Archives of Ophthalmology

1980 Archives of Ophthalmology

doi: 10.1001/archopht.1980.01020040184001

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Blodi, Frederick C.;Waring, George O.;Krachmer, Jay

1980 Archives of Ophthalmology

doi: 10.1001/archopht.1980.01020040229002

Abstract A new and still experimental procedure, radial keratotomy, is currently being performed in an attempt to eliminate the need for glasses and contact lenses in myopes. Caution must be exercised to prevent the proliferation of this operation before its efficacy and safety are established by careful studies in this country. The statement made by a group of corneal specialists who recently met in Atlanta represents a reasonable position at this time. Fourteen ophthalmologists, 13 of whom are full-time university professors, participated in a workshop on the use of radial keratotomy to treat myopia sponsored by Emory University, Atlanta, March 15,1980. Six additional full-time university professors who were unable to attend the workshop participated in writing the statements that follow. After discussing the indications for such an operation, the procedure itself, the experimental animal work being done, the clinical results, and the socioeconomic implications, the participants agreed on the following conclusions. References 1. National Advisory Eye Council meeting, announcements . Invest Ophthalmol Vis Sci 18:882, 1979.

Jakobiec, Frederick A.

1980 Archives of Ophthalmology

doi: 10.1001/archopht.1980.01020040230003pmid: 6998439

Abstract While the natural history of untreated choroidal melanoma and the effects of enucleation are now subjects engulfed in a scientific maelstrom,1-3 modest progress is being made in understanding the biologic behavior of conjunctival melanoma. One might expect as many or more problems in studying conjunctival melanoma because it is a rare disease, occurring approximately one fortieth as often as choroidal melanoma.4 The valuable article in this issue of the Archives by Liesegang and Campbell (see p 1385) about the experience of the Mayo Clinic, Rochester, Minn, with conjunctival melanoma provides a timely stimulus for examining the present state of our knowledge about this disease, the relationship of conjunctival melanomas to cutaneous melanomas, and persistent areas of uncertainty or controversy. During the past decade, dermatopathologists have made impressive strides in unraveling the evolution of cutaneous melanoma. These breakthroughs have been codified in four major monographs.5-8 Ophthalmic pathologists have taken References 1. Zimmerman L, McLean I: An evaluation of enucleation in the management of uveal melanomas . Am J Ophthalmol 87:741-760, 1979. 2. Jakobiec FA: A moratorium on enucleation for choroidal melanoma? Am J Ophthalmol 87:842-846, 1979. 3. Manschot WA, van Peperzeel HA: Choroidal melanoma: Enucleation or observation? A new approach . Arch Ophthalmol 98:71-77, 1980.Crossref 4. Henkind P: Conjunctival melanocytic lesions: Natural history , in Jakobiec FA (ed): Ocular and Adnexal Tumors . Birmingham, Ala, Aesculapius Publishing Co, 1978, pp 572-582. 5. Milton GA: Malignant Melanoma of the Skin and Mucous Membrane . New York, Churchill-Livingstone, 1977. 6. McGovern V: Malignant Melanoma: Clinical and Histological Diagnosis . New York, John Wiley & Sons Inc, 1976. 7. Kopf A, Bart R, Rodriguez-Sains R, et al: Malignant Melanomas . New York, Masson Publishing USA Inc, 1979. 8. Clark W, Goldman L, Mastrangelo M (eds): Human Malignant Melanoma . New York, Grune & Stratton Inc, 1979. 9. Bernardino J, Naidoff M, Clark W: Malignant melanomas of the conjunctiva . Am J Ophthalmol 82:383-394, 1976. 