Archives of Ophthalmology

BARKAN, OTTO

1950 Archives of Ophthalmology

doi: 10.1001/archopht.1950.00910010808001

Abstract IN THIS communication the mode of action of cyclodialysis is interpreted on the basis of histologic observations in 2 eyes operated on for chronic glaucoma. Tension was successfully normalized by cyclodialysis and remained so from the time of operation until the patient's death, fifteen months later. Gonioscopic findings in similar cases are coordinated in the study, and certain surgical conclusions are drawn. Heretofore, histologic examination of eyes treated by cyclodialysis has been performed only in cases in which the operation failed, with 1 exception. This was an eye operated on by Elsching1 in which tension was normalized for fifteen years, from the date of operation until the patient's death. The upper inner part of the anterior chamber (untouched by the cyclodialysis spatula) showed broad glaucomatous synechias of the root of the iris. Schlemm's veins were partly occluded. In the region of cyclodialysis the synechias were separated from the References 1. Elschnig, A.: Zur Wirkungsweise der Cyklodialyse , Ber. ü. d. Versamml. d. deutsch. ophth. Gesellsch. 90:21, 1933. 2. Barkan, O.; Boyles, S. F., and Maisler, S.: On the Genesis of Glaucoma: Improved Method Based on Slitlamp Microscopy of Angle of Anterior Chamber , Am. J. Ophth. 19:209-215, 1936. 3. Vannas, M. V.: Zykloskopische Untersuchungen über das Verhalten des Strahlenkörpers nach der Heineschen Operation , Klin. Monatsbl. f. Augenh. 95:629, 1935. 4. Barkan, O.; Boyle, S. F., and Maisler, S.: On the Surgery of Glaucoma: Mode of Action of Cyclodialysis , Am. J. Ophth. 19:21-25, 1936. 5. Sugar, S., in Berliner, M. I.: Biomicroscopy of the Eye: Slit Lamp Microscopy of the Living Eye , New York, Paul B. Hoeber, Inc., 1943, vol. 1, 642-643. 6. Clarke, S.: Gonioscopic Observations in Cyclodialysis Operations , Am. J. Ophth. 24:1026-1028, 1941. 7. Barkan, O.: Cyclodialysis, Multiple or Single, with Air Injection , Am. J. Ophth. 30:1063-1073, 1947. 8. Meller, J.: Personal communication to the author. 9. Barkan, O.: Choice of Operation in Glaucoma , Am. J. Ophth. 24:1-11, 1941. 10. Barkan: Footnotes 7 and 9.

VANNAS, MAUNO

1950 Archives of Ophthalmology

doi: 10.1001/archopht.1950.00910010819002

Abstract LITTLE is known about the effect of operation on the lacrimal gland, and no reports are available on transplantation of this organ, in contrast to the vast literature on surgical procedures on other parts of the lacrimal apparatus. Obviously, the subject not only is of theoretic interest but has important practical aspects. Disturbances in the secretion of tears are of two types: In one type, the eyes are dry, owing to lack of tears; in the other, there appears to be an overproduction of tears. The question whether deficient secretion can be corrected by substitution of the glandular tissue with transplants from the lacrimal glands of the second type has not been studied. With this possibility in mind, I attempted to graft the palpebral portion of the lacrimal gland from healthy persons with annoying epiphora to the eyes of patients with advanced corneal and conjunctival xerosis due to old trachoma. References 1. I use this technic routinely in removal of the palpebral part of the lacrimal gland. A description of the method will be published in the American Journal of Ophthalmology. 2. Radnót, M.: Die pathologische Histologie der Tränendrüse , Basel, S. Karger, 1939. 3. Greene, E. C.: Anatomy of the Rat , Transactions of the American Philosophical Society, new series, vol. 27, Philadelphia, University of Pennsylvania Press, 1935. 4. Griffith, J. Q. Jr., and Farris, E. A.: The Rat in Laboratory Investigations , Philadelphia, J. B. Lippincott Company, 1942. 5. Jaffé, R.: Anatomie und Pathologie der Spontanerkrankungen der kleinen Laboratoriumtiere: Kaninchen , Meerschweinchen, Ratte, Maus, Berlin, Julius Springer, 1931. 6. Loeb, L.: The Biological Basis of Individuality , Springfield, I11., Charles C Thomas, Publisher, 1944.

