A report is given of 4 patients with progressive ophthalmopathy in Graves' disease treated by total or subtotal thyroidectomy. The post-operative ophthalmological examination revealed evident regression of ocular symptoms and signs. Serial examinations of the ocular motility, the field of binocular single vision, as well as ultrasonic study were performed and gave an objective support to the improvement of the ocular disturbances. The symptomatical and presumed causal treatment of Graves' ophthalmopathy is reviewed and the possible immunological basis is discussed. It is concluded that a reduction in thyroid mass seems to diminish ophthalmic manifestations of Graves' disease.

Severe proliferative retinopathy in a young man with diabetes of very short duration. Acta Med Scand 1985; 217: 571-4.A 22-year-old man developed typical insulin-dependent diabetes mellitus. At the time of diagnosis no signs of diabetic retinopathy were found by an experienced ophthalmologist, but florid proliferative diabetic retinopathy was observed only seven months later. Despite treatment with laser and vitrectomy the eye lesions progressed to total blindness within 30 months after the diagnosis of diabetes.

The development of fluorescein angiography and the introduction of laser technology into the treatment of macular diseases has considerably widened our knowledge of the pathological processes in the macular region. A number of clinicopathological reports have confirmed the angiographic findings and interpretations. T h e aetiological factors that lay behind the clinical lesions are, however, still unknown. The clinical pictures have, as a result of the above, more relation to the histological than to the aetiological classifications. Clinical classification includes an analysis and categorization of the individual diseases. This process takes place daily in the surgery of every ophthalmologist by means of the ophthalmoscope. T h e ophthalmoscopical examination is enhanced by knowledge of the angiographic picture of the lesion. This means that in the great majority of cases it is possible using the ophthalmoscope alone, to evaluate the type and anatomical localization of the pathological lesions. Fluorescein angiography is the most important single supplementary examination, both with regard to the diagnosis, indication for treatment and the The present work describes 9 clinically and histopathologically welldefined lesions, which isolated or in combination are seen in the majority of adult macular diseases. follow-up.

Five patients with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) have been subject to a follow-up study. All the patients had bilateral lesions. The follow-up period ranged from 1 month to 8 years (mean 4 years). All had resumed their previous work, although two patients had severe visual loss in one eye (6/36). No recurrences were observed. Automatic perimetry of the central visual field revealed moderate central scotomata between 5 and 10 db, corresponding to derangement of the pigment epithelium. This may indicate that the pigment derangement may be caused by alterations in the pigment granules in the pigment epithelial cells, and that the pigment epithelial cells have recovered. There were absolute scotomata in two eyes corresponding to chorioretinal atrophy.

The clinical syndromes central serous retinopathy (RCS) and presenile exudative disciform macular degeneration (PEDMD) are well known, but the causes of the pathophysiological and pathoanatomical changes in the choriocapillaris, Bruch's membrane and pigment epithelium as predisposing factors are unknown. Apparently these two degenerative macular conditions are different. However, they possibly represent two manifestations of the same nosological entity, which is initially dominated by a subretinal exudation in the macular region. It is therefore also reasonable to consider that RCS can be part of, or an initial stage of PEDMD. In the present study these possibilities have been demonstrated by a follow-up examination, using among other things fluorescein angiography of a selective material of 20 patients with RCS. In addition, it is shown that RCS can be a more serious condition with regard to the central vision than is generally accepted.