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Results of preliminary clinical trials of spectra-color ultrasonography are presented. The instrumentation is calibrated so that normal ocular tissues produce a near-white display. Scans of eyes with various diseases differ from the scans of normal eyes, indicating a variation in frequency responses.

Diagnostic ultrasound is a noninvasive, well tolerated, safe procedure with no toxicity which aids the ophthalmologist by demonstrating the integrity of the intraocular contents or the presence of tumors, retinal detachments, vitreous membranes or hemorrhage, foreign bodies or other structural changes in eyes with opaque media which cannot be adequately evaluated optically. Orbital mass lesions and inflammatory changes can be demonstrated and ultrasonic evaluation should be utilized early in the diagnostic evaluation of exophthalmus in combination with other radiographic techniques. The ultrasound examination does require a certain technical skill and experience in interpretation as well as judgment in order for it to be a reliable diagnostic test.

A 10 year review of enucleations at the University of Ottawa affiliated hospitals revealed that of 29 eyes with a visible fundus lesion diagnosed as choroidal malignant melanoma only one was incorrectly diagnosed.

Clinical and histopathological findings are described in 6 cases of chronchial carcinoma metastatic to the choroid of the eye. These findings show that especially in bronchial carcinoma, metastases of the choroid often are the first symptoms of the disease even before the primary site of the tumor is recognized. As these metastases often grow in a manner quite different from that of other uveal metastases, they are likely to be mistaken for uveal melanomas. Yet the right diagnosis is decisive for the right therapy. While in case of melanoma the eye has to be enucleated, x-ray therapy should be employed in metastatic carcinoma. Thus the patient can be prevented from becoming blind and from enucleation. The effect of x-ray treatment on the carcinoma cells in the choroid is demonstrated histologically in one of the cases.

The Wills Eye Hospital experience with 17 cases of malignant melanoma of the uvea affecting children and young adults was reviewed. They did not appear to differ clinically or histologically from uveal melanomas in older patients, except that in most cases there was a considerable delay in diagnosis, perhaps reflecting a lack of clinical suspicion. Ancillary diagnostic techniques, such as fluorescein angiography, ultrasonography, and 32P studies were often helpful in arriving at the correct diagnosis once the lesion was suspected and referred for evaluation. Malignant melanoma of the uveal tract is not exclusively a disease of old age, and this diagnosis should not be excluded on the basis of the patient's age alone.

The extreme polymorphy of the histological structure of the malignant melanoblastoma of the choroid, and the diverse forms of the tumor echogram stimulated the comparative investigation of such tumors in 22 cases. The complicated combination of different histological details cannot be revealed through clinical echo-ophthalmography. However, connections between the histological preparation and the interference picture can be demonstrated subsequently.

We have developed a scleral-indentor-illuminator which, when combined with indirect ophthalmoscopy, gives better visualization of some choroidal lesions than conventional ophthalmoscopy. The thin, angulated probe tip allows for extreme posterior placement.

A 57-year-old white woman presented with a small malignant melanoma of the choroid in the macular area of the right eye. The lesion failed to produce a visual field defect or to show fluorescence with angiography, but the radioactive phosphorus uptake(P) test was positive. Histologically, the retinal pigment epithelium was intact over the tumor and the sensory retina was normal. This unusual finding was the most likely explanation for the normal visual field. The intact retinal pigment epithelium over this nonfluroescent melanoma suggests that the destruction of the retinal pigment epithelium occurring with most choroidal melanomas may partially explain why these tumors usually demonstrate fluorescence. This case emphasizes the great accuracy of the P test for diagnosing small malignant tumors of the choroid, even before other popular diagnostic modalities indicate the malignancy of the lesion.

The evidence provided by previous studies of malignant melanomas of the choroid has indicated that a small melanoma is most likely a spindle cell tumor, evolving in a relatively benign growth pattern. However, this generalization has not been tested with regard to the small melanomas which can be considered for conservative management. We have studied 264 malignant melanomas of the choroid; 50 of these were designated as small melanomas (less than 10 mm in diameter and 3 mm in elevation). We found a surprisingly large percentage (22.0%) of mixed andepithelioid tumors (considered to be more malignant) in the group of small tumors. In 33 patients with a possible five-year survival, two (6.1%) died of metastases. Of 22 possible ten-year follow-ups, five patients died of metastatic melanoma (22.7%). These deaths occurred in one patient with a spindle cell A melanoma, three with spindle cell B melanomas, and one with a mixed melanoma. All five of these patients were women, and all had posterior pole tumors. No deaths occurred in patients with tumors less than 7 mm in diameter and 2 mm in elevation. The relatively good five-year survival in the patients with smaller melanomas supports the views held by previous authors that small melanomas carry a better prognosis than larger tumors. However, mixed and epithelioid tumors in our series do not seem to have a worse prognosis than spindle cell tumors. Cell type may be of less prognostic significance than tumor size in the case of small melanomas.

