Showing papers in "Archives of Ophthalmology in 1962"

The use of liquid silicone in retinal detachment surgery.

Abstract: Introduction Silicone rubber has been widely used as implant material in plastic surgery and in retinal detachment procedures. 1 Liquid silicone was first injected into the vitreous cavity of rabbits by Stone, 2 who reported that silicone fluids of various viscosities were well tolerated and produced "very little change in the rabbit eyes over a period of two years." He went on to predict that it might be possible to find a "viscosity" that would maintain the "clarity" of the vitreous and help in "replacing the retina." Recently, other investigators 3-5 have confirmed Stone's observations. However, their animal experiments emphasized the possibilities of complications. Everett 4 reported cataract formation following the injection of liquid silicone into the vitreous cavity of rabbits; Galavin 5 produced glaucoma by the injection of liquid silicone into the posterior chamber of the rabbit eye. The present study serves a dual purpose: (1) to report further

Epidemiology of uveitis. Incidence and prevalence in a small urban community.

Abstract: In this paper the literature concerning the demographic characteristics of uveitis will be reviewed, and a 10-year retrospective survey of the disease among residents of Rochester, Minnesota, will be presented. Descriptive epidemiology attempts to measure the risk of developing a disease in different populations and to characterize the affected individuals with respect to geographic location, age, sex, race, occupation, socioeconomic status, and time of illness. There is, to our knowledge, no data on the prevalence of uveitis in the United States based on a survey of all residents of a community. If the prevalence of uveitis could be measured accurately in several places, it might be possible to identify those population characteristics associated with an unusual prevalence of the disease. Clinical and laboratory research as well as epidemiological analysis could then be concentrated on populations with contrasting risks of developing uveitis, in the hope of identifying causal factors with a

Use of 5-Iodo-2′-Deoxyuridine (IDU) in Treatment of Herpes Simplex Keratitis

Abstract: Herpes simplex infection of the cornea, unlike infection of the skin, tends to be chronic and to lead to opaque and blinding scars. A recent review of a large series of cases indicated that spontaneous clearing of herpetic keratitis within a reasonable period of time does not occur in more than 10% of cases. Temporary diminution of vision seems to be the rule, and "permanent diminution of vision was probably obtained in the majority of cases." 1 Present therapy of herpes simplex keratitis consists primarily of the removal of infected tissue. When only the corneal epithelium is involved by the infection, removal of the area of ulcer seems to speed healing. This removal may be facilitated by the use of denaturing agents such as iodine or silver nitrate, by mechanical curettage, or by the use of enzymes such as chymotrypsin. Some of the agents which precipitate tissue protein also kill

IDU therapy of herpes simplex.

Abstract: To date, there has been no well-documented description of effective therapy for any "true" viral disease, although the Chlamydozoaceae, the very large viruses, are sensitive to ordinary broad-spectrum antibiotics. To be sure, many agents, such as specific antibody or interferon, prevent the appearance of viral disease in vitro and in vivo. None of these, however, has cured or improved viral disease once it was present. Present therapy of herpes simplex keratitis with debriding agents, though helpful, is by no means uniformly satisfactory and does not eliminate virus. 1 This communication will report the use of a drug, 5-iodo-2'-deoxyuridine (IDU), a viral antibiotic which cures or ameliorates experimental herpes simplex keratitis, 2 even after the keratitis is extensive and severe. Methods and Materials The corneas of albino rabbits were traumatized by 3 interlocking circles in the central cornea made with a 5 mm. trephine set to a depth of 0.05 mm.

Electroretinogram in diabetic retinopathy.

Abstract: The classical electroretinogram (ERG) has been intensively studied, mainly concerning its initial deflections (a- andb- waves), in various diseases of the eye since the systematic work initiated by Karpe1who defined several basic pathologic types of ERG. Several papers have appeared in relation to the classical ERG in diabetic retinopathy. Francois and Derouck3recorded the ERG in advanced diabetic retinopathy exhibiting numerous hemorrhages and exudates and saw the values in normal limits. Muller-Limmroth4and Schmoger5stated that in the early stage of diabetic retinopathy the ERG was found to be normal. Jacobson6believes that diabetic retinopathy usually does not compromise the ERG amplitude until the disease has reached far advanced stages, such as retinitis proliferans and detachment of the retina. Straub7examined the ERG's of 24 diabetic patients with slight retinopathy, demonstrating that the ERG was normal in 20 cases and subnormal in

Congenital blepharophimosis associated with a unique generalized myopathy.

