Archives of Ophthalmology

Aiello, Lloyd M.;Berrocal, Jose;Davis, Matthew D.;Ederer, Fred;Goldberg, Morton F.;Harris, John E.;Klimt, Christian R.;Knatterud, Genell L.;Margherio, Raymond R.;McLean, Edward N.;McMeel, J. Wallace;Myers, Frank L.;Norton, Edward W. D.;Patz, Arnall;Prout, Thaddeus;Riekhof, F. Tempel;Straatsma, Bradley R.;Tasman, William;Van Heuven, W. A. J.;Watzke, Robert C.

1973 Archives of Ophthalmology

doi: 10.1001/archopht.1973.01000050349001pmid: 4746083

Abstract Diabetic retinopathy has become one of the four most common causes of blindness in the United States.1 Although photocoagulation has been employed in its treatment for more than ten years, its true value remains controversial. In spite of the need for objective, definitive evidence, an adequately controlled study of photocoagulation in the treatment of proliferative diabetic retinopathy has not been performed. This is not surprising, considering the complexity and expense of largescale clinical trials in chronic disease. However, as Inglefinger2 has aptly stated, "When serious diseases are treated by serious methods... then ethical as well as scientific considerations require that medicine depend on the most reliable and the best controlled data available—the kind of data that is sought by randomized clinical study." In keeping with this admonition, a randomized clinical trial of photocoagulation in the treatment of proliferative diabetic retinopathy has been designed and launched. This study References 1. Kahn HA, Moorehead HB: Statistics on Blindness in the Model Reporting Area, 1969-70 , publication 73-427. US Dept of Health, Education, and Welfare, National Institutes of Health, 1973. 2. Inglefinger FJ: The randomized clinical trial . N Engl J Med 287:100-101, 1972.Crossref

Smith, J. Lawton;Hoyt, William F.;Susac, John O.

1973 Archives of Ophthalmology

doi: 10.1001/archopht.1973.01000050351002pmid: 4746084

Abstract In the acute phase of Leber optic neuropathy, there are three characteristic fundus changes: (1) circumpapillary telangiectatic microangiopathy, (2) swelling of the nerve fiber layer around the disc ("pseudoedema"), and (3) absence of staining on fluorescein angiography. These findings are illustrated by eight cases and in our experience are pathognomonic for this disease. References 1. Duke-Elder S: System of Ophthalmology . St. Louis, CV Mosby Co, 1971, vol 12, pp. 108-111. 2. Lauber H: Eine Fall con familiarer retrobulbarer Neuritis . Wien Klin Wochen schr 15: 1264-1265, 1902. 3. van Heuven GJ: Die Diagnose der hereditaren Leberschen Sehnervenatrophie . Klin Monatsbl Augenheilkd 73:252-253, 1924. 4. Imachi J, Nishizaki K: Neurosurgical treatment of Leber's optic atrophy . Folia Ophthalmol Jap 21:209-217, 1970.

Uriu, Stanley A.;Reinecke, Robert D.

