252 AMERICAN JOURNAL OF OPHTHALMOLOGY FEBRUARY, 1979
behind the equator. The physical signs described as brawny scleritis can be observed in many patients with early anterior necrotizing scleral disease and certainly 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 important that everyone adhere to a single nomenclature.
P. G. WATSON, F.R.C.S. A. J. L Y N E , F.R.C.S.
D. LLOYD-JONES, F.R.C.S. London, England
Choroidal Folds
Editor: In the article, "Choroidal folds" (Am. J.
Ophthalmol. 86:380, 1978), by F. E. Can-gemi, C. L. Trempe, and J. B. Walsh, the authors show in Figure 2 a photograph of "markedly irregular choroidal fold formation noted after a scleral buckling procedure." These irregular folds are definitely not in the choroid. They represent remaining 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, especially after drainage of subretinal fluid, these irregularities may remain visible because the retina did not have enough time to flatten out while dehydrating.
ROBERT MACHEMER, 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
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 production and management with intravitreal air. Trans. Am. Ophthalmol. Soc. 67:394, 1969; Ophthalmol. 68:1022, 1969.
Peripapillary Pigmentary Retinal Degeneration
Editor: In the article, "Peripapillary pigmen
tary retinal degeneration" (Am. J. Ophthalmol. 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 choriocapil-laris 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 chorio-capillaris.1 Without having the whole an-giographic sequence for interpretation it is impossible to decide whether the atrophy of choriocapillaris in the areas of delayed filling is total or partial, in no case can the choriocapillaris be normal.2
L E A HYVARINEN, M.D. Helsinki, Finland
R E F E R E N C E S
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.: Interpretation of choroidal fluorescence. In Proceedings of the International Symposium on Fluorescein Angiography, Albi, 1969. Basel, S. Karger, 1971, pp. 183-188.
Corneal Decomposition after Corneal Endothelium Cell Count
Editor: Lowered endothelial cell density may
lead to a higher incidence of corneal