Cyclic macular edema

Three patients with macular edema noted that their vision improved during the course of the day. In one patient, a 25-year-old man, visual acuity improved from 20/40 to 20/30; in the second, a 53-year-old woman, it improved from 20/60 to 20/40; in the third, a 30-year-old man, it improved from 20/25 to 20/20. The Rayleigh match showed a wider divergence in color matches to test wavelengths during the morning hours in one patient. The Stiles-Crawford effect was abnormal in all three patients but showed no cyclic pattern. All three patients had difficulty with Arden plates, but no cyclic pattern was apparent. The cyclic change in visual acuity could not be corrected by a change in refraction and may have been the result of a change in the macular edema.

Bronchogenic carcinoma located in the aortic window. The importance of the primary lesion as a determinant of survival

Thirty-four patients with an aortic window lesion were carefully staged with gallium scans and mediastinoscopy according to the TNM classification system for carcinoma of the lung. All were in Stage III. Twenty-five patients had non-oat cell carcinomas (15 squamous cell, eight adeno-, two large cell) and nine had oat cell carcinomas. Quantitative ventilation-perfusion lung scans were particularly helpful in verifying the subaortic location of the tumor by showing a less than 20% interference with pulmonary blood flow or ventilation secondary to left mainstem bronchus or pulmonary artery invasion. Decision for resectability in 13 Stage III M0 patients was based on the length of the uninvolved proximal left main pulmonary artery seen on pulmonary arteriogram. Eight patients (seven non-oat cell and one oat cell) had resection after radiation and prior to chemotherapy (after two cycles of chemotherapy and prior to radiation therapy for the oat cell) with a resultant survival rate better than those of M0 and M1 non-oat cell or oat cell patients without resection. The survival rates of nine non-oat cell M0 patients, nine non-oat cell M1 patients, and eight oat cell patients, all without resection, were not statistically different. This similarity in survival rates is explained by the observation that 38% of the non-oat cell M1, 71% of the non-oat cell M0, and 63% of the oat cell patients died from complications of their primary tumor. Patients with aortic window lesions, irrespective of their histology, have an extremely poor prognosis due to the high incidence of lethal complications of their primary tumor. Complete resection when feasible, as judged by pulmonary arteriography, provides the best control of the primary tumor and, as a consequence, gives longer survival.

Acute retinal necrosis syndrome

Six patients with the acute retinal necrosis (ARN) syndrome are described. Ophthalmoscopic examination demonstrated occlusion of peripheral retinal vessels and patchy areas of peripheral retinal whitening spreading rapidly over a period of weeks to markedly decreased vision. In four patients, the disease was bilateral. Histologic examination of vitrectomy specimens from three cases and one enucleated eye revealed chronic granulomatous inflammation. Extensive medical evaluations were noncontributory, with no evidence of compromised immune systems. No patient demonstrated a response to any form of therapy. The etiology is unknown.

Changes in outflow facility in experimental hyphema

To characterize the pathophysiology of hyphema clearance, we studied changes in the facility of outflow in experimental hyphema in freshly enucleated rabbit eyes. Hyphemas, with washed normal or sickled red cells (RBCs) (suspended in isotonic phosphate buffer to obtain a hematocrit value comparable to that of whole blood) and occupying 50% to 100% of the anterior chamber volume, caused a marked cell "crowding" in the chamber angle and an increase in the outflow resistance; the facility stabilized at a value 60% lower than the control (p = < 0.001). No significant change in outflow facility was observed in hyphemas of either RBC type occupying 25% of the anterior chamber volume (p = N.S.). Whole blood hyphema occupying 50% of the anterior chamber volume reduced the facility of outflow by 80% of the control mock aqueous value (p = < 0.001); a comparison with 50% hyphema produced by washed RBCs indicated a significant contribution by the plasma (fibrin) component (p = 0.0025) in increasing the resistance to outflow.