1973 Archives of Ophthalmology

doi: 10.1001/archopht.1973.01000050357003pmid: 4746085

Abstract There appear to be no reports to date indicating any relationship between the use of alternate-day steroid therapy and thromboembolic phenomena, let alone the relationship of these factors to temporal arteritis. We report two cases of thromboembolic complications occurring during prednisone treatment of temporal arteritis. Demonstration of a causal link awaits further study, for the association reported here may be due to chance. Our intent is only to alert other physicians to the possibility of such a link. References 1. Spencer RW, Andelman SY: Steroid cataracts . Arch Ophthalmol 74:38-41, 1965.Crossref 2. Ogelsby RB, et al: Cataracts in patients with rheumatic diseases treated with corticosteroids . Arch Ophthalmol 66:519-523; 625-630, 1961.Crossref 3. Giles CL, et al: The association of cataract formation and systemic corticosteroid therapy . JAMA 182:719-722, 1962.Crossref 4. Wiesinger H, Irby R: Posterior subcapsular cataract (PSC) in patients with rheumatoid arthritis treated with corticosteroids . Invest Ophthalmol 2:294, 1963. 5. Havre DC: Cataracts in children on longterm corticosteroid therapy . Arch Ophthalmol 73:818-821, 1965.Crossref 6. Braver DA, Richards RD, Good TA: Posterior subcapsular cataracts in steroid treated children . Arch Ophthalmol 77:161-162, 1967.Crossref 7. Fürst C, Smiley WK, Ansell BM: Steroid cataract . Ann Rheum Dis 25:364-368, 1966. 8. Toogood JH, et al: Posterior subcapsular cataracts as a complication of adrenocortical steroid therapy . Can Med Assoc J 86:52-56, 1962. 9. Bernstein HN, Schwartz B: Effects of longterm systemic steroids on ocular pressure and tonographic values . Arch Ophthalmol 68:742-753, 1962.Crossref 10. Bernstein HN, Mills DW, Becker B: Steroid induced elevation of intraocular pressure . Arch Ophthalmol 70:15-18, 1963.Crossref 11. Kalina RE: Increased intraocular pressure following subconjunctival corticosteroid administration . Arch Ophthalmol 81:788-790, 1969.Crossref 12. Alfano JE: Changes in the intraocular pressure associated with systemic steroid therapy . Am J Ophthalmol 56:245-247, 1963. 13. MacGregor RR, Sheagren JN, Lipsett MB: Alternate day prednisone therapy . N Engl J Med 280:1427-1431, 1969.Crossref 14. Portner MM, et al: Successful initiation of alternate day prednisone in chronic steroid dependent asthmatic patients . J Allergy Clin Immunol 49:16-26, 1972.Crossref 15. Fisher DA, Panos TC: Intermittent corticosteroid therapy, present status . Postgrad Med 39:650-657, 1966. 16. Hamilton CR Jr, Shelley WM, Tumulty PA: Giant cell arteritis: Including temporal arteritis and polymyalgia rheumatica . Medicine 50:1-27, 1971.Crossref 17. Shick RM, et al: Effects of cortisone and ACTH on periarteritis nodosa and cranial arteritis . Pro Staff Meet Mayo Clin 25:492-494, 1950. 18. Birkhead NC, Wagener HP, Shick RM: Treatment of temporal arteritis with adrenal corticosteroids: Results of 55 cases in which lesions were proven at biopsy . JAMA 163:821-827, 1957.Crossref 19. Meadows SP: Temporal or giant cell arteritis . Proc Roy Soc Med 59:329-333, 1966. 20. Russell RWR: Giant cell arteritis: A review of 35 cases . Quart J Med 28:471-489, 1959. 21. Hollenhorst RW, et al: Neurologic aspects of temporal arteritis . Neurology 10:490-498, 1960.Crossref 22. Cranial arteritis and polymyalgia rheumatica, editorial . Lancet 2:926-927, 1967. 23. Harter JG, Reddy WJ, Thorn GW: Studies on an intermittent corticosteroid dosage regimen . N Engl J Med 269:591-596, 1963.Crossref 24. Siegel SC, et al: Effects of alternate-day steroid therapy in asthmatic children . J Allerg 36:209, 1965. 25. Saxena KM, Crawford JD: Medical intelligence, current concepts, the treatment of nephrosis . N Engl J Med 272:522-526, 1965.Crossref 26. Soyka LF, Saxena KM: Alternate-day steroid therapy for nephrotic children . JAMA 192:225-230, 1965.Crossref 27. Ackerman GL, Nolan CM: Adrenocortical responsiveness after alternate-day corticosteroid therapy . N Engl J Med 278:405-409, 1968.Crossref 28. Hume M, et al: Venous Thrombosis and Pulmonary Embolism . Cambridge, Mass, Harvard University Press, 1970, pp 54-58. 29. Cooke WT, et al: Temporal arteritis: A generalized vascular disease . Quart J Med 15: 27-76, 1946. 30. Andersen T: Arteritis temporalis (Horton): A symptom of a generalized vascular disease . Acta Med Scand 128:151-178, 1947.Crossref 31. Forsham PH: The adrenals , in Williams RH (ed): Textbook of Endocrinology , ed 4. Philadelphia, WB Saunders Co, 1968, chap 5. 32. Cosgriff SW: Thromboembolic complications associated with ACTH and cortisone therapy . JAMA 147:924-926, 1951.Crossref 33. Hartman MM: Thromboembolic phenomena in severe asthma . Calif Med 98:27-32, 1963. 34. Symchych PS, Perrin EV: Thrombosis of the main pulmonary artery in nephrosis . Am J Dis Child 110:636-642, 1965.Crossref 35. Cosgriff SW, Diefenbach AF, Vogt W Jr: Hypercoagulability of the blood associated with ACTH and cortisone therapy . Am J Med 9:752-756, 1950.Crossref 36. Hume DM, Moore FD: The use of ACTH, cortisone and adrenal cortical extracts in surgical patients , in Mote JR (ed): Proceedings of the Second Clinical ACTH Conference . New York, Blakiston, 1951, vol 2, pp 289-303. 37. Margulis RR, in discussion, Hume DM, Moore FD: The use of ACTH, cortisone and adrenal cortical extracts in surgical patients , in Mote JR (ed): Proceedings of the Second Clinical ACTH Conference . New York, Blakiston, 1951, vol 2, pp 289-303. 38. Russek HI, Zohman BL, Russek AS: Risk of thromboembolic complications from cortisone therapy . Am Heart J 47:653-657, 1954.Crossref 39. Allanby KD: Deaths associated with steroid hormone therapy: An analysis of 18 cases . Lancet 1:1104-1110, 1957.Crossref 40. David DS, Grieco H, Cushman P Jr: Adrenal glucocorticoids after 20 years: A review of their clinically relevant consequences . J Chronic Dis 22:637-711, 1970.Crossref 41. Smith RW, et al: The influence of ACTH and cortisone on certain factors of blood coagulation . Science 112:295-297, 1950.Crossref 42. Ozsoylu S, Strauss HS, Diamond LK: Effects of corticosteroids on coagulation of the blood . Nature 195:1214-1215, 1962.Crossref 43. Canale VC, et al: Effect of corticosteroids on factor VIII level . J Pediatr 71:878-880, 1967.Crossref 44. Trieger N, McGovern JJ: Evaluation of corticosteroids in hemophilia: A controlled study during oral surgery . N Engl J Med 266:432-437, 1962.Crossref 45. Monto RW, et al: Observations on the effect of ACTH and cortisone in the coagulation of blood . J Lab Clin Med 36:1008, 1950. 46. Aronson SB, et al: Pathogenic approach to therapy of peripheral corneal inflammatory disease . Am J Ophthalmol 70:65-90, 1970. 47. Elliott JH, et al: Heparin therapy of peripheral corneal ischemic syndromes , in Symposium on the Cornea: Transactions of the New Orleans Academy of Ophthalmology . St. Louis, CV Mosby Co, 1972, pp 78-104.

