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Asteroid Bodies: In the anterior chamber
VOL. 62, NO. 6
NOTES, CASES, INSTRUMENTS
1207
ACKNOWLEDGMENT
I wish to thank Dr. Samuel Gartner for his help in the preparation of this article. REFERENCES
1. Reese, A. B.: Tumors of the Eye. New York, Hoeber, 1963, ed. 2, p. 9. 2. Barry, R. D.: Keratoacanthoma in ocular pathology. Brit. J. Ophth. 46:528, 1962. 3. Bellamy, E. D., et. al.: Keratoacanthoma of the bulbar conjunctiva. Arch. Ophth. 70:512, 1963. 4. Christensen, L., and Fitzpatrick, T. B.: Ker atoacanthoma of the ocularadnexa. Arch. Ophth. 53:857, 1955. 5. Freeman, R. G., et. al.: Keratoacanthoma of the conjunctiva. Arch. Ophth. 65 :817, 1961. 6. Givner, I., et. al.: Keratoacanthoma. Am. J. Ophth. 49:822, 1960. 7. Ruedeman, A. D., Jr., and Hoak, C. G.: Molluscum sebaceum (keratoacanthoma). Am. J. Ophth. 40:199, 1955. 8. Walter, W. C.: Pseudo-epitheliomatous hyperplasia of the conjunctiva. Am. J. Ophth. 53:999, 1962.
Fig. 1 (Gupta and Gupta). Asteroid bodies in the anterior chamber. C A S E REPORT
ASTEROID BODIES I N THE ANTERIOR CHAMBER
J. S. GUPTA, F.R.C.S. AND S. D. G U P T A , F . R . C . S .
Chandigarh, India Asteroid hyalitis is a condition in which dull-white or creamy spherical deposits of calcium, which contain lipids, a r e attached to the vitreous fibrils. T h e y move with the vitreous when the eye is rotated but do not settle, as does synchysis scintillans. Rodman, Johnson and Zimmerman 1 considered the asteroid bodies t o be degenerative products of the fibrils and believe that they do not affect the structure of the vitreous gel. Usually, asteroid bodies are uniformly distributed in the vitreous, but, i n the fol lowing case, these bodies migrated to the an terior chamber of the eye and settled on the posterior surface of cornea and on the sur face of the iris. From the Department of Ophthalmology, Institute of Post-Graduate Medical Education and Research.
R. K. (No. X-15109) was first seen in consulta tion on February 20, 1965, complaining of gradual diminuation of vision in both eyes. Slitlamp exam ination showed almost mature cataracts in both eyes. The anterior chambers, corneas and irises were free of deposits. On February 24, 1965, an intracapsular extrac tion was done on the right eye. On the eighth post operative day, slitlamp examination revealed a quiet eye and a moderate degree of vitreous protrusion into the anterior chamber. In addition, a large num ber of white spherical deposits were scattered over and attached to the vitreous face and iris. A few ad hered to the corneal endothelium. The vitreous face was intact (fig. 1). The ophthalmoscopic study showed typical asteroid hyalitis. The asteroid bodies were fixed in the vitreous gel and oscillated with ocular movements. The fixed position of the bodies and the normal consistency of vitreous gel excluded the possibility of synchysis scintillans. The corrected vision was 20/30. On April 26, 1965, the left lens was extracted intracapsularly. Recovery was uneventful. This eye did not show any evidence of asteroid hyalitis. Subsequent examinations to July 18, 1965, showed that the asteroid bodies in the right eye were un changed in number and position. COMMENTS
Although not described in the literature, w e a r e of the opinion that asteroid bodies may accumulate on or near the anterior vit reous face a n d m a y be deposited in Burger's space. W h e n this is opened, as in cataract extraction, these bodies may be dispersed
1208
AMERICAN JOURNAL OF OPHTHALMOLOGY
and settle on various structures of the ante rior chamber. SUMMARY
Following cataract extraction asteroid bodies were found in the anterior chamber and adherent to the iris and corneal endothelium. REFERENCE
1. Rodman, H. I., Johnson, F. B., and Zimmer man, L. E.: New histopathological and histochemical observations concerning asteroid hyalitis. Arch. Ophth. 66 :S52, 1961.
