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Showing papers in "British Journal of Ophthalmology in 1962"


Journal ArticleDOI

40,330 citations


Journal ArticleDOI
TL;DR: The abnormalities detected by this test are different in nature from those which may be demonstrated by any other diagnostic procedure, and the test is of value not only because it is an addition to the techniques available to the clinical worker but also because it sheds new light upon the nature of the disease processes.
Abstract: THE diagnosis of disturbances of retinal function is often accurate and simple. The affected structure can be inspected by the ophthalmologist, and the patient can give detailed accounts of the changes in his sensation. However, there are very few methods available for the objective investigation of retinal function. The only test which is not directly related to perception is the electroretinogram, ERG, which, in spite of its value in a few conditions, has not so far proved of very general use. The reason for this seems to be that the ERG is basically an index of the function of the retinal neurones, a less sensitive one than the patient's sensation. This paper introduces another objective test of retinal function. It is based, as is the ERG, upon the measurement of potential changes. However, it differs fundamentally from the ERG in that, while the latter records rapid alteration in retinal nervous activity, this new test is concerned with the slower changes in potential which occur as a result of alterations in the metabolism of the pigment epithelium. The abnormalities detected by this test are therefore different in nature from those which may be demonstrated by any other diagnostic procedure, and the test is of value not only because it is an addition to the techniques available to the clinical worker but also because it sheds new light upon the nature of the disease processes. The technique of the test is to measure the corneo-fundal potential by placing electrodes on the skin medial and lateral to the globe. This method is well known, and is at present widely employed to register eye movements. It has been proved of value in aviation medicine, in studies of reading, in the analysis of amblyopia, and in the differential diagnosis of nystagmus, since it is accurate, rapid, and involves no discomfort to the patient. In previous work the presence of the eye movement potential is thus merely employed as a convenient way of recording mechanical displacement of the eye. By contrast, the present test depends upon an analysis of the nature and variation of the potential itself. The technique of measuring eye movements by monitoring potential changes is usually called electro-oculography, and accordingly we have termed this new functional test the electro-oculogram, abbreviated to EOG.

332 citations


Journal ArticleDOI
TL;DR: The pioneer worker in the study of the ophthalmic artery, particularly its branches and their variations, was Meyer (1887), whose observations have been accepted more or less as classical for the last threequarters of a century.
Abstract: THE pioneer worker in the study of the ophthalmic artery, particularly its branches and their variations, was Meyer (1887), whose observations on twenty cases have been accepted more or less as classical for the last threequarters of a century. No detailed investigation has since been carried out in this field and the descriptions of the branches of this artery which appear in the various text-books of anatomy and ophthalmology merely reflect his conclusions. Moreover, little information regarding the branches and their anomalies is available in the literature. It was therefore thought desirable to study this problem afresh in detail.

283 citations


Journal ArticleDOI
TL;DR: It was therefore considered desirable to study the origin, course, branches, and anastomoses of the ophthalmic artery in detail.
Abstract: EXTENSIVE accounts of the blood vessels of the orbit are to be found in various text-books of ophthalmology and anatomy, but there are few systematic descriptions of the anomalies. The various authors differ very little from one another in their descriptions, and deal almost exclusively with the socalled normal pattern of the ophthalmic artery. It was therefore considered desirable to study the origin, course, branches, and anastomoses of the ophthalmic artery in detail.

204 citations


Journal ArticleDOI
TL;DR: The purpose of this study is to apply techniques to the living and freshly enucleated eyes of individual subjects to determine whether vascular changes within the human eye significantly modify its pressure-volume relationship.
Abstract: IN a previous investigation a significant difference was found in the pressure response of the living and dead eyes of individual rabbits when a given volume of fluid was injected into the eye (Eisenlohr and Langham, 1962). An increase in the intra-ocular pressure of living animals was found to force blood from the eye and the amount lost per unit pressure increase was found to reach a maximum as the pressure approached the arterial blood pressure. The observations were made by recording manometrically the response of the intra-ocular pressure either to a sudden injection of a predetermined volume of fluid given in ascending and descending pressure steps or to a continuous infusion of saline at a rate greatly exceeding the outflow of aqueous humour. The latter method gave a continuous function of the pressure response of the eye and had the merit that observations over a wide range of pressures could be completed within 10 to 15 seconds. It is the purpose of this study to apply these techniques to the living and freshly enucleated eyes of individual subjects to determine whether vascular changes within the human eye significantly modify its pressure-volume relationship. Since this work was begun, Ytteborg (1960a,b) has investigated this problem in a somewhat different manner. The results and conclusions to be reported in this paper agree in some but not in all respects with those of Ytteborg, and the reasons for the differences are discussed.