Sipperley, Jack;Anderson, Douglas R.;Hamasaki, Duco

1973 Archives of Ophthalmology

doi: 10.1001/archopht.1973.01000050360004pmid: 4746086

Abstract In six human volunteers, serial electroretinograms (ERGs) were performed over five minutes at intraocular pressure artificially elevated with a suction cup. Compared to the base line ERG, there was no decrease in b-wave amplitude unless intraocular pressures approached or exceeded diastolic ophthalmic artery pressure, as determined by suction cup ophthalmodynamometry. Although reduced severely, the b-wave was not completely obliterated within five minutes, even at intraocular pressures above the mean ophthalmic artery pressure and in some cases above systolic artery pressure. References 1. Ward B: Some effects of short-term pressure increases in the cat eye . Am J Optom 44: 183-191, 1967.Crossref 2. Fujino T, Hamasaki DI: Effect of intraocular pressure on the electroretinogram . Arch Ophthalmol 78:757-765, 1967.Crossref 3. Uenoyama K, McDonald JS, Drance SM: The effect of artificially elevated intraocular pressure on the electroretinogram of the cat . Canad J Ophthalmol 3:154-158, 1968. 4. Uenoyama K, McDonald JS, Drance SM: The effect of artificially elevated intraocular pressure on the electroretinogram of the rabbit . Canad J Ophthalmol 3:58-64, 1968. 5. Fujino T, Hamasaki DI: The effect of occluding the retinal and choroidal circulations on the electroretinogram of the monkey . J Physiol 180:837-845, 1965. 6. Gerstle CL, Anderson DR, Hamasaki, DI: Pressure effect on ERG and optic nerve conduction of vision impulse: Short-term effects in owl monkeys . Arch Ophthalmol 90:121-124, 1973.Crossref 7. Galin MA, Baras I, Cavero R: Ophthalmodynamometry using suction . Arch Ophthalmol 81:494, 1969.Crossref 8. Karlberg B, Hedin A, Bjornberg K: Electroretinography during short-term intraocular tension rise . Acta Ophthalmol 46:742, 1968.Crossref

