Arch Ophthal Research Articles

Cigarette smoking and the risk of development of lens opacities: Hiller R, Sperduto RD, Podgor MJ, et al. Arch Ophthal 115:1113, 1997

Cigarette smoking and the risk of development of lens opacities: Hiller R, Sperduto RD, Podgor MJ, et al. Arch Ophthal 115:1113, 1997

A Case of Jeune Syndrome (Asphyxiating Thoracic Dystrophy)

A Case of Jeune Syndrome (Asphyxiating Thoracic Dystrophy)

533 WAGNER-STICKLER SYNDRCME: A GENETIC STUDY

Based on our study of 32 affected individuals in 10 families, we suggest that the Wagner and the Stickler syndromes could be the same disorder. Both the Wagner and the Stickler syndromes are autosomal dominant disorders with a similar pattern of eye abnormalities, including myopia, presenile cataracts, strabismus, vitreo-retinal degeneration, retinal detachment and retino-schisis. Only the Stickler syndrome has been associated with non-ocular problems, such as cleft palate, micrognathia, mid facial hypoplasia, hearing loss and degenerative arthritis. All of the index cases in our study were ascertained because of their retinal symptoms as having the Wagner syndrome. Three families were included in a report on Wagner syndrome in Arch Ophthal. 89:176, 1973 by Hirose et al.

Aphakic flat anterior chamber.

To the Editor. —I write concerning the article Aphakic Flat Anterior Chamber: Treatment by Anterior Vitriotomy (Arch Ophthal 86 :506-516, 1971). Drs. Cotlier and Herman have performed a service by presenting this paper concerning a group of patients with aphakic eyes with pupillary-block and flat AC not relieved by iridectomy (FAC-NI). There is, however, a small area of ambiguity within the paper which requires clarification. Several times within the paper and also in Table 10 the authors state that the mechanism of the FAC-NI syndrome is pupillary-block. Since, almost by definition, pupillary-block is interrupted or circumvented by adequate iridectomy, it would seem that pupillary-block is not an important factor in the mechanism of this syndrome; ie, (1) that either pupillary-block is not present at all, or (2) that pupillary-block is present in addition to other more important pathogenetic factors which do not respond to iridectomy. Since treatment by iridectomy is

Ocular cystine deposits in an adult.

<h3>To the Editor.</h3> —Although not recognized as such, the case reported as "Ocular Cystine Deposits in an Adult" (Arch Ophthal<b>85</b>:690-694, 1971) may well represent a different eye disorder with a specific metabolic defect. However, the studies are incomplete and thus deprive those interested in biochemical anomalies of the eye of an answer. Whether the case reported represents one of adult cystinosis is in question. All but one of the reported cases with adult cystinosis had in addition to corneal cystine deposits, similar cystine accumulations in the bone marrow.^1,2It is not stated in the paper whether or not conjunctival cystine (by paper chromatography) was found in excessive amounts, whether control samples had been tested for cystine, and whether cholesterol or other lipids or amino acids were tested for in the biopsy material. It is disturbing that in attempting to link their findings to cystinosis the authors

Cataract surgery in dogs.

To the Editor. —The Annual Review, Lens ( Arch Ophthal 85: 485-500, 1971), contains a paragraph (second paragraph, p 490) which is misleading and thus requires further comment. The cited reference indicates the status of cataract extraction in the dog as ... an overall failure rate of over 50% and a success rate not exceeding 25%. Anatomical considerations are suggested as the reason for the poor success rate, and then the closing statement reports that ... extracapsular extraction is still the procedure of choice in the dog. Unfortunately, the reviewer does not note that the quoted figures refer to cataract extractions primarily attempted by the intracapsular technique, a technique which is widely recognized as being unsuitable for the dog based upon current knowledge. It is regrettable that the reviewer encountered the cited reference in the Transactions of the Ophthalmological Societies of the United Kingdom rather than the veterinary publication, The Journal of

