Archives of Ophthalmology

Kim, Daniel K.;Tanenbaum, Myron;Flemmings, Shirley J.

1989 Archives of Ophthalmology

doi: 10.1001/archopht.1989.01070020345001pmid: 2783053

Abstract To the Editor. —The use of postoperative ice compresses is a mainstay of patient management following oculoplastic surgery. Despite this widely recognized benefit of postoperative ice compresses, little attention has been paid to the use of intraoperative crushed ice. We are strong advocates of intraoperative ice compresses during oculoplastic procedures, many of which require 1.5 to 2 or more hours. We present a simple, economical, and efficient method for the application of intraoperative compresses of crushed ice. Report of a Case. —An 82-year-old white man was taken to the operating room for resection of a large basal cell carcinoma of the left lower eyelid. This procedure involved frozen-section monitoring of the surgical margins. Approximately 45 to 50 minutes elapsed while the surgical specimens were being processed. The operative field around the left eye was covered with a sterile bag filled with crushed ice (Figure). The cool, crushed ice compress helped References 1. McDonald WD, Guthrie JD Jr. Cryotherapy in the postoperative setting . J Foot Surg . 1985;24:438-441. 2. Abramson DI. Physiologic basis for the use of physical agents in peripheral vascular disorders . Arch Phys Med Rehabil . (March) , 1965:216-244. 3. Olson JE, Stranvino VD. A review of cryotherapy . Phys Ther . 1972;52:840-853. 4. McMaster WC, Liddle S, Waugh TR. Laboratory evaluation of various cold therapy modalities . Am J Sports Med . 1978;6:291-294.Crossref

Herbort, Carl P.;Weissman, Scott S.;Ostler, H. Bruce;Cevallos, Ada;Char, Devron H.

1989 Archives of Ophthalmology

doi: 10.1001/archopht.1989.01070020345002pmid: 2476978

Abstract To the Editor. —Retinoic acid has improved clinical signs in most cicatrizing dry eye conditions, but not in keratoconjunctivitis sicca.1 Even in the absence of cicatrization, it has produced a substantial improvement in some cases of conjunctival and corneal keratinization.2 We found that ocular surface keratinization was predictive of response to topical retinoic acid treatment in the course of a randomized, double-masked, placebo-controlled, crossover trial.We quantified conjunctival and corneal keratinization by dividing the ocular surface into 11 zones and scored each area from 0 (no keratinization) to 3 (thick keratin plaque), based on slit-lamp examination and rose bengal staining. The numbers were added to determine a total clinical keratinization score. Conjunctival scrapings were Giemsa stained; an average of 200 to 300 epithelial cells were randomly counted from areas of each slide to determine the percentage of keratinized cells and keratinizing epithelial cells. Report of a Case. —A References 1. Soong HK, Martin NF, Wagoner MD, et al. Topical retinoid therapy for squamous metaplasia of various ocular surface disorders: a multicenter, placebo-controlled, double-masked study . Ophthalmology . 1988;95:1442-1446.Crossref 2. Herbort CP, Zografos L, Zwingli M, Schoeneich M. Topical retinoic acid in dysplastic and metaplastic keratinization of corneo-conjunctival epithelium . Graefes Arch Clin Exp Ophthalmol . 1988;226:22-26.Crossref

Ball, Stuart F.

