Archives of Ophthalmology

Thomas, John V.;Green, W. Richard;Maumenee, A. Edward

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010419001pmid: 444117

Abstract • Complete follow-up information was obtained on 65 patients whose eyes had been enucleated for small choroidal melanomas three months to 34 years previously. All tumors were 300 cu mm (10×10×3 mm) or less in volume. The average and median lengths of follow-up were nine years and 7.2 years, respectively. The 5-, 10-, and 15-year tumor-related death rates were found to be lower than those previously reported for small melanomas after enucleation, and the same as the estimated tumor-related mortality in patients who had not undergone enucleation. The average volume of tumors that caused metastatic death was more than twice that of tumors that did not. There were no metastatic deaths in 42 patients with tumors less than 98 cu mm (7×7×2 mm) in volume. Waiting to observe growth in tumors less than 98 cu mm in size did not appear to increase the risk of death from metastatic melanoma. References 1. Callender GR: Malignant melanotic tumors of the eye: A study of histologic types in 111 cases . Trans Am Acad Ophthalmol Otolaryngol 36:131-142, 1931. 2. Wilder HC, Callender GR: Malignant melanoma of the choroid: Further studies on prognosis by histologic type and fiber content . Am J Ophthalmol 22:851-855, 1939. 3. Callender GR, Wilder HC, Ash JE: Five hundred melanomas of the choroid and the ciliary body followed five years or longer . Am J Ophthalmol 25:962-967, 1942. 4. Paul EV, Parnell BL, Fraker M: Prognosis of malignant melanomas of the choroid and ciliary body . Int Ophthalmol Clin 2:387-402, 1962.Crossref 5. Fitterman HN, McLean JA: Malignant melanoma: A 15-year review . Am J Ophthalmol 56:90-97, 1963. 6. Shammas HF, Blodi FC: Prognostic factors in choroidal and ciliary body melanomas . Arch Ophthalmol 95:63-69, 1977.Crossref 7. McLean IW, Foster WD, Zimmerman LE: Prognostic factors in small malignant melanomas of choroid and ciliary body . A rch Ophthalmol 95:48-58, 1977.Crossref 8. Jensen OA: Malignant melanomas of the human uvea: Recent follow-up of cases in Denmark, 1943-1952 . Acta Ophthalmologica 48:1113-1128, 1970.Crossref 9. MacRae A: Prognosis in malignant melanoma of choroid and ciliary body . Trans Ophthalmol Soc UK 73:3-30, 1953. 10. Wilder HC, Paul EV: Malignant melanoma of the choroid and ciliary body: A study of 2,535 cases . Milit Surg 109:370-378, 1951. 11. Marquardt R: Untersuchungen zur Prognose der malignen Melanome der Gefässhaut des Auges . Klin Monatsbl Augenheilkd 150:51-56, 1967. 12. Callender GR, Wilder HC: Melanoma of the choroid: The prognostic significance of agryophil fibers . Am J Cancer 25:251-258, 1935.Crossref 13. Jensen OA: Malignant melanomas of the uvea in Denmark, 1943-1952: A clinical, histopathological and prognostic study . Acta Ophthalmologica , (suppl 75) , 1963, pp 1-231. 14. Flocks M, Gerende JH, Zimmerman LE: The size and shape of malignant melanomas of the choroid and ciliary body in relation to prognosis and histologic characteristics: A statistical study of 210 tumors . Trans Am Acad Ophthalmol Otolaryngol 59:740-758, 1955. 15. Wright CJE: Prognosis in cutaneous and ocular malignant melanoma: A study of 222 cases . J Pathol Bacteriol 61:507-525, 1949.Crossref 16. Donders PC: Malignant melanoma of the choroid . Trans Ophthalmol Soc UK 93:745-751, 1973. 17. Terry TL, Johns JP: Uveal sarcoma—malignant melanoma: Statistical study of 94 cases . Am J Ophthalmol 18:903-913, 1935. 18. Davidorf FH, Lang JR: The natural history of malignant melanoma of the choroid: Small vs large tumors . Trans Am Acad Ophthalmol Otolaryngol 79:310-320, 1975. 19. Naumann GOH, Yanoff M, Zimmerman LE: Histogenesis of malignant melanomas of the uvea: I. Histopathologic characteristics of nevi of the choroid and ciliary body . Arch Ophthalmol 76:784-796, 1966.Crossref 20. Naumann GOH, Hellner K, Naumann LR: Pigmented nevi of the choroid: Clinical study of secondary changes in the overlying tissues . Trans Am Acad Ophthalmol Otolaryngol 75:110-123, 1971. 21. Ruiz RS: Early treatment in malignant melanomas of the choroid , in Brockhurst RJ, Boruchoff SA, Hutchinson BT, et al (eds): Controversy in Ophthalmology . Philadelphia, WB Saunders Co, 1977, pp 604-610. 22. Curtin VT: Malignant melanoma management , in Brockhurst RJ, Boruchoff SA, Hutchinson BT, et al (eds): Controversy in Ophthalmology . Philadelphia, WB Saunders Co, 1977, pp 635-640. 23. Zimmerman LE, McLean IW, Foster WD: Does enucleation of the eye containing a malignant melanoma prevent or accelerate the dissemination of tumor cells? An unanswered question. Br J Ophthalmol, to be published. 24. Zimmerman LE, McLean IW: A comparison of progress in the management of retinoblastomas and uveal melanomas. Br J Ophthalmol, to be published. 25. Cutler SJ, Ederer F: Maximum utilization of the life-table method in analyzing survival . J Chronic Dis 8:699-712, 1958.Crossref

Keane, James R.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010423002pmid: 444118

Abstract • Hysterical hemianopias are uncommon and usually occur in association with other lateralized complaints. The most frequent pattern consists of decreased vision in one eye, an ipsilateral hemianopia on testing the "affected" eye, full fields in the other eye, and a complete hemianopia toward the affected side on testing with both eyes open. The incompatibility of the monocular and binocular fields quickly demonstrates the functional nature of this alleged visual loss. References 1. Scott GI: Traquair's Clinical Perimetry , ed 7. London, Henry Kimpton, 1957, pp 290-297. 2. Walsh FB, Hoyt WF: Clinical Neuro-Ophthalmology , ed 3. Baltimore, Williams & Wilkins Co, 1969, p 2527. 3. Parinaud M: The ocular manifestations of hysteria , in Norris WF, Oliver CA, (eds): System of Disease of the Eye . Philadelphia, JB Lippincott Co, 1900, pp 727-769. 4. De Schweinitz GE: Ocular manifestations of hysteria , in Posey WC, Spiller WG, (eds): The Eye and the Nervous System . Philadelphia, JB Lippincott Co, 1906, pp 614-695. 5. Schlaegel TF Jr, Hoyt M: Psychosomatic Ophthalmology . Baltimore, Williams & Wilkins Co, 1957, pp 350-403. 6. Thompson HS, Newsome DA, Loewenfeld IE: The fixed dilated pupil . Arch Ophthalmol 86:21-27, 1971.Crossref 7. Keane JR: Suprasellar tumors and incidental optic disc anomalies: Diagnostic problems in two patients with hemianopic temporal scotomas . Arch Ophthalmol 95:2180-2183, 1977.Crossref 8. Savino PJ, Paris M, Schatz JH, et al: Optic tract syndrome: A review of 21 patients . Arch Ophthalmol 96:656-663, 1978.Crossref 9. Bender MB, Strauss I: Defects in visual field of one eye only in patients with a lesion of one optic radiation . Arch Ophthalmol 17:765-787, 1937.Crossref 10. Gogela LJ, Rucker CW: Psychogenic changes in the field of vision . Am J Ophthalmol 34:185-188, 1951. 11. Drews RC: Organic versus functional ocular problems . Int Ophthalmol Clin 7:665-696, 1967. 12. Schlaegel TF Jr, Quilala FV: Hysterical amblyopia . Arch Ophthalmol 54:875-884, 1955.Crossref 13. Schlaegel TF Jr: Spiral visual fields . Arch Ophthalmol 59:18-23, 1958.Crossref 14. Levatin P: Pupillary escape in disease of the retina or optic nerve . Arch Ophthalmol 62:768-779, 1959.Crossref

Pokorny, Joel;Smith, Vivianne C.;Johnston, Patrick B.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010425003pmid: 444119

Abstract • A 9-year-old boy with dense fibrous scars at the macula had visual acuities of 6/12 and 6/9 and an abnormal color match (pseudoprotanomaly). The StilesCrawford effect functions were abnormal in both eyes, showing maximal sensitivity at the nasal edge of each pupil. The data suggest that the foveal photoreceptors, although spared destruction by an adjacent focus of healed chorioretinitis, have been distorted by fibrous traction arising from that defect. References 1. Laties A, Enoch JM: An analysis of retinal receptor orientation: I. Angular relationship of neighboring photoreceptors . Invest Ophthalmol 10:69-77, 1971. 2. Enoch JM, Laties A: An analysis of retinal receptor orientation: II. Predictions for psychophysical tests . Invest Ophthalmol 10:959-970, 1971. 3. Enoch JM, Hope GM: An analysis of retinal receptor orientation: III. Results of initial psychophysical tests . Invest Ophthalmol 11:765-782, 1972. 4. Enoch JM, Hope GM: Analysis of retinal receptor orientation: IV. Center of the entrance pupil and the center of convergence of orientation and directional sensitivity . Invest Ophthalmol 11:1017-1021, 1972. 5. Stiles WS, Crawford BH: The luminous efficiency of rays entering the eye pupil at different points . Proc R Soc Lond Biol 112:428-450, 1933.Crossref 6. Crawford BH: The Stiles-Crawford effects and their significance in vision , in Jameson D, Hurvich LM (eds): Handbook of Sensory Physiology, vol 7/4: Visual Psychophysics . Berlin, Springer-Verlag, 1972. 7. Smith VC, Pokorny J, Diddie KR: Color matching and Stiles-Crawford effect in central serous choroidopathy . Mod Probl Ophthalmol 19:284-295, 1978. 8. Fankhauser F, Enoch JM: The effects of blur on perimetric thresholds . Arch Ophthalmol 68:240-251, 1962.Crossref 9. Fankhauser F, Enoch J, Cibis P: Receptor orientation in retinal pathology . Am J Ophthalmol 52:767-783, 1961. 10. Enoch JM, Van Loo JA, Okun E: Realignment of photoreceptors disturbed in orientation secondary to retinal detachment . Invest Ophthalmol 12:849-853, 1973. 11. Smith VC, Pokorny J, Ernest JT, et al: Visual function in acute posterior multifocal placoid pigment epitheliopathy . Am J Ophthalmol 85:192-199, 1978. 12. Gass JDM: Pathogenesis of disciform detachment of the neuroepithelium: V. Disciform macular degeneration secondary to focal choroiditis . Am J Ophthalmol 63:661-687, 1967.

Abramson, David H.;Piro, Philip A.;Ellsworth, Robert M.;Kitchin, F. David;McDonald, Marguerite

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010428004pmid: 444120

Abstract • Lactate dehydrogenase (LDH) activity was determined in 24 cases of histologically proved retinoblastoma. The mean level was 1,825 IU/L, with a range of 10 to 15,920 IU/L. Twenty-two patients had elevated aqueous humor LDH levels. In two, the aqueous humor level was within the normal range. Student's t testing showed a highly significant difference between cataract and retinoblastoma aqueous humor. The retinoblastoma aqueous humor to blood ratio ranged from 0.045 to 58,529—not a good index of retinoblastoma. Isozyme patterns of retinoblastoma aqueous humor were statistically similar to those of normal cataract aqueous humor. The serum LDH level of cataract patients was not statistically different from that of retinoblastoma patients. The LDH 5/LDH 1 ratio of retinoblastoma aqueous humor ranged from 0.042 to 27.05—not a good index of retinoblastoma, as 28 of 34 aqueous samples of cataract patients had LDH 5 > LDH 1. Ten of 13 retinoblastoma patients had aqueous humor LDH 5 > LDH 1. The best index of the presence or absence of retinoblastoma is the total aqueous humor LDH level. References 1. Dias PLR, Senthe Shanmuganathau S, Rajaratnam M: Lactate dehydrogenase activity of aqueous humor in retinoblastoma . Br J Ophthalmol 55:130-132, 1971.Crossref 2. Swartz M, Herbert RW, Goldberg MF: Aqueous lactic acid dehydrogenase in retinoblastoma . Am J Ophthalmol 78:612-617, 1974. 3. Kabak J, Romano PE: Aqueous humor lactic dehydrogenase isoenzymes in retinoblastoma . Br J Ophthalmol 59:268-269, 1975.Crossref 4. Kaneko A: Lactic acid dehydrogenase activity and isoenzymes in the retinoblastoma . Acta Soc Ophthalmol Jpn 76:672-682, 1972. 5. McDonald MB, Abramson DH, Ellsworth RM, et al: Lactate dehydrogenase levels and isoenzyme patterns in the serum and aqueous humor of adult cataract patients . Arch Ophthalmol 95:2068-2069, 1977.Crossref 6. Wroblewski E, Decker B, Wroblewski R: Activity of lactic dehydrogenase in spinal fluid . Am J Pathol 28:269, 1957.

