Showing papers by "Moorfields Eye Hospital published in 1976"

Herpetic Corneal Epithelial Disease

Abstract: • The clinical differentiation of corneal epithelial lesions due to herpes simplex or herpes zoster may be confusing. Practical clinical tests, including the use of topical ocular stains, are useful to differentiate corneal epithelial lesions caused by these two viruses. Two distinctive types of zoster corneal epithelial disease may be seen: an early dendritic form, and a delayed form characterized by corneal mucus plaques that may take a dendriform pattern. These plaques are composed of mucus that is adherent to swollen, degenerating epithelial cells. The clinical differentiation between these two viruses is essential since topically applied corticosteroids are contraindicated in epithelial herpes simplex and often are indicated in the management of epithelial herpes zoster.

Evaluation of eyes enucleated for scleritis.

Abstract: A series of 30 enucleated eyes, all of which had a primary histological diagnosis of scleritis, was analysed. The average age of patients at enucleation was 68 years; many of these patients had had the disease for more than 30 years. In 40 per cent the diagnosis of scleritis was unsuspected and was often masked by multiple complications. Scleritis with uveitis and glaucoma was the most common combination to come to enucleation. In 82 per cent, pain was the reason for enucleation, which suggests that some patients were on inadequate levels of steroid treatment or were unable to tolerate them. In the series, 37 per cent of the eyes perforated. Perforation occurred in those patients who were having steriods but not in those who were not, but the data are inconclusive as to which method of steroid administration was most likely to cause ocular perforation.

Spheroidal degeneration of cornea and conjunctiva.

Abstract: A study of almost 1000 outpatients at a London eye hospital showed the presence of asymptomatic yellowish, spheroidal deposits in the peripheral cornea or conjunctiva, or both, in about 6 per cent, with a preponderance of males and older subjects among those affected. This prevalence is less than is observed in people in countries exposed to higher levels of sunlight. Histological study of the deposits showed some tinctorial similarities with pseudoelastic fibres of pingueculae, with which they were sometimes associated, but also significant differences suggesting that the spheroidal deposits might be a composite of degenerate collagen and a second non-collagenous protein. Until a more precise terminology is feasible we suggest that a purely descriptive name such as spheroidal degeneration or droplet keratopathy should be used to describe this entity.

Clinical Trials of Topical Interferon Therapy of Ulcerative Viral Keratitis

Abstract: An open trial suggested that monkey interferon had a therapeutic effect on ulcerative vaccinial keratitis in humans. A randomized, double-blind, placebo-controlled trial of either monkey interferon or drops of idoxuridine (given hourly by day and at 2-hr intervals by night for three days) suggested a therapeutic effect from idoxuridine but not from monkey interferon. Results of experiments with rabbits suggested that a daily application of human interferon (1.1 X 10(7) international units/ml) would be effective in the prevention of herpetic ulcers but might not affect established lesions. Preliminary results are encouraging in a placebo-controlled, randomized trial of human interferon given once daily for seven days for prevention of recrudescence of epithelial herpetic lesions after minimal wiping debridement with a cotton-tipped swab. The design of the trial is closely analogous to that of the experiments with rabbits and permits ethically acceptable, placebo-controlled trials of antiviral agents.

The Macular Disciform Response and Laser Treatment

Abstract: In disciform macular degeneration the retina and pigment epithelium are detached from the underlying choroid by serous fluid, and the subpigment epithelial space is occupied by blood vessels originating from the choroid. Recent interest in the disease is due to the realisation that disciform degeneration in the elderly is the commonest cause of registerable blindness in England and Wales (SORSBY, 1966), to fluorescein fundus angiography which allows the study of the morphology of the disease during life (GASS, 1967) and to photocoagulation which provides a means of treating the lesion.

Subconjunctival and episcleral lipid deposits.

Abstract: Biomicroscopical examination of the bulbar conjunctiva and anterior episclera of 1000 randomly selected outpatients showed the presence of multiple discrete lipid globules in 30 per cent. The lipid deposits were asymptomatic. Their prevalence was age-related, while their distribution and composition were consistent with origin from the conjunctival blood vessels.

A study of some factors concerned in the schooling of visually handicapped children.

Abstract: SUMMARY Sixty children integrated into the fully-sighted school system and 34 children attending partially-sighted schools were assessed. All were using low vision aids. It was found that there was little difference in acuity, parental or school support, but the integrated children tended to be more intelligent and came from a higher socioeconomic group. More children could avoid special schools if given appropriate services at an early age and assessment should be by a multidisciplinary team.

The morphology of posterior segment lesions of the eye in patients with onchocerciasis

Abstract: Posterior segment ocular lesions were examined in 244 selected patients with onchocerciasis from the Sudansavanna and rain-forest areas of the United Cameroon Republic. Fluorescein fundus angiography was performed on 210 cases. As a result of this study the following conclusions were drawn: 1. (i) The heterogeneity of single lesions, and the occurrence of different types of lesion in a single eye or two eyes, prevented subdivision of the disease into distinct forms and suggested that inflammation alone was responsible for fundus lesions in onchocerciasis. 2. (ii) Optic nerve disease alone, or in the presence of choroidoretinal changes, was responsible for a large proportion of the blindness due to posterior segment lesions in onchocerciasis (87.6% in this series).

