Archives of Ophthalmology

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150705001pmid: 9194719

Abstract Objective: To evaluate the efficacy of oral acyclovir in preventing stromal keratitis or iritis in patients with epithelial keratitis caused by herpes simplex virus (HSV). Methods: Patients with HSV epithelial keratitis of 1-week or less duration were treated with topical trifluridine and were randomly assigned to receive a 3-week course of oral acyclovir, 400 mg 5 times a day (hereafter referred to as the acyclovir group), or placebo (hereafter referred to as the placebo group). The development of HSV stromal keratitis or iritis was assessed during 12 months of follow-up. Results: Stromal keratitis or iritis developed in 17 (11%) of the 153 patients in the acyclovir group and in 14 (10%) of the 134 patients in the placebo group. Compared with the placebo group, the adjusted rate ratio for the development of stromal keratitis or iritis in the acyclovir group was 1.16 (95% confidence interval, 0.56-2.43). The development of stromal keratitis or iritis was more frequent in patients with a history of HSV stromal keratitis or iritis than in those without such a history (23% vs 9%; P=.01). Conclusions: For patients with HSV epithelial keratitis treated with topical trifluridine, no apparent benefit of a 3-week course of oral acyclovir in preventing HSV stromal keratitis or iritis was seen during the subsequent year. The 1-year rate of development of stromal keratitis or iritis was lower than previously reported in the literature, except in patients with a history of HSV stromal keratitis or iritis. References 1. National Institutes of Health. Workshop on the treatment and prevention of herpes simplex virus infections . J Infect Dis . 1973;127:117-119.Crossref 2. Liesegang TJ, Melton LJ, Daly PJ, llstrup DM. Epidemiology of ocular herpes simplex: incidence in Rochester, Minn, 1950 through 1982 . Arch Ophthalmol . 1989;107:1155-1159.Crossref 3. Dawson CR, Togni B. Herpes simplex eye infections: clinical manifestations, pathogenesis and management . Surv Ophthalmol . 1976;21:121-135.Crossref 4. Pepose JS. Herpes simplex keratitis: role of viral infection versus immune response . Surv Ophthalmol . 1991;35:345-352.Crossref 5. Liesegang TJ. Epidemiology of ocular herpes simplex: natural history in Rochester, Minn, 1950 through 1982 . Arch Ophthalmol . 1989;107:1160-1165.Crossref 6. Norn MS. Dendritic (herpetic) keratitis, I: incidence, seasonal variations, recurrence rate, visual impairment, therapy . Acta Ophthalmol . 1970;48:91-107.Crossref 7. McGill J, Williams H, McKinnon J, et al. Reassessment of idoxuridine therapy of herpetic keratitis . Trans Ophthalmol Soc U K . 1974;94:542-552. 8. McGill J, Holt-Wilson AD, McKinnon JR, et al. Some aspects of the clinical use of trifluorothymidine in the treatment of herpetic ulceration of the cornea . Trans Ophthalmol Soc U K . 1974;94:342-352. 9. Wilhelmus KR, Coster DJ, Donovan HC, et al. Prognostic indicators of herpetic keratitis: analysis of a five-year observation period after corneal ulceration . Arch Ophthalmol . 1981;99:1578-1582.Crossref 10. Herpetic Eye Disease Study Group. Manual of Operations, version date August 1, 1994. Available from the National Technical Information Service, Springfield, Va (accession No. PB97-112999). 11. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration . Cancer Chem Rep . 1966;50:163-170. 12. Hung SO, Patterson A, Rees PJ. Pharmacokinetics of oral acyclovir (Zovirax) in the eye . Br J Ophthalmol . 1984;68:192-195.Crossref

Mathers, William D.;Goldberg, Marc A.;Sutphin, John E.;Ditkoff, Jonathan W.;Folberg, Robert

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150716002pmid: 9194720

Abstract Objective: To describe a series of patients with proved herpes simplex virus keratitis (herpetic keratitis) who also had documented Acanthamoeba keratitis. Methods: Herpetic keratitis was documented with viral cultures, immunologic stains, or histopathologic examination for multinucleated giant cells in the corneal epithelium. Acanthamoeba organisms were identified using confocal microscopy and epithelial biopsy with hematoxylin-eosin staining. Biopsy of the stroma and epithelium was used to identify Acanthamoeba organisms in 1 case. Results: Cultures for herpes simplex virus were positive in 6 of the 9 cases. Immunologic stains were positive in an additional 2 cases, and in 1 case multinucleated giant cells were present in the epithelium consistent with the diagnosis of herpes simplex virus keratitis. Tandem scanning confocal microscopic findings were positive for Acanthamoeba in 8 of the 9 cases, and all of them demonstrated Acanthamoeba organisms in epithelial scrape biopsy specimens. In 1 case, which was not evaluated with confocal microscopy, Acanthamoeba was detected using a stromal and epithelial biopsy. Two of the 9 patients had a history of contact lens use. Conclusion: Acanthamoeba keratitis may be present as a secondary or opportunistic infection in patients with herpetic keratitis. References 1. Kay-Tearney ML, McGhee CN, Crawford GL, Trown K. Acanthamoeba keratitis: a masquerade of presentation in six cases . Aust N Z J Ophthalmol . 1993;21:237-245.Crossref 2. Cohen EJ, Buchanan HW, Laughrea PA, Adams CP, Galentine PG, Visvesvara GS. Diagnosis and management of Acanthamoeba keratitis . Am J Ophthalmol . 1985;100:389-395. 3. Bacon AS, Dart JK, Ficker LA, Matheson M, Wright P. Acanthamoeba keratitis: the value of early diagnosis . Ophthalmology . 1993;100:1238-1243.Crossref 4. Petroll WM, Jester JV, Cavanagh HD. Quantitative three-dimensional confocal imaging of the cornea in situ and in vivo: system design and calibration . Scanning . 1996;18:45-49.Crossref 5. Visvesvara GS, Stehr-Green JK. Epidemiology of free-living ameba infections . J Protozool . 1990;37:25S-33S.Crossref 6. Illingworth CD, Cook SD, Karabatsas CH, Easty DL. Acanthamoeba keratitis: risk factors and outcome . Br J Ophthalmol . 1995;79:1078-1082.Crossref 7. Auran JD, Starr MB, Jakobiec FA. Acanthamoeba keratitis: a review of the literature . Cornea . 1987;6:2-26.Crossref 8. Bacon AS, Frazer DG, Ficker LA, Matheson M, Dart JK, Wright P. A review of 72 consecutive cases of Acanthamoeba keratitis, 1984-1992 . Eye . 1993;7:719-725.Crossref 9. Winchester K, Mathers WD, Sutphin JE, Daley TE. Diagnosis of Acanthamoeba keratitis in vivo with confocal microscopy . Cornea . 1995;14:10-17.Crossref 10. Mathers WD, Sutphin JE, Folberg R, Meier PA, Elgin RG, Wenzel RP. Outbreak of keratitis presumed to be caused by Acanthamoeba . Am J Ophthalmol . 1996;121:129-142. 11. Cavanagh HD, Petroll WM, Alizadeh HA. Clinical and diagnostic use of in vivo confocal microscopy in patients with corneal disease . Ophthalmology . 1993;100:1444-1433.Crossref 12. Newsome AL, Curtis FT, Culbertson CG, Allen SD. Identification of Acanthamoeba in brochoalveolar lavage specimens . Diagn Cytopathol . 1992;8:231-234.Crossref 13. Florakis GJ, Folberg R, Krachmer JH, Tse DT, Roussel TJ, Vrabec MP. Elevated corneal epithelial lines in Acanthamoeba keratitis . Arch Ophthalmol . 1988;106:1202-1206.Crossref 14. Jones DB. Acanthamoeba: the ultimate opportunist? Am J Ophthalmol . 1986;102:527-530. 15. Seal DV. Acanthamoeba keratitis: a problem for contact lens users that is here to stay . BMJ . 1994;308:1116-1177.Crossref 16. McCulley JP, Alizadeh HA, Niederkorn JY. Acanthamoeba keratitis . Contact Lens Assoc Ophthalmol . 1995;21:73-76. 17. Redford CF, Dart JK, Minassian DC. Risk factors for Acanthamoeba keratitis . BMJ . 1996;312:183.Crossref 18. Leopold IH, Sery TW. Epidemiology of herpes simplex keratitis . Invest Ophthalmol . 1963;2:498. 19. Pavan-Langston D, Boisjoly H. Management of herpes simplex virus ocular infections . In: Darrel R, ed. Viral Diseases of the Eye. Philadelphia , Pa: Lea & Febiger, 1985:29-45. 20. Nesburn AB. Immunologic aspects of herpes simplex disease . In: Suran I, Gery I, Nussenblatt R, eds. Immunology of the Eye, Workshop III: Immunologic Aspects of Ocular Disease . Bethesda Md: National Eye Institute: 1981:21-42. 21. Jenkins FJ, Baum A. Stress and reactivation of latent herpes simplex virus: a fusion of behavioral medicine and molecular biology . Ann Behav Med . 1995;17:116-123.Crossref 22. Kaufman HE, Varnell ED, Gebhardt BM, Thompson HW, Hill JM. Propranolol supression of ocular HSV-1 reactivation and recurrent lesions in the rabbit . Curr Eye Res . 1996;15:680-684.Crossref 23. Laibson PR, Kibrick S. Reactivation of herpetic keratitis by epinephrine in rabbits . Arch Ophthalmol . 1966;75:254-260.Crossref

Wiffen, Steven J.;Weston, Bonnie C.;Maguire, Leo J.;Bourne, William M.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150721003pmid: 9194721

Abstract Objective: To investigate the value of donor corneal rim cultures performed routinely at the time of penetrating keratoplasty. Design: Retrospective review of Mayo Clinic medical records for all corneal transplantations for which donor rim cultures have been performed. Main Outcome Measures: Frequency of positive cultures, occurrence of endophthalmitis within 2 months of undergoing surgery, action taken in response to the culture results, and costs of cultures. Results: Donor rim culture results were available for 1078 of 1083 consecutive transplantations performed from 1981 to 1995. Three cases of endophthalmitis (0.28%) and 1 suture abscess occurred. Rim cultures were negative in all of these cases. Action was documented in response to positive cultures in 17 cases (8.1%). The estimated average cost of routine rim cultures in 1994 was $137 per donor cornea. Bacterial or fungal cultures were positive in 209 (19.4%) cases. Two microorganisms were cultured simultaneously in 17 cases (1.6%) and 3 in 2 cases (0.2%). Staphylococcus coagulase-negative (130 cases [12.1%], and Streptococcus species, viridans group (23 cases [2.1%]), were the most common isolates. Fifty-two (62.7%) of 83 coagulase-negative Staphylococcus species isolates tested were resistant to gentamicin. There were more positive cultures from corneas stored in Optisol (37/183 [20%]) than in Optisol GS (16/144 [11%]) (P=.03). Fewer cultures were positive from live donors (9/93 [10%]) compared with cadaveric donors (181/909 [20%]) (P=.02). Positive cultures were more frequent for corneas excised in situ (39/125 [31.2%]) than for those enucleated (152/851 [17.9%]) (P<.001). Conclusions: Despite differences in rates of positive donor rim cultures with different harvesting and storage techniques, for our practice, routine donor corneal rim cultures had no predictive value for infective complications of penetrating keratoplasty and, therefore, added an unnecessary expense to the management of our patients. References 1. Eye Bank Association of America. Medical Standards . Washington, DC: Eye Bank Association of America; 1995. 2. Lindstrom RL. Advances in corneal preservation . Trans Am Ophthalmol Soc . 1990;88:555-648. 3. Doughman DJ, Lindstrom RL, Skelnick, DL, Mindrup EA, Nelson, JD. Long-term organ culture corneal storage: Minnesota system . In: Brightbill F, ed. Corneal Surgery: Theory, Technique and Tissue . St Louis, Mo: Mosby-Year Book Inc; 1993:614-622. 4. Woolson RF. Statistical Methods for the Analysis of Biomedical Data . New York, NY: John Wiley & Sons Inc; 1987. 5. Pardos GJ, Gallagher MA. Microbial contamination of donor eyes . Arch Ophthalmol . 1982;100:1611-1613.Crossref 6. Guss RB, Koenig S, de la Pena W, Marx M, Kaufman HE. Endophthalmitis after penetrating keratoplasty . Am J Ophthalmol . 1983;95:651-658. 7. Leveille AS, McMullan FD, Cavanagh HD. Endophthalmitis following penetrating keratoplasty . Ophthalmology . 1983;90:38-39.Crossref 8. Antonios SR, Cameron JA, Badr IA, Habash NR, Cotter JB. Contamination of donor cornea: postpenetrating keratoplasty endophthalmitis . Cornea . 1991;10:217-220.Crossref 9. Kattan HM, Flynn HWJ, Pflugfelder SC, Robertson C, Forster RK. Nosocomial endophthalmitis survey: current incidence of infection after intraocular surgery . Ophthalmology . 1991;98:227-238.Crossref 10. Aiello LP, Javitt JC, Canner JK. National outcomes of penetrating keratoplasty: risks of endophthalmitis and retinal detachment . Arch Ophthalmol . 1993;111:509-513.Crossref 11. Kloess PM, Stulting RD, Waring G, Wilson LA. Bacterial and fungal endophthalmitis after penetrating keratoplasty . Am J Ophthalmol . 1993;115:309-316. 12. Eye Bank Association of America. Statistical Report . Washington, DC: Eye Bank Association of America; 1994. 13. Mannis MJ, Smolin G. Natural defense mechanisms of the ocular surface . In: Pepose JS, Holland GN, Wilhelmus KR, eds. Ocular Infection and Immunity . St Louis, Mo: Mosby-Year Book Inc; 1996:185-190. 14. Nassif KF. Ocular surface defense mechanisms . In: Tabbara KF, Hyndiuk RA, eds. Infections of the Eye . Boston, Mass: Little Brown & Co; 1996:35-41. 15. Osato MS: Normal ocular flora . In: Pepose JS, Holland GN, Wilhelmus KR, eds. Ocular Infection and Immunity . St Louis, Mo: Mosby-Year Book Inc; 1996:191-199. 16. Polack FM, Locatcher KD, Gutierrez E. Bacteriologic study of 'donor' eyes: evaluation of antibacterial treatments prior to corneal grafting . Arch Ophthalmol . 1967;78:219-225.Crossref 17. Sperling S, Sorensen IG. Decontamination of cadaver corneas . Acta Ophthalmol . 1981;59:38-46. 18. Gomes JAP, Dana M-R, Dua HS, et al. Positive donor rim culture in penetrating keratoplasty . Cornea . 1995;14:457-462.Crossref 19. Farrell PL, Fan JT, Smith RE, Trousdale, MD. Donor cornea bacterial contamination . Cornea . 1991;10:381-386.Crossref 20. Varner AC, Rich LF, Crow BL, MacRae S. Survival of Streptococcus in Optisol-GS medium . J Refract Surg . 1995;11:207-209. 21. Mascarella K, Cavanagh HD. Penetrating keratoplasty using McCarey-Kaufman preserved corneal tissue . South Med J . 1979;72:1268-1271.Crossref 22. Mathers WD, Lemp MA. Corneal rim cultures . Cornea . 1987;6:231-233.Crossref 23. Fong LP, Gladstone D, Casey TA. Corneo-scleral rim cultures: donor contamination: a case of fungal endophthalmitis transmitted by K-Sol stored cornea . Eye . 1988;2:670-676.Crossref 24. Mindrup EA, Dubbel PA, Doughman DJ. Betadine decontamination of donor globes . Cornea . 1993;12:324-329.Crossref

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150726004

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 the photo essay titled "Thrombotic Thrombocytopenic Purpura Associated With Purtscher Retinopathy," published in the January Archives (1997;115:128-129), the legend for Figure 2 incorrectly specified the 2 photographs. The legend is reprinted correctly here. Arteriovenous phase fluorescein angiogram photographs, showing almost confluent capillary nonperfusion confined to the macula and the peripapillary region in both eyes (the periphery was not affected). Left eye (left) and right eye (right).