10. Silvers D, Jakobiec FA, Freeman T, et al: Melanoma of the conjunctiva: A clinicopathologic study , in Jakobiec FA (ed): Ocular and Adnexal Tumors . Birmingham, Ala, Aesculapius Publishing Co, 1978, pp 583-599. 11. Zimmerman LE: The histogenesis of conjunctival melanomas: The first Algernon B. Reese Lecture , in Jakobiec FA (ed): Ocular and Adnexal Tumors . Birmingham, Ala, Aesculapius Publishing Co, 1978, pp 600-630. 12. Clark W, Folberg R, Ainsworth A: Tumor progression in primary human cutaneous malignant melanomas , in Clark W, Goldman L, Mastrangelo M (eds): Human Malignant Melanoma . New York, Grune & Stratton Inc, 1979, pp 15-31. 13. Clark W, Bernardino V, Reed R, et al: Acral lentiginous melanomas , in Clark W, Goldman L, Mastrangelo M (eds): Human Malignant Melanoma . New York, Grune & Stratton Inc, 1979, pp 109-124. 14. Smith C: Carcinoma in situ . Hum Pathol 9:373-374, 1978.Crossref 15. Ackerman AB: Carcinoma in situ . Hum Pathol 10:127-128, 1979.Crossref 16. Ackerman AB, Su W: The histology of cutaneous malignant melanoma , in Kopf A, Bart R, Rodriguez-Sains R, et al: Malignant Melanomas . New York, Masson Publishing USA Inc, 1979, pp 25-147. 17. Elder D, Ainsworth A, Clark W: The surgical pathology of cutaneous malignant melanoma , in Clark W, Goldman L, Mastrangelo M (eds): Human Malignant Melanoma . New York, Grune & Stratton Inc, 1979, pp 109-124. 18. Sagebiel R: Histopathology of borderline and early malignant melanomas . Am J Surg Pathol 3:543-552, 1979.Crossref 19. Mintzis M, Silvers D: Ultrastructural study of superficial spreading melanoma and benign simulants . Cancer 42:502-511, 1978.Crossref 20. Clark W, Ainsworth A, Bernardino E, et al: The developmental biology of primary human malignant melanomas . Semin Oncol 2:83-103, 1975. 21. Reese AB: Precancerous and cancerous melanomas . Am J Ophthalmol 61:1272-1277, 1966. 22. Clark W, Reimer R, Greene M, et al: Origin of familial malignant melanomas from heritable melanocytic lesions: 'The B-K mole syndrome.' Arch Dermatol 114:732-738, 1978.Crossref 23. Bellet R, Shields J, Soll D, et al: Primary choroidal and cutaneous melanomas occurring in a patient with the B-K mole syndrome phenotype . Am J Ophthalmol 89:567-570, 1980. 24. Reese AB: Tumors of the Eye . Hagerstown, Md, Harper & Row Publishers Inc, 1976, pp 249-257. 25. Blodi F, Watson P: Seventh Cambridge Ophthalmological Symposium (1977), pigmented tumors of the eye . Trans Ophthalmol Soc UK 97 ( (pt 3) ):358-447, 1977. 26. Leonard D, Lund H: Pathology of malignant melanoma , in Andrade R, Gumport S, Popkin G, et al (eds): Cancer of the Skin . Philadelphia, WB Saunders Co, 1976, vol 2, pp 1019-1044. 27. Reed R, Ichinose H, Clark W, et al: Common and uncommon melanocytic nevi and borderline melanomas . Semin Oncol 2:119-147, 1975. 28. Reed R: New Concepts in Surgical Pathology of the Skin . New York, John Wiley & Sons Inc, 1976, pp 75-89. 29. Reed R, Leonard D: Neurotropic melanoma: A variant of desmoplastic melanoma . Am J Surg Pathol 3:301-311, 1979.Crossref 30. Warner T, Seo I, Bennett J: Minimal deviation melanoma with epidermotropic metastases arising in a congenital nevus . Am J Surg Pathol 4:175-184, 1980.Crossref 31. Breslow A: Thickness, cross-sectional areas, and depth of invasion in the prognosis of cutaneous melanoma . Ann Surg 172:902-908, 1970.Crossref 32. McGovern V, Shaw H, Milton G, et al: Prognostic significance of the histological features of malignant melanoma . Histopathology 3:385-393, 1979.Crossref 33. Jay B: Naevi and melanomata of the conjunctiva . Br J Ophthalmol 49:169-204, 1965.Crossref 34. Lommatzsch P: Beta irradiation of conjunctival melanomas . Trans Ophthalmol Soc UK 97( (pt 3) ):378-380, 1977.