REPAIR OF ENTROPION

To the Editor. —It has been brought to my attention that Morris Feldstein, MD, New York, has reported a technique in Ophthalmic Surgery ( 1: 20-23, 1970) entitled Repair of Senile Entropion, which is similar to the technique I reported ( Arch Ophthal 85: 304-305, 1971). The most significant difference in technique is that Dr. Feldstein tucks the capsulopalpebral (inferior tarsal) fascia in addition to creating a cicatricial barrier between the orbicularis and the lower eyelid retractors. We have not found this necessary for mild, intermittent, or acute entropion. Dr. Feldstein's technique would probably be more effective than ours in severe or well-established entropion. We have preferred other surgical procedures for this category of entropion, but I would strongly recommend that this extremely safe procedure be more widely tried.

Marginal myotomy.

<h3>To the Editor.</h3> —Dr. John Kennedy recommends the marginal myotomy, as described by Morgan, as the initial weakening procedure of the medial recti for esotropia in infants because the recession procedure is difficult in the infant, and buried sutures often cause excessive reaction and consequent limitation of abduction due to scar formation (Arch Ophthal<b>84</b>:625-626, 1970). I have performed recession of the medial recti in several hundred infants over the past 23 years and find the procedure to be no more difficult in infants than adults provided small instrumentation and sutures are used. Nor am I aware of excessive reaction caused by the buried sutures with consequent limitation of abduction due to scar formation. Most disturbing to me is Dr. Kennedy's advice to perform a crippling procedure on a muscle as the initial surgery for strabismus, The primary objective of the strabismus surgeon should be to manipulate the

TREPONEMES OR GLASS?

To the Editor. —In reference to the article entitled Uveitis and Intraocular Treponemes by Randolph Whitfield, MD, and Emil Wirostko, MD, ( Arch Ophthal 84 :12-15, 1970), I would like to point out the similarity between the treponemes shown in their photomicrograph and what we have termed in our article Treponema-like Forms and Artifacts by Ernesto N. Rios Montenegro, MD, William G. Nicol, MD, and J. Lawton Smith, MD, in the American Journal of Ophthalmology ( 68 :197-205, 1969). The small-corkscrew-like form in the upper right hand corner of their photomicrograph on page 14 is what I consider a typical glass shaving. This can be most easily seen if their photomicrograph is compared carefully to Fig 4 to 6 in our article. Glass shavings do not show true fluorescence in a fluorescent antibody darkfield preparation, but their mild bluish or greenish color can be confused easily with true fluorescence. Whitfield

EYES CONTAINING ANTERIOR CHAMBER ACRYLIC IMPLANTS

To the Editor. —In May 1967, Dr. Bresnick wrote to me from the Institute of Ophthalmology in Judd Street, London, asking if I could supply him with full details of those anterior-chamber-implant-containing eyes which I had sent to the institute for pathological examination. This I did and I was, therefore, very interested to read the paper in which Dr. Bresnick referred to these and other eyes (Arch Ophthal 82: 726-737, 1969). I was, however, slightly disappointed with the use to which all this valuable material has been put. The paper itself had been put together in a rather unclear fashion. Take the important Table 1 for example. The casual reader may conclude that cases 2, 7, 13, 14, and 16 were Mr. Choyce's cases and it did take me quite a time before I realised that in fact, only case 13 was mine, and that was far from being a

Metastatic carcinoma.

<h3>To the Editor.</h3> —In a recent clinicopathologic case report, "Metastatic Carcinoma Simulating a Postoperative Endophthalmitis" (Arch Ophthal<b>83</b>:59-60,1970), Levine and Williamson described a patient who developed a hypopyon one month after cataract extraction. Three months later, when the patient died, metastatic bronchogenic carcinoma in the iris was noted. The article left several important questions unanswered: Was the preoperative medical review of systems positive for respiratory or neurological complaints, a history of recent weight loss, or other symptoms suggestive of metastatic disease? Did the preoperative physical examination reveal any evidence of pulmonary or metastatic disease? Were the preoperative laboratory examinations suggestive of an ocult malignancy (anemia, abnormal liver function tests, elevated serum calcium level, etc)? What did the routine preoperative chest roentgenogram reveal? At the time the hypopyon was noted, were cervical or other lymph nodes palpable? What was the extent of the primary tumor? What other organs were involved