Christy, Norval E.;Lall, Pramila

1973 Archives of Ophthalmology

doi: 10.1001/archopht.1973.01000050363005pmid: 4355638

Abstract Experience with over 77,000 consecutive cataract extractions performed mainly by two surgeons over a 16-year period in a village hospital in Pakistan is reviewed. The incidence of immediate postoperative endophthalmitis is studied in some detail in 54,000 of these cases. In about 10,000 cases, prophylactic subconjunctival injections of antibiotics, such as framycetin, chloramphenicol, gentamicin sulfate, and penicillin sodium, were given. The incidence of immediate postoperative endophthalmitis was not notably reduced by these medications. Techniques and complications that added to the intraocular instrumentation were accompanied by an increased rate of endophthalmitis. References 1. Leopold IH, Apt L: Postoperative intraocular infections . Am J Ophthalmol 50:1225-1247, 1960. 2. Franken S, Mehta KR: Ophthalmic morbidity in the dry belt of Punjab and Haryana: Research report VRA-IND-11-64. Indian Counc of Med Res Spec Rep Ser, to be published. 3. Burns RP: Postoperative infections in an ophthalmic hospital with comments upon bacteriophage typing of staphylococci as a preventive tool . Am J Ophthalmol 48:519-526, 1959. 4. Bellows JG: Postoperative endophthalmitis: A major challenge . Ann Ophthalmol 2:124, 1970. 5. Awan AH: Pakistan and its health problems . Bull Pakistan Med Assoc (W.Z.) 2:16-20, 1962. 6. World Bank Atlas IBRD, Washington, 1971 7. Baqai M: The Pakistan Times , (March 23) , 1972, p 5. 8. Alimuddin M: Incidence and treatment of trachoma in Pakistan . Br J Ophthalmol 42:360-366, 1958.Crossref 9. Christy NE: Effect of early ambulation on the incidence of postoperative complication of cataract surgery . Am J Ophthalmol 49:293-297, 1960. 10. Christy NE: Cataract extractions in a Pakistani village hospital . Isr J Med Sci 8:1250-1254, 1972. 11. Allen HF, Mangiaracine AB: Bacterial endophthalmitis after cataract extraction: A study of 22 infections in 20,000 operations . Arch Ophthalmol 72:454-462, 1964.Crossref 12. Allen HF, Mangiaracine AB: Bacterial endophthalmitis after cataract extraction: II. Incidence in 36,000 consecutive operations with special reference to preoperative topical antibiotics. Trans Am Acad Ophthalmol Otolaryngol, to be published. 13. Kanski JJ: Treatment of suppurative intraocular infections . Br J Ophthalmol 54:316-322, 1970.Crossref 14. Locatcher-Khorazo D, Gutierrez E: Eye infections following cataract extraction with special reference to the role of Staphylococcus aureus . Am J Ophthalmol 41:981-986, 1956. 15. Jaffe NS: The vitreous . Arch Ophthalmol , 87:599-611, 1972.Crossref 16. Chalkley THF, Shoch D: An evaluation of prophylactic antibiotic injection in cataract surgery . Am J Ophthalmol 64:1084-1087, 1967. 17. Aronstam RH: Pitfalls of prophylaxis alteration of postoperative infection by penicillinstreptomycin . Am J Ophthalmol 57:312-315, 1964. 18. Rollins HJ Jr: Endophthalmitis: A review of 28 cases . South Med J 58:353-357, 1965.Crossref 19. Nevau M, Elliot AJ: Prophylaxis and treatment of endophthalmitis . Am J Ophthalmol 48:368-373, 1959.

Dohlman, Claes H.;Boruchoff, S. Arthur;Mobilia, Eleanor F.

