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