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Fifteenth Annual Residents’ Days Meeting of the Bascom Palmer Eye Institute
VOL. 88, NO. 4
MEETINGS, CONFERENCES, SYMPOSIA
cervical ganglion unilaterally while the other group of rabbits had preganglionic lesions produced by severing the cervical sympathetic trunk proximal to the superi or cervical ganglion on one side. Each of the rabbits developed a miotic pupil ipsilateral to the surgical lesion. Topical co caine (10%) did not dilate the presence of a true Horner's syndrome in each experi mental" animal. In rabbits with postganglionic lesions hydroxyamphetamine (1%) failed to dilate the miotic (Horner's) pupil as well as it dilated the normal. Conversely, in those animals with pre ganglionic lesions both miotic and normal pupils dilated equally. These ex perimental results support the clinical use of hydroxyamphetamine in Horner's syn drome to differentiate postganglionic from more proximal lesions of the sympa thetic pathway. IN VITRO M O D E L O F RETHOLENTAL FIBROPLASIA
Brenda J. Tripathi (Chicago) Vasoconstriction, vasobliteration, and eventual destruction of immature retinal vessels occurred when newly born kittens and rabbits were subjected to prolonged exposure to hyperoxia (100% O2). On re turn to air, new vessels and fibrous tissue grew from the remaining disk vessels in a haphazard manner similar to the events occurring in retrolental fibroplasia of pre mature human infants. The in vitro model described consisted of immature retinal vessels obtained from eyes of 8- to 10-day-old rabbits. To inves tigate the precise mode of oxygen toxicity, the following experiments were carried out and the sequence of events in live cultures was documented by phase constrast microscopy and time-lapse cinemicrography and in fixed and stained specimens by light and electron micros copy. 1. Immediately on removal, the vascu lar explants were subjected to hyperoxia
785
(100% O2) while maintained in a tissue culture medium. After six to eight hours, the vessels showed a vasoconstriction fol lowed by a retraction process (24 hours) and eventual necrosis (72 hours). No growth occurred from these explants. 2. Mesenchymal cells, derived from the vascular explants after seven to ten days of incubation in a normal tissue culture environment, when subjected to hyperoxia showed cell retraction, cessa tion of movement, and necrosis. Ultrastructural analysis revealed that the cytocidal effect of hyperoxia was medi ated selectively through the proliferative changes in the lysosomal system of the cells. 3. A 30% concentration of oxygen was found to be safe for both the intact vessels and the cultured mesenchymal cells; 40% oxygen could be administered with little side effect provided it was alternated every six hours with ambient air. P. K. BASU F I F T E E N T H ANNUAL R E S I D E N T S ' DAYS M E E T I N G O F T H E BASCOM PALMER EYE I N S T I T U T E The 15th Annual Residents' Days Meeting of the Bascom Palmer Eye Insti tute was held at the Key Biscayne Hotel, Key Biscayne, Florida, June 8-10, 1979. The first day was moderated by Don Nicholson. The morning session was de voted to neuro-ophthalmology and motility. Mark Daily presented four cases of patients with amaurosis fugax, who sub sequently underwent carotid endarterectomy. He discussed the indications and results of carotid endarterectomy. Robert Tomsak and J. Lawton Smith discussed four patients with persisting homonymous hemianopia associated with migraine. They had computed to mography scan evidence of occipital lobe infarction. The value of a careful history, visual field examination, and computed tomography was emphasized.