Liesegang, Thomas J.;Campbell, R. Jean

1980 Archives of Ophthalmology

doi: 10.1001/archopht.1980.01020040237004pmid: 7417073

Abstract • One hundred twenty-six surgically excised pigmented lesions of the conjunctiva were evaluated and correlated with clinical data and follow-up information. Of these, 42 were classified as conjunctival melanomas, with 18 arising apparently de novo, 15 from acquired melanosis, and nine from nevi. The six tumor deaths occurred only in patients with melanomas arising de novo or from acquired melanosis. Patients with tumor deaths usually demonstrated local recurrences long before metastases occurred. Moreover, several patients had local recurrences treated repeatedly for years without metastatic spread. Recent clinical findings relating to skin melanomas were applied and evaluated. References 1. Reese AB: Precancerous and cancerous melanosis , in Boniuk M (ed): Ocular and Adnexal Tumors: New and Controversial Aspects. St Louis, CV Mosby Co, 1964, pp 19-23. 2. Silvers DN, Jakobiec FA, Freeman TR, et al: Melanoma of the conjunctiva: A clinicopathologic study , in Jakobiec FA (ed): Ocular and Adnexal Tumors . Birmingham, Ala, Aesculapius Publishing Co, 1978, pp 583-599. 3. Zimmerman LE: The histogenesis of conjunctival melanomas: The first Algernon B. Reese lecture , in Jakobiec FA (ed): Ocular and Adnexal Tumors . Birmingham, Ala, Aesculapius Publishing Co, 1978, pp 600-630. 4. Lewis PM, Zimmerman LE: Delayed recurrences of malignant melanomas of the bulbar conjunctiva . Am J Ophthalmol 45:536-543, 1958. 5. Jakobiec FA, Rootman J, Jones IS: Secondary and metastatic tumors of the orbit , in Duane TD (ed): Clinical Ophthalmology . Hagerstown, Md, Harper & Row Publishers Inc, 1978, vol 2, chap 46, pp 1-67. 6. McGovern VJ, Mihm MC Jr, Bailly C, et al: The classification of malignant melanoma and its histologic reporting . Cancer 32:1446-1457, 1973.Crossref 7. Bernardino VB Jr, Naidoff MA, Clark WH Jr: Malignant melanomas of the conjunctiva . Am J Ophthalmol 82:383-394, 1976. 8. Gow JA, Spencer WH: Intraocular extension of an epibulbar malignant melanoma . Arch Ophthalmol 90:57-59, 1973.Crossref 9. Breslow A: Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma . Ann Surg 172:902-908, 1970.Crossref 10. Jay B: Naevi and melanomata of the conjunctiva . Br J Ophthalmol 49:169-204, 1965.Crossref 11. Reese AB: Precancerous and cancerous melanosis . Am J Ophthalmol 61:1272-1277, 1966. 12. Lederman M: Radiotherapy of cancerous and precancerous melanosis . Trans Ophthalmol Soc UK 78:147-164, 1958. 13. Lederman M: Discussion of pigmented tumors of the conjunctiva , in Boniuk M (ed): Ocular and Adnexal Tumors: New and Controversial Aspects . St Louis, CV Mosby Co, 1964, pp 32-40.

Jakobiec, Frederick A.;Brownstein, Seymour;Wilkinson, Ralph D.;Khalil, Mourad;Cooper, William C.;Shibata, Henry R.

