Archives of Ophthalmology

Lawton, Andrew W.;Karesh, James W.

doi: 10.1001/archopht.1986.01050180040020pmid: 3013142

Abstract To the Editor. —Glioblastoma multiforme, although the most malignant tumor of glial origin, generally has a low tendency to metastasize; surgical intervention may increase the rate of metastasis. One of the more unusual sites for glioblastoma to spread, despite its proximity, is the orbit. This may occur, however, and must be considered in the context of previously treated disease or a combination of proptosis and altered mental status. Report of a Case. —A 30-year-old woman presented with right proptosis and a right medial orbital rim mass that had been present for two weeks. A right frontal glioblastoma had been excised about one year previously, followed by chemotherapy and radiation therapy. A computed tomographic scan two months before presentation showed a normal right orbit. Physical examination revealed a visual acuity of 20/25 in the right eye. There were 4 mm of right proptosis demonstrated by Hertel exophthalmometry, plus 5 mm of References 1. Hoyt WF, Piavanetti E, Malamud N, et al: Cranio-orbital involvement in glioblastoma multiforme . Neurochirurgia 1972;15:1-8. 2. Cross KR, Cooper TJ: Intracranial neoplasms with extracranial metastases . J Neuropathol Exp Neurol 1952;11:200-208.Crossref 3. Wilkinson HA, Marigiotta M: Unilateral proptosis secondary to intracerebral glioblastoma . Neurochirurgia 1968;11:113-117.

Doft, Bernard H.

doi: 10.1001/archopht.1986.01050180041022pmid: 3718304

Abstract To the Editor. —The technique of transretinal drainage of subretinal fluid along with gas fluid exchange at pars plana vitrectomy has been popularized by Charles.1,2 Drainage of subretinal fluid is achieved by placing a trans-pars plana tapered needle into the subretinal space through a retinal hole while gas is infused from the infusion port into the vitreous cavity. Controlled suction on the needle combined with infusion force of the gas will allow the subretinal fluid to exit via the tapered needle.In some cases, there is a preexistent or iatrogenically induced retinal hole that can be employed. However, it may be necessary to intentionally create a retinotomy for the purpose of transretinal drainage of subretinal fluid. Several approaches have been employed. Using the vitrectomy cutter creates a hole of uncontrolled size, often larger than required, and may result in bleeding from severed retinal vessels. Using a myringotomy type blade References 1. Charles S: Vitreous microsurgery, in Handbooks in Ophthalmology . Baltimore, Williams & Wilkins, 1981, vol 1, p 81. 2. Charles S, Wang C: A motorized gas injector for vitreous surgery . Arch Ophthalmol 1981;99:1398.Crossref 3. Gonvers M: Retinal perforator for internal drainage . Am J Ophthalmol 1984;97:786-787.

Katz, Norman N. K.

doi: 10.1001/archopht.1986.01050180042023pmid: 3521556

Abstract To the Editor. —I read with great interest the article in the Archives by Dr Waring, "Making Sense of 'Keratospeak.' "1 I suggest that the following two additional surgical procedures be included in the list proposed by the author. Rotational Autograft. —This is a procedure in which a functionally significant but well-demarcated corneal opacity located in the visual axis may be displaced to a more eccentric position on the cornea (Fig 1). This procedure is of value in selected patients, especially under circumstances when donor material is unavailable for more conventional corneal transplantation. I recently had the opportunity to observe this procedure employed with success when I was in Bangladesh as a medical missionary. Keratoprosthesis. —This procedure is generally employed in "last ditch" circumstances, ie, several failed transplants, severe alkali burns, ocular pemphigoid, and severely damaged ocular anterior segments. An alloplastic device is implanted in the cornea and References 1. Waring GO: Making sense of keratospeak: A classification of refractive corneal surgery . Arch Ophthalmol 1985;103:1472-1477.Crossref 2. Stallard HB: Eye Surgery . Baltimore, Williams & Wilkins, 1973, pp 452-455. 3. Cardona H: Prosthokeratoplasty, course 340 . Ophthalmology 1985;92( (suppl 2) ):178.Crossref

doi: 10.1001/archopht.1986.01050180042024pmid: 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 Obituary. —John H. King, Jr, MD, died at the age of 75 years on March 16, 1986. Dr King graduated from Georgetown University Medical School, Washington, DC, in 1933. He became the first medical director of Andrews Air Force Base in Maryland and founded the Eye Service at Walter Reed Army Medical Center, Washington, DC. In 1955, he retired from the military and entered private practice. In 1969, he founded the International Eye Foundation. During his entire career, he was actively involved in innovations in eye banking, corneal surgery, and international programs for the prevention and treatment of blindness. He is survived by his wife Helen Tewksbury King, his children, and grandchildren. IAPB Third General Assembly Announced. —The International Agency for the Prevention of Blindness (IAPB) Third General Assembly will convene in New Delhi Dec 6-11, 1986. The Third General Assembly's theme will be "A Decade of Progress." At the

