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Hypoplasia of the Optic Nerve⋆
888
NOTES, CASES, INSTRUMENTS
13. Thygeson, P., and Fritz, M. H.: Cortisone in the treatment of phlyctenular keratoconjunctivitis. Am. J. Ophth., 34:357 (Mar.) 1951. 14. Coriell, L. L., Siegel, A. G, Cook, C. D., Murphy, L., and Stokes, J., Jr.: Use of pituitary adrenocorticotropic hormone (ACTH) in poliomyelitis. J.A.M.A., 142:1279-1281 (Apr.) 1950.
HYPOPLASIA O F T H E OPTIC NERVE* DAVID C. BOYCE,
M.D.
Grand Rapids, Michigan
It was our good fortune several months ago to have in this clinic a case of a rare con genital anomaly, hypoplasia of the optic nerve. The patient was a two-year-old white boy who, according to his parents, had been blind since birth. His mother's pregnancy was uneventful, and he was apparently a nor mal term baby. The family history was nega tive concerning a similar eye anomaly. An older brother was completely normal. Upon general examination, it was found that he was of normal weight and height for * From the Department of Ophthalmology, State University of Iowa Hospitals, Iowa City, Iowa.
his age. No neurologic or other abnormality was noted. The eyes were of normal size. Their move ments were purposeless and a lateral and somewhat rotational nystagmus was present. The child did not respond to any visual stimulus. The anterior segments were normal. The pupils were three mm., round, and no reaction to light could be elicited. The ocular tension as judged by finger palpation (which is not too dependable in children, of course) was normal in each eye. Examination under anesthesia revealed no abnormality of the lens or vitreous. Each nervehead, however, was found to be about one third the normal size, and each was some what pale temporally. The vessels emerged from the discs in normal fashion, but there after they became somewhat tortuous (fig. 1). Otherwise, no abnormality of the fundi
Fig. 1 (Boyce). Hypoplasia of the optic nerves. (Photograph of a drawing by Lee Allen.)
NOTES, CASES, INSTRUMENTS
889
was noted. The refractive error, as judged the ganglion cells are formed. Their axons by the ophthalmoscope, was a moderate my pass out through the papilla and the optic stalk. opia. It was reasoned that the probable initial This case is very similar to one reported in 1 failure of the ganglion cells, and thus of their 1941 by Scheie and Adler. Their patient, a three-year-old boy, was. normal in every axons, resulted in the lack of development respect except for his eyes. These were nor of the papilla. Although this has not been mal except for hypoplasia of die optic nerves, confirmed by histologic sections in man, a the description of which is almost identical to similar-appearing nervehead in a cat was found to be due to just this cause, as re our case. corded by Szymanski in 1926.2 It is quite Previous to their case report, Scheie and • Adler could find only five cases of hypoplasia probable that this is a likely explanation for of the optic nerve in man in the literature. the anomaly in man. It has been further hypothesized that, if There have been several reports of such the mesodermal elements had not entered the anomalies in lower animals. An. explanation of this anomaly of the fetal fissure in time, it would have closed nerve was offered by Scheie and Adler, the over, leaving no papilla at all. Cases of this epitome of which follows: As you recall, nature have been reported by Krause and after the optic vesicle is formed (four-mm. Retze (as cited by Scheie and Adler). A case midway between this extreme and stage), the fetal fissure develops (4.5 mm. that of hypoplasia was reported by Ridley.2 stage). This runs ventrolaterally from the The nerveheads in this patient were very front of the vesicle to the optic stalk. Simultaneously mesoderm with primitive small and cupped. A few threadlike vessels blood channels invades the fetal fissure, and were seen emerging from the discs, but only the vessels later form the hyaloid vascular one of these appeared to contain blood. 110 Fulton Street, East (2). system. Later on (17-mm. stage), after the inner layer of the optic vesicle has developed I wish to acknowledge the help of Dr. Otis S. and cell types have become differentiated, Lee and Mr. Lee Allen in preparing this case report. REFERENCES
1. Scheie, H. G., and Adler, F. H.: Aplasia of the optic nerve. Am. J. Ophth., 26:41-70, 1941. 2. Ridley, H.: Aplasia of the optic nerves. Brit. J. Ophth., 22:669-671, 1938.