Brigatti, Luca;Nouri-Mahdavi, Kouros;Weitzman, Marc;Caprioli, Joseph

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150727005pmid: 9194722

Abstract Objective: To evaluate computerized neural networks to determine visual field progression in patients with glaucoma. Methods: Two hundred thirty-three series of Octopus G1 visual fields of 181 patients with glaucoma were collected. Each series was composed of 4 or more reliable visual fields from patients who had previously undergone automated perimetry. The visual fields were independently evaluated in a masked fashion by 3 experienced observers (K.N.-M, M.W., and J.C.) and were judged to show progression based on the agreement of 2 observers. The stable and progressed series were matched for mean defect at baseline. The threshold data were submitted to a back propagation neural network that was trained to classify each series as stable or progressed. Two thirds of the data were used for the training and the remaining one third to test the performance of the network. This was repeated 3 times to classify all of the series (changing the training and test series). Results: Fifty-nine series of visual fields showed progression and 151 were judged stable. Neural network sensitivity was 73% and specificity was 88% (threshold for progression=0.5). The concordance of the neural network with the observers was good (0.50≤κ≥0.64). Conclusions: A neural network can be trained to recognize visual field progression in good concordance with experienced observers. Neural networks may be used to aid the physician in the evaluation of glaucomatous visual field progression. References 1. Werner EB, Petrig B, Krupin T, Bishop K. Variability of automated visual fields in clinically stable glaucoma patients . Invest Ophthalmol Vis Sci . 1989;30:1083-1089. 2. Boeglin RJ, Caprioli J, Zulauf M. Long-term fluctuation of the visual field in glaucoma . Am J Ophthalmol . 1992;113:396-400. 3. Bebie H, Fankhauser F. Statistical program for the analysis of perimetric data . Doc Ophthalmol Proc Ser . 1981;26:9-10. 4. Holmin C, Krakau CET. Regression analysis of the central visual field in chronic glaucoma cases: a follow-up study using automatic perimetry . Acta Ophthalmol . 1982;60:267-274.Crossref 5. Wu DC, Schwartz B, Nagin P. Trend analyses of automated visual fields . Doc Ophthalmol Proc Ser . 1987;49:175-189. 6. Hills JF, Johnson CA. Evaluation of the t test as a method of detecting visual field changes . Ophthalmology . 1988;95:261-266.Crossref 7. Hoskins HD, Magee SD, Drake MV, Kidd MN. Confidence intervals for change in automated visual fields . Br J Ophthalmol . 1988;72:591-597.Crossref 8. Heijl A, Lindgren G, Lindgren A, et al. Extended empirical statistical package for evaluation of single and multiple fields in glaucoma: statpac 2 . In: Mills, RP, Heijl, A, eds. Perimetry Update 1990/1991 . Amsterdam, the Netherlands: Kugler Publications; 1991:303-315. 9. Morgan RK, Feuer WJ, Anderson DR. Statpac 2 glaucoma change probability . Arch Ophthalmol . 1991;109:1690-1692.Crossref 10. Noureddin BN, Poinoosawmy D, Fietzke FW, Hitchings RA. Regression analysis of visual field progression in low-tension glaucoma . Br J Ophthalmol . 1991;75:493-495.Crossref 11. Wild J, Hussey M, Flanagan J, Trope G. Pointwise topographical and longitudinal modeling of the visual field in glaucoma . Invest Ophthalmol Vis Sci . 1993;34:1907-1916. 12. Smith SD, Katz J, Quigley HA. Analysis of progressive change in automated visual fields in glaucoma . Invest Ophthalmol Vis Sci . 1996;37:1419-1428. 13. Brigatti L, Hoffman D, Caprioli J. Neural networks to identify glaucoma with structural and functional measurements . Am J Ophthalmol . 1996;121:511-523. 14. Goldbaum MH, Sample PA, White H, et al. Interpretation of automated perimetry for glaucoma by neural network Invest Ophthalmol Vis Sci . 1994;35:3362-3373. 15. Mutlukan E, Keating D. Visual field interpretation with a personal computer based neural network . Eye . 1994;8:321-323.Crossref 16. Accornero N, Capozza M. OPTONET: neural network for visual field diagnosis . Med Biol Eng Comput . 1995;33:223-226.Crossref 17. Liu X, Cheng G, Wu JX. Identifying the measurement noise in glaucomatous testing: an artificial neural network approach . Artif Intell Med . 1994;6:401-416.Crossref 18. Madsen EM, Yolton RL. Demonstration of a neural network expert system for recognition of glaucomatous visual field changes . Mil Med . 1994;159:553-557. 19. Spenceley SE, Henson DB, Bull DR. Visual field analysis using artificial neural networks . Ophthalmic Physiol Opt . 1994;14:239-248.Crossref 20. Caudill M, Butler C. Naturally Intelligent Systems . Cambridge, Mass: MIT Press; 1990. 21. Hanley JA, McNeil BJ. The meaning and use of the area under the receiver operating characteristic (ROC) curve . Radiology . 1982;143:29-36.Crossref 22. Armitage P, Berry G. Statistical Methods in Medical Research . 3rd ed. Oxford, England: Blackwell Scientific Publications Ltd; 1994:443-447. 23. Landis JR, Koch GG. The measurement of observer agreement for categorical data . Biometrics . 1997;33:159-174.Crossref 24. Fleiss JL. The measurement of interrater agreement . In: Statistical Methods for Rates and Proportions . New York, NY: John Wiley & Sons Inc; 1981:211-236. 25. Werner EB, Bishop KI, Koelle J, et al. A comparison of experienced clinical observers and statistical tests in detection of progressive visual field loss in glaucoma using automated perimeter . Arch Ophthalmol . 1988;106:619-623.Crossref

Iwata, Fumino;Patronas, Nicholas J.;Caruso, Rafael C.;Podgor, Marvin J.;Remaley, Nancy A.;Kupfer, Carl;Kaiser-Kupfer, Muriel I.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150731006pmid: 9194723

Abstract Objective: To assess the association of visual field, vertical cup-disc (VC/D) ratio, and vertical height of optic chiasm. Design: Case series. Setting: Outpatient eye clinic. Patients: Eighteen patients with low, normal, or elevated intraocular pressure, with or without visual field defects. Intervention: Measurement of visual field, VC/D ratio, and vertical height of optic chiasm. Main Outcome Measures: Association between VC/D ratio and visual field defects compared with association between vertical height of optic chiasm and visual field defects. Results: Visual field defects were graded as 0, 1 to 10, and 11 to 20 (from least to most severe). Group mean VC/D ratios were 0.47 (0), 0.55 (1-10), and 0.69 (11-20) for right eyes and 0.48(0), 0.57 (1-10), and 0.75 (11-20) for left eyes. The significance level for trend was P=.02 for right eyes and P=.006 for left eyes. Group mean chiasm heights were 3.5 (0), 2.9 (1-10), and 2.2 (11-20) mm for right eyes and 3.5 (0), 2.8 (1-10), and 2.2 (11-20) mm for left eyes. The significance level for trend was P<.001 for right eyes and P=.002 for left eyes. To assess the simultaneous effects of VC/D ratio and chiasm height on the visual field defects groups, we used ordinal logistic regression models. Models with both variables implied that chiasm height was a stronger predictor of visual field defects group than VC/D ratio (for right eyes, P=.04 [VC/D ratio], P=.001 [chiasm height]; for left eyes, P=.11 [VC/D ratio], P=.005 [chiasm height]). Conclusions: When chiasm and VC/D ratio were analyzed in the same model, chiasm height was a stronger predictor of visual field defects. In advanced visual field defects, the optic chiasm is atrophic. References 1. Damms T, Dannheim F. Sensitivity and specificity of optic disc parameters in chronic glaucoma . Invest Ophthalmol Vis Sci . 1993;34:2246-2250. 2. Montgomery DM, Craig JP. Optic disc interpretation in glaucoma: is confidence misplaced? Ophthalmol Physiol Opt . 1993;13:383-386.Crossref 3. Abrams LS, Scott IU, Spaeth GL, Quigley HA, Varma R. Agreement among optometrists, ophthalmologists, and residents in evaluating the optic disc for glaucoma . Ophthalmology . 1994;101:1662-1667.Crossref 4. lester M, Traverso CE, Rolando M, Calabria G, Zingirian M. Study of the correlation between average values of optic disc parameters and their measurement variability using stereovideographic digital analysis . Ophthalmologica . 1995;209:177-181.Crossref 5. Bartz-Schmidt KU, Sundtgen M, Widder RA, Wever J, Krieglstein GK. Limits of two-dimensional planimetry in the follow-up of glaucomatous optic discs . Graefs Arch Clin Exp Ophthalmol . 1995;233:284-290.Crossref 6. Nicolela MT, Drance SM. Various glaucomatous optic nerve appearances: clinical correlations . Ophthalmology . 1996;103:640-649.Crossref 7. The Advanced Glaucoma Intervention Study Investigators. Advanced Glaucoma Intervention Study, II: visual field test scoring and reliability . Ophthalmology . 1994;101:1445-1455.Crossref 8. Leske MC, Connell AMS, Schachat AP, Hyman L, the Barbados Eye Study Group. The Barbados Eye Study: prevalence of open angle glaucoma . Arch Ophthalmol . 1994;112:821-829.Crossref 9. Winer BJ, Brown DR, Michels KM. Statistical Principles in Experimental Design . 3rd ed. New York, NY: McGraw-Hill Book Co; 1991. 10. Dixon WJ, ed. BMDP Statistical Software Manual: To Accompany the 7.0 Software Release . Berkeley: University of California Press; 1992. 11. Agresti A. Categorical Data Analysis . New York, NY: John Wiley & Sons Inc; 1990. 12. Gass A, Barker GJ, MacManus D, et al. High resolution magnetic resonance imaging of the anterior visual pathway in patients with optic neuropathies using fast spin echo and phased array local coils . J Neurol Neurosurg Psychiatry . 1995;58:562-569.Crossref 13. Imamura Y, Mashima Y, Oshitari K, Oguchi Y, Momoshima S, Shiga H. Detection of dilated subarachnoid space around the optic nerve in patients with papilloedema using T2 weighted fast spin echo imaging . J Neurol Neurosurg Psychiatry . 1996;60:108-109.Crossref 14. Tanino T, Mashima Y, Harashima N, Oshitari K, Oguchi Y. T2-weighted fast-spin echo MRI in patients with normal tension glaucoma (NTG) . Invest Ophthalmol Vis Sci . 1996;37( (suppl) ):S28. 15. Brodsky MC, Glasier CM, Pollock SC, Angtuago EJ. Optic nerve hypoplasia: identification by magnetic resonance imaging . Arch Ophthalmol . 1990;108:1562-1567.Crossref 16. Parravano JG, Toledo A, Kucharczyk W. Dimensions of the optic nerves, chiasm and tracts: MR quantitative comparison between patients with optic atrophy and normals . J Comput Assist Tomogr . 1993;17:688-690.Crossref 17. Stroman GA, Stewart WC, Golnik KC, Cur JK, Olinger RE. Magnetic resonance imaging in patients with low-tension glaucoma . Arch Ophthalmol . 1995;113:168-172.Crossref

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150734007

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

Davis, Janet L.;Taskintuna, Ibrahim;Freeman, William R.;Weinberg, David V.;Feuer, William J.;Leonard, Robert E.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150735008pmid: 9194724

Abstract Objective: To describe intraocular inflammation due to treatment with intravenous cidofovir dihydrate for cytomegalovirus retinitis. Design: Retrospective cohort. Setting: Three university outpatient ophthalmology clinics. Patients: All patients treated with intravenous cidofovir therapy before October 31, 1996. Intervention: Treatment with intravenous cidofovir was given according to standardized protocols. Intraocular inflammation was treated according to the best medical judgment. Main Outcome Measures: The presence of new intraocular inflammation, the severity of inflammation, visual acuity, and intraocular pressure. Results: Eleven cases of iritis (26%) occurred among 43 patients. In 6 cases, the iritis was bilateral. Patients who experienced iritis were more likely to have been previously treated for cytomegalovirus retinitis (P=.03), to be diabetic (P=.05), or to be receiving protease inhibitors (P<.001). Four patients and 15 control subjects had also taken rifabutin (P=.70). The onset of iritis occurred at a mean (±SD) of 4.9±1.8 days after a cidofovir dose and after a mean (±SD) of 4.2±1.6 doses of cidofovir. Six eyes of 4 patients had hypotony. Five eyes of 5 patients had a persistent decrease in visual acuity of at least 2 Snellen lines. Conclusions: Acute intraocular inflammation may occur with or without hypotony after intravenous cidofovir therapy, similar to the reactions seen after intravitreous administration. Although the manifestations may be severe, they are manageable with topical corticosteroid therapy in most cases. Cidofovir therapy can be continued in some patients if medical necessity warrants, but recurrent inflammation or permanent hypotony may occur. References 1. Holland GN, Shuler JD. Progression rates of cytomegalovirus retinopathy in ganciclovir-treated and untreated patients . Arch Ophthalmol . 1992;110:1435-1442.Crossref 2. Studies of the Ocular Complications of AIDS Research Group. Foscarnet-ganciclovoir cytomegalovirus retinitis trial, 4: visual outcomes . Ophthalmology . 1994;101:1250-1261.Crossref 3. Studies of the Ocular Complications of AIDS Research Group with the AIDS Clinical Trials Group. Combination foscarnet and ganciclovir therapy vs monotherapy for the treatment of relapsed cytomegalovirus retinitis in patients with AIDS: the cytomegalovirus retreatment trial . Arch Ophthalmol . 1996;114:23-33.Crossref 4. Kirsch LS, Arevalo JF, DeClercq E, et al. Phase I/II study of intravitreal cidofovir for the treatment of cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome . Am J Ophthalmol . 1995;119:466-476. 5. Kirsch LS, Arevalo JF, Chavez de la Paz E, et al. Intravitreal cidofovir (HPMPC) treatment of cytomegalovirus retinitis in patients with acquired immune deficiency syndrome . Ophthalmology . 1995;102:533-542.Crossref 6. Mehta C, Patel N. StatXact: Statistical Software for Exact Nonparametric Inference . Cambridge, Mass: Cytel Software Corp; 1992. 7. Fraunfelder FT, Grove JA. Drug-Induced Ocular Side Effects . 4th ed. Baltimore, Md: Williams & Wilkins; 1996. 8. Akingbehin T, Villada JR. Metipranolol-associated granulomatous anterior uveitis . Br J Ophthalmol . 1991;75:519-523.Crossref 9. Melles RB, Wong IG. Metipranolol-associated granulomatous iritis . Am J Ophthalmol . 1994;118:712-715. 10. Beck RW, Moke P, Blair RC, Nissenbaum R. Uveitis associated with topical β-blockers . Arch Ophthalmol . 1996;114:1181-1182.Crossref 11. Shafran SD, Singer J, Zarowny DP, et al. A comparison of two regimens for the treatment of Mycobacterium avium complex bacteremia in AIDS: rifabutin, ethambutol, and clarithromycin versus rifampin, ethambutol, clofazimine, and ciprofloxacin: Canadian HIV Trials Network Protocol 010 Study Group . N Engl J Med . 1996;335:377-383.Crossref 12. Tseng AL, Walmsley SL. Rifabutin-associated uveitis . Ann Pharmacother . 1995;29:1149-1155. 13. Jacobs DS, Piliero PJ, Kuperwaser MG, et al. Acute uveitis associated with rifabutin use in patients with human immunodeficiency virus infection . Am J Ophthalmol . 1994;118:716-722. 14. Saran BR, Maguire AM, Nichols C, et al. Hypopyon uveitis in patients with acquired immunodeficiency syndrome treated for systemic Mycobacterium avium complex infection with rifabutin . Arch Ophthalmol . 1994;112:1159-1165.Crossref 15. Polis MA, Spooner KM, Baird BF, et al. Anticytomegaloviral activity and safety of cidofovir in patients with human immunodeficiency virus infection and cytomegalovirus viruria . Antimicrob Agent Chemother . 1995;39:882-886.Crossref 16. Chavez de la Paz E, Arevalo JF, Kirsch LS, et al. Anterior nongranulomatous uveitis following intravitreal HPMPC (cidofovir) for the treatment of cytomegalovirus retinitis: analysis and prevention . Ophthalmology . 1997;104:539-544.Crossref 17. Rahhal FM, Arevalo JF, Munguia D, et al. Intravitreal cidofovir for the maintenance treatment of cytomegalovirus retinitis . Ophthalmology . 1996;103:1078-1083.Crossref 18. Banker AS, Arevalo JF, Munguia D, et al. Intraocular pressure and aqueous humor dynamics in AIDS patients treated with intravitreal cidofovir (HPMPC) for cytomegalovirus retinitis. Ophthalmology. In press. 19. Taskintuna I, Rahhal FM, Arevalo JF, et al. Low dose intravitreal HPMPC (cidofovir) therapy of cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome. Ophthalmology. In press.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150743009pmid: 9194725