1973 Archives of Ophthalmology

doi: 10.1001/archopht.1973.01000050369006pmid: 4746087

Abstract Two hundred seventy-eight patients with corneal disease were fitted with soft hydrophilic contact lens for therapeutic purposes, such as comfort, protection, or healing. In about half the number of cases, the lens was felt to be beneficial, primarily in those cases with edema, dry eyes, ulcers, or trichiasis. Serious complications were relatively few, mainly consisting of inflammation with stromal infiltrates. Eleven patients develped stromal infiltrates, at least four of which were definite infections, causing permanent damage. It was concluded, however, that in many cases of corneal disease the advantages of applying a soft contact lens far outweighs its risks. The importance of frequent observation and prophylactic antibiotics is stressed in cases with epithelial defect and in dry eyes. References 1. Wichterle 0, Lim D: Hydrophilic gels for biological use . Nature 185:117-118, 1960.Crossref 2. Dreifus M, Wichterle O: Clinical experiences with hydrogel contact lenses . Cesk Oftalmol 20:393-399, 1964. 3. Rycroft BW: The new hydrophilic gel contact lenses . Highlights Ophthalmol 7:253, 1964. 4. Gasset AR, Kaufman HE: Therapeutic uses of hydrophilic contact lenses . Am J Ophthalmol 69:252-259, 1970. 5. Lerman S, Sapp G: The hydrophilic (Hydron) corneoscleral lens in the treatment of bullous keratopathy . Ann Ophthalmol 2:142-144, 1970. 6. Kaufman HE, et al: The medical uses of soft contact lenses . Trans Am Acad Ophthalmol Otolaryngol 75:361-373, 1970. 7. Buxton JN, Locke CR: A therapeutic evaluation of hydrophilic contact lenses . Am J Ophthalmol 72:532-534, 1971. 8. Leibowitz HM, Rosenthal P: Hydrophilic contact lenses in corneal disease: I. Superficial sterile, indolent ulcers . Arch Ophthalmol 85: 163-166, 1971.Crossref 9. Leibowitz HM, Rosenthal P: Hydrophilic contact lenses in corneal disease: II. Bullous keratopathy . Arch Ophthalmol 85:283-285, 1971.Crossref 10. Espy JW: Management of corneal problems with hydrophilic contact lenses . Am J Ophthalmol 72:521-526, 1971. 11. Feldman GL, et al: Clinical experiences with cosmetic and therapeutic soft lenses . J Contact Lens Soc 5:11, 1971. 12. Gasset AR, Kaufman HE: Bandage lenses in the treatment of bullous keratopathy . Am J Ophthalmol 72:376-380, 1971. 13. Aquavella JV, Jackson GK: Therapeutic effect of Bionite lenses: Mechanism of action . Ann Ophthalmol 3:1341-1350, 1971. 14. Hill RM: Effects of hydrophilic plastic lenses on corneal respirations . J Am Optom Assoc 38:181, 1967. 15. Morrison DR, Edelhauser HF: Permeability of hydrophilic contact lenses . Invest Ophthal 11:58-63, 1972. 16. Holly FJ, Refojo MF: Oxygen permeability of hydrogel contact lenses . J Am Optom Assoc 43:1173-1180, 1972. 17. Bernstein HN, Maddox Y: Corneal pathogenicity of Serratia marcescens . Trans Am Acad Ophthalmol Otolaryngol 74:432-440, 1973.

