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• Vision loss progressing over several days, reduced pupil reactions to light, and swollen optic nerves were the clinical features in six patients with severe renal disease manifested by uremia, anemia, and (in four patients) moderately or severely elevated blood pressure. In two patients pale edema of the optic nerve head extended into the macula. One patient with renal transplant rejection was in the early phases of cryptococcal meningitis that went undiagnosed for two weeks. Medical management with hemodialysis was followed by improvement of vision in four patients. In one patient, resumption of oral corticosteroid therapy was followed by improvement in vision. The patient whose vision improved the most rapidly was managed by prompt use of both dialysis and oral corticosteroid therapy. The patient with cryptococcal meningitis did not recover vision.

Premorbid ophthalmoscopic and histopathologic findings were correlated in a case of bilateral optic nerve hypoplasia in a 9-month-old infant with bilateral hydranencephaly. The double-ring sign was due to an extension of retina and retinal pigment epithelium (RPE) over the outer portion of the lamina cribrosa. The outer ring was the junction between sclera and lamina cribrosa, and the inner ring was the termination of the RPE. The center of the inner ring was the hypoplastic nerve head, which appeared whitish because of fibroglial tissue surrounding the central retinal vessels where they entered the optic nerve head. We speculate that an in utero vascular insult, after the third month of development, led to cystic cavitation of the anterior cerebral hemispheres, with subsequent retrograde degeneration of developing retinal ganglion cells.

A patient with myasthenia gravis, hyperthyroidism, and exophthalmos developed spontaneous involuntary movements of the eyes. These movements were unique in our experience, and reference to similar movements has not been found in the literature. It is the purpose of this communication to describe these abnormal movements in the hope that others may recall having seen similar cases. Report of Case A 40-year-old white female with myasthenia gravis of 7 years' duration was seen because of watering, bulging eyes of 2 months' duration. In the past she had recurrent weakness of the fourth and fifth fingers of the left hand which subsided spontaneously (Fig. 1). She subsequently developed limitation of extraocular movements and variable degrees of ptosis which was sometimes aggravated at the time of her menses. Neostigmine was said to have produced no improvement in her ocular symptoms, but later a brief trial on pyridostigmine bromide (Mestinon) improved vocal weakness.

• Two cases are reported in which pars plana vitrectomy was employed to restore vision and confirm the diagnosis of "primary" intraocular reticulum cell sarcoma. Cytologic study of material removed from the vitreous cavity confirmed the clinical diagnosis. The clinical, histologic, and cytologic features of intraocular reticulum cell sarcoma are reviewed.

In two siblings with olivopontocerebellar degeneration, the retinal pigment epithelium or the sensory retinal or both appeared to be damaged first. These layers were markedly involved before secondary changes in the choriocapillaris, the inner retinal layers, or the optic nerve occurred.

During evaluation for active disciform macular disease of presumed ocular histoplasmosis in one eye, 12 patients were observed to have small inactive asymptomatic macular scars in the fellow eye. Activity later developed around these scars. Risk of development of the macular disciform syndrome in the second eye of histoplasmosis patients with prior activity in the first eye seems to be related to the presence of small asymptomatic scars in the macula of the second eye. If no scars or angiographic changes are present in the second eye, there seems to be less chance of developing an active lesion. If small atrophic scars are present, the chances of a future disciform syndrome may be increased. Careful follow-up and prompt detection and treatment of early activity will usually result in a better prognosis.

Histoplasmin skin tests and dilated funduscopic examination for presumed ocular histoplasmosis were carried out on 842 individuals, aged 13 years and older, from Walkersville, Md. Seventy percent of the male and 51% of the female population were sensitive to the histoplasmin skin test; among reactors, males had a mean diameter of induration of 11.6 mm, and females had a mean induration of 9.7 mm. Histoplasmin sensitivity was most frequent in the third to the sixth decade, and mean induration size was largest in the third to the fifth decade. Twenty-one individuals were identified as having only peripheral atrophic scars of presumed ocular histoplasmosis. The frequency of these scars was 2.5% and was similar in both sexes and at all age groups. One case of a disciform lesion was identified by the survey, giving a prevalence of about 0.1% in the community and a prevalence of about 4.5% among those with peripheral atrophic scars. All cases of presumed ocular histoplasmosis were histoplasmin-positive; male cases had a mean induration of 15.0 mm, and female cases had an induration of 10.7 mm.

RECOGNITION and understanding of various ocular responses to reduced blood supply is increasing because of greater interest in cervical vascular disease. In spite of this interest, histopathologic confirmation of clinically observed events is rare. It is the purpose of this report to describe a case in which the clinical aspects were defined from onset to death over four years later. Report of a Case A 69-year-old white man (JHH 101-53-67), was first seen at age 64 because of intermittent loss of vision of the right eye of four months duration, persistent poor vision for two months, and extreme right-sided head and eye ache of 24-hour duration. Vision was 15/200 right eye and 20/15 left eye. The right eye exhibited moderate diffuse injection of vessels, clear cornea, and an irregular pupil which reacted poorly directly and consensually (Fig 1, left ). The left eye was normal. Slit-lamp examination of the right eye

Twenty-one persons with nondisciform scars suggestive of histoplasmosis were identified during a community survey for ocular histoplasmosis. A classification of characteristic and "questionable" scars was developed. One hundred sixty-three scars were analyzed in 42 eyes, with a range of 1 to 70 scars and a mean of 7.8 scars per patient. Most cases had from one to four scars. Peripapillary scars were present in 28% of cases. Scars were bilateral in 62%. Three persons had paramacular scars. Fluorescein angiography did not reveal any "activity" in the peripheral scars although some leakage was observed in one peripapillary lesion.