Abstract Objectives: To verify and quantify previously reported risk factors for development of choroidal neovascularization (CNV) in the fellow eye of patients with 1 eye affected with CNV secondary to age-related macular degeneration, to examine the value of characteristics of the pericentral macula in the quantification of risk for developing CNV, and to explore whether the presence of occult CNV in the first eye affects the development of CNV in the fellow eye. Design, Patients, and Setting: Follow-up study of fellow eyes of 670 patients enrolled in multicenter, randomized clinical trials of laser photocoagulation of juxtafoveal or subfoveal CNV. Main Outcome Measure: Development of CNV. Results: Three characteristics of the central macula of the fellow eye and 1 systemic factor were associated independently with an increased risk of developing CNV: the presence of 5 or more drusen (relative risk, 2.1; 95% confidence interval,1.3-3.5), focal hyperpigmentation (relative risk, 2.0; 95% confidence interval, 1.4-2.9), 1 or more large drusen (relative risk, 1.5; 95% condfidence interval 1.0-2.2), and definite systemic hypertension (relative risk, 1.7; 95% confidence interval, 1.2-2.4). Estimated 5-year incidence rates ranged from 7% for the subgroup with no risk factors to 87% for the subgroup with all 4 risk factors. Characteristics of the pericentral macula were not strongly associated with the development of CNV. The presence of occult CNV in the first eye affected had no influence on the development of CNV or on the type of CNV in the fellow eye. Conclusions: The prognosis of the fellow eye is affected strongly by characteristics of its central macula and by systemic hypertension. These factors should be considered when counseling patients with unilateral neovascular age-related macular degeneration and when targeting patients for preventive interventions. References 1. Vingerling JR, Klaver CCW, Hofman A, de Jong PTVM. Epidemiology of age-related maculopathy . Epidemiol Rev . 1995;17:347-360. 2. Kahn HA, Leibowitz HM, Ganley JP, et al. The Framingham Eye Study, II: association of ophthalmic pathology with single variables previously measured in the Framingham Heart Study . Am J Epidemiol . 1977;106:33-41. 3. Maltzman BA, Mulvihill MN, Greenbaum A. Senile macular degeneration and risk factors: a case-control study . Ann Ophthalmol . 1979;11:1197-1201. 4. Delaney WV Jr, Oates RP. Senile macular degeneration: preliminary study . Ann Ophthalmol . 1982;14:21-24. 5. Hyman LG, Lilienfeld AM, Ferris FL, Fine SL. Senile macular degeneration: a case-control study . Am J Epidemiol . 1983;118:213-227. 6. Sperduto RD, Hiller R. Systemic hypertension and age-related maculopathy in the Framingham study . Arch Ophthalmol . 1986;104:216-219.Crossref 7. Newsome DA, Swartz M, Leone NC, Elson RC, Miller E. Oral zinc in macular degeneration . Arch Ophthalmol . 1988;106:192-198.Crossref 8. Goldberg J, Flowerdew G, Smith E, Brody JA, Tso MOM. Factors associated with age-related macular degeneration: an analysis of data from the first National Health and Nutrition Examination Survey . Am J Epidemiol . 1988;128:700-710. 9. Klein R, Klein BEK, Linton KLP, DeMets DL. The Beaver Dam Eye Study: the relationship of age-related maculopathy to smoking . Am J Epidemiol . 1993;137:190-200. 10. Klein R, Klein BEK, Franke T. The relationship of cardiovascular disease and its risk factors to age-related maculopathy: the Beaver Dam Eye Study . Ophthalmology . 1993;100:406-414.Crossref 11. Gass JDM. Drusen and disciform macular detachment and degeneration . Arch Ophthalmol . 1973;90:206-217.Crossref 12. Teeters VW, Bird AC. The development of neovascularization in senile disciform macular degeneration . Am J Ophthalmol . 1973;76:1-18. 13. Chandra SR, Gragoudas ES, Friedman E, Van Buskirk EM, Klein ML. Natural history of disciform degeneration of the macula . Am J Ophthalmol . 1974;78:579-582. 14. Gregor Z, Bird AC, Chisholm IH. Senile disciform macular degeneration in the second eye . Br J Ophthalmol . 1977;61:141-147.Crossref 15. Gregor Z, Joffe L. Senile macular changes in the black African . Br J Ophthalmol . 1978;62:547-550.Crossref 16. Strahlman ER, Fine SL, Hillis A. The second eye of patients with senile macular degeneration . Arch Ophthalmol . 1983;101:1191-1193.Crossref 17. Bressler SB, Maguire MG, Bressler NM, Fine SL, Macular Photocoagulation Study Group. Relationship of drusen and abnormalities of the retinal pigment epithelium to the prognosis of neovascular macular degeneration . Arch Ophthalmol . 1990;108:1442-1447.Crossref 18. Eye Disease Case-Control Study Group. Risk factors for neovascular age-related macular degeneration . Arch Ophthalmol . 1992;110:1701-1708.Crossref 19. Eye Disease Case-Control Study Group. Antioxidant status and neovascular age-related macular degeneration . Arch Ophthalmol . 1993;111:104-109.Crossref 20. Seddon JM, Ajani UA, Sperduto RD, et al. Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration: Eye Disease Case-Control Study Group . JAMA . 1994;272:1413-1420.Crossref 21. Cruickshanks KJ, Klein R, Klein BEK. Sunlight and age-related macular degeneration: the Beaver Dam Eye Study . Arch Ophthalmol . 1993;111:514-518.Crossref 22. Holz FG, Wolfensberger TJ, Piguet B,. Bilateral macular drusen in age-related macular degeneration . Ophthalmology . 1994;101:1522-1528.Crossref 23. Macular Photocoagulation Study Group. Krypton laser photocoagulation for neovascular lesions of age-related macular degeneration: results of a randomized clinical trial . Arch Ophthalmol . 1990;108:816-824.Crossref 24. Macular Photocoagulation Study Group. Laser photocoagulation for juxtafoveal choroidal neovascularization: five-year results from randomized clinical trials . Arch Ophthalmol . 1994;112:500-509.Crossref 25. Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal neovascular lesions in age-related macular degeneration: results of a randomized clinical trial . Arch Ophthalmol . 1991;109:1220-1231.Crossref 26. Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal recurrent neovascular lesions of age-related macular degeneration: results of a randomized clinical trial . Arch Ophthalmol . 1991;109:1232-1241.Crossref 27. Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal neovascular lesions of age-related macular degeneration: updated findings from two clinical trials . Arch Ophthalmol . 1993;111:1200-1209.Crossref 28. Macular Photocoagulation Study Group. Macular Photocoagulation Study Manual of Procedures . Springfield, Va: National Technical Information Service; 1990. NTIS Accession No. PB90-115536. 29. Macular Photocoagulation Study Group. Subfoveal neovascular lesions in age-related macular degeneration: guidelines for evaluation and treatment in the macular photocoagulation study . Arch Ophthalmol . 1991;109:1242-1257.Crossref 30. Bressler NM, Bressler SB, West SK, Fine SL, Taylor HR. The grading and prevalence of macular degeneration in Chesapeake Bay watermen . Arch Ophthalmol . 1989;107:847-852.Crossref 31. Klein R, Davis MD, Magli YL, Segal P, Klein BEK, Hubbard L. The Wisconsin age-related maculopathy grading system . Ophthalmology . 1991;98:1128-1134.Crossref 32. International ARM Epidemiological Study Group. An international classification and grading system for age-related maculopathy and age-related macular degeneration . Surv Ophthalmol . 1995;39:367-374.Crossref 33. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations . J Am Stat Assoc . 1958;53:457-481.Crossref 34. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration . Cancer Chemother Rep 1966;50:163-170. 35. Cox DR. Regression models and life tables . J R Stat Soc B . 1972;2:187-220. 36. Macular Photocoagulation Study Group. Five-year follow-up of fellow eyes of patients with age-related macular degeneration and unilateral extrafoveal choroidal neovascularization . Arch Ophthalmol . 1993;111:1189-1199.Crossref 37. Macular Photocoagulation Study Group. Argon laser photocoagulation for senile macular degeneration: results of a randomized clinical trial . Arch Ophthalmol . 1982;100:912-918.Crossref

Goltz, Herbert C.;Steinbach, Martin J.;Gallie, Brenda L.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150750010pmid: 9194726

Abstract Objective: To determine the incidence and magnitude of head turn in persons unilaterally enucleated at an early age and in normally sighted persons patched monocularly. Setting: The Hospital for Sick Children, Toronto, Ontario. Participants: Fifty-two unilaterally enucleated children and adults without nystagmus (median age, 10 years) who were enucleated at an early age (median age, 18 months) due to retinoblastoma and 28 normally sighted children and adults. Methods: Enucleated subjects were videotaped while walking 15 m toward a camera under 2 conditions: (1) fixation relaxed (just looking at the camera) and (2) fixation forced (trying to identify a small fixation target on the camera). Control subjects were tested in the fixation forced condition only. Head turn incidence and magnitude were independently rated. Three categories of head turn were used: "obvious" (>10°), "small" (5°-10°), and "no" (0°-4°). Results: In the fixation relaxed condition, 22 (42%) of 52 enucleated subjects exhibited head turn; when fixation was forced, the incidence increased to 25 (58%) of 43 subjects. Head turn was virtually always in the direction of the missing eye. Incidence and magnitude of head turn were unrelated to age at enucleation or number of years since enucleation. In the control group, there was no consistent finding of head turn across subjects when 1 eye was patched. Conclusions: One-eyed children frequently exhibit head turn unrelated to the presence of nystagmus. The direction of the head turn is "adaptive" because occlusion by the nose in the lower contralateral field is reduced. References 1. Helveston EM, Pinchoff B, Ellis FD, Miller K. Unilateral esotropia after enucleation in infancy . Am J Ophthalmol . 1985;100:96-99. 2. Kushner BJ. Unilateral esotropia after enucleation in infancy . Am J Ophthalmol . 1985;100:744-745. 3. Metz HS. Unilateral esotropia after enucleation in infancy . Am J Ophthalmol . 1985;100:859-860. 4. Ciancia AO. Infantile esotropia with abduction nystagmus . Int Ophthalmol Clin . 1989;29:24-29.Crossref 5. Jampolsky A. Unequal visual inputs in strabismus management: a comparison of human and animal strabismus . In: Helveston EM, Jampolsky A, Knapp P, et al, eds. Symposium on Strabismus: Transactions of the New Orleans Academy of Ophthalmology . St Louis, Mo: CV Mosby; 1978. 6. Kushner BJ. Ocular causes of abnormal head posture . Ophthalmology . 1979;86:2115-2125.Crossref 7. Goltz HC, Steinbach MJ, Gallie BL. Head turn in monocular viewing . Invest Ophthalmol Vis Sci Suppl . 1990;31:2955. 8. Young JDH. Head posture measurement . J Pediatr Ophthalmol Strab . 1988;25:86-89. 9. Hering E; Radde A, trans. Spatial Sense and Movements of the Eye . Baltimore, Md: American Academy of Optometry; 1942;42f. 10. Moidell B, Steinbach MJ, Ono H. Egocentre location in children enucleated at an early age . Invest Ophthalmol Vis Sci . 1988;29:1348-1351. 11. Day S. Visual development in the monocular individual: implications for the mechanisms of normal binocular vision development and the treatment of infantile esotropia . Trans Am Ophthalmol Soc . 1995;93:524-581. 12. Dengis CA, Steinbach MJ, Ono H, et al. Learning to look with one eye: the use of head turn by normals and strabismics . Vis Res . 1996;36:3237-3242.Crossref

Tanihara, Hidenobu;Hangai, Masanori;Sawaguchi, Shoichi;Abe, Haruki;Kageyama, Masa-aki;Nakazawa, Fumio;Shirasawa, Ei-ichi;Honda, Yoshihito