145 citations


Journal ArticleDOI
TL;DR: Neoprene latex was injected in situ, either through the internal carotid artery or through the most proximal part of the ophthalmic artery, after opening the skull and removing the brain.
Abstract: Neoprene latex was injected in situ, either through the internal carotid artery or through the most proximal part of the ophthalmic artery, after opening the skull and removing the brain. The artery was first irrigated with water. After injection the part was covered with cotton wool soaked in 10 per cent. formalin for from 24 to 48 hours to coagulate the latex. The roof of the orbit was then opened and the ophthalmic artery was carefully studied within the orbit.

117 citations


Journal ArticleDOI
TL;DR: This paper presents an analysis of 200 " second eyes" of patients who developed an attack of acute angle-closure glaucoma in the "first or other eye" and shows that 23 had bilateral onset or at least had both eyes involved by the time they presented to hospital.
Abstract: DURING 1961, under Research Project No. 14 of tlie Ophthalmic Research Institute of Australia and Research Project No. 13 of The Royal Victoriani Eye and Ear Hospital, 240 cases of angle-closure glaucoma were documented. Cases were drawn from the 1950 to 1961 cross-indexed history files of the hospital, to which were added a few cases seen in private practice during that time. The hospital patients included public and intermediate (semi-private) classes. New cases presenting during 1961 were personally examined and old patients were requested to attend for a research interview and tests. Many could not be traced or were deceased, but usually their case records, although very incomplete, contained information that could be used in some of the analyses. Some patients attended the hospital during this time only because of the involvement of the second eye, and the first eye might have suffered an acute attack many years previously, so that in such cases the time period extends over more than 10 years. Cases of angle-closure glaucoma were selected according to the criteria defined by the participants of the C.I.O.M.S. Symposium on Glaucoma (Duke-Elder, 1955) and of the first Macy Congress on Glaucoma (Newell, 1956), and those previously proposed by Barkan (1938), Sugar (1941), and Chandler (1952) under the title of \"narrow-angle glaucoma\". Other types of acute glaucoma were excluded, but the decisions for some exclusions became very difficult. There is no doubt that the various forms of glaucoma do not always occur as distinct entities. This paper presents an analysis of 200 \" second eyes\" of patients who developed an attack of acute angle-closure glaucoma in the \"first or other eye\". Table I (overleaf) shows that 23 (just over 10 per cent.) had bilateral onset or at least had both eyes involved by the time they presented to hospital. In another series of 200 cases, Bain (1957) recorded seventeen cases with bilateral onset. Of the remaining 177 cases in the present series, 64 received prophylactic surgery and 113 were treated conservatively.

117 citations


Journal ArticleDOI
TL;DR: The relationship between infantile dacryocystitis and delayed development of the naso-lacrimal duct was first suggested by Peters (1891), RochonDuvigneaud (1899), Stephenson ( 1899), and Gunn (1900).
Abstract: DACRYOCYSTITIS in infants occurs as the result of an obstruction at the lower end of the naso-lacrimal duct which may be developmental or acquired in origin, and the treatment will depend upon the nature of this obstruction. It has been amply demonstrated that the last portion of the naso-lacrimal duct to become canalized is the point of coalescence between the nasal sprout of the mother cord of the developing lacrimal duct and the nasal mucous membrane. This stage may be delayed until term or later in up to 35 pcr cent. of cases (Schwarz, 1935), and a figure as high as 73 per cent. has been found by Cassady (1952). The relationship between infantile dacryocystitis and delayed development of the naso-lacrimal duct was first suggested by Peters (1891), RochonDuvigneaud (1899), Stephenson (1899), and Gunn (1900), and it is now generally believed that this condition is the direct result of the failure of the membrane at the lower end of the naso-lacrimal duct to rupture at birth (Kriimer, 1922; Crigler, 1923; Cassady, 1948a, b; Duke-Elder, 1952; Mann, 1957; and many others). As Cassady (1948b) stated,

108 citations



Journal ArticleDOI
TL;DR: With the development of the new digest method of Kuwabara and Cogan (1960), it has been possible to isolate the affected capillaries and with the icquisition of an electron microscope at this Institute a detailed study of the changes in the internal structure of the endothelial cell has become feasible.
Abstract: IN reviewing the mechanisms which might be involved in the phenomenon of oxygen vaso-obliteration in the immature retina, it was recently suggested that swelling of the retinal tissue around the vessels could be the primary factor concerned. The detailed evidence upon which this suggestion was based has already been reported (Ashton, 1957; Ashton, Graymore, and Pedler, 1957) and further supporting data have since been published (Graymore, 1958; Pedler, 1959a, b). It was pointed out, however, that a more direct action of oxygen on the vessel wall could not be excluded by the negative evidence then obtained, because the techniques available at that time were not entirely satisfactory. With the development of the new digest method of Kuwabara and Cogan (1960), it has been possible to isolate the affected capillaries, and with the icquisition of an electron microscope at this Institute a detailed study of the changes in the internal structure of the endothelial cell has become feasible. The findings obtained are presented and discussed in this paper.

