Archives of Ophthalmology

Metz, Henry S.

doi: 10.1001/archopht.1986.01050230024011pmid: 3778269

Abstract To the Editor. —In a recent article, Nelson1 described the unusual occurrence of marked adduction deficiency in two patients who were thought to have Duane's retraction syndrome (DRS) following a large, but not immense, medial rectus recession. This most unusual occurrence was felt to be significant, and Dr Nelson recommended care in performing a large medial rectus recession in DRS because of such an unexpected result.The diagnosis of DRS in these patients must be questioned. In the first case, the patient had 35 prism diopters (PD) of esotropia in primary position. Although this may occur in DRS, it is distinctly unusual, given the experience of Wong et al2 and Isenberg and Urist.3 The illustrations of the patient do demonstrate narrowing of the lid fissure on adduction and widening of the lid fissure on attempted abduction, but the limitation of adduction of the left eye on right References 1. Nelson LB: Severe adduction deficiency following a large medial rectus recession in Duane's retraction syndrome . Arch Ophthalmol 1986; 104:859-862.Crossref 2. Wong GY, Jampolsky A, Scott AB: Primary position deviation in Duane's syndrome . Med Coll Virginia Q 1972;8:302-303. 3. Isenberg S, Urist MJ: Clinical observations in 101 consecutive patients with Duane's retraction syndrome . Am J Ophthalmol 1977;84:419-425. 4. Scott AB, Wong GY: Duane's syndrome: An electromyographic study . Arch Ophthalmol 1972;87:140-147.Crossref 5. Sato S: Electromyographic study on retraction syndrome . Jpn J Ophthalmol 1960;4:57-66.

Nelson, Leonard B.

doi: 10.1001/archopht.1986.01050230024012pmid: N/A

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract In Reply. — Although the great majority of esotropic patients with DRS have a deviation of 30 PD or less, the fact that one of the patients had 35 PD of esotropia should not cause the diagnosis of DRS to be in doubt. It has been my experience that adults with esotropia and DRS tend to have larger deviations. The patient with 35 PD of esotropia was 32 years old at the time of diagnosis and had the other associated ocular motility findings. If this patient had a recovering sixth-nerve palsy, and if a 7-mm medial rectus recession had been performed, then it is certainly possible that a consecutive exotropia could develop but not a limitation of adduction to this degree.Unfortunately, I did not examine the child who was operated on three times prior to my evaluation. I did discuss his case in detail with the other ophthalmologist, who

Petersen, Robert A.;Holmes, Lewis B.

doi: 10.1001/archopht.1986.01050230025014pmid: 3778270

Abstract To the Editor. —In 1977 one of us (R.A.P.) described 17 children born to severely diabetic mothers who exhibited optic nerve hypoplasia with good visual acuity but visual field defects.1 Two of these patients and the otherwise unaffected sibling of a third had microcornea. A variety of other malformations have been identified as well, including vertebral, limb, cardiac, facial, central nervous system, and renal anomalies.2 Because the prevalence of optic nerve hypoplasia in infants of diabetic mothers is unknown, eye examinations were performed in a group of infants born to mothers who had entered the Diabetes in Early Pregnancy Study.3 From 98 women entered into the study from March 1984 through June 1985, permission was obtained to examine the eyes of 43 infants. The examiner was unaware of the diabetic status of the mother.Of these infants, 28 were born to diabetic mothers and 15 were born References 1. Petersen RA, Walton DS: Optic nerve hypoplasia with good visual acuity and visual field defects . Arch Ophthalmol 1977;95:254-258.Crossref 2. Grix A: Malformations in infants of diabetic mothers . Am J Med Genet 1982;13:133-137.Crossref 3. Mills JL, Fishl AR, Knopp RH, et al: Malformations in infants of diabetic mothers: Problems in study design . Prev Med 1983;12:274-286Crossref

Newman, Nancy M.

doi: 10.1001/archopht.1986.01050230025016pmid: 2430556

Abstract To the Editor. —In the June issue of the Archives, Miller1 presented photographic documentation of the appearance of optic disc drusen in a patient who initially had anomalously elevated discs without visible drusen. Such a patient has previously been presented with photographs by Huber in Fig 2-38 of the third edition of his book Eye Signs and Symptoms in Brain Tumors.2 Dr Huber has graciously allowed me to present those photographs in other publications.3 While I am not certain that this is the only other photographically documented and published case, it does precede Miller's note by a decade. Additionally, for most ophthalmologists, ultrasonography is probably a more accessible means of documenting suspected buried drusen. It is certainly less expensive and without the radiation exposure attendant on computed tomographic scanning. Moreover, although I have not made a comparative study, it is my impression that drusen can often be References 1. Miller NR: Appearance of optic disc drusen in a patient with anomalous elevation of the optic disc . Arch Ophthalmol 1986;104:794-795.Crossref 2. Huber A: Eye Signs and Symptoms in Brain Tumors , ed 3, Frederick C. Blodi (trans). St Louis, CV Mosby Co, 1976, p 149. 3. Newman NM: Exploration de la couche des fibres nerveux retinienne , in Hamard H (ed): Neuropathies Optiques . Paris, Masson, 1986, pp 143-157.

