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Fluorescein Microangiography Of The Ocular Fundus
VOL. 78, NO. 4
741
BOOK REVIEWS
BOOK R E V I E W S SCANNING ELECTRON MICROSCOPIC STUDIES
OF THE EYE STRUCTURE. By F. Hervouet
and M. Ertus. Paris, Masson & Cie, 1973. Clothbound, 118 pages, table of contents, index, 155 black and white figures. $39.62 The authors have compiled a modest text on ocular histology, utilizing the remarkable effects produced by the scanning electron microscope. They presuppose that the reader is familiar with normal ocular histology; thus, the text is not an exhaustive treatise on the normal histology of the ocular tissues. Each figure is accompanied by a French and English title. The microscopy and reproduc tion of the prints is only fair. The use of letters or arrows would have been helpful to indicate specific areas in the illustrations. A number of figures do not clearly show the findings indicated by the legends, for ex ample, several depicting the pathologic corneal endothelium. The legends of other figures introduce misconceptions. An ex ample' is the failure to state that the corneal endothelial cells are joined to each other by various types of junctional complex and by rather intimate interdigitations, rather than by a binding substance and intercellular fila ments. The English translations of the leg ends are not always as clear as those in French, causing some difficulty in interpreta tion of the legends. The reader is often con fused by the use of terms upper, lower, in ner, and outer in various illustrations, and this could have been avoided by early defini tion of the meaning of these terms. The section on the choroid was disappoint ing to me because it does not show clearly the purported structure of Bruch's mem brane, as depicted in Figures 71 through 75. Flat and meridional sections viewed with conventional microscopy show it much better. A new concept to me is the striation seen in the lens capsule at intervals of 4 [x. In a section on zonular fibers the authors ignore all recent electron microscopic observations
of their origin from the basement membrane of the ciliary epithelial cells. Some rather nice photographs show the blending of the zonular fibers with the lens capsule but the authors state that the fibers do not become part of the capsule, forming a zonular lamella instead. This also is contrary to transmission microscopic studies. In the introductory comments about the retina, I think the authors' preparatory meth ods yielded the poor results that led to such discouraging statements as, "It is well-nigh impossible to grasp the complexity of the retina by scanning microscopy." I disagree; our scanning electron microscopic work re solves the membrane disks in the outer seg ments extremely well. Because of the ljrnitations of their microscopy I think the authors have done exactly what in the last introduc tory sentence they wished to avoid. Some conclusions are drawn based on really poor evidence. The entire presentation of the relation of pigment epithelium to the outer segments of the rods and cones is poor, and many artifacts are revealed. The discussion on the external limiting membrane is incomprehensible in view of modern work in this area by light transmission electron microscopy. As the authors state in their introduction, "They feel the need of outside contact, criti cism, contradiction and fresh ideas to work on." I hope similar reviews will amplify the authors' request. MICHAEL J.
FLUORESCEIN
MICROANGIOGRAPHY
HOGAN
OF
THE
By Koichi Shimizu. Baltimore, Williams and Wilkins Company, 1973. Clothbound, 153 pages, table of con tents, index, over 60 black and white fig ures. $17.75 OCULAR
FUNDUS.
Professor Shimizu has put together an atlas of fluorescein angiography, which he states in his preface is a supplement to the 1968 atlas he published with Professor Shi-
AMERICAN JOURNAL OF OPHTHALMOLOGY
742
kano. T h e present atlas is made u p of large, good quality black-and-white fluorescein angiograms. There are also several appropriate color ocular fundus photographs, and some of the basic physiological principles govern ing the fluorescent pattern a r e illustrated with diagrams. T h e atlas is divided into six chapters, but for purposes of this review I have arbi trarily divided it into three parts. T h e first part is of rather esoteric interest and con cerns the angiographic findings in Behqet's and H a r a d a ' s diseases, systemic lupus erythematosus, and pulseless disease. T h e atlas may be divided into a second part in which the fluorescein patterns of diseases of rela tively common occurrence a r e described. Both central and branch retinal vein obstruc tion, central serous retinopathy (choroidopa t h y ) , and retinal detachment a r e illustrated through their fluorescein angiographic pat terns. Diagrams a r e used liberally to de scribe the author's theories of the pathophysiology of the various lesions. Finally, there is a third area which the au thor covers in splendid detail. H e discusses and illustrates the dynamics of the retinal, choroidal, a n d optic disk circulations. There is a lengthy presentation of the peripapillary capillaries (Chapter 1) as well as a descrip tion of the various stages of the fluorescence of the optic disk (Chapter 4 ) . T h e author recognizes that basic to the understanding of abnormal patterns of fluorescence, the nor mal vascular dynamics must be elucidated. This atlas carries out the task admirably well and may be used not only as a supplement to the first volume but as a primer to intro duce the underlying principles of fluorescein angiography. J. T E R R Y E R N E S T ANNUAL
REVIEW
O F ALLERGY.
