Showing papers in "Archives of Ophthalmology in 1973"

Drusen and disciform macular detachment and degeneration.

Abstract: Follow-up studies on 200 patients who had macular drusen were done for an average of four years. Loss of central vision was caused by disciform detachment of the pigment epithelium and retina, or less often by geographic atrophy of the pigment epithelium and retina. The average age of onset of loss of central vision in the first eye was 66 years and in the second eye 70 years. No clinical fluorescein angiographic or electrophysiologic criteria were found to differentiate patients with familial from those with so-called senile drusen. probably all patients with macular drusen have the same autosomal dominant heredodegenerative disease, which rarely causes significant loss of central vision prior to the sixth and seventh decades of life. Fifty-three patients were treated with photocoagulation, the value of which is still uncertain.

Factors affecting tear film breakup in normal eyes.

Abstract: Tear film breakup time (BUT) was measured in 50 normal subjects. The reproducibility of this value, its relationship to age and sex, the effects of lid holding, and the instillation of a local anesthetic were studied. Results have defined a range of normal values and indicate that holding the lids and the instillation of a local anesthetic significantly reduce BUT. No relationship between BUT and age, sex, or corneal sensation was noted. Breakup time is a reproducible phenomenon in an individual eye.

Studies of factors involved in the production of low tension glaucoma.

Abstract: Forty-five patients with low tension glaucoma were compared with 45 ocular hypertensive patients matched for age and sex. The low tension glaucoma group had a significantly higher rate of hemodynamic crises, low systemic blood pressure, and low ophthalmic blood pressure. Progression occurred in fewer than half of the patients with low tension glaucoma.

Cornea and sclera.

Abstract: cesses affecting the cornea. Diagnosis and treatment of corneal disease de¬ mand an understanding of the events occurring in the reparative processes in the cornea. Widespread clinical interest has engendered intense re¬ search activity, and the resultant lit¬ erature is voluminous. The appli¬ cation of the techniques of electron microscopy, in particular, has given considerable aid to our understanding of corneal healing. This review will concentrate on re¬ search in the past two decades and is limited, in the main, to English lan¬ guage sources. The interest in corneal wound heal¬ ing extends back well into the 19th century. Early studies described basic events in corneal wound healing in excellent detail. A subsequent lull in research in this subject is evident un¬ til the 1940s, when a series of fine papers extending our knowledge ap¬ peared; many of these studies were the result of World War II research directed to the effects of noxious agents on the cornea. Periodic studies appeared in the 1950s describing ex¬ perimental histological and histochemical findings; application of the techniques of electron microscopy in the 1960s has added a new dimension

Lesions simulating malignant melanoma of the posterior uvea.

Abstract: Ferry reported that in a large series of eyes enucleated because of a visible lesion suspected preoperatively of being a melanoma, 19% were found histopathologically to contain a simulating lesion. The present study was undertaken to update Ferry's data. After the completion of Ferry's study, 5,889 intact eyes were received from October 1962 through December 1969. These were reviewed using Ferry's criteria for selection of cases. Simulating lesions were found responsible for 20% of enucleations for malignant melanoma. Many of the same diagnostic problems continue to plague the ophthalmologist, who often fails to utilize certain diagnostic techniques that are presently available to aid in differential diagnosis.

Ocular fundus in acute Leber optic neuropathy.

Abstract: In the acute phase of Leber optic neuropathy, there are three characteristic fundus changes: (1) circumpapillary telangiectatic microangiopathy, (2) swelling of the nerve fiber layer around the disc ("pseudoedema"), and (3) absence of staining on fluorescein angiography. These findings are illustrated by eight cases and in our experience are pathognomonic for this disease.

Aphakic and Phakic Retinal Detachment: I. Preoperative Findings

Abstract: A population of rhegmatogenous, nontraumatic, primary retinal detachments of 4,922 patients (5,500 eyes) was used for this investigation. This selected population was divided into two groups: aphakic retinal detachment, composed of 1,240 patients (1,374 eyes) and phakic retinal detachment which included 3,682 patients (4,126 eyes). The preoperative features are delineated and the two groups are compared as to age, sex, right eye versus left eye, bilaterality, type and quadrantal distribution of retinal breaks, type and extent of retinal detachment, fixed retinal folds and massive preretinal retraction, demarcation lines, acquired retinoschisis, myopia, peripheral degeneration, choroidal detachment, glaucoma, vitreous or subhyaloid hemorrhage, uveitis, and macular degeneration. The time lapse between cataract extraction and retinal detachment is examined. The origin of the differences between the two groups is discussed.