Purcell, John J.;Krachmer, Jay H.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010430005pmid: 444121

Abstract • A 4-year-old boy with severe, diffuse, asymptomatic, punctate, epithelial corneal erosions had bilateral sharply decreased corneal sensation with normal skin sensation in the distribution of the trigeminal nerves. Subsequent family studies disclosed five family members with similar corneal changes and decreased corneal sensation and no punctate erosions. None had decreased skin sensation in the distribution of the fifth cranial nerve. No environmental factors or evidence of local or systemic disease accounted for these findings. References 1. Hewsen GE: Congenital trigeminal anesthaesia . Br J Ophthalmol 47:308-311, 1963.Crossref 2. Anseth A: Congenital bilateral corneal anesthesia . Acta Ophthalmol 46:909-911, 1968.Crossref 3. Walsh FB, Hoyt WF: Clinical Neuroophthalmology . Baltimore, Williams & Wilkins Co, 1969, vol 1, pp 383-385, 1206. 4. Stewart HL, Wind CA, Kaufman, HE: Unilateral congenital corneal anesthesia . Am J Ophthalmol 74:334-335, 1972. 5. Lawford JB: Bilateral (congenital) anesthaesia of conjunctiva and cornea: Neuroparalytic keratitis . Trans Ophthalmol Soc UK 27:80, 1907. 6. Verrey A, Jequier M: Keratitis neuroparalytiques familiales . Bull Soc Fr Ophtalmol 62:171-177, 1949. 7. Schenk H: Hornhautbefunde bei idiopathischer Anästhesie der Hornhaut . Klin Monatsbl Augenheilkd 133:506-518, 1958. 8. Carpel EF: Congenital corneal anesthesia . Am J Ophthalmol 85:357-359, 1978. 9. Riley CM, Moore RH: Familial dysautonomia differentiated from related disorders: Case reports and discussion of current concepts . Pediatrics 37:435-446, 1966. 10. Bowen R: Hereditary ectodermal dysplasia of the anhidrotic type . South Med J 50:1018-1021, 1957.Crossref 11. Ford FK, Wilkins L: Congenital universal insensitivity to pain . Bull J Hopkins Hosp 62:448-466, 1938. 12. MoHandessan MM, Romano PE: Neuroparalytic keratitis in Goldenhar-Gorlin syndrome . Am J Ophthalmol 85:111-113, 1978. 13. Shields JA, Waring GO, Monte LG: Ocular findings in leprosy . Am J Ophthalmol 77:880-890, 1974. 14. Schirmer KE, Mellor LD: Corneal sensitivity after cataract extraction . Arch Ophthalmol 65:433-436, 1961.Crossref 15. Goldberg MF: Genetic and Metabolic Eye Disease . Boston, Little Brown & Co, 1974, pp 281-323. 16. Schwartz DE: Corneal sensitivity in diabetes . Arch Ophthalmol 91:174-178, 1974.Crossref 17. McDonald R: Carbon disulfide poisoning . Arch Ophthalmol 20:839-845, 1938.Crossref 18. Sjögren H: A contribution to our knowledge of the ocular changes induced by sulphurated hydrogen . Acta Ophthalmol 17:166-171, 1939.Crossref

Wolters, Robert W.;Jorgensen, James H.;Calzada, Evangeline;Poirier, Robert H.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010433006pmid: 375885

Abstract • The limulus endotoxin assay has been previously demonstrated to be the most sensitive method available for detection of bacterial endotoxin. A commercially available form of limulus amoebocyte lysate was used in this study for detection of Gram-negative corneal infections in both experimental animals and in a group of nine patients. The limulus assay enabled rapid detection of Gram-negative infections in both the experimentally induced ulcers in rabbits and in the patients studied. False-positive reactions did not occur in corneal infections due to either Gram-positive bacteria, fungi, or herpes simplex keratitis. The limulus test proved to be more sensitive than examination of Gram-stained smears of corneal scrapings and became positive earlier than bacterial cultures. The limulus test was helpful in the diagnosis of partially antibiotic-treated corneal infections but could not be used to assess the response to antimicrobial therapy, since endotoxin persisted in the corneal scrapings for some time after initiation of therapy. References 1. Jones DB: Early diagnosis and therapy of bacterial corneal ulcers . Int Ophthalmol Clin 13:1-29, 1973.Crossref 2. Allen HF: Current status of prevention, diagnosis, and management of bacterial corneal ulcers . Ann Ophthalmol 3:235-246, 1971. 3. Avallone AN, Parrett C, Smith RE, et al: Rapid detection of experimental E coli endophthalmitis by the limulus lysate test . Invest Ophthalmol 17:528-531, 1978. 4. McBeath J, Forster RK, Rebell G: Diagnostic limulus lysate assay for endophthalmitis and keratitis . Arch Ophthalmol 96:1265-1267, 1978.Crossref 5. Levin J, Bang FB: The role of endotoxin in the extracellular coagulation of limulus blood . Bull Johns Hopkins Hosp 115:265-274, 1964. 6. Loeb L: Ameboid movement and agglutination in amoebocytes of limulus and the relation of these processes to tissue formation and thrombosis . Protoplasma 2:512, 1927.Crossref 7. Bang FB: A bacterial disease of Limulus polyphemus . Bull Johns Hopkins Hosp 98:325-351, 1956. 8. Levin J, Bang FB: Clottable protein in limulus: Its localization and kinetics of its coagulation by endotoxin . Thromb Diath Haemorrh 19:186-197, 1968. 9. Rojas-Corona RR, Skarnes R, Tamakuma S, et al: The limulus coagulation test for endotoxin: A comparison with other assay methods . Proc Soc Exp Biol Med 132:599-601, 1969.Crossref 10. Jorgensen JH, Lee JC: Rapid diagnosis of Gram-negative bacterial meningitis by the limulus endotoxin assay . J Clin Microbiol 7:12-17, 1978. 11. Ellison AC, Poirier RH: Therapeutic effects of heparin on Pseudomonas-induced corneal ulceration . Am J Ophthalmol 82:619-627, 1976. 12. Brown SI: Symposium on corneal infection and immunity: Collagenase and corneal ulcers . Invest Ophthalmol 10:203, 1971. 13. Poirier RH, Jorgensen J: Endotoxin assay for rapid diagnosis of Pseudomonas corneal ulcer . Lancet 2:85-86, 1977.Crossref 14. Jorgensen JH, Jones PM: Comparative evaluation of the limulus assay and the direct Gram stain for detection of significant bacteriuria . Am J Clin Pathol 63:142-148, 1975. 15. Levin J, Poore TE, Zauber NP, el al: Detection of endotoxin in the blood of patients with sepsis due to Gram-negative bacteria . N Engl J Med 283:1313-1316, 1970.Crossref 16. Jorgensen JH, Smith RF: Rapid detection of contaminated intravenous fluids using the limulus in vitro endotoxin assay . Appl Microbiol 26:521-524, 1973. 17. Nachum R, Lipsey A, Siegel SE: Rapid detection of Gram negative bacterial meningitis by the limulus lysate test . N Engl J Med 289:931-934, 1973.Crossref

Judisch, G. Frank;Martin-Casals, Aurelio;Hanson, James W.;Olin, William H.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010436007pmid: 220941