CASSADY, J. VERNAL;THOMPSON, JOHN M.;POPE, J. LON

1950 Archives of Ophthalmology

doi: 10.1001/archopht.1950.00910010828003

Abstract THEORIES to explain the occurrence of hyphema following cataract extraction have suggested a low ascorbic acid content, trauma from the dressing of the eye, blepharospasm, rupture of the new-formed capillaries of the wound and hemorrhage from an iridectomy. The usually accepted explanation of postoperative hemorrhage is rupture of newformed capillaries in the healing wound. The fact that these hemorrhages often occur at night on the third or fourth postoperative day, when the least trauma is being exerted, and often in the most cooperative and placid patients, does not make this explanation of the hyphema entirely satisfactory. Hyphema rarely occurs if a preliminary iridectomy has been done. The incidence in several published series is reduced from 10 or 12 to 2 or 3 per cent if a preliminary iridectomy has been performed. Yet the wound healing and the rupture of the capillaries in these wounds would be comparable if no iridectomy References 1. DeVoe, G.: Hemorrhage After Cataract Extraction: Clinical and Experimental Investigation of Its Cause and Treatment , Arch. Ophth. 28:1069-1096 ( (Dec.) ) 1942.Crossref 2. Franta, J.: Die Askorbinsäure (Vitamin C) in Metabolismus des Kammerwassers , Arch. f. Augenh. 110:574-609 ( (Nov.) ) 1937. 3. Gapeev, P. I.: Ascorbic Acid Content of Aqueous Humor, Crystalline Lens and Blood in Cataract Patients and in Normal Persons , Vestnik oftal. 18:154-160, 1941 4. abstracted, Am. J. Ophth. 24:1466 ( (Dec.) ) 1941 5. Arch. Ophth. 27:1219-1220 ( (June) ) 1942. 6. Moreu, A.: El hifema post operatorio en la extracción del cristalino , Arch. Soc. ofta. hispano-am. 5:467-471 ( (June) ) 1945. 7. Roe, J. H., and Kuether, C. A.: The Determination of Ascorbic Acid in Whole Blood and Urine Through the 2, 4-Dinitrophenylhydrazine Derivative of Dehydroascorbic Acid , J. Biol. Chem. 147:399-407 ( (Feb.) ) 1943. 8. Bessey, O. A.; Lowry, O. H., and Brock, M. J.: The Quantitative Determination of Ascorbic Acid in Small Amounts of White Blood Cells and Platelets , J. Biol. Chem. 168:197-205 ( (April) ) 1947.

CAMERON, PAUL B.

1950 Archives of Ophthalmology

doi: 10.1001/archopht.1950.00910010833004

Abstract FAMILY groups have been reported1 in whose members ptosis of the eyelids appeared at birth as a mendelian dominant trait. The present report is concerned with a family group in which ptosis developed in certain members, also as a mendelian dominant trait, only after the eyelids had been normal until 40 years of age. The earliest known affected member (1, fig. 1) was born in the 1840's, had normal eyelids within the memory of some living members of the family and first noted drooping of the lids at about the age of 40, the ptosis increasing in degree until his death, at the age of 70, when he was virtually blind. It is stated that he could lift his lids only a mere bit. Four of his 7 children had ptosis of the eyelids in later life. Member 15, a granddaughter of 1, was 68 years of age. In References 1. Briggs, H. H.: Hereditary Congenital Ptosis, with Report of 64 cases Conforming to the Mendelian Rule of Dominance , Tr. Am. Ophth. Soc. 16:255, 1918. 2. Fuchs, E.: Ueber isolierte doppelseitige Ptosis , Arch. f. Ophth. 36:234, 1890.

ROSS, JOSEPH V. M.

1950 Archives of Ophthalmology

doi: 10.1001/archopht.1950.00910010838005

Abstract THE PUPILLARY PATHWAYS THE ANOMALIES of the pupillary pathways are manifold and intricate. Since it is a truism that to understand better the abnormal, one must know the normal, it would seem proper to review briefly a few salient points concerning these pathways.The size and action of the pupils are determined by the local state of the iris itself, the chemical events occurring at the myoneural junctions, the balance of neural stimuli flowing through the sympathetic and parasympathetic systems and the person's general emotional state. Of greatest importance concerning the local state of the iris is the condition of its blood vessels, relaxation (congestion or sclerosis) of the vessels resulting in miosis and constriction in mydriasis. Although all these factors seem at first glance somewhat distinct, they are so closely interrelated that it is only in unusual circumstances that one can determine their individuality.The normal pupillary diameter is References 1. Duke-Elder, W. S.: Text-Book of Ophthalmology , St. Louis, C. V. Mosby Company, 1949, vol. 4, pp. 3731-3806.

WOODS, ALAN C.;WOOD, RONALD M.;NAQUIN, HOWARD A.

