The phenomenon known as Leao's spreading depression is investigated in this collection of ten original articles. New ideas about the fundamental mechanisms, which focus on the involvement of polyunsaturated fatty acids and free radicals, are presented. The relationship of spreading depression with clinical entities such as migraine, epilepsy, ischemic and protein-deficiency conditions of the nervous tissue are discussed as well. Studies dealing with the application of non-invasive techniques to monitor the disease are included.

Contents Introduction .......................................... . 1 The Primate Eye ...................................... . 2 Embryology of Retina and Choroid ....................... . 4 Microscopic Anatomy .................................. . 4 Retina ............................................ . 4 Choroid ........................................... . 8 Material and Methods .................................. . 10 Fine Structure of the Retina 14 RetinaI Pigment Epithelium ............................. . 16 Photoreceptor Cells ................................... . 30 Outer Plexiform Layer and Horizontal Cells .................. . 64 Bipolar, Radial Clial, and Amacrine Cells .................... . 76 Canglion Cells and InternaI Limiting Membrane ............... . 98 Spatial Density of RetinaI Cells .......................... . 112 Fine Structure of the Choroid ........................... . 116 Choroidocapillaris and Its Fiber System ..................... . 118 Arteries, Veins, and Lymphatic Spaces ...................... . 134 Choroidal Nerves .................................... . 142 Cells of Choroidal Connective Tissue ....................... . 148 References ........................................... . 153 Index ................................................ . 157 vii This volume describes the morphology of the primate re tina as seen with the electron microscope. As it is an atlas, the electron micrographs are its most In trad lietian important part. The text accompanies the figures, highlighting selected topics either to explain structures or to point out structure-function relation ships. A scholarly review of the whole spectrum of research on the re tina and choroid is not feasible in a single volume. Thus, whenever available, review artides or monographs, rather than original work, are cited for reference."

Pediatric Oculoplastic Surgery is the definitive text for ocular disorders and how they apply specifically to children. Addressing everything from genetic considerations, embryology and anatomy, anesthesia, dermatologic considerations, benign and malignant tumors, fetal wound healing, establishing propoer diagnosis, timing for surgical interventions and surgical procedures. This volume is an essential addition to the library of every pediatric ophthalmologist and reconstructive surgeon. The distinguished contributors have combined their surgical knowledge and experience with over 1,100 color photographs and custom illustrations to present comprehensive and readily usable information on the identification and treatment of a wide range of ocular disorders.

The eye has fascinated scientists from the earliest days of biological in vestigation. The diversity of its parts and the precision of their interaction make it a favorite model system for a variety of developmental studies. The eye is a particularly valuable experimental system not only because its tissues provide examples of fundamental processes, but also because it is a prominent and easily accessible structure at very early embryonic ages. In order to provide an open forum for investigators working on all aspects of ocular development, a series of symposia on ocular and visual devel opment was initiated in 1973. A major objective of the symposia has been to foster communication between the basic research worker and the clinical community. It is our feeling that much can be learned on both sides from this interaction. The idea for an informal meeting allowing maximum ex change of ideas originated with Dr. Leon Candeub, who supplied the nec essary driving force that made the series a reality. Each symposium has concentrated on a different aspect of ocular development. Speakers have been selected to approach related topics from different perspectives."

In its long series of annual reports, the Belgian Society of Ophthal- mology has a tradition of bringing into focus the recent advances in ophthalmology. But it seems surprising that one has to go back to 1940 to find a major report on the corneal diseases, when R. Rub- brecht wrote an "Aperr;u de la pathologie et de la therapeutique generale des maladies de la cornee". However, this omission is only apparent. In fact, many reports, since then, have contributed to our knowledge of the advances in corneal research. The corneal dimensions were documented in "La biometrie ocu- laire clinique (Y. Delmarcelle et aI., 1976)", the fine structure of the cornea in "L'ultrastructure de tissues oculaires (L. Missotten, 1964)", and many aspects of its metabolism in "Les verres de contact (P. Cochet et ai, 1967)" and "Les complications oculaires des erreurs congenitales du metabolism (J.P. Groux et O. Kallay, 1971)" . Bacterial keratitis was a main topic in "La therapeutique par les antibiotiques autres que la Penicillamine en Ophtalmologie (1. Michiels, 1952). Fungal corneal infections were described in detail in "Les mycoses oculaires" (J . Fran90is et M. Elewaut-Rysselaere, 1968)" and the toxic effects of drugs were dealt with in "Les effets nocifs des medications generales sur I'appareil visuel (J. Michiels et coil. 1972)".