1980 Archives of Ophthalmology

doi: 10.1001/archopht.1980.01020040242005pmid: 7417074

Abstract • Two patients who had refused exenteration for widespread conjunctival melanoma were treated by a combination of cryotherapy and surgical excisions. Cryotherapy was delivered only to the extensive areas of flat intraepithelial melanocytic proliferation (precancerous melanosis), while the surgical excisions were performed on the focal nodules, representing localized invasive melanoma. In our two patients, the invasive nodules measured, respectively, 1.2 and 1.5 mm in greatest thickness, placing them in a low to borderline risk group for metastasis. Repeated cryoapplications were required to control the widespread flat intraepithelial disease. The conjunctiva tolerated these procedures well because the substantia propria is not sacrificed as it must be in surgical conjunctivectomy, allowing comparatively normal reepithelialization to occur from adjacent zones, after the treated epithelium containing the melanocytes sloughs. No evidence of invasive melanoma (cancerous melanosis) has developed in any of the cryotreated areas of intraepithelial disease (precancerous melanosis); sequential biopsies have established that the atypical melanocytes have disappeared from the epithelium. References 1. Zimmerman LE, Maumencee AE, Reese AB, et al: Pigmented tumors of the conjunctiva , in Boniuk M (ed): Ocular and Adnexal Tumors . St Louis, CV Mosby Co, 1964, pp 24-48. 2. Jay B: Naevi and melanomata of the conjunctiva . Br J Ophthalmol 49:169-204, 1965.Crossref 3. Zimmerman LE: Criteria for management of melanosis . Arch Ophthalmol 76:307-308, 1966.Crossref 4. Reese AB: Precancerous and cancerous melanosis . Am J Ophthalmol 61:1272-1277, 1966. 5. Silvers DN, Jakobiec FA, Freeman T, et al: Melanoma of the conjunctiva: A clinicopathologic study , in Jakobiec FA (ed): Ocular and Adnexal Tumors . Birmingham, Ala, Aesculapius Publishing Co, 1978, pp 583-599. 6. Henkind P: Conjunctival melanocytic lesions: Natural history , in Jakobiec FA (ed): Ocular and Adnexal Tumors . Birmingham, Ala, Aesculapius Publishing Co, 1978, pp 572-582. 7. Zimmerman LE: The histogenesis of conjunctival melanomas , in Jakobiec FA (ed): Ocular and Adnexal Tumors . Birmingham, Ala, Aesculapius Publishing Co, 1978, pp 600-630. 8. Clark W, Goldman L, Mastrangelo M (eds): Human Malignant Melanoma . New York, Grune & Stratton Inc, 1979. 9. Kopf A, Bart R, Rodriguez-Sains R, et al: Malignant Melanoma . New York, Masson Publishing Co, 1979. 10. Breslow A: Thickness cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma . Ann Surg 172:902-908, 1970.Crossref 11. Griffith WR, Green WR, Weinstein GW: Conjunctival malignant melanoma originating in acquired melanosis sine pigmento . Am J Ophthalmol 75:595-599, 1972. 12. Torre D: Cryosurgical treatment of eyelid tumors , in Jakobiec FA (ed): Ocular and Adnexal Tumors . Birmingham, Ala, Aesculapius Publishing Co, 1978, pp 517-524. 13. Wilkes TD, Fraunfelder FT: Principles of cryosurgery . Ophthalmic Surg 10:21-30, 1979. 14. Zacarian SA: Cryogenics, the cryolesion and the pathogenesis of cryonecrosis , in Zacarian SA (ed): Cryosurgical Advances in Dermatology and Tumors of the Head and Neck . Springfield, Ill, Charles C Thomas Publisher, 1977, pp 3-37. 15. Fraunfelder FT, Wallace TR, Farris HE, et al: The role of cryosurgery in external ocular and periocular disease . Trans Am Acad Ophthalmol Otolaryngol 83:713-724, 1977.