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150754011pmid: 9194727

Abstract Objective: To identify molecular mechanisms of retinal responses to intraocular pressure elevation in primate experimental glaucoma. Methods: An experimental glaucoma model was created by repeated laser trabeculophotocoagulation. After the preparation of complementary DNAs from extracted total RNAs in the retinas, polymerase chain reaction (PCR) experiments were performed for the following screening target genes: β-tubulin β2 and β5 and glial fibrillary acidic protein (GFAP). To investigate the amplified sequences derived from the PCR experiments, sequencing, subcloning, and Southern blot analysis of PCR products were performed. In addition, an immunohistochemical analysis was performed in an attempt to show the distribution of the target gene products in the retinas. Results: A series of PCR experiments suggested up-regulation of gene expression for GFAP but not for β-tu bulins. Sequencing of the PCR products and results of the Southern blot analysis showed that the amplified sequences were derived mainly from the target gene, GFAP, and that increased expression of GFAP was found despite the severity of glaucoma. Immunohistochemical studies also demonstrated increased expression of GFAP proteins in Müller cells and astrocytes in the retinas of primate eyes with experimental glaucoma. Conclusion: Our study showed up-regulation of GFAP at gene and protein levels, which suggests that glial components in the retina may contribute to the pathologic processes induced by elevated intraocular pressure. References 1. Quigley HA, Nickells RW, Kerrigan LA, Pease ME, Thibault DJ, Zack DJ. Retinal ganglion cell death in experimental glaucoma and after axotomy occurs by apoptosis . Invest Ophthalmol Vis Sci . 1995;36:774-786. 2. Deckwerth TL, Johnson EM Jr. Temporal analysis of events associated with programmed cell death (apoptosis) of sympathetic neurons deprived of nerve growth factor . J Cell Biol . 1993;123:1207-1222.Crossref 3. Grosche J, Hartig W, Reichenbach A. Expression of glial fibrillary acidic protein (GFAP), glutamine synthetase (GS), and Bcl-2 proto-oncogene protein by Müller (glial) cells in retinal light damage of rats . Neurosci Lett . 1995;185:119-122.Crossref 4. Yoshida A, Ishiguro S, Tamai M. Expression of glial fibrillary acidic protein in rabbit Müller cells after lensectomy-vitrectomy . Invest Ophthalmol Vis Sci . 1993;34:3154-3160. 5. Osborne NN, Block F, Sontag KH. Reduction of ocular blood flow results in glial fibrillary acidic protein (GFAP) expression in rat retinal Müller cells . Vis Neurosci . 1991;7:637-639.Crossref 6. Hangai M, Yoshimura N, Yoshida M, Yabuuchi K, Honda Y. lnterleukin-1 gene expression in transient retinal ischemia in the rat . Invest Ophthalmol Vis Sci . 1995;36:571-578. 7. Tanihara H, Inatani M, Honda Y. Growth factors and their receptors in the retina and pigment epithelium . Prog Retinal Eye Res . 1997;16:271-301.Crossref 8. Brubaker RF. Delayed functional loss in glaucoma: 52nd Edward Jackson Memorial Lecture . Am J Ophthalmol . 1996;121:473-483. 9. Hangai M, Kaneda Y, Tanihara H, Honda Y. In vivo gene transfer into retina mediated by a novel liposome system . Invest Ophthalmol Vis Sci . 1996;371:2678-2685. 10. Fukuchi T, Sawaguchi S, Yue BY, Iwata K, Hara H, Kaiya T. Sulfated proteoglycans in the lamina cribrosa of normal monkey eyes and monkey eyes with laser-induced glaucoma . Exp Eye Res . 1994;58:231-243.Crossref 11. Tanihara H, Yoshida M, Yoshimura N. Tumor necrosis factor-α gene is expressed in stimulated retinal pigment epithelial cells in culture . Biochem Biophysic Res Commun . 1992;18:1029-1034.Crossref 12. Tanihara H, Yoshida M, Matsumoto M, Yoshimura N. Identification of transforming growth factor-β expressed in cultured human retinal pigment epithelial cells . Invest Ophthalmol Vis Sci . 1993;34:413-419. 13. Reeves SA, Helman LJ, Allison A, Israel MA. Molecular cloning and primary structure of human glial fibrillary acidic protein . Proc Natl Acad Sci U S A . 1989;86:5178-5182.Crossref 14. Lewis SA, Gilmartin ME, Hall JL, Cowan NJ. Three expressed sequences within the human β-tubulin multigene family each define a distinct isotype . J Mol Biol . 1985;182:11-20.Crossref 15. Lee MG, Loomis C, Cowan NJ. Sequence of an expressed human β-tubulin gene containing ten Alu family members . Nucleic Acids Res . 1984;12:5823-5836.Crossref 16. Marchuk D, Drumm M, Saulino A, Collins FS. Construction of T-vectors: a rapid and general system for direct cloning of unmodified PCR products . Nucleic Acids Res . 1991;19:1154.Crossref 17. Yoshida M, Tanihara H, Yoshimura N. Gene expression of platelet-derived growth factor in cultured human retinal pigment epithelial cells: a quantitative PCR study . Biochem Biophysic Res Commun . 1992;189:66-71.Crossref 18. Yoshida M, Yoshimura N, Hangai M, Tanihara H, Honda Y. Interleukin-1α, interleukin-1β, and tumor necrosis factor gene expression in endotoxin-induced uveitis . Invest Ophthalmol Vis Sci . 1994;35:1107-1113. 19. Shields MB. The optic nerve head and peripapillary retina . In: Textbook of Glaucoma . 3rd ed. Baltimore, Md: Williams & Wilkins; 1992:84-125. 20. Distler C, Weigel H, Hoffmann KP. Glia cells of the monkey retina, I: astrocytes . J Comp Neurol . 1993;333:134-147.Crossref 21. Singelman J, Ozanics V. Retina In: Jakobiec FA, ed. Ocular Anatomy, Embryology, and Teratology . Philadelphia, Pa: Harper & Row; 1982:485. 22. Bjorklund H, Bignami A, Dahl D. Immunohistochemical demonstration of glial fibrillary acidic protein in normal rat Müller glia and retinal astrocytes . Neurosci Lett . 1985;54:363-368.Crossref 23. Okada M, Matsumura M, Ogino N, Honda Y. Müller cells in detached human retina express glial fibrillary acidic protein and vimentin . Graefes Arch Clin Exp Ophthalmol . 1990;228:467-474.Crossref 24. Erickson PA, Fisher SK, Guerin CJ, Anderson DH, Kaska DD. Glial fibrillary acidic protein increases in Müller cells after retinal detachment . Exp Eye Res . 1987;44:37-48.Crossref 25. Lewis GP, Erickson PA, Guerin CJ, Anderson DH, Fisher SK. Changes in the expression of specific Müller cell proteins during long-term retinal detachment . Exp Eye Res . 1989;49:93-111.Crossref 26. Lewis GP, Matsumoto B, Fisher SK. Changes in the organization and expression of cytoskeletal proteins during retinal degeneration induced by retinal detachment . Invest Ophthalmol Vis Sci . 1995;36:2404-2416. 27. Lewis GP, Guerin CJ, Anderson DH, Matsumoto B, Fisher SK. Rapid changes in the expression of glial cell proteins caused by experimental retinal detachment . Am J Ophthalmol . 1994;118:368-376. 28. Ekstrom P, Sanyal S, Narfstrom K, Chader GJ, van Veen T. Accumulation of glial fibrillary acidic protein in Müller radial glia during retinal degeneration . Invest Ophthalmol Vis Sci . 1988;29:1363-1371. 29. Bignami A, Dahl D. The radial glia of Müller in the rat retina and their response to injury: an immunofluorescence study with antibodies to the glial fibrillary acidic (GFA) protein . Exp Eye Res . 1979;28:63-69.Crossref

Syed, Nasreen A.;Nork, T. Michael;Poulsen, Gretchen L.;Riis, Ronald C.;George, Catherine;Albert, Daniel M.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150760012pmid: 9194728

Abstract Objectives: To describe and classify a retinal tumor found in a dog that histologically resembles human retinoblastoma and to discuss the molecular mechanisms of retinal oncogenesis. Methods: A dog eye with a retinal tumor was examined histologically. Studies including immunocytochemical analysis for retinal S-antigen and glial fibrillary acidic protein, enzyme histochemical analysis for carbonic anhydrase, and nick-end DNA labeling were used to characterize the tumor. Normal retina from another dog and other tumors from dogs, including 2 ciliary body medulloepitheliomas and a brain medulloepithelioma, were examined as controls. Results: The retinal tumor disclosed characteristics typical of human retinoblastoma, including Flexner-Wintersteiner rosettes. It showed strong immunoreactivity with S-antigen and glial fibrillary acidic protein. Carbonic anhydrase activity also could be shown in the tumor. Apoptosis was found to be the predominant method of cell death as shown by nick-end DNA labeling. In contrast to the other tumors examined, this tumor contained areas with retinal photoreceptor and glial differentiation. Conclusion: The histopathologic findings and differential staining characteristics in this retinal tumor are compatible with retinoblastoma, making this, to our knowledge, the first documented case of spontaneous retinoblastoma in an animal. References 1. Dryja TP, Rapaport JM, Joyce JM, Petersen RA. Molecular detection of deletions involving band q14 of chromosome 13 in retinoblastomas . Proc Natl Acad Sci U S A . 1986;83:7391-7394.Crossref 2. Friend SH, Bernards R, Rogelj S, et al. A human DNA segment with properties of the gene that predisposes to retinoblastoma and osteosarcoma . Nature . 1986;323:643-646.Crossref 3. Draper GJ, Sanders BM, Kingston JE. Second primary neoplasms in patients with retinoblastoma . Br J Cancer . 1986;53:661-671.Crossref 4. Dunn JM, Phillips RA, Becker AJ, Gallie BL. Identification of germline and somatic mutations affecting the retinoblastoma gene . Science . 1988;241:1797-1800.Crossref 5. Roarty JD, McLean IW, Zimmerman LE. Incidence of second neoplasms in patients with bilateral retinoblastoma . Ophthalmology . 1988;95:1583-1587.Crossref 6. Sanders BM, Jay M, Draper GJ, Roberts EM. Non-ocular cancer in relatives of retinoblastoma patients . Br J Cancer . 1989;60:358-365.Crossref 7. Lee W-H, Bookstein R, Hong F, Young L-J, Shew J-Y, Lee EY-HP. Human retinoblastoma susceptibility gene: cloning, identification and sequence . Science . 1987;235:1394-1399.Crossref 8. Goodrich DW, Lee WH. Molecular characterization of the retinoblastoma susceptibility gene . Biochim Biophys Acta . 1993;1155:43-61. 9. Hamel PA, Phillips RA, Muncaster M, Gallie BL. Speculations on the roles of RB1 in tissue-specific differentiation, tumor initiation, and tumor progression . FASEB J . 1993;7:846-854. 10. Wilcock B. The eye and the ear . In: Jubb KVF, Kennedy PC, Palmer N, eds. Pathology of Domestic Animals . 4th ed. San Diego, Calif: Academic Press Inc; 1993:495-520. 11. Hogan RN, Albert DM. Does retinoblastoma occur in animals? Prog Vet Comp Ophthalmol . 1991;1:73-82. 12. Verhoeff FH, Jackson E. Minutes of the proceedings: sixty-second annual meeting . Trans Am Ophthalmol Soc . 1926;24:38-43. 13. Nork TM, McCormick SA, Chao GM, Odom JV. Distribution of carbonic anhydrase among human photoreceptors . Invest Ophthalmol Vis Sci . 1990;31:1451-1458. 14. Jakobiec FA, Brodie SE, Haik B, Iwamoto T. Giant cell astrocytoma of the retina: a tumor of possible Müller cell origin . Ophthalmology . 1983;90:1565-1576.Crossref 15. Molnar ML, Stefansson K, Marton LS, Tripathi RC, Molnar GK. Distribution of S-100 protein and glial fibrillary acidic protein in normal and gliotic human retina . Exp Eye Res . 1984;38:27-34.Crossref 16. Eisenfeld AJ, Bunt-Milam AH, Sarthy PV. Müller cell expression of glial fibrillary acidic protein after genetic and experimental photoreceptor degeneration in the rat retina . Invest Ophthalmol Vis Sci . 1984;25:1321-1328. 17. Nork TM, Ghobrial MW, Peyman GA, Tso MOM. Massive retinal gliosis: a reactive proliferation of Müller cells . Arch Ophthalmol . 1986;104:1383-1389.Crossref 18. Nork TM, Wallow IHL, Sramek SJ, Anderson G. Müller's cell involvement in proliferative diabetic retinopathy . Arch Ophthalmol . 1987;105:1424-1429.Crossref 19. Bjorklund H, Bignami A, Dahl D. Immunohistochemical demonstration of glial fibrillary acidic protein in normal rat Müller glia and retinal astrocytes . Neurosci Lett . 1985;54:363-368.Crossref 20. Nork TM, Mangini NJ, Millecchia LL. Rods and cones contain antigenically distinctive S-antigens . Invest Ophthalmol Vis Sci . 1993;34:2918-2925. 21. Nork TM, Schwartz TL, Doshi HM, Millecchia LL. Retinoblastoma: cell of origin . Arch Ophthalmol . 1995;113:791-802.Crossref 22. Gavrieli Y, Sherman Y, Ben-Sasson SA. Identification of programmed cell death in situ via specific labeling of nuclear DNA fragmentation . J Cell Biol . 1992;119:493-501.Crossref 23. Donoso LA, Folberg R, Arbizo V. Retinal S antigen and retinoblastoma: a monoclonal antibody histopathologic study . Arch Ophthalmol . 1985;103:855-857.Crossref 24. Mirshahi M, Boucheix C, Dhermy P, Haye C, Faure JP. Expression of the photoreceptorspecific S-antigen in human retinoblastoma . Cancer . 1986;57:1497-1500.Crossref 25. Perentes E, Herbort CP, Rubinstein LJ, et al. Immunohistochemical characterization of human retinoblastomas in situ with multiple markers . Am J Ophthalmol . 1987;103:647-658. 26. Rodrigues MM, Wiggert B, Shields J, et al. Retinoblastoma: immunohistochemistry and cell differentiation . Ophthalmology . 1987;94:378-387.Crossref 27. Lane JC, Klintworth GK. A study of astrocytes in retinoblastomas using the immunoperoxidase technique and antibodies to glial fibrillary acidic protein . Am J Ophthalmol . 1983;95:197-207.Crossref 28. Jiang Q, Lim R, Blodi FC. Dual properties of cultured retinoblastoma cells: immunohistochemical characterization of neuronal and glial markers . Exp Eye Res . 1984;39:207-215.Crossref 29. Molnar ML, Stefansson K, Marton LS, Tripathi RS, Molnar GK. Immunohistochemistry of retinoblastomas in humans . Am J Ophthalmol . 1984;97:301-307. 30. Terenghi G, Polak JM, Ballesta J, et al. Immunocytochemistry of neuronal and glial markers in retinoblastoma . Virchows Arch . 1984;404:61-73.Crossref 31. Craft JL, Sang DN, Dryja TP, Brockhurst RJ, Robinson NL, Albert DM. Glial cell component in retinoblastoma . Exp Eye Res . 1985;40:647-659.Crossref 32. Messmer EP, Font RL, Kirkpatrick JB, Hopping W. Immunohistochemical demonstration of neuronal and astrocytic differentiation in retinoblastoma . Ophthalmology . 1985;92:167-173.Crossref 33. Schroder HD. Immunohistochemical demonstration of glial markers in retinoblastomas . Virchows Arch . 1987;411:67-72.Crossref 34. Shuangshoti S, Chaiwun B, Kasantikul V. A study of 39 retinoblastomas with particular reference to morphology, cellular differentiation and tumour origin . Histopathology . 1989;15:113-124.Crossref 35. He W, Hashimoto H, Tsuneyoshi M, Enjoji M, Inomata H. A reassessment of histologic classification and an immunohistochemical study of 88 retinoblastomas: a special reference to the advent of bipolar-like cells . Cancer . 1992;70:2901-2908.Crossref 36. Kyritsis AP, Tsokos M, Triche TJ, Chader GJ. Retinoblastoma: origin from a primitive neuroectodermal cell? Nature . 1984;307:471-473.Crossref 37. Donoso LA, Felberg NT, Augsburger JJ, Shields JA. Retinal S-antigen and retinoblastoma: a monoclonal antibody and flow cytometric study . Invest Ophthalmol Vis Sci . 1985;26:568-571. 38. Kivela T, Tarkkanen A. Recurrent medulloepithelioma of the ciliary body: immunohistochemical characteristics . Ophthalmology . 1988;95:1565-1575.Crossref 39. Desai VN, Lieb WE, Donoso LA, Eagle RC Jr, Shields JA, Saunders R. Photoreceptor cell differentiation in intraocular medulloepithelioma: an immunohistopathologic study . Arch Ophthalmol . 1990;108:481-482.Crossref 40. Lohse MJ, Benovic JL, Codina J, Caron MG, Lefkowitz RJ. β-Arrestin: a protein that regulates β-adrenergic receptor function . Science . 1990;248:1547-1550.Crossref 41. Morgenbesser SD, Williams BO, Jacks T, DePinho RA. p53-dependent apoptosis produced by Rb-deficiency in the developing mouse lens . Nature . 1994;371:72-74.Crossref 42. Wu X, Levine AJ. p53 and E2F-1 cooperate to mediate apoptosis . Proc Natl Acad Sci U S A . 1994;91:3602-3606.Crossref 43. Büchi ER, Bernauer W, Daicker B. Cell death and disposal in retinoblastoma: an electron microscopic study . Graefes Arch Clin Exp Ophthalmol . 1994;232:635-645.Crossref 44. Nork TM, Poulsen GL, Millecchia LL. p53 regulates apoptosis in human retinoblastoma . Arch Ophthalmol . 1997;115:213-219.Crossref 45. Bunt AH, Tso MO. Feulgen-positive deposits in retinoblastoma: incidence, composition, and ultrastructure . Arch Ophthalmol . 1981;99:144-150.Crossref 46. Knudson AG Jr. Mutation and cancer: statistical study of retinoblastoma . Proc Natl Acad Sci U S A . 1971;68:820-823.Crossref 47. Comings DE. A general theory of carcinogenesis . Proc Natl Acad Sci U S A . 1973;70:3324-3328.Crossref 48. Gallie BL, Dunn JM, Hamel PA, Muncaster M, Cohen BL, Phillips RA. How do retinoblastoma tumours form? Eye . 1992;6:226-231.Crossref 49. Lee EY, Chang CY, Hu N, et al. Mice deficient for Rb are nonviable and show defects in neurogenesis and haematopoiesis . Nature . 1992;359:288-294.Crossref 50. Jacks T, Fazeli A, Schmitt EM, Bronson RT, Goodell MA, Weinberg RA. Effects of an Rb mutation in the mouse . Nature . 1992;359:295-300.Crossref 51. Clarke AR, Maandag ER, van Roon M, et al. Requirement for a functional Rb-1 gene in murine development . Nature . 1992;359:328-330.Crossref 52. Albert DM, Griep AE, Lambert PF, Howes KA, Windle JJ, Lasudry JG. Transgenic models of retinoblastoma: what they tell us about its cause and treatment . Trans Am Ophthalmol Soc . 1994;92:385-400. 53. DeCaprio JA, Ludlow JW, Lynch D, et al. The product of the retinoblastoma susceptibility gene has properties of a cell cycle regulatory element . Cell . 1989;58:1085-1095.Crossref 54. Hollingsworth R Jr, Hensey CE, Lee WH. Retinoblastoma protein and the cell cycle . Curr Opin Genet Dev . 1993;3:55-62.Crossref 55. Buchkovich K, Duffy LA, Harlow E. The retinoblastoma protein is phosphorylated during specific phases of the cell cycle . Cell . 1989;58:1097-1105.Crossref 56. Chen P-L, Scully P, Shew J-Y, Wang JYJ, Lee W-H. Phosphorylation of the retinoblastoma gene product is modulated during the cell cycle and cellular differentiation . Cell . 1989;58:1193-1198.Crossref 57. Mihara K, Cao XR, Yen A, et al. Cell cycle-dependent regulation of phosphorylation of the human retinoblastoma gene product . Science . 1989;246:1300-1303.Crossref 58. Yonish-Rouach E, Grunwald D, Wilder S, et al. p53-mediated cell death: relationship to cell cycle control . Mol Cell Biol . 1993;13:1415-1423. 59. Albert DM, Rabson AS, Dalton AJ. In vitro neoplastic transformation of uveal and retinal tissue by oncogenic DNA viruses . Invest Ophthalmol Vis Sci . 1968;7:357-365. 60. Mukai N, Murao T. Retinal tumor induction by ocular inoculation of human adenovirus in 3-day-old rats . J Neuropathol Exp Neurol . 1975;34:28-35.Crossref 61. Mukai N, Nakajima T, Freddo T, Jacobson M, Dunn M. Retinoblastoma-like neoplasm induced in C3H/BifB/Ki strain mice by human adenovirus serotype 12 . Acta Neuropathol (Berl) . 1977;39:147-155.Crossref 62. Albert DM, Lahav M, Colby ED, Shadduck JA, Sang DN. Retinal neoplasia and dysplasia, I: induction by feline leukemia virus . Invest Ophthalmol Vis Sci . 1977;16:325-337. 63. Mukai N, Kalter SS, Cummins LB, Matthews VA, Nishida T, Nakajima T. Retinal tumor induced in the baboon by human adenovirus 12 . Science . 1980;210:1023-1025.Crossref 64. Whyte P, Buchkovich KJ, Horowitz JM, et al. Association between an oncogene and an anti-oncogene: the adenovirus EIA proteins bind to the retinoblastoma gene product . Nature . 1988;334:124-129.Crossref 65. DeCaprio JA, Ludlow JW, Figge J, et al. SV 40 large tumor antigen forms a specific complex with the product of the retinoblastoma susceptibility gene . Cell . 1988;54:275-283.Crossref 66. Dyson N, Howley PM, Munger K, Harlow E. The human papillomavirus—16 E7 oncoprotein is able to bind to the retinoblastoma gene product . Science . 1989;243:934-937.Crossref 67. Howard E, Marcus D, O'Brien J, Albert D, Bernards R. Five DNA tumor viruses undetectable in human retinoblastomas . Invest Ophthalmol Vis Sci . 1992;33:1564-1567. 68. Sawaguchi S, Peng Y, Wong F, Tso MO. An immunopathologic study of retinoblastoma protein . Trans Am Ophthalmol Soc . 1990;88:51-61. 69. McLean IW. Retinoblastomas, retinocytomas, and pseudoretinoblastomas . In: Spencer, WH, ed. Ophthalmic Pathology . 4th ed. Philadelphia, Pa: WB Saunders Co; 1996:1332-1380.