1950 Archives of Ophthalmology

doi: 10.1001/archopht.1950.00910010849006

Abstract IN A PREVIOUS report,1 it was shown that a combination of streptomycin and promizole® (4, 2′-diaminophenyl-5′-thiazolylsulfone) had a marked therapeutic effect on experimental ocular tuberculosis in immune-allergic rabbits. It is well known that experimental ocular tuberculosis runs a much severer and more fulminating course in the normal rabbit than it does in the previously infected, or immuneallergic rabbit. The following experimental studies were therefore undertaken to determine (1) the effect of streptomycin and promizole® on experimental ocular tuberculosis in the normal rabbit—a much severer test of the therapeutic efficacy of these agents—and (2) whether these agents operated independent of the immunity factor produced by a former systemic infection. PLAN OF EXPERIMENT Thirty normal rabbits, of both sexes, and of the same stock used in the previous experiments of this series, were inoculated in the anterior chamber of the right eye with 0.1 cc. of a six week culture References 1. Woods, A. C., and Wood, R. M.: Studies in Experimental Ocular Tuberculosis: XIII. Effect of Streptomycin and Promizole® in Experimental Ocular Tuberculosis in the Immune-Allergic Rabbit , Arch. Ophth. 40:413 ( (Oct.) ) 1948.Crossref 2. Petragnani's medium is widely used as a routine medium for the isolation of Myco. tuberculosis from clinical material. Dubos' medium was also used in this study because it will frequently give earlier isolations, especially when there are no interfering contaminants. 3. Middlebrook, G., and Yegian, D.: Certain Effects of Streptomycin on Mycobacterium in Vitro , Am. Rev. Tuberc. 54:553, 1946.

WOODS, ALAN C.;WOOD, RONALD M.;NAQUIN, HOWARD A.

1950 Archives of Ophthalmology

doi: 10.1001/archopht.1950.00910010860007

Abstract AUREOMYCIN has been shown to be successful in the treatment of a wide variety of infectious diseases.1 It has also been shown that resistance to aureomycin by many organisms is developed much more slowly and to a less degree than is resistance to streptomycin.2 Braley and Sanders3 reported 2 cases of tuberculous uveitis in which decided improvement followed treatment with aureomycin. Schoenbach4 treated 6 patients with various forms of tuberculosis. Two of these 6 showed improvement, 1 with a renal infection, the other with scrofulous draining sinuses of the neck. Steenken and Wolinsky5 found the in vitro sensitivity of the H37 RV strain of Mycobacterium tuberculosis to vary from 5 to 40 micrograms per cubic centimeter, depending on the medium used for the assay. These authors treated the disease in guinea pigs with aureomycin and concluded that the course of the clinical disease was not References 1. Long, P. H.; Schoenbach, E. B.; Bliss, E. A.; Bryer, M. S., and Chandler, C. A.: The Experimental and Clinical Use of Polymyxin, Chloromycetin, and Aureomycin , California Med. 70:1, 1949. 2. Price, C. W.; Randall, W. A., and Welch, H.: Bacteriological Studies of Aureomycin , Ann. New York Acad. Sc. 51:211, 1948.Crossref 3. Braley, A. E., and Sanders, M.: Aureomycin in Ocular Infections: A Study of Its Spectrum , Ann. New York Acad. Sc. 51:280, 1948.Crossref 4. Schoenbach, E. B.: The Newer Antibiotics: Polymyxin, Chloromycetin, and Aureomycin (Janeway Memorial Lecture) , J. Mt. Sinai Hosp. 16:71, 1949. 5. Steenken, W., Jr., and Wolinsky, E.: Tuberculostatic Activity of Aureomycin in Vitro and in Vivo , Am. Rev. Tuberc. 59:221, 1949. 6. This preparation was supplied by Lederle Laboratories, Inc., Pearl River, N. Y. 7. Dornbush, A. C., and Pelcak, E. J.: The Determination of Aureomycin in Serum and Other Body Fluids , Ann. New York Acad. Sc. 51:218, 1948.Crossref 8. J. Exper. Med. 83:409 [ (May) ] 1946Crossref