Abstract • Four new patients with oculodentodigital dysplasia (ODD) have been examined. The salient and fairly constant features of ODD appear to be (1) unique facial appearance, (2) microcornea with other inconstant ocular findings, (3) syndactyly of the hands with additional characteristic phalangeal aberrations, (4) diffuse skeletal dysplasia, (5) enamel dysplasia, and (6) trichosis. Echographic studies indicate that ODD globes have microcornea with otherwise normal dimensions. An increased number of vessels crossing the optic discs was observed in three patients from one family. The distance between the inner canthi and the medial orbital walls in three patients we studied suggests that previous reports of hypertelorism may have been illusions resulting from microcornea, small palpebral fissures, and variably present epicanthus. References 1. References 7, 8, 9, 10, 12, 14-18, 20, 22. 2. Meyer-Schwickerath G, Gruterich E, Weyers H: Microphthalmussyndrom . Klin Monatsbl Augenheilkd 131:18-30, 1957. 3. Lohmann W: Beitrag zur Kenntnis des reinen Mikrophthalmus . Arch Augenheilkd 86:136-141, 1920. 4. Bauer KH: Homoiotransplanation von Epidermis bei eineiigen Zwillingen . Beitr Klin Chir 141:442-447, 1927. 5. Pitter J, Svejda J: Uber den Einfluess der Rontgenstrahlen auf die Entstchung von Missbildungen der menschlichen Frucht . Ophthalmologica 123:386-393, 1952.Crossref 6. Betetto G: Microftalmo e malformazioni dell dita . Ann Ottal 84:368-381, 1958. 7. David JEA, Palmer PES: Familial metaphysial dysplasia . J Bone Joint Surg Br 40:86-93, 1958. 8. Gorlin RJ, Meskin LH, Geme JW: Oculodentodigital dysplasia . J Pediatr 63:69-75, 1963.Crossref 9. Gillespie FD: A hereditary syndrome: Dysplasia oculodentodigitalis . Arch Ophthalmol 71:187-192, 1964.Crossref 10. Eidelman E, Chosack A, Wagner ML: Orodigitofacial dysostosis and oculodentodigital dysplasia . Oral Surg 23:311-319, 1967.Crossref 11. Kurlander GH, Lavy NW, Campbell JA: Roentgen differentiation of the oculodentodigital syndrome and the Hallermann-Streiff syndrome in infancy . Radiology 86:77-85, 1966. 12. Rajic DS, de Veber LL: Hereditary oculodentoosseous dysplasia . Ann Radiol 9:224-231, 1966. 13. Sugar HS, Thompson JP, Davis JD: The oculo-dento-digital dysplasia syndrome . Am J Ophthalmol 61:1448-1451, 1966. 14. Pfeiffer RA, Erpenstein H, Junemann G: Oculo-dento-digitale Dysplasie . Klin Monatsbl Augenheilkd 152:247-262, 1968. 15. Yoshino S, Yamauchi Y, Mikami R: Four cases of oculodentodigital syndrome . Orthop Surg 19:91-92, 1968. 16. Reisner SH, Kott E, Bornstein B, et al: Oculodentodigital dysplasia . Am J Dis Child 118:600-607, 1969. 17. Dehmel H, Branbring M: Okulo-dento-digitales Syndrom . Arch Kinderheilkd 183:76-79, 1971. 18. Taysi K, Say B, Firat T, et al: Oculodentodigital dysplasia syndrome . Acta Paediatr Scand 60:235-238, 1971.Crossref 19. Kadrnka-Lovrencic M, Jurkovic S, Reiner-Banovac Z, et al: Dysplasia oculodentodigitalis . Monatsschr Kinderheilkd 121:595-599, 1973. 20. Dudgeon J, Chisholm IA: Oculo-dento-digital dysplasia . Trans Ophthalmol Soc UK 94:203-210, 1974. 21. Guizar-Vazques J, Rostenberg I, Armendares S: Oculodentodigital dysplasia (author's translation) . Rev Invest Clin 27:59-64, 1975. 22. Gellis SS, Feingold M: Oculodentodigital dysplasia: Picture of the month . Am J Dis Child 128:81-82, 1974. 23. Weintraub DM, Baum JL, Pashayan HM: A family with oculodentodigital dysplasia . Cleft Palate J 12:323-329, 1975. 24. Weintraub DM, White GE, Dines MM, et al: Intraoral findings of oculodentodigital dysplasia . J Dent Child 43:427-429, 1975. 25. Vittori F, Carbonnel Y: Oculodentodigital syndrome (oculodentodigital dysplasia) . Pediatrie 31:593-601, 1975. 26. Sommermater JI, Lacoste JL: The association of oculodentodigital abnormalities . Rev Odontostomatol 5:351-357, 1976. 27. Brailey WA: Double microphthalmos with defective development of iris, teeth, and anus: Glaucoma at an early age . Trans Ophthalmol Soc UK 10:139-140, 1890. 28. Wolff E: A microphthalmic family . Proc R Soc Med 23:623-625, 1930. 29. Ciotola G: Microftalmo e malformazioni delle dita (sindattilia, polidattilia) . Boll Ocul 17:855-867, 1938. 30. Mohr OL: Dominant acrocephalosyndactyly . Hereditas 25:193-203, 1939.Crossref 31. Berliner ML: Unilateral microphthalmia with congenital anterior synechiae and syndactyly . Arch Ophthalmol 26:653-660, 1949.Crossref 32. Cowan A: Leontiasis ossea . Oral Surg 12:983-995, 1959.Crossref 33. Duggan JW, Hassard DTR: Familial microphthalmos . Trans Can Ophthalmol Soc 24:210-216, 1961. 34. Littlewood JM, Lewis GM: The Holmes-Adie syndrome in a boy with acute juvenile rheumatism and bilateral syndactyly . Arch Dis Child 38:86-88, 1963.Crossref 35. Henkes HE: Verworven corneadystrofie bij hypoplasie van irisstromablad en kamerhoek, gepaard gaande met blauwe sclerale band, glaucoma infantile en schedel-, begitsen extremiteis-afwijkingen (dysplasia oculo-dento-digitalis) . Ned Tijdschr Geneeskd 109:681-683, 1965. 36. Sorgel HJ, Heidrich R: A rare dysplasia: The oculodentodigital syndrome . Z Aerztl Fortbild 59:504-506, 1965. 37. Maroncelli M: Considerazioni anatomocliniche su di un caso di microftalmia congenita . Valsalva 44( (suppl 1) ):61-70, 1969. 38. Holmes LB, Walton DS: Hereditary microcornea, glaucoma, and absent frontal sinuses: A family study . J Pediatr 74:968-972, 1969.Crossref 39. Karel I, Sedlackova E, Kominek J, et al: Oculodentodigital dysplasia . Cesk Oftalmol 25:88-97, 1969. 40. Ginsburg LD, Sedano HO, Gorlin RJ: Focal dermal hypoplasia syndrome . Am J Roentgenol Radium Ther Nucl Med 110:561-571, 1970.Crossref 41. Dilling-Ostrowska E, Zuchowicz M: Case of Gillespie's syndrome . Neurol Neurochir Pol 7:97-99, 1969. 42. Cernea P, Constantin F: Dyscéphalie, conjonctivite mucosynechiante et malformations des extrémités . Arch Ophtalmol 34:349-358, 1974. 43. Torsuev NA: Case of oculodentodigital dysplasia . Vestn Dermatol Venerol 11:45-46, 1974. 44. Jaworska M, Ploska-Urbanek B: Case of oculo-dento-digital syndrome . Pediatr Pol 51:853-856, 1975. 45. Gemme G, Bonioli E, Ruffa G, et al: Unusual case of ocular and digital changes classifiable as oculodentodigital dysplasia . Minerva Pediatr 28:2155-2160, 1976. 46. Zellweger H, Ionasescu VV: Familial oculo-dento-digital dysplasia, abstracted . Am J Hum Genet 26:97A, 1974. 47. Hansman C: Growth of interorbital distance and skull thickness as observed in roentgenographic measurements . Radiology 86:87-96, 1966. 48. Laestadius ND, Aase JM, Smith DW: Normal inner canthal and outer orbital dimensions . J Pediatr 74:465-468, 1969.Crossref 49. McKusick VA: Mendelian Inheritance in Man , ed 4. Baltimore, Johns Hopkins University Press, 1975, p 237. 50. Duke-Elder S: System of Ophthalmology . London, Henry Kimpton, 1964, vol 3, pt 2, pp 488-494, 503. 51. Duke-Elder S, Wybar KC: System of Ophthalmology . London, Henry Kimpton, 1961, vol 2, p 505. 52. Greig D: Hypertelorism: A hitherto undifferentiated congenital deformity . Edinb Med J 31:560, 1924. 53. Mustarde J: Epicanthus and telecanthus . Int Ophthalmol Clin 4:359-376, 1964.Crossref 54. Seltzer S: The Dental Pulp . Philadelphia, JB Lippincott Co, 1975, pp 306-307. 55. Ahmad A, Pruett RC: The fundus in mongolism . Arch Ophthalmol 94:772-776, 1976.Crossref

Slusher, M. Madison;Holland, Walter D.;Weaver, Richard G.;Tyler, Marshall E.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010443008pmid: 444122

Abstract • Only seven cases of identifiable intraocular botfly larva infestation have been reported in North America—five since 1969. Two additional cases, both from the same institution, are documented here. The offending maggot or larva was visible in both instances. The findings in each case were diagnostically and morphologically striking. The characteristic funduscopic finding of subretinal tracks, along with the appearance of the larva—encysted in one patient and freefloating in the other—deserves emphasis, since this condition is not always benign and may not be as rare as previously assumed. References 1. Gass JDM, Lewis RA: Subretinal tracks in ophthalmomyiasis . Arch Ophthalmol 94:1500-1505, 1976.Crossref 2. Hunt EW Jr: Unusual case of ophthalmomyiasis interna posterior . Am J Ophthalmol 70:978-980, 1970. 3. Hennessy DJ, Sherrill JW, Binder PS: External ophthalmomyiasis caused by Estrus ovis . Am J Ophthalmol 84:802-805, 1977. 4. Fitzgerald CR, Rubin ML: Intraocular parasite destroyed by photocoagulation . Arch Ophthalmol 91:162-164, 1974.Crossref 5. DeBoe MP: Dipterous larva passing from the optic nerve into the vitreous chamber . Arch Ophthalmol 10:824-825, 1933.Crossref 6. Dixon JM, Winkler CH, Nelson JH: Ophthalmomyiasis interna caused by cuterebra larva . Trans Am Ophthalmol Soc 67:110-115, 1969.

Roper, Daniel L.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010446009pmid: 375886

Abstract • A 34-month-old boy had a corneal ulcer due to Shigella sonnei. To my knowledge, this is the first documented case reported where the same organism was recovered from the stool. One other case of S sonnei and two cases of Sflexneri corneal ulcers have appeared in the literature. All cases have been in young black boys between the ages of 23 months and 6 years. The exact pathogenesis remains unclear, but direct fecalocular inoculation into a preexisting epithelial defect, a probable herpetic dendrite in this case, is most likely. References 1. Suie T, Blatt MM, Havener WH, et al: Bacterial corneal ulcers . Am J Ophthalmol 48:775-777, 1959. 2. Sigetenhorst ML, Gingrich WD: Bacteriologic studies of keratitis . South Med J 50:346-350, 1957.Crossref 3. Cassady JV: Pseudomonas corneal ulceration . Am J Ophthalmol 48:741-750, 1959. 4. MacDonald R Jr, Blatt M, Edwards WC: Shigella corneal ulcer . Am J Ophthalmol 60:136-139, 1965. 5. Ryan JM, Riley HD Jr: Shigella keratitis: A case report . J Pediatr 74:294-296, 1969.Crossref 6. Hyman BN: Shigella sonnei corneal ulcer . Am J Ophthalmol 69:873-874, 1970. 7. Nelson JD, Kusmiesz H, Jackson LH, et al: Trimethoprim-sulfamethoxazole therapy for shigellosis . JAMA 235:1239-1243, 1976.Crossref 8. Jawetz E, Melnick JL, Adelberg EA: Review of Medical Microbiology , ed 8. Los Altos, Calif, Lange Publications, 1968, p 211. 9. Haltalin KC: Ampicillin and shigellosis . Am J Dis Child 125:458, 1973. 10. Ross S, Controni G, Khan W: Resistance of Shigellae to ampicillin and other antibiotics: Its clinical and epidemiological implications . JAMA 221:45-47, 1972.Crossref 11. Reller LB, Gangarosa EJ, Brachman PS: Shigellosis in the United States: Five-year review of nationwide surveillance, 1963-1968 . Am J Epidemiol 91:161-169, 1970. 12. Farrar WE Jr, Eidson M, Wells JG: Extensive urban outbreak caused by antibiotic-sensitive Shigella sonnei . JAMA 235:1026-1029, 1976.Crossref 13. Nelson JD, Haltalin KC: In vitro effectiveness of four cephalosporins against Shigellae and clinical ineffectiveness of cephaloglycin . Chemotherapy 17:48-50, 1972.Crossref 14. Nelson JD, Haltalin KC: Comparative efficacy of cephalexin and ampicillin for shigellosis and other types of acute diarrhea in infants and children . Antimicrob Agents Chemother 7:415-420, 1975.Crossref 15. Jarvis KJ, Scrimgeour G: In vitro sensitivity of Shigella sonnei to trimethoprim and sulfamethoxazole . J Med Microbiol 3:554-557, 1970.Crossref 16. Franzen C, Lidin-Janson G, Nygren B: Trimethoprim-sulfamethoxazole in enteric infections . Scand J Infect Dis 4:231-240, 1972. 17. Nunnery AW, Riley HD Jr: Gentamicin: Clinical and laboratory studies in infants and children . J Infect Dis 119:460-464, 1969.Crossref 18. Keefer CB: Bacterial infections of the gastrointestinal tract . N Engl J Med 222:105-109, 1940.Crossref 19. Gekker JD, Belaya JA: Experimental keratoconjunctivitis as a model for the study of dysentery . J Hyg Epidemiol Microbiol Immunol 1:70-74, 1957. 20. Manolov DG: A study of some questions of pathogenicity and immunity in dysentery using experimental models of Shigella keratoconjunctivitis in guinea pigs . J Hyg Epidemiol Microbiol Immunol 1:322-328, 1957. 21. Serény B: Experimental keratoconjunctivitis shigellosa . Acta Microbiol Acad Sci Hung 4:367-376, 1957. 22. Reed WP, Cushing AH: Role of immunoglobulins in protection against Shigella-induced keratoconjunctivitis . Infect Immun 6:1265-1268, 1975.

