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Bascom Palmer Eye Institute
MEETINGS, CONFERENCES, SYMPOSIA EDITED BY THOMJ
BASCOM PALMER EYE I N S T I T U T E RESIDENTS' DAY
The fifth annual Bascom Palmer Eye In stitute Residents' Day was held June 5, 1969. A large number of guests and alumni joined the residents and staff to hear 22 papers presented by the current residents and fellows. Robert C. Magoon and James C. Major chaired the morning and afternoon programs. A major portion of the program was de voted to retinal and choroidal diseases with emphasis on fluorescein angiography. With this method, Henry M. Ramseur demon strated a form of cystoid macular edema in patients with retinitis pigmentosa. This re sembled the edema present following cataract extraction but had less fluorescein leakage during the late phase of angiography. Dennis M. Robertson discussed the management of avulsed vessels over round retinal holes and the problems of recurrent vitreous bleeding. Although the majority of cases were initially treated with photocoagulation, there is inade quate evidence to support this as the best early management. Roy H. Bresky reviewed a series of branch vein occlusions. These oc curred most commonly in the superior tem poral quadrant. Arteriovenous compression was demonstrable in 84% of the cases with fluorescein leakage distal to the compression. Guy E. O'Grady reviewed the ophthalmoscopic, pathologic, and fluorescein changes associated with hypertensive choroidopathy. A series of macular holes in 90 eyes was presented by Thomas M. Aaberg. He empha sized that trauma was not a common cause and that the visual deficit was usually stable after the initial observation. There was an average interval of 19 months before the hole formation in the second eye of the 12 bilateral cases. Fluorescein angiography may be helpful in differentiating this lesion from
CHALKLEY,
M.D.
a macular cyst because of the increased cho roidal transmission of dye noted in macular holes. Charles J. Blair reviewed the clinical and pathologic changes following experi mental laser and light coagulation in an eye subsequently removed after radiation for squamous cell carcinoma of the maxillary sinus. Multiple applications in the papillomacular bundle did not produce a demon strable nerve fiber bundle field defect al though electron microscopy revealed axonal swelling of nerve fibers in several areas. Thomas B. Coulter analyzed the ophthalmoscopic and fluorescein changes in 23 eyes with choroidal rupture. Nonadjacent macular lesions (folds, hemorrhage, etc.) accounted for the visual loss in the majority of pa tients. Flourescein leakage occurred at the edge of the rupture in acute cases because of vascular damage. In late cases there was increased transmission of dye in the center of the tear, presumably due to scierai staining. Stephen M. Kulvin discussed the use of indocyanine (Cardiogreen) for fundus angiog raphy. Unfortunately, this requires carotid injection of the dye for adequate visualization of vascular detail. Three papers dealt with the management of medically uncontrolled glaucoma: R. Larry Brenner reviewed 60 cases treated by fistulizing operation during a three-year period. Posterior lip sclerectomy was the most com mon procedure. Twenty-five percent of the cases achieved full control of intraocular pressure without medication after one pro cedure, with no difference in the success rate between the Negro and Caucasian groups. An additional 27% was controlled with medication. Of some concern was the large number of operative eyes (29%) pro gressing to mature cataract during a threeyear followup. O. E. James's review of a small series of patients treated with cyclocryotherapy suggested that this may be the
VOL. 69, NO. 1
MEETINGS, CONFERENCES, SYMPOSIA