786
AMERICAN JOURNAL OF OPHTHALMOLOGY
Randy Campo, Robert Osher, and Har old Shaw, Jr., presented a series of 50 cases of bilateral occipital lobe infarction. They reviewed the anatomy of the occipi tal lobe, and the pathogenesis of infarc tion, as well as the various manifestations, and suggested study of this problem. Jose Berrocal discussed subacute sclerosing pan encephalitis in general, as well as the ophthalmic complications. Donald Puro, Lanning Kline, and Joel Glaser presented a case of a man with an occipital intradural arterio venous manformation, who developed bilateral chronic papilledema with frequent tran sient obscurations of vision and progres sive visual field loss. A unilateral optic nerve sheath decompression led to total resolution of his transient obscurations, and stabilization of the visual fields. Steven Hunter, Robert Osher, and Joel Glaser discussed the manifestation, differ ential diagnosis, and management of infiltrative lesions of the retrobulbar optic nerve and optic disk. Bertrand Anz presented a case of a patient with postcataract extraction optic atrophy caused by an aspergilloma of the sphenoid sinus. He described the course and results of therapy. Jonathan Trobe, Joel Glaser, and Janet Cassaday evaluated the reliability of a panel of experts in differentiating various causes of optic atrophy by examining disk photographs. They found that the experts could reliably differentiate glaucoma from other types of optic atrophy, but could not differentiate among the other etiologies. They discussed the visual cri teria that were found to be most valuable. Paul Shipkin and Joel Glaser described five patients with optic nerve hypoplasia (three bilateral and two unilateral), normal visual acuity, and visual field de fects simulating serious orbital or brain parenchymal disease. Calvin Mein and Patrick O'Connor pre sented a case of a 29-year-old woman with
OCTOBER, 1979
a left temporal parietal infarct, and a right afferent pupillary defect. They discussed their finding that optic tract lesions ante rior to the lateral geniculate can cause afferent pupillary defects. John Costin and J. Lawton Smith pre sented four patients with alcoholic cerebellar atrophy, and down-beating nystag mus. Ruling out other causes of nystag mus, they introduced the syndrome of alcoholic down-beat nystagmus. Robert Osher, Norman Schatz, and Thomas Duane described a group of pa tients with gaze-evoked retraction of the globe, caused by infiltrative myopathy. They discussed the evaluation, differen tial diagnosis, and management. David Lasley presented evidence that in the human brain, crossed disparities (target closer than fixation point) are pro cessed in channels independent of those used in the processing of uncrossed dis parities (targets further than fixation point). James Magnusen, Robert Osher, and John Flynn analyzed the results of all of the cases patients with heterotropia who have undergone muscle surgery with ad justable sutures at the Bascom Palmer Eye Institute. They found the use of adjustable sutures (adjusted and tied on the first postoperative day) to be an effec tive procedure in selected cases. The afternoon session was devoted to external and infectious diseases. Richard Tenzel discussed the importance and techniques of photography in eye plastic surgery. Cecil Crabb and Don Nicholson pre sented the first reported case of intra ocular invasion by basal cell carcinoma of the eyelid and reviewed the clinical and histopathologic findings. Charles Barr and Henry Gelender re ported light and electron microscopic studies demonstrating multilaminated intracytoplasmic crystals in the corneas of two patients with IgG kappa chain mono-
VOL. 88, NO. 4
MEETINGS, CONFERENCES, SYMPOSIA
clonal gammopathy. Histochemical stud ies suggested that these polychromatic crystals distributed throughout the corneal stroma were composed of immunoglobulin. Scott Jaben and Doyle Stulting injected animal corneas with Fusarium solani and studied the clinical and pathological characteristics. They also presented a re view of all patients at the Eye Institute since 1975 with fungal keratitis, and dis cussed their medical management. Raananah Katz and Gerbert Rebell pre sented the results of bacterial cultures taken from three locations: (1) the con junctiva at the time of completion of surgical preparation, (2) fluid pooled in the cul-de-sac during cataract surgery, and (3) anterior chamber fluid at the com pletion of surgery. Steven Civiletto and Jerome Fisher pre sented data showing that intravitreal in jection of 2.25 mg of Ancef was effective in sterilizing rabbit eyes that had been injected with 700 organisms of Staphylococcus aureus 48 hours earlier. They also formulated a drug clearance decay curve. Michael Cobo, D. J. Custer, Noel Rice, and Barrie Jones reviewed 132 penetrat ing keratoplasties and 14 lamellar keratoplasties, all performed for herpetic kerati tis, at Moorfields Eye Hospital. Preoperative inflammatory status and degree of vascularization were found to be major prognostic factors. Lamellar keratoplasty carried a uniformly poor prognosis. They also reviewed the role of antiviral cover in routing postoperative care, and during intensive corticosteroid therapy. Michael Cobo and Barrie Jones tested the effectiveness of acycloguanosine against herpes simplex dendritic keratitis in man. They found it to be clinically effective, with no adverse side effects. J. Donald Gass moderated the session on retinal diseases on June 9. Harry Flynn discussed the Early Treatment Di abetic Retinopathy Study.