Brook, Itzhak;Bateman, J. Bronwyn;Pettit, Thomas H.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010448010pmid: 109067

Abstract • Meningococcal conjunctivitis is typically described as an acute purulent infection. An atypical case of mild catarrhal conjunctivitis occurred in a 19-year-old college student. The meningococci were identified as Neisseria meningitidis, group A, and were isolated from the throats of the patient and her roommate. The conjunctivitis responded rapidly to treatment with sodium sulfacetamide, and it was not treated systemically. A short review of the literature of meningococcal conjunctivitis is presented, and the current recommendation for prophylaxis is discussed. References 1. Stuart RS, McWalter D: Primary meningococcal conjunctivitis in children . Lancet 1:246-249, 1948.Crossref 2. Theodore FH, Kost PF: Meningococcic conjunctivitis . Arch Ophthalmol 31:245-247, 1944.Crossref 3. DeBord GG: Species of the tribes Mimeae, Neisserieae, and Streptococceae which confuse the diagnosis of gonorrhea by smears . J Lab Clin Med 28:710-714, 1943. 4. Thygeson P: Primary meningococcic conjunctivitis treated by sulfadiazine . Am J Ophthalmol 27:400-401, 1944. 5. Bauer CE, Gall EA, Cox CD: Meningococcal conjunctivitis: A report of three cases . Milit Surg 95:24-27, 1944. 6. Allen JH, Erdman GL: Meningococcic conjunctivitis . Am J Ophthalmol 29:721-723, 1946. 7. Reid RD, Bronstein LH: Meningococcic conjunctivitis . JAMA 124:703, 1944.Crossref 8. Mangiaracine AB, Pollen A: Meningococcic conjunctivitis . Arch Ophthalmol 31:284-288, 1944.Crossref 9. Shuttleworth FN, Benstead JG: Primary meningococcal ophthalmia . Br Med J 2:568-569, 1947.Crossref 10. Lewis N, Ferris AA: A case of primary meningococcal conjunctivitis . Med J Aust 1:621-622, 1948. 11. Gray JDA, Lambert RA: Meningococcal conjunctivitis . Br Med J 1:17-18, 1949.Crossref 12. Kahaner JR, Lanou WW: Exogenous meningococcic conjunctivitis . NY State J Med 45:1687-1688, 1945. 13. Miller H: Neisseria meningitidis isolated from case of acute conjunctivitis. Public Health Rep, No. 1010, 1955 14. Hausman D: Neonatal meningococcal conjunctivitis . Br Med J 1:748, 1972.Crossref 15. Reese FM: Meningococcus conjunctivitis followed by septicemia and beginning meningitis . Am J Ophthalmol 19:780-782, 1936. 16. Dillman CE: Meningococcemia after meningococcal conjunctivitis . South Med J 60:456, 1967.Crossref 17. Kuhns DM, Nelson CT, Feldmann HA: The prophylactic value of sulfadiazine . JAMA 123:335-339, 1943.Crossref 18. Fraser DW, Thornsberry C, Feldman RA: Trends in meningococcal disease . J Infect Dis 125:443-446, 1972.Crossref 19. Deal WB, Sanders E: Efficacy of rifampin in treatment of meningococcal carriers . N Engl J Med 281:641-645, 1969.Crossref 20. Devine LF, Johnson DP, Hageman CR: The effects of minocycline on meningococcal nasopharyngeal carrier state in naval personnel . Am J Epidemiol 93:337-345, 1977. 21. Vestibular reactions to minocycline—follow-up . Morbidity and Mortality Weekly Report 24:55-56, 1975. 22. Artenstein MS: Prophylaxis for meningococcal disease: Commentary . JAMA 231:1035-1037, 1975.Crossref 23. Eickhoff TC: Meningococcal prophylaxis . JAMA 234:150-151, 1975.Crossref 24. Finely RA: Prophylaxis against meningococcal disease . JAMA 236:459-461, 1976.Crossref

Srinivasan, B. Dobli;Jakobiec, Frederick A.;Iwamoto, Takeo;DeVoe, A. Gerard

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010450011pmid: 444123

Abstract • In seven patients who each had either a methyl methacrylate corneal shell, a postenucleation ocular prosthesis, or a keratoprosthesis, giant papillary conjunctivitis of the tarsus of the upper lids developed after prolonged wear. These cases expand the spectrum of disease that was initially described in wearers of hard and soft contact lenses. The papillary changes in prostheses wearers did not always produce symptoms and were not readily reversible. Basophils and mast cells characterized the inflammatory infiltrate, suggesting an antigen-antibody mechanism underlying the response. Increased production of epithelial mucin, in contrast to goblet cell mucin, may play a role in producing symptoms in this syndrome. References 1. Allansmith MR, Korb DR, Greiner JV, et al: Giant papillary conjunctivitis in contact lens wearers . Am J Ophthalmol 83:697-708, 1977. 2. Greiner JV, Covington HI, Allansmith MR: Surface morphology of giant papillary conjunctivitis in contact lens wearers . Am J Ophthalmol 85:242-252, 1978. 3. Dark AJ, Durrant TE, McGinty F, et al: Tarsal conjunctiva of the upper eyelid . Am J Ophthalmol 77:555-564, 1974. 4. Srinivasan BD, Worgul BV, Iwamoto T, et al: The conjunctival epithelium: II. Histochemical and ultrastructural studies on human and rat conjunctiva . Ophthalmol Res 9:65-79, 1977.Crossref 5. Iwamoto T, Smelser GK: Electron microscopic studies on the mast cells and blood and lymphatic capillaries of the human corneal limbus . Invest Ophthalmol 4:815-834, 1965.

Boynton, James R.;Pheasant, Thomas R.;Johnson, Bruce L.;Levin, Daniel B.;Streeten, Barbara W.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010454012pmid: 444124

Abstract • In 1966, Kenny described two patients with an unusual congenital syndrome including dwarfism, thickened long bone cortex, transient hypocalcemia, and normal intelligence. These and other patients previously were incorrectly described as "myopic." Ocular findings in four subjects ranged from uncomplicated nanophthalmos with hyperopia to extreme pseudopapilledema, vascular tortuosity, and macular crowding. Postmortem findings from one patient showed calcium deposits demonstrable only by special histochemical stains that were distributed uniquely in the cornea. This distribution differed greatly from the pattern seen in band keratopathy. Retinal calcification was also an unusual feature. Because one patient exhibited a pseudodoubling of the optic papilla, the literature was reviewed. We conclude that no convincing case of true doubling of the optic nerve has been described. Ophthalmologists should be alert for undiagnosed electrolyte abnormalities, especially hypocalcemia, in patients with Kenny's syndrome. References 1. All four of the patients reported here were seen by Frederic M. Kenny, MD, who confirmed the diagnosis. 2. Kenny FM, Linarelli L: Dwarfism and cortical thickening of tubular bones . Am J Dis Child 111:201-207, 1966. 3. Caffey J: Congenital stenosis of medullary spaces in tubular bones and calvaria in two proportionate dwarfs: Coupled with transitory hypocalcemia tetany . AJR 100:1-11, 1967.Crossref 4. Frech RS, McAlister WH: Medullary stenosis of the tubular bones associated with hypocalcemic convulsions and short stature . Radiology 91:457-461, 1968.Crossref 5. Wilson MG, Maronda RF, Mikity VG, et al: Dwarfism and congenital medullary stenosis (Kenny syndrome) . Birth Defects 10:128-132, 1974. 6. O'Grady RB: Nanophthalmos . Am J Ophthalmol 71:1251-1253, 1971. 7. Boynton JR, Purnell EW: Bilateral microphthalmos without microcornea associated with unusual papillomacular retinal folds and high hyperopia . Am J Ophthalmol 79:820-826, 1975. 8. Spencer WH: Drusen of the optic disk and aberrant axoplasmic transport . Am J Ophthalmol 85:1-12, 1978. 9. Mohamed MA, Tapeto-retinal degenerations: Report of a new syndrome . Bull Ophthalmol Soc Egypt 63:223-227, 1970. 10. Duke-Elder S, Abrams D: Ophthalmic optics and refraction , in Duke-Elder S (ed): System of Ophthalmology . St Louis, CV Mosby Co, 1970, vol 5, p 298. 11. Reber M: Microphthalmic complique d'Hypermetropie excessive et d'Anomalies de la macula observee chex trois soeurs . Ann Oculist 119:445-446, 1898. 12. Malbran E, Priani P, Lombardi A: Macroquistes de retina, retinosquises e hipermetropia elevada . Arch Oftalmol Buenos Aires 45:180-185, 1970. 13. Von Zuccoli A: Neuer Beitrag zum bild der Makrozysten bei der hohen Hypermetropie . Ophthalmologica 145:419-424, 1963.Crossref 14. Lamba PA, Prakash P, Dayal Y: Duplication of the optic papilla . Orient Arch Ophthalmol 6:87-90, 1968. 15. Aouchiche M, Boyer R, Fetchi A: A propos du diagnostic, des doubles papille . Bull Soc Fr Ophtalmol 84:625-635, 1971. 16. Straburzynski J: Double optic disc in patient with Marfan's syndrome . Klin Oczna 42:913-915, 1972. 17. Von Bajan M, Holmay O: Doppelte Sehnervenscheibe bei einem Jugendlichen . Klin Monatsbl Augenheilkd 151:207-210, 1967. 18. Bonamour MG: A propos des "double papille." Bull Soc Fr Ophtalmol 64:802-805, 1964. 19. Lamba PA: Doubling of the papilla . Acta Ophthalmol 47:4-9, 1969.Crossref 20. Duke-Elder S: System of Ophthalmology . St Louis, CV Mosby Co, 1963, vol 3, pt 2. 21. Berkow JW, Fine BS, Zimmerman LE: Unusual ocular calcification in hyperparathyroidism . Am J Ophthalmol 66:812-824, 1968. 22. Adachi M, Wellmann KF, Volk BW: Histochemical studies on the pathogenesis of idiopathic non-arteriosclerotic cerebral calcification . J Neuropathol Exp Neurol 27:483-499, 1968.Crossref 23. Norman RM, Urich H: The influence of a vascular factor on the distribution of symmetrical cerebral calcifications . J Neurosurg Psychiatry 23:142-147, 1960.Crossref 24. Friedman AH, Beckerman B, Gold DH, et al: Drusen of the optic disc . Survey Ophthalmol 21:375-390, 1977.Crossref

Metz, Henry S.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010459013pmid: 444125

Abstract • Of 15 patients with monocular limitation of elevation, six had no deviation in primary gaze while the remaining nine had hypotropia of the involved eye. Twelve of 15 patients had restriction to upgaze on forced duction testing. Eleven of these 12 had normal upward saccadic velocity, which suggested normal elevator function. Four patients had reduced saccadic velocity, which indicated true elevator weakness. Superior rectus muscle paresis alone could account for limited elevation and would reduce upward saccadic speed. Patients with a diagnosis of "double elevator palsy" only infrequently (about one quarter of cases) have palsy of an elevator muscle and may have only a single elevator palsy. The identification of a true elevator weakness is most important in planning management. References 1. Metz HS, Scott AB, O'Meara D, et al: Ocular saccades in lateral rectus palsy . Arch Ophthalmol 84:453-460, 1970.Crossref 2. Metz HS: Third nerve palsy: Saccadic velocity studies . Ann Ophthalmol 5:526-528, 1973. 3. Scott AB: Force and velocity tests in strabismus . Trans Am Acad Ophthalmol Otolaryngol 79:727-752, 1975. 4. Scott W, Jackson OB: Double elevator palsy: The significance of inferior rectus restriction . Am Orthopt J 27:5-10, 1977. 5. McNeer K, Jampolsky A: Double elevator palsy caused by anomalous insertion of the inferior rectus . Am J Ophthalmol 59:317-319, 1965. 6. White JW: Paralysis of the superior rectus and inferior oblique muscles of the same eye . Arch Ophthalmol 27:366-371, 1942.Crossref 7. Rosner RS: Double elevator paralysis . Am J Ophthalmol 55:87-93, 1963. 8. Watson AG Jr: A new operation for double elevator paresis . Trans Can Ophthalmol Soc 25:182-187, 1962. 9. Jampel RS, Fells P: Monocular elevation paresis caused by a central nervous system lesion . Arch Ophthalmol 80:45-47, 1968.Crossref 10. Robinson DA: A quantitative analysis of extraocular muscle cooperation and squint . Invest Ophthalmol 14:801-825, 1975. 11. Scott AB: Muscle forces and innervations , in Lennerstrand G, Bach-y-Rita P (eds): Basic Mechanisms of Ocular Motility and Their Clinical Implications . New York, Pergamon Press, 1975, pp 181-191. 12. Lennarson L, Scott WE: Effects of large superior rectus muscle recession on upgaze saccadic velocities. Read before the annual meeting of the Association for Research in Vision and Ophthalmology, Sarasota, Fla, April 27, 1977. 13. Metz HS, Scott WE, Madson E, et al: Saccadic velocity and active force studies in blow-out fractures of the orbit . Am J Ophthalmol 78:665-670, 1974. 14. Metz HS: Saccadic velocity studies in endocrine eye disease . Am J Ophthalmol 84:695-699, 1977. 15. Rosenbaum AL, Metz HS: Diagnosis of lost or slipped muscles by saccadic velocity measurements . Am J Ophthalmol 77:215-222, 1974. 16. Dunlap EA: Vertical displacement of horizontal recti , in Symposium on Strabismus . St Louis, CV Mosby Co, 1971, pp 307-329. 17. Knapp P: The surgical treatment of double elevator paralysis . Trans Am Ophthalmol Soc 67:304-323, 1969.

