The diagnosis of Descemet membrane detachment can be easily overlooked or misdiagnosed. The clinical presentation, clinical course, and pathogenesis depend on the type of nonpenetrating filtering surgery performed. Ophthalmologists should be aware of this unusual complication, which is likely to be more common after nonpenetrating filtering surgery than after trabeculectomy. A period of observation before attempting descemetopexy is recommended.

To study the possible physiological role of atrial natriuretic peptide (ANP) in the regulation of intraocular pressure (IOP) the effects of an increase of endogenous ANP within the physiological range induced by the neutral endopeptidase 24.11 (NEP) inhibitor candoxatril were examined. In a single masked placebo controlled trial, seven patients were studied with normal IOP (six male, one female; average age 50 (range 37-62 years). Intraocular pressure in each eye was measured after 2 weeks of placebo, after 4 weeks of candoxatril 200 mg twice daily, and during the first 3 days of placebo washout. With 4 weeks of candoxatril, endogenous plasma ANP levels increased from 4-2 (SEM 1.5) to 6*0 (1.5) pmol/ I (p<004) and there was a significant decrease in mean arterial pressure from 119 (4) A role for atrial natriuretic peptide (ANP) in the regulation of intravascular fluid volume and blood pressure is now well established.I There is also preliminary evidence for pharmacological effects of ANP on the regulation of aqueous humour production and of intraocular pressure (IOP). Atrial natriuretic peptide has been identified in the anterior uvea in the rat,3 and specific receptors for ANP have been demonstrated in the pigmented epithelium of the ciliary processes in the rabbit.4 Intravenous or intravitreal injection of pharmacological doses of ANP cause a reduction in aqueous humour production and lower IOP in the rabbit.5-9 In primates, administration of ANP intravenously, or by injection into the anterior chamber of the eye, increases uveoscleral outflow.'0 Furthermore, acute intravenous injection of high dose ANP in patients with pathologically raised IOP reduced the intraocular pressure by around 15%." However, it is unclear whether ANP plays a physiological role in the regulation of IOP. Neutral endopeptidase (NEP) 24.11 inhibition is an important mechanism for the normal catabolism of ANP. We therefore examined the possible physiological effects of ANP in the eye by studying IOP during acute and chronic elevation of endogenous ANP within the normal range by the oral prodrug candoxatril which is metabolised to the NEP 24.11 inhibitor UK 73 967.12 Materials and methods We studied seven patients (six male, one female; average age 50 (range 37-62) years) with normal intraocular pressure (right eye 18 (SEM 1) mm Hg, range 11-22 mm Hg; left eye 17 (2) mm Hg, range 10-22 mm Hg) and average supine blood pressure 162/97

Diabetic macular changes in the form of yellowish spots and extravasations that permeated part or the whole thickness of the retina were observed for the first time by Eduard Jaeger in 1856. This was only possible as a result of the newly developed direct ophthalmoscope that was first described in 1855. Jaeger's findings were controversial at the time and Albrecht von Graefe openly claimed that there was no proof of a causal relationship between diabetes and retinal complications. It was only in 1872 that Edward Nettleship published his seminal paper "On oedema or cystic disease of the retina" providing the first histopathological proof of "cystoid degeneration of the macula" in patients with diabetes. In 1876, Wilhelm Manz described the proliferative changes occurring in diabetic retinopathy and the importance of tractional retinal detachments and vitreous haemorrhages. In the early years of the 20th century, the debate continued whether macular changes were directly related to diabetes or whether they were due to hypertension and arteriosclerosis. It was not until the second half of the century that the work of Arthur James Ballantyne in Glasgow provided more evidence that suggested that diabetic retinopathy represents a unique vasculopathy.

Myopic foveoschisis is a rare form of a tractional maculopathy, which occurs in patients with elevated axial length. The contraction of the posterior hyaloid exerts tangential traction on the retinal surface with a subsequent continuous splitting of the retinal layers. Internal limiting membrane (ILM) peeling has been advocated in foveoschisis, but it has been associated with post-operative macular hole formation. We report on a modified surgical technique, which spares the fovea and may reduce the risk for macular hole formation. Retrospective analysis of 6 patients with myopic foveoschisis. The mean age was 53.8 ± 12.9 years (4M, 2F) and mean myopia was - 18.3 ± 6.5 Dpt. After a 23 g pars plana vitrectomy, the ILM was peeled on the entire macular surface, except in the foveal region lest the thin foveal structures be damaged. All patients received a gas tamponnade with 23 % SF6 and maintained a face down position for 5 days. Mean best-corrected pre-operative visual acuity was 0.87 ± 0.56 logMAR, which increased to 0.60 ± 0.40 logMAR at the end of follow-up. The retinal thickness, as measured by optical coherence tomography, decreased from 799 ± 352 micrometers to 318 ± 60 micrometers at the end of follow-up 7.8 ± 5.7 months. No case developed a macular hole. Vitrectomy with fovea sparing ILM peeling is a promising surgical technique, which results in an improved foveal anatomy and retinal function. Due to the sparing of the fovea, this surgical technique may reduce the risk of macular hole formation in the post-operative period.