Abramson, David H.;Rodriguez-Sains, Rene S.;Rubman, Robert

1980 Archives of Ophthalmology

doi: 10.1001/archopht.1980.01020040249006pmid: 7417075

Abstract • A 51-year-old white man had the B-K mole syndrome (multiple large atypical cutaneous nevi of the upper part of the trunk and extremities, inherited as an autosomal dominant trait, and thought to be more susceptible to malignant transformation), so named after two patients in whom the syndrome was first observed. Two cutaneous malignant melanomas (thigh and back) and an ocular malignant melanoma (ciliary body and iris) simultaneously developed. Patients with B-K mole syndrome have been known to have a very high risk for the development of cutaneous melanoma (including multiple primary cutaneous melanomas) and multiple primary malignancies. There may be a propensity in these patients for development of ocular melanomas. References 1. Clark WH Jr, Reimer RR, Greene M, et al: Origin of familial malignant melanomas from heritable melanocytic lesions: "The B-K mole syndrome." Arch Dermatol 114:732-738, 1978.Crossref 2. Reimer RR, Clark WH Jr, Greene MH, et al: Precursor lesions in familial melanoma: A new genetic preneoplastic syndrome . JAMA 239:744-746, 1978.Crossref 3. Lynch HT, Organ CH Jr, Harris RE, et al: Familial cancer: Implications for surgical management of high-risk patients . Surgery 83:104-113, 1978. 4. Hochberg LA, Grayzel D, Berson SL, et al: Multiple primary tumors with fibrosarcoma and coexisting carcinoma of the lung . Arch Surg 59:166-175, 1949.Crossref 5. Moertel CG, Dockerty MB, Baggenstoss AH: Multiple primary malignant neoplasms . Cancer 14:221-248, 1961.Crossref 6. Abramson DH, Ellsworth RM, Zimmerman LE: Non-ocular cancer in retinoblastoma . Trans Am Acad Ophthalmol Otolaryngol 81:454-458, 1976. 7. Morgan SS, Heidenry R, Bowen SF Jr: Malignant melanoma of the iris and ciliary body occurring as a third primary malignancy . Am J Ophthalmol 76:26-29, 1973. 8. Pheasant TR, Michelson JB, Shields JA, et al: Uveal melanoma occurring as a fourth primary malignancy . Ann Ophthalmol 11:626-627, 1979. 9. Warren S, Gates O: Multiple primary malignant tumors . Am J Cancer 16:1358-1414, 1932. 10. Scotto J, Fraumeni JF Jr, Lee JA: Melanomas of the eye and other noncutaneous sites: Epidemiologic aspects . J Nati Cancer Inst 56:489-491, 1976. 11. Bellet RE, Vaisman I, Mastrangelo MJ, et al: Multiple primary malignancies in patients with cutaneous melanoma . Cancer 40:1974-1981, 1977.Crossref 12. Kopf AW, Bart RS, Rodriguez-Sains, RS: Malignant melanoma: A review . J Dermatol Surg Oncol 3:41-125, 1977.Crossref 13. Kopf AW, Bart RS, Rodriguez-Sains RS, et al: Malignant Melanoma . New York, Masson Publishing USA Inc, 1979. 14. Fletcher WS: Pigment Cell: Mechanism in Pigmentation . New York, S Karger AG, 1973, vol 1, pp 255-260. 15. Lynch HT, Frichot BC, Lynch P, et al: Family studies of malignant melanoma and associated cancer . Surg Gynecol Obstet 141:517-520, 1975. 16. Moseley HS, Guilano AE, Storm FK, et al: Multiple primary melanoma . Cancer 43:939-944, 1979.Crossref 17. Ferry AP, Font RL: Carcinoma metastatic to the eye and orbit: I. A clinicopathologic study of 227 cases . Arch Ophthalmol 92:276-286, 1974.Crossref 18. Ferry AP, Font RL: Carcinoma metastatic to the eye and orbit: A clinicopathological study of 26 patients with carcinoma metastatic to the anterior segment of the eye . Arch Ophthalmol 93:472-482, 1975.Crossref 19. Albert DM, Rubenstein RA, Scheie HG: Tumor metastasis to the eye: I. Incidence in 213 adult patients with generalized malignancy . Am J Ophthalmol 63:723-726, 1967. 20. Ferry AP: Primary malignant melanoma of the skin metastatic to the eye . Am J Ophthalmol 74:12-19, 1972. 21. Fishman ML, Tomaszewski MM, Kuwabara T: Malignant melanoma of the skin metastatic to the eye: Frequency in autopsy series . Arch Ophthalmol 94:1309-1311, 1976.Crossref 22. Hirst LW, Reich J, Galbraith JEK: Primary cutaneous malignant melanoma metastatic to the iris . Br J Ophthalmol 63:165-168, 1979.Crossref 23. Font RL, Naumann G, Zimmerman LE: Primary malignant melanoma of the skin metastatic to the eye and orbit . Am J Ophthalmol 63:738-754, 1967. 24. Lynch HT, Anderson DE, Krush AJ: Heredity and intraocular malignant melanoma . Cancer 21:119-125, 1968.Crossref 25. Turkington RW: Familial factor in malignant melanoma . JAMA 192:77-82, 1965.Crossref 26. Lynch HT, Krush AJ: Heredity and malignant melanoma: Implications for early cancer detection . Can Med Assoc J 99:17-21, 1968. 27. Paton D, Thomas LB: Simultaneous occurrence of primary malignant melanomas of the eye and the skin . Arch Ophthalmol 62:645-652, 1959.Crossref