SYSTEMIC REACTION TO TROPICAMIDE

To the Editor. —I read with interest Wahl's report of a systemic reaction to tropicamide (Arch Ophthal 82 :320-321, 1969). However, the description of the episode leads one to suspect that it was not an anaphylactic reaction, as stated by Wahl. Anxiety and bronchospasm, with pruritis, sneezing, coughing, and wheezing, are prominent manifestations of anaphylaxis, but are not described in this case. Cyanosis, loss of consciousness, and seizures occur late, when bronchoconstriction is sufficiently intense to produce hypoxemia and cerebral hypoxia. Without aggressive therapy the condition worsens, vascular tone is lost, shock ensues, and death can occur. By contrast, the initial manifestation in the present case was loss of consciousness, which was followed by generalized muscular rigidity, opisthotonos, pallor, and finally cyanosis. Recovery was rapid and spontaneous, with generalized weakness and drowsiness which resolved over the course of several hours. This is the description of a grand mal seizure, not

Comment on "determination of retinal correspondence".

To the Editor. —Merton C. Flom, PhD, and Kenton E. Kerr, MOptom, have presented a paper Determination of Retinal Correspondence ( Arch Ophthal 77 :200-213 [Feb] 1967) in which they challenge the view that the presence or absence of differences in the mode of localization in various tests for retinal correspondence (ARC) offers an indication of how thoroughly the ARC is established in a patient. The authors base their conclusion on elaborate statistical analyses which for all that remain unconvincing for a number of reasons. First, the group of subjects on whom they report is very heterogeneous. Included are 47 constant squinters (both esotropes and exotropes, the proportion is not given), 22 occasional (intermittent?) squinters, and 24 nonsquinters (presumably patients with heterophoria). Second, this inhomogeneity is the more disturbing since the groups are clinically ill defined. Patients who have to begin with a heterophoria have, by definition, normal correspondence. They

FREEZING INJURY TO THE CORNEA

<h3>To the Editor.</h3> —My experience in a series of more than 800 consecutive cryoextractions of cataracts included only one instance of freezing injury to the cornea, followed by transient corneal edema. This is in accord with the experience of Worthen and Brubaker (<i>Arch Ophthal</i><b>79:</b>8-9 [Jan] 1968) who found no lasting damage in more than 1,200 cryoextractions. I believe that corneal damage can be avoided by proper use of a suitably insulated cryoextractor.

WHAT'S THE ANGLE ON MYDRIASIS?

To the Editor. —The fact that cycloplegics may cause a significant elevation in the intraocular pressure of some normal eyes and some eyes with open-angle glaucoma in the absence of angle closure has received further documentation by the careful study reported by L. S. Harris (Cycloplegic-Induced Intraocular Pressure Elevations, Arch Ophthal 79: 242-246 [March] 1968). The effect of 10% phenylephrine, a commonly used mydriatic, upon intraocular pressure is less clearly defined. Several investigators 1-4 have reported phenylephrine has no effect upon intraocular pressure in open-angle glaucoma. Conversely, Lee 5 reported the paradoxical rise of intraocular pressure of some patients with open-angle glaucoma following instillation of 1% epinephrine or 10% phenylephrine. In these cases outflow facility was decreased without gonioscopically visible closure of the anterior chamber angle. In a personal study of 21 patients with open-angle glaucoma under medical treatment (pilocarpine, anticholinesterases, epinephrine bitartrate, and carbonic anhydrase inhibitors, singly or

FOREIGN BODY IN THE EYE

<h3>To the Editor.</h3> —Regarding the query on feeling of foreign body in the eye (Arch Ophthal<b>76</b>:902 [Dec] 1966), one more very frequently overlooked possibility in patients of this age and older is senile laxity of the conjunctiva when it is thrown into folds by movement of the eye and pressure by the lids especially at the lower limbus (Hughes, W.L.: Conjunctivochalasis,<i>Amer J Ophthal</i><b>25</b>:48, 1942). Other manifestations of this condition are sudden sharp pains, recurrent subconjunctival hemorrhages, and even peripheral marginal corneal ulceration in severe cases. P. S. I enjoy the new query department very much.