The region of the skull base was long considered a surgical barrier because of its complex anatomy. With few exceptions, the region immediately beyond the dura or bony skull base constituted a "no man's land" for the surgeon working from the other direction. A major reason for this was the high morbidity associated with operative procedures in that area using traditional dissection techniques. This situation changed with the advent of the operating microscope. Used initially by ear, nose and throat specialists for resective and reconstructive surgery of the petrous bone and parana sal sinuses, the operating microscope was later introduced in other areas, and neurosurgeons began using it in the mid-1960s. With technical equality thus established, the groundwork was laid for taking a new, systematic, and interdisciplinary approach to surgical problems of the skull base. Intensive and systematic cooperation between ear, nose and throat surgeons and neurologic surgeons had its origins in the departments of the University of Mainz bindly supported by our chairmen Prof. Dr. Dr. hc Kurt Schiirmann (Department of Neurosurgery) and Prof. Dr. W. Kley (Depart ment of Ear, Nose and Throat Diseases, Head and Neck Surgery). The experience gained from this cooperation was taught in workshops held in Hannover from 1979 to 1986, acquiring a broader interdisciplinary base through the participation of specialists from the fields of anatomy, patholo gy, neuroradiology, ophthalmology, and maxillofacial surgery.

This monographic work authored by eminent neurophysiologists will be of major interest to researchers investigating the visual system or working in behavioral neuroscience and sleep research. The book deals with the neuronal circuits of the visual thalamocortical system, the brainstem and basal forebrain modulatory systems and their neurotransmitters acting upon these circuits, and the neuronal activities in the visual thalamocortical system as changed during shifts in behavioral states of vigilance from wake to sleep. Data discussed consist of recent studies on light and electron microscopy, extra- and intracellular recordings of thalamic and cortical neurons, neurotransmitter actions, and state-dependent cellular activities in the visual system.

Noninvasive Diagnostic Techniques in Ophthalmology explores the special noninvasive tools developed to function as diagnostic indicators and to further our understanding of ocular function. The volume's focus is on new development in instrumentation and techniques for studying the cornea, lens, retina, vitreous, and aqueous dynamics; whereby special attention is given to how each technique has improved our understanding of basic processes and diagnostic capability. Theoretical aspects, possible sources of error, current problems and limitations, safety evaluation, and future applications and directions are considered. Topics examined include ophthalmic image processing; magnetic resonance imaging of the eye and orbit; diagnostic ocular ultrasound; corneal topography; holographic contour analysis of the cornea; wide field and color specular microscopy; use of the Fourier transform method for statistical evaluation of corneal endothelial morphology; confocal microscopy; in vivo corneal redox fluorometry; evaluation of cataract function with the Scheimp-flug camera; fluorescence and Raman spectroscopy of the crystallin lens; in vivo uses of quasi-elastic light scattering; fundus reflectometry; and clinical visual psychophysics measurements. The book offers discussions of fractal analysis of human retinal blood vessel patterns, scanning laser tomography of the living human eye, fundus imaging and diagnostic screening for public health, and digital image processing for ophthalmology, as well as a detailed appendix comprising additional topics and sources.