deROETTH, ANDREW

1950 Archives of Ophthalmology

doi: 10.1001/archopht.1950.00910010864008

Abstract IN 1943 Nachmansohn and Machado1 discovered a new enzyme, choline acetylase, which in cell-free solution, under strict anaerobic conditions and in the presence of adenosine triphosphate, synthesizes acetylcholine in vitro. The presence of the enzyme was demonstrated in2 nerve-containing and muscle-containing tissues of a wide variety of animals, viz., in those tissues that also contain an appreciable amount of cholinesterase. Since the acetylase forms and the esterase splits acetylchline, such a finding should not be surprising. To demonstrate the presence of choline acetylase in ocular tissues, the following experiment was undertaken. METHOD Preparation of the Ensyme. —The acetone-dried powder method as described by Nachmansohn and John2c was employed, since it yields higher values than the fresh tissue homogenates. The animals were killed, the eyes enucleated and the tissues dissected and placed immediately into solid carbon dioxide, such a step being necessary because choline acetylase, being a very References 1. Nachmansohn, D., and Machado, A. L.: The Formation of Acetylcholine. A New Enzyme: "Choline Acetylase,'' J. Neurophysiol. 6:397, 1943. 2. (a) Nachmansohn, D.; John, H. M., and Waelsch, H.: Effect of Glutamic Acid on the Formation of Acetylcholine , J. Biol. Chem. 150:485, 1943. 3. (b) Nachmansohn, D., and John, H. M.: On the Formation of Acetylcholine in the Nerve Axon , Science 102:250, 1945Crossref 4. (c) Studies on Choline Acetylase: I. Effect of Amino Acids on the Dialyzed Enzyme , J. Biol. Chem. 158:157, 1945. 5. (d) Nachmansohn, D.; John, H. M., and Berman, M.: Studies on Choline Acetylase: II. The Formation of Acetylcholine in the Nerve Axon , J. Biol. Chem. 163:475, 1946. 6. (e) Nachmansohn, D., and Berman, M.: Studies on Choline Acetylase: III. On the Preparation of the Coenzyme and Its Effect on the Enzyme , J. Biol. Chem. 165:551, 1946. 7. (f) Nachmansohn, D.; Berman, M., and Weiss, M. S.: Presence of Choline Acetylase in Striated and Cardiac Muscle , J. Biol. Chem. 167:295, 1947. 8. (g) Nachmansohn, D., and Weiss, M. S.: Studies on Choline Acetylase: IV. Effect of Citric Acid , J. Biol. Chem. 172:677, 1948. 9. Chang, H. C., and Gaddum, J. H.: Choline Esters in Tissue Extracts , J. Physiol. 79:255, 1933. 10. deRoetth, A., Jr.: Cholinesterase Activity in Ocular Tissues and Fluids, to be published.

BLAUSTEIN, ANCEL;CACCAVO, ARNOLD

1950 Archives of Ophthalmology

doi: 10.1001/archopht.1950.00910010868009

Abstract DURING the last fifteen years the literature on infectious mononucleosis has increased greatly,1 and with this addition has come the realization that the signs and symptoms of the disease are manifold and its clinical behavior not always predictable. In 1941 Thelander and Shaw2 reviewed the cerebral complications but did not mention papilloretinal edema. In 1948 Tidy3 reviewed the neurologic findings, but likewise did not mention retinal edema. Ashworth and Motto4 in 1947 reported a case of infectious mononucleosis complicated by bilateral papilloretinal edema in the absence of a clinical picture of meningitis or encephalitis. No other reports in which papilloretinal edema was one of the major features have since appeared. The following case was of considerable interest to us because of the confusion of the history that colored the differential diagnosis. The laboratory data and the subsequent progression of clinical events substantiated the diagnosis of infectious References 1. Schmidt, J., and Nyfeldt, A.: Infectious Mononucleosis and MeningoEncephalitis , Ugesk f. læger 100:336, 1938 2. abstracted, J. A. M. A. 110:1884 ( (May 28) ) 1938. 3. Tidy, H. L.: Glandular Fever and Infectious Mononucleosis , Lancet 2:180 and 236, 1934.Crossref 4. Zohman, B. L., and Silverman, E. G.: Infectious Mononucleosis and Encephalomyelitis , Ann. Int. Med. 16:1233, 1942.Crossref 5. Landes, R.; Reich, J. P., and Perlow, S.: Central Nervous System Manifestations of Infectious Mononucleosis , J. A. M. A. 116:2482-2484 ( (May 31) ) 1941.Crossref 6. Epstein, S. H., and Dameshek, W.: Involvement of Central Nervous System in Case of Glandular Fever , New England J. Med. 205:1238-1241, 1931.Crossref 7. Johansen, A. H.: Serous Meningitis and Infectious Mononucleosis , Acta. med. Scandinav. 76:269-272, 1931.Crossref 8. Ricker, W.; Blumberg, A.; Peters, C. H., and Widerman, A.: The Association of the Guillain-Barré Syndrome with Infectious Mononucleosis , Blood 2:217-226, 1947. 9. Bethell, F. H.; Sturgis, C. C.; Hettig, R. A., and Mallery, O. T., Jr.: Blood: Review of Recent Literature , Arch. Int. Med. 69:1051-1126 ( (June) ) 1942.Crossref 10. Philip, A. J.: Infectious Mononucleosis: Unusual Case , New York State J. Med. 41:1664-1665, 1941. 11. Fowler, W. M., and Tidrick, R. T.: Unusual Manifestations of Infectious Mononucleosis , Am. J. Clin. Path. 10:548-553, 1940. 12. Thelander, H. E., and Shaw, E. B.: Infectious Mononucleosis, with Special Reference to Cerebral Complications , Am. J. Dis. Child. 61:1131-1145 ( (June) ) 1941.Crossref 13. Tidy, H.: Infectious Mononucleosis , Blood 3:823-829, 1948. 14. Ashworth, J., and Motto, S. A.: Infectious Mononucleosis Complicated by Bilateral Papilloretinal Edema , New England J. Med. 237:544-545, 1947.Crossref