Abstract: Congenital blepharophimosis (Phimosis Palpebrum, von Ammon, 1841)1is described as a general diminution of the palpebral aperture in all its dimensions but with the eyelids normally differentiated.2It is exemplified by Atkinson's report3of an adult woman with a palpebral aperture 8 mm. long and 3 mm. wide. Blepharophimosis was dominant in the family pedigrees studied by Dimitry,4Waardenburg,5and Klein.6In a series of 153 cases of ptosis of genetic origin, Edmund7found 12 cases of congenital blepharophimosis. After hereditary studies, these 12 cases were expanded to 23, of which 8 were isolated cases and 15 were present in 2 families. Eye defects associated with congenital blepharophimosis2,6,7include strabismus, nystagmus, amblyopia, microphthalmus, anophthalmus, ptosis, epicanthus, inverse epicanthus, microcornea, and hypermetropia. Calmettes8reported patients with macular heterotopia associated with blepharophimosis. Other defects observed2,7with blepharophimosis include asymmetry of the ears,

Effects of long-term systemic steroids on ocular pressure and tonographic values.

Abstract: Introduction With the increasing use of long-term systemic steroid therapy, reports on its possible ocular effects have been sporadically appearing in the literature. Recently cataract formation has been noted. 1 However, the majority of these reports have concerned themselves with the relationship of steroids to intraocular pressure. There is suggestive evidence that steroids may play a role in the normal physiological control of intraocular pressure. Hill et al. 2 showed that the normal production of endogenous steroids follows a diurnal curve, similar to the ocular tension diurnal curve in the majority of individuals. 3,4 Because of these parallel diurnal fluctuations, Linner 5 investigated their possible relationship by measuring intraocular pressure and aqueous flow in a small group of patients without endogenous steroid production because of hypophysectomy or adrenalectomy. These patients were receiving exogenous steroids and presumably had a relatively constant level of steroids throughout the day and night. He found

A Review of the Schirmer Test for Tear Production

Abstract: Schirmer, in his original report1on lacrimation, used blotting paper to collect tears elicited by one of the following 3 methods of stimulating lacrimation: (1) inserting the strip of paper itself; (2) irritating the nasal mucosa after the cornea had been anesthetized, and (3) having the patient look into the sun. After considerable study he decided to concentrate on the first method, and since then all subsequent studies have been based on this method. In the few studies reported since then, deRoetth2-4used Whatman standard No. 41 filter paper in the form of a strip measuring 35 by 5 mm. At one end, a 5 mm. length of the strip is bent over and inserted over the outer half of the lower lid for 5 minutes. The amount of paper moistened is reported. He showed that in general after the age of 50 years there was a progressive

Ocular manifestations of ethambutol, Toxic amblyopia after administration of an experimental antituberculous drug.

Abstract: Introduction Ethambutol* (2,2'-(ethylenediamino) di1-butanol) is an experimental drug which shows promise against resistant tubercle bacilli. It has been used experimentally in patients refractory to all other antituberculous medication. To date, 18 patients have been placed on the drug in various centers throughout the country. They received dosages varying from 60 to 100 mg. per kilogram body weight per day. Eight of these patients developed either mild or severe toxic amblyopia. The following case demonstrates the features of the ocular toxicity of ethambutol. Report of a Case The patient, a 49-year-old white male, was admitted on March 9, 1961, with tuberculosis resistant to streptomycin, isoniazid (INH), and aminosalicylic acid (PAS). He has been known to have diabetes since April, 1960. The patient smokes 1½ packages of cigarettes a day and is a chronic alcoholic. The past history is otherwise negative. Physical Examination. —Vital signs were normal. The trachea was deviated to

Visual Fiber Anatomy in the Infrageniculate Pathway of the Primate: Uncrossed and Crossed Retinal Quadrant Fiber Projections Studied with Nauta Silver Stain

Abstract: The classical approach to the topographical representation of the retina in the anterior visual system has been to produce specific retinal lesions in experimental animals, followed by histoanatomic demonstration of nerve-fiber degeneration (by the Marchi technique) in sections of the optic nerves, chiasm, and optic tracts. Despite the competent investigations of the past, many details of the organization of the infrageniculate visual fibers are lacking. During the past decade a silver-staining technique has been developed for demonstration of degenerating axons (rather than the staining of degenerating myelin by the Marchi technique). This technique and the Zeiss retinal photocoagulator provide a new approach for observations of the nerve-fiber organization in the optic nerves, chiasm, and optic tracts. We wish to report anatomic studies which employ these techniques. Previous Experimental Studies For more than a century it has been believed that the nerve fibers originating from specific retinal areas have a definite,

The effects of blur upon perimetric thresholds. A method for determining a quantitative estimate of retinal contour.