Shimada, Kohkichi;O'Connor, G. Richard

1973 Archives of Ophthalmology

doi: 10.1001/archopht.1973.01000050374007pmid: 4746088

Abstract An immune adherence hemagglutination (IAHA) test has been developed for the rapid detection of antibodies against Toxoplasma gondii. This test, which utilizes human type 0 erythrocytes and Toxoplasma organisms fixed in formaldehyde solution, is easy to perform, safe, and sensitive. Like the Toxoplasma dye test, the IAHA reaction detects antibodies to surface antigens of Toxoplasma. Unlike the Toxoplasma dye test, the procedure does not require the continuous maintenance of living parasites. Sera from 80 patients presumed to have toxoplasmic retinochoroiditis and from two rabbits with established Toxoplasma infections were tested by the dye test, the standard hemagglutination (HA) test, and the IAHA test. While there was good general agreement of results in all three tests, the results of the IAHA test correlated more closely with those of the dye test than with those of the standard HA test. References 1. Sabin AB, Feldman HA: Dye tests as microchemical indicators of a new immune phenomenon affecting a protozoan parasite (Toxoplasma) . Science 108:660-663, 1948.Crossref 2. Jacobs L, Lunde MN: A hemagglutination test for toxoplasmosis . J Parasitol 43:308-314, 1957.Crossref 3. Warren J, Sabin AB: The complement fixation reaction in toxoplasmic infection . Proc Soc Exp Biol Med 51:11-14, 1942.Crossref 4. Goldman M: Staining Toxoplasma gondii with fluorescein-labeled antibody: A new test for antibodies to Toxoplasma based upon inhibition of specific staining . J Exp Med 105:557-573, 1957.Crossref 5. O'Connor GR: Precipitating antibody to Toxoplasma: A follow-up study on findings in the blood and aqueous humor . Am J Ophthalmol 44:75-85, 1957. 6. Mayumi M, Okochi K, Nishioka K: Detection of Australia antigen by means of immune adherence hemagglutination test . Vox Sang 20: 178-181, 1971.Crossref 7. Ito M, Tagaya I: Immune adherence hemagglutination test as a new sensitive method for titration of animal virus antigens and antibodies . Jap J Med Sci Biol 19:109-126, 1966.Crossref 8. Nishioka K: Measurements of complement by agglutination of human erythrocytes reacting in immune adherence . J Immunol 90:86-97, 1963. 9. Kabat EA, Mayer MM: Experimental Immunochemistry , ed 2. Springfield, Ill, Charles C Thomas Publisher, 1964, p 133. 10. Nozik RA, O'Connor GR: Experimental toxoplasmic retinochoroiditis . Arch Ophthalmol 79:485-489, 1968.Crossref 11. Maloney ED, Kaufman HE: The rapid and convenient detection of Toxoplasma antibodies using formaldehyde-treated human erythrocytes . Am J Ophthalmol 50:945-950, 1960. 12. Mitchell RG, Green CA: The hemagglutination test for Toxoplasma antibodies . J Clin Pathol 13:331-335, 1960.Crossref 13. Lunde MN, Jacobs L: Differences in Toxoplasma dye test and hemagglutination antibodies shown by antigen fractionation . Am J Trop Med Hyg 16:26-30, 1967. 14. Nishioka K, et al: Immunocytological studies on cultured cells derived from nasopharyngeal carcinoma and Burkitt lymphoma, and an improved method for immune adherence reaction . Gann Monograph 10:265-282, 1970.

Arstikaitis, Maria J.

1973 Archives of Ophthalmology

doi: 10.1001/archopht.1973.01000050378008pmid: 4746089

Abstract Of 33 cases of Stevens-Johnson syndrome treated over a 20-year period, five developed keratitis sicca with corneal pannus and one developed corneal pannus alone. The severity of the ophthalmic complications was related to the severity of the disease in its acute phase and was not related to the local treatment used on the eyes. References 1. Stevens AM, Johnson FC: New eruptive fever associated with stomatitis and ophthalmia: Report on two cases in children . Am J Dis Child 24:526-533, 1922.Crossref 2. Wilk F, Scholz R: Über Erythema Exsudativum Multiforme und Lyell-Syndrom . Wien Med Wochenschr 118:663-668, 1968. 3. Calcaterra TC, Strahan RW: Stevens-Johnson syndrome: Oropharyngeal manifestations . Arch Otolaryngol 93:37-41, 1971.Crossref 4. Ostler HB, Conant MA, Groundwater J: Lyell's disease, the Stevens-Johnson syndrome, and exfoliative dermatitis . Trans Am Acad Ophthalmol Otolaryngol 74:1254-1265, 1970. 5. Botelho SY: Tears and lacrimal gland . Sci Am 211:78-86, 1964.Crossref 6. Bennett JE: The management of total xerophthalmia . Trans Am Ophthalmol Soc 66:503-529, 1968.

Brauninger, Gordon E.;Hood, C. Ian;Worthen, David M.

