repair of fresh retinal detachments. Eye. In press. 3. Chen JC, Robertson JE, Coonan P, et al. Results and complications of pneumatic retinopexy . Ophthalmology . 1988;95:601-605.Crossref

Snyder, William B.;Lynn, John R.;Fellman, Ronald L.;Starita, Richard J.

1990 Archives of Ophthalmology

doi: 10.1001/archopht.1990.01070130018007pmid: 2244824

Abstract To the Editor. —We read with interest the case report by Dannemann et al1 in the July 1989 issue of the Archives. The authors reported an interesting dramatic event during ultrasonography and concluded from this one event that "ultrasonography should be limited to those cases where funduscopic evaluation is impossible but necessary for clinical management."This conclusion is unwarranted and overstated. The primary variable in this patient was the hypotony. For other patients, contributory factors include vomiting, coughing, and inadvertent Valsalva maneuvers. Ultrasonography is helpful in separating serous choroidals from hemorrhagic choroidals; when the latter are kissing, drainage often accelerates improvement. Careful ultrasonography should not be withheld from the management of these References 1. Dannemann AF, Majerovics A, Kaback MB. Documentation of suprachoroidal hemorrhage during B-scan ultrasonography . Arch Ophthalmol . 1989;107:960.

Johnston, Carol A.;Teitelbaum, Charles S.

1990 Archives of Ophthalmology

doi: 10.1001/archopht.1990.01070130018006pmid: 2244825

Abstract To the Editor. —Ophthalmic ultrasound using the B-scan mode has been widely used by ophthalmologists for the diagnosis of ocular disease when the media is not clear enough for visual diagnosis and for the evaluation of intraocular tumors and foreign bodies.1 When instrumentation designed for ocular use is not available, neurosurgically or urologically oriented machines may be used for ocular diagnosis.We have used the Diasonic 400 Series Ultrasonic Imaging System (Diasonics Inc, Malipitas, Calif) using a neurosurgical probe with a 10-MHz transducer to perform B-scan ultrasonography. This has been useful in screening patients with cataract with opaque media, looking for retinal detachments in patients with vitreous hemorrhage, and for examining patients with intraocular tumors (Figure, choroidal melanoma). We found the images obtained to be of high quality. In addition, the ability to measure lesion size was useful in the evaluation of a patient with a choroidal tumor.We References 1. Coleman DJ, Lizzi FL, Jack RL. Ocular diagnosis . In: Coleman DJ, Lizzi FL, Jack RL, eds. Ultrasonography of the Eye and Orbit . Philadelphia, Pa: Lea & Febiger; 1977:158.

Kaback, Martin B.;Dannemann, Andrew;Majerovics, Anna

1990 Archives of Ophthalmology

doi: 10.1001/archopht.1990.01070130018008

Abstract In Reply. —We appreciate the interesting comments made by Snyder et al regarding our report. The purpose of it was twofold. First, the source of a suprachoroidal hemorrhage had, to our knowledge, never been documented. The occurrence of hemorrhage during an ultrasonographic examination allowed us to visualize and document what appeared to be an arterial source for this infrequent postoperative complication. Second, we raised the possibility that the examination may have contributed to the development of the hemorrhage. Although hypotony is often present in eyes that develop suprachoroidal hemorrhages, additional risk factors, such as ocular trauma and inflammation, are probably necessary before a bleed occurs.1 It also appears that eyes with glaucoma,2 high myopia,3 and aphakia,4 as well as those eyes that have undergone vitrectomy, are much more prone to suprachoroidal hemorrhaging. In susceptible eyes, minor trauma (globe indentation) or elevations of central venous pressure may References 1. Brubaker RF. Intraocular surgery and choroidal hemorrhage . Arch Ophthalmol . 1984;102:1753.Crossref 2. Cantor LB, Katz LJ, Spaeth GL. Suprachoroidal expulsive hemorrhage in glaucoma patients undergoing intraocular surgery . Ophthalmology . 1985;92:1266-1270.Crossref 3. Ruderman JM, Harbin TS Jr, Campbell DG. Postoperative suprachoroidal hemorrhage following filtration procedures . Arch Ophthalmol . 1986;104:201-205.Crossref 4. Gressel MG, Parrish RK, Heuer DK. Delayed nonexpulsive suprachoroidal hemorrhage . Arch Ophthalmol . 1984;102:1757-1760.Crossref

Buettner, Helmut

1990 Archives of Ophthalmology

doi: 10.1001/archopht.1990.01070130019009pmid: 2244826

Abstract To the Editor. —Spontaneous involution, a rarely observed occurrence in a choroidal osteoma, was noted in the eye of a 25-year-old woman who had been followed up for 8 years. Report of a Case. —In 1978 a 17-year-old white woman noted blurred vision in her right eye. A yellow-red choroidal lesion measuring 3×4 disc diameters was found in the right posterior pole. It involved the superior half of the macula, reducing visual acuity to 20/30 (Fig 1, top). Ultrasonographic (Fig 1, bottom) and computed tomographic findings supported the clinical diagnosis of a choroidal osteoma.In 1979, while the patient participated in a basketball game, her visual acuity suddenly decreased to 20/60 due to the development of a serous retinal detachment associated with a hemorrhage under the retinal pigment epithelium overlying the center of the lesion (Fig 2, top). The hemorrhage and detachment slowly resolved, leaving rather mottled-appearing retinal pigment epithelium References 1. Gass JDM, Guerry RK, Jack RL, Harris G. Choroidal osteoma . Arch Ophthalmol . 1978;96:428-435.Crossref 2. Trimble SN, Schatz H, Schneider GB. Spontaneous decalcification of a choroidal osteoma . Ophthalmology . 1988;95:631-634.Crossref 3. Bonucci E. New knowledge of the origin, function and fate of osteoclasts . Clin Orthop . 1981;152:252-269. 4. Minne HW, Pfeilschifter J, Scharla S, et al. Inflammation-mediated osteopenia in the rat: a new animal model for pathological loss of bone mass . Endocrinology . 1984;115:50-54.Crossref 5. Walters LM, Schneider GB. A functional and morphological study of cells adjacent to ectopic bone implants in rats . Am J Anat . 1985;173:287-297.Crossref

Putterman, Allen M.

1990 Archives of Ophthalmology

doi: 10.1001/archopht.1990.01070130020010pmid: 2244827

Abstract To the Editor. —Reconstruction of the upper eyelid crease has become a popular adjunct to cosmetic blepharoplasty.1 It is used in patients who have a low, poorly defined, or duplicated crease. Reconstruction of a high upper eyelid crease is also helpful in the patient with potential dry eve syndrome because it requires less upper lid skin to be removed for the same cosmetic effect as would be obtained with excision of skin without crease reconstruction; therefore, it decreases lagophthalmos and the risk of exposure keratopathy.1The reconstruction of an upper eyelid crease must be discussed with the patient preoperatively. Although most patients find a high upper eyelid crease to be cosmetically appealing, there are some who strongly dislike its appearance. It is therefore advantageous to be able to demonstrate to patients preoperatively how they will look with crease reconstruction and to predetermine the desired level to reconstruct the References 1. Tenzel R. Upper eyelid crease formation . In: Putterman AM, ed. Cosmetic Oculoplastic Surgery . New York, NY: Grune & Stratton; 1989;179-186.