DeVOE, ARTHUR GERARD

1950 Archives of Ophthalmology

doi: 10.1001/archopht.1950.00910010872010

Abstract FAT EMBOLISM has been described1 as a condition in which fat is circulating in the blood stream in globules large enough to occlude the capillaries and induce multiple anoxic foci. Although this disease is considered something of a rarity, Scuderi2 in 1941 stated that there were over 600 references to fat embolism in the literature. He further stated that clinically the condition was difficult to substantiate, the difficulty being due not so much to the fault of the diagnostician as to the nature of the disease. A recent report by Fritz and Hogan3 has indicated the rarity of ocular signs of the condition. Further investigation has revealed that, although ocular fat embolism is not so rare as has been thought, it nevertheless is distinctly unusual. Particularly is the diagnosis rarely based on pathologic study. At least 23 case reports of ocular fat embolism are readily available, 7 References 1. Robb-Smith, A. H. T.; Hunt, A. H.; Russell, D., and Greenfield, J. G.: Discussion on Fat Embolism and the Brain , Proc. Roy. Soc. Med. 34:639-656, 1941. 2. Scuderi, C. S.: Fat Embolism: A Clinical and Experimental Study , Surg., Gynec. & Obst. 72:732-746, 1941. 3. Fritz, M. H., and Hogan, M. J.: Fat Embolization Involving the Human Eye , Am. J. Ophth. 31:527-534, 1948. 4. Urbanek, J.: Fat Embolus of the Eye , Arch. f. Ophth. 131:147-173, 1933 5. abstracted, Am. J. Ophth. 17:383, 1934. 6. Löwenstein, A.: Fettembolie als Ursache der Angiopathia retinae traumatica (Purtscher) , Klin. Monatsbl. f. Augenh. 96:62-71, 1936 7. abstracted, Am. J. Ophth. 19:440-441, 1936. 8. Evans, J. J.: Cerebral Fat Embolism with Recovery and Involvement of the Central Retinal Artery , Brit. J. Ophth. 24:614-616, 1940. 9. Bernhard, F.: Ueber Fettembolie in dem Blutgefassen des Auges , med. Wchnschr. 72:1590, 1925. 10. Walsh, F. B.: Clinical Neuro-Ophthalmology , Baltimore, Williams & Wilkins Company, 1947, pp. 1009-1012. 11. Hosch: Fettembolie der Retina , Arch. f. Augenh. 54:162-164, 1906. 12. Oppolzer, R.: Die Fettembolie der Netzhaut nach Traumen , Arch. f. klin. Chir. 179:176-210. 1934. 13. Groskloss, H. H.: Fat Embolism , Yale J. Biol. & Med. 8:59-61 and 175-197, 1935 14. 297-316, 1936. 15. Vance, B. M.: The Significance of Fat Embolism , Arch. Surg. 23:426-465 ( (Sept.) ) 1931. 16. Hurd, L. M., and Holden, W. A.: A Case of Paraffin Injection into the Nose Followed Immediately by Blindness from Embolism of the Central Artery of the Retina , M. Rec. 64:53-55, 1903. 17. Uhtoff, W.: Injury to the Eyes After Paraffin Injections for Saddle Nose , Ophth. Rec. 15:115-117, 1906. 18. Wright, R. B.: Fat Embolism , Ann. Surg. 96:75-84, 1932. 19. Löwenstein, A., and Foster, J.: Fatty Embolism of the Retinal Artery Found in Eyes After Enucleation and Orbital Exenteration , Brit. J. Ophth. 32:819-823 ( (Nov.) ) 1948. 20. von Czerny: Ueber die klinische Bedeutung der Fettembolie , Berl. klin. Wchnschr. 12:593 and 605, 1875.