Abstract: Introduction This paper serves a twofold purpose. Some of the effects of blur of the retinal image upon perimetric thresholds are considered, and a clinical procedure is presented which utilizes these characteristics in order to provide a quantitative estimate of retinal contour. The method does not provide a measure of the true contour, but rather provides a precise reference or relative contour which may be compared with that obtained in other portions of the retina, or which may be compared with a similar set of determinations obtained at a different time. The procedure is based upon the assumption that the contrast or luminous increment threshold is lowest when the perimetric test target, imaged upon its corresponding retinal area, is focused upon the retina. The clinical method permits quantitative determination of shifts in a fore-and-aft direction of the retinal receptors in that part of the visual field usually studied with a

Occult temporal arteritis.

Abstract: The classic syndrome of temporal arteritis has been the subject of much attention in general medical and ophthalmic literature, and its features are familiar to most ophthalmologists. However, little emphasis has been given to the fact that temporal arteritis may be a distinctly occult disease without sufficient symptoms and signs to alert the physician to its presence. Because of the devastating ocular complications of the disease and its potential reversibility by appropriate therapy, it is essential that ophthalmologists recognize temporal arteritis at the earliest possible stage of the disease. It is the purpose of this paper to discuss the occult nature which this disease may assume and to document this occult form with 5 cases. Classical Temporal Arteritis Temporal arteritis was first described by Hutchinson in 1890, 1 but attention was not attracted to it as a significant syndrome until Horton 2 in 1932 described it in detail. Since this

Ocular tolerance to silicones. I. Replacement of aqueous and vitreous by silicone fluids.

Abstract: Silicone preparations possess a wide variety of physical characteristics that are uniquely suited for ophthalmic use. Their optically clear fluids may serve as substitutes for aqueous and vitreous. Their rubber preparations, though opaque, yield fine cords or tubes that may provide more permanent drainage channels for aqueous. Their solid and optically clear preparations may provide intraocularly placed optical lenses; the procedure of siliconizing cloth and providing a uniform and thorough coating of each fiber permits the use of the physical properties of the cloth and the biological properties of the silicones; such preparation may be of value in reinforcing the sclera. Indeed, if these compounds are tolerated by the eye, the variety of situations wherein their mechanical or refractive properties may be used in ocular conditions is very great. Stone1reported tolerance of the rabbit eye to silicone fluid injected in the vitreous. These attractive features suggested an investigation

Intraocular pressure and blood flow through the uvea.

Abstract: There is evidence for interrelationships between uveal blood flow, aqueous formation, intraocular pressure, and venous pressure counteracting aqueous drainage. It can therefore be expected that the relationship between intraocular pressure and blood flow through the uvea should be complicated. The purpose of the present investigation was to study part of the latter relationship, namely, the changes in uveal blood flow produced by changes in intraocular pressure. This problem was studied earlier by Sondermann,30and other investigators have reported about the influence of the intraocular pressure on the blood flow through the choroid. The findings were rather conflicting. Sondermann,30working with rabbits, found no constant relationship between the intraocular pressure and the flow from an opened vortex vein but reported that as a rule an increase in intraocular pressure gave a decrease in blood flow. Bornschein and Zwieauer,12using a dye injection technique in rabbits, found evidence for

Retinal vascular patterns. V. Experimental ischemia of the cat eye.

Abstract: Parts I through IV1-4of this series describe normal and pathologic retinal vascular patterns of human eyes. The technique employed allows study of the retinal vascular tree as a whole mount. Many of these mounts from diseased eyes showed capillary acellularity. While it was inferred that this acellularity was caused by ischemia, no proof could be given. The present experiment was designed to study the sequential changes following temporary and unrelieved ischemia of the eye. If the acellularity was found in such an experiment, then a more secure interpretation of changes in diseased eyes would be justified. Procedure Cats were used because the retinal vascular pattern closely resembles that of the human retina, and the fundus could be continuously visualized with the ophthalmoscope throughout the course of the experiment. Three methods of inducing retinal ischemia were employed: elevation of the intraocular pressure above the arterial pressure of the eyes;

Mydriatic-cycloplegic treatment in malignant glaucoma.