The 14th Congress of SIDUO, held in Tokyo from October 26 to October 30, 1992, was the first congress meeting to be held in Asia in the 30-year history of SIDUO. The congress was organized by the Department of Oph- thalmology, St. Marianna University School of Medicine, with the support of the Japanese Ophthalmological Society, the Japan Society of Ultrasonics in Medicine and the Japan Society of Ophthalmologists. The organizing committee consisted of the following members. Congress President: Sadanao Tane, M. D. (Professor and Chairman, St. Marianna University School of Medicine) Vice-presidents: Atsushi Sawada, M. D. (Professor and Chairman, Miyazaki Medical College) Masayasu Ito, Ph. D. (Tokyo University of Agriculture and Technology) Secretary General: Yasuo Sugata, M. D. (Tokyo Metropolitan Komagome Hospital) Finance Committee: Koji Ohashi, M. D. (Assistant Professor, St. Marianna University School of Medicine) Akira Komatsu, M. D. (Assistant Professor, St. Marianna University School of Medicine) Toshio Kaneko, M. D. (Assistant Professor, St. Marianna University School of Medicine) Publicity and Exhibition Committee: Hideyuki Hayashi, M. D. (Assistant Professor, School of Medicine, Fukuoka University) Akihiro Kaneko, M. D. (National Cancer Center) The Honorary Presidents were Yukio Yamamoto, M. D. (Tokyo Tama Geriatrics Hospital) and Yasuo Uemura, M. D. (Professor Emeritus, Keio University) . The opening ceremony began with the Francois Memorial Lecture given by Professor Peter Till (Standardized Echography: Quantitative Analysis of XlI Tissue Backscatter - A Major Source of Information for Tissue Diagnoses).

Part of the Oxford American Ophthamology Library, this book provides clear and detailed guidelines on the diagnosis and treatment of glaucoma. Coverage spans the entire spectrum of glaucoma, including descriptions of traditional and newly emerging modalities available for glaucoma diagnosis and management. Chapters discuss current imaging technology for glaucoma diagnosis and monitoring, providing practical tips using case examples. Management is also thoroughly addressed, from the treatment of primary open angle glaucoma to management of complex secondary glaucoma. Evidence-based management of glaucoma in different stages of the disease is also discussed with highlights of the multicenter glaucoma clinical trials.

Proceedings of the 9th SIDUO Congress, held in Leeds, UK, July 20-23 1982

Herpes Simplex Virus is the fifth monograph to be published in the Bloomsbury Series of Clinical Science. It provides an authoritative review of the key issues related to this common clinical problem. The characteristics of the virus, its epidemiology and the diag nosis and management of the various forms of infection are all considered. Adrian Mindel is an international authority on this subject; he joined the Academic Department of Genito-urinary Medicine at the Middlesex Hospital in 1980 and has been actively involved in HSV research since that time. His major research interests include the epidemiology and treatment of genital herpes, the epidemi ology of neo-natal herpes and the many and varied features of HSV infections in immuno-compromised patients. The continuing aim of the Bloomsbury Series is to identify the growing areas of clinical research and relate these to current and future medical practice. In Herpes Simplex Virus such aspirations have been successfully achieved. London, May 1989 Jack Tinker Preface There has been considerable interest in herpes simplex viruses (HSV) over recent years. Amongst the many reasons for this are the introduction of safe and efficacious therapy, the recognition that HSV may cause life-threatening infections in neonates and immunocompromised patients, the observation that genital herpes is one of the commonest viral sexually transmitted diseases and the possible association of HSV with cervical cancer."

The Seventh Symposium on Ocular and Visual Development was held in October, 1982. The aim of the meeting was to develop a broad perspective on visual acuity. The subject was discussed initially in terms of molecular events of photoreception, and the metabolism of the photoreceptor ele ments. Subsequent papers presented the development and complexity of the neurocircuitry and transmitter systems in the retina that process the visual information prior to transfer to the brain. The meeting concluded with a series of papers on behavioral and physiological methods of mea surement of visual acuity in humans, particularly young children. This volume arose from the papers presented at the meeting. We feel that the juxtaposition of research of broadly differing methodologies will be stim ulating, rather than daunting, and will generate an enhanced understand ing of this complex subject. We are indebted to our colleagues: Dr. M. Mote from Temple University, and Drs. J. Siegfried, P. Dayhaw-Barker, and L. Press from the Pennsylvania College of Optometry for their expertise and assistance in the organization of the meeting; to the speakers for their presentations and contributions to this volume; and to the reviewers of the manuscripts for their helpful comments. This symposium could not have been held without the generous support of the Temple University College of Arts and Sciences and the Pennsyl vania College of Optometry. We also thank Merck, Sharp and Dohme, Inc. for their donation."

Fresh insights into the pathogenic mechanisms by which hyperglycemia induces tissue and organ injurt are the basis for rapidly evolving promising therapies in diabetes. Especially promising as targets for intervention are products of oxidative stress, including kinins and growth factors. Improving results of renal replacement regimes now incorporating pancreatic islet transplants are able to delay and prevent end-organ damage in diabetic individuals. The evolving story of the taming of diabetes is of direct concern to nephrologists, endocrinologists, ophthalmologists, primary care physicians and medical students.