787
Bernard Doft and George Blankenship reported on their ongoing prospective randomized study designed to determine if the complications from panretinal photocoagulation differ, depending on whether the laser treatment is adminis tered in a single sitting, or divided into multiple sittings. William Hutton presented a series of 45 eyes with clear media and traction retinal detachments which involved or threat ened the macula, and which underwent pars plana vitrectomy. He found that the configuration of the detachment and the activity of the retinopathy were of prog nostic importance, but that the degree of epiretinal membrane formation was not. George Hilton discussed his current technique of pars plana vitrectomy, in cluding description of instrumentation and operating room setup. Ralph Hamilton, Jay Skyler, and George Blankenship measured lipid per oxides, cholesterol, triglycerides, and hemoglobin AiC in diabetic patients, with and without retinopathy, to help deline ate the mechanisms of vascular prolifera tion. Roy Goodart and George Blankenship compared the vitrectomy results of 80 eyes that had previtrectomy panretinal photocoagulation with those of 402 eyes without photocoagulation. The two groups had similar procedures, and there was little difference between the two groups in postoperative follow-up results. Helmut Buettner, Ira Priluck, and Dennis Robertson presented three cases of acute macular neuroretinopathy. The patients were young and healthy with mild visual impairment, paracentral scotomata, and corresponding dark, wedgeshaped parafoveal lesions of the deep sensory retina, with only minimal angiographic abnormalities. Ronald Michels discussed 12 eyes with macular pucker after otherwise successful retinal reattachment operations, which
788
AMERICAN JOURNAL OF OPHTHALMOLOGY
were treated by vitreous surgery to re move the epiretinal membranes. The ana tomic and functional results were pre sented, in addition to histologic and elec tron microscopic findings of the tissue excised. Robert Braunstein and J. Donald Gass documented three cases of branch retinal artery occlusion occurring with toxoplasmic retinochoroiditis. Hernando Zegarra, Froncie Gutman, and James Conforto outlined the natural course of central retinal vein occlusion in 25 patients. They divided the patients into two categories, and found that the visual prognosis in venous stasis retinopathy was more favorable than in hemorrhagic retinopathy. Giles Desroches presented the clinical and echographic findings in four patients with posterior nodular scleritis causing posterior mass lesions. He discussed the echographic findings that differentiate this lesion from other posterior mass le sions. Gregory Brinton and Gary Abrams dis cussed five cases with the ultrasonographic picture of a diffuse posterior seg ment opacity and a central clear zone that extended to the disk. They presented evi dence that this ultrasonographic pattern suggests total retinal detachment with dense subretinal blood or cholesterol crystals. Stuart Green and Gary Abrams used the Sonometrics DBR A-scan unit to study a group of patients with retinal detachment treated with encircling scleral buckles. They documented a postoperative in crease in axial length, and correlated this with refractive status and buckle height. David Yarian presented evidence that metastatic malignant melanomas dissemi nated at the time of enucleation surgery could not cause patient death for many years. He discussed tumor doubling times, and showed that even a rapidly growing tumor would need to grow for
OCTOBER, 1979
many years before it would reach a size that could be lethal to the patient. J. Donald Gass described the clinical features of the "unilateral wipeout syn drome," and presented evidence that this syndrome is possibly caused by nematodes. Ronald Klein, Bruce Szamier, Eliot Berson, and Stanford Meyers showed the pathology of a postmortem donor eye from a 24-year-old man with x-chromosome-linked retinitis pigmentosa. The rods and cones were reduced in number, and cones had abnormal outer segments. The pigment epithelium contained large numbers of melanolysosomes, and few free melanin granules in the far periph ery. The session on June 10 included papers on glaucoma, vitreous, and cataract. Douglas Anderson moderated this ses sion. Dan Agness and Jonathan Herschler described a modified trabeculectomy pro cedure that has improved the formerly universally poor prognosis of neovascular glaucoma. Most of their patients with over one year of follow-up maintained ambulatory vision and adequate intraocu lar pressure control. Ronald Radius, Jonathan Herschler, A. Chaflin, and G. Fiorentino showed the nature of aqueous humor changes follow ing experimental filtration surgery in monkeys, and correlated this with chang es in human aqueous after failed glauco ma surgery. They discussed the implica tions with respect to improving results of filtration surgery. Jonathan Pederson studied serial disk photographs from 248 glaucoma patients over a period of up to 14 years. He found that of the 26 eyes that showed definite progression of cupping, 3 1 % had early vertical extension, and 69% had a uniform increase in the cup size as the first change noted. Visual field changes usually be came manifest only after asymmetric ver tical expansion of the cup.
