British Journal of Ophthalmology

Canning, C. R.; Hungerford, J.

doi: 10.1136/bjo.72.4.241pmid: 3288276

The cause of uveal melanoma is unknown. In a few cases, however, factors are found in association with the disease which may play some part in the aetiology. One such factor is inheritance. Twelve families have been reported with adequate documentation during the last century in which two or more members have had uveal melanomas. At least some of these may be the result of an inherited disorder. On available data inheritance is most likely autosomal dominant with partial expressivity or incomplete penetrance. This report describes two more families each of which have two members with uveal melanomas.

Seregard, S.; Daunius, C.; Kock, E.; Popovic, V.

doi: 10.1136/bjo.72.4.244pmid: 3378018

The first two Swedish cases of primary bilateral malignant melanoma of the choroid are presented. In one case bilateral histological confirmation was obtained as both eyes were enucleated. In the other case one eye was enucleated and the other irradiated with an episcleral ruthenium plaque. Sweden has a population of 8.38 millions, so that bilateral choroidal melanomas may be less rare than previously thought.

Jones, D. R.; Scobie, I. N.; Sarkies, N. J.

doi: 10.1136/bjo.72.4.246pmid: 3378019

A blind painful eye may harbour an unsuspected malignant melanoma. We report a case of ocular melanoma that presented with confusion owing to direct extension via the optic nerve into the anterior cranial fossa.

Weisenthal, R.; Frayer, W. C.; Nichols, C. W.; Eagle, R. C.

doi: 10.1136/bjo.72.4.248pmid: 3288277

Malignant lymphocytic lymphoma rarely involves the eye. In two patients we found ocular signs and symptoms as the initial presentation of systemic disease. In the first patient periorbital swelling and ptosis of one year's duration ultimately proved to be the result of malignant lymphoma. After resolution of swelling and ptosis with chemotherapy, the patient returned with diffuse iris involvement and uveitis with a hypopyon. In the second patient an acute change of refractive error proved to be the result of a lymphomatous deposit in the choroid. In both instances common symptoms were the initial manifestations of a diffuse malignant disease.

Hague, S.; Hill, D. W.

doi: 10.1136/bjo.72.4.253pmid: 3378020

Ophthalmic artery perfusion pressures and retinal arteriolar calibres were studied in 10 human subjects when sitting, standing, and lying. Differing responses in perfusion pressure were found; autoregulatory responses were found in 13 of the 18 significant calibre changes on moving from sitting to standing and 13 of 22 significant calibre changes on moving from standing to lying. The remaining significant calibre changes were non-autoregulatory, the arterioles dilating with perfusion pressure increase and constricting with decrease.

Alvarez, E.; Damato, B. E.; Jay, J. L.; McClure, E.

doi: 10.1136/bjo.72.4.258pmid: 3378021

Oculokinetic perimetry is a new method of visual field assessment in which the patient moves the eye around a central static target to look sequentially at an array of numbers. When fixation on a number is accompanied by disappearance of the central target, that number is deleted from a recording chart. Inversion of the recording chart gives a plot of the central visual field. In this study we have shown that in 64 eyes of 37 patients, with unequivocal field loss attending a glaucoma clinic, the test is efficient and reliable when compared with conventional static (Dicon 3000) and kinetic (Tübingen Oculus) field tests. The results were identical in 88% of eyes tested and approximately comparable in another 6%. Quantitative equivalent targets for the different methods are described. Oculokinetic perimetry was carried out by a previously untrained person, and it is suggested that this new method merits further study as a screening device for glaucoma in the community.

Fink, A. I.; Jordan, A. J.; Lao, P. N.; Fong, D. A.

doi: 10.1136/bjo.72.4.263pmid: 3378022

Sixty-one patients (82 eyes) were studied after argon laser trabeculoplasty (ALT) to determine the lasting efficacy of such treatment. This investigation, now in its fourth year, was prospective, and the information derived was analysed with the aid of a computer. Success was defined as intraocular pressure (IOP) below baseline (22 mmHg). The mean follow-up time was 24.5 months, when the success rate was 74% compared with 75% at three months. Success declined to 45% at 42 months. No significant difference was noted when (a) first lasered eyes of all patients and those fellow eyes treated were analysed separately, (b) when right and left eyes were analysed separately, nor (c) when patients were divided into two treatment groups, (I) 100 burns at 1 W, and (II) 65 burns at 850 mW. Eight of 11 eyes showed progressive postlaser field loss despite below-baseline intraocular pressures. ALT is an alternative to carbonic anhydrase inhibitor therapy, with a success rate of 66.7% at two years. However, repeat ALT was successful in only 25% of patients seven months after treatment.

Brooks, A. M.; Gillies, W. E.

doi: 10.1136/bjo.72.4.270pmid: 3132201

A series of 474 mixed cases of glaucoma was assessed to determine whether there were any genetic differences between different types of glaucoma. A careful distinction was made between chronic open angle glaucoma (COAG), acute and chronic angle closure glaucoma, ocular hypertension, low tension glaucoma, patients with large cup disc ratios, and various types of secondary glaucoma including pseudoexfoliation of the lens capsule, uveitic and traumatic glaucoma. Using ABO blood groups, Rhesus groups, ABH secretion or non-secretion, and phenylthiourea tasting we identified certain differences. The differences from normal were significant decrease in Rh-negative patients in chronic closed angle glaucoma (p less than 0.05), a decrease in ABH secretors in ocular hypertension (p less than 0.01), and fewer HB secretors in patients with COAG (p less than 0.02). There was a significant decrease in AH secretors and increase in HB secretors in both pseudoexfoliation with raised intraocular pressure compared with COAG (p less than 0.01) and in secondary glaucomas as a group compared with COAG (p less than 0.01). Tasters of phenylthiourea were more common in traumatic and uveitic glaucoma than in normal controls (p less than 0.05). These results suggest that secondary glaucoma develops in different subjects from COAG, while patients who develop a rise in intraocular pressure proceed to cupping and field loss if they have a certain genetic constitution. The groups of patients are too small for the differences to be of great prognostic value.

Serle, J. B.; Asbell, P. A.; Obstbaum, S. A.; Podos, S. M.; Anh-Le, N.

doi: 10.1136/bjo.72.4.274pmid: 3378023

Sixteen patients enrolled in the PERK study were evaluated by fluorophotometry 24 hours or six months following radial keratotomy. A comparison of eyes operated and not operated upon showed that endothelial permeability was not significantly altered 24 hours and six months after surgery. Aqueous humour flow rates and anterior chamber elimination coefficients were significantly higher 24 hours after surgery in the eyes operated on than in those not operated on. Six months after surgery there was no longer a significant difference in these factors. The increase in aqueous humour flow rates 24 hours after surgery may represent a subclinical breakdown in the blood-aqueous barrier.

Foulds, W. S.; Aitken, D.; Lee, W. R.

doi: 10.1136/bjo.72.4.278pmid: 3378024

Small portions of dehydrated hydrophilic polymer (HPU 90, Smith and Nephew) have been inserted into the suprachoroidal space in rabbits to investigate the possible use of suprachoroidal plombage in retinal detachment surgery. As it hydrates, the material causes a pronounced elevation of choroid and retina, and the implants have been well tolerated for periods of up to one year in experimental animals. The implant slowly breaks down and stimulates a simple macrophagic reaction: fibrosis in the overlying choroid is associated with ischaemic gliosis and chorioretinal fusion.