Shall we count numbers of eyes or numbers of subjects

Abstract: The number of patients or animals studied is an important criterion for critically evaluating biomedical research. With other factors equal, results of a study of 40 subjects are more "solid" than those of a study of only 20. That is, a larger study provides more information than a smaller study. Or, in other words, estimates of parameters such as the mean, standard deviation, or the proportion with a given characteristic generally have greater precision when derived from a larger sample. The number of subjects is usually denoted by the letter n. In ophthalmic investigations is n the number of eyes or the number of subjects? Published vision research papers often give either the number of eyes studied and not the number of subjects, or the number of subjects and not the number of eyes. The purpose of this communication is to explain the need not only for giving both numbers,

Blood-borne Candida Endophthalmitis: A Clinical and Pathologic Study of 21 Cases

Abstract: Candidemia may be followed by hematogenousCandidaendophthalmitis. Six clinical cases and 15 postmortem cases in which focal retinal or chorioretinal lesions developed following candidemia are presented. Common clinical features include a history of gastrointestinal or biliary tract disease, recent surgery, prolonged use of intravenous catheters, recent bacterial sepsis, and intensive treatment with systemically administered antibiotics. Early treatment with antifungal drugs appears efficacious. It is proposed that a search for intraocular lesions be performed in every patient with candidemia and that discovery of such a lesion be a strong indication for treatment with amphotericin B.

Neodymium Laser Cyclocoagulation

Abstract: Nineteen neodymium laser cyclocoagulations were performed on 18 glaucomatous eyes. Thirteen eyes can be considered successfully treated if a criterion of an intraocular pressure of 30 mm Hg or less is used. All 18 eyes are now pain-free. Neodymium cyclocoagulation seems as effective as ruby cyclocoagulation in blue and brown eyes, and may possibly be more effective in dark-brown eyes. The intraocular pressure lowering effect of neodymium cyclocoagulation may be slightly greater than that of ruby cyclocoagulation. To date, no serious complications of this procedure have been found.

Cupping and Pallor of the Optic Disc

Abstract: The optic disc can be described essentially by cupping and pallor. These are distinct signs; each can progress independently. Cupping has been considered by many as equivalent to the amount of paleness or color contrast estimated by subjective disc examination with a monocular direct ophthalmoscope. In normal eyes, maximum color contrast coincides generally with the degree of cupping. In glaucomatous eyes, increase in cupping occurs. Maximal color contrast no longer coincides with the degree of cupping. This is best seen by examination of the disc with a contact lens and slit lamp. In addition to change in surface contour of the disc, deviation of small vessels defines the extent of cupping. Pallor of the disc is defined by maximum color contrast as well as lack of small vessels.

Immunoglobulins in the Human Eye: Location, Type, and Amount

Abstract: Immunoglobulins were found in all structures of the eye except the lens. The highest concentrations (up to one-half the amount in serum) were found in the cornea, choroid, and conjunctiva. Moderate concentrations were found in the muscle and sclera. Low concentrations (less than 5% of the serum level) were found in the ciliary body, iris, aqueous, and retina. All five immunoglobulins and albumin were present in the immunoglobulin-containing tissues except for the cornea, which did not routinely contain IgM.

Isolated homonymous hemianopia. A review of 104 cases.

Abstract: In a retrospective review of 104 cases of homonymous hemianopia, cerebral infarction was the diagnosis in 89% of the patients. This diagnosis was twice as common as reported in a previous series, which included other neurologic findings along with homonymous field defects. The majority of patients were white and between the ages of 50 and 70 years, often having a history of vascular disease. Eighty-eight percent of the patients showed a static or improved clinical course, while only 12% showed visual field or central nervous system deterioration. A routine work-up, excluding contrast studies, was sufficient to select 11 out of the 12 cases that were not due to infarction. Data that were suggestive of a noninfarctive cause were patients aged under 40 years, incongruous field defects, abnormal skull x-ray films, abnormal opticokinetic nystagmus, and elevated levels of spinal fluid protein.

Ocular aftermath of Stevens-Johnson syndrome.

Abstract: Of 33 cases of Stevens-Johnson syndrome treated over a 20-year period, five developed keratitis sicca with corneal pannus and one developed corneal pannus alone. The severity of the ophthalmic complications was related to the severity of the disease in its acute phase and was not related to the local treatment used on the eyes.

Division of labor in human extraocular muscle.

Abstract: Electromyographic (EMG) recordings from human extraocular and levator muscles were made during fixation, following, vergence, and saccadic movements, and during blinks and lateral head tilting. Motor units that altered activity with one type of movement also did so with eye movements of other types or during fixation at another gaze position. Recordings made from the orbital layers of the muscle (away from the globe) showed activity earlier in recruitment of the muscle, while motor units recorded from layers near the globe became active later in the recruitment pattern. These findings support the notion that various histologic muscle fiber types are functionally differentiated on the basis of the amount of work that they do, rather than on the basis of the type of eye movement to which they contribute.