This volume contains the proceedings of a work shop entitled "Physiological and Pathological Aspects of Eye Movements" held at the Pont d'Oye Castle, Habay-Ia-Neuve, Belgium, March 27-30 1982. The meeting was sponsored by the European Communi ties. It brought together specialists of oculomotricity mainly from Europe but also from North-America. With such actions, the Communities want to encourage inter national and multidisciplinary contacts between re searchers of a particular field. Oculomotor neuroscien tists, for quite a long time, have developed such con tacts. This cooperation - this is not so common in biological research - embodies various approaches, from basic mechanisms to behavioral studies, but also this applied science that medicine is or should be. Many basic discoveries about eye movement mechanisms, made with the help of human of animal subjects, have found rapid medical applications in neurology, neuro ophthalmology or otolaryngology. This is illustrated in this book by the fact that results obtained on rats or cats are interspersed with reports of clinical in vestigations. The workshop was mainly focused onto three themes: (a) eye and head movements in man, (b) visuo-vestibular interaction and (c) eye-head coordination. In each theme, one or more "review" papers were included. In addition, most of the oral presentations or posters on display mainly contained unpublished material."

In Dedication to Hermann Burian (1906-1974) T. LAWWILL (Louisville) This 14th Symposium of the International Society for Clinical Electro- retinography is dedicated to the memory of a great ophthalmologist, great physiologist, former officer of this Society, and my professor, Hermann Martin Burian. Dr. Burian was a visual physiologist and an ophthalmologist. His physiol- ogy heritage was the finest. His father, Richard, was an eminent European physiologist who at the time of Dr. Burian's birth was director of the Stazione Zoologica in Naples. The family later moved to Leipzig and Belgrade, where Dr. Burian's father held professorships. Hermann Burian's ophthalmological academic heritage was also outstand- ing. After graduating from medical school in 1930 in Belgrade, he became a student of Tschermak and along the way worked with such famous men as Siegrist, Goldmann and Weigert. In 1936, Dr. Burian came to the USA to join the Dartmouth Eye Insti- tute. Here he worked in ocular motility under Professor Bielschowsky and in physiological optics under Professor Ames. He was chief ophthalmologist of the Darmouth Eye Institute from 194245. He was in the private practice of ophthalmology in Boston for six years before moving to Iowa City, Iowa where, for twenty years, he practiced and taught ophthalmology and carried out research on many problems in ophthalmology and visual physiology. Dr. Burian's two main interests were strabismus and electrophysiology, but this did not keep him from publishing outstanding work on glaucoma, congenital anomalies, and color vision.

We have registered the ERG in 26 chronic uraemics treated with periodic haemodialysis, nearly always finding a subnormal b-wave. In 11 chronic uraemics treated only with dietetic-conservative therapy, the electroretino- gram resulted only slightly reduced and with a voltage clearly superior to that of the previous group. REFERENCES Agzamova, H.S. Tonographic values in patients with chronic renal insufficiency. Of tal. Zh. 20: 32-34 (1975). Berlyne, G.M. Microcrystalline conjunctival calcification in renal failure. Lancet II: 366-370 (1968). Biagini, M. & E.M. Gloria. Comportamento della pressione intraoculare durante emo- dialisi in pazienti affetti da uremia cronica.Ann. Ottal. 93: 705-713 (1967). Boudet, Ch., B. Arnaud & D. Pincemin. Cataracte au cours d'h'emodialyses (dans les insuffisances renales chroniques). Bull. Soc. Ophtal. France 73: 199-205 (1973). Burn, R.A. Intraocular pressure during haemodialysis. Br. I. Ophthal. 57: 511-513 (1973). Cavallacci, G., G. Tota & A. Wirht. Studio sperimentale sull'effetto della difenilidan- toina sull'Elettroretinogramma. Ann. Ottal. 100: 560-568 (1974). Demco, T.A., A.Q. McCormick & J.S.F. Richards. Conjunctival and corneal changes in chronic renal failure. Can. I. Ophthal. 9: 208-213 (1974). Deodati, F., P. Bec, M. Camezind & J .B. Labro. Les manifestations oculaires au cours de l'hemodialyse periodique. Bull. Soc. Ophtal. France 71: 87-92 (1971). Ehlers, N., F. Kruse Hansen, H.E. Hansen & O.A. Jensen. Corneoconjunctival changes in uremia. Acta Ophthal. Kbh. 50: 83-94 (1972).