Fletcher, Astrid E.;Ellwein, Leon B.;Selvaraj, S.;Vijaykumar, V.;Rahmathullah, Raheem;Thulasiraj, R. D.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150769013pmid: 9194729

Abstract Objective: To develop and validate vision function (VF) and quality of life (QOL) instruments in patients with cataracts in the context of large volume surgery in a developing country. Materials and Methods: The instruments were developed using a consensus approach. One hundred patients who were undergoing cataract surgery at Aravind Eye Hospital, Madurai, India, were interviewed preoperatively and 3 and 12 months postoperatively. Standard clinical procedures were followed, including measurement of visual acuity. Between-interviewer reproducibility was measured by repeated administration of the preoperative questionnaire. Withininterviewer reproducibility was measured preoperatively in a separate study of 50 patients. Results: Preoperative scores from the VF and QOL instruments were significantly associated with visual acuity (r=0.4). Internal reliability (Cronbach α) was greater than.9. Both instruments showed large changes after surgery, with effect sizes of 3 or greater for most VF scales (range, 1.8-3.7) and 1 or greater for QOL scales (range, 1.0-2.2). Changes in visual acuity after surgery were correlated with changes in the VF (r=0.44) and QOL (r=0.41) scale scores. Betweeninterviewer reproducibility was acceptable (total VF scale, Spearman r=0.7; total QOL scale, r=0.74). The κ values were lower for within-interviewer reproducibility. Conclusions: The study provided strong evidence for the validity, reproducibility, and responsiveness of the instruments, and for the feasibility of using them in the setting of a large volume of cataract surgery in a developing country. References 1. Patrick DL, Erickson P. Assessing health related quality of life for clinical decision making . In: Walker SR, Rosser RM, eds. Quality of Life Assessment: Key Issues in the 1990s . Norwell, Mass: Kluwer Academic Publishers; 1993:11-63. 2. Fletcher A, Gore S, Jones D, Fitzpatrick R, Spiegelhalter D, Cox D. Quality of life measures in health care, II: design, analysis and interpretation . BMJ . 1992;305:1145-1148.Crossref 3. Bernth-Petersen P. The effectiveness of cataract surgery: a retrospective study . Acta Ophthalmol (Copenh) . 1981;58:50-56. 4. Applegate WB, Miller ST, Elam JT, et al. Impact of cataract surgery with lens implantation on vision and physical function in elderly patients . JAMA . 1987;257:1064-1066.Crossref 5. Mangione CM, Phillips RS, Seddon JM, Lawrence MG, Cook EF, Goldman L. Development of the 'Activities of Daily Vision Scale.' Med Care . 1992;30:1111-1126.Crossref 6. Mangione CM, Phillips RS, Lawrence MG, Seddon JM, Orav J, Goldman L. Improved visual function and attenuation of declines in health-related quality of life after cataract extraction . Arch Ophthalmol . 1994;112:1419-1425.Crossref 7. Steinberg EP, Tielsch JM, Schein OD, et al. The VF-14: an index of functional impairment in patients with cataract . Arch Ophthalmol . 1994;112:630-638.Crossref 8. Scott IU, Schein OD, West S, Bandeen-Roche K, Enger C, Folstein MF. Functional status and quality of life measurement among ophthalmic patients . Arch Ophthalmol . 1994;112:329-335.Crossref 9. Brenner MH, Curbow B, Javitt JC, Legro MW, Sommer A. Vision change and quality of life in the elderly: response to cataract surgery and treatment of other chronic ocular conditions . Arch Ophthalmol . 1993;111:680-685.Crossref 10. Ellwein L, Fletcher A, Negrel D, Thulasiraj R. Quality of life assessment in blindness prevention interventions . Int Ophthalmol . 1995;18:263-268.Crossref 11. Sloane ME, Ball K, Owsley C, Bruni SR, Roenkar DL. The visual activities questionnaire: developing an instrument for assessing problems in everyday visual tasks . Tech Dig Noninvas Assess Vis Syst . 1992;1:26-29. 12. Ferris FL, Kassoff A, Bresnick GH, Bailey I. New visual acuity charts for clinical research . Am J Ophthalmol . 1982;94:91-96. 13. Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status . Med Care . 1989;27:S178-S189.Crossref 14. Javitt JC, Brenner MH, Curbow B, Legro MW, Street DA. Outcomes of cataract surgery: improvement in visual acuity and subjective visual function after surgery in the first, second and both eyes . Arch Ophthalmol . 1993;111:686-691.Crossref 15. Steinberg EP, Tielsch JM, Schein OD, et al. National study of cataract outcomes: variation in 4-month postoperative outcomes as reflected in multiple outcome measures . Ophthalmology . 1994;101:1131-1141.Crossref 16. Guyatt G, Walter S, Norman G. Measuring change over time: assessing the usefulness of evaluative instruments . J Chronic Dis . 1987;40:171-178.Crossref 17. Wiklund I, Karlberg J. Evaluation of quality of life in clinical trials . Control Clin Trials . 1991;12:204S-216S.Crossref

Gutierrez, Peter;Wilson, M. Roy;Johnson, Chris;Gordon, Mae;Cioffi, George A.;Ritch, Robert;Sherwood, Mark;Meng, Karen;Mangione, Carol M.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150779014pmid: 9194730

Abstract We examined the influence of glaucomatous visual field defects on vision-targeted and generic health-related quality of life. Vision-targeted and generic health status were assessed across 5 glaucoma treatment categories and a normal reference group from 5 tertiary care ophthalmology practices during regularly scheduled eye care visits. The sample consisted of 147 patients who were members of specific glaucoma treatment categories and 44 reference group patients. For patients with glaucoma, eligibility included a diagnosis of glaucoma at least 1 year prior to enrollment and no evidence of other eye disease. Participants completed 2 vision-targeted surveys, the National Eye Institute Visual Functioning Questionnaire and the VF-14, and a generic health-related quality of life measure, the Medical Outcomes Study 36-Item Short Form. Data from automated perimetry (Humphrey Field Analyzer 24-2, Humphrey Instruments, San Leandro, Calif) were used to generate Advanced Glaucoma Intervention Study scores for all participants. The Medical Outcomes Study 36-Item Short Form scores from glaucoma and reference group participants collected on a random half of the sample were similar. However, comparisons of the vision-targeted surveys demonstrated significant mean differences on 7 of 11 National Eye Institute Visual Functioning Questionnaire scales, and a trend toward significant differences for the VF-14 (P<.07 by linear regression). Greater visual field defects in the better eye were significantly associated with poorer National Eye Institute Visual Functioning Questionnaire scores (P<.05), as well as with worse VF-14 scores. These findings were most dramatic for patients with the most severe field loss in the better eye. Vision-targeted questionnaires were more sensitive than a generic health-related quality of life measure to differences between glaucoma and normal reference participants. Our findings indicate that self-reports of vision-targeted health-related quality of life are sensitive to visual field loss and may be useful in tandem with the clinical examination to fully understand outcomes of treatment for glaucoma. References 1. Mangione CM, Lee PP, Hays RD. Measurement of visual functioning and healthrelated quality of life in eye disease and cataract surgery . In: Spilker B, ed. Quality of Life and Pharmacoeconomics in Clinical Trials . 2nd ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1996:1045-1051. 2. Janz NK. Implementing quality of life in a clinical trial: the Collaborative Initial Glaucoma Treatment Study . In: Anderson DR, Drance SM, eds. Encounters in Glaucoma Research: How to Ascertain Progression and Outcome . 3rd ed. New York, NY: Kugler Publications; 1996:45-62. 3. Esterman B. Functional scoring of the binocular field . Ophthalmology . 1982;89:1226-1234.Crossref 4. Advanced Glaucoma Intervention Study Investigators. Advanced Glaucoma Intervention Study, 2: visual field test scoring and reliability . Ophthalmology . 1994;101:1589-1595.Crossref 5. Patrick DL, Deyo RA. Generic and disease-specific measures in assessing health status and quality of life . Med Care . 1989;27( (suppl) ):S217-S232.Crossref 6. Damiano AM, Steinberg EP, Cassard SD, et al. Comparison of generic versus disease-specific measures of functional impairment in patients with cataract . Med Care . 1995;33( (suppl) ):AS120-AS130. 7. Applegate WB, Miller ST, Elam JT, Freeman JM, Wood TO, Gettlefinger TC. Impact of cataract surgery with lens implantation on vision and physical function in elderly patients . JAMA . 1987;257:1064-1066.Crossref 8. Brenner MH, Curbow B, Javitt JC, Legro MW, Sommer A. Vision change and quality of life in the elderly: response to cataract surgery and treatment of other chronic ocular conditions . Arch Ophthalmol . 1993;111:680-685.Crossref 9. Javitt JC, Brenner MH, Curbow B, et al. Outcomes of cataract surgery improvement in visual acuity and subjective visual function after surgery in the first, second, and both eyes . Arch Ophthalmol . 1994;112:630-638.Crossref 10. Steinberg EP, Tielsch JM, Schein OD, et al. National study of cataract surgery outcomes: variation in 4-month postoperative outcomes as reflected in multiple outcome measures . Ophthalmology . 1994;101:1131-1141.Crossref 11. Mangione CM, Phillips RS, Lawrence MG, et al. Improved visual function and attenuation of age-related declines in health-related quality of life after cataract extraction . Arch Ophthalmol . 1994;112:1419-1425.Crossref 12. Folstein MF, Folstein SE, McHush PR. The Mini-Mental State Examination: a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res . 1975;12:189-198.Crossref 13. Chylack LT Jr, Leske MC, McCarthy D, Khu PM, Kashiwagi T, Sperduto R. Lens Opacities Classification System II (LOCS II) . Arch Ophthalmol . 1989;107:991-997.Crossref 14. Ware JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36), I: conceptual framework and item selection . Med Care . 1992;30:473-483.Crossref 15. McHorney CA, Ware JE, Raczek AE. The MOS 36-Item Short Form Health Survey (SF-36), II: psychometric and clinical tests of validity in measuring physical and mental health constructs . Med Care . 1993;31:247-263.Crossref 16. Hays RD, Sherbourne CD, Mazel RM. The RAND 36-Item Health Survey 1.0 . Health Econ . 1993;2:217-227.Crossref 17. Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions: results from the Medical Outcomes Study . JAMA . 1989;262;907-913.Crossref 18. Mangione CM, Lee PP, Berry SH, et al. Development of a questionnaire for assessment of visual function: Association for Research in Vision and Ophthalmology . Invest Ophthalmol Vis Sci . 1995;36:1962. Abstract. 19. Mangione CM, Lee PP, Berry SH, et al. The NEI-VFQ 51-item test version and its relationship with visual acuity across 5 diseases: Association for Research in Vision and Ophthalmology . Invest Ophthalmol Vis Sci . 1996;37( (suppl) ):873. Abstract. 20. Steinberg EP, Tielsch JM, Schein OD, et al. The VF-14: an index of functional impairment in patients with cataract . Arch Ophthalmol . 1994;112:630-638.Crossref 21. Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 Health Survey Manual and Interpretation Guide . Boston, Mass: Nimrod Press; 1993. 22. Ferris FL, Kassoff A, Bresnick GH, Bailey I. New visual acuity charts for clinical research . Am J Ophthalmol . 1982;94:91-96. 23. Choplin NT, Edwards RP. Visual Field Testing With the Humphrey Field Analyzer . Thorofare, NJ: SLACK Inc; 1995. 24. McDowell I, Newell C. Measuring Health: A Guide to Rating Scales and Questionnaires . New York, NY: Oxford University Press Inc; 1987. 25. Kravitz RL, Greenfield S, Rogers W, et al. Differences in mix of patients among medical specialties and system of care: results from the Medical Outcomes Study . JAMA . 1992;267:1617-1623.Crossref 26. Mangione CM, Orav JE, Lawrence MG, Phillips RS, Seddon JH, Goldman L. Prediction of visual function after cataract surgery: a prospectively validated model . Arch Ophthalmol . 1995;113:1305-1311.Crossref 27. Cronbach LJ. Coefficient alpha and the internal structure of tests . Psychometrika . 1951;16:297-334.Crossref 28. Nunnally, JC. Psychometric Theory . 2nd ed. New York, NY: McGraw-Hill Book Co; 1978. 29. Mangione CM, Phillips RS, Seddon JM, et al. Development of the 'Activities of Daily Vision Scale': a measure of functional status . Med Care . 1992;30:1111-1126.Crossref

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150786015

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 the landmark article entitled "A Contact Lens," published in the January Archives (1997;115: 120-121), the original source of the article was inadvertently omitted. The source should be noted as follows: abridged from Arch Ophthalmol Otolaryngol. 1888; 17:215-226.