The use of B-can ultrasonography in ophthalmology is becoming increasingly important. There are several advantages of the Bronson-Turner system when compared with other B-scan instruments. The unit is quite compact and much less expensive. There is no need for a special laboratory and trained personnel, since it is operated easily by the ophthalmologist. Because a water bath is not necessary, uncooperative patients and children can be evluated. This instrument has been proven reliable and accurate in the diagnosis of retinal detachment, choroidal tumors, and intraocular foreign bodies, and is also capable of revealing more subtle abnormalities such as retinoschisis and vitreous membranes. The Bronson-Turner ultrasonoscope provides the clinician with a valuable instrument to evaluate ocular abnormalities in the presence of opaque media.

One hundred consecutive histologically confirmed malignant melanomas of the posterior uvea; on which the 32-P test was performed prior to enucleation, were classified according to cell type. The 32-P uptake results of the pure spindle cell melanomas were compared with the results in the mixed and epithelioid cell tumors. There appears to be no relationship between 32-P uptake and cell type using the Callender classification. The 32-P uptake results in the 100 melanomas were then compared with the results in teh 30 benign lesions which are known to simulate melanoma occasionally. There was a significant difference in 32-P uptake between the benign and malignant lesions, and no false-positive results were encountered. The importance of the 32-P test as a diagnostic adjunct for malignant intraocular tumors is emphasized.

A secondary glaucoma due to an intraocular tumour with retinal detachment in a 16-years-old patient whose brother had died of suspected leucaemia illustrates the difficulties in the clinical diagnosis at this age. Although the ophthalmoscopical appearance was that of Coats's lesion a malignant melanoma of the choroid could not be ruled out. The histopathological examination revealed a retinoblastoma.

In 3 cases of bloodfilled macrocyst of the retina diagnosis malignant melignant melanoma was made twice. The differential diagnosis of macrocyst of the retina and of malignant melanoma of the choroid is discussed. The macrocyst of the retina is a special form of of retinoschisis. It differs as well in the age group of the patients as in its localisation from presenile and senile retinoschisis. As a complication of macrocyst an oral tear of the retina must be considered.

Using a combination of echography, infrared photography and fluorescein angiography in tumor simulating changes of the fundus an optimum combination of these diagnostic methods was achieved. The echography allows exact measurements of the prominence and in lesions exceeding 1.1 to 1.5 mm also a tissue differentiation. By infrared photography melanin could be differentiated from the bloodpigments and lipofuscin and the extension of pigmented tissues could be revealed. Fluoresceinangiography visualizes the vascular pattern and the permeability of the vessels of tumors or pseudotumors. Up to now 100 cases with tumorlike fundus lesions were subjected to this combined examination method and many of these cases preserved from enucleation.

Ninety-five cases of malignant choroidal melanoma collected during a 15-year period have been studied with special emphasis on histological type, coexistence of benign nevus, and prognosis. Elements of benign nevus were found in 78% of the cases. The data tend to support the hyposis that most cases of malignant choroidal melanoma have their origin in a preexisting benign nevus, and that the tumours undergo a gradual change from a differentiated to a less differentiated type.

We examined the eyes of 50 patients with nevus flammeus of the face (port wine stain). Of 26 patients with nevus flammeus involving the area of both the first and second sensory branches of the trigeminal nerve, 4 had glaucoma and 8 were glaucoma suspects. Because the age at which glaucoma develops is uncertain, these patients require periodic ocular assessment. When the nevus flammeus involved the area of V1 alone or V2 alone, there was no associated glaucoma.

Sixty patients presenting with retinal detachment have been examined using a Nuclear Enterprises Diasonograph 4102; 25 with no identifiable cause (primary), the remainder due to causes such as vitreous haemorrhage, trauma, inflammatory eye disease, aphakia and neoplasm. In the diagnosis and management of retinal detachment echography has a definite but limited application, particularly in patients who have cloudy or opaque media and in whom detachment secondary to a malignant melanoma is suspected. In patients with trauma or vitreous haemorrhage important therapeutic considerations depend upon a precise knowledge of the structure of the globe and complicating features such as vitreous fibrosis or retinal detachment. In such patients the value of echo amplitude measurements in combination with B-scan echography is described. In primary retinal detachment because of vitreous haziness, the extent, size and degree of displacement of the retinal detachment may be more precisely demonstrated echographically than by conventional ophthalmoscopy, facilitating surgical management.