By
Claude
OCTOBER, 1974
This book is the second in a series of an nual reviews intended for those interested in clinical allergy. T h e current edition is nearly 200 pages longer than the previous one, contains twice as many black and white figures, and has 32 instead of 20 chapters. T h e format is a general description of each chapter's subject followed by a review of the recently published pertinent articles. Chapter 17, "Ocular allergy," by I. H . Leopold and A . S. Vogel, is 12 pages long, and has 35 references. A general descrip tion is presented of immediate and delayed hypersensitivity as these processes a r e dis played in the eye. This is followed by a review of articles from the past several years on immune processes in and around the eye. Included are several interesting articles from the nonophthalmic journals such as articles on thyroid exophthalmos appearing in the endocrinologic literature. T h e book contains an enormous amount of information about an exciting and everexpanding field. While the idea of the book is admirable, it falls short of its mark, though not so short as last year. T h e faults are mostly those of the publishers. T h e ref erence form varies from chapter to chapter. Some references are interspersed throughout the text, others appear at the end, some con tain titles, others do not. F o r instance, D r s . Leopold a n d Vogel's contribution contains some references with and some without title, and a most uneven form of notation for volume, page, and year. T h e type is very small and the book is loose-leaf bound. All this adds up to the appearance of a book produced in haste, which makes reading dif ficult. F o r those who have the motivation to dig out the information the volume does con tain a review of current aspects of clinical hypersensitivity diseases with an emphasis on atopic mechanisms.
Albee Frazier. Flushing, N . Y . , Medical MATHEA ALLANSMITH Examination Publishing Co., Inc., 1974. Paperback, 530 pages, table of contents, index, over 50 black and white figures. O P H T H A L M I C SYNDROMES. By H . V . Nema. Ontario-, Canada, Butterworth and Com$15
741
BOOK REVIEWS
BOOK R E V I E W S SCANNING ELECTRON MICROSCOPIC STUDIES
OF THE EYE STRUCTURE. By F. Hervouet
and M. Ertus. Paris, Masson & Cie, 1973. Clothbound, 118 pages, table of contents, index, 155 black and white figures. $39.62 The authors have compiled a modest text on ocular histology, utilizing the remarkable effects produced by the scanning electron microscope. They presuppose that the reader is familiar with normal ocular histology; thus, the text is not an exhaustive treatise on the normal histology of the ocular tissues. Each figure is accompanied by a French and English title. The microscopy and reproduc tion of the prints is only fair. The use of letters or arrows would have been helpful to indicate specific areas in the illustrations. A number of figures do not clearly show the findings indicated by the legends, for ex ample, several depicting the pathologic corneal endothelium. The legends of other figures introduce misconceptions. An ex ample' is the failure to state that the corneal endothelial cells are joined to each other by various types of junctional complex and by rather intimate interdigitations, rather than by a binding substance and intercellular fila ments. The English translations of the leg ends are not always as clear as those in French, causing some difficulty in interpreta tion of the legends. The reader is often con fused by the use of terms upper, lower, in ner, and outer in various illustrations, and this could have been avoided by early defini tion of the meaning of these terms. The section on the choroid was disappoint ing to me because it does not show clearly the purported structure of Bruch's mem brane, as depicted in Figures 71 through 75. Flat and meridional sections viewed with conventional microscopy show it much better. A new concept to me is the striation seen in the lens capsule at intervals of 4 [x. In a section on zonular fibers the authors ignore all recent electron microscopic observations
of their origin from the basement membrane of the ciliary epithelial cells. Some rather nice photographs show the blending of the zonular fibers with the lens capsule but the authors state that the fibers do not become part of the capsule, forming a zonular lamella instead. This also is contrary to transmission microscopic studies. In the introductory comments about the retina, I think the authors' preparatory meth ods yielded the poor results that led to such discouraging statements as, "It is well-nigh impossible to grasp the complexity of the retina by scanning microscopy." I disagree; our scanning electron microscopic work re solves the membrane disks in the outer seg ments extremely well. Because of the ljrnitations of their microscopy I think the authors have done exactly what in the last introduc tory sentence they wished to avoid. Some conclusions are drawn based on really poor evidence. The entire presentation of the relation of pigment epithelium to the outer segments of the rods and cones is poor, and many artifacts are revealed. The discussion on the external limiting membrane is incomprehensible in view of modern work in this area by light transmission electron microscopy. As the authors state in their introduction, "They feel the need of outside contact, criti cism, contradiction and fresh ideas to work on." I hope similar reviews will amplify the authors' request. MICHAEL J.