Jabs, Douglas A.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150787016pmid: 9194731

Abstract Cytomegalovirus (CMV) retinitis is the most common intraocular opportunistic infection in patients with the acquired immunodeficiency syndrome.1 Studies have suggested that CMV retinitis will develop in approximately 25% to 35% of patients with the acquired immunodeficiency syndrome sometime between the diagnosis of acquired immunodeficiency syndrome and death.1,2 Without treatment, CMV retinitis spreads throughout the retina resulting in total retinal destruction and blindness.3 Drugs for CMV retinitis that have been approved by the Food and Drug Administration as of April 1996 include intravenous ganciclovir,3-6 intravenous foscarnet,6,7 oral ganciclovir,8,9 the ganciclovir intraocular device,10 and intravenous cidofovir.11,12, Intravenous ganciclovir and foscarnet have been demonstrated to be effective for the treatment of CMV retinitis3-7 but require the placement of a permanent indwelling central venous catheter for the administration of daily intravenous infusions. Central venous catheters may adversely affect quality of life and are associated with References 1. Jabs DA. Ocular manifestations of HIV infection . Trans Am Ophthalmol Soc . 1995;93:623-683. 2. Hoover DR, Peng Y, Saah A, et al. Occurrence of cytomegalovirus retinitis after human immunodeficiency virus immunosuppression . Arch Ophthalmol . 1996;114:821-827.Crossref 3. Jabs DA, Enger C, Bartlett JG. Cytomegalovirus retinitis and acquired immunodeficiency syndrome . Arch Ophthalmol . 1989;107:75-80.Crossref 4. Spector SA, Weingeist T, Pollard RB, et al. A randomized, controlled study of intravenous ganciclovir therapy for cytomegalovirus peripheral retinitis in patients with AIDS . J Infect Dis . 1993;168:557-563.Crossref 5. Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Mortality in patients with the acquired immunodeficiency syndrome treated with either foscarnet or ganciclovir for cytomegalovirus retinitis . N Engl J Med . 1992;326:213-220.Crossref 6. Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Foscarnet-ganciclovir cytomegalovirus retinitis trial, 4: visual outcomes . Ophthalmology . 1994;101:1250-1261.Crossref 7. Palestine AG, Polis MA, De Smet MD, et al. A randomized, controlled trial of foscarnet in the treatment of cytomegalovirus retinitis in patients with AIDS . Ann Intern Med . 1991;115:665-673.Crossref 8. Drew WL, Ives D, Lalezari JP, et al. Oral ganciclovir as maintenance treatment for cytomegalovirus retinitis in patients with AIDS . N Engl J Med . 1995;333:615-620.Crossref 9. The Oral Ganciclovir European and Australian Cooperative Study Group. Intravenous versus oral ganciclovir: European/Australian comparative study of efficacy and safety in the prevention of cytomegalovirus retinitis recurrence in patients with AIDS . AIDS . 1995;9:471-477.Crossref 10. Martin DF, Parks DJ, Mellow SD, et al. Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant . Arch Ophthalmol . 1994;112:1531-1539.Crossref 11. Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Parenteral cidofovir for cytomegalovirus retinitis in patients with AIDS: the HPMPC peripheral cytomegalovirus retinitis trial . Ann Intern Med . 1997;126:264-274.Crossref 12. Lalezari JP, Stagg RJ, Kuppermann BD, et al. Intravenous cidofovir for peripheral cytomegalovirus retinitis in patients with AIDS . Ann Intern Med . 1997;126:257-263.Crossref 13. Lalezari J, Friedberg D, Bisset J, Giordano M, Hardy D, Robinson C. A comparison of the safety and efficacy of 3G, 4.5G and 6G doses of oral ganciclovir versus IV ganciclovir for maintenance treatment of CMV retinitis . Abstracts XI Int Conference AIDS . 1996;2:225. 14. Lalezari JP, Drew WL, Glutzer E, et al. (S)-1-[3-hydroxy-2-(phosphonyl-methoxy) propyl] cytosine (cidofovir): results of a phase I/II study of a novel antiviral nucleotide analogue . J Infect Dis . 1995;171:788-796.Crossref 15. Kirsch LS, Arevalo JF, De Clercq E, et al. Phase I/II study of intravitreal cidofovir for the treatment of cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome . Am J Ophthalmol . 1995;119:466-476. 16. Rahhal FM, Arevalo JF, Chavez de la Paz E, Munguia D, Azen SP, Freeman WR. Treatment of cytomegalovirus retinitis with intravitreous cidofovir in patients with AIDS . Ann Intern Med . 1996;125:98-103.Crossref 17. Friedberg DN. Hypotony and visual loss with intravenous cidofovir treatment of cytomegalovirus retinitis . Arch Ophthalmol . 1997;115:801-802.Crossref 18. Davis JL, Taskintuna I, Freeman WR, Weinberg DV, Feuer WJ, Leonard RE. Iritis and hypotony after treatment with intravenous cidofovir dihydrate for cytomegalovirus retinitis . Arch Ophthalmol . 1997;115:733-737.Crossref 19. Saran BR, Maguire AM, Nichols C, et al. Hypopyon uveitis in patients with acquired immunodeficiency syndrome treated for systemic Mycobacterium avium complex infection with rifabutin . Arch Ophthalmol . 1994;112:1159-1165.Crossref

Holz, Frank G.;Owens, Sarah L.;Marks, James;Haimovici, Robert;Bird, Alan C.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150790017pmid: 9194732

Abstract We report the electron microscopic findings in a patient with autosomal dominant drusen. The clinical features of the drusen resembled those occurring in age-related macular degeneration and were different from other dominantly inherited drusen syndromes, including malattia leventinese and Doyne honeycomb familial choroiditis. The predominant ultrastructural features included deposition of material between the basement membrane of the retinal pigment epithelium and inner collagenous layer of the Bruch membrane, which was composed of membranous material, tubelike structures, and vesicles. These ultrastructural findings were similar to those found in aging, implying that this autosomal dominant macular degeneration may represent a homologue of age-related macular degeneration. References 1. Gass JDM. Drusen and disciform macular detachment and degeneration . Arch Ophthalmol . 1973;90:206-217.Crossref 2. Teeters VW, Bird AC. The development of neovascularization of senile disciform macular degeneration . Am J Ophthalmol . 1973;76:1-18. 3. Sarks JP, Sarks SH, Killingsworth MC. Evolution of geographic atrophy of the retinal pigment epithelium . Eye . 1988;2:552-557.Crossref 4. Hogan MJ, Alvarado JA. Studies on the human macula, IV: aging changes in Bruch's membrane . Arch Ophthalmol . 1967;77:410-420.Crossref 5. Sarks SH. Ageing and degeneration of the macular region: a clinicopathological study . Br J Ophthalmol . 1976;60:324-341.Crossref 6. Green WR, Key SN III. Senile macular degeneration: a histopathological study . Trans Am Ophthalmol Soc . 1977;75:180-254. 7. Feeney-Burns L, Ellersieck MR. Age-related changes in the ultrastructure of Bruch's membrane . Am J Ophthalmol . 1985;100:686-697. 8. Green WR, Enger C. Age-related macular degeneration: histopathologic studies . Ophthalmology . 1993;100:1519-1535.Crossref 9. Meyers SM, Zachary AA. Monozygotic twins with age-related macular degeneration . Arch Ophthalmol . 1988;106:651-653.Crossref 10. Grizzard WS. Twin study of age-related macular degeneration. Presented at the XIXth Congress of the Club Jules Gonin Meeting; September 9-13, 1994; Versailles, France. 11. Piguet B, Wells JA, Palmvang IB, Wormald R, Chisholm IH, Bird AC. Age-related Bruch's membrane change: a clinical study of the relative role of heredity and environment . Br J Ophthalmol . 1993;77:400-403.Crossref 12. Hyman LG, Lilienfeld AM, Ferris FL, Fine SL. Senile macular degeneration: a case-control study . Am J Epidemiol . 1983;118:213-227. 13. Klein ML, Mauldin WM, Stoumbos VD. Hereditary and age-related macular degeneration: observations in monozygotic twins . Arch Ophthalmol . 1994;112:932-937.Crossref 14. Meyers SM, Greene T, Gutman FA. A twin study of age-related macular degeneration . Am J Ophthalmol . 1995;120:757-766. 15. Wedl C. Rudiments of Pathological History . London, England: George Busk; 1854:282. 16. Donders FC. Beiträge zur pathologischen Anatomie des Auges . Graefes Arch Clin Exp Ophthalmol . 1855;1:106-118.Crossref 17. Piguet B, Haimovici R, Bird AC. Dominantly inherited drusen represent more than one disorder: a historical review . Eye . 1995;9:34-41.Crossref 18. Ghadially FN. Ultrastructural pathology of the cell and matrix . London, England: Butterworths; 1988:1234-1238. 19. Jakus MA. Studies on the cornea: the fine structure of Descemet's membrane . J Biophys Biochem Cytol . 1965;2:243-248.Crossref 20. Klainguti R. Die tapeto-retinale degeneration im Kanton Tessin . Klin Monatsbl Augenheilkd . 1932;89:253-254. 21. Doyne RW. Peculiar condition of choroiditis occurring in several members of the same family . Trans Ophthalmol Soc U K . 1910;30:93-95. 22. Pearce WG. Doyne's honeycomb retinal degeneration: clinical and genetic features . Br J Ophthalmol . 1968;52:73-78.Crossref 23. Dusek J, Streicher T, Schmidt K. Hereditäre drusen der Bruch'schen membran, II: untersuchung von semidünnschnitten und elektronenmikroskopischen ergebnissen . Klin Monatsbl Augenheilkd . 1982;181:79-83.Crossref 24. Treacher Collins E. A pathological report upon a case of Doyne's choroiditis ('honeycomb' or 'family' choroiditis) . Ophthalmoscope . 1913;11:537-538. 25. Heiba IM, Elston RC, Klein BE, Klein R. Sibling correlations and segregation analysis of agerelated maculopathy: the Beaver Dam Eye Study . Genet Epidemiol . 1994;11:51-67.Crossref 26. Wells J, Wroblewski J, Keen J, et al. Mutation in the human retinal degeneration slow (RDS) gene can cause either retinitis pigmentosa or macular dystrophy . Nat Genet . 1993;3:213-218.Crossref 27. Gorin MB, Jackson KE, Ferrell RE, et al. A peripherin/retinal degeneration slow mutation (Pro-210-Arg) associated with macular and peripheral retinal degeneration . Ophthalmology . 1995;102:246-255.Crossref 28. Weber BHF, Vogt G, Pruett RC, Stöht H, Felbor U. Mutations in the tissue inhibitor of metalloproteinases-3 (TIMP3) in patients with Sorsby's fundus dystrophy . Nat Genet . 1994;8:352-356.Crossref 29. Héon E, Piguet B, Munier F, et al. Linkage of autosomal dominant radial drusen (malattia leventinese) to chromosome 2p16-21 . Arch Ophthalmol . 1996;114:193-198.Crossref

Robertson, Dennis M.;Campbell, R. Jean

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150795018pmid: 9194733

Abstract We report intravitreal invasion by melanoma cells from a choroidal melanoma after brachytherapy. A malignant melanoma of the choroid with collar-button configuration was treated with iodine 125 brachytherapy. Years later, the collar button developed a dark-chocolate color and began shedding pigmented debris into the vitreous. Coalescence of this debris into spheroidal aggregates suggested the presence of malignant cells; the eye was enucleated. Histologic sections demonstrated a choroidal melanoma with intraretinal and intravitreal invasion by melanoma. Clinical evidence of intraretinal invasion by melanoma cells along with pigmented debris within the vitreous cavity, especially when clustered in spheroidal aggregates, suggests the presence of intravitreal invasion by malignant cells. In this case, intravitreal invasion was verified histologically. References 1. Traboulsi El, Jalkh AE, Frangieh GT, Tomb J. Vitreous histocytology of primary choroidal malignant melanoma . Ann Ophthalmol . 1987;19:45-47. 2. Dunn WU, Lambert HM, Kincaid MC, Dieckert JP, Shore JW. Choroidal malignant melanoma with early vitreous seeding . Retina . 1988;8:188-192.Crossref 3. El Baba F, Hagler WS, De La Cruz A, Green WR. Choroidal melanoma with pigment dispersion in vitreous and melanomalytic glaucoma . Ophthalmology . 1988;95:370-377.Crossref 4. Robertson DM, Campbell RJ, Weaver DT. Residual intrascleral and intraretinal melanoma: a concern with lamellar sclerouvectomy for uveal melanoma . Am J Ophthalmol . 1992;113:466-468. 5. Augsburger JJ, Golden Ml, Shields JA. Fluorescein angiography of choroidal malignant melanomas with retinal invasion . Retina . 1984;4:232-234.Crossref

Scull, Judith J.;Alcocer, Carlos E.;Deschênes, Jean;Burnier, Miguel N.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150798019pmid: 9194734