VOL. 88, NO. 4
MEETINGS, CONFERENCES, SYMPOSIA
Jonathan Herschler and Robert Osher presented evidence that early glaucomatous cupping can be recognized when one of the small curvilinear vessels that fre quently lie on the surface of the nerve head is "bared" (falls within the confines of the cup). They also observed this with optic atrophy from other causes, but did not find it with normal optic nerves. Nelson Redfern and Jonathan Herschler presented a case of Lowe's syndrome, and discussed the manifestations. Vincent De Luise analyzed fresh speci mens of trabecular meshwork and angle structures from three patients with con genital glaucoma, who underwent trabeculectomy. Using light and electron microscopy, he presented the histopathologic features of this disease. Mary Szatkowski presented the tech niques of open-sky anterior vitrectomy, used when there is vitreous loss at the time of cataract surgery. She showed a movie demonstrating the techniques. Jean-Marie Parel described and ex plained new instrumentation that he has devised for transvitreal diathermy. Stanley Chang and Gary Abrams evalu ated cases before vitreous or retinal de tachment surgery, or both, with a simulta neous contact A- and B-scan system (Ocuscan). They developed a quantitative method for differentiating vitreous mem branes or hemorrhage from retinal de tachment. Oscar Cuzzani and Gary Abrams stud ied the effect of central (core) vitrectomy on the intraocular proliferation of autologous fibroblasts injected into rabbit eyes. They found that the control eyes devel oped filamentous proliferation which later caused traction retinal detachment,
789
but the core vitrectomized eyes developed dense sheets of proliferation along the inner surface of the remaining vitreous, causing more rapid and severe traction retinal detachment. Charles Wilkinson compared the surgi cal results of a group of 50 cases of retin al detachment in eyes with intraocular lenses, with those of a similar number of routine aphakic retinal detachments. Donald Arkfeld presented his study on the postoperative intraocular pressures in eyes with and without intraocular lenses. Guy O'Grady reviewed his eight years' experience in the training of residents in ophthalmic microsurgery at the Miami Veterans Administration Hospital. He emphasized methods to facilitate teach ing of a variety of standard surgical ap proaches in cataract surgery, without undue risk to the patient. Robert Welsh showed a movie, and discussed cinema photography through the slit lamp beam-splitter to verify the value of estimated endothelial cell counts before and after lens implants. Willaim Culbertson used the specular endothelial microscope in a prospective study to evaluate corneal endothelial cell loss after intraocular surgery. He found that progressive cell loss occurred follow ing keratoplasty and intraocular lens im plantation, but there was minimal pro gressive attrition after simple cataract ex traction and phacoemulsification. At the conclusion of the meetings, grateful appreciation was expressed to Lee Duffner for the time he invested in organizing the 15th Annual Residents' Days Meeting of the Bascom Palmer Eye Institute. G R E G O R Y S. B R I G H T O N
MEETINGS, CONFERENCES, SYMPOSIA