68 citations


Journal ArticleDOI
TL;DR: If thorough screening of a small selected section of the population would be clinically valuable in the early diagnosis of glaucoma simplex is found, screening on such a scale would have to be limited to tonometry and optic disc inspection.
Abstract: THE purpose of the present study is to find out if thorough screening of a small selected section of the population would be clinically valuable in the early diagnosis of glaucoma simplex. Mass screening of people over 40 years of age would certainly reduce the incidence of blindness due to glaucoma, but screening on such a scale would, for practical reasons, have to be limited to tonometry and optic disc inspection. Relatives of patients with known glaucoma simplex were investigated. The study was carried out in two parts. In the first instance, siblings between the ages of 40 and 60 years were submitted to careful examination. This age range was chosen because glaucoma is rarely fully developed under 40 years of age. The results of these tests showed that, whilst many siblings had normal intra-ocular pressures and full fields, their coefficients of outflow were considerably reduced. The second part of the study was therefore extended to the investigation by tonography of the offspring of patients with simple glaucoma. The offspring were aged between 15 and 55 years at the time of examination.

Journal ArticleDOI
TL;DR: The use of Dawson's superimposition method together with the mathematical integration method enabled us to record the responses of the occipital lobe to light-stimulation in man and revealed the correspondence of the amplitude of the cl-wave with the level of activity of the scotopic mechanism.
Abstract: IN a previous paper (van Balen and Henkes, 1960) we indicated the possibility of recording the response of the occipital lobe to light-stimulation in man. The use of Dawson's superimposition method together with the mathematical integration method enabled us to record the responses in all normal subjects. The specific response of the visual cortex consists of four different components: a small surface-positive wave a, followed by a somewhat larger negative wave b, then by the main positive deflection c and a smaller negative deflection d (van Balen and Henkes, 1960, Fig. 5). The positive deflection c consists of two components: cl and c2. A study of the specific response to light stimulation of varying intensities and at different levels of dark adaptation revealed the correspondence of the amplitude of the cl-wave with the level of activity of the photopic mechanism, and of the amplitude of the c2wave with the level of activity of the scotopic mechanism. The photopic and scotopic mechanisms, however, are concepts of the physiology of the retina and coincide more or less with the anatomical concepts of cones and rods. In the ganglion cell layer of the retina a regrouping occurs. Foveal cones in monosynaptic units form the foveal system; peripheral cones and rods in polysynaptic units form the extra-foveal system. Anatomically the foveal and extra-foveal systems can be distinguished in all parts of the visual system. In the visual cortex (striate area), for instance, a foveal (\" macular\") and extrafoveal (\"extra-macular\") projection field can be distinguished. These data lead one to expect the separate representation of the foveal and extra-foveal systems in the occipital response.

Journal ArticleDOI
D. F. Cole1
TL;DR: It is possible to estimate the sodium and anion conductivities of the ciliary epithelium and the active transport potential of the sodium pump if measurements are made of the total electrical resistance of the membrane, the P.D. across it and the relationship to the activity of sodium ions in the solution on the stromal side.
Abstract: D. F. COLE Medical Research Council Ophthalmological Research Unit, Institute of Ophthalmology, University ofLondon THE present paper deals with some electrical properties of the isolated ciliary body of the ox and the rabbit when various concentrations of anions and cations are present in the solutions on the inner (aqueous or epithelial) and outer (stromal) sides. There is evidence (Cole, 1960a, b; 1961a, b) that the ciliary body, like many other regions where there is a secretory epithelium, transports sodium ion actively in a determined direction by means of a relatively specific carrier (cf. Hokin and Hokin, 1960) or sodium \"pump\" (Ussing, 1960) energized from metabolic processes occurring within the epithelial cells. Such a transfer of sodium ions to the aqueous side of the blood-aqueous barrier would tend to create an electrical potential and so influence the passage of other ions. It would favour the migration of anions, such as chloride, to the aqueous side and this would, in its turn, tend to reduce the potential difference (P.D.) arising from sodium transport. The implications of these interactions have been worked out in considerable detail for frog skin by Linderholm (1952, 1954) and this treatment has been applied to the present problem. As is shown below, it is possible to estimate the sodium and anion conductivities of the ciliary epithelium and the active transport potential of the sodium pump if measurements are made of the total electrical resistance of the membrane, the P.D. across it and the relationship of this P.D. to the activity of sodium ions in the solution on the stromal side. These measurements, together with values for the \"short-circuit current\" (Ussing and Zerahn, 1951) have been obtained using ox or rabbit ciliary bodies in vitro with various bathing media (cf. Table I) on the outer (stromal) side.