Abstract A 67-year-old woman with a history of a skin melanoma that was excised 7 years previously had a 6-month history of decreased vision in her right eye. A choroidal melanoma was diagnosed clinically, and the eye was enucleated. The results of a histopathological examination revealed a primary uveal melanoma. Slides of the skin melanoma were obtained, and the initial diagnosis was confirmed. In an attempt to illustrate a biological difference between the 2 melanomas, immunohistochemical studies were performed on sections of the 2 specimens using S-100 protein, HMB-45, and S-100-β. Primary cutaneous and choroidal melanomas appearing in a patient with no predisposition are rare; this is believed to be only the fifth such case reported in the literature. References 1. Rodriguez-Sains RS. Are concurrent or subsequent malignant melanomas in the skin and eye related or coincidental? J Dermatol Surg Oncol . 1980;6:915-918.Crossref 2. Cochran AJ, Holland GN, Wen D, et al. Detection of cytoplasmic S-100 protein in primary and metastatic intraocular melanomas . Invest Ophthalmol Vis Sci . 1983;24:1153-1155. 3. Hackisuka H, Sakamoto F, Nomura H, Mori O, Sasai Y. Immunohistochemical study of S-100 protein and neurone specific enolase (NSE) in melanocytes and the related tumors . Acta Histochem . 1986;80:215-223.Crossref 4. Gown AM, Vogel AM, Hoak D, et al. Monoclonal antibodies specific for melanocytic tumors distinguish subpopulations of melanocytes . Am J Pathol . 1986;123:195-203. 5. Burnier MN Jr, McLean IW, Gamel JW. Immunohistochemical evaluation of uveal melanocytic tumors . Cancer . 1991;68:809-814.Crossref 6. Kan-Mitchell J, Liggett PE, Taylor CR, et al. Differential S-100-β expression in choroidal and skin melanomas: quantitation by the polymerase chain reaction . Invest Ophthalmol Vis Sci . 1993;34:3366-3375. 7. de Bustros S, Augsburger JJ, Shields JA, Shakin EP, Pryor CC II. Intraocular metastases from cutaneous malignant melanoma . Arch Ophthalmol . 1985;103:937-940.Crossref 8. Font RL, Naumann G, Zimmerman LE. Primary malignant melanoma of the skin metastatic to the eye and orbit: report of ten cases and review of the literature . Am J Ophthalmol . 1967;63:438-454. 9. Vink J, Crijns MB, Mooy CM, Bergman W, Oosterhuis JA, Went LN. Ocular melanoma in families with dysplastic nevus syndrome . J Am Acad Dermatol . 1990;23:858-862.Crossref 10. Bataille V, Pinney E, Hungerford JL, Cuzich J, Bishop T, Newton J. Five cases of coexistent primary ocular and cutaneous melanoma . Arch Dermatol . 1993;129:198-201.Crossref 11. Paton D, Thomas LB. Simultaneous occurrence of primary malignant melanomas of the eye and the skin . Arch Ophthalmol . 1959;62:645-652.Crossref 12. Eide N, Foerster A. Simultaneous occurrence of primary choroidal and cutaneous malignant melanoma and skin metastasis . Acta Ophthalmol Scand . 1993;71:496-499.Crossref 13. Augsberger JJ, Shields JA, Mastrangelo MJ, Frank PE. Diffuse primary malignant melanoma after prior primary cutaneous melanoma . Arch Ophthalmol . 1980;98:1261-1264.Crossref 14. Gilbert CM, El Baba F, Schachat AP, Grossniklaus H, Green WR. Nonsimultaneous primary choroidal and cutaneous melanomas . Ophthalmology . 1987;94:1169-1172.Crossref 15. Kan-Mitchell J, Rao N, Albert DM, Liggett PE, Van Eldik LJ, Taylor CR. S-100 immunophenotypes of uveal melanomas . Invest Ophthalmol Vis Sci . 1990;31:1492-1496. 16. Martins MC, Scull JJ, Alcocer CE, Deschênes J, Burnier MN Jr. Immunohistochemical expression of S-100β in choroidal melanomas . Invest Ophthalmol Vis Sci . 1996;37( (suppl) ):244.

Dichtl, Albert;Jonas, Jost B.;Mardin, Christian Y.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150802020pmid: 9194735

Abstract Flame-shaped or splinterlike hemorrhages of the optic disc are part of the panoply of morphological changes characterizing glaucomatous optic nerve damage. With relatively high specificity, disc hemorrhages indicate the presence and progression of glaucoma.1-3 This study was performed to evaluate whether optic disc hemorrhages as seen clinically on optic disc photographs can be detected on optic disc images obtained by confocal scanning laser tomography. This is a new method for the semiautomatic, 3-dimensional measurement of optic disc structures.4,5 For confocal scanning laser tomography, we used the Heidelberg retina tomograph (HRT). PATIENTS AND METHODS The study included 15 eyes of 13 white patients with primary openangle glaucoma. On clinical optic disc photographs, all eyes showed 1 optic disc hemorrhage; 1 eye had 2 disc hemorrhages. The mean (±SD) age of the 12 women and 1 man was 53.3±9.48 years (range, 38-69 years), and the mean (±SD) refractive error was References 1. Drance SM, Begg IS. Sector hemorrhage: a probable acute disc change in chronic simple glaucoma . Can J Ophthalmol . 1970;5:137-141. 2. Airaksinen PJ, Mustonen E, Alanko HI. Optic disc hemorrhages: an analysis of stereophotographs and clinical data of 112 patients . Arch Ophthalmol . 1981;99:1795-1801.Crossref 3. Jonas JB, Xu L. Optic disc hemorrhages in glaucoma . Am J Ophthalmol . 1994;118:1-8. 4. Kruse FE, Burk ROW, Völcker HE, Zinser G, Harbarth U. Reproducibility of topographic measurements of the optic nerve head with laser tomographic scanning . Ophthalmology . 1989;96:1320-1324.Crossref 5. Burk ROW, Rohrschneider K, Takamoto T, Völcker HE, Schwartz B. Laser scanning tomography and stereophotogrammetry in threedimensional optic disc analysis . Graefes Arch Clin Exp Ophthalmol . 1993;231:193-198.Crossref

Friedberg, Dorothy N.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150803021pmid: 9194736

Abstract Cidofovir, a nucleotide analog, has recently been approved as intravenous treatment for cytomegalovirus (CMV) retinitis. A long halflife allows infrequent dosing, obviating the need for an indwelling catheter. The drug is most toxic in the kidneys.1 Newly diagnosed and relapsed CMV retinitis has been treated with intravitreal cidofovir therapy.2,3 In a dose escalation study, hypotony and vitritis occurred at high doses of intravitreal drug.3 The intravitreal concentration of cidofovir after intravenous administration is unknown. This report describes the development of iritis, hypotony, and reversible visual loss in a patient receiving intravenous cidofovir therapy. See also pages 733 and 785 Report of a Case. Peripheral CMV retinitis was diagnosed in the left eye of a 41-year-old man with the acquired immunodeficiency syndrome and a CD4+ count of 0.01 ×109/L (10 cells/μL) in May 1994. His visual acuity was 20/30 OS, and his intraocular pressure (IOP) References 1. Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Parenteral cidofovir for the treatment of cytomegalovirus retinitis in patients with AIDS: the HPMPC peripheral cytomegalovirus retinitis trial . Ann Intern Med . 1997;126:264-274.Crossref 2. Kirsch LS, Arevalo JF, Chavez de la Paz E, Munguia D, de Clercq E, Freeman WR. Intravitreal cidofovir treatment of cytomegalovirus retinitis in patients with acquired immune deficiency syndrome . Ophthalmology . 1995;102:533-543.Crossref 3. Kirsch LS, Arevalo JF, de Clercq E, et al. Phase I/II study of intravitreal cidofovir for the treatment of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome . Am J Ophthalmol . 1995;119:466-476. 4. Arevalo J, Munguia D, Faber D, et al. Correlation between intraocular pressure and CD4+ T-lymphocyte counts in patients with human immunodeficiency virus with and without cytomegalovirus retinitis . Am J Ophthalmol . 1996;122:91-96.

Friedlander, Steven M.;Goldstein, Debra A.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150804022pmid: 9194737

Abstract The ganciclovir implant (Vitrasert, Chiron, Emoryville, Calif) offers patients with cytomegalovirus (CMV) retinitis potential freedom from daily intravenous infusions or weekly intravitreal injections of ganciclovir, foscarnet, or both.1 Potential problems with this method of treatment include lack of systemic CMV coverage, no treatment of the contralateral eye, development of ganciclovir resistance, and direct complications of the implant surgery. We describe the reactivation of CMV retinitis that developed in a patient in the early postoperative period following ganciclovir implant placement. This potentially visionthreatening complication should be considered in any patient receiving the ganciclovir implant. Report of a Case. A 37-year-old man with human immunodeficiency virus was diagnosed with active granular CMV retinitis in the left eye. His visual acuity on presentation was 20/25 OD and 20/40 OS. The patient refused systemic treatment and a therapeutic regimen of weekly intravitreal injections of ganciclovir (200-2000 μg) was started. He responded dramatically to References 1. Martin DF, Parks DJ, Mellow SD, et al. Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant: a randomized controlled clinical trial . Arch Ophthalmol . 1994;112:1531-1539.Crossref 2. Anand R, Nightingale SD, Fish RH, Smith TJ, Ashton P. Control of cytomegalovirus retinitis using sustained release of intraocular ganciclovir . Arch Ophthalmol . 1993;111:223-227.Crossref 3. Liesegang TJ. Biology and molecular aspects of herpes simplex and varicella-zoster virus infections . Ophthalmology . 1992;99:781-799.Crossref

Pece, Alfredo;Bolognesi, Gianluigi;Introini, Ugo;Brancato, Rosario;Piccolino, Felice Cardillo

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150806023pmid: 9194738

Abstract The Vogt-Koyanagi-Harada syndrome is a bilateral uveitis with serous detachments and signs of systemic disease and meningeal irritation.1 We describe a patient in whom fluorescein angiographic findings were characteristic of Harada disease, without systemic disorders (Vogt-Koyanagi-Harada-type syndrome), and whose condition was evaluated also by indocyanine green angiography (ICGA).2,3 Report of a Case. A 33-year-old man complained of sudden vision loss in both eyes the day before admission to the hospital. His medical history was negative for visual problems. Blood samples obtained for routine and immune or inflammatory tests were unremarkable. Cerebrospinal fluid was not tested. Visual acuity was 20/100 OU, intraocular pressure and the anterior segment were normal, and slight vitreal Tyndall effect was present. Biomicroscopic findings included retinal serous lifting at the posterior pole and multiple retinal pigment epithelium (RPE) detachments and multiple grayish areas in the RPE. A fluorescein angiogram showed rounded subretinal hypofluorescent areas at References 1. Moorthy RS, Inomata H, Rao NA. Vogt-Koyanagi-Harada syndrome . Surv Ophthalmol . 1995;39:265-292.Crossref 2. Yannuzzi LA, Sorenson JA, Guyer DR, Slakter JS, Chang B, Orlock D. Indocyanine green videoangiography: current status . Eur J Ophthalmol . 1994;4:69-81. 3. Yusuke O, Seiyo H, Yoshiyuki H, Yasuo T. Indocyanine green angiographic findings in Vogt-Koyanagi-Harada disease . Am J Ophthalmol . 1996;122:58-66.

Goldstein, Jeffrey B.;Biousse, Valerie;Newman, Nancy J.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150808024pmid: 9194739

Abstract Acute unilateral mydriasis can be the heralding sign of a neuro-ophthalmologic emergency. Textbooks often assert that pupillary dilation may be the first and only sign of third nerve dysfunction from aneurysmal or tumoral compression, tentorial herniation, or meningeal inflammation or infiltration. Evaluation for these entities frequently involves extensive, costly, and invasive testing. Less harmful causes of an acutely dilated pupil—specifically, pharmacologic dilation—must also be considered. We describe a patient in whom an aerosolized anticholinergic solution caused unilateral mydriasis. Report of a Case. A 17-year-old white male with a history of myelodysplastic syndrome was hospitalized with complications following a bone marrow transplant and was, subsequently, intubated for respiratory compromise. Two days after extubation, the patient had a dilated left pupil as well as new onset seizure activity.Neurologic consultation revealed that the left pupil was dilated 7 mm, with normal visual acuity and normal eye movements. Given the patient's immunocompromised References 1. Jannun DR, Mickel SF. Anisocoria and aerosolized anticholinergics . Chest . 1986;90:148-149.Crossref 2. Samaniego F, Newman LS. Migratory anisocoria: a novel clinical entity . Am Rev Respir Dis . 1986;134:844. 3. Thiele EA, Riviello JJ. Scopolamine patchinduced unilateral mydriasis . Pediatrics . 1995;96( (pt 1) ):525. 4. Flach AJ, Donahue ME. Pet flea and tick collar-induced anisocoria . Arch Ophthalmol . 1994;112:586.Crossref

Shields, Jerry A.;Shields, Carol L.;De Potter, Patrick

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150810025pmid: 9194740

Abstract To our knowledge, there are no articles that describe the specific step-by-step details of the surgical removal of premalignant and malignant conjunctival tumors. We describe our current approach to the surgical management of squamous cell carcinoma (intraepithelial or invasive), localized melanoma, and primary acquired melanosis of the conjunctiva. The surgical method differs with limbal tumors, extralimbal tumors, and primary acquired melanosis. Limbal lesions are managed by localized alcohol corneal epitheliectomy, removal of the main mass by a partial lamellar scleroconjunctivectomy, and supplemental cryotherapy. Tumors located in the extralimbal conjunctiva are managed by alcohol application, wide circumferential surgical resection, and cryotherapy. Primary acquired melanosis is managed by alcohol epitheliectomy, removal of suspicious foci, quadrantic staging biopsies, and cryotherapy from the underside of the conjunctiva. In all cases, a "no touch" method is used and direct manipulation of the tumor is avoided to prevent tumor cell seeding into a new area. We have employed this technique on 109 patients with conjunctival squamous neoplasms and 137 patients with conjunctival melanoma, about 80 of which neoplasms were associated with primary acquired melanosis. Our observations suggest that well-planned initial surgical management using this technique decreases the chance of tumor recurrence for conjunctival melanoma and squamous cell carcinoma. We describe a detailed stepwise approach to the surgical management of conjunctival neoplasms. It requires meticulous clinical evaluation and complete removal of the tumor in one operation using a specific technique. References 1. Shields JA, Shields CL. Tumors of the conjunctiva and cornea . In: Smolin G, Thoft RA, eds. The Cornea . 3rd ed. Boston, Mass: Little Brown & Co Inc; 1993:579-595. 2. Spencer WH, Zimmerman LE. Conjunctiva . In: Spencer WH, Font RL, Green WR, Howes EL Jr, Jakobiec FA, Zimmerman LE, eds. Ophthalmic Pathology: An Atlas and Textbook . Philadelphia, Pa: WB Saunders Co;1985:177-222. 3. De Potter P, Shields CL, Shields JA, Menduke H. Clinical predictive factors for development of recurrence and metastasis in conjunctival melanoma: a review of 68 cases . Brit J Ophthalmol . 1993;77:624-630.Crossref 4. Erie JC, Campbell RJ, Liesegang TJ. Conjunctival and corneal intraepithelial and invasive neoplasia . Ophthalmology . 1986;93:176-183.Crossref 5. Grossniklaus HE, Green WR, Luckenbach M, Chan CC. Conjunctival lesions in adults: a clinical and histopathologic review . Cornea . 1987;6:78-116.Crossref 6. Lee GA, Hirst LW. Ocular surface squamous neoplasia . Surv Ophthalmol . 1995;39:429-450.Crossref 7. Jakobiec FA, Folberg R, Iwamoto T. Clinicopathologic characteristics of premalignant and malignant melanocytic lesions of the conjunctiva . Ophthalmology . 1989;96:147-166.Crossref 8. Parideans AD, Mionassian DC, McCartney AC, Hungerford JL. Prognostic factors in primary malignant melanoma of the conjunctiva: a clinicopathologic study of 256 cases . Br J Ophthalmol . 1994;78:252-259.Crossref 9. Crawford JB. Conjunctival melanomas: prognostic factors: a review and analysis of a series . Trans Am Ophthalmol Soc . 1980;78:467-502. 10. Folberg R, McLean IW, Zimmerman LE. Primary acquired melanosis of the conjunctiva . Hum Pathol . 1985;16:129-135.Crossref 11. Folberg R, McLean IW, Zimmerman LE. Conjunctival melanosis and melanoma . Ophthalmology . 1984;91:673-678.Crossref 12. Folberg R, McLean IW, Zimmerman LE. Malignant melanoma of the conjunctiva . Hum Pathol . 1985;16:136-143.Crossref 13. Reese AB. Precancerous and cancerous melanosis . Am J Ophthalmol . 1966;61:1272-1277. 14. Buuns DR, Tse DT, Folberg R. Microscopically controlled excision of conjunctival squamous cell carcinoma . Am J Ophthalmol . 1994;117:97-102. 15. Fraunfelder FT, Wingfield D. Management of intraepithelial conjunctival tumors and squamous cell carcinomas . Am J Ophthalmol . 1983;95:359-363. 16. Elkon D, Constable WC. The use of strontium-90 in the treatment of carcinoma in situ of the conjunctiva . Am J Ophthalmol . 1979;87:84-86. 17. Peksayar G, Soyturk MK, Demiryont M. Longterm results of cryotherapy on malignant epithelial tumors of the conjunctiva . Am J Ophthalmol . 1989;107:337-349. 18. Frucht-Pery J, Rozenman Y. Mitomycin C therapy for corneal intraepithelial neoplasia . Am J Ophthalmol . 1994;117:161-168. 19. Waring GO III, Roth AM, Ekins MB. Clinical and pathologic description of 17 cases of corneal intraepithelial neoplasia . Am J ophthalmol . 1984;97:547-559. 20. Char DH. The management of lid and conjunctival malignancies . Surv Ophthalmol . 1980;24:679-689.Crossref 21. Jakobiec FA, Iwamoto T. Cryotherapy for intraepithelial conjunctival melanocytic proliferations . Arch Ophthalmol . 1983;101:904-912.Crossref 22. Jakobiec FA, Rini FJ, Fraunfelder FT, Brownstein S. Cryotherapy for conjunctival primary acquired melanosis and malignant melanoma: experience with 62 cases . Ophthalmology . 1988;95:1058-1070.Crossref 23. Lommatzsch P. Beta-ray treatment of malignant epithelial tumors of the conjunctiva . Am J Ophthalmol . 1976;81:198-206. 24. Lederman M, Wybar K, Busby E. Malignant epibulbar melanoma: natural history and treatment by radiotherapy . Br J Ophthalmol . 1984;68:605-617.Crossref 25. Brownstein S, Jakobiec FA, Wilkinson RD, Lombardo J, Jackson WB. Cryotherapy for precancerous melanosis (atypical melanocytic hyperplasia) of the conjunctiva . Arch Ophthalmol . 1981;99:1224-1231.Crossref 26. Jakobiec FA, Brownstein S, Albert W, Schwarz F, Anderson R. The role of cryotherapy in the management of conjunctival melanoma . Ophthalmology . 1982;89:502-515.Crossref 27. Jakobiec FA, Brownstein S, Wilkinson RD, Khalil M, Cooper WC, Shibata HR. Combined surgery and cryotherapy for diffuse malignant melanoma of the conjunctiva . Arch Ophthalmol . 1980;98:1390-1396.Crossref 28. Tucker SM, Hurwitz JJ, Pavlin CJ, Howarth DJC, Nianiaris N. Scleral melt after cryotherapy for conjunctival melanoma . Ophthalmology . 1993;100:574-577.Crossref 29. Gloor P, Alexandrakis G. Clinical characterization of primary acquired melanosis . Invest Ophthalmol Vis Sci . 1995;36:1721-1729. 30. Finger PT, Milner MS, McCormick ST. Topical chemotherapy for conjunctival melanoma . Br J Ophthalmol . 1993;77:751-753.Crossref 31. Frucht-Pery J, Pe'er J. Use of mitomycin C in the treatment of conjunctival primary acquired melanosis with atypia . Arch Ophthalmol . 1996;114:1261-1264.Crossref