cervical ganglion unilaterally while the other group of rabbits had preganglionic lesions produced by severing the cervical sympathetic trunk proximal to the superi or cervical ganglion on one side. Each of the rabbits developed a miotic pupil ipsilateral to the surgical lesion. Topical co caine (10%) did not dilate the presence of a true Horner's syndrome in each experi mental" animal. In rabbits with postganglionic lesions hydroxyamphetamine (1%) failed to dilate the miotic (Horner's) pupil as well as it dilated the normal. Conversely, in those animals with pre ganglionic lesions both miotic and normal pupils dilated equally. These ex perimental results support the clinical use of hydroxyamphetamine in Horner's syn drome to differentiate postganglionic from more proximal lesions of the sympa thetic pathway. IN VITRO M O D E L O F RETHOLENTAL FIBROPLASIA
Brenda J. Tripathi (Chicago) Vasoconstriction, vasobliteration, and eventual destruction of immature retinal vessels occurred when newly born kittens and rabbits were subjected to prolonged exposure to hyperoxia (100% O2). On re turn to air, new vessels and fibrous tissue grew from the remaining disk vessels in a haphazard manner similar to the events occurring in retrolental fibroplasia of pre mature human infants. The in vitro model described consisted of immature retinal vessels obtained from eyes of 8- to 10-day-old rabbits. To inves tigate the precise mode of oxygen toxicity, the following experiments were carried out and the sequence of events in live cultures was documented by phase constrast microscopy and time-lapse cinemicrography and in fixed and stained specimens by light and electron micros copy. 1. Immediately on removal, the vascu lar explants were subjected to hyperoxia
785
(100% O2) while maintained in a tissue culture medium. After six to eight hours, the vessels showed a vasoconstriction fol lowed by a retraction process (24 hours) and eventual necrosis (72 hours). No growth occurred from these explants. 2. Mesenchymal cells, derived from the vascular explants after seven to ten days of incubation in a normal tissue culture environment, when subjected to hyperoxia showed cell retraction, cessa tion of movement, and necrosis. Ultrastructural analysis revealed that the cytocidal effect of hyperoxia was medi ated selectively through the proliferative changes in the lysosomal system of the cells. 3. A 30% concentration of oxygen was found to be safe for both the intact vessels and the cultured mesenchymal cells; 40% oxygen could be administered with little side effect provided it was alternated every six hours with ambient air. P. K. BASU F I F T E E N T H ANNUAL R E S I D E N T S ' DAYS M E E T I N G O F T H E BASCOM PALMER EYE I N S T I T U T E The 15th Annual Residents' Days Meeting of the Bascom Palmer Eye Insti tute was held at the Key Biscayne Hotel, Key Biscayne, Florida, June 8-10, 1979. The first day was moderated by Don Nicholson. The morning session was de voted to neuro-ophthalmology and motility. Mark Daily presented four cases of patients with amaurosis fugax, who sub sequently underwent carotid endarterectomy. He discussed the indications and results of carotid endarterectomy. Robert Tomsak and J. Lawton Smith discussed four patients with persisting homonymous hemianopia associated with migraine. They had computed to mography scan evidence of occipital lobe infarction. The value of a careful history, visual field examination, and computed tomography was emphasized.