Rogell, Gerald D.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010462014pmid: 571710

Abstract • Internal ophthalmoplegia was found in eight eyes of four patients with juvenileonset diabetes. All eight eyes had received argon laser panretinal photocoagulation (PRP) for proliferative diabetic retinopathy. Internal ophthalmoplegia was not found in any of the 14 eyes of seven patients with juvenile diabetes who had not had photocoagulation treatment. This group included one patient in whom internal ophthalmoplegia was present after treatment. Laser injury to the short ciliary nerves, as they course anteriorly on the inner surface of the sclera, is the probable cause of internal ophthalmoplegia in these patients. To my knowledge, this complication has not been reported previously, but it appears to be a common side effect of PRP. References 1. Frank RN: Visual fields and electroretinography following extensive photocoagulation . Arch Ophthalmol 93:591-598, 1975.Crossref 2. Little HL: Complications of argon laser retinal photocoagulation: A five-year study . Int Ophthalmol Clin 16:145-159, 1976. 3. Thomas NE, Morse PH: Anterior segment complications of argon laser therapy . Ann Ophthalmol 8:299-301, 1976. 4. Watzke RC: Complications of photocoagulation , in Symposium on Retinal Disease: Transactions of the New Orleans Academy of Ophthalmology . St Louis, CV Mosby Co, 1977, p 153. 5. Diabetic Retinopathy Study Reading Center Staff: Manual of Operations, Diabetic Retinopathy Study . Baltimore, University of Maryland Institute of International Medicine, Diabetic Retinopathy Study Coordinating Center, 1972. 6. Warwick R (ed): Wolff's Anatomy of the Eye and Orbit , ed 7. Philadelphia, WB Saunders Co, 1976, pp 275-289, 309-312. 7. Apple DJ, Goldberg MF, Wyhinny GJ: Histopathology and ultrastructure of the argon laser lesion in human retinal and choroidal vasculatures . Am J Ophthalmol 75:595-609, 1973.

Moss, Alan P.;Sugar, Alan;Hargett, Newell A.;Atkin, Adam;Wolkstein, Murray;Rosenman, Kenneth D.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010464015pmid: 312638

Abstract • Thirty employees of an industrial plant involved in the manufacture of silver nitrate and silver oxide underwent ophthalmologic evaluation in an effort to evaluate the frequency and extent of ocular argyrosis. The most frequently noted ocular abnormality was pigmentation of the conjunctiva, present in 20 workers; corneal pigmentation occurred in 15 workers. A direct relationship existed between the levels of pigmentation and duration of employment. Ocular pigmentation was seen more frequently than cutaneous pigmentation. Ten workers noted decreased night vision, but electrophysiologic and psychophysiologic studies of seven of these ten workers demonstrated no functional deficits. References 1. Petering HG: Pharmacology and toxicology of heavy metals: Silver . Pharmacol Ther A 1:127-130, 1976. 2. Grant WM: Toxicology of the Eye , ed 2. Springfield, Ill, Charles C Thomas Publisher, 1974, pp 909-918. 3. Calvery HO, Lightbody HD, Rones B: Effect of some silver salts on the eye . Arch Ophthalmol 25:839-847, 1941.Crossref 4. Loewenstein A: Argyrosis of conjunctiva, cornea and tear-sac . Br J Ophthalmol 25:360-369, 1941.Crossref 5. Gutman FA, Crosswell HH: Argyrosis of the cornea without clinical conjunctival involvement . Am J Ophthalmol 65:183-187, 1968. 6. Hanna C, Fraunfelder FT, Sanchez J: Ultrastructural study of argyrosis of the cornea and conjunctiva . Arch Ophthalmol 92:18-22, 1974.Crossref 7. Jensen SF: Argyrosis of conjunctiva in studio photographer . Acta Ophthalmol 40:544-547, 1962.Crossref 8. Yanoff M, Scheie HG: Argyrosis of the conjunctiva and lacrimal sac . Arch Ophthalmol 72:57-58, 1964.Crossref 9. Rosen E: Argyrolentis . Am J Ophthalmol 33:797-800, 1950. 10. Bartlett RE: Generalized argyrosis with lens involvement: Unusual case . Am J Ophthalmol 38:402-403, 1954. 11. Grayson M, Pieroni D: Severe silver nitrate injury to the eye . Am J Ophthalmol 70:227-229, 1970. 12. Hamilton A, Hardy HL: Industrial Toxicology , ed 3. Acton, Mass, Publishing Sciences Group Inc, 1974, pp 171-172. 13. Duke-Elder S, Leigh AG: Diseases of the Outer Eye: Cornea and Sclera , in Duke-Elder S (ed): System of Ophthalmology , vol 8, pt 2. St Louis, CV Mosby Co, 1965, p 990. 14. Hess RF, Garner LF: The effect of corneal edema on visual function . Invest Ophthalmol 16:5-13, 1977.

Treister, Giora;Machemer, Robert

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010467016pmid: 312639

Abstract • Various anterior segment problems can be approached through the pars plana and treated with instrumentation that has been developed for vitreous surgery. Two cases of aphakic bullous keratopathy due to vitreous touch and three cases of subluxated lenses were successfully treated. Of two cases of advanced, persistent hyperplastic primary vitreous, one showed a successful result. References 1. Treister G, Machemer R: Pars plana approach for pupillary membranes . Arch Ophthalmol 96:1014-1016, 1978.Crossref 2. Bornchoff SA: Clinical causes of corneal edema . Int Ophthalmol Clin 8:581, 1968. 3. Snip RC, Kenyon KR, Greene WR: Retrolental fibrous membrane in the vitreous touch syndrome . Am J Ophthalmol 79:233, 1975. 4. Douvas NG: Roto-extractor instrumentation, indications, techniques and results . Doc Ophthalmol 7(proc series):131-154, 1975. 5. Cerasoli JR, Kasner D: A follow-up study of vitreous loss during cataract surgery managed by anterior vitrectomy . Am J Ophthalmol 71:1040-1043, 1971. 6. Machemer R: Vitrectomy: A pars plana approach . New York, Grune & Stratton Inc, 1975. 7. Gass JDM: Surgical excision of persistent hyperplastic primary vitreous . Arch Ophthalmol 83:163-168, 1970.Crossref 8. Nankin SJ, Scott WE: Persistent hyperplastic primary vitreous: Roto-extraction and other surgical experience . Arch Ophthalmol 95:240-243, 1977.Crossref

Curtin, Brian J.;Iwamoto, Takeo;Renaldo, Donald P.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010470017pmid: 444126

Abstract • The posterior sclera of three normal eyes and five staphylomatous, myopic eyes was examined by electron microscopy. The following notable differences were found in myopic sclera: a predominantly lamellar, collagen fiber bundle arrangement; a reduction in the diameter of the fibrils; a greater dispersion for the range of fibril diameters; an increase in unusual star-shaped fibrils on cross section; and a greater prevalence of fibril groups with uniform but extremely fine diameters. These findings essentially agree with those in other studies of the myopic sclera. The ultramicroscopic changes encountered in pathologic myopia are judged to be compatible with an abnormal proteoglycan composition of the interfibrillary substance in the ectatic sclera. References 1. Coulombre AJ: The eye , in DeHaan RL, Ursprung H (eds): Organogenesis . New York, Holt Rinehart & Winston Inc, 1965, p 219. 2. Garzino A: Modificazione del collagene sclerale nella miopia maligna . Rass Ital Ottal 25:241-280, 1956. 3. Curtin BJ, Teng CC: Scleral changes in pathological myopia . Trans Am Acad Ophthalmol Otolaryngol 62:777-788, 1957. 4. Blach RK: The Nature of Degenerative Myopia: A Clinicopathological Study, thesis. Cambridge University, Cambridge, England, 1964, pp 47-58. 5. Curtin BJ: Physiopathologic aspects of scleral stress-strain . Trans Am Ophthalmol Soc 67:417-461, 1969. 6. Iwamoto T, DeVoe AG: Electron microscopic studies on Fuchs' combined dystrophy . Invest Ophthalmol 10:9-28, 1971. 7. Nikolaeva TE: Electron microscopic investigation of sclera in emmetropic and myopic eyes . Vestn Oftalmol 5:53-57, 1973. 8. Curtin BJ: The pathogenesis of congenital myopia . Arch Ophthalmol 69:60-67, 1963. 9. Blach RK, Jay B, MacFaul P: The concept of degenerative myopia . Proc R Soc Med 58:109-112, 1965. 10. Watson PG, Hazelman BL: The Sclera in Systemic Disorders . Philadelphia, WB Saunders Co, 1976, pp 36-37. 11. Borcherding MS, Blacik LJ, Sittig RA, et al: Proteoglycans and collagen fiber organization in human corneoscleral tissue . Exp Eye Res 21:59-70, 1975.Crossref

Carroll, C. Patrick;Keates, Richard H.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010474018pmid: 375887

Abstract • Bone formation occurred in a periosteal graft that was used to anchor a Cardona keratoprosthesis. References 1. Breslin CW, Katz JI, Kaufman HE: Surgical management of necrotizing scleritis . Arch Ophthalmol 95:2038-2040, 1977.Crossref 2. Rao NR, Aquavella SV, Palumbo AJ: Periosteal graft in scleromalacia . Ophthalmic Surg 8:86-92, 1977. 3. Castroviejo R, Cardona H, DeVoe AG: Latest techniques of prostokeratoplasty. Read before the 22nd International Congress of Ophthalmology, Paris, April 24-25, 1974. 4. Cardona H: Prosthokeratoplasty in chemical burns and ocular pemphigoid . Can J Ophthalmol 11:35, 1976.

Jakobiec, Frederick A.;Moorman, Lemuel T.;Jones, Ira S.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010475019pmid: 444127