Muirhead, J. Fraser

doi: 10.1001/archopht.1986.01050230025015pmid: N/A

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract To the Editor. —According to the Random House Dictionary of the English Language, compliance is "A tendency to yield readily to others, esp. in a weak and subservient way."Glaucoma treatment requires long-term patient self-medication. Patients must therefore cooperate in their own treatment. Although different strategies may be needed to achieve cooperation with different patients, the essence is persuasion, not coercion. Hence, compliance is not an appropriate term and should be replaced by another. I suggest patient cooperation.

Miller, Neil R.

doi: 10.1001/archopht.1986.01050230025017pmid: N/A

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract In Reply. —I appreciate Dr Newman's comments regarding the development of visible drusen in optic discs that are initially observed to be elevated but in which drusen cannot be observed. About seven years ago, I had the opportunity to review the original slides of the photographs to which Dr Newman refers, and it was my impression that I could identify the drusen in the original photographs, particularly the one at 12 o'clock in the right disc and the one at 6 o'clock in the left disc, although of course they were not as prominent as they were ten years later. In my case, despite my belief that drusen were present, I could not see them by direct ophthalmoscopy or slit-lamp biomicroscopy, and I could not identify them on either color photographs or fluorescein angiography. Nevertheless, I agree that Huber's photographs are impressive, and I am delighted to give him and

Drews, Robert C.

doi: 10.1001/archopht.1986.01050230025013pmid: N/A

Abstract To the Editor. —The adoption of Système International units announced in a recent issue of the Archives1 has been a long time coming.2 It will certainly be distasteful to have to rememorize all laboratory values, but some generation of physicians has to do it sooner or later.I am happy to see that intraocular pressure will continue to be expressed in millimeters of mercury, since pascals (newtons per square meter) are so ungainly large.3 The advantage of retaining acuities in Snellen notation is arguable. It is nice for those of us in the United States, but Snellen notation is seldom used elsewhere in the world. References 1. Lundberg GD, Iverson C, Radulescu G: Now read this: The SI units are here . Arch Ophthalmol 1986;104:819-830.Crossref 2. Metrication: Just a second . Arch Ophthalmol 1972;87:620. 3. Drews RC: Metrication . Arch Ophthalmol 1973;89:438-439.Crossref

Deutman, A. F.

doi: 10.1001/archopht.1986.01050230026019pmid: 2430557

Abstract To the Editor. —In their interesting article "Subretinal Neovascularization Following Metallic Intraocular Foreign Body Trauma," in the April 1986 Archives, Trimble and Schatz1 state that "subretinal neovascularization as a complication of chorioretinal injury from a metallic intraocular foreign body, to our knowledge, has not previously been reported."It may be of interest to them that I reported, in The Blood-Retinal Barriers,2 a case of a patient in whom subretinal neovascularization developed at the impact site after a direct hit on the paramacular retina by a copper wire. The wire struck the macula just superonasal to the fovea, after which it fell into the vitreous.I suggested that this appeared to be a model for the development of subretinal new vessels in humans. I agree that the metal wire makes a break in the retina, retinal pigment epithelium, Bruch's membrane, and, possibly, the choricapillaris, which triggers the formation of References 1. Trimble SN, Schatz H: Subretinal neovascularization following metallic intraocular foreign-body trauma . Arch Ophthalmol 1986;104:515-519.Crossref 2. Deutman AF: Significance of the alteration of the outer blood-retinal barrier , in Cunha Vaz JG (ed): The Blood-Retinal Barriers . New York, Plenum Press, 1980, pp 365-374.

Schatz, Howard;Trimble, Susan N.

doi: 10.1001/archopht.1986.01050230026020pmid: N/A

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract In Reply. —We are not surprised that this phenomenon of subretinal neovascularization following an injury to Bruch's membrane (and the pigment epithelium and choriocapillaris) has been seen by others. We thank Dr Deutman for bringing the experience of a previous case to our attention.

Meisler, David M.;Udell, Ira J.;Stock, E. Lee;Lass, Jonathan H.

doi: 10.1001/archopht.1986.01050230026018pmid: 3778271

Abstract To the Editor. —Giant papillary conjunctivitis (GPC) is an inflammatory condition characterized by large papillary excrescences of the upper tarsal conjunctiva.1 It has been associated with the wearing of soft and rigid contact lenses, which is often discontinued because of ocular discomfort. Recently, however, certain measures have been suggested that seem to restore contact lens tolerance. These include improved lens handling and hygiene, switching or replacing lenses, and the topical application of cromolyn.2,3 While it appears that these therapeutic maneuvers lessen the symptoms and perhaps the signs of GPC in some patients, it is possible that the underlying inflammatory process may be allowed to continue in a contact lens wearer whose symptoms are masked or minimized by these maneuvers.White subepithelial changes of the upper tarsal conjunctiva have been observed in patients with GPC.1 These occur to a varying extent. They are found at the apexes of References 1. Allansmith MR, Korb DR, Greiner JV, et al: Giant papillary conjunctivitis in contact lens wearers . Am J Ophthalmol 1977;83:697-708. 2. Donshik PC, Ballow M, Luistro A, et al: Treatment of contact lens-induced giant papillary conjunctivitis . CLAO J 1984;10:346-350. 3. Meisler DM, Berzins UJ, Krachmer JH, et al: Cromolyn treatment of giant papillary conjunctivitis . Arch Ophthalmol 1982;100:1608-1610.Crossref