Abstract: The term malignant glaucoma refers to a condition in which, after operation for angleclosure glaucoma, the anterior chamber becomes extremely shallow or flat, and the tension abnormally high. This condition was first described by von Graefe almost a hundred years ago.1The mechanism of malignant glaucoma has not yet been satisfactorily explained. Malignant glaucoma apparently occurs only in association with angle-closure glaucoma, either acute or subacute, typically in eyes having very shallow anterior chambers before operation.2Although malignant glaucoma occurs in a very small percentage of patients having surgery for angle-closure glaucoma, if it develops in one eye, it almost invariably develops in the second eye if operation is performed on the second eye when the tension is elevated. Malignant glaucoma may occur even if by the use of acetazolamide and urea the tension is brought to normal but the angle remains closed. On the other hand, if

Concerning cyclodialysis and hypotony.

Abstract: Since 1905, when Heine described hisneue glaucomoperation,14cyclodialysis, this unique procedure has excited continuing interest. After a discussion concerning cyclodialysis and 1 of its complications, hypotony, we shall report on a case of long-standing postoperative hypotony (6 years) and the noteworthy result of therapy. The mode of action of cyclodialysis has been diligently sought. It was Heine's contention that his operation created a pathway through which aqueous could reach the suprachoroidal space, where it would be absorbed. Elschnig10and then Barkan3histologically demonstrated the presence of this surgically created pathway or cleft in the successfully cyclodialyzed eye. Some investigators16,19believe that cyclodialysis promotes the escape of aqueous through the usual exit channels either by facilitating access to, or egress from, the canal of Schlemm. By photographing the aqueous veins before and after transcorneal cyclodialysis, an admittedly crude technique, Saeteren and Thomassen20concluded that aqueous

Refraction and Its Components, During the Growth of the Eye from the Age of Three.

Abstract: Using a technique called photographic ophthalmophakometry, the authors have measured the axial length of the eye in 1,530 subjects, ranging from 3 to 22 years of age, and have sought to correlate this with their refractive error. These investigators found that the axis increased in length by about 1.0 mm. between the third and thirteenth year and that this was usually compensated by flattening of both lens and cornea. However, there was much variation in the relative change in these two factors, and therefore, the refractive error was not predictable. As the preface states, this monograph supplements an earlier presentation by the same authors. In addition, for the mathematically minded, there is a chapter called "The Computation of Optical Dimensions" by A. G. Bennett.

Transient increase in outflow facility after superior cervical ganglionectomy in rabbits.

Abstract: The ocular hypotony observed by Linner and Prijot 1 to occur 24 hours after excision of the superior cervical ganglion in rabbits was shown by Langham and Taylor 2 and by Sears and Barany 3 to be due to a marked increase in facility of outflow. The phenomenon (henceforth called the ganglionectomy effect) has been tentatively explained by Sears and Barany as being partly due to the release of a facility-increasing α-adrenergic substance from degenerating nerve endings in the eye and partly to a decrease in a facility-decreasing β-adrenergic substance. The present paper reports a number of further experiments regarding this question. Methods Technique. —With unimportant exceptions, the technique used was that employed by Sears and Barany. 3 Briefly, albino rabbits, mainly males, weighing between 2 and 2.5 kg., underwent superior cervical ganglionectomy under a short-acting barbiturate. For measurement of facility and pressure (in the standard experiment 24 hours later)

Fate of Cells in the Corneal Graft

Abstract: The aim of the corneal transplant in man is to maintain corneal transparency. Even under the best conditions a proportion of the grafts that initially "take" suffer from the clinical problem of "graft sickness" with late clouding. These grafts are the homoplastic type, and evidence is accumulating which indicates that the homograft rejection phenomenon in the cornea is an immune response. 1,2 Thus, the clouding in an otherwise successful graft would result from a reaction of the host to the antigen of the donor tissue. An observation made by Merwin and Hill, 3 in working with subcutaneous homografts in mice, was that only those grafts which did not vascularize survive. This led to further studies and observations that homografts in cell-impervious millipore membranes survived in normal and in tissue-immunized mice. 4,5 From this and other experiments, it was concluded that in this example the antibodies cytotoxic to the homografts were

Corneal wound healing. I. The movement of polymorphonuclear leukocytes into corneal wounds.