1973 Archives of Ophthalmology

doi: 10.1001/archopht.1973.01000050382009pmid: 4746090

Abstract An apparently simple cutaneous horn of the lid margin was found to be the manifestation of an underlying occult sebaceous carcinoma of the eyelid. The case is reported because it is not generally recognized that a cutaneous horn may be the sign of a sebaceous carcinoma, which is best initially treated by adequate excision. References 1. Boniuk M, Zimmerman LE: Sebaceous carcinoma of the eyelid, eyebrow, caruncle and orbit . Trans Am Acad Ophthalmol Otolaryngol 72:619-641, 1960. 2. Ginsberg J: Present status of meibomian gland carcinoma . Arch Ophthalmol 73:271-277, 1965.Crossref 3. McGavran MH: The pathologic anatomy of the human pilosebaceous unit , in Helwig R (ed): The Skin . Baltimore, Williams & Wilkins Co, 1971, p 80. 4. Lennox B, Sayed BR: Cutaneous horns . J Pathol Bact 88:575-579, 1964.Crossref

Font, Ramon L.

1973 Archives of Ophthalmology

doi: 10.1001/archopht.1973.01000050384010pmid: 4355639

Abstract A 45-year-old white man had chronic ulcerative keratitis, believed to be herpetic, for two years. Penetrating keratoplasty was performed after a descemetocele had almost perforated the cornea. Microscopically, epithelial cells at the edges of the ulcer contained reddish-purple intranuclear inclusions consistent with Cowdry type A inclusion bodies, although they were not surrounded by a halo. Electron microscopic studies of the formalin-fixed, paraffin-embedded tissue revealed intranuclear, cytoplasmic, and extracellular viral particles that were morphologically typical of herpes simplex. A brief review of the literature establishes the practical application of electron microscopy as a diagnostic tool, especially when inclusion bodies suspected of viral origin are observed in tissues that have been stored in formalin or embedded in paraffin, even for a prolonged period of time. References 1. Zimmerman LE, et al: Application of electron microscopy to histopathologic diagnosis . Trans Am Acad Ophthalmol Otolaryngol 76:101-107, 1972. 2. Fine BS, et al: Electron microscopy of pathologic ocular tissue . Int Ophthalmol Clin 11: 57-86, 1971. 3. Morecki R, Becker NH: Human herpes-virus infection: Its fine structure identification in paraffin-embedded tissue . Arch Pathol 86:292-296, 1968. 4. Hashida T, Yunis EJ: Re-examination of encephalitis brains known to contain intranuclear inclusion bodies: Electron-microscopic observations following prolonged fixation in formalin . Am J Clin Pathol 53:537-543, 1970. 5. Nash G, Foley FD: Herpetic infection of the middle and lower respiratory tract . Am J Clin Pathol 54:857-863, 1970. 6. Edelhauser HF, Schultz RO, Van Horn DL: Experimental herpes simplex keratitis: Corneal hydration, electrolyte content and structural changes . Am J Ophthalmol 68:458-466, 1969. 7. Witmer R, Iwamoto T: Electron microscopic observations of herpes-like particles in the iris . Arch Ophthalmol 79:331-337, 1968.Crossref 8. Takemura T: Electron microscope study of human herpetic keratitis (on the tenth day after the onset of typical dendritic keratitis) . Exp Eye Res 2:305-306, 1963.Crossref 9. Dawson C, Togni B, Moore TE Jr: Structural changes in chronic herpetic keratitis . Arch Ophthalmol 79:740-747, 1968.Crossref 10. Morgan C, Rose HM, Mednis B: Electron microscopy of herpes simplex virus: I. Entry . J Virol 2:507-516, 1968. 11. O'Callaghan DJ, et al: Kinetics of viral DNA, protein and infectious particle production and alterations in host macromolecular synthesis in equine abortion (herpes) virus-infected cells . J Virol 2:793-804, 1968. 12. Feldman LA, Sheppard RD, Bornstein MB: Herpes simplex virus-host cell relationships in organized cultures of mammalian nerve tissues . J Virol 2:621-628, 1968. 13. Walter EL: An inquiry into the pathogenesis of herpesvirus disease . Bull Int Acad Pathol 10:46-49, 1969.