1989 Archives of Ophthalmology

doi: 10.1001/archopht.1989.01070020346003pmid: 2783054

Abstract To the Editor. —I found the article by Kondo and Araie1 regarding fluorouracil concentrations after subconjuctival injection of interest, but I believe that their experimental design poses some problems with extrapolation of the results to the clinical situation.In their model, the drug was injected in a superotemporal location, permitting gravity to assist in the movement of both the subconjunctival and tear-borne fluorouracil inferiorly. Clinically, however, the filter site is most often located superiorly and the injection site inferiorly; thus, the drug must diffuse against the combined forces of gravity and aqueous outflow through the fistula. Even if there is no subconjunctival scarring, the injected drug is unlikely to diffuse and "rapidly reach the conjunctiva and sclera on the side 180° away from the injection site" in the clinical situation at the rate demonstrated in the Kondo and Araie's model.The reported even distribution (1.6 to 2.4 μg/g) of References 1. Kondo M, Araie M. Concentration change of fluorouracil in the external segment of the eye after subconjunctival injection . Arch Ophthalmol . 1988;106:1718-1721.Crossref 2. Calabresi P, Parks RE Jr. Antiproliferative agents and drugs used in immunosuppression . In: Gilman AG, Goodman LS, eds. The Pharmacological Basis of Therapeutics . 7th ed. New York, NY: Macmillan Publishing Co Inc; 1985:1267-1271. 3. Weinreb RN. Adjusting the dose of 5-fluorouracil after filtration surgery to minimize side effects . Ophthalmology . 1987;94:564-570.Crossref

Kondo, Masaki;Araie, Makoto

1989 Archives of Ophthalmology

doi: 10.1001/archopht.1989.01070020346004

Abstract In Reply. —Dr Ball's letter correctly addressed some of the concerns that we had in extrapolating our results obtained using normal rabbit eyes to the clinical situation. The main purpose of our article was to report that 24 hours after the subconjunctival injection of 5 mg of fluorouracil, its levels in the cornea, sclera, and conjunctiva were still above the reported fluorouracil concentrations for 50% inhibition of cultured fibroblast proliferation levels, which may have clinical implications for the safe use of this drug. As expressly stated in the "Comment" section, it is difficult to estimate the fluorouracil levels postoperatively in the human eye with glaucoma from the results we obtained.1 There are too many differences in the conditions between normal rabbit eyes and human eyes with glaucoma postoperatively. For example, we injected fluorouracil through the superior rectus muscle belly to minimize reflux.1 In patients, this method of injection References 1. Kondo M, Araie M. Concentration change of fluorouracil in the external segment of the eye after subconjunctival injection . Arch Ophthalmol . 1988;106:1718-1721.Crossref 2. Fantes EF, Parrish RK II, Heuer DK, et al. Subconjunctival 5-fluorouracil mechanisms of ocular penetration . Ophthalmic Surg . 1987;18:375-378.

Wolin, Mitchell J.;Holds, John B.;Anderson, Richard L.

1989 Archives of Ophthalmology

doi: 10.1001/archopht.1989.01070020347005pmid: 2783055

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. —Ophthalmologists are sometimes confronted with patients who have a severe cosmetic deformity following the loss of orbital tissues or exenteration. Ocular or oculofacial prostheses are available for these patients, but they may not be aesthetically or functionally acceptable in all cases. Men can frequently use a simple black eye patch (Hathaway patch) in these circumstances, which may evoke a certain "machismo" image. However, this image does not afford the same appeal to most women.We recently treated a woman who created a variety of patches with pleasing and often entertaining themes (Figure). She constructed her own patches from spare material to match her daily dress. She also made special patches to incorporate the motifs of holidays or seasons. She has received many positive comments and reinforcements on the appearance of her patches, which made this attractive young lady less self-conscious about her deformity.We feel that such

McMillan, James;Char, Devron H.;McLean, Ian W.;Gamel, John W.