Considering the high incidence of myopia - and its inherent morbidit- it may wonder that the item is dealt with only sporadically in recent literature, and almost never at international conferences. However, there was a First International Conference on Myopia in New York 1964, and the Second was held in Yokohama 1978, affiliated to the XXIII World Congress of Ophthalmology. Here it was attempted to set out lines for future myopia research, and, as a practical implicaton, the arrange ment of the Third International Conference on Myopia was entrusted to Danish ophthalmolOgists. This conference took place in Copenhagen, August 24-27, 1980. To make the scope the widest possible, the conference was, as was the pre decessing in Japan, open not only to ophthalmologists, but 'to all being active in the various aspects of myopia research'. The conference report gives a picture of the Copenhagen meeting. Furthermore, a platform or current status of myopia research has hereby been established. The editors have made it their main task to arrange the papers, and to bring them in a form suited for print, while criticism by editorial referees has been considered inappropriate. The papers give an impression of the ambiguity still prevailing in the field, and although 't, rends' are obvious, a fmal consensus of Conference was not arrived at. To document this state of affairs, however, is considered a useful task."

The forth meeting of the Organizing Committee of the Glaucoma Society of the International Congress of Ophthalmology was held on March 10-13,1990 in Bali, Indonesia. Traditionally this meeting is attended by committee mem- bers and invited experts and precedes the International Congress of Ophthal- mology under the auspices of the International Council of Ophthalmology. The scientific format was structured by Stephen M. Drance, OC, MD,lVan- couver (President of the Society from 1982-1990) and John Hetherington, JR, MD,ISan Francisco (General Secretary of the Society from 1982-1990). The local organization was in the very competent assistance of Josef Kadi, an ophthalmologist from Surabaya, Indonesia. Glaucoma Update IV comprises forty presentations from this meeting high- lighting the latest progress in global glaucomatology. Basic research related to the pathomechanisms of the disease, new diagnostic approaches and treat- ment modalities contribute to the best possible care of our patients. The ob- jectives of the Society are to share the frontiers of knowledge presented in these proceeding with everyone dealing with glaucoma patients all over the world. The Society is indebted to Chibret International/Rahway, Allergan Pharma- ceuticals/Irvine, and Otsuka Pharmaceuticals/Tokushima for support of the meeting and to Chibret Pharmaceuticals GmbH Munich for supporting the printing expenses of this volume.

The 4th International Visual Field Symposium of the International Perimetric Society, was held on the 13-16 April 1980 in Bristol, England, at the occasion of the 6th Congress of the European Society of Ophthalmology. The main themes of the symposium were comparison of classical perimetry with visual evoked response, comparison of classical perimetry with special psychophysi cal methods, and optic nerve pathology. Understandably many papers dealt with computer assisted perimetry. This rapidly developing subgroup of peri metry may radically change the future of our method of examination. New instruments were introduced, new and exciting software was proposed and the results of comparative investigations reported. There have been many confusing statements in the literature on the relative value of perimetry and the registration of visual evoked responses. Several reports attempted to bring some clarity in this issue. There is reason for further comparative research. A number of papers dealt with special psychophysical methods, i.e. methods not using the simply monocular differential threshold. The old critical fusion frequency received new attention. Fundusperimetry was used for testing spatial summation. Acuity perimetry, binocular perimetry etc. showed that there exist many possibilities for examining visual function. At present it is not clear to us what exactly the place of these methods is in our diagnostic armament. However it is quite clear that some of them are promising and may lead to a further differentiation of perimetric methods."