Journal ArticleDOI
TL;DR: The authors have shown that the protein concentration usually, but not always, increases with the duration of the detachment and the electrophoretic pattern of fluid with a high protein content resembles that obtained from human plasma, and the five components (albumin and globulin) are similar.
Abstract: THis paper presents the results of a study of the chemical composition of subretinal fluid from cases of retinal detachment, with particular reference to the protein and ascorbic acid content of the fluid. Many workers have studied the chemical composition of subretinal fluid obtained from patients undergoing surgery for retinal detachment. It is generally agreed that the subretinal fluid contains more protein than normal human vitreous: Magitot and Lenoir (1932) 0-135-6-0 per cent.; Arruga (1933) 0 09-9 per cent.; Magitot (1934) 0-135-15 per cent.; Franta (1937) 0 72-3 35 per cent.; Weve and Fischer (1940) 0 055-7 72 per cent.; Contino (1941) 0-37-3-85 per cent.; Santoni (1946) 0-6-2-64 per cent. These authors have shown that the protein concentration usually, but not always, increases with the duration of the detachment. This high protein content has been the major argument against the vitreal origin of the subretinal fluid. Recently, paper electrophoretic studies by Santoni (1954), Dorello (1955), Reichling (1955), Nakano (1958) and Smith and Douty (1960) have demonstrated the variable content of the albumin and globulin fractions in the subretinal fluid. The electrophoretic pattern of fluid with a high protein content resembles that obtained from human plasma, and the five components (albumin and

Journal ArticleDOI
TL;DR: An X-linked degenerative retino-choroidal disease, hereditary retinoschisis, has been identified in the last 10 years and a family has been found, which shows a progressive disease from childhood, with reduced vision, slight hemeralopia, restricted visual fields, and a similar condition of the fundus.
Abstract: AN X-linked degenerative retino-choroidal disease, hereditary retinoschisis, has been identified in the last 10 years. In milder cases the disease takes the form of radial macular degeneration, but in severe cases a grey sheet-like veil is attached to the detachment in the retinal vasculature, especially in the lower temporal quadrant. In differential diagnosis, according to Ricci (1960), a dominant hereditary hyaloid-retinal degeneration (Wagner, 1938) and a recessive hereditary hyaloid-tapeto-retinal degeneration (Favre, 1958) should be borne in mind. Genealogical tables covering several generations have been described by Sorsby, Klein, Gann, and Siggins (1951), Levy (1952), Jager (1953), Balian and Falls (1960), and Gieser and Falls (1961). The last described a 13-yearold girl-possibly a latent carrier-with cystic (perhaps traumatic) macular degeneration. Rieger (1941) described a girl in whom the pathological picture was reminiscent of retinoschisis, but gave no genealogical or genetic details. In South-West Finland, a family has been found (Fig. 1, opposite), which shows a progressive disease from childhood, with reduced vision, slight hemeralopia, restricted visual fields, and a similar condition of the fundus.

Journal ArticleDOI
TL;DR: The purpose of the present study is to extend the analysis of the co-operative action of the extraocular muscles to any conceivable ocular rotation in a 600 x 600 field of fixation, to determine the component directions of pull, and to present the results in six easily readable charts.
Abstract: IN every excursion of the eyes, two times six muscles act with extraordinary speed, precision, and harmony in rotating them into a new position of fixation. Some of these muscles contract while the others extend, and this is achieved in countless variations and apportionments. In a previous study (Boeder, 1961), the co-operative action of the extraocular muscles was analysed for several types of ocular rotations. With the measurements given by Volkmann (1869) of the locations of the effective origins and insertions of the six extra-ocular muscles as a basis, the simultaneous changes in length which take place in these muscles in these rotations were calculated on the assumption that there is no muscle slack in any equilibrium position of the eye, and that for any fixation consistent with Listing's law, there exists one and only one set of contractive states of the muscles, no matter from which direction the fixation is reached. The purpose of the present study is to extend this analysis to the general case, that is, to any conceivable ocular rotation in a 600 x 600 field of fixation, to determine the component directions of pull, and to present the results in six easily readable charts. To accomplish this we proceed as follows: Ocular fixations and rotations are specified by marking the points where the line of fixation of the mobile eye pierces a concentric stationary reference sphere of a radius equal to that of Volkmann's eye (12-25 mm.). There is, for instance, a point on the reference sphere which marks the primary position of the eye. Any other normal fixation can be regarded as having been reached from the primary position by a rotation about an axis lying in Listing's plane. When the eye rotates about such an axis from the primary position to any other, the line of fixation traces an arc of a great circle on the reference sphere. At the same time, the insertion of any extra-ocular muscle travels on a parallel circle from its \"primary position\" through an arc which subtends the same angle as that described by the line of fixation. This establishes a correspondence between a normal fixation and the position (as well as the orientation) of the muscle's insertion; that is, for any point in the

