Frank L. Myers

Photocoagulation Treatment of Proliferative Diabetic Retinopathy: The Second Report of Diabetic Retinopathy Study Findings

Data from the Diabetic Retinopathy Study (DRS) show that photocoagulad inhibited the progression of retinopathy. These beneficial effects were noted to some degree in all those stages of diabetic retinopathy which were included in the Study. Some deleterious effects of treatment were also found, including losses of visual acuity and constriction of peripheral visual field. The risk of these harmful effects was considered acceptable in eyes with retinopathy in the moderate or severe retinopathy in the moderate or severe proliferative stage when the risk of severe visual loss without treatment was great. In early proliferative or severe nonproliferative retinopathy, when the risk of severe visual loss without treatment was less, the risks of harmful treatment effects assumed greater importance. In these earlier stages, DRS findings have not led to a clear choice between prompt treatment and deferral of treatment unless and until progression to a more severe stage occurs.

Scleral Buckling Procedure for Retinal Detachments Secondary to Proliferative Diabetic Retinopathy

Ninety-two patients (99 eyes) underwent scleral buckling procedures for retinal detachment associated with proliferative diabetic retinopathy. Fifty-three procedures were for rhegmatogenous retinal detachment and 46 for tractional retinal detachment. The average follow-up period was 38 months. Anatomic success was assessed in terms of closure of retinal breaks (59/69, 86%), macular reattachment (42/90, 46%), and reduction in extent of retinal detachment postoperatively as compared to preoperatively (62/99, 63%). The visual acuity was better postoperatively in 33/99 (34%) of the eyes; 58/99 (58%) of the eyes maintained finger counting visual acuity. Improvement in visual acuity was more frequent in eyes with rhegmatogenous detachment (23/53, 43%) than in those with traction detachment (10/46, 22%). Although improvement is generally limited, some patients are markedly benefitted by scleral buckling procedures.

Choroidal and Ciliary Body Malignant Melanoma

In the not-too-distant past, it was often stated that choroidal melanomas were sufficiently rare to warrant evaluation and treatment by a handful of specialists who dealt only with such problems. I am not so sure this is true anymore. From 1986 to 1993, the Collaborative Ocular Melanoma Study (COMS) investigators have evaluated 5239 new patients for choroidal melanoma in 44 centers. It certainly remains the most common primary intraocular malignant disease, and as such it would seem deserving of a book devoted to the subject. In his book, Choroidal and Ciliary Body Malignant Melanoma , Johnson has attempted to fill that void and, I think, has succeeded rather well. The book is comprehensive but not overburdening, and he has chosen to give a balanced view of the controversies in the management of the condition. Because diagnosis does not seem to be quite the problem it was in the past (the COMS