252
AMERICAN JOURNAL OF OPHTHALMOLOGY
behind the equator. The physical signs described as brawny scleritis can be ob served in many patients with early anteri or necrotizing scleral disease and certain ly not all patients with posterior scleritis (including those described in the article) have the edema and gross redness said to occur in brawny scleritis. Posterior scleritis is a severe condition, which not only produces the proptosis, exudation, detachments, and masses in the posterior segment, but also macular and disk edema. If ophthalmologists are to recognize posterior scleritis, it is im portant that everyone adhere to a single nomenclature. P. G. W A T S O N , F.R.C.S. A. J. L Y N E , F.R.C.S. D. L L O Y D - J O N E S , F.R.C.S.
London,
England
Choroidal Folds Editor: In the article, "Choroidal folds" (Am. J. Ophthalmol. 86:380, 1978), by F. E. Cangemi, C. L. Trempe, and J. B. Walsh, the authors show in Figure 2 a photograph of "markedly irregular choroidal fold forma tion noted after a scleral buckling proce dure." These irregular folds are definitely not in the choroid. They represent re maining irregularities of the outer retinal surface. During retinal detachment the retina is edematous, causing the outer retinal layers to show folds. 1 - 3 When the retina is reattached, especial ly after drainage of subretinal fluid, these irregularities may remain visible because the retina did not have enough time to flatten out while dehydrating. R O B E R T M A C H E M E R , M.D.
Durham, North
Carolina
REFERENCES 1. Machemer, R., and Norton, E. W. D.: Experi mental retinal detachment in the owl monkey. 1. Methods of production and clinical picture. Am. J. Ophthalmol. 66:388, 1968. 2. Kroll, A. J., and Machemer, R.: Experimental
FEBRUARY, 1979
retinal detachment and reattachment. II. Electron microscopy. In Transactions of the New Orleans Academy of Ophthalmology. St. Louis, C. V. Mosby, 1969, pp. 258-277. 3. Machemer, R., Aaberg, R. M., and Norton, E. W. D.: Giant retinal tears. 2. Experimental pro duction and management with intravitreal air. Trans. Am. Ophthalmol. Soc. 67:394, 1969; Oph thalmol. 68:1022, 1969.
Peripapillary Pigmentary Retinal Degeneration Editor: In the article, "Peripapillary pigmen tary retinal degeneration" (Am. J. Oph thalmol. 86:65, 1978), by K. G. Noble and R. E. Carr, the authors state that "in none of these four cases was there evidence on fluorescein angiography of choriocapillaris atrophy." However, if one compares Figures 2 and 6 a marked patchy delay in the appearance of the dye in the choroid beneath the lower temporal vessels is evident in areas where there are pigment clumps. This phenomenon is typically seen in areas of patchy atrophy of choriocapillaris. 1 Without having the whole angiographic sequence for interpretation it is impossible to decide whether the atro phy of choriocapillaris in the areas of delayed filling is total or partial, in no case can the choriocapillaris be normal. 2 L E A H Y V A R I N E N , M.D.
Helsinki,
Finland
REFERENCES 1. Hyvarinen, L., Maumenee, A. E., Kelley, J., and Cantollino, S.: Fluorescein angiographic findings in RP. Am. J. Ophthalmol. 71:17, 1971. 2. Hyvarinen, L., and Maumenee, A. E.: Interpre tation of choroidal fluorescence. In Proceedings of the International Symposium on Fluorescein Angi ography, Albi, 1969. Basel, S. Karger, 1971, p p . 183-188.
Corneal Decomposition after Corneal Endothelium Cell Count Editor: Lowered endothelial cell density may lead to a higher incidence of corneal
AMERICAN JOURNAL OF OPHTHALMOLOGY
behind the equator. The physical signs described as brawny scleritis can be ob served in many patients with early anteri or necrotizing scleral disease and certain ly not all patients with posterior scleritis (including those described in the article) have the edema and gross redness said to occur in brawny scleritis. Posterior scleritis is a severe condition, which not only produces the proptosis, exudation, detachments, and masses in the posterior segment, but also macular and disk edema. If ophthalmologists are to recognize posterior scleritis, it is im portant that everyone adhere to a single nomenclature. P. G. W A T S O N , F.R.C.S. A. J. L Y N E , F.R.C.S. D. L L O Y D - J O N E S , F.R.C.S.
London,
England
Choroidal Folds Editor: In the article, "Choroidal folds" (Am. J. Ophthalmol. 86:380, 1978), by F. E. Cangemi, C. L. Trempe, and J. B. Walsh, the authors show in Figure 2 a photograph of "markedly irregular choroidal fold forma tion noted after a scleral buckling proce dure." These irregular folds are definitely not in the choroid. They represent re maining irregularities of the outer retinal surface. During retinal detachment the retina is edematous, causing the outer retinal layers to show folds. 1 - 3 When the retina is reattached, especial ly after drainage of subretinal fluid, these irregularities may remain visible because the retina did not have enough time to flatten out while dehydrating. R O B E R T M A C H E M E R , M.D.
Durham, North
Carolina
REFERENCES 1. Machemer, R., and Norton, E. W. D.: Experi mental retinal detachment in the owl monkey. 1. Methods of production and clinical picture. Am. J. Ophthalmol. 66:388, 1968. 2. Kroll, A. J., and Machemer, R.: Experimental
FEBRUARY, 1979
retinal detachment and reattachment. II. Electron microscopy. In Transactions of the New Orleans Academy of Ophthalmology. St. Louis, C. V. Mosby, 1969, pp. 258-277. 3. Machemer, R., Aaberg, R. M., and Norton, E. W. D.: Giant retinal tears. 2. Experimental pro duction and management with intravitreal air. Trans. Am. Ophthalmol. Soc. 67:394, 1969; Oph thalmol. 68:1022, 1969.
Peripapillary Pigmentary Retinal Degeneration Editor: In the article, "Peripapillary pigmen tary retinal degeneration" (Am. J. Oph thalmol. 86:65, 1978), by K. G. Noble and R. E. Carr, the authors state that "in none of these four cases was there evidence on fluorescein angiography of choriocapillaris atrophy." However, if one compares Figures 2 and 6 a marked patchy delay in the appearance of the dye in the choroid beneath the lower temporal vessels is evident in areas where there are pigment clumps. This phenomenon is typically seen in areas of patchy atrophy of choriocapillaris. 1 Without having the whole angiographic sequence for interpretation it is impossible to decide whether the atro phy of choriocapillaris in the areas of delayed filling is total or partial, in no case can the choriocapillaris be normal. 2 L E A H Y V A R I N E N , M.D.
Helsinki,
Finland
REFERENCES 1. Hyvarinen, L., Maumenee, A. E., Kelley, J., and Cantollino, S.: Fluorescein angiographic findings in RP. Am. J. Ophthalmol. 71:17, 1971. 2. Hyvarinen, L., and Maumenee, A. E.: Interpre tation of choroidal fluorescence. In Proceedings of the International Symposium on Fluorescein Angi ography, Albi, 1969. Basel, S. Karger, 1971, p p . 183-188.
Corneal Decomposition after Corneal Endothelium Cell Count Editor: Lowered endothelial cell density may lead to a higher incidence of corneal