FLUORESCEIN
MICROANGIOGRAPHY
HOGAN
OF
THE
By Koichi Shimizu. Baltimore, Williams and Wilkins Company, 1973. Clothbound, 153 pages, table of con tents, index, over 60 black and white fig ures. $17.75 OCULAR
FUNDUS.
Professor Shimizu has put together an atlas of fluorescein angiography, which he states in his preface is a supplement to the 1968 atlas he published with Professor Shi-
AMERICAN JOURNAL OF OPHTHALMOLOGY
742
kano. T h e present atlas is made u p of large, good quality black-and-white fluorescein angiograms. There are also several appropriate color ocular fundus photographs, and some of the basic physiological principles govern ing the fluorescent pattern a r e illustrated with diagrams. T h e atlas is divided into six chapters, but for purposes of this review I have arbi trarily divided it into three parts. T h e first part is of rather esoteric interest and con cerns the angiographic findings in Behqet's and H a r a d a ' s diseases, systemic lupus erythematosus, and pulseless disease. T h e atlas may be divided into a second part in which the fluorescein patterns of diseases of rela tively common occurrence a r e described. Both central and branch retinal vein obstruc tion, central serous retinopathy (choroidopa t h y ) , and retinal detachment a r e illustrated through their fluorescein angiographic pat terns. Diagrams a r e used liberally to de scribe the author's theories of the pathophysiology of the various lesions. Finally, there is a third area which the au thor covers in splendid detail. H e discusses and illustrates the dynamics of the retinal, choroidal, a n d optic disk circulations. There is a lengthy presentation of the peripapillary capillaries (Chapter 1) as well as a descrip tion of the various stages of the fluorescence of the optic disk (Chapter 4 ) . T h e author recognizes that basic to the understanding of abnormal patterns of fluorescence, the nor mal vascular dynamics must be elucidated. This atlas carries out the task admirably well and may be used not only as a supplement to the first volume but as a primer to intro duce the underlying principles of fluorescein angiography. J. T E R R Y E R N E S T ANNUAL
REVIEW
O F ALLERGY.
By
Claude
OCTOBER, 1974
This book is the second in a series of an nual reviews intended for those interested in clinical allergy. T h e current edition is nearly 200 pages longer than the previous one, contains twice as many black and white figures, and has 32 instead of 20 chapters. T h e format is a general description of each chapter's subject followed by a review of the recently published pertinent articles. Chapter 17, "Ocular allergy," by I. H . Leopold and A . S. Vogel, is 12 pages long, and has 35 references. A general descrip tion is presented of immediate and delayed hypersensitivity as these processes a r e dis played in the eye. This is followed by a review of articles from the past several years on immune processes in and around the eye. Included are several interesting articles from the nonophthalmic journals such as articles on thyroid exophthalmos appearing in the endocrinologic literature. T h e book contains an enormous amount of information about an exciting and everexpanding field. While the idea of the book is admirable, it falls short of its mark, though not so short as last year. T h e faults are mostly those of the publishers. T h e ref erence form varies from chapter to chapter. Some references are interspersed throughout the text, others appear at the end, some con tain titles, others do not. F o r instance, D r s . Leopold a n d Vogel's contribution contains some references with and some without title, and a most uneven form of notation for volume, page, and year. T h e type is very small and the book is loose-leaf bound. All this adds up to the appearance of a book produced in haste, which makes reading dif ficult. F o r those who have the motivation to dig out the information the volume does con tain a review of current aspects of clinical hypersensitivity diseases with an emphasis on atopic mechanisms.
Albee Frazier. Flushing, N . Y . , Medical MATHEA ALLANSMITH Examination Publishing Co., Inc., 1974. Paperback, 530 pages, table of contents, index, over 50 black and white figures. O P H T H A L M I C SYNDROMES. By H . V . Nema. Ontario-, Canada, Butterworth and Com$15