786
AMERICAN JOURNAL OF OPHTHALMOLOGY
Randy Campo, Robert Osher, and Har old Shaw, Jr., presented a series of 50 cases of bilateral occipital lobe infarction. They reviewed the anatomy of the occipi tal lobe, and the pathogenesis of infarc tion, as well as the various manifestations, and suggested study of this problem. Jose Berrocal discussed subacute sclerosing pan encephalitis in general, as well as the ophthalmic complications. Donald Puro, Lanning Kline, and Joel Glaser presented a case of a man with an occipital intradural arterio venous manformation, who developed bilateral chronic papilledema with frequent tran sient obscurations of vision and progres sive visual field loss. A unilateral optic nerve sheath decompression led to total resolution of his transient obscurations, and stabilization of the visual fields. Steven Hunter, Robert Osher, and Joel Glaser discussed the manifestation, differ ential diagnosis, and management of infiltrative lesions of the retrobulbar optic nerve and optic disk. Bertrand Anz presented a case of a patient with postcataract extraction optic atrophy caused by an aspergilloma of the sphenoid sinus. He described the course and results of therapy. Jonathan Trobe, Joel Glaser, and Janet Cassaday evaluated the reliability of a panel of experts in differentiating various causes of optic atrophy by examining disk photographs. They found that the experts could reliably differentiate glaucoma from other types of optic atrophy, but could not differentiate among the other etiologies. They discussed the visual cri teria that were found to be most valuable. Paul Shipkin and Joel Glaser described five patients with optic nerve hypoplasia (three bilateral and two unilateral), normal visual acuity, and visual field de fects simulating serious orbital or brain parenchymal disease. Calvin Mein and Patrick O'Connor pre sented a case of a 29-year-old woman with
OCTOBER, 1979
a left temporal parietal infarct, and a right afferent pupillary defect. They discussed their finding that optic tract lesions ante rior to the lateral geniculate can cause afferent pupillary defects. John Costin and J. Lawton Smith pre sented four patients with alcoholic cerebellar atrophy, and down-beating nystag mus. Ruling out other causes of nystag mus, they introduced the syndrome of alcoholic down-beat nystagmus. Robert Osher, Norman Schatz, and Thomas Duane described a group of pa tients with gaze-evoked retraction of the globe, caused by infiltrative myopathy. They discussed the evaluation, differen tial diagnosis, and management. David Lasley presented evidence that in the human brain, crossed disparities (target closer than fixation point) are pro cessed in channels independent of those used in the processing of uncrossed dis parities (targets further than fixation point). James Magnusen, Robert Osher, and John Flynn analyzed the results of all of the cases patients with heterotropia who have undergone muscle surgery with ad justable sutures at the Bascom Palmer Eye Institute. They found the use of adjustable sutures (adjusted and tied on the first postoperative day) to be an effec tive procedure in selected cases. The afternoon session was devoted to external and infectious diseases. Richard Tenzel discussed the importance and techniques of photography in eye plastic surgery. Cecil Crabb and Don Nicholson pre sented the first reported case of intra ocular invasion by basal cell carcinoma of the eyelid and reviewed the clinical and histopathologic findings. Charles Barr and Henry Gelender re ported light and electron microscopic studies demonstrating multilaminated intracytoplasmic crystals in the corneas of two patients with IgG kappa chain mono-
VOL. 88, NO. 4
MEETINGS, CONFERENCES, SYMPOSIA
clonal gammopathy. Histochemical stud ies suggested that these polychromatic crystals distributed throughout the corneal stroma were composed of immunoglobulin. Scott Jaben and Doyle Stulting injected animal corneas with Fusarium solani and studied the clinical and pathological characteristics. They also presented a re view of all patients at the Eye Institute since 1975 with fungal keratitis, and dis cussed their medical management. Raananah Katz and Gerbert Rebell pre sented the results of bacterial cultures taken from three locations: (1) the con junctiva at the time of completion of surgical preparation, (2) fluid pooled in the cul-de-sac during cataract surgery, and (3) anterior chamber fluid at the com pletion of surgery. Steven Civiletto and Jerome Fisher pre sented data showing that intravitreal in jection of 2.25 mg of Ancef was effective in sterilizing rabbit eyes that had been injected with 700 organisms of Staphylococcus aureus 48 hours earlier. They also formulated a drug clearance decay curve. Michael Cobo, D. J. Custer, Noel Rice, and Barrie Jones reviewed 132 penetrat ing keratoplasties and 14 lamellar keratoplasties, all performed for herpetic kerati tis, at Moorfields Eye Hospital. Preoperative inflammatory status and degree of vascularization were found to be major prognostic factors. Lamellar keratoplasty carried a uniformly poor prognosis. They also reviewed the role of antiviral cover in routing postoperative care, and during intensive corticosteroid therapy. Michael Cobo and Barrie Jones tested the effectiveness of acycloguanosine against herpes simplex dendritic keratitis in man. They found it to be clinically effective, with no adverse side effects. J. Donald Gass moderated the session on retinal diseases on June 9. Harry Flynn discussed the Early Treatment Di abetic Retinopathy Study.