Postoperative Endophthalmitis Following Cataract Surgery: Effects of Subconjunctival Antibiotics and Other Factors

Abstract: Experience with over 77,000 consecutive cataract extractions performed mainly by two surgeons over a 16-year period in a village hospital in Pakistan is reviewed. The incidence of immediate postoperative endophthalmitis is studied in some detail in 54,000 of these cases. In about 10,000 cases, prophylactic subconjunctival injections of antibiotics, such as framycetin, chloramphenicol, gentamicin sulfate, and penicillin sodium, were given. The incidence of immediate postoperative endophthalmitis was not notably reduced by these medications. Techniques and complications that added to the intraocular instrumentation were accompanied by an increased rate of endophthalmitis.

Vascular Changes in the Anterior Uvea of the Rabbit Produced by Prostaglandins

Abstract: The normal vascular pattern of the albino rabbit iris was studied using fluorescein iris angiography. Having established the normal appearances, the technique was used to demonstrate changes in caliber and permeability of the anterior uveal blood vessels after the topical application of prostaglandins E1, E2, and F2α. Changes in intraocular pressure were also recorded. The prostaglandin antagonist, polyphloretin phosphate, administered by subconjunctival injection 30 minutes before the prostaglandin was given was found to antagonize the vasodilation and the increase in permeability normally produced by prostaglandins E1and E2, and the rise in intraocular pressure produced by all three prostaglandins.

Complications in Use of Soft Contact Lenses in Corneal Disease

Abstract: Two hundred seventy-eight patients with corneal disease were fitted with soft hydrophilic contact lens for therapeutic purposes, such as comfort, protection, or healing. In about half the number of cases, the lens was felt to be beneficial, primarily in those cases with edema, dry eyes, ulcers, or trichiasis. Serious complications were relatively few, mainly consisting of inflammation with stromal infiltrates. Eleven patients develped stromal infiltrates, at least four of which were definite infections, causing permanent damage. It was concluded, however, that in many cases of corneal disease the advantages of applying a soft contact lens far outweighs its risks. The importance of frequent observation and prophylactic antibiotics is stressed in cases with epithelial defect and in dry eyes.

Wagner's hereditary vitreoretinal degeneration and retinal detachment.

Abstract: Forty-one patients with Wagner's vitreoretinal degeneration were studied. The polymorphous ocular signs of this disease included vitreous changes, myopia, cataract, retinal pigmentation, retinal breaks, patchy areas of thinned pigment epithelium or of chorioretinal atrophy, narrowing or sheathing of the retinal vessels, extensive white with pressure, lattice degeneration, marked meridional folds, optic atrophy and subnormal or normal electroretinograms. The main cause of blindness was retinal detachment of relatively poor surgical prognosis due to a variety of causes. Various types of retinal breaks were found in close association with vitreous and retinal disease. Early diagnosis of this disease is important. Members of the patient's family should be checked for retinal breaks. Prophylactic treatment for retinal detachment should be considered before cataract develops.

Herpes Zoster Dendritic Keratitis

Abstract: Three cases of herpes zoster ophthalmicus characterized by classical dendritic keratitis are reported. Careful scraping and culture of just the epithelial cells involved in the corneal lesions revealed that the etiological agent was herpes zoster virus and not herpes simplex as had commonly been believed. Two patients were treated with steroids and idoxuridine and one with steroids alone. All three recovered quickly without adverse effects.

Incidence of Retinal Detachment Following Cataract Extraction

Abstract: The incidence of retinal detachment following cataract extraction has been reported in the literature as being between 0.4% to 3.5%. This communication reports the incidence of retinal detachment in 5,541 eyes, all of which had zonulolysis by alpha chymotrypsin. In this series, 122 eyes (2.2%) developed retinal detachment following cataract extraction, a rate showing no increase over those series reported without the use of alpha chymotrypsin.

Intracranial pressure and ocular hemodynamics.

Abstract: In owl monkeys, controlled elevation of subarachnoid pressure was produced either intracranially, in the optic nerve sheath, or in both. When intracranial pressure was elevated, orbital venous pressure became elevated, but it did not keep pace with intracranial pressure elevation, because orbital veins have anastomoses to facial veins and need not depend entirely on cavernous sinus for drainage. The central retinal vein pressure is additionally affected by pressure in optic nerve sheaths, and keeps pace with vaginal sheath pressure elevation, because anastomotic connections at the optic disc between central retinal vein and vortex vein were not sufficient to relieve fully pressure in the central retinal vein. Intraocular blood flow was slowed in regions drained by central retinal vein (retina and disc). The choroidal flow, which drains via vortex veins into orbital veins, was affected less.