1989 Archives of Ophthalmology

doi: 10.1001/archopht.1989.01070020348006pmid: 2783056

Abstract To the Editor. —DNA content flow cytometric analysis and morphometric determination of SD of necleolar area (SDNA) correlate with uveal melanoma mortality.1,2 In this retrospective study we assessed the relative prognostic accuracy of these techniques.One hundred twenty-seven enucleated uveal melanomas submitted to the Armed Forces Institute of Pathology, Washington, DC, prior to 1973 were analyzed in a masked manner. The DNA content was studied on deparaffinized 50-μm stained sections (Chromomycin A-3) using a cytometer (FACS IV, Becton-Dickinson, Mountain View, Calif).2 Histogram peaks with coefficients of variation less than 8.0 were accepted. Single-peak histograms were assumed to be diploid. The lowest DNA content spike in a multiple peak was considered diploid and the others aneuploid. Degree of aneuploidy was expressed as a "DNA index" that equaled the ratio of the aneuploid to diploid peaks; diploid tumors were assigned a DNA index of 1.0.Nucleolar areas of 200 randomly References 1. McLean IW, Gamel JW. Prediction of metastasis of uveal melanoma: comparison of morphometric determination of nucleolar size and spectrophotometric determination of DNA . Invest Ophthalmol Vis Sci . 1988;29:507-511. 2. Meecham WJ, Char DH. DNA content abnormalities and prognosis in uveal melanoma . Arch Ophthalmol . 1986;104:1626-1629.Crossref 3. Feichter GE, Goerttler K. Pitfalls in the preparation of nuclear suspension from paraffin-embedded tissue for flow cytometry . Cytometry . 1986;7:616.Crossref

Bosley, Thomas M.

1989 Archives of Ophthalmology

doi: 10.1001/archopht.1989.01070020349008

Abstract In Reply. —I appreciate the careful attention Dr Bates gave to our article. However, I disagree with his concerns about the safety and utility of OPG-Gee testing in the setting of possible GCA.Ocular pneumoplethysmography has proved to be remarkably safe in more than 1 million procedures during the last 15 years. Several large series have not reported ophthalmic complications,1,2 and, to my knowledge, the only reported mishap during testing is displacement of one iris plane intraocular lens3 that was repositioned without surgery. This safety record may be related to the fact that the human globe is accustomed to transient elevations of intraocular pressure, such as during eye rubbing, to levels of well above that used in the test.4,5Dr Bates suggests that GCA may create a "thrombogenic environment" and that OPG-Gee testing may be dangerous in this setting. He offers no histologic, experimental, or clinical data References 1. Meissner I, Wiebers DO, Whisnant JP, O'Fallon WM. The natural history of asymptomatic carotid artery occlusive lesions . JAMA . 1987;258:2704-2707.Crossref 2. Moll FL, Eikelboom BC, Vermeulen FEE, VanLier HJJ, Schulte BPM. Dynamics of collateral circulation in progressive asymptomatic carotid disease . J Vasc Surg . 1986;3:470-474.Crossref 3. Faulkner HW. Ocular pneumoplethysmography after lens implantation . Am Intra-ocular Implant Soc J . 1980;6:369-370. Letter.Crossref 4. Miller D. Pressure of the lid on the eye . Arch Ophthalmol . 1967;78:328-330.Crossref 5. Fraunfelder FT, Boozman FW III, Wilson RS, Thomas AH. No-touch technique for intraocular malignant melanomas . Arch Ophthalmol . 1977;95:1616-1620.Crossref

Bates, James H.

1989 Archives of Ophthalmology

doi: 10.1001/archopht.1989.01070020349007pmid: 2783057

Abstract To the Editor. —I wish to make some comments on the article by Bosley et al1 in the March issue of the Archives regarding the use of ocular pneumoplethysmography (OPG-Gee) in the diagnosis of giant-cell arteritis (GCA). While I appreciate the results of the study, the conclusion that the OPG-Gee is a clinically practical, cost-effective, and safe procedure in the diagnosis of GCA is in question. The latter point of safety is surely the most obvious.Having observed the procedure during my residency, I was impressed by the sustained high intraocular pressure and transient ocular ischemia it produced. The intraocular pressure reaches levels between 110 to 145 mm Hg,2 which is allowed to slowly decrease in a period of 28 to 40 seconds.3 This intraocular pressure exceeds ophthalmic artery systolic pressure and causes transient occlusion of the ophthalmic artery, the posterior ciliary arteries, and the central retinal References 1. Bosley TM, Savino PJ, Sergott RC, Eagle RC, Sandy R, Gee W. Ocular pneumoplethysmography can help in the diagnosis of giant-cell arteritis . Arch Ophthalmol . 1989;107:379-381.Crossref 2. Folger WN. Non-invasive studies . In: Sundt TM, ed. Occlusive Cerebrovascular Disease: Diagnosis and Surgical Management . Philadelphia, Pa: WB Saunders Co; 1987:73. 3. Gee W. Ocular pneumoplethysmography . Surv Ophthalmol . 1985;29:276-292.Crossref

Minogue, Michael J.;Playfair, T. Justin;Gregory-Roberts, John C.;Robinson, Lyon P.