Journal ArticleDOI
TL;DR: Eye surgeons face this complication less frequently than general or thoracic surgeons, but few of those who have practised for many years have not met cases of actual or threatened cardiac arrest.
Abstract: CARDIAC arrest is a frightening complication which may confront a surgeon at any operation. It is fortunate that it is relatively uncommon, but there is a danger of false security. Eye surgeons face this complication less frequently than general or thoracic surgeons, but few ofthose who have practised for many years have not met cases of actual or threatened cardiac arrest. Kirsch, Samet, Kugel, and Axelrod (1957) have estimated that cardiac arrest occurs in about 1 in 1,500 cases in general surgery and in about one in 3,500 cases in eye operations. Snyder, Snyder, and Chaffin (1953) considered that cardiac arrest occurs in about 1 in 2,500 cases. Milstein (1956) quoted estimates varying from 1 in 858 to 1 in 4,950 operations. Gartner and Billet (1958) estimated that about 45 deaths occurred during eye surgery in the United States of America every year. This problem is, therefore, a very real one.

Journal ArticleDOI
TL;DR: Recent evidence, gained from the study of the disease in rats, has now shown that the breakdown of the visual cells actually begins before the differentiation of the retina has been completed, raising the question whether certain enzymes essential to glycolysis are lacking in the retina, or whether the blood stream is failing to supply necessary substances.
Abstract: ALTHOUGH the clinical features of human retinitis pigmentosa and its modes of inheritance are well-known, the paucity of information concerning any biochemical factor in the disease is such that we have virtually no knowledge of its aetiology. The present investigation, although largely of a routine nature, was undertaken as a first step towards clearing up this obscurity. Owing to the rarity of the cases-and the difficulty of bringing patients up to hospital for examination, the inquiry has spread over a number of years. The results have shown how desirable and necessary it is to investigate young subjects at a time when the disease is developing-rather than the older advanced cases in whom it is stationary. It is usually the latter who come to the ophthalmologist for advice, and it is unfortunate that parents who are themselves affected are often unwilling to alarm their children-or to learn the truth concerning their condition-by allowing them to be examined at an early stage. The pathological evidence already obtained from human cases of retinitis pigmentosa, and from the analogous hereditary diseases in animals, points to a primary degeneration of visual cells which is followed by pigmentary degeneration of the retina. Duke-Elder (1940) has suggested that these changes may be \"the result of a common aetiological factor, rather than related to each other by cause and effect\", but in the analogous lesion in rats, at least, the pigment migration occurs only at a late stage and appears to be a secondary feature. The degeneration of the neuro-epithelium was at first regarded as being a form of abiotrophy in man (Collins, 1919), in the rat (Bourne, Campbell, and Tansley, 1938), and in the red setter (Lucas, 1954; Parry, 1953). Recent evidence, gained from the study of the disease in rats, has now shown that the breakdown of the visual cells actually begins before the differentiation of the retina has been completed (Lucas, Attfield, and Davey, 1955). The breakdown is also preceded by a loss of retinal function, as shown by a diminution in the amount of retinal anaerobic glycolysis (Walters, 1959). There is also some evidence that aerobic glycolytic potential is lost before a decline in retinal respiration in the early stages of the degeneration (Graymore, 1960). This observation raises the question whether certain enzymes essential to glycolysis are lacking in the retina, or whether the blood stream is failing to supply necessary substances.

Journal ArticleDOI
TL;DR: The use of corneal grafting has increased considerably in the last 15 years and it was therefore thought of interest to survey the frequency of infection and the bacterial strains found post mortem in the conjunctival sac and on the cornea in eyes suitable for use as donor eyes.
Abstract: THE use of corneal grafting has increased considerably in the last 15 years and it was therefore thought of interest to survey the frequency of infection and the bacterial strains found post mortem in the conjunctival sac and on the cornea in eyes suitable for use as donor eyes. We have also investigated the possibility of reducing the frequency of infection by pre-treatment with antibiotics. The normal bacteria of the cornea and conjunctiva have been the subject of several previous investigations. Fick (1887) published his findings in 85 conjunctival sacs in 57 individuals; 49 of the conjunctivae were normal and bacteria were found in 79-6 per cent. of them, 18-5 per cent giving a polymicrobial culture, and 12 per cent. being sterile. 36 conjunctivae showed evidence of chronic catarrh and all gave pos'ltive cultures. Barfoed (1953) examined the bacterial flora in 501 normal conjunctivae; 34 1 per cent. gave a pure culture, 21 4 per cent. gave a polymicrobial culture, and 44-5 per cent. were negative. In 533 cases of acute conjunctival inflammation, bacteria were present in 86-3 per cent. Rycroft (1956) found that 46 out of 107 donor eyes were infected.