Melamed, Shlomo

doi: 10.1001/archopht.1986.01050180048025pmid: 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 Automated perimetry is an exciting, rapidly evolving field, which is widely used clinically and contributes significantly to the ophthalmic diagnostic tools currently available. Computed visual field analysis is considered more sensitive than manual perimetry, and it assists the clinician in collecting data in a more objective and unbiased way then before. Although much progress has already been made, some problems still remain unresolved, such as test inconsistencies, long-term fluctuations, determination of clear criteria for early visual field defects, and progression of visual field loss, to name only a few. The International Perimetric Society is a well-recognized forum in which these and other problems are thoroughly discussed by authorities in the field. The proceedings of the Sixth International Perimetric Society Symposium held May 27 to 31,1984, in Santa Margherita Ligure, Italy, reflect the abundance of information gathered and the pace of progress made in recent years. The major topics of the

Sloane, Albert E.

doi: 10.1001/archopht.1986.01050180049027pmid: 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 The author has set for himself what would appear to be an unattainable goal—a truly comprehensive treatise. In The Myopias, Curtin has succeeded in producing a work of landmark merit. Within the bounds of current knowledge, there is no aspect of myopia that has not been discussed. Even the disproven cultlike treatments are dealt with objectively. This prodigious work has 2822 references and is divided into four principal parts: (1) basic science of myopia, (2) the clinical myopias, (3) pathologic myopia, and (4) special forms of myopia. The four parts are subdivided into 20 sec "[T]his work should serve as an incentive... [to] assure that the myopic patient be examined for more than spectacles or contact lenses." tions, which are further divided into over 100 subdivisions. The socioeconomic implications, etiology, and psychological aspects, as well as the optics, are discussed. Oculometry and visual fields are also included, and the section

Steinert, Roger F.

doi: 10.1001/archopht.1986.01050180049026pmid: 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 This volume is a compendium of the presentations at a 2½-day session devoted mainly to herpetic eye disease. The faculty was an international sampling of a number of prominent basic scientists and clinicians with a major interest in ocular viral disease. The majority of the material is devoted to herpes simplex, although several papers do address varicella-zoster, and there was occasional reference to cytomegalovirus. The papers are organized in the order of the logically constructed presentation sessions. These sessions began with virology, models of pathogenesis, pathology, and immunology. The emphasis here is on basic science, and there is only limited material of direct relevance to the practicing clinician. The volume then proceeds to address manifestations of clinical disease, current clinical antiviral agents, experimental topical and oral antiviral agents, and then keratoplasty as the ultimate surgical alternative. Most of the papers appear—at least partly—to be formal written versions of the material

Goldberg, Morton F.

doi: 10.1001/archopht.1986.01050180051028pmid: 3718305

Abstract The rate and magnitude of change in the socioeconomic aspects of medicine have been nothing short of staggering during the past few years. Many ophthalmologists have wistfully uttered, "If I could only predict the changes in health care delivery over the next five to ten years, I could prepare myself properly." Accurate forecasts of future ophthalmic practices, however, are difficult to make.1 A recently published study, "Health Care in the 1990s: Trends and Strategies," could prove to be helpful.2 This 42-page pamphlet, published under the combined aegis of the American College of Hospital Administrators and Arthur Andersen & Co, is replete with provocative predictions. These two organizations used an interesting predictive technique, namely, a Delphi panel of 1,000 experts from various sectors of the health care industry, including physicians, hospital managers, executives of other types of health care providers (eg, ambulatory care centers, health maintenance organizations), legislators, governmental References 1. Goldberg MF, Sugar J: Ophthalmology: Contempo 1985 . JAMA 1985;254:2301-2302.Crossref 2. Health Care in the 1990s: Trends and Strategies . Chicago, Arthur Andersen & Co and American College of Hospital Administrators, 1984.