Abstract: In the current American ophthalmic literature it has been assumed that polymorphonuclear leukocytes arrive at corneal wounds by migration through corneal stromal tissue from perilimbal vessels.1-4The idea, first expressed by Julius Cohnheim in 1867,5that inflammatory cells can also reach the edges of corneal wounds by passage from "conjunctival secretions" directly into the wound defect has largely escaped notice. The experimental observations in this report emphasize the importance of the latter route of arrival. They are in accord with the recent publications of Heydenreich6,7in Germany and confirm Cohnheim's original observations. Materials and Methods Albino rabbits weighing 2-3 kg. were anesthetized with intravenous injection of sodium pentobarbital. Clean, linear incisions of uniform depth were made in the cornea with razor edge either centrally or adjacent to the limbus. The animals were killed at intervals varying from 0 minutes to 2 weeks from the time of wounding.

Surgery of the filtering bleb.

Abstract: Documentation for techniques of surgical manipulation of a filtering bleb is meager in ophthalmological literature. Of particular interest in this matter is: (1) the management of loss of the filtering bleb after external filtering surgery for glaucoma, (2) management of external fistulization of a filtering bleb, (3) treatment of extension of a filtering bleb into the cornea with and without abnormal hypotony, and (4) the management of postoperative fistulization of the corneoscleral section in cataract surgery which results in the formation of a filtering bleb. It is the intent of this communication to present methods of treating these fortunately infrequent complications. Loss of the Filtering Bleb At the first dressing in the uncomplicated external filtering operation for glaucoma, one notes the presence of a bleb, a wellformed anterior chamber, and the absence of hyphema and choroidal detachment. Absence of or marked reduction in the size of the bleb may be

Electrophysiological Abnormalities in Pigmentary Degenerations of the Retina: Assessment of Value and Basis

Abstract: In primary pigmentary retinal degeneration (retinitis pigmentosa) the electroretinogram (ERG) has been reported to be extinguished (Karpe, 1945; Bjork and Karpe, 1951; Armington, 1954; Francois, 1952; Dodt and Wadensten, 1954). The ERG as used by Karpe and his followers is purely a measure of rod function, and in these first investigations the highly specific depression of the ERG (especially of the b-wave) was thought to confirm the theory that the disease was a primary degeneration of the rods. However, some discrepancies soon became apparent. Dodt and Wadensten (1954) and Riggs (1954) commented that in patients with well-preserved vision no electrical response could be recorded at all, even though the light intensities and conditions of the test were such that the photopic system of the retina was active. Riggs suggested that functional "perforations" occurred in the retinal periphery, which acted as electrical shunts and prevented the remote corneal electrode picking up

Drug Effects on Ciliary Muscle and Choroid Preparations in Vitro

Abstract: The muscular effects of pharmacological substances on isolated iris preparations have been reported by Wessely,1Poos,2and many others. However, similar experiments with isolated ciliary muscle preparations have failed. Poos encountered technical difficulties and did not pursue the matter further. Meesmann3compared the relatively easy task of obtaining preparations from the isolated iris with the "almost hopeless" endeavor to obtain similar preparations from the ciliary muscle. In a previous report, we briefly mentioned an in vitro method of studying the effects of drugs on the ciliary muscle of the cat, using segments of the ciliary body4(henceforth referred to as ciliary muscle preparations or ciliary muscle strips). The present investigation attempts to compare drug effects on similar preparations of ciliary muscle and choroid, obtained from several species. The emphasis was placed on the musculature of the cat eye. Monkey and rabbit eyes were included to screen

Mannitol Infusion to Reduce Intraocular Pressure

Abstract: In 1904, Cantonnet recommended lessubstances osmotiques(sodium chloride, lactose) in the treatment of glaucoma.1Since then a number of osmotic agents have been used, with more or less success, to lower both cerebrospinal fluid pressure and intraocular pressure.2-4Recently, intravenous hypertonic urea has been effectively used.5,6 Mannitol, a 6-carbon hexahydric alcohol, has been employed fairly extensively as an osmotic diuretic.7,8Recent experimental and clinical studies have demonstrated that hypertonic mannitol solutions are effective in lowering cerebrospinal fluid pressure and decreasing brain mass.9,12,20Mannitol is stable in solution, inert, and nontoxic, and its distribution is limited to the extracellular fluid compartment.8-10These facts indicated that hypertonic mannitol might be an excellent agent for the reduction of intraocular pressure. Methods and Materials Ten consecutive patients who received mannitol infusions are included in this study. The group is comprised of 2 patients from the neurosurgical service

IDU and hydrocortisone in experimental herpes simplex keratitis.