SIMPLE HAND APPLANATION T O N O M E T E R F O R U S E ON T H E SEATED AS W E L L AS ON T H E SUPINE PATIENT J.
DRAEGER,
M.D.
Hamburg, Germany
An instrument that would permit exact measurements of intraocular pressure in the seated as well as supine patient has long been desired. This factor is especially im portant for measurements taken in the early morning with the patient still in bed and for tonometry in bed-ridden patients, as well as for really accurate measurements to deter mine the rigidity coefficient. An exact and convenient tonometer is also needed for house calls, consulting activities and so forth. Maklakoff1 made the first attempt to con struct an instrument of this type. His to nometer is used, practically unchanged, in Russia and neighboring countries. Measure ments with this instrument, made by noting the applanated surface produced by a cer tain weight, are unfortunately subject to nu merous errors and consequent inaccuracies. Romer2 extended the work of Maklakoff, trying to obtain more accurate measureFrom the Universitats-Augenklinik (Head: Prof. Dr. H. Sautter).
Hamburg
DECEMBER, 1966
ments of the applanated surface. For this he used a binocular and divided the images with a prism, similar to the method later used by Goldmann.3 However, the instru ment was unwieldy and hardly progressed beyond the trial stage. Perkins 4 simplified the Romer instrument; instead of the bin ocular for observation of the applanated surface, he used a simple +18D lens. The disadvantage inherent in these in struments is the inaccuracy of using a vari able applanated surface, as Goldmann and Schmidt have shown.5 Only recently (Goldmann and Schmidt6) has another applanation tonometer for use on the supine patient been described; it cor responds to the Goldmann slitlamp tonome ter. The instrument is balanced for vertical application by means of a counter weight. An eyepiece is substituted for the slitlamp microscope and illumination is bent coaxially to the observing beam by a surface mir ror. The weight alteration is manipulated by a screw. A scale on the back of the instru ment records the tension. All previous attempts to construct a con venient tonometer independent of the slit lamp have permitted measurements only on supine patients. They have also required strictly vertical application, since any incli nation of the instrument leads to a change in weight and therefore to an increasing error in measurement. I have tried to develop an instrument for
Fig. 1 (Draeger). Hand applanation tonometer in use on a supine patient.
NOTES, CASES, INSTRUMENTS
1207
ACKNOWLEDGMENT
I wish to thank Dr. Samuel Gartner for his help in the preparation of this article. REFERENCES
1. Reese, A. B.: Tumors of the Eye. New York, Hoeber, 1963, ed. 2, p. 9. 2. Barry, R. D.: Keratoacanthoma in ocular pathology. Brit. J. Ophth. 46:528, 1962. 3. Bellamy, E. D., et. al.: Keratoacanthoma of the bulbar conjunctiva. Arch. Ophth. 70:512, 1963. 4. Christensen, L., and Fitzpatrick, T. B.: Ker atoacanthoma of the ocularadnexa. Arch. Ophth. 53:857, 1955. 5. Freeman, R. G., et. al.: Keratoacanthoma of the conjunctiva. Arch. Ophth. 65 :817, 1961. 6. Givner, I., et. al.: Keratoacanthoma. Am. J. Ophth. 49:822, 1960. 7. Ruedeman, A. D., Jr., and Hoak, C. G.: Molluscum sebaceum (keratoacanthoma). Am. J. Ophth. 40:199, 1955. 8. Walter, W. C.: Pseudo-epitheliomatous hyperplasia of the conjunctiva. Am. J. Ophth. 53:999, 1962.
Fig. 1 (Gupta and Gupta). Asteroid bodies in the anterior chamber. C A S E REPORT
ASTEROID BODIES I N THE ANTERIOR CHAMBER
J. S. GUPTA, F.R.C.S. AND S. D. G U P T A , F . R . C . S .
Chandigarh, India Asteroid hyalitis is a condition in which dull-white or creamy spherical deposits of calcium, which contain lipids, a r e attached to the vitreous fibrils. T h e y move with the vitreous when the eye is rotated but do not settle, as does synchysis scintillans. Rodman, Johnson and Zimmerman 1 considered the asteroid bodies t o be degenerative products of the fibrils and believe that they do not affect the structure of the vitreous gel. Usually, asteroid bodies are uniformly distributed in the vitreous, but, i n the fol lowing case, these bodies migrated to the an terior chamber of the eye and settled on the posterior surface of cornea and on the sur face of the iris. From the Department of Ophthalmology, Institute of Post-Graduate Medical Education and Research.