Abstract • Two benign acquired melanocytic lesions of the iris stroma had distinctive clinical and pathologic features. One tumor was loculated and polypoid, suggesting ectopic glandular tissue, while the other was a flat tumor with a rich surface capillarity. Both lesions histologically were composed of mononucleated, binucleated, and multinucleated hypopigmented epithelioid and elongated "myoid" cells, widely separated in a finely fibrillar eosinophilic stroma. The ultrastructural features of one case included hyperconvoluted nuclei, conspicuous cytoplasmic filaments and rare, filamentarystriated (leptomeric) structures, scant organelles and inclusions except for numerous mitochondria and glycogen granules, small and infrequent melanosomes, and a fibrillary extracellular matrix focally organized into banded basement membrane material. References 1. Naumann G, Yanoff M, Zimmerman L: Histogenesis of malignant melanoma of the uvea: I. Histopathologic characteristics of nevi of the choroid and ciliary body . Arch Ophthalmol 76:784-796, 1966.Crossref 2. Zimmerman LE: Melanocytes, melanocytic nevi, and melanocytomas . Invest Ophthalmol 4:11-41, 1965. 3. Shields J, Annesley W, Spaeth G: Necrotic melanocytoma of iris with secondary glaucoma . Am J Ophthalmol 84:826-829, 1977. 4. Jakobiec FA, Tannenbaum M: The ultrastructure of orbital fibrosarcoma . Am J Ophthalmol 77:899-917, 1974. 5. Spitz S: Melanomas of childhood . Am J Pathol 24:591-600, 1948. 6. Echevarria R, Ackerman L: Spindle and epitheliod cell nevi in the adult: A clinicopathologic report of 26 cases . Cancer 20:175-189, 1967.Crossref 7. Kopf A, Andrade R: Benign juvenile melanoma in Andrade R, Gumport S, Popkin G, et al (eds): Cancer of the Skin . Philadelphia, WB Saunders Co, 1976, pp 715-754. 8. Ellsworth RM: Juvenile melanoma of the uvea . Trans Am Acad Ophthalmol Otolaryngol 64:148-149, 1960. 9. Samuels S: Juvenile melanoma of the iris . Trans Am Acad Ophthalmol Otolaryngol 67:718-721, 1963. 10. Jones S, Dukes T: Juvenile melanoma of the eyelid . Am J Ophthalmol 56:816-821, 1963. 11. Helwig E: Heath Memorial Award Lecture: Malignant melanoma in children , in Neoplasms of the Skin and Malignant Melanoma . Chicago, Year Book Medical Publishers Inc, 1976, pp 11-26. 12. McGovern VJ: Malignant Melanoma: Clinical and Histological Diagnoses . New York, John Wiley & Sons Inc, 1976, pp 15, 27, 150. 13. Mark G, Mihm M, Liteplo M, et al: Congenital melanocytic nevi of the small and garment type . Human Pathol 4:395-418, 1973.Crossref 14. Lee WR: The fine structure of three malignant melanomas of the iris . Albrecht von Graefes Arch Klin Exp Ophthalmol 188:91-108, 1973.Crossref 15. Iwamoto T, Jones I, Howard G: Ultrastructural comparison of spindle A, spindle B and epithelioid-type cells in uveal malignant melanoma . Invest Ophthalmol 11:873-889, 1972. 16. Schreiner E, Wolff K: Die Ultrastruktur des benignen juvenilen Melanoms . Arch Klin Exp Dermatol 237:749-756, 1970.Crossref 17. Iwamoto T, Reese A, Mund M: Tapicao melanoma of the iris: II. Electron microscopy of the melanoma cells compared with normal iris melanocytes . Am J Ophthalmol 74:851-861, 1972. 18. Miranda A, Godman G: The effects of cytocholasin D in differentiating muscle . Cell 5:1-22, 1973. 19. Morris D, Henkind P: Neoplasms of the iris pigment epithelium . Am J Ophthalmol 66:31-41, 1968. 20. Jakobiec FA, Howard G, DeVoe AG: Sector hamartoma of the iris . Arch Ophthalmol 93:614-618, 1975.Crossref 21. Hogan M, Alvarado J, Weddell J: Histology of the Human Eye . Philadelphia, WB Saunders Co, 1971, pp 242-256, 293-297, 405-427. 22. Font R, Zimmerman LE, Fine BS: Adenoma of retinal pigment epithelium: Histochemical and electron microscopic observations . Am J Ophthalmol 73:544-554, 1972. 23. Streeten B, McGraw J: Tumor of the ciliary pigment epithelium . Am J Ophthalmol 74:420-423, 1972. 24. Minkler D, Allen A: Adenocarcinoma of the retinal pigment epithelium . Arch Ophthalmol 96:2252-2254, 1978.Crossref 25. Machemer R, Van Horn D, Aaberg T: Pigment epithelial proliferation in human retinal detachment with massive periretinal proliferation . Am J Ophthalmol 85:181-191, 1978. 26. Wallow I, Tso M: Proliferation of the retinal pigment epithelium over malignant choroidal tumors: A light and electron microscopic study . Am J Ophthalmol 73:914-926, 1972.

Hall, William C.;O'Day, Denis M.;Glick, Alan D.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010480020pmid: 220942

Abstract • Fullness developed in the left side of a 5-month-old male infant's face in the region of the zygoma. An incisional biopsy specimen showed the mass to be a melanotic neuroectodermal tumor, and radical excision was performed. There has been no recurrence of the tumor one year later. Tumors of this type occur in the face, particularly in the maxilla. and have only rarely been reported around the orbit. References 1. Lurie HI: Congenital melanocarcinoma, melanotic adamantinoma, retinal anlage tumor, progonoma, and pigmented epulis of infancy . Cancer 14:1090-1108, 1961.Crossref 2. Stowens D, Lin T: Melanotic progonoma of the brain . Hum Pathol 5:105-113, 1974.Crossref 3. Borello ED, Gorlin RJ: Melanotic neuroectodermal tumor of infancy: A neoplasm of neural crest origin . Cancer 19:196-206, 1966.Crossref 4. Stowens D: A pigmented tumor of infancy: The melanotic progonoma . J Pathol Bacteriol 73:43-51, 1957.Crossref 5. Blanc WA, Rosenblatt P, Wolff JA: Melanotic progonoma (retinal anlage tumor) of the shoulder in an infant . Cancer 11:959-962, 1958.Crossref 6. Medenis R, Slaughter DP, Barber TK: Melanotic progonoma in childhood . Pediatrics 29:600-604, 1962. 7. Porter JE, Cummings GO Jr: Melanotic progonoma of the maxilla . Arch Pathol 76:267-270, 1963. 8. Caldwell JD, Ernst KF, Thompson HD: Retinal anlage tumor of the maxilla . Oral Surg 8:796-802, 1955.Crossref 9. Clarke BE, Parsons H: An embryological tumor of retinal anlage involving the skull . Cancer 4:78-85, 1951.Crossref 10. Halpert B, Patzer R: Maxillary tumor of retinal anlage . Surgery 22:837-841, 1947. 11. Kerr DA, Pullon PA: A study of the pigmented tumors of jaws of infants (melanotic ameloblastoma, retinal anlage tumor, progonoma) . Oral Surg 18:759-772, 1964.Crossref 12. Lucas RB: Retinal anlage tumour of the maxilla . Br J Cancer 11:26-29, 1957.Crossref 13. Martin H, Foote FW Jr: A third case of so-called retinal anlage tumor . Cancer 4:86-91, 1951.Crossref 14. Reyes HA, Gonzalez-Angulo A, Navarrete-Reyna A: Retinal anlage tumor of infancy: Report of a case occurring in the anterior fontanel . J Pediatr 64:268-271, 1964.Crossref 15. Shafer WG, Frissell CT: The melanoameloblastoma and retinal anlage tumors . Cancer 6:360-364, 1953.Crossref 16. Trabue JC, Martin BC: An additional case report of tumor of retinal anlage of the maxilla . Plast Reconstruct Surg 14:160-164, 1954.Crossref 17. Krompecher E: Zur Histogenese und Morphologie der Adamantinome und sonstiger Kiefergeschwalste . Beitr Pathol Anat 64:165-197, 1918. 18. Wass SH: Melanotic adamantinoma of the mandible in a child aged 5 months . Proc R Soc Med 41:281-283, 1948. 19. Battle RJV, Hovell JH, Spencer H: Pigmented adamantinomata . Br J Surg 39:368-370, 1952.Crossref 20. Valetti L, Patane E: Un raro caso di adamantinoma melanotico en un lattante . Arch Ital Pediatr 20:272-279, 1959-60. 21. Jones P, Williams A: A case of multicentric melanotic adamantinoma . Br J Surg 48:282-285, 1960.Crossref 22. Mitchell WM, Read TT: Congenital pigmented epulis in a 3-month infant . J Pathol Bacteriol 80:83-86, 1960.Crossref 23. MacDonald AM, White M: Pigmented congenital epulides of neuroepithelial origin: The description of a further case with successful excision and survival . Br J Surg 41:610-614, 1954.Crossref 24. Willis RA: The histogenesis of pigmented epulis of infancy . J Pathol Bacteriol 76:89-96, 1958.Crossref 25. Mancini AM, Mosello R: In tema di neoplasie disembryogenetiche del cavo orale osservatione di un caso di "epulide pigmentata infantile." Arch Ital Anat Istol Pathol 34:61-75, 1960. 26. Mummery J, Pitts AT: A melanotic epithelial odontoma in a child . Br Dent J 47:12-13, 1926. 27. Eaton WI, Ferguson JP: A retinoblastic teratoma of the epididymis: Case report . Cancer 9:718-720, 1956.Crossref 28. Kuhn R, Cabanne F, Garneau R: Lé rétinoblastome pigmentaire hétérotopique: Rapport d'un cas et étude génale . Sem Hop Paris 30:178-185, 1954. 29. Soderberg NB, Padgett EC: Two unusual melanomas of the alveolus and maxilla . Am J Orthod Oral Surg 27:270-274, 1941.Crossref 30. Vanek J: Choristom retinalen Ursprungs im Oberkeifer bei einem Saugling . Zentralbl Allg Pathol 95:221-225, 1956. 31. Koudstaal J, Oldhoff J, Panders AK, et al: Melanotic neuroectodermal tumor of infancy . Cancer 22:151-161, 1968.Crossref 32. Templeton AC: Orbital tumor in African children . Br J Ophthalmol 55:254-261, 1971.Crossref 33. Misugi K, Okajima H, Newton WA, et al: Mediastinal origin of a melanotic progonoma or retinal anlage tumor: Ultrastructural evidence for neural crest origin . Cancer 18:447-484, 1965.Crossref 34. Tiecke RW, Bernier JL: Melanotic ameloblastoma . Oral Surg 9:1197-1209, 1956.Crossref 35. Bratton AB, Robinson SHG: Gliomata of nose and oral cavity: Report of two cases . J Pathol Bacteriol 58:643-648, 1946.Crossref 36. Dooling EC, Chi JG, Gilles FH: Melanotic neuroectodermal tumor of infancy . Cancer 39:1535-1541, 1977.Crossref

Petursson, Gissur J.;Fraunfelder, Frederick T.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010484021pmid: 444128

Abstract • Buttonholing of conjunctival flaps at the time of filtering glaucoma surgery or a leak in the flap postoperatively can cause serious problems and may be most difficult to repair. A new delicate atraumatic needle has been used successfully in five cases to close conjunctiva to conjunctiva or conjunctiva to cornea defects. References 1. Galin MA: Symposium on Glaucoma: Transactions of the New Orleans Academy of Ophthalmology . St Louis, CV Mosby Co, 1975, pp 271-272. 2. McLean JM: Atlas of Glaucoma Surgery . St Louis, CV Mosby Co, 1967, p 116. 3. Chandler PA, Grant WM: Lectures on Glaucoma . Philadelphia, Lea & Febiger, 1965, pp 393-394. 4. Boyd BF (ed): Highlights of Ophthalmology , 1978-1979. Panama, RP, Clinica Boyd and Center for Advanced Studies in Ophthalmology, vol 15, pp 162-172. 5. Iliff CE: Flap perforation in glaucoma surgery sealed by a tissue patch . Arch Ophthalmol 71:215, 1964.Crossref 6. Frederick AR: A new needle design for scleral buckling procedures . Ophthalmic Surg 9:85-86, 1978.

Rainin, Edgar A.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010486022pmid: 444129

Abstract • A new surgical procedure has been developed for the correction of senile entropion of the lower lid. The procedure consists of horizontal shortening of the lower lid by a pentagonal wedge resection combined with an infratarsal eyelid suture technique. Twenty eyelids of 13 patients with entropion have been operated on over the last 4½ years with use of various modifications of this procedure. The average follow-up period is two years three months, with the longest being 4½ years and the shortest being three months. There has only been one temporary recurrence and no overcorrections. The technique is simple and effective when applied to chronic senile entropion unassociated with severe enophthalmos or any cicatricial component. References 1. Sisler HA, LaBay GR, Finlay JR: Senile ectropion and entropion: A comparative histopathological study . Ann Ophthalmol 8:319-322, 1976. 2. Arruga H: Ocular Surgery . New York, McGraw-Hill Book Co, 1952, pp 88, 182. 3. Arruga H: Ocular Surgery . New York, McGraw-Hill Book Co, 1952, pp 90, 93. 4. Ziegler SL: Galvanocautery puncture in ectropion and entropion . JAMA 53:183, 1909.Crossref 5. Duke-Elder S: Textbook of Ophthalmology . St Louis, CV Mosby Co, 1939, vol 5, p 5186. 6. Wies FA: Surgical treatment of entropion . J Int Coll Surg 21:758-760, 1954. 7. Jones LT: The anatomy of the lower eyelid . Am J Ophthalmol 49:29, 1960. 8. Jones LT, Reeh MJ, Tsujimura JD: Senile entropion . Am J Ophthalmol 55:463, 1963. 9. Quickert MH, Rathbun E: Suture repair of entropion . Arch Ophthalmol 85:304-305, 1971.Crossref 10. Quickert MH: Malpositions of the eyelid , in Sorsby A (ed): Modern Ophthalmology , ed 2. London, Butterworth & Co Ltd, 1972, vol 4, pp 941-943. 11. Wheeler JM: Spastic entropion correction by orbicularis transplantation . Trans Am Ophthalmol Soc 36:157-162, 1938. 12. Bulter JBV: A simple operation for entropion . Arch Ophthalmol 40:665-667, 1948.Crossref 13. Fox SA: Relief of senile entropion . Arch Ophthalmol 46:424, 1951.Crossref 14. Hill JC, Witzell SH: Can noncicatricial entropion treatment be improved? An analysis of treatment of 82 cases of nonciccatricial entropion of the lower lid: A preliminary report . Trans Can Ophthalmol Soc 8:69, 1956. 15. Schimek RA: A simplified entropion operation . Am J Ophthalmol 43:245, 1957. 16. Bick MW: Orbital tarsal disparity . Arch Ophthalmol 75:386, 1966.Crossref 17. Smith B, Cherubini TD: Oculoplastic Surgery . St Louis, CV Mosby Co, 1970, pp 92-94.