Abstract: The indiscriminate clinical use of corticosteroids "when the eye is red" has contributed greatly to the severity and variety of herpes simplex keratitis. 1,2 Similarly, the deleterious effects of corticosteroids on experimental herpes simplex keratitis have been well documented. 3,4 Since, when used indiscriminately, corticosteroids are dangerous, and since the antiviral agents described to date are not effective in treating iritis or disease accompanied by folds in Descemet's membrane, 5 it would be desirable if topical corticosteroids could be used with safety. The preparation, 5-iodo-2'-deoxyuridine (IDU), is a specific antiviral agent that stops viral replication. 6,7 The experiments described below document the effects of the combination of IDU with corticosteroids. Methods and Materials Albino rabbits were infected with strains of herpes simplex virus as previously described. 6 Drops of IDU were administered as a 0.1% solution and hydrocortisone as a 0.5% solution. In some experiments, when the two were given

Extravascular Lesions of Diabetic Retinopathy

Abstract: A previous report from this laboratory concerned the histologic abnormalities in the vessels of diabetic retinopathy. 1 The present report is concerned with the extravascular changes. These extravascular lesions of diabetic retinopathy consist of hemorrhages and a miscellany of hyalinelipid material that both clinicians and pathologists have called exudate. The implication has been that the vessels have become leaky as a result of arteriolar obstruction or pathologic changes in the vessel walls and that the extravascular material is serum or material derived from serum. It was the purpose of the present study to document the histopathologic changes on the basis of material at our disposal, to reassess the evidence of an exudative basis for the accumulation of abnormal material in the retina, and to correlate the occurrence of these deposits with the vascular changes. The subject of hemorrhages has been omitted from this discussion since it has been abundantly described

Cataract Formation After Triparanol Therapy

Abstract: Triparanol (MER/29) is a compound which inhibits the synthesis of cholesterol from its immediate precursor, desmosterol. It is being used extensively to reduce the concentration of cholesterol in the blood and other body tissues. This desire to reduce blood cholesterol levels is primarily the interest of internists and those in the general practice of medicine. Ophthalmologists have been hopeful that such a drug would help in the treatment or retardation of some of the ocular conditions associated with atherosclerosis, arteriosclerosis, and arteriolosclerosis. How extensively ophthalmologists are using the drug is not known to the authors. The cutaneous side-effects of triparanol were reported by Achor, Winkelmann, and Perry 1 in April, 1961. Two cases of moderately severe cutaneous reaction were reported, and the milder reactions of 5 other patients were discussed. The side-effects were loss of hair, change in color of hair, and ichthyosis. Both patients with moderately severe reactions also

The Conjunctival Sign of Sickle-Cell Disease: Further Observations

Abstract: The diagnostic value of a specific conjunctival vascular pattern in sickle-cell disease has been reported previously.1It has been pointed out that only those cases with clinically significant sickle-cell disease manifest a peculiar type of intravascular sludging which has not been found in normal persons or in other disease entities. In the 2-year interval since that paper was submitted for publication, additional experience has been gained. It is the purpose here to supplement the former report with findings from a larger series of cases. The reliability of this conjunctival sign can now be more accurately expressed. Observations of sludged blood in various diseases have been made by Knisely and others.2Attention has recently been drawn to an unpublished thesis by de Quevedo (1952)8which reports conjunctival sludging in 5 patients with sickle-cell anemia. It was then Goodman, von Sallmann, and Holland (1957)4who noted and illustrated

Studies in the Susceptibility of the Eye to Raised Intraocular Pressure

Abstract: One of the fundamental and practical problems in the concept of chronic simple glaucoma is the relationship of the intraocular pressure to the changes and progression produced in the visual field. The present study is concerned with this problem. Chandler's1retrospective study of patients having glaucoma for a long time suggests that eyes with advanced cupping and field changes withstand increased and even "normal" intraocular pressure poorly, whereas those in which cupping is limited to 1 pole of the disk appear to withstand intraocular pressure somewhat better (normal disks may show no field loss for long periods of time even when the intraocular pressure is at a level which would produce progression in eyes with cupping). Goldmann's analysis2of Leydhecker's figures suggests that in the eyes of patients with chronic glaucoma, field changes may take place from 15 to 18 years after early glaucoma is detected. It would