OBJECTIVES:To describe the histopathologic findings attributable to irradiation in eyes with uveal malignant melanoma treated with iodine I 125 brachytherapy and to compare these findings with those reviewed in a previous study that compared histopathologic findings in eyes enucleated after proton beam teletherapy with those seen in eyes in a nonirradiated control group.METHODS:The slides from 22 eyes with uveal melanoma that had undergone enucleation after the administration of 125I brachytherapy were studied. The histopathologic features of the tumor and the retina were graded. Results were compared with findings from a previously reported group of 47 proton beam-treated eyes and its control group.RESULTS:Patient age, time between irradiation and enucleation, and ciliary body involvement were similar for the 125I brachytherapy-treated group and the proton beam-treated group and its control group. This allows comparison of the histopathologic findings. Comparing the 125I brachytherapy- and proton beam-treated groups, most histopathologic features were similar with nominally statistically significant differences only for cell type, number of mitotic figures, and fibrous metaplasia of the retinal pigment epithelium adjacent to the tumor.CONCLUSIONS:Irradiation of uveal melanoma induces changes in the tumor and in the surrounding retina. Brachytherapy and charged particle therapy are the 2 principal methods of irradiation. This study demonstrates that similar changes are produced by 125I plaque irradiation and proton beam irradiation.

Practical Atlas of Retinal Diseases and Therapy, edited by William R. Freeman, MD, is a multiauthor effort to present current information in the field of vitreoretinal diseases. Each chapter is written by an internationally renowned authority in the field. The first part of the book deals with the hereditary chorioretinal dystrophies and new devices for retinal function testing. This is followed by inflammatory diseases of the retina and choroid, including uveitis, multifocal chorioretinopathies, and opportunistic retinitis. The last section of the first part discusses the diagnosis and treatment of posterior uveal tumors. The next part of the book covers most of the common retinopathies that involve the retina and choroid, such as vascular occlusions, diabetic retinopathy, macular degeneration, complications of cataract surgery, and peripheral retinal lesions. The last chapters discuss surgical aspects of vitreoretinal disease, including scleral buckling, pneumatic retinopexy, vitreoretinal surgery, proliferative retinopathy and retinopathy of prematurity, and management

A patient with proliferative diabetic retinopathy was treated by panretinal and focal photocoagulation. Later, he developed one area of clinically diagnosed chorioretinal and choriovitreal neovascularization (CNV), neovascular glaucoma, and a blind painful eye necessitating enucleation. Clinicopathologic correlations of this eye including fundus photography, fluorescein angiography, light and electron microscopy are reported. Histopathologic examination revealed three areas of CNV, suggesting that some CNV may go undetected clinically also in other cases and thus may occur more frequently than evident from the literature. Our CNV occurred at sites of focal treatment. Retreatment of one area was unsuccessful. Choriovitreal neovascularization passed through discontinuities of Bruch's membrane into the retina and showed fenestrae of the endothelial cells. Endothelial fenestrae may account for the profuse fluorescein leakage seen clinically in CNV.

A 13-year-old girl and a 20-year-old man with juvenile-onset diabetes mellitus developed transient bilateral optic disk edema with minimal impairment of optic nerve function and with minimal diabetic retinopathy. This conditions, termed diabetic papillopathy appears to be a local optic disk vasculopathy, and generally resolves without treatment. Diabetic papillopathy should not be mistaken for papilledema or for the optic disk neovascularization of diabetic retinopathy.

The effect of vasodilators on choroidal blood flow (CBF) was studied by the krypton clathrate Kr 85 desaturation technique in anesthetized cats. Niacin, papaverine hydrochloride, phentolamine mesylate, and tolazoline hydrochloride were injected via the lateral long posterior ciliary artery (LLPCA) and the femoral artery. The systemic administration of these drugs via the femoral artery, in the doses used, had no significant effect on mean arterial pressure, choroidal vascular resistance (CVR), or CBF. Local administration of the same agents via the LLPCA caused a decrease in CVR with a corresponding increase in CBF.

Conjunctival capillary fragility (CCF) and skin capillary fragility (SCF) were studied by a negative-pressure suction cup method in 25 normal subjects and 38 diabetic patients with diabetic retinopathy. The CCF was significantly higher (P less than .001) in patients with diabetic retinopathy than in normal subjects; there was no significant difference in the SCF.

Of 84 patients with unilateral disciform macular degeneration, 36 were followed up for one to four years (average, 22 months). The fellow eye in 13 cases developed disciform lesions during that follow-up period. A significantly greater number of drusen were found in the fellow eyes of patients with unilateral disciform macular degeneration than in the eyes of a comparable control group of patients (P less than .001). Furthermore, the eyes with unilateral disciform macular degeneration that developed disciform lesions in the other eye were characterized as a group by a significantly larger number of drusen than those that did not. We postulate that drusen are precursors of disciform macular degeneration in fellow eyes and are probably manifestations of the same exudative process.

Of 84 patients with unilateral disciform macular degeneration, 36 were followed up for one to four years (average, 22 months). The fellow eye in 13 cases developed disciform lesions during that follow-up period. A significantly greater number of drusen were found in the fellow eyes of patients with unilateral disciform macular degeneration than in the eyes of a comparable control group of patients (P less than .001). Furthermore, the eyes with unilateral disciform macular degeneration that developed disciform lesions in the other eye were characterized as a group by a significantly larger number of drusen than those that did not. We postulate that drusen are precursors of disciform macular degeneration in fellow eyes and are probably manifestations of the same exudative process.

The right eye of a 9-year-old white boy with Best's vitelliform macular dystrophy had an intact egg-yolk lesion and a retinal pigment epithelial defect superiorly, suggesting an early pseudohypopyon stage. The disruptive phase of the left eye showed subretinal hemorrhages, a "signet ring," and a subretinal neovascular membrane.

Data are presented from 27 patients (34 eyes) with central serous choroidopathy who were followed up for an average of 23 months without therapeutic intervention. The detachment completely resolved in all cases. The average duration of detachment was three months. In all eyes, the visual acuity returned to 20/40 or better, and in all but two eyes, the final visual acuity was 20/30 or better. Central serous choroidopathy is essentially a benign and self-limited disorder, and treatment by photocoagulation is seldom needed.

The effects of autonomic agents on the choroidal circulation were studied by the radioactive krypton desaturation technique in anesthetized cats. Levarterenol, epinephrine, and acetylcholine, when administered locally via the lateral long posterior ciliary artery (LLPCA), caused the anticipated changes in choroidal vascular resistance (CVR), and corresponding changes in choroidal blood flow (CBF). When administered systemically via the femoral artery, the changes in the mean arterial pressure (MAP) tended to mask any changes in CVR resulting in an opposite effect on CBF. Isoproterenol was found to have no effect on CBF when administered via the LLPCA; when injected via the femoral artery, it resulted in a decrease in MAP and CBF without a significant change in CVR.