R. K. (No. X-15109) was first seen in consulta tion on February 20, 1965, complaining of gradual diminuation of vision in both eyes. Slitlamp exam ination showed almost mature cataracts in both eyes. The anterior chambers, corneas and irises were free of deposits. On February 24, 1965, an intracapsular extrac tion was done on the right eye. On the eighth post operative day, slitlamp examination revealed a quiet eye and a moderate degree of vitreous protrusion into the anterior chamber. In addition, a large num ber of white spherical deposits were scattered over and attached to the vitreous face and iris. A few ad hered to the corneal endothelium. The vitreous face was intact (fig. 1). The ophthalmoscopic study showed typical asteroid hyalitis. The asteroid bodies were fixed in the vitreous gel and oscillated with ocular movements. The fixed position of the bodies and the normal consistency of vitreous gel excluded the possibility of synchysis scintillans. The corrected vision was 20/30. On April 26, 1965, the left lens was extracted intracapsularly. Recovery was uneventful. This eye did not show any evidence of asteroid hyalitis. Subsequent examinations to July 18, 1965, showed that the asteroid bodies in the right eye were un changed in number and position. COMMENTS
Although not described in the literature, w e a r e of the opinion that asteroid bodies may accumulate on or near the anterior vit reous face a n d m a y be deposited in Burger's space. W h e n this is opened, as in cataract extraction, these bodies may be dispersed
1208
AMERICAN JOURNAL OF OPHTHALMOLOGY
and settle on various structures of the ante rior chamber. SUMMARY
Following cataract extraction asteroid bodies were found in the anterior chamber and adherent to the iris and corneal endothelium. REFERENCE
1. Rodman, H. I., Johnson, F. B., and Zimmer man, L. E.: New histopathological and histochemical observations concerning asteroid hyalitis. Arch. Ophth. 66 :S52, 1961.
SIMPLE HAND APPLANATION T O N O M E T E R F O R U S E ON T H E SEATED AS W E L L AS ON T H E SUPINE PATIENT J.
DRAEGER,
M.D.
Hamburg, Germany
An instrument that would permit exact measurements of intraocular pressure in the seated as well as supine patient has long been desired. This factor is especially im portant for measurements taken in the early morning with the patient still in bed and for tonometry in bed-ridden patients, as well as for really accurate measurements to deter mine the rigidity coefficient. An exact and convenient tonometer is also needed for house calls, consulting activities and so forth. Maklakoff1 made the first attempt to con struct an instrument of this type. His to nometer is used, practically unchanged, in Russia and neighboring countries. Measure ments with this instrument, made by noting the applanated surface produced by a cer tain weight, are unfortunately subject to nu merous errors and consequent inaccuracies. Romer2 extended the work of Maklakoff, trying to obtain more accurate measureFrom the Universitats-Augenklinik (Head: Prof. Dr. H. Sautter).
Hamburg
DECEMBER, 1966
ments of the applanated surface. For this he used a binocular and divided the images with a prism, similar to the method later used by Goldmann.3 However, the instru ment was unwieldy and hardly progressed beyond the trial stage. Perkins 4 simplified the Romer instrument; instead of the bin ocular for observation of the applanated surface, he used a simple +18D lens. The disadvantage inherent in these in struments is the inaccuracy of using a vari able applanated surface, as Goldmann and Schmidt have shown.5 Only recently (Goldmann and Schmidt6) has another applanation tonometer for use on the supine patient been described; it cor responds to the Goldmann slitlamp tonome ter. The instrument is balanced for vertical application by means of a counter weight. An eyepiece is substituted for the slitlamp microscope and illumination is bent coaxially to the observing beam by a surface mir ror. The weight alteration is manipulated by a screw. A scale on the back of the instru ment records the tension. All previous attempts to construct a con venient tonometer independent of the slit lamp have permitted measurements only on supine patients. They have also required strictly vertical application, since any incli nation of the instrument leads to a change in weight and therefore to an increasing error in measurement. I have tried to develop an instrument for
Fig. 1 (Draeger). Hand applanation tonometer in use on a supine patient.