The three most striking characteristics of the cornea are: a) Its structure or rather its perfectly regular architectonic, by virtue of which it is transparent. b) The absence of vessels, the cornea being nourished by the perilimbic vessels, the endothelial surface in communication with the aqueous humour and the epithelial surface in contact with the pre-corneal film. c) The very slow turnover of the cells, that is to say the keratocytes, with the result that the metabolism of the cornea is very weak. It is this third characteristic which justifies our present investigation. The keratocytes, which are apparently inactive, have in fact a latent activity. They can be activated by central corneal incisions and also by tissue cultures. Under either of those conditions, the keratocytes become very active, develop all the cytoplasmic organites and produce mucopoly saccharides as well as the precursors of the collagen (Fig. 1). In order to study the pathological keratocyte, we chose a storage disease, wherein the catabolism of the mucopolysaccharides is blocked, namely the macular dystrophy of the cornea. We undertook the same investigation both for normal and for pathologi cal corneas and studied the keratocyte 'in situ' and in tissue cultures using various microscopical and histochemical techniques. In macular dystrophy, we investigated also the deteriorations secondary to the changes in the keratocytes."

The XVlIIth ISCEV symposium was organized by the Netherlands Ophthal- mic Research Institute and took place May 18-22, 1980, at the Wilhelmina Gasthuis in Amsterdam. The invited speakers and the theme "Electrophysio- logy and pathology of the visual pathways" were selected by a programme committee consisting of G.H.M. van lith, D. van Norren, L.H. van der Tweel and H. Spekreijse. The success of a symposium depends not only on the topics selected but also on the clarity and qUality of the presentations. In this respect it is a pleasure to acknowledge the four invited speakers for their clear and comprehensive presentations of recent research results. My co-editor, P. Apkarian, and I wish to thank all participants for timely submission of the manuscripts and for prompt response to inquiries regarding editorial matters. Mr. Peters of Junk Publishers should be acknowleged for observing publication deadlines, thus ensuring that the proceedings will reach all participants prior to the next ISCEV meeting.

Aspects of Lyme Borreliosis is a comprehensive scientific presentation of virtually all aspects of lyme borreliosis. It starts with a concise history of lyme borreliosis and its causative agent, Borrelia burgdorferi. The morphological and biological characteristics of B. burgdorferi are presented, followed by outlines on the ecology and histopathology of LB.The various aspects of the clinical manifestations of LB are systematically dealt with, starting with a clinical overview. A special chapter covers the microbiological diagnosis. After a presentation on the susceptibility of B. burgdorferi in vitro and in animals against a great variety of antibiotics, a thorough discussion on the treatment of LB including criticalremarks follows. The book closes with a chapter on the epidemiology of LB.

Forty-eight eyes with massive periretinal proliferation were examined with ultrasonography. In addition to the triangular retinal detachment T-sign was indicative of severe MPP. And irregular thickening and bending of the retina were observed on ultrasonography in eyes with MPP. The detached retina was immobile in all eyes. Preoperative ultrasonographic findings did not prove the value on the assessment of operative prognosis. REFERENCES Bronson, N.R. & Turner, F.T. A simple B-scan uitrasonoscope. Arch. Ophthalmol. 90: 237 (1973). Coleman, D.J., Koning, W.F. & Katz L.: A Hand-Operated ultrasound scan system for ophthalmic evaluation, Am. J. Ophthalmol. 68: 258 (1969). Fuller. D.G., Laqua, H. & Machemer, R. Ultrasonographic diagnosis of massive periretinal proliferation in eyes with opaque media (triangular retinal detachment). Am. J. Ophthalmol. 83: 460 (1977). Laqua, H. & Machemer, R. Glial cell proliferation in retinal detachment (massive periretinal proliferation). Am. 1. Ophthalmol. 80: 1 (1975). Laqua, H. & Machemer R. Oinical-pathological correlation in Massive periretinal proliferation. Am. J. Ophthalmol. 80: 912 (1975). Machemer, R. & Laqua, H. Pigment epithelial proliferation in retinal detachment (massive periretinal proliferation). Am. J. Ophthalmol. 80: 1 (1975). Machemer, R. & Laqua, H. A logical approach to the treatment of massive periretinal proliferation. Ophthalmology 85: 584 (1978). Machemer, R. Van Horn, D. & Aaberg, T.M. Pigment epithelial proliferation in human retinal detachment with massive periretinal proliferation, Machemer, R. Pathogenesis and classification of massive periretinal proliferation. Br. J. Ophthalmol. 62: 737 (1978).