Krachmer, Jay H.;Fenzl, Robert E.

1980 Archives of Ophthalmology

doi: 10.1001/archopht.1980.01020040252007pmid: 6998440

Abstract • Improved techniques and procedures have resulted in a higher rate of clear grafts after penetrating keratoplasty. A clear graft, however, does not give a good visual result if high corneal astigmatism prevents the successful wearing of spectacles or contact lenses. This article describes the methods and results of two microsurgical techniques—the corneal wedge resection to steepen the flat meridian and relaxing incisions to flatten the steep meridian. Average reduction in corneal astigmatism was greater for the wedge resection (ten cases) (6.50 diopters as compared with 4.25 D [16 cases] for the relaxing incisions). The relaxing incisions operation was successful in 75% of cases with stabilization of corneal curvature readings in an average of three weeks and is an outpatient procedure. After a wedge resection, corneal stabilization usually takes months. We believe that wedge resection should be reserved for cases in which relaxing incisions are unsuccessful. References 1. Lans LJ: Experimentelle Untersuchungen über die Entstehung von Astigmatismus durch nicht-perforirende Corneawunden . Albrecht Von Graefes Arch Klin Exp Ophthalmol 45:117-152, 1898.Crossref 2. Poyales I: Actas I Congreso Oftalmologico Latino . Rome, Arte della Stampa, 1953. 3. Barraquer J, Muiños A: Lamellar scleral resection: Indications and technique . Am J Ophthalmol 41:92-98, 1956. 4. Snellen H: Die Richtung der Hauptmeridiane des astigmatischen Auges . Albrecht Von Graefes Arch Klin Exp Ophthalmol 15:199-207, 1869.Crossref 5. Bates WH: A suggestion of an operation to correct astigmatism . Arch Ophthalmol 23:9-13, 1894. 6. Sato T: Posterior incision of cornea . Am J Ophthalmol 33:943-948, 1950. 7. Troutman RC: Astigmatic considerations in corneal graft . Ophthalmic Surg 10:21-26, 1979. 8. Troutman RC (ed): Proceedings of the Third International Symposium Microsurgery Study Group, Merida, Yucatan . Basel, Switzerland, S Karger AG, 1972. 9. Troutman RC: Microsurgery of the Anterior Segment of the Eye . St Louis, CV Mosby Co, 1977, p 286. 10. Troutman RC: Microsurgical control of corneal astigmatism in cataract and keratoplasty . Trans Am Acad Ophthalmol Otolaryngol 77:563-572, 1973. 11. Wiedman M: Cylinders into spheres: Astigmatic cornea repair. Read before the Tenth Corneal Research Conference, Boston, June 17, 1977. 12. Barner SS: Surgical treatment of corneal astigmatism . Ophthalmic Surg 7:43-48, 1976.

Rao, Gullapalli N.;Stevens, Richard E.;Mandelberg, Alan I.;Aquavella, James V.