Williams, Brian J.;Durcan, F. Jane;Mamalis, Nick;Veiga, John

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150818026pmid: 9194741

References 1. Srinivasan D, Jakobiec FA, Iwamoto T, DeVoe G. Epibulbar mucogenic subconjunctival cysts . Arch Ophthalmol . 1978;96:857-859.Crossref 2. Apple DJ, Rabb MF. Conjunctiva and Eyelids: Ocular Pathology Clinical Applications and Self-Assessment . 3rd ed. St Louis, Mo: CV Mosby Co; 1985:449-451. 3. Conlon MR, Alfonzo EC, Starck T, Albery DA. Tumors of the cornea and conjunctiva . In: Albert DM, Jakobiec FA, eds. Principles and Practice of Ophthalmology . Philadelphia, Pa: WB Saunders Co; 1994;1:278. 4. Singh D. Localized bullous separation of Descemet's membrane after previous cataract surgery . J Cataract Refract Surg . 1996;22:147-149.Crossref 5. Stark WJ. Epithelial inclusion cyst . J Cataract Refract Surg . 1996;22:395.Crossref

Bell, Dugald;Yang, Huam K.;O&apos;Brien, Colm

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150820027pmid: 9194742

References 1. Gass JDM. Cavernous hemangioma of the retina: a neuro-oculocutaneous syndrome . Am J Ophthalmol . 1971;71:799-814. 2. Kushner MS, Jampol LM, Haller JA. Cavernous haemangioma of the optic nerve . Retina . 1994;14:359-361.Crossref 3. Klein M, Goldberg MF, Cotlier E. Cavernous haemangioma of the retina: report of four cases . Ann Ophthalmol . 1975;7:1213-1221. 4. Schwartz AC, Weaver RG Jr, Bloomfield R, Tyler ME. Cavernous hemangioma of the retina, cutaneous angiomas, and intracranial vascular lesion by computed tomography and nuclear magnetic resonance imaging . Am J Ophthalmol . 1984;98:483-487.Crossref

Thompson, H. Stanley

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150822028

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

Persaud, D. David;Trope, Graham

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150824029pmid: 9194743

Abstract We read with interest the editorial by Jonathan C. Javitt, MD, MPH,1 in the April 1996 issue of the Archives. We commend Dr Javitt for his appropriate interpretation of the results of the RAND study and its implications for ophthalmology. We also applaud his attempt to develop a mechanism whereby ophthalmologists will be able to continue practicing their craft while improving the health of the population. His noteworthy points include the following: Careful attention must be paid to the number of ophthalmologists being trained. Residency training programs should be of the highest quality. The public health evidence supports a need for greater access to eye care. Unfortunately, the concept of marketing ophthalmic services to the public in an effort to reduce the disparity between demand for eye care and perceived ophthalmic need makes assumptions that may not result in the anticipated gains in services demanded. Because References 1. Javitt JC. The RAND manpower study: retire, refract or re-educate? Arch Ophthalmol . 1996;114:476-477.Crossref 2. Sutherland RW, Fulton MJ. Health Care in Canada . Ottawa, Ontario: Health Group; 1990. 3. Ramsay C, Walker M. Fraser Forum. Waiting Your Turn: Hospital Wait Lists in Canada . 5th ed. Vancouver, British Columbia: The Fraser Institute; 1995. 4. Lee PP, Jackson CA, Relies DA. Estimating eye care workforce supply and requirements . Ophthalmology . 1995;102:1964-1972.Crossref 5. Shortell SM, Gillies RR, Anderson DA, Erickson KM, Mitchell JB. Remaking Health Care in America . San Francisco, Calif: Jossey-Bass Publishers Inc; 1996. 6. Compete with optometry on price and service? Argus . (November/December) 1995:17. Editorial.

Javitt, Jonathan C.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150824030

Abstract In reply Drs Persaud and Trope have raised a similar issue as the one raised previously by Dr Hassin,1 namely, that efforts to improve compliance with care cannot be successful in a country that does not have universal access to care. While universal access is a highly desirable goal, my editorial was based on evidence that there is notable underutilization of care among the five sixths of the US population who are insured and do have access. Recently, we published additional data on underutilization of preventive eye care among Medicare beneficiaries with diabetes mellitus. This only serves to strengthen our conclusion that considerable good can be done for the public welfare and for our profession if eye care is effectively marketed. References 1. Hassin H. A tactical response to the RAND study . Arch Ophthalmol . 1997;115:132.Crossref

Fry, Luther L.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150825033pmid: 9194745

Abstract I read with interest the letter by Vrabec et al1 about forceps-induced scratching of a foldable acrylic intraocular lens. I have had several such instances myself and, although they do not seem to affect vision, they are undesirable. On reviewing the videotape, I believe all of my cases have been caused by the.12 forceps. These were used to hold the anterior edge of the wound, scratching the foldable lens as it was inserted. I have since modified my technique and either start the lens in the incision without holding the edge with forceps or if necessary hold the edge of the wound with the forceps only to get the lens started, then insert the forceps through the side port to stabilize the eye while the lens is inserted. I use a 3.75-mm incision for the 6.0-mm acrylic lens, and this does at times require a fair amount of squeezing. References 1. Vrabec MP, Syverud JC, Burgess CJ. Forceps-induced scratching of a foldable acrylic intraocular lens . Arch Ophthalmol . 1996;114:777.Crossref

Sugar, Alan

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150825032

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 Teichmann is completely correct. The oscillating blade of the automated keratome is in a fixed position. The thickness of the excised cornea is determined by a depth plate that limits the protrusion of corneal tissue above the plane of the blade. If the plate is not properly seated, excessive corneal protrusion may allow a full-thickness incision. As the intraocular pressure is intentionally elevated by a suction ring, often to 65 mm Hg, the intraocular contents are immediately forced into such a perforating wound. In the case reported, the plate had not been fully seated in the automated keratome.The comments of Dr Teichmann remind us that accuracy and precision are as important when reporting the outcomes and complications of refractive surgery as when performing the surgery itself.

Devoto, Martin H.;Egbert, James E.;Tomsick, Thomas A.;Kulwin, Dwight R.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150825035pmid: 9194746

Abstract We read with interest the article by Goldberg et al1 in the June 1996 issue of the Archives and would like to comment on the importance of ophthalmologic monitoring during the procedure to detect and treat vision-threatening increases in orbital pressure. We recently treated a 35-year-old white man with a spontaneous cavernous sinus-dural fistula. An arteriogram demonstrated poor venous access through the usual transcutaneous approaches. We were asked to provide access for a superior ophthalmic vein cannulation. An anterior orbitotomy was performed while the patient was under general anesthesia, and the superior ophthalmic vein was isolated. A micropuncture introducer (4F Micropuncture Introducer, Cook Corp, Bloomington, Ind) was introduced. A microcatheter (Tracker-18, Target Therapeutics, Fremont, Calif) was placed through the introducer into the posterior cavernous sinus. Platinum microcoils were passed into the sinus. Approximately 1 hour after commencement of the procedure, increasing exophthalmos of the right eye was noted, along References 1. Goldberg RA, Goldey SH, Duckwiler G, Vinnuela F. Management of cavernous sinus-dural fistulas: indications and techniques for primary embolization via the superior ophthalmic vein . Arch Ophthalmol . 1996;114:707-714.Crossref 2. Kupersmith MJ. Neurovascular Neuro-Ophthalmology . New York, NY: Springer-Verlag NY Inc; 1993:102,139-140.

Teichmann, Klaus D.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150825031pmid: 9194744

Abstract In the Case Report by Sugar,1 a serious complication of automated lamellar keratectomy is described, namely, perforation of the globe. The sentence explaining the cause of this disaster notes "that the blade had not been fully seated in the keratome." To my understanding, this sentence should read "that the plate had not been fully seated in the keratome." Was this indeed a spelling error? The difference is important as proper insertion of the plate can be easily verified by the typical click sound and by external visual inspection. References 1. Sugar MD. Outcome of cornea, iris, and lens perforation during automated lamellar keratectomy . Arch Ophthalmol . 1996;114:1144-1145.Crossref

Vrabec, Michael P.;Syverud, James C.

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150825034

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 We read with interest the letter by Dr Fry. It is quite possible that a.12 forceps could be another source of scratch marks on an acrylic intraocular lens. In these cases, one would expect to see 1 line and not 2, as was described in our case.The modifications in Dr Fry's technique are important, namely, to enlarge the wound as well as to avoid contact between the intraocular lens implant and a device that could scratch it.

Burgett, Richard A.;Kawasaki, Aki

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150826036pmid: 9194747

Abstract We read with interest the article by Lagrèze et al1 that was published in the April 1996 issue of the Archives. The authors described 2 patients with similar eye movement disorders that they attributed to a midline mesencephalic cleft. This clinicalradiographic association had not been previously reported. We would like to share a similar case. A 67-year-old man had a history of ptosis and diplopia since early adulthood. Photographs from childhood confirmed normal eyelid position and ocular alignment until the age of 18 years. His diplopia required increasing prism diopter (Δ) strength during a 20-year period, but he preferred to use a compensatory head turn. No family members had similar problems. In the past 10 years, a slowly progressive gait ataxia had developed. On neuro-ophthalmic examination, his visual acuity was 20/20 OU and the visual fields were normal. The pupils, anterior segments, and fundi were normal. An external examination References 1. Lagrèze W-DA, Warner JEA, Zamani AA, Gouras GK, Koralnik IJ, Bienfang DC. Mesencephalic clefts with associated eye movement disorders . Arch Ophthalmol . 1996;114:429-432.Crossref

Neider, Michael

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150827037

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 Saine and Tyler have assembled a book that may be the most comprehensive textbook on ophthalmic photography; it is certainly the most up to date regarding electronic imaging of the fundus. It is creatively illustrated and contains several hundred images, both color and black and white. The book is divided into 9 main chapters, each with a title page containing an outline of the topics to be discussed. Many chapters make use of sidebars, shaded boxes containing helpful hints and practical suggestions. They provide additional detail to the text with, for example, tips for dilating the difficult patient and suggestions for determining the correct film exposure for young children. Three appendixes provide a list of helpful abbreviations used in ophthalmic photography, a list of professional societies and companies of general interest to the photographer, including manufacturers of stereo equipment, digital cameras, and software useful in ophthalmic photography. A comprehensive index

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150828038

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 Leonard A. Levin, MD, PhD, Was Honored With the Young Investigator Award of the North American Neuro-ophthalmology Society in February 1997 at the Society's 23rd annual meeting in Keystone, Colo. Dr Levin is assistant professor of ophthalmology and visual sciences, neurology, and neurological surgery at the University of Wisconsin Medical School, Madison. Dr Levin is also an associate editor of the Archives of Ophthalmology. James Katowitz, MD, Has Been Elected President of the American Society of Ophthalmic Plastic and Reconstructive Surgery for 1997. Dr Katowitz is professor of ophthalmology at the University of Pennsylvania Medical School, Philadelphia. Associaton for Research in Vision and Ophthalmology 1997 Award Recipients were honored at the annual meeting in Fort Lauderdale, Fla, in May. The Proctor Medal was presented to George B. Benedek, PhD, professor of physics and biological physics, Massachusetts Institute of Technology, Cambridge; the Friedenwald Award was presented to Davida Y. Teller,

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150830039

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

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150831040

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 THERAPEUTIC. CIBA Vision Ophthalmics (CVO) has launched the ExcACT™ Excimer Beam Test to insure proper excimer laser performance each and every time a procedure is done. ExcACT contains a small sheet of film encased in a protective cover, with a label to record pertinent information on each patient. One ExcACT is used before each patient to provide beam symmetry, homogeneity and energy data that is then conveniently stored in the chart for future reference as necessary. The ExcACT Excimer Beam Test allows, for the first time, precise, reliable detection of fluctuations in the beam's characteristics between patients and over time between manufacturer's service calls. CVO executives stress ExcACT is not intended as a replacement for the excimer laser manufacturer's recommended method of calibration and beam profile testing. What it provides is a highly reliable tool to augment and enhance verification of system performance over time and between patients. Each box

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150832041

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

1997 Archives of Ophthalmology

doi: 10.1001/archopht.1997.01100150834042

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