787
Bernard Doft and George Blankenship reported on their ongoing prospective randomized study designed to determine if the complications from panretinal photocoagulation differ, depending on whether the laser treatment is adminis tered in a single sitting, or divided into multiple sittings. William Hutton presented a series of 45 eyes with clear media and traction retinal detachments which involved or threat ened the macula, and which underwent pars plana vitrectomy. He found that the configuration of the detachment and the activity of the retinopathy were of prog nostic importance, but that the degree of epiretinal membrane formation was not. George Hilton discussed his current technique of pars plana vitrectomy, in cluding description of instrumentation and operating room setup. Ralph Hamilton, Jay Skyler, and George Blankenship measured lipid per oxides, cholesterol, triglycerides, and hemoglobin AiC in diabetic patients, with and without retinopathy, to help deline ate the mechanisms of vascular prolifera tion. Roy Goodart and George Blankenship compared the vitrectomy results of 80 eyes that had previtrectomy panretinal photocoagulation with those of 402 eyes without photocoagulation. The two groups had similar procedures, and there was little difference between the two groups in postoperative follow-up results. Helmut Buettner, Ira Priluck, and Dennis Robertson presented three cases of acute macular neuroretinopathy. The patients were young and healthy with mild visual impairment, paracentral scotomata, and corresponding dark, wedgeshaped parafoveal lesions of the deep sensory retina, with only minimal angiographic abnormalities. Ronald Michels discussed 12 eyes with macular pucker after otherwise successful retinal reattachment operations, which
788
AMERICAN JOURNAL OF OPHTHALMOLOGY
were treated by vitreous surgery to re move the epiretinal membranes. The ana tomic and functional results were pre sented, in addition to histologic and elec tron microscopic findings of the tissue excised. Robert Braunstein and J. Donald Gass documented three cases of branch retinal artery occlusion occurring with toxoplasmic retinochoroiditis. Hernando Zegarra, Froncie Gutman, and James Conforto outlined the natural course of central retinal vein occlusion in 25 patients. They divided the patients into two categories, and found that the visual prognosis in venous stasis retinopathy was more favorable than in hemorrhagic retinopathy. Giles Desroches presented the clinical and echographic findings in four patients with posterior nodular scleritis causing posterior mass lesions. He discussed the echographic findings that differentiate this lesion from other posterior mass le sions. Gregory Brinton and Gary Abrams dis cussed five cases with the ultrasonographic picture of a diffuse posterior seg ment opacity and a central clear zone that extended to the disk. They presented evi dence that this ultrasonographic pattern suggests total retinal detachment with dense subretinal blood or cholesterol crystals. Stuart Green and Gary Abrams used the Sonometrics DBR A-scan unit to study a group of patients with retinal detachment treated with encircling scleral buckles. They documented a postoperative in crease in axial length, and correlated this with refractive status and buckle height. David Yarian presented evidence that metastatic malignant melanomas dissemi nated at the time of enucleation surgery could not cause patient death for many years. He discussed tumor doubling times, and showed that even a rapidly growing tumor would need to grow for
OCTOBER, 1979
many years before it would reach a size that could be lethal to the patient. J. Donald Gass described the clinical features of the "unilateral wipeout syn drome," and presented evidence that this syndrome is possibly caused by nematodes. Ronald Klein, Bruce Szamier, Eliot Berson, and Stanford Meyers showed the pathology of a postmortem donor eye from a 24-year-old man with x-chromosome-linked retinitis pigmentosa. The rods and cones were reduced in number, and cones had abnormal outer segments. The pigment epithelium contained large numbers of melanolysosomes, and few free melanin granules in the far periph ery. The session on June 10 included papers on glaucoma, vitreous, and cataract. Douglas Anderson moderated this ses sion. Dan Agness and Jonathan Herschler described a modified trabeculectomy pro cedure that has improved the formerly universally poor prognosis of neovascular glaucoma. Most of their patients with over one year of follow-up maintained ambulatory vision and adequate intraocu lar pressure control. Ronald Radius, Jonathan Herschler, A. Chaflin, and G. Fiorentino showed the nature of aqueous humor changes follow ing experimental filtration surgery in monkeys, and correlated this with chang es in human aqueous after failed glauco ma surgery. They discussed the implica tions with respect to improving results of filtration surgery. Jonathan Pederson studied serial disk photographs from 248 glaucoma patients over a period of up to 14 years. He found that of the 26 eyes that showed definite progression of cupping, 3 1 % had early vertical extension, and 69% had a uniform increase in the cup size as the first change noted. Visual field changes usually be came manifest only after asymmetric ver tical expansion of the cup.
