Showing papers by "Moorfields Eye Hospital published in 1977"

The Surgical Management of the Congenital Glauicomas

Abstract: Summary A review of 158 cases of simple congenital glaucoma reveals that the glaucoma was controlled by goniotomy in 86%, confirming that goniotomy is an effective and safe procedure in this disease. In complicated congenital glaucoma the results of surgery vary according to the primary diagnosis. Precise diagnosis in children with congenital glaucoma is important when planning treatment and assessing prognosis.

Migraine as a sequela of blunt head injury

Abstract: Evidence that a blunt head injury can engender a migrainous state in susceptible individuals is provided by a series of 13 patients who developed recurring attacks of classic migraine after suffering such injury. Among a group of patients with post-traumatic headache of more than one year's standing, the preponderant type of headache was found to be of the migrainous variety. The significance of these findings is discussed.

An Evaluation of C.A.T. in the Diagnosis of Orbital Space-Occupying Lesions

Abstract: The introduction of computerised tomography into clinical practice by AMBROSE and HOUNSFIELD in 1972 opened a new era in the diagnosis of soft-tissue tumours in the orbit. In a preliminary communication (1) the findings in the first 17 histologically proven primary tumours and granulomas examined by this technique were recorded. Progressive refinements in the apparatus (vide infra) and a 4-5-fold increase in the number of verified cases now allows a more mature assessment of C.A.T. scanning and its place in relation to other methods of orbital investigation.

Abstracts of Free Communications

Abstract: The surface mucous cells of gastric fundus secrete mucous glycoprotein which covers the inner surface of the stomach. Subcellular fractionation of gastric scrapings in sucrose density gradients yielded a microsomal fraction of 1.12 g/ml buoyant density density, enriched in glycosyl-transferases for galactose, fucose and acetyl-galactosamine, when tested with properly modified glycoproteins as exogenous acceptor molecules. This fraction was devoided of Na+, K+-activated ATPase and of thiamine-pyrophosphatase (TPPase). Electronmicroscopic examination revealed some Golgi-like structures. In the absence of exogenous acceptors the sugar moieties appeared to be transferred to endogenous acceptor molecules. Native glycoprotein, isolated from the gastric mucus layer, did not accept glycosyl-moieties, when added to the fraction. The enzyme involved in endogenous sulphate incorporation appeared to be present in a less dense fraction, enriched in TPPase activity too. The latter enzyme has been demonstrated cytochemically in the mature Golgi cisternae of gastric epithelial cells (J.J. Geuze, unpublished results).

Loss of accommodation and convergence

Abstract: It is not unusual to see patients in an eye clinic who have difficulties either with accommodation or convergence. It is, however, extremely uncommon to see children or adults presenting with a severe disabling loss of both accommodation and convergence. An ophthalmologist seeing such a patient must consider these symptoms as a possible presenting feature of a serious underlying neurological lesion. However, there would appear to be a group of patients who present with these symptoms who do not appear to have any underlying progressive neurological disease. A 12-year-old boy presented with sudden total loss of accommodation and convergence which remained unchanged for over twelve months. It was not associated with any other neurological signs. From other cases quoted in the literature it is suggested that this is a benign condition and that invasive neurological investigations are not justified. Symptomatic help with prisms and reading glasses is suggested.

Penicillamine in corneal ulceration.

Abstract: The cornea is a complex multilayered structure whose optical clarity depends on the precise arrangement of the constituent parts. Beneath the surface epithelium lies the main bulk of the cornea, which is composed of collagen fibrils in a surrounding protective matrix of proteoglycan and structural glycoproteins. The collagen comprises 60% of the dry weight of the cornea, and it has been shown that in certain conditions associated with loss of corneal substance, the collagen is attacked by a variety of enzymes, loosely called collagenases. Since Gross & Lapiere (1962) first reported their series of studies showing that collagenolytic enzymes were present in tissues and could work at physiological pHs, a number of authors have shown that it was possible to inhibit lysis of collagen with substances such as sodium edetate in an experimental model using tissue cultures of epithelial and stromal explants on collagen substrates. Brown et al. (1969) first showed that the ulcerated tissue of alkali-burned cornet had considerable collagenolytic activity, and by perfusing alkali-burned rabbit cornea twice daily with cysteine and sodium edetate they were able to reduce ulceration by 70 %. However, these chemicals, particularly sodium edetate, produced considerable conjunctival irritation. Subsequent studies by Itoi et al. (1969) showed that there was no inhibition of collagenase activity using cysteine at levels below those toxic to the epithelium. Brown & Weller (1970) showed in human studies that cysteine was effective in preventing corneal ulceration in 80% of alkali-burned eyes and sodium edetate in 35%, and that sodium calcium edetate was quite ineffective. The mechanism of inhibition of collagenase was shown to be related partly to chelation of metallic ions, including calcium and zinc, such inhibition being reversible on addition of higher concentrations of the necessary ions, but also partly irreversible, resulting from reduction of disulphide bonds in collagenase with subsequent binding to the SH site liberated. More recent studies have shown the importance of stromal proteoglycans in alkali burns and the early loss of these substances when corneal pathological changes ensue. Furthermore, crude preparations of corneal proteoglycans were shown to inhibit collagenase, although purified preparations of heparin, chondroitin sulphate and keratan sulphate were ineffective. Francois et al. (1973) published findings in the treatment of various types of corneal pathological changes using penicillamine, and we wish to report here our experience using this compound in the treatment of experimentally induced alkali burns in rabbits, and also in the treatment of Mooren's ulceration in human subjects.