1980 Archives of Ophthalmology

doi: 10.1001/archopht.1980.01020040255008pmid: 6998441

Abstract • The morphologic features of corneal endothelium were studied with clinical specular microscopy in 33 cases of clear corneal transplants. A complete morphologic profile of the corneal endothelium, which included cell density, mean cell area, and variation in cell size (polymegethism), was obtained with an automated, pattern-analysis system. Our observations demonstrated variation in all these parameters of graft endothelium with time, indicating that graft endothelium is in a state of transition during healing and that the end point to the healing process is still to be determined. References 1. Bron AJ, Brown NAP: Endothelium of the corneal graft . Trans Ophthalmol Soc UK 94:863-873, 1974. 2. Laing RA, Sandstrom MM, Berropsi AR, et al: Morphological changes in corneal endothelial cells after penetrating keratoplasty . Am J Ophthalmol 82:459-464, 1976. 3. Bourne WM, Kaufman HE: The endothelium of clear corneal transplants . Arch Ophthalmol 94:1730-1732, 1976.Crossref 4. Rao GN, Waldron WR, Aquavella JV: Morphology of graft endothelium and donor age. Br J Ophthalmol, to be published. 5. Sato T: Studies on the endothelium of the corneal graft . Jpn J Ophthalmol 22:114-126, 1978. 6. Bourne WM, O'Fallon WM: Endothelium cell loss during penetrating keratoplasty . Am J Ophthalmol 85:760-766, 1978. 7. Rao GN, Shaw EL, Arthur EJ, et al: Morphological appearance of the healing corneal endothelium . Arch Ophthalmol 96:2027-2030, 1978.Crossref 8. Rao GN, Shaw EL, Stevens RE, et al: Automated pattern analysis of corneal endothelium. Ophthalmology, to be published. 9. Rao GN, Shaw EL, Arthur EJ, et al: Endothelial cell morphology and corneal deturgescence . Ann Ophthalmol 11:885-899, 1979. 10. Rao GN, Shaw EL, Aquavella JV: Endothelial cell morphology and corneal deturgescence , in Proceedings of the 23rd International Congress on Ophthalmology, Kyoto, 1978 . Amsterdam, Excerpta Medica, 1979, p 1647. 11. Shaw EL, Rao GN, Arthur EJ, et al: The functional reserve of corneal endothelium . Ophthalmology 85:640-649, 1978.Crossref 12. Bourne WM, Brubaker RF, O'Fallon WM: Use of air to decrease endothelial cell loss during intraocular lens implantation . Arch Ophthalmol 97:1473-1475, 1979.Crossref

Raber, Irving M.;Arentsen, Juan J.;Laibson, Peter R.

1980 Archives of Ophthalmology

doi: 10.1001/archopht.1980.01020040259009pmid: 6998442

Abstract • Twelve cases of traumatic wound dehiscence occurred in ten patients after penetrating keratoplasty. Nine of the ten patients were males between the ages of 11 and 44 years. Ten of the 12 traumatic wound ruptures occurred with the sutures in place. Final visual acuity was better than 6/60 in only four patients. The grafts have remained clear in six of the ten patients, while one patient awaits a regraft. Four patients required repeat keratoplasty. The primary cause of visual failure was damage to the retina and posterior segment. The importance of protecting the eye after corneal transplantation is stressed. References 1. Binder PS, Abel RA Jr, Polack FM, et al: Keratoplasty wound separations . Am J Ophthalmol 80:109-115, 1975. 2. Brown SI, Tragakis MP: Wound dehiscence with keratoplasty: Complication of the continuous suture technique . Am J Ophthalmol 72:115, 116, 1971. 3. Friedman AH: Late traumatic wound rupture following successful partial penetrating keratoplasty . Am J Ophthalmol 75:117-120, 1973.

