Archives of Ophthalmology

1991 Archives of Ophthalmology

doi: 10.1001/archopht.1991.01080040004001

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

Spaeth, George L.;Chang, Patricia C. T.;Soong, H. Kaz

1991 Archives of Ophthalmology

doi: 10.1001/archopht.1991.01080040023004pmid: 2012533

Abstract To the Editor. —We read the timely article by Sharma and coworkers1 of nine cases of Acanthamoeba keratitis in non-contact lens wearers in India during a 2-year period. We fully agree with the authors that the diagnosis of Acanthamoeba keratitis may be unduly delayed if the clinician fails to consider risk factors other than contact lens wear, ie, foreign-body injuries to the cornea and contact with contaminated water.2 There is very little reason to believe Acanthamoeba keratitis in non-contact lens wearers is a new phenomenon; it is more likely that many of these cases were missed in the past. Only now are we able to appreciate the true incidence of Acanthamoeba keratitis in non-contact lens wearers, owing to a combination of heightened awareness, better clinical diagnostic criteria, and improved laboratory studies.See also p 471.In our own 2-year experience, three of 12 cases of culture-proven Acanthamoeba ulcerative References 1. Sharma S, Srinivasan M, George C. Acanthamoeba keratitis in non-contact lens wearers . Arch Ophthalmol . 1990;108:676-678.Crossref 2. Auran JD, Starr MB, Jakobiec FA. Acanthamoeba keratitis: a review of the literature . Cornea . 1987;6:2-26.Crossref 3. Stehr-Green J, Bailey TM, Visvesvara GS. The epidemiology of Acanthamoeba keratitis in the United States . Am J Ophthalmol . 1989;107:331-336.

Flach, Allan J.

1991 Archives of Ophthalmology

doi: 10.1001/archopht.1991.01080040023002pmid: 2012532

Abstract To the Editor. —I read with interest the answer to the question, "What antiglaucomatous medications are safe to use during pregnancy?" in the "Questions and Answers" Section in the November 1990 issue of the Archives.1 Dr Spaeth states, "Women of childbearing age should be cautioned against conceiving while they are receiving carbonic anhydrase inhibitors since they are known to be teratogenic. In contrast,... the miotics, sympathomimetics, and β-blockers... are not thought to be teratogenic in the doses used in ophthalmology."This is not correct. Although the carbonic anhydrase inhibitors are well known to cause reproducible forelimb defects in rodents,2 they have never been proven to be teratogenic in humans or even in nonhuman primates.3 In fact, at least one small series described 12 women who took acetazolamide with no defects observed in their offspring.4 Furthermore, both pilocarpine hydrochloride5 and the sympathomimetics6 have also produced References 1. Spaeth GL. Glaucoma treatment and pregnancy . Arch Ophthalmol . 1990;108:1536.Crossref 2. Layton WM, Hallesy DW. Deformity of forelimb in rats: associated with high doses of acetazolamide . Science . 1965;149:306-308.Crossref 3. Wilson JG. Use of rhesus monkeys in teratological studies . Fed Proc . 1971;30:104-109. 4. Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy . Littleton, Mass: Publishing Sciences Group Inc; 1977. 5. Landauer W. On teratogenic effects of pilocarpine in chick development . J Exp Zool . 1953;122:469-483.Crossref 6. Jost A, Raffi J, Cowitat M. Congenital amputations determined by the br gene and those induced by adrenalin injection in the rabbit fetus . In: Swinyard CA, ed. Limb Development and Deformity: Problems of Evaluation and Rehabilitation . Springfield, Ill: Charles C Thomas Publisher; 1969:187-199. 7. Lenz W, Knapp K. Thalidomide embryopathy . Arch Environ Health . 1962;5:100-105.Crossref 8. Shepard TH. Catalog of Teratogenic Agents . 6th ed. Baltimore, Md: The Johns Hopkins University Press; 1989:1660-1665.