González, Caleb

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010489023pmid: 375889

Abstract • The suturing technique for strabismus resection has been simplified with the use of a single double-armed suture in the form of a vertical mattress. Synthetic ophthalmic suture material has made this technique still more desirable because of the tensile strength and tissue-gripping characteristics of these materials. References 1. Von Noorden GK: A selection of surgical techniques in strabismus . Highlights Ophthalmol 14:63-104, 1975-1976. 2. Helveston E, Meyers S: Synthetic absorbable suture . Ophthalmic Surg 5:63-68, 1974. 3. White RH, Parks MM: Polyglycolic acid sutures in ophthalmic surgery . Trans Am Acad Ophthalmol Otolaryngol 78:632-636, 1974. 4. Massin M, Hudelo J: L'incision de la conjunctive au limbe dans les operations pour strabisme et pour décollement de retine . Ann Ocul 195-995, 1962. 5. Reinecke RD, Miller D (eds): Figure of eight technique in muscle resections , in Strabismus , ed 2. New York, Appleton-Century-Crofts, 1977, pp 282-296.

Kleinberg, John;Dea, Frank J.;Anderson, Janet A.;Leopold, Irving H.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010491024pmid: 444130

Abstract • Ocular penetration of lincomycin hydrochloride in albino rabbits was determined by bioassay. On topical application, the frequency of multiple instillation of drops played an important role in producing therapeutic levels in the anterior chambers. Therapeutic levels were attained in the cornea, aqueous humor, and iris-ciliary body, with peak values occurring at 30 to 45 minutes. Varying the pH of the dosing solution did not change ocular absorption and distribution substantially. Removal of corneal epithelium, however, greatly enhanced absorption. Relative to clindamycin, lincomycin hydrochloride had longer onset of peak values and lower overall concentration in ocular tissues. Intravitreous injection of lincomycin hydrochloride produced therapeutic and steady levels of antibiotic in anterior chambers. Injection produced a concentration in aqueous humor twice that achievable topically. The major route of elimination from the posterior chamber was through retina-choroid. References 1. Goodman L, Gilman A: The Pharmacological Basis of Therapeutics , ed 5. New York, Macmillan Co Publishers, 1975, pp 1227-1230. 2. Magerlein B, Birkenmayer R, Kagan F: Chemical modification of lincomycin . Antimicrob Agents Chemother , 1967, pp 727-736. 3. Becker E: The intraocular penetration of lincomycin . Am J Ophthalmol 67:963-965, 1969. 4. Coles R, Boyle G, Leopold I: Lincomycin levels in rabbit ocular fluids and serum . Am J Ophthalmol 72:464-471, 1971. 5. Imai M: Penetration of lincomycin into tissues of rabbit eyes . Jpn Clin Ophthalmol 23:1175-1182, 1969. 6. Bloom M, Golden B, McKee A: Antibiotic concentration in ocular tissue . Arch Ophthalmol 83:78-83, 1970.Crossref 7. Mercer KB, DeOlden JE, Leopold IH: Intraocular penetration of topical clindamycin in rabbits . Arch Ophthalmol 96:880-884, 1978.Crossref 8. Abel R Jr, Boyle G: Dissecting ocular tissue for intraocular drug studies . Invest Ophthalmol 15:216-219, 1976. 9. Nakatsue T: Intraocular penetration of antibiotics into rabbit eye with purulent uveitis . Nippon Ganga Gakkai Zasshi 75:1244-1247, 1961. 10. Maurice D: Injection of drugs into the vitreous body , in Leopold I, Burns R (eds): Symposium on Ocular Therapy . New York, John Wiley & Sons Inc, 1976, vol 9, pp 59-72.

Edelhauser, Henry F.;Hine, James E.;Pederson, Harlan;Van Horn, Diane L.;Schultz, Richard O.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010495025pmid: 444131

Abstract • Rabbit corneas were treated with three drops of phenylephrine hydrochloride with the epithelium intact or denuded. Corneal thickness was measured before and after drug treatment, and at various times after treatment the corneas were fixed for scanning and transmission electron microscopic observation. The results of this study show that phenylephrine caused a dramatic increase in corneal thickness (drug-induced edema) and cellular vacuolation within the keratocytes and endothelial cells in the corneas without the epithelium. Corneal thickness did not change and the ultrastructural changes were minimal following drug application in those corneas with the epithelium intact. Results of this study also suggest that phenylephrine has a cytotoxic effect on the corneal endothelium and keratocytes when used in corneas where the epithelium has been removed. In corneas with intact epithelium, the damage was less severe and limited to the epithelium. References 1. Lansche RK: Systemic reactions to topical epinephrine and phenylephrine . Am J Ophthalmol 61:95-98, 1966. 2. McReynolds WV, Havener WH, Henderson JW: Hazards of the use of sympathomimetic drugs in ophthalmology . Arch Ophthalmol 56:176-179, 1956.Crossref 3. Solosko D, Smith RB: Hypertension following 10% phenylephrine ophthalmic . Anesthesiology 36:187-189, 1972.Crossref 4. Wilensky JT, Woodward HJ: Acute systemic hypertension after conjunctival installation of phenylephrine hydrochloride . Am J Ophthalmol 76:156-157, 1973. 5. Haddad NJ, Mayer NJ, Riley FC: Mydriatic effect of phenylephrine hydrochloride . Am J Ophthalmol 70:729-733, 1970. 6. Brian Smith R, Read S, Oczypok PM: Mydriatic effect of phenylephrine . Eye Ear Nose Throat Monthly 55:133-134, 1976. 7. Case reports , in National Drug Registry of Drug-Induced Ocular Side Effects . Little Rock, University of Arkansas for Medical Sciences, 1978. 8. Machemer R: Vitrectomy—A Pars Plana Approach , Machemer R, Benson WE (eds). New York, Grune & Stratton, 1975, p 51. 9. Mishima S, Hedbys BO: Measurement of corneal thickness with the Haag-Streit pachometer . Arch Ophthalmol 80:710-713, 1968.Crossref 10. Cleveland PH, Schneider CW: A simple method of preserving tissue for scanning electron microscopy . Vision Res 9:1401-1402, 1969.Crossref 11. Pfister RR, Burstein N: Effects of ophthalmic drugs, vehicles and preservatives on corneal epithelial surface: Scanning electron microscope study . Invest Ophthalmol 15:246-259, 1976. 12. Hull DS, Hine JE, Edelhauser HF, et al: Permeability of the isolated rabbit cornea to corticosteroids . Invest Ophthalmol 13:457-459, 1974. 13. O'Brien WJ, Edelhauser HF: The corneal penetration of ionfluorothymidine, adenine arabinoside, and idoxuridine: A comparative study . Invest Ophthalmol 16:1093-1103, 1977. 14. Millard BJ, Priaulx DJ, Shatton E: The stability of aqueous solutions of phenylephrine at elevated temperatures: Identification of the decomposition products . J Pharm Pharmacol 25( (suppl) ):24-31, 1973. 15. Janigan DT, Santamaria A: A histochemical study of swelling and vacuolation of proximal tubular cells in sucrose nephrosis in the rat . Am J Pathol 39:175-185, 1961. 16. Shabo AL, Maxwell DS, Kreiger AE: Structural alterations in the ciliary process and the blood-aqueous barrier of the monkey after systemic urea injections . Am J Ophthalmol 81:162-172, 1976. 17. Geroski DH, Edelhauser HF: Corneal metabolism: Endothelial response to epithelial scraping, topical anesthesia, and phenylephrine . Invest Ophthalmol 17( (suppl) ):211, 1978. 18. Hyndiuk RA, Kazarian EL, Seidman S: Neurotropic corneal ulcers in diabetes mellitus . Arch Ophthalmol 95:2193-2196, 1977.Crossref 19. Cable MK, Hendrickson RO, Calvin H: Evaluation of drugs in ointment for mydriasis and cycloplegia . Arch Ophthalmol 96:84-86, 1978.Crossref 20. Kaback MB, Podos SM, Harbin TS Jr, et al: The effects of dipivalyl epinephrine on the eye . Am J Ophthalmol 81:768-772, 1976.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010505026

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 Error in Letter to the Editor. —In the letter to the editor titled "Possible Pineal-Suprachiasmatic Clock Regulation of Development and Life Span," published in the February Archives (97:359, 1979), the second sentence in the second paragraph should have read, "Blind persons younger than age 65 with retrolental fibroplasia were found to have a significantly better ten-year survival rate (P < .05) than other blind persons younger than age 65."

Radius, Ronald L.;Anderson, Douglas R.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010506027pmid: 109068

Abstract • The fiber bundle striations recognized clinically in normal monkey eyes appear to be bundles of axons compartmentalized within glial tunnels formed by Müller's-cell processes, when viewed histologically. The dark boundaries that separate individual bundles are the broadened foot endings of these cells near the inner surface of the retina. Within one week after focal retinal photocoagulation, characteristic fundus changes could be seen in experimental eyes. In histologic sections of the involved retina, there was marked cystic degeneration of the retinal nerve fiber layer. Within one month, atrophy of distal axon segments was complete. With the drop-out of damaged axons and thinning of individual fiber bundles, retinal striations became less prominent. The resulting fundus picture in these experimental eyes is similar to fiber bundle defects that can be seen clinically in various neuro-ophthalmic disorders. References 1. Hoyt WF, Schlicke B, Ecklehoff RJ: Funduscopic appearance of a nerve fiber bundle defect . Br J Ophthalmol 56:577-583, 1972.Crossref 2. Hoyt WF: Ophthalmoscopy of the retinal nerve fiber layer in neuro-ophthalmic diagnosis . Aust J Ophthalmol 3:14-34, 1976.Crossref 3. Hoyt WF, Frisen L, Newman NM: Funduscopy of nerve fiber layer defects in glaucoma . Invest Ophthalmol 12:814-829, 1975. 4. Sommer A, Miller NR, Pollack I, et al: The retinal nerve fiber layer in the diagnosis of glaucoma . Arch Ophthalmol 95:2149-2156, 1977.Crossref 5. Saltzmann M: The Anatomy and Histology of the Human Eye Ball in the Normal State , Brown EVL (trans). Chicago, University of Chicago Press, 1912, pp 76-79. 6. Radius RL, Anderson DR: The course of axons through the retina and optic nerve head. Arch Ophthalmol, to be published. 7. Anderson DR: Ascending and descending optic atrophy produced experimentally in squirrel monkeys . Am J Ophthalmol 76:693-711, 1973. 8. Radius RL, Anderson DR: Retinal ganglion cell degeneration in experimental optic atrophy . Am J Ophthalmol 86:673-679, 1978.