VOL. 88, NO. 4
MEETINGS, CONFERENCES, SYMPOSIA
Jonathan Herschler and Robert Osher presented evidence that early glaucomatous cupping can be recognized when one of the small curvilinear vessels that fre quently lie on the surface of the nerve head is "bared" (falls within the confines of the cup). They also observed this with optic atrophy from other causes, but did not find it with normal optic nerves. Nelson Redfern and Jonathan Herschler presented a case of Lowe's syndrome, and discussed the manifestations. Vincent De Luise analyzed fresh speci mens of trabecular meshwork and angle structures from three patients with con genital glaucoma, who underwent trabeculectomy. Using light and electron microscopy, he presented the histopathologic features of this disease. Mary Szatkowski presented the tech niques of open-sky anterior vitrectomy, used when there is vitreous loss at the time of cataract surgery. She showed a movie demonstrating the techniques. Jean-Marie Parel described and ex plained new instrumentation that he has devised for transvitreal diathermy. Stanley Chang and Gary Abrams evalu ated cases before vitreous or retinal de tachment surgery, or both, with a simulta neous contact A- and B-scan system (Ocuscan). They developed a quantitative method for differentiating vitreous mem branes or hemorrhage from retinal de tachment. Oscar Cuzzani and Gary Abrams stud ied the effect of central (core) vitrectomy on the intraocular proliferation of autologous fibroblasts injected into rabbit eyes. They found that the control eyes devel oped filamentous proliferation which later caused traction retinal detachment,
789
but the core vitrectomized eyes developed dense sheets of proliferation along the inner surface of the remaining vitreous, causing more rapid and severe traction retinal detachment. Charles Wilkinson compared the surgi cal results of a group of 50 cases of retin al detachment in eyes with intraocular lenses, with those of a similar number of routine aphakic retinal detachments. Donald Arkfeld presented his study on the postoperative intraocular pressures in eyes with and without intraocular lenses. Guy O'Grady reviewed his eight years' experience in the training of residents in ophthalmic microsurgery at the Miami Veterans Administration Hospital. He emphasized methods to facilitate teach ing of a variety of standard surgical ap proaches in cataract surgery, without undue risk to the patient. Robert Welsh showed a movie, and discussed cinema photography through the slit lamp beam-splitter to verify the value of estimated endothelial cell counts before and after lens implants. Willaim Culbertson used the specular endothelial microscope in a prospective study to evaluate corneal endothelial cell loss after intraocular surgery. He found that progressive cell loss occurred follow ing keratoplasty and intraocular lens im plantation, but there was minimal pro gressive attrition after simple cataract ex traction and phacoemulsification. At the conclusion of the meetings, grateful appreciation was expressed to Lee Duffner for the time he invested in organizing the 15th Annual Residents' Days Meeting of the Bascom Palmer Eye Institute. G R E G O R Y S. B R I G H T O N