Dendritic Lesions in Herpes Zoster Ophthalmicus

Abstract: Thirteen dendritic corneal lesions have been observed in nine patients suffering from herpes zoster. These lesions appear morphologically distinct from herpes simplex dendrites. Cultures from all lesions were negative for herpes simplex virus, and serum antibodies to herpes simplex were not present in five patients tested. The role of steroids in the treatment of these lesions is discussed with respect to the fact that dendritic lesions do not invariably indicate the presence of herpes simplex virus infection of the cornea in patients with zoster keratitis.

Prognostic Importance of Choroidal Invasion in Retinoblastoma

Abstract: The incidence of choroidal invasion in retinoblastoma, and its effects on prognosis were investigated by studying serial sections of enucleated eyes. Each patient was observed for a minimum of five years. It was found that choroidal invasion is both more common and less dangerous than previously believed.

Epithelium and Stroma in Alkali-Burned Corneas

Abstract: The epithelium and stroma of experimentally alkali-burned corneas were studied by electron microscopy In the ulcerating corneas, the number of basal epithelial cells increased at the edge of the regenerating epithelium These corneas had no basement membrane, and many cytoplasmic processes protruded into the stroma Some of the cytoplasmic processes contained vesicles, and many similar vesicles were found in the superficial stroma around these processes In the ulcerated stroma, collagen fibers of the most superficial lamellae changed into fine fibrils and were continuous with an exudative mass The nonulcerated cornea did not show these abnormalities These observations suggest that basal cells in the regenerating epithelium secrete some substances into the stroma, which may be responsible for, or related to, ulcer formation in the alkali-burned corneas

Staphylococcus epidermidis (albus) endophthalmitis. Report of two cases after cataract extraction.

Abstract: Two cases of bacterial endophthalmitis following cataract extraction are described. The causative agent was Staphylococcus epidermidis (albus) , which was confirmed by smears and identified in cultures of the aqueous aspirates.

Retinal Tributary Vein Occlusion: History and Management by Photocoagulation

Abstract: One hundred thirteen cases of tributary retinal vein occlusions were evaluated with none progressing to central vein occlusions. Sixteen patients had open angle glaucoma, or elevated intraocular pressures. Only one patient with macular edema regained a visual acuity of 20/20. More pronounced visual depressions were found with more proximal occlusion sites. Fourteen patients with macular edema and 30 with vitreous hemorrhages received photocoagulation with improved or stabilized visual acuities being the rule. Photocoagulation also appeared to prevent the development and recurrences of vitreous hemorrhages.

Octafluorocyclobutane and other gases for vitreous replacement.

Abstract: In this study, an attempt was made to find a nontoxic gas for vitreous replacement that would be more slowly reabsorbed than air. One-tenth milliliter of air, helium, neon, argon, krypton, xenon, sulfur hexafluoride, and octafluorocyclobutane (Freon-C318) were injected into rabbit eyes. Octafluorocyclobutane, an insoluble gas of high molecular weight, remained the longest, an average of 7.47 days compared to 1.72 days for air. Ophthalmoscopic and histologic examination of two of the octafluorocyclobutane-injected eyes showed no evidence of toxic reaction. Inexpensive and readily available, octafluorocyclobutane merits further experimental study, particularly for use in retinal detachment surgery.

Hyphema due to wound vascularization after cataract extraction.

Abstract: Hyphema that develops months or years after uncomplicated cataract extraction is a clinical entity resulting from focal vascularization of the limbal wound. Vessels from the episclera may penetrate the wound, terminating in capillaries that are the source of bleeding. Sudden blurring of vision sometimes following minimal trauma is the primary symptom. The bleeding, initially, is minimal and occurs only periodically; therefore, it is easily overlooked. Gonioscopic examinations may reveal the bleeding site in the inner lips of the incision. Accumulation of blood in the lower angle leads to angle-closure glaucoma. The most effective therapy to control the bleeding remains to be established. Surgical excision of the neovascularized area and argon-laser coagulation seem to be promising therapies.

Endothelial Cells in Alkali-Burned Corneas: Ultrastructural Alterations

Abstract: Two types of alkali-burned corneas were prepared and studied by electron microscopy at various intervals. In small central burns, the endothelial cells degenerated and were replaced from the periphery. After a few days, fibroblast-like cells covered the Descemet membrane, which was not destroyed. These gradually reached the center of the burn and formed a cellular retrocorneal membrane with many collagenous fibers between them. A new endothelium and Descemet membrane formed on the posterior surface of the retrocorneal membrane. When the entire cornea was burned, all endothelial cells were destroyed. A few days later, fibroblasts, present in the angle tissue, produced a connective tissue retrocorneal membrane. This did not form a new endothelium or Descemet membrane. It is concluded that there are two sources of retrocorneal membranes, which result in dissimilar end results.