Anderson, Richard L.

doi: 10.1001/archopht.1986.01050180052029pmid: 3718306

Abstract Mohs' micrographic technique, described in this issue of the Archives,1 and which has also been called chemosurgery, microsurgery, microscopically controlled excision, Mohs' microsurgery, and Mohs' technique, has revolutionized the management of difficult eyelid cancer. Dr Mohs' wealth of experience and careful long-term patient follow-up are unexcelled, and his cure rates for eyelid tumors with the micrographic technique set a standard that we all should envy. While most ophthalmologists spend more time studying rare intraocular tumors, eyelid tumors are by far the most common malignant neoplasm managed in our field. Mortality ranging from 2% to 11% due to epithelial eyelid tumors was reported at reputable institutions before such developments as the micrographic technique.2-4 In my opinion, all eyelid tumors that are large, recurrent, or have indefinite margins should be managed by the micrographic technique. Indeterminant forms of therapy for primary basal cell carcinoma of the eyelids, such as References 1. Mohs FE: Micrographic surgery for the microscopically controlled excision of eyelid cancers . Arch Ophthalmol 1986;104:901-909.Crossref 2. Aurora AL, Blodi FC: Reappraisal of basal cell carcinoma of the eyelids . Am J Ophthalmol 1970;70:329-336. 3. Birge HL: Cancer of the eyelids: I. Basal cell and mixed basal cell and squamous cell epithelioma . Arch Ophthalmol 1938;19:700-708.Crossref 4. Payne JW, Duke JR, Butner R, et al: Basal cell carcinoma of the eyelids: A long-term follow-up study . Arch Ophthalmol 1969;81:553-558.Crossref 5. Anderson RL: A warning on cryosurgery for eyelid malignancies . Arch Ophthalmol 1978;96:1289-1290.Crossref 6. Dutton JJ, Anderson RL, Tse DT: Combined surgery and cryotherapy for scleral invasion of epithelial malignancies . Ophthalmic Surg 1984;15:289-294. 7. Divine RD, Anderson RL: Nitrous oxide cryotherapy for intraepithelial epithelioma of the conjunctiva . Arch Ophthalmol 1983;101:782-786.Crossref 8. Jakobiec FA, Brownstein S, Albert W, et al: The role of cryotherapy in the management of conjunctival melanoma . Ophthalmology 1982;89:502-515.Crossref 9. Anderson RL, Ceilley RI: A multispecialty approach to the excision and reconstruction of eyelid tumors . Trans Am Acad Ophthalmol Otolaryngol 1978;85:1150-1163. 10. Anderson RL: Results in eyelid malignancies treated with the Mohs fresh-frozen technique , in Transactions of the New Orleans Academy of Ophthalmology . St Louis, CV Mosby Co, 1982, pp 380-391. 11. Doxanas MT: Orbicularis muscle mobilization in eyelid reconstruction . Arch Ophthalmol 1986;104:910-914.Crossref

Lundberg, George D.;Iverson, Cheryl

doi: 10.1001/archopht.1986.01050180053030pmid: N/A

Abstract As of July 1,1986, in all articles appearing in JAMA and the nine AMA specialty journals, clinical laboratory data will be expressed in conventional units followed in parentheses by Systeme International (SI) units. This is the first phase of our two-year conversion to SI—the measurement system currently in use by most of the world, as discussed previously in this and other AMA journals.1-4 This gradual transition was designed to allow time for learning and is in keeping with the recommendation of the AMA Council on Scientific Affairs, which was adopted by the House of Delegates as policy in December 1984: "4. Develop and implement an educational effort for all physicians to assist them in making an error-free clinical conversion to SI units."2 Promoted by the American National Metric Council (ANMC) and supported by many organizations, the conversion to SI units was mandated by the House of Delegates of References 1. Powsner ER: SI quantities and units for American medicine . JAMA 1984;252:1737-1741.Crossref 2. Council on Scientific Affairs: SI units for clinical laboratory data . JAMA 1985;253:2552-2554. 3. Powsner ER: The SI for American medicine . AJDC 1986;140:97-98. 4. SI units for reporting of laboratory data . Arch Pathol Lab Med 1985;109:1054. 5. Young DS: SI units for clinical laboratory data . JAMA 1978;240:1618-1621.Crossref 6. Metric Commission Canada, Sector 9.10 Health and Welfare: The SI Manual in Health Care. Ottawa, Metric Commission Canada, 1981. 7. Lundberg G: When to panic over an abnormal value . Med Lab Observer 1972;4 ( (March-April) ):47-54. 8. Lundberg G: One medical world . JAMA 1983;250:242.Crossref