Journal ArticleDOI
TL;DR: The conclusion that the pressure gradient within the retinal vein is maintained by a high "flow resistance" is inescapable, though for the purpose of the thesis to be presented, its precise topology is immaterial.
Abstract: AT the root of the clinical phenomena to be described, lies a singular haemodynamic arrangement to be found in the central retinal vein. Within a space of a.few millimetres, the pressure in this vessel drops from around 20 mm. Hg at the optic disc, to levels ranging from zero in the upright position, to 10 mm. in recumbency. The examination of the vein, however, reveals no special device whereby this high-pressure gradient is maintained. After entering the nerve-head, the vein traverses the lamina cribrosa and then maintains its central position within the optic nerve for a further distance of a'few millimetres. The lamina cribrosa, being able to withstand these pressure differences, is the only structure in the course of the central retinal vein capable of acting as a\"throttle\" device to maintain this pressure gradient. Being unyielding within this pressure range, the interstices of the lamina cannot be anything but fixed in size. Poiseuille's formula would suggest that, in order to bring about a 50 per cent. reduction ofpressure after emission through the lamina cribrosa, the diameter ofthe vein would have to be reduced by only some 16 per cent. In keeping with this inferred \"throttle\" action of the lamina cribrosa are the observations that, in cats and dogs, pressure variations in the perioptic subarachnoid space below 18 mm. Hg failed to affect the pressure of the central retinal vein at the nerve-head (Gibbs, 1936). The conclusion that the pressure gradient within the retinal vein is maintained by a high \"flow resistance\" is inescapable, though for the purpose of the thesis to be presented, its precise topology is immaterial. Two clinical phenomena occasionally encountered in association with obstruction of the central retinal vein must now be considered:

Journal ArticleDOI
D. F. Cole1
TL;DR: Results are presented which deal with the actions of three different types of substance, all of which diminish the rate of formation of the aqueous, which has already been shown to prevent experimental ocular hypertension caused by increased permeability of the blood-aqueous barrier.
Abstract: SINCE the formation of the aqueous humour depends largely upon active transport across the blood-aqueous barrier (in particular the ciliary epithelium), the rate of formation will be influenced by substances which act upon the barrier by modifying its properties or behaviour. In the present paper results are presented which deal with the actions of three different types of substance, all ofwhich diminish the rate of formation of the aqueous. Evidence for a mechanism transporting sodium ions actively from the plasma to the aqueous has been discussed elsewhere (Cole, 1960b, 1961a), and it was thought that such a system might be subject to inhibition by an aldosterone antagonist, spirolactone, which has been shown to reduce sodium reabsorption in the renal tubules (Celia and Kagawa, 1957; Kagawa, Celia, and van Arman, 1957; Liddle, 1957, 1958; Vander, Wilde, and Malvin, 1960). Noell (1953, 1954) has shown that chronic administration of iodate, which has long been known to cause pathological changes of the pigment epithelium (Vito, 1935; Kalt, 1937; Sorsby, 1941), abolishes the steady retinal potential as a result of this selective damage. It appeared possible that this action on the pigmented cells might not be confined to the retina but might also extend anteriorly into the pigment-cell layer of the ciliary body and thereby interfere with the normal production of the aqueous humour. The third substance studied was polyphloretin phosphate, which has already been shown to prevent experimental ocular hypertension caused by increased permeability of the blood-aqueous barrier (Cole, 1961b). The possibility that ultrafiltration across the normal barrier contributes to the influx measured in experiments of the present type has already been raised (Cole, 1960b), and it was thought that, in contrast to the other two inhibiting agents, spirolactone and iodate, polyphloretin phosphate would tend to reduce this ultrafiltration component without inhibiting the active transport processes.l