Factors Influencing Absorption of Subretinal Fluid

Abstract: In 200 cases of retinal detachment successfully treated without drainage of subretinal fluid, complete reattachment of the retina was achieved in the first post-operative week in 76% of cases Delay in subretinal fluid absorption in the remaining 24% of cases was directly related to the duration of the retinal detachment, but was not influenced by the patients age, refractive error or the characteristics of the detachment

Cataracts in early childhood: etiology and genetic aspects.

Abstract: visual stimulus deprivation in bilateral cases and variable squint in uniocular cases, although there is some evidence that the nystagmus may subside if very prompt surgical treatment is carried out. Management of cataracts in childhood therefore depends on the etiology and the natural history and may be divided into specific and supportive measures. The specific treatment includes the refractive correction and the determination of the cause of the lens opacities, which leads on to genetic counselling, for a considerable proportion of cases which are developmental are also hereditary in origin. Where lens opacities complicate a metabolic disorder such as galactoswmia specific biochemical treatment may be available and the cataract may be wholly or partly reversible in the early stages with prompt dietary control. The density of the lens opacities and their presence in one eye or both eyes is most important in determining the place and timing of surgical treatment. In general, surgery is technically easier as the eye assumes near-adult proportions at the age of 2-3 years, so that if there is no urgency for surgical treatment it is best postponed until after that age is reached. There are two critical periods with regard to surgery: (1) During infancy when the possibility of the development of stimulus-deprivation amblyopia may require urgent operation. (2) The period around the time of starting full-time education at 5-7 years when the child's visual acuity may be accurately assessed using simple subjective tests, and when it may become clear that the best obtainable visual acuity, particularly for near work, is less than would be required for attendance at a school for normally-sighted children. If all optical aids have been tried without success then surgical treatment is indicated. Certain additional factors also need consideration when surgery is planned: (1) In certain disorders such as homocystinuria general anesthesia may be a very hazardous procedure leading to the development of thromboembolic episodes which occasionally have a fatal outcome (Henkind & Ashton 1965). (2) Even when contact lenses can be tolerated, phakic vision is always to be preferred to aphakic vision because of the restricted visual field and the total loss of accommodation which the latter produces. (3) The long-term complications of cataract surgery in childhood, most importantly retinal detachment; these are additional to the risk of immediate postoperative problems such as endophthalmitis, particularly in rubella cases. Although cataract in early childhood is relatively uncommon it is of very varied etiology and effect, so that each case requires careful evaluation and individual management for the affected child to have the best chance of achieving his maximum long-term vision. REFERENCES Fine S R (1968) Blind and Partially-sighted Children. HMSO, London Fraser G R & Friedmann A I (1967) The Causes of Blindness in Childhood. Johns Hopkins Press, Baltimore Henkind P & Ashton N (1965) Transactions ofthe Ophthalmological Society ofthe United Kingdom 85, 21 Hubel DH & Wiesel T N (1963) Journal ofNeurophysiology 26, 994 (1965) Journal ofNeurophysiology 28, 1041 Von Noorden G K (1974) British Journal ofOphthalmology 58, 158 Von Noorden G K, Dowling J E & Ferguson D C (1970) Archives ofOphthalmology 84, 206 Von Noorden G K & Maumenee A E (1968) American Journal ofOphthalmology 65, 220

The need for antiviral therapy and prophylaxis of viral ocular disease.

Abstract: The cost of development of a compound with clinical potential as an antiviral agent is so great that it cannot be undertaken unless there is likely to be a market that will return the investment. The current practice, assessment of the prospect on the basis of the present market for idoxuridine and calculation of a likely percentage of capture by a potentially superior compound, is basically erroneous and may lead to gross underestimates of the market. In addition to the market for agents effective in treatment of dendritic and amoeboid ulcers, there is a potentially much greater market, first, for somewhat less toxic compounds that may be used more or less continuously over very long periods for prevention of recurrences. Substances with promise of filling each of these requirements are already under investigation. There is also a potential market for therapeutic preparations with activities against a range of agents, particularly herpesviruses, adenoviruses, and chlamydiae, that commonly cause follicular conjunctivitis or keratoconjunctivitis.

Psychosomatic eye disorders.

Abstract: Summary Most presenting symptoms in ophthalmology, as in general medicine, are largely or wholly psychogenic; and the patient's range from the common neurotics, with their eyestrain, through the hysterics and malingerers to the frank psychotic with his hallucinations and self-mutilations.

Diseases Affecting the Pigment Epithelium

Abstract: Diseases causing swelling and subsequent atrophy of the pigment epithelium and choriocapillaris taken many forms, and attempts have been made to identify distinct clinical entities within this group of diseases on the basis of their morphological and behavioural characteristics. These include Harada’s disease (SHIMIZU, 1973), placoid pigment epitheliopathy (GASS, 1968), geographical (or serpiginous) choroidopathy (Hamilton & Bird, 1974) and acute retinal pigment epitheliitis (Krill & Deutman, 1972).

The Management of the Vascular Retinopathies

Abstract: The first classification of the vascular retinopathies was given by DESMAR-RES in 1858. He described the retinopathy of Glycosuria, Albuminuria and Spermatorrhoea. Today we include: 1) Retrolental fibroplasia, 2) Sickle cell retinopathy, 3) Venous retinopathy, 4) The retinopathies associated with hyperviscosity, 5) Diabetic retinopathy, 6) Hypertensive retinopathy and the collagenoses, 7) The predominantly ischaemic retinopathies.