best form of management of severe sec ondary glaucoma. George Dinter presented a retrospective study of 68 eyes treated with cyclodiathermy. Hemorrhagic glaucoma ac counted for 35% of the cases. In only IS patients was partial control of intraocular pressure achieved and some visual function retained. Twenty-two eyes were subse quently blind or enucleated. Choroidal melanomas were discussed by two residents. James R. Cerasoli empha sized the dangers of intraocular biopsy by a case presentation and a review of the liter ature. Benjamin M. Crowder reviewed the pathology of 146 eyes submitted to the Bascom Palmer Eye Institute with the clini cal diagnosis of malignant melanoma. Eight had some other lesion, of which two were choroidal hemangiomas. The use of indirect ophthalmoscopy, fluorescein angiography, and a longer followup of suspicious lesions have reduced the incidence of an incorrect diagnosis. Steven Charles presented an experimental study in the monkey relating pupillary size to change in intraocular pressure. Alan Bird reviewed five cases of giant supraclinoid aneurysms. All were women between the age of 50 and 60 years, who had developed a decrease in vision in one eye as the first symptom. Visual loss in the second eye oc curred later. The best management is prob ably clamping of the common carotid artery with ophthalmodynamometric monitoring. David M. Hunter presented three cases of a previously undescribed central lenticular cleft which accounted for transient hyperopia. Its occurrence in diabetes, hyperosmolar syndrome, and an electric cataract suggested an etiologic relationship with lens water me tabolism. Lee R. Duffner reviewed the two-
157
to 14-month postoperative findings in 67 eyes receiving pupillary iris-clip lenses after cataract extraction. Three lenses were re moved, and of the remaining 64 eyes, 52 had vision of 20/40 or better. Dan B. Jones presented five cases of Fusarium keratitis successfully treated with a new 5% suspension of pimaricin. All achieved better than 20/30 vision, in con trast to the previously poor results with topi cal amphotericin B. Camine Bedotto's re view of 18 cases of carcinoma in situ of the limbus suggested that extensive conjunctival and corneal resection with lamellar keratoplasty is the treatment of choice. Joel H. Kramer presented a family with Best's vitelline dystrophy and re-emphasized the value of electro-oculography in disclosing this ab normality. Ernesto N. Rios Montenegro categorized the treponemal-like artifacts found in dark field examination, fluorescent antibody stain ing, and silver staining techniques used to detect tréponèmes n ocular fluid and tissue. The scientific program was concluded with a case presentation of congential syphilis by William G. Nichol. T. pallidium was demon strated by dark field examination of the aqueous ; fluorescent antibody staining of the retina, choroid, and vitreous; and silver staining of liver tissue. A busness meeting followed with the elec tion of new officers for the coming year: Norman Sanders, President; Gordon R. Miller, Vice-President ; and Lee R. Duffner, Secretary-Treasurer. The day was concluded with the traditional dinner at the Miami Springs Villas followed by informal speeches by departing senior residents and a review of the year by Dr. Edward W. D. Norton. Dan B. Jones
BASCOM PALMER EYE I N S T I T U T E RESIDENTS' DAY
The fifth annual Bascom Palmer Eye In stitute Residents' Day was held June 5, 1969. A large number of guests and alumni joined the residents and staff to hear 22 papers presented by the current residents and fellows. Robert C. Magoon and James C. Major chaired the morning and afternoon programs. A major portion of the program was de voted to retinal and choroidal diseases with emphasis on fluorescein angiography. With this method, Henry M. Ramseur demon strated a form of cystoid macular edema in patients with retinitis pigmentosa. This re sembled the edema present following cataract extraction but had less fluorescein leakage during the late phase of angiography. Dennis M. Robertson discussed the management of avulsed vessels over round retinal holes and the problems of recurrent vitreous bleeding. Although the majority of cases were initially treated with photocoagulation, there is inade quate evidence to support this as the best early management. Roy H. Bresky reviewed a series of branch vein occlusions. These oc curred most commonly in the superior tem poral quadrant. Arteriovenous compression was demonstrable in 84% of the cases with fluorescein leakage distal to the compression. Guy E. O'Grady reviewed the ophthalmoscopic, pathologic, and fluorescein changes associated with hypertensive choroidopathy. A series of macular holes in 90 eyes was presented by Thomas M. Aaberg. He empha sized that trauma was not a common cause and that the visual deficit was usually stable after the initial observation. There was an average interval of 19 months before the hole formation in the second eye of the 12 bilateral cases. Fluorescein angiography may be helpful in differentiating this lesion from
CHALKLEY,
M.D.