1989 Archives of Ophthalmology

doi: 10.1001/archopht.1989.01070020351009pmid: 2789506

Abstract To the Editor. —Paecilomyces lilacinus is a highly pathogenic fungus within the eye, and its in vitro sensitivity to amphotericin B is low.1,2 Cure of endophthalmitis due to this organism has been reported after the use of intravitreal antimycotic therapy.1 However, two of three patients with P lilacinus keratitis treated by penetrating keratoplasty developed intractible endophthalmitits postoperatively and failed to respond to multiple vitrectomies and multiple intraocular injections of miconazole.2We report a case of exogenous P lilacinus endophthalmitis that was successfully treated after the third recurrence by 11 intravitreal injections of 10 μg of amphotericin B over 14 days. Report of a Case. —A 43-year-old farmer developed fungal keratitis after injuring his right eye. Despite administration of topical natamycin and miconazole, the infection worsened, and a therapeutic penetrating keratoplasty was performed on March 27,1981. Septate fungal hyphae were noted in the deep corneal stroma of References 1. Miller GR, Rebell G, Magoon RC, Kulvin SM, Forster RK. Intravitreal antimycotic therapy and the cure of mycotic endophthalmitis caused by Paecilomyces lilacinus pseudophakos . Ophthalmic Surg . 1987;9:54-63. 2. Kozarsky AM, Stulting RD, Waring GO III, Cornell FM, Wilson LA, Cavanagh HD. Penetrating keratoplasty for exogenous Paecilomyces keratitis followed by post-operative endophthalmitis . Am J Ophthalmol . 1984;98:552-557. 3. Doft BH, Weiskopf J, Nilsson-Ehle I, Wingard LB Jr. Amphotericin clearance in vitrectomized versus non-vitrectomized eyes . Ophthalmology . 1985;92:1601-1605.Crossref

Judson, Peter H.

1989 Archives of Ophthalmology

doi: 10.1001/archopht.1989.01070020352011pmid: 2783059

Abstract To the Editor. —Aminoglycoside antibiotics are routinely injected subconjunctivally at the conclusion of routine cataract extraction by many cataract surgeons. Both tobramycin sulfate and gentamicin sulfate are highly effective against Staphylococcus species and a broad range of gram-negative pathogens, especially Pseudomonas species.1 However, irreversible rapid retinal toxicity may occur if these drugs enter the eye. Report of a Case. —A 58-year-old woman underwent routine extracapsular cataract extraction with posterior chamber intraocular lens implantation in her left eye. A 4-mL retrobulbar injection of equal amounts of 1% xylocaine with epinephrine and 0.75% marcaine and 0.5 mL of hyaluronidase was given preoperatively. The procedure was uneventful and the posterior capsule was noted to be intact. At the conclusion of the procedure, 20 mg of tobramycin was injected subconjunctivally within the superior fornix-based conjunctival flap, thereby ballooning the flap over the corneoscleral wound.On the first postoperative day, a good red reflex References 1. Paven-Langston D, ed. Manual of Ocular Diagnosis and Therapy . Boston, Mass: Little Brown & Co Inc; 1980:438-441. 2. D'Amico DJ, Caspers-Velv L, Liberti J, et al. Comparative toxicity of intravitreal aminoglycoside antibiotics . Am J Ophthalmol . 1985;100:264-275. 3. Balien JV. Accidental intraocular tobramycin injection: a case report . Ophthalmic Surg . 1983;14:353-354.