132 AMERICAN JOURNAL OF OPHTHALMOLOGY January, 1986

References

1. Lemagne, J.-M., Brucher, J.-M., and Michiels,J.: Clinical, biochemical and histological results of alevator transposition for ptosis in cynomolgus mon-keys. Orbit 4:141, 1985.

2. Lemagne, J.-M., and Brucher, J.-M.: La trans-position frontale du muscle releveur. Resultats ex-perimentaux et application au traitement du ptosisavec syncinesie de Marcus Gunn. Acta Neurol. Belg.85:190, 1985.

_______ Reply _

EDITOR:I thank Dr. Lemagne for his comments re-

garding my article. Unfortunately, I was notpresent at his oral presentation in Europe tohear about his technique. The reprint! heprovided, describing his variation of levatortransposition, was informative. It was not ref-erenced in my article since it was publishedin a limited circulation journal, which is notindexed with the Medlars system, and waspublished after my article was submitted toTHE AMERICAN JOURNAL OF OPHTHALMOLOGY.

RUSSELL W. NEUHAUS, M.D.Austin, Texas

Reference

1. Lemagne, J.-M., Brucher, J.-M., and Michiels,J.: Clinical, biochemical and histological results of alevator transposition for ptosis in cynomolgus mon-keys. Orbit 4:141, 1985.

Subretinal Neovascularization AfterExperimental Ocular Histoplasmosis in

a Subhuman Primate

EDITOR:The article, "Subretinal neovascularization

after experimental ocular histoplasmosis in asubhuman primate" by J. V. Jester and R. E.Smith (Am. J. Ophthalmol. 100:252, August1985), described the development of subreti-

nal neovasculariztion following internal carot-id injection of Histoplasma capsulatum organ-isms. Acute lesions, for the most part,reportedly resolved, and fluorescein studiesdone at 30 months failed to demonstrate typi-cal subretinal neovascularization. Neverthe-less, histologic techniques documented thepresence of capillary loops in the subretinalspace.

This lack of typical leakage and staining of"naturally occurring" subretinal neovascular-ization in the diurnal nonhuman primate wasalso observed and reported by us in a previ-ous publication describing the clinical pictureand histopathologic correlation of "spontane-ously occurring" subretinal neovascular mem-branes in an aged myopic rhesus macaque."We observed reduced fluorescence in older,larger subretinal neovascular membranes andmore marked staining in smaller, presumablynewer, ingrowths. Apparently, this report es-caped the notice of Drs. Jester and Smith.

It is interesting that, although we were ableto demonstrate obvious ingrowth of choroidalvessels through Bruch's membrane, the stain-ing characteristics in the larger, presumablyolder, lesion began to take on the characteris-tics of nonleaking retinal vessels with time.The study of Okhuma and Ryan" of the per-meability of subretinal neovascular mem-branes created by using laser burns can berelated to this phenomenon of reduced leak-age with maturation of subretinal choroidalmembrane vessels over time. Perhaps themonkey is sufficiently different not to be acomparable and adequate animal model. Con-versely, we may be missing many subretinalnets, or nonleaking parts of subretinal nets,in humans whose ingrowths have been pres-ent for a long time and have matured.

It would be extremely interesting to pursuefurther studies on "naturally occurring" sub-retinal neovascular membranes in the diurnalnonhuman primate. We suggest that suchmembranes in the monkey may be related toage, myopia, or both, as well as to histoplas-mosis.

THOMAS J. STAFFORD, M.D.Evanston, Illinois

STUART H. ANNESS, M.D.Cincinnati, Ohio

BEN S. FINE, M.D.Washington, D.C.

Vol. 101, No. 1 Correspondence 133

References

1. Stafford, T. J., Anness, S. H., and Fine, B. S.:Spontaneous degenerative maculopathy in the mon-key. Ophthalmology 91:513, 1984.

2. Okhuma, H., and Ryan, S. J.: Experimentalsubretinal neovascularization in the monkey. Arch.Ophthalmol. 101:1102, 1983.

_______ Reply _

EDITOR:We thank Drs. Stafford, Anness, and Fine

for their comments and for bringing to ourattention their observations of spontaneoussubretinal neovascularization in a subhumanprimate. Their report had, indeed, escapedour notice. We do thoroughly screen our ani-mals for any such fundus and fluorescein an-giographic abnormalities before inclusion inour studies, and have on occasion excludedsome animals that have had drusen or pig-ment epithelial defects.

We also agree that the significance of non-leaky subretinal nets remains unclear. Wheth-er this is peculiar to the nonhuman primate orwhether it suggests a possible subclinicalhuman condition remains to be determined. Athorough ultrastructural study of "histospots" would perhaps help answer this ques-tion.

JAMES V. JESTER, PH.D.RONALD E. SMITH, M.D.Los Angeles, California

Effect of Cataract Surgery onIntraocular Pressure Reduction

Obtained With Laser Trabeculoplasty

EDITOR:I read with interest the article, "Effect of

cataract surgery on intraocular pressure re-duction obtained with laser trabeculoplasty"(Am. J. Ophthalmol. 100:373, Sept. 1985), byS. V. 1. Brown, J. V. Thomas, D. 1. Budence,A. R. Bellows, and R. J. Simmons. I havesome thoughts that perhaps their conclusionswere not warranted by the data. They con-clude, "we suggest that it may be beneficialfor eyes with coexisting cataract and glauco-ma to undergo laser trabeculoplasty beforecataract surgery." They make this assertiondespite evidence that cataract surgery has noinfluence on intraocular pressure after trabec-uloplasty.

It is common to find a significant decreasein intraocular pressure for a period of timeafter cataract extraction in both glaucomatousand nonglaucomatous eyes. One might as-sume, therefore, that trabeculoplasty inter-fered with this commonly observed postopera-tive decrease in intraocular pressure. It maybe more reasonable to conclude then, thatafter laser trabeculoplasty, cataract surgerywill not have its commonly observed decreasein intraocular pressure. It seems to me, thatthe suggestion that trabeculoplasty be per-formed before cataract surgery may not bewarranted.

LAWRENCE M. HURVITZ, M.D.Sarasota, Florida