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doi: 10.1136/bjo.68.11.770pmid: 6498132
Light and electron microscopy were used to examine tissue excised during surgery from eight patients with advanced destructive scleral disease. These comprised two cases of scleromalacia perforans, three cases of anterior necrotising scleritis alone or in conjunction with other systemic diseases, and three cases in which scleritis developed following ocular surgery. It was not possible to distinguish between these three categories by histological or cytopathological criteria. All showed extensive granulomatous infiltration of the conjunctiva, episclera, and sclera by plasma cells and lymphocytes. Mast cells were abundant throughout these inflamed tissues. Examination of scleral stroma from sites in advance of the granuloma revealed active fibroblastic cells in the absence of other inflammatory cells. Fibroblastic transformation of scleral cells may be one of the earliest events in scleral degradation during necrotising disease.
doi: 10.1136/bjo.68.11.781pmid: 6498133
Electron microscopy of tissue excised during surgery in eight cases of advanced anterior necrotising scleritis showed degradation of collagen in the scleral stroma by both intracellular and extracellular mechanisms. In the first of these mechanisms cells resembling active fibroblasts and macrophages were observed in the process of phagocytosis of collagen fibrils into vacuoles associated with dense cytoplasmic granules. In the second mechanism collagen fibrils in large areas of the scleral stroma appeared swollen and unravelled, or completely solubilised, without close association with stromal cells. Both activation and degeneration of stromal fibrocytes were evident in zones of extracellular fibril degradation. These changes appeared to take place prior to invasion of the stroma by cells of the granuloma.
doi: 10.1136/bjo.68.11.790pmid: 6388626
Of 50 cases of strabismus having surgical operations designed on the basis of A scan ultrasonography 45 (90%) had less than 10 dioptres eso- or exodeviation two months postoperatively; 22 eso-, 25 exo-, and 3 vertical deviations were included in the series. A scan ultrasonography is done preoperatively to find the diameter and thus the circumference of the globe. This is used with the angle of deviation to estimate the amount of recession and/or resection necessary to correct the deviation. Attention is drawn to the oculomotor axis, which is 10-12 degrees divergent to the anteroposterior axis and around which the recti muscles act. The oculomotor equator is at right angles to this axis and is closer to the limbus medially than laterally, so that excessive recession of the medial rectus is more likely than of the lateral rectus.
Nelson, L. B.; Ervin-Mulvey, L. D.; Calhoun, J. H.; Harley, R. D.; Keisler, M. S.
doi: 10.1136/bjo.68.11.796pmid: 6498134
Patients with nystagmus and an eccentric null point in lateral gaze may assume an abnormal head position to maximise visual acuity. Surgical procedures for this condition can result in significant undercorrection of the head turn. A follow-up of 15 patients for an average of 33 months revealed a sustained improvement in head position with the use of the augmented modified Kestenbaum procedure.
Fitzgerald, B. A.; Billson, F. A.
doi: 10.1136/bjo.68.11.801pmid: 6498135
Abnormalities in visually evoked responses have been used to demonstrate abnormal optic nerve fibre projections in human albinos, who have anomalous nystagmoid movements. Using visually evoked potentials we tested the hypothesis that patients with dissociated vertical deviation (another group with anomalous nystagmoid movements) may have abnormal visual evoked responses similar to those of albinos. Patients with dissociated vertical deviation (both unilateral and alternating), patients with congenital esotropia without dissociated vertical deviation, and normal subjects were investigated. The results showed a very high incidence of abnormal visual evoked responses in patients with dissociated vertical deviation, while recordings from the other groups were normal. As well as suggesting the possibility of abnormalities of optic nerve fibre projections, the visual evoked responses showed a marked increase in latency in all patients with dissociated vertical deviation. These results occurred regardless of the visual acuity or amblyopia of the eyes tested. The possible existence of abnormal pathway projection in the presence of dissociated vertical deviation is discussed.
McCoy, R.; White, L.; Tait, B.; Ebringer, R.
doi: 10.1136/bjo.68.11.807pmid: 6333893
Serum levels of immunoglobulin A, G, and M were examined in 99 patients with acute anterior uveitis (AAU). The mean level of serum IgA was raised (p less than 0.001) in AAU patients when compared with healthy control subjects. The levels of serum IgG and IgM were not significantly different from those in the control group. The raised levels of serum IgA were found to occur predominantly in the HLA-B27 positive group of patients (p less than 0.001) and were highest in HLA-B27 positive patients with sacroiliitis or associated spondylarthritic diseases (p less than 0.001). The HLA-B27 negative group of AAU patients did not have a significantly raised mean serum IgA. The raised level of serum IgA in HLA-B27 positive AAU patients suggests that there has been a response to an environmental or infectious agent(s) acting across a mucosal tissue in these patients. This agent could be responsible for the initiation of the acute ocular inflammation.
Heredia, C. D.; Huguet, J.; Cols, N.; Engel, P.; García-Calderón, P. A.
doi: 10.1136/bjo.68.11.811pmid: 6333894
In a group of 46 patients with retinitis pigmentosa (RP) we studied the presence of circulating immune complexes (CIC) and the alterations in the complement system. Our results showed the presence of CIC in 43.5% of the patients studied, reduced levels of the complement components C3 and C4 (p less than 0.001), and of the haemolytic activity CH50 (p less than 0.001) when compared with a control group consisting of a 100 healthy subjects. We found a statistically significant correlation between the values of C3 and CIC (p less than 0.01), C4 and CIC (p less than 0.01), and between CH50 and CIC (p less than 0.001). These findings indicate that the CIC may play a role in the pathogenesis of primary retinitis pigmentosa.
Gilbert, C. M.; Owens, S. L.; Smith, P. D.; Fine, S. L.
doi: 10.1136/bjo.68.11.815pmid: 6541945
The Wilmer Retinal Vascular Center's experience with central serous chorioretinopathy from 1970 to the end of 1979 was reviewed and compared with previous studies. Retrospective analysis of 73 patients seen at follow-up suggests no clinically significant effect of focal argon laser photocoagulation on final visual acuity or recurrence rate. Patients with initial visual acuity of 20/20 remained at that level, and patients with initial visual acuity of less than 20/30 gained, on average, two to three Snellen lines at follow-up. Approximately one-third of both untreated and treated patients had recurrence or presumed persistence during the follow-up period. With the inclusion of episodes that occurred before the first Wilmer Institute visit about half of each group had recurrence or presumed persistence. Recurrences were most often due to leakage from a site within one disc diameter of the original site of leakage.
Ross, J. E.; Bron, A. J.; Clarke, D. D.
doi: 10.1136/bjo.68.11.821pmid: 6498136
A battery of vision tests was used to quantify visual defect in a group of 50 patients with chronic simple glaucoma. The vision tests were near and distance visual acuity, visual fields, and contrast sensitivity to static and temporally modulated sinusoidal grating patterns. Of these, static contrast sensitivity function appears to be the most sensitive method of measuring visual defect in glaucoma patients. The visual disability experienced by the glaucoma patients was quantified by means of a questionnaire, and the relationship between perceived visual disability and visual defect was examined. It was found that results from a group of tests, near visual acuity, visual field, and contrast sensitivity measures, are the best predictors of the difficulty experienced by patients in performing visually dependent daily activities.
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