a macular cyst because of the increased cho roidal transmission of dye noted in macular holes. Charles J. Blair reviewed the clinical and pathologic changes following experi mental laser and light coagulation in an eye subsequently removed after radiation for squamous cell carcinoma of the maxillary sinus. Multiple applications in the papillomacular bundle did not produce a demon strable nerve fiber bundle field defect al though electron microscopy revealed axonal swelling of nerve fibers in several areas. Thomas B. Coulter analyzed the ophthalmoscopic and fluorescein changes in 23 eyes with choroidal rupture. Nonadjacent macular lesions (folds, hemorrhage, etc.) accounted for the visual loss in the majority of pa tients. Flourescein leakage occurred at the edge of the rupture in acute cases because of vascular damage. In late cases there was increased transmission of dye in the center of the tear, presumably due to scierai staining. Stephen M. Kulvin discussed the use of indocyanine (Cardiogreen) for fundus angiog raphy. Unfortunately, this requires carotid injection of the dye for adequate visualization of vascular detail. Three papers dealt with the management of medically uncontrolled glaucoma: R. Larry Brenner reviewed 60 cases treated by fistulizing operation during a three-year period. Posterior lip sclerectomy was the most com mon procedure. Twenty-five percent of the cases achieved full control of intraocular pressure without medication after one pro cedure, with no difference in the success rate between the Negro and Caucasian groups. An additional 27% was controlled with medication. Of some concern was the large number of operative eyes (29%) pro gressing to mature cataract during a threeyear followup. O. E. James's review of a small series of patients treated with cyclocryotherapy suggested that this may be the
VOL. 69, NO. 1
MEETINGS, CONFERENCES, SYMPOSIA
best form of management of severe sec ondary glaucoma. George Dinter presented a retrospective study of 68 eyes treated with cyclodiathermy. Hemorrhagic glaucoma ac counted for 35% of the cases. In only IS patients was partial control of intraocular pressure achieved and some visual function retained. Twenty-two eyes were subse quently blind or enucleated. Choroidal melanomas were discussed by two residents. James R. Cerasoli empha sized the dangers of intraocular biopsy by a case presentation and a review of the liter ature. Benjamin M. Crowder reviewed the pathology of 146 eyes submitted to the Bascom Palmer Eye Institute with the clini cal diagnosis of malignant melanoma. Eight had some other lesion, of which two were choroidal hemangiomas. The use of indirect ophthalmoscopy, fluorescein angiography, and a longer followup of suspicious lesions have reduced the incidence of an incorrect diagnosis. Steven Charles presented an experimental study in the monkey relating pupillary size to change in intraocular pressure. Alan Bird reviewed five cases of giant supraclinoid aneurysms. All were women between the age of 50 and 60 years, who had developed a decrease in vision in one eye as the first symptom. Visual loss in the second eye oc curred later. The best management is prob ably clamping of the common carotid artery with ophthalmodynamometric monitoring. David M. Hunter presented three cases of a previously undescribed central lenticular cleft which accounted for transient hyperopia. Its occurrence in diabetes, hyperosmolar syndrome, and an electric cataract suggested an etiologic relationship with lens water me tabolism. Lee R. Duffner reviewed the two-
157
to 14-month postoperative findings in 67 eyes receiving pupillary iris-clip lenses after cataract extraction. Three lenses were re moved, and of the remaining 64 eyes, 52 had vision of 20/40 or better. Dan B. Jones presented five cases of Fusarium keratitis successfully treated with a new 5% suspension of pimaricin. All achieved better than 20/30 vision, in con trast to the previously poor results with topi cal amphotericin B. Camine Bedotto's re view of 18 cases of carcinoma in situ of the limbus suggested that extensive conjunctival and corneal resection with lamellar keratoplasty is the treatment of choice. Joel H. Kramer presented a family with Best's vitelline dystrophy and re-emphasized the value of electro-oculography in disclosing this ab normality. Ernesto N. Rios Montenegro categorized the treponemal-like artifacts found in dark field examination, fluorescent antibody stain ing, and silver staining techniques used to detect tréponèmes n ocular fluid and tissue. The scientific program was concluded with a case presentation of congential syphilis by William G. Nichol. T. pallidium was demon strated by dark field examination of the aqueous ; fluorescent antibody staining of the retina, choroid, and vitreous; and silver staining of liver tissue. A busness meeting followed with the elec tion of new officers for the coming year: Norman Sanders, President; Gordon R. Miller, Vice-President ; and Lee R. Duffner, Secretary-Treasurer. The day was concluded with the traditional dinner at the Miami Springs Villas followed by informal speeches by departing senior residents and a review of the year by Dr. Edward W. D. Norton. Dan B. Jones