Journal ArticleDOI
TL;DR: The published cases of aberrant lacrimal gland in the bulbar conjunctiva amount to sixteen, or including the very rare intra-ocular forms, to eighteen.
Abstract: AN aberrant lacrimal gland is an unusual congenital and developmental abnormality. The clinical picture differs from that of an ectopic lacrimal gland, because in the aberrant forms, the main lacrimal gland is in its place and the other gland is additional. In ectopia, the original lacrimal gland is considered to have luxated, and this is not as rare as the appearance of aberrant tissue (Duke-Elder, 1952; Gemolotto, 1956; Mann, 1957; Miani, 1957). The first case was published by Schirmer (1891), and those of Duclos (1921) and Drak (1925) much later (Fran9ois and Rabaey, 1951); van Heuven (1928) reported a further case and Eross (1940) yet another. When the sixth case was reported by Dame (1946), he suggested that this was the first to be published. Fran9ois and Rabaey (1951) reported a case of their own. Bunce (1952) reported a case of aberrant lacrimal tissue in the iris (Mettier, 1958). Christensen and Anderson (1952) reported a case in which both the cornea and uvea were affected. Boase(1954) and Paez Allende(1945) reported two separate cases. Hughes and Ballen (1956) described a case of aberrant lacrimal gland in the bulbar conjunctiva. Nover (1957) reported four cases of limbal aberrant glands, and Sommer (1958) and Mettier (1958) described two similar cases. Thus the published cases of aberrant lacrimal gland in the bulbar conjunctiva amount to sixteen, or including the very rare intra-ocular forms, to eighteen. The rarity of the condition has led to the report of the following case observed in the Clinic of Ophthalmology, University of Ankara; this patient showed certain congenital defects which were not noted in any of the previous reports.

Journal ArticleDOI
TL;DR: Morphological studies which have attempted to establish the site of obstruction have been handicapped by the difficulty in obtaining rapidly-fixed glaucomatous material at an early stage in the disease, and by the variations in normal structure which have made observations of pathological change difficult to assess.
Abstract: THE site of obstruction to aqueous outflow in chronic simple glaucoma must lie between the anterior chamber and episcleral plexus, yet opinion remains divided between those who believe that the obstruction occurs while aqueous passes through the trabecular meshwork before entering Schlemm's canal and those who believe that it occurs in the scleral plexus beyond the canal. Support is given to the latter view by the vascular changes associated with diurnal variations in intra-ocular pressure (Duke-Elder, 1955), by the infrequent appearance of blood in Schlemm's canal on gonioscopy in glaucomatous eyes, and by the direct measurement of pressures within the canal of Schlemm in the eyes of normal monkeys (Perkins, 1955). The altered blood flow in laminated aqueous veins following compression of episcleral vessels in glaucomatous eyes (Goldmann, 1949), and the direct measurement of resistance to outflow in normal eyes after removal of the trabecular meshwork (Grant, 1958), support the former view. Morphological studies which have attempted to establish the site of obstruction have been handicapped by the difficulty in obtaining rapidly-fixed glaucomatous material at an early stage in the disease, and by the variations in normal structure which have made observations of pathological change difficult to assess. Various authors have reported abnormalities within the trabecular meshwork, the canal, or the scleral plexus. In the meshwork, obstruction has been -attributed to spongy or foamy degeneration of the cytoplasm (Flocks, 1959; Becker, 1959), to granular degeneration of collagen, and to proliferation of endothelial cells (Teng, Paton, and Katzin, 1955). Trabecular sclerosis has been described (Theobald and Kirk, 1956; Kornzweig, Feldstein, and Schneider, 1958), although it is not clear which portion of the fibres becomes sclerotic, nor has a distinction been made between thickening due to swelling and that due to fibre proliferation. A uniform thickening of the clear zone has been described in trephine biopsies among other changes in the meshwork (Unger and Rohen, 1960), and proliferation of the so-called curly collagen in the clear zone has been found in one case of glaucoma (Garron, 1959a). Adhesions

Journal ArticleDOI
TL;DR: This paper aims at describing, illustrating, and interpreting the ocular lesions associated with onchocerciasis, with particular attention to the choroido-retinal lesions.
Abstract: THIS paper aims at describing, illustrating, and interpreting the ocular lesions associated with onchocerciasis. The literature of onchocerciasis already includes many pictures of the ocular lesions. The paintingst and diagrams in this paper supplement those previously published and are intended to fill gaps in the existing literature. The accompanying text expresses the author's views on the interpretation of the lesions and refers to alternative opinions. Particular attention is paid to the choroido-retinal lesions because they have been the subject of much controversy. It is hoped that the paper as a whole will assist workers in the field to distinguish and understand the lesions of onchocerciasis.