Hayreh, Sohan Singh

1980 Archives of Ophthalmology

doi: 10.1001/archopht.1980.01020040262010pmid: 7417076

Abstract • Findings are described from 13 eyes in which post-cataract-extraction anterior ischemic optic neuropathy (PCE-AION) developed immediately after an uncomplicated cataract extraction. During the early stages of the disease, the disc is edematous, with optic disc-related visual-field defects, but after about two months, the disc is pale. The almost invariable high rise of intraocular pressure during the immediate postoperative period plays a critical role in production of PCE-AION in eyes with vulnerable optic nerve head circulation. There is a high risk of development of PCE-AION in the second eye in patients with PCE-AION in the first eye, but this can be prevented by prophylactic measures. Post-cataract-extraction AION needs to be differentiated from ordinary AION seen in aphakic eyes months or years after the cataract extraction. References 1. Vila-Coro A: Atrofia del nervio optico despues de la operacion de cataracta . Arch Soc Oftalmol Hisp Am 6:901-904, 1946. 2. Townes CD, Moran CT, Pfingst HA: Complications of cataract surgery . Trans Am Ophthalmol Soc 49:91-107, 1951. 3. Reese AB, Carroll FD: Optic neuritis following cataract extraction . Trans Am Acad Ophthalmol Otolaryngol 62:765-768, 1958. 4. Townes CD: In discussion of Reese and Carroll.3 Trans Am Acad Ophthalmol Otolaryngol 62:768-769, 1958. 5. Maumenee AE: In discussion of Reese and Carroll.3 Trans Am Acad Ophthalmol Otolaryngol 62:769-770, 1958. 6. Welch RB, Cooper JC: Macular edema, papilledema, and optic atrophy after cataract extraction . Arch Ophthalmol 59:665-675, 1958.Crossref 7. Gartner S: Optic neuritis and macular edema following cataract extraction . Eye Ear Nose Throat Monthly 43:45-49, 1964. 8. Oliver M: Posterior pole changes after cataract extraction in elderly subjects . Am J Ophthalmol 62:1145-1148, 1966. 9. O'Keeffe D, Choudhury KC: Bilateral optic neuritis following cataract extraction . Br J Ophthalmol 50:608-609, 1966.Crossref 10. Gass JDM: Ischemic optic neuropathy in aphakia (and phakia) , in Welsh RC, Welsh J (eds): The New Report on Cataract Surgery . Miami, Fla, Miami Education Press, 1969, pp 84-86. 11. Carroll FD: Optic nerve complications of cataract extraction . Trans Am Acad Ophthalmol Otolaryngol 77:623-629, 1973. 12. Hayreh SS: Blood supply of the optic nerve head and its role in optic atrophy, glaucoma, and oedema of the optic disc . Br J Ophthalmol 53:721-748, 1969.Crossref 13. Hayreh SS: Structure and blood supply of the optic nerve , in Heilmann K, Richardson KT (eds): Glaucoma: Conception of a Disease . Stuttgart, West Germany, Georg Thieme Verlag, 1978, pp 78-96. 14. Gormaz A: Ocular tension after cataract surgery . Am J Ophthalmol 53:832-841, 1962. 15. Kirsch RE: Glaucoma following cataract extraction associated with use of α-chymotrypsin . Arch Ophthalmol 72:612-620, 1964.Crossref 16. Giardini A, Paliaga GP: Cataract extraction with optimum wound closure . Br J Ophthalmol 48:133-138, 1964.Crossref 17. Galin M, Barasch KR, Harris LS: Enzymatic zonulolysis and intraocular pressure . Am J Ophthalmol 61:690-696, 1966. 18. Rich WJCC: Intraocular pressure and wound closure after cataract extraction . Trans Ophthalmol Soc UK 88:437-439, 1968. 19. Rich WJ, Radtke ND, Cohan BE: Early ocular hypertension after cataract extraction . Br J Ophthalmol 58:725-731, 1974.Crossref 20. Hayreh SS, Podhajsky P: Visual field defects in anterior ischemic optic neuropathy . Doc Ophthalmol Proc Series 19:53-71, 1979. 21. Hayreh SS: Ischemic optic neuropathy . Int Ophthalmol 1:9-18, 1978.Crossref 22. Hayreh SS: Anterior ischaemic optic neuropathy: I. Terminology and pathogenesis . Br J Ophthalmol 58:955-963, 1974.Crossref 23. Hayreh SS: Anterior ischaemic optic neuropathy: II. Fundus on ophthalmoscopy and fluorescein angiography . Br J Ophthalmol 58:964-980, 1974.Crossref 24. Hayreh SS: Anterior Ischemic Optic Neuropathy . Berlin, Springer-Verlag, 1975.