1991 Archives of Ophthalmology

doi: 10.1001/archopht.1991.01080040023003

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 In Reply —I am not quite sure what point Dr Flach was making. Of the two sentences he quotes, he says, "This is not correct." However, as Dr Flach points out, carbonic anhydrase inhibitors are unquestionably teratogenic in certain animals. Thus, at least the final portion of the first sentence is correct. To my knowledge, the second sentence is also correct, since I know of no evidence to indicate that miotics, sympathomimetics, and β-blockers cause abnormalities in the doses used in ophthalmology. The studies by Landauer and Jost and colleagues, cited by Flach, employed vastly larger doses, such as direct injection of epinephrine into a rabbit fetus. I may have overlooked information showing that miotics, sympathomimetics, and β-blockers are teratogenic in the doses used in ophthalmology. If I have, I would be grateful to be given the information so that I could make more accurate statements in the future. I

Sassani, Joseph W.

1991 Archives of Ophthalmology

doi: 10.1001/archopht.1991.01080040024007pmid: 1859533

Abstract To the Editor. —I was pleased to read the report by Warren and associates1 describing their experience with the disposable skin biopsy punch. In 1981, we described the use of an essentially identical instrument, the Baker's disposable biopsy punch, for obtaining tarsal conjunctival biopsy specimens.2Since our initial report, we have modified our procedure. The biopsy "button" is outlined using the Acuderm punch described by Warren and associates. (We have discontinued use of the Baker's punch due to its unavailability.) As the biopsy specimen is outlined, the punch penetrates the tissue to the desired depth. A suture is passed through the base of the specimen and used to provide traction as the biopsy button is amputated at its base with fine scissors or a scalpel.After the needle is safely disposed of, the specimen is permitted to remain on the suture during fixation to facilitate specimen identification, orientation, References 1. Warren RC, Nerad JA, Carter KD. Punch biopsy technique for the ophthalmologist . Arch Ophthalmol . 1990;108:778-779.Crossref 2. Sassani J, Cutler J. A new application for the disposable skin biopsy punch . Am J Ophthalmol . 1981;92:737. 3. Spaulding AG. Skin tumors and trephines . Ophthalmic Surg . 1979;10:39-41.

Yee, Robert D.

1991 Archives of Ophthalmology

doi: 10.1001/archopht.1991.01080040024006

Abstract In Reply. —Small children with nystagmus whom ophthalmologists encounter most often have congenital nystagmus (CN). However, other causes of nystagmus should be sought. The most important are neurologic disorders, since the child's general health can be at risk and early medical intervention might be needed. Therefore, I emphasize detecting neurologic disorders by seeking neurologic signs and symptoms and looking for nystagmus characteristics that are uncommon in CN, eg, vertical and torsional directions. Neuroradiologic tests are not used routinely, but are performed when neurologic disorders are suspected.I agree with Dr Brodie that electrophysiologic tests, such as electroretinography, are useful in detecting some ocular abnormalities associated with nystagmus. The nystagmus can usually be distinguished from CN. For example, nystagmus associated with rod monochromatism often has a higher frequency and/or smaller amplitude than CN.1 Congenital nystagmus has characteristic waveforms that can be revealed by eye movement recordings in young children. References 1. Yee RD, Baloh RW, Honrubia V. Eye movement abnormalities in rod monochromacy . Ophthalmology . 1981;88:1010-1018.Crossref 2. Dell'Osso LF, Daroff RB. Congenital nystagmus waveforms and foveation strategy . Doc Ophthalmol . 1975;39:155-182.Crossref

Brodie, Scott E.

1991 Archives of Ophthalmology

doi: 10.1001/archopht.1991.01080040024005pmid: 2012534

Abstract To the Editor. —The recent discussion in the Archives by Yee1 on the initial evaluation of nystagmus in infants and small children emphasizes the need for neuroradiologic imaging in cases where the nystagmus pattern is atypical. This approach deemphasizes the likelihood of primary sensory abnormalities as a frequent cause of nystagmus in infants.Carr and Siegel2 have provided a useful differential scheme for congenital nystagmus. In many instances, including achromatopsia, congenital stationary night blindness, and Leber's congenital amaurosis, nystagmus due to sensory abnormalities cannot be reliably recognized on funduscopic examination, or by evaluation of the nystagmus pattern. In such circumstances, an electroretinogram (which may easily be obtained without sedation in infants less than 1 year of age) may be a more productive and far less expensive study than computed tomography or magnetic resonance imaging.Reports of the relative frequency of sensory vs motor causes of nystagmus depend so References 1. Yee RD. Evaluating nystagmus in young children . Arch Ophthalmol . 1990;108:793.Crossref 2. Carr RE, Siegel IM. Nystagmus and decreased vision from birth . In: Electrodiagnostic Testing of the Visual System: A Clinical Guide . Philadelphia, Pa: FA Davis Co Publishers; 1990:131-133. 3. Isenberg SJ. Workup of common differential diagnostic problems . In: The Eye in Infancy . Chicago, Ill: Year Book Medical Publishers Inc; 1989:81-84.