REPLY TO DR. SNYDACKER

To the Editor. —We appreciate Dr. Snydacker's letter bringing attention to the fine work of Dr. Gernet. We agree that with proper stabilization of the patient's head and of the contact-ring transducer, as described by Gernet and also by Jansson, there is no significant distortion of the globe. In this respect our system offers no particular advantage as it, too, causes no distortion of the globe (Arch Ophthal 77 :124 [Jan] 1967). We must admit, however, that we see no advantage in combining optical with ultrasonic measurements, since the statistical loss of accuracy found in a combined measurement technique outweighs the slightly greater accuracy of the optical measurement as compared to the ultrasonic measurement of the anterior chamber (0.036-mm error compared to 0.032-mm error respectively according to Jansson: Measurement of Intraocular Distances by Ultrasound and Comparison Between Optical and Ultrasonic Determination of the Depth of the Anterior Chamber, Acta Ophthal

PATHOGENESIS OF GLAUCOMA

To the Editor: I would like to comment upon the article by L. Christensen and Ray Irvine, Jr., Pathogenesis of Primary Shallow Chamber Angle Closure Glaucoma (Arch Ophthal 75 :490, 1966). The operation suggested by Drs. Christensen and Irvine has been described by Scott and Smith in the British Journal of Ophthalmology as Retrolental Decompression ( 45 :654, 1961). The drainage fluid derived from this surgical procedure is obtained from the capsulohyaloid sinus which lies anterior to the anterior hyaloid membrane. This might be considered basic biomicroscopy and can be readily demonstrated. Since the fluid contained in the posterior vitreous cavity (PVC) differs from that of in the posterior chamber, this fluid cannot be derived from the aqueous. The lens diaphragm moves forward because in the capsulohyaloid sinus pushes against the lens periphery (in a circumferential girdle of 3 mm), not because of aqueous lakes within the vitreous.

STERILITY AND CRYOSURGERY

To the Editor: We have read with interest Dr. John G. Bellows' letter on sterility and cryosurgery ( Arch Ophthal 74 :290-291, 1965). Our experiences are consistent with his finding that cryogens are practically free of bacteria. We examined samples of liquid nitrogen by evaporating the samples under sterile conditions and subsequent determining germ count in the container. We found one living bacterium for every 5 to 10 ml of liquid nitrogen. It should be taken into account, however, that even the most dangerous bacteria are not at all impaired at the temperature of the liquid nitrogen. We added lyophilized cultures of Pseudomonas aeruginosa and Staphylococcus aureus thoroughly ground with talc to liquid nitrogen and determined the germ count in the container after the nitrogen had evaporated. The bacteria could be recovered in full number in both cases. We have drawn the conclusion that, in spite of the sterility (in the

"LONG-TERM TREATMENT WITH IDOXURIDINE AND STEROIDS"

To the Editor: A note of caution should be added to the article by Drs. Dohlman and Zucker on Long-term Treatment with Idoxuridine and Steroids, ( Arch Ophthal 74:172-174, 1965). Concomitant administration of topical antibiotics with idoxuridine and steroids may prevent secondary bacterial infections, but an additional risk is undertaken—that of secondary mycotic keratitis. I recently saw a 25-year-old landscaper with a left herpetic keratitis (with slight stromal involvement) and iritis. Treatment consisted of idoxuridine ointment and suspension of prednisolone acetate 0.5% with polymyxin B sulfate and neomycin sulfate five times a day, and atropine. By the seventh day the stroma was clear and the dendrite was almost gone; treatment was continued. Three days later a white corneal ulcer appeared at the site of the former dendrite. Two days later, the infection appeared typically mycotic. Scraping and culture revealed Cephalosporium . Previous medication was replaced with hourly instillations of amphotericin B. When