Carney, Leo G.;Hill, Richard M.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010509028pmid: 36059

Abstract • With the use of a closed chamber microelectrode system, we measured the relative buffering capacities of 490 human tear samples from young healthy adults. The buffering capacities of the 457 waking-hour samples did show small but regular oscillations that were similar to those previously reported for blood and tear pH, but only rarely did the buffering capacity of one sample approach double that of another. The buffering capacities of 33 tear samples, associated with periods of prolonged eye closure (sleep), were not significantly different (P < .05) from those of the open eye. References 1. Henderson LJ: Blood . New Haven, Conn, Yale University Press, 1928. 2. Pitts RF: Physiology of the Kidney and Body Fluids , ed 2. Chicago, Year Book Medical Publishers Inc, 1968. 3. Brewin EG, Gould RF, Nashat FS, et al: An investigation of problems of acid-base equilibrium in hypothermia . Guys Hosp Rep 104:177-214, 1955. 4. Schwartz WB, Relman AS: Critique of the parameters used in evaluation of acid-base disorders: "Whole blood buffer base" and "standard bicarbonate" compared with blood pH and plasma bicarbonate concentration . N Engl J Med 268:1382-1388, 1963.Crossref 5. Davenport HW: The ABC of Acid-Base Chemistry , ed 6. Chicago, University of Chicago Press, 1975. 6. Altman PL, Dittmer DS: Blood and Other Body Fluids . Bethesda, Md, Federation of American Societies for Experimental Biology, 1971. 7. Carney LG, Hill RM: Human tear pH: Diurnal variations . Arch Ophthalmol 94:821-824, 1976.Crossref 8. Cullen GE, Earle IP: Studies of the acid-base condition of the blood: II. Physiological changes in acid-base conditions throughout the day . J Biol Chem 83:545-559, 1929. 9. Shock NW, Hastings AB: Studies on the acid-base balance of the blood: II. Variation in acid-base balance of the blood in normal individuals . J Biol Chem 104:583-600, 1934. 10. Hastings AB, Eisele CW: Diurnal variations in the acid-base balance . Proc Soc Exp Biol Med 43:308-312, 1940.Crossref 11. Fatt I, Hill RM, Takahashi GH: Carbon dioxide efflux from the human cornea . Nature 203:738-740, 1964.Crossref 12. Tapaszto I: Pathophysiology of human tears , in Holly FJ, Lemp MA (eds): The Precorneal Tear Film and Dry Eye Syndromes . Boston, Little Brown & Co, 1973, vol 13, pp 119-147.

Cowden, John W.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010511029pmid: 375890

Abstract • An attachment permits slit-lamp examination of excised donor cornea in McCarey-Kaufman medium. The bottle that contains the excised cornea is placed in a holder and examined with the slit lamp by means of a mirror placed at a 45° angle. This mirror reflects the slit beam up through the bottom of the bottle. This allows accurate examination of the donor cornea in a stable manner that was not previously possible.

Iliff, Charles E.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010512030pmid: 375891

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.

Waikhom, Jila S.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010513031pmid: 444134

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 To the Editor. —The recent article in the Archives entitled "Ocular Injuries From Exploding Beverage Bottles" by Mondino et al (96:2040-2041, 1978) is of interest to me, because I happened to see two cases of similar injuries with considerable damage to the eyes, in the summer of 1977. The first case was in a young girl who had been trying to remove the cap from one of the new unbreakable plastic bottles, when the cap hit her left eye, causing corneoscleral laceration, vitreous prolapse, and cataract formation. The second case also occurred when the cap of a bottle hit the patient's eye while she was working in the kitchen; it caused a corneal opacity without affecting her vision.If I see two serious eye injuries in a small community of 25,000 people, in one summer, I must conclude that beverage-bottle injuries of the eyes must not be very infrequent, but

Davidorf, Frederick H.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010513034pmid: 444135

Abstract To the Editor. —In a recently published article, Zimmerman et al1 of the Armed Forces Institute of Pathology challenge the standard oncologic treatment of a malignancy, that is, en bloc excision. In a study of malignant melanoma of the choroid and ciliary body, they suggest that the enucleation of the affected eye actually may be the cause of the dissemination of tumor cells, resulting in metastatic disease. This conclusion is based on two observations. First, citing sub References 1. Zimmerman LE, McLean IW, Foster WD: Does enucleation of the eye containing a malignant melanoma prevent or accelerate the dissemination of tumor cells? Br J Ophthalmol 62:420-425, 1978.Crossref 2. Eggers C, deCholnoky T, Jessup DSD: Cancer of the breast . Ann Surg 113:321-340, 1941.Crossref 3. Park WW, Lees JC: The absolute curability of cancer of the breast . Surg Gynecol Obstet 93:129-152, 1951. 4. Brennan MJ: Breast cancer , in Holland JF, Frei E III (eds): Cancer Medicine . Philadelphia, Lea & Febiger Publishers, 1974, p 1778. 5. Reese AB: Tumors of the Eye . New York, Harper & Row Publishers, 1963, p 241. 6. Davidorf FH, Lang JR: The natural history of malignant melanoma of the choroid: Small vs large tumors . Trans Am Acad Ophthalmol Otolaryngol 79:310-320, 1975. 7. Newspaper Enterprise Association Inc: The World Almanac and Book of Facts 1978 . New York, Doubleday & Co, 1978, p 955.

Fox, Kenneth R.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010513032pmid: 444133

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 To the Editor. —In regard to a recent article in the Archives by Mondino et al (96:2040-2041, 1978), I have personally seen nearly half a dozen injuries related to "exploding" carbonated beverage bottles in 1978. I would concur that the incidence is surely higher than that suggested by infrequent reports in the literature; however, I would suggest that this may be so because serious injury may be rare, relative to incidence of all such injuries.For example, on Feb 3, 1978, I was asked to see a 26-year-old woman who had sustained an explosion injury to her right eye that day, from a carbonated beverage bottle. The injury was

Fraunfelder, Frederick T.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010513033pmid: 444132

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 To the Editor. —In a recent issue of the Archives (96:1897-1901,1978) Vaughn et al described their experimental data on the perfusion of the anterior chamber of rabbits with carbachol. They noted transitory but reversible swelling of the cornea, which implied some transitory endothelium dysfunction. However, they advised caution in using this solution in humans in whom the cornea has already compromised endothelial cells.In the past two years, the National Registry of Drug-Induced Ocular Side Effects has had numerous reports of patients having transitory and even persistent corneal edema after the use of this drug intraocularly to induce miosis. In the majority of cases of persistent corneal edema that have

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010515035

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010516036

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 Election of Officers. —During the 16th General Assembly of the Venezuelan Ophthalmological Society, the following officers were elected for the term 1978-1980: Dr Oscar Beaujón R. as president, Dr José M. Vargas as vice-president, Dr Enrique Piñerúa as secretary-general, and Dr Stanislao Aronowicz as treasurer. Conference in Israel. —The American Israeli Ophthalmological Society will hold a conference in Jerusalem, June 3-13, 1979. For further information, please contact Dr Albert Hornblass, c/o Archaeological Tours, 424 Madison Ave, New York, NY 10017. Ophthalmic Seminar. —The Department of Ophthalmology at Park Ridge Hospital, Rochester, NY, will hold an ophthalmic seminar, Aug 10-11, 1979. Topics will be current concepts in vitrectomy, pediatric ophthalmology, and diseases of the anterior segment. For further information, please contact Katherine Sgabelloni, RN, Coordinator, Ophthalmic Services, Park Ridge Hospital, 1555 Long Pond Rd, Rochester, NY 14626. Annual Meeting in Ophthalmology and Otolaryngology. —The annual meeting of the North and South

Kolder, Hansjoerg E.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010518042

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 book contains the personal accounts of several implant surgeons with extensive experience. It includes material that is not otherwise available. The descriptions are detailed and explicit. The design criteria for intraocular lenses are included, as well as surgical modifications that reveal an ongoing in-depth analysis of the procedures by their proponents. The chapter on the molecular basis of implant material is well prepared and enlightening. The management of secondary implants and the results of pseudophakos in children are presented with caution. P. Choyce reviews his preferred technique for intraocular lens implantation, which is as follows: general anesthesia, no microscope, Graefe's section, implantation of a Mark VIII lens—its feet resting snugly in the chamber angle—and sutures for closure through superficial tissue layers; vitreous loss is not a deterrent for implantation. This description of the favorite technique of a widely emulated surgeon is revealing and humbling. Dr Jaffe used a

Blodi, Frederick C.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010518040

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, for a long time, been associated with the editorial staff of JAMA and, for the last few years, has been responsible for the book reviews in that magazine. This book developed out of courses in medical writing. The author gives most helpful guidelines on how to write a manuscript, how to edit it, and how to revise it. Particularly delightful are his style analyses and his remarks about translations. This book should be profitable for anybody who plans to write a scientific article or a medical book.

Blodi, Frederick C.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010518041

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 monograph comes from the Department of Anatomy of the medical school in Lubeck, West Germany. The investigation, performed largely by electron microscopy, is concerned specifically with the postnatal development of the retina of the cat. The cat is born blind with closed eyelids. The lids open between the seventh and tenth postnatal day. The initial phase of development lasts one week, and during that time the ganglion cell layer and the nerve fiber layer become demarcated from each other by Müller's fibers. The main growth phase

Blodi, Frederick C.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010518039

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, who is professor of ophthalmology at Düsseldorf, West Germany, has used an interesting and novel approach for the discussion of ocular diseases. For each sign and symptom, the differential diagnosis is discussed in detail. This should be an easy and excellent way of diagnosing any affection of the visual system. The text is precise and concise. Numerous subheadings provide a systematic approach to the topics and

Blodi, Frederick C.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010518037

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 fact that a fourth edition of this book has appeared proves its popularity. It has certainly become the basic textbook of ophthalmology for students, interns, and young residents. The basic concept has not changed but every chapter has been brought up to date. It is actually remarkable how well the recent literature has been incorporated into the book. The bibliography covers all of 1977 and the early part of 1978. The illustrations are superb and the list of references after each chapter should prove most useful for anybody who would like to study a certain aspect of ophthalmology in depth. This book should continue to be the reference text for ophthalmology. It should be recommended reading in every medical school and in every eye residency program.

Blodi, Frederick C.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010518038

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 short and concise booklet is an introduction to ocular pharmacology. It was apparently written for nurses and ophthalmic assistants, but it could also be of use to first-year residents and medical students. The monograph is up to date and should be a useful reference book.

Blodi, Frederick C.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010519044

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 is indeed an unusual tome. It presents a collection of articles all dealing with ocular oncology. It comprises nearly 900 pages and more than 800 illustrations. It covers nearly all aspects of ocular tumors in an encyclopedic fashion. Nothing like this has ever been offered to the ophthalmic community and it is unlikely that anything like it will come forward in any language in the near future. The book is dedicated to Algernon B. Reese, the doyen of ocular pathology in this country. The editor is now in charge of the laboratory at the College of Physicians and Surgeons, New York, where Dr Reese worked for many decades. The book has 71 contributors and most of them are ophthalmic pathologists. Many of the authors are associated with the College of Physicians and Surgeons or with the Armed Forces Institute of Pathology (AFIP) in Washington, DC. A number of chapters

Mensher, John H.

1979 Archives of Ophthalmology

doi: 10.1001/archopht.1979.01020010519043

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 Montague Ruben has edited and contributed to an in-depth and detailed collection of essays on the various aspects of the technology related to soft contact lenses. The book is divided into sections, the first of which deals with the historical background. It is of interest to note where all this work began and to see how much has developed in roughly two decades. There follow seven chapters that deal with the physicochemical properties of the soft materials. Oxygen permeability, metabolic changes induced by the covering of a cornea, temperature alterations, and optical qualities are thoroughly and technically presented. Next the techniques of fitting are presented. Both the spuncast and lathe-cut lenses are discussed. Residual astigmatism problems, continuous-wear lenses and the difficulties associated with them, and the therapeutic uses of soft lenses in anterior membrane diseases and keratoconus are well presented. Chapters are included concerning soft lenses as drug delivery systems