Tamai, Makoto;Nakazawa, Mitsuru

1991 Archives of Ophthalmology

doi: 10.1001/archopht.1991.01080040025009pmid: 2012536

Abstract To the Editor. —Biochemical characteristics of the vitreous have been studied in animals, but very few studies have been conducted in clinical cases.1,2 The major difficulty has been the problem of collecting undiluted vitreous samples from human eyes. We have invented a safe method and device for this purpose. Materials and Methods. —A collection bottle with openings on both sides was tightly secured to the suction tubes; one tube, 10 cm in length, was connected to the cutter and the other was fitted to the pump of the vitreous machine. Initally, the vitreous cavity was observed and cut without suction pressure to determine a safe depth and position for the tip of the cutter. Next, the infusion cannula for air was opened and inflated. After collecting a certain amount of vitreous, we stopped the machine, and the air in the infusion pipe was changed to an irrigating solution. We References 1. Rubinstein E, Goldfarb J, Keren G, Blumenthal M, Treister G. The penetrations of gentamicin into the vitreous humor in man . Invest Ophthalmol Vis Sci . 1983;24:637-639. 2. Campochiaro PA, Jerdan JA, Glaser BM, Cardin A, Michels RG. Vitreous aspirates from patients with proliferative vitreoretinopathy stimulate retinal pigment epithelial cell migration . Arch Ophthalmol . 1985;103:1403-1405.Crossref 3. McCuen BM II, Bessler M, Hickingbotham D, et al. Automated fluid-gas exchange . Am J Ophthalmol . 1983;95:717.

Doft, Bernard H.;Donnelly, Karen

1991 Archives of Ophthalmology

doi: 10.1001/archopht.1991.01080040025008pmid: 2012535

Abstract To the Editor. —Vitreous specimens in endophthalmitis can be obtained by aspiration through a needle, vitrectomy biopsy procedure, or full vitrectomy approach. In theory, a vitreous biopsy procedure in which the vitreous is cut may be safer than vitreous aspiration. When performing a vitreous biopsy in endophthalmitis, it is widely believed1 that an infusion line is necessary to prevent the globe from collapsing. However, one can use a single 20-gauge sclerotomy without infusion to rapidly and simply perform a vitrectomy biopsy in this disease. Additional sclerotomy openings are not required. The suction outflow end of the vitrectomy cutter is connected to a "vitreous biopsy tubing adaptor," which consists of 2.5 cm of silicone tubing connected to a female Luer lock as shown in the Figure. The Luer lock is attached to a tuberculin syringe so that suction can be controlled manually. The cutting function is machine controlled.Under the References 1. Forster RK. Endophthalmitis . In: Schwab IR. ed. Duane's Clinical Ophthalmology . Revised ed. Philadelphia, Pa:JB Lippincott; 1989;4:chap24.

Connett, John E.;Scott, William

1991 Archives of Ophthalmology

doi: 10.1001/archopht.1991.01080040026011

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 In Reply. —Dr Mims and Mr Wood present their view that the Prism Adaptation Trial (PAT) "was flawed because the... [PAT surgical table] called for amounts of surgery... that were simply too small" for the control group, and suggested that surgical amounts should be determined by the use of a dose-response curve described in their 1986 article. In response, we note the following: There were more overcorrections in the PAT control groups, which received smaller amounts of surgery on average, than in the prism-adapted surgical group. We concluded that prism adaptation appears to identify a subgroup of patients in whom it is safe to perform larger amounts of surgery without increasing the rate of overcorrection. If larger amounts of surgery had been performed routinely in the control groups, it is likely that the number of overcorrections would have increased. It is not clear, as claimed by Mims and Wood in