Journal ArticleDOI
TL;DR: Details of a uniocular case presenting in middle age with typical clinical features of a aplasia of the optic nerve occurring as an isolated abnormality in an eye of normal external appearance are considered worthy of record.
Abstract: APLASIA of the optic nerve occurring as an isolated abnormality in an eye of normal external appearance is rare. It is seen more frequently in association with more obvious developmental anomalies of the eye and its adnexa, and with such gross defects as anencephaly. When both eyes are affected by aplasia of the optic nerves alone, grossly defective vision is apparent early in life; but when the condition is uniocular it may present as a diagnostic problem at a later age. There may be a history of poor vision from birth, and of an accompanying squint since infancy in the affected eye, and ophthalmoscopy reveals an abnormally small disc. There is no appreciable refractive error, and the condition is not familial. Details of a uniocular case presenting in middle age with these typical clinical features are therefore considered worthy of record.

Journal ArticleDOI
TL;DR: CASES of endophthalmitis due to invasion of the eye by migrating larvae of Toxocara canis, the common round worm of the dog, have been reported by Irvine and Irvine (1959), Harris, and Duguid (1961a, b).
Abstract: CASES of endophthalmitis due to invasion of the eye by migrating larvae of Toxocara canis, the common round worm of the dog, have been reported by Irvine and Irvine (1959), Harris (1961), and Duguid (1961a, b), while five of the 46 cases reported by Wilder (1950) as nematode endophthalmitis were later identified by Nichols (1956) as being caused by Toxocara. Ashton (1960) described four cases of retinal granuloma due to Toxocara canis. A further example of this disease occurring in the remote island of Mauritius is here reported.

Journal ArticleDOI
TL;DR: Myxoma of the conjunctiva is extremely rare and the following case report is, therefore, of interest.
Abstract: MYXOMATA are rare connective tissue tumours which may occur in various parts of the body. They arise chiefly in loose subcutaneous and aponeurotic tissue in bone, genito-urinary tract, skin, and heart. Less frequently affected are the intestines, nares and sinuses, muscles, joints, pharynx, breast, and orbit (Stout, 1948). Myxoma of the conjunctiva is extremely rare and the following case report is, therefore, of interest.

Journal ArticleDOI
TL;DR: The fine structure of the trabecular fibres has been re-examined in order to correlate the findings of light and electron microscopy more accurately and to define in greater detail the third-dimensional relationships of the fibre components.
Abstract: THE description of the microscopic structure of individual trabecular fibres given by Salzmann (1912) has been accepted for many years, and it is only as a result of recent electron microscopic studies that his classical concepts have had to be modified. The principle modification concerns the finer structure of the \"clear\" zone which lies beneath the trabecular endothelium and surrounds the central collagen core. Salzmann thought this layer to be a structureless glass membrane, but Garron, Feeney, Hogan, and McEwen (1958) have shown that many fibres, resembling collagen but possessing a 1000 A.U. banding, lie in this zone, and they believe that clumps of these fibres near the central collagen core have been mistaken in the past for elastic tissue (Ashton, Brini, and Smith, 1956). The fine structure of the trabecular fibres has been re-examined in order to correlate the findings of light and electron microscopy more accurately and to define in greater detail the third-dimensional relationships of the fibre components. In view of the numerous reports which attribute the onset of glaucoma to \"sclerosis\" or thickening of the fibres in the meshwork, a study has been made of variations in the trabecular fibres at different ages.

Journal ArticleDOI
TL;DR: Though cerebral cysticercosis is a well-known entity, cysts in the anterior chamber have been described, but a cyst situated directly over the optic disc is very rare.
Abstract: CYSTICERCOSIS of the brain has been known for centuries and most of the earlier reports came from central Europe. MacArthur (1934) and Dixon and Hargreaves (1944) have aroused interest in the problem of cerebral cysticercosis recently. From India very many reports have been published about the cerebral manifestations of cysticercosis (Dogra and Ahern, 1935; Menon and Veliath, 1940; McRobert, 1944; Subramaniam, 1946; Gault and Balasubrahmanyan, 1948; Raman, Ramamurthi, and David, 1950; Dave, 1950; Reddy, 1951; Chandy and Vaishnava, 1958) and some have emphasized unusual manifestations such as marked muscular development (Subramaniam, 1946) and pseudohypertrophic muscular dystrophy (McGill, 1947; Singh and Jolly, 1957). Most of these reports have come from southern India, though many of MacArthur's cases came from army cantonments of northern India. Cases have been reported from the Punjab by Singh and Jolly (1957) and Wahi and Chugh (1958). Though cerebral cysticercosis is a well-known entity, cysticercosis of the eye (alone or in combination with cerebral or generalized cysticercosis) is less often seen (Meyerson and Pienaar, 1961; Balakrishnan, 1961). Retinal and vitreous cysticercosis (Reddy and Reddy, 1957) and cysts in the anterior chamber have been described, but a cyst situated directly over the optic disc is very rare. We record below one such case presenting with generalized cysticercosis and cysticercosis cellulosae of the optic disc.