STREPTOMYCIN IN EALES'S DISEASE PETER SYKOWSKI,
M.D.
Schenectady, New York
Recently, Woods 1 presented a paper on the therapeutic action of streptomycin and promizole in clinical ocular tuberculosis in which he described his results in two cases of hemorrhagic retinitis or Eales's disease. The results were absorption of hemorrhages and improvement in the visual acuity. Earlier, Schultz and Grunwell2 described a case of recurrent retinal periphlebitis treated with parenteral streptomycin but without improvement.
Recently, I 3 presented a case of retinal tu berculosis in which, after therapy with strep tomycin, the retinal hemorrhages disappeared and the visual acuity improved. It was as sumed—though not proved—that streptomy cin was of value in the treatment of retinal tuberculosis. The object of this paper is to present a brief follow-up of this case and to present another case of Eales's disease treated with streptomycin. REPORT OF CASES CASE 1
This is a follow-up report on A. B., a 32year-old white man, seen in July, 1947, who experienced vitreous hemorrhages in both
NOTES, CASES, INSTRUMENTS
13. Thygeson, P., and Fritz, M. H.: Cortisone in the treatment of phlyctenular keratoconjunctivitis. Am. J. Ophth., 34:357 (Mar.) 1951. 14. Coriell, L. L., Siegel, A. G, Cook, C. D., Murphy, L., and Stokes, J., Jr.: Use of pituitary adrenocorticotropic hormone (ACTH) in poliomyelitis. J.A.M.A., 142:1279-1281 (Apr.) 1950.
HYPOPLASIA O F T H E OPTIC NERVE* DAVID C. BOYCE,
M.D.
Grand Rapids, Michigan
It was our good fortune several months ago to have in this clinic a case of a rare con genital anomaly, hypoplasia of the optic nerve. The patient was a two-year-old white boy who, according to his parents, had been blind since birth. His mother's pregnancy was uneventful, and he was apparently a nor mal term baby. The family history was nega tive concerning a similar eye anomaly. An older brother was completely normal. Upon general examination, it was found that he was of normal weight and height for * From the Department of Ophthalmology, State University of Iowa Hospitals, Iowa City, Iowa.
his age. No neurologic or other abnormality was noted. The eyes were of normal size. Their move ments were purposeless and a lateral and somewhat rotational nystagmus was present. The child did not respond to any visual stimulus. The anterior segments were normal. The pupils were three mm., round, and no reaction to light could be elicited. The ocular tension as judged by finger palpation (which is not too dependable in children, of course) was normal in each eye. Examination under anesthesia revealed no abnormality of the lens or vitreous. Each nervehead, however, was found to be about one third the normal size, and each was some what pale temporally. The vessels emerged from the discs in normal fashion, but there after they became somewhat tortuous (fig. 1). Otherwise, no abnormality of the fundi
Fig. 1 (Boyce). Hypoplasia of the optic nerves. (Photograph of a drawing by Lee Allen.)
NOTES, CASES, INSTRUMENTS
889
was noted. The refractive error, as judged the ganglion cells are formed. Their axons by the ophthalmoscope, was a moderate my pass out through the papilla and the optic stalk. opia. It was reasoned that the probable initial This case is very similar to one reported in 1 failure of the ganglion cells, and thus of their 1941 by Scheie and Adler. Their patient, a three-year-old boy, was. normal in every axons, resulted in the lack of development respect except for his eyes. These were nor of the papilla. Although this has not been mal except for hypoplasia of die optic nerves, confirmed by histologic sections in man, a the description of which is almost identical to similar-appearing nervehead in a cat was found to be due to just this cause, as re our case. corded by Szymanski in 1926.2 It is quite Previous to their case report, Scheie and • Adler could find only five cases of hypoplasia probable that this is a likely explanation for of the optic nerve in man in the literature. the anomaly in man. It has been further hypothesized that, if There have been several reports of such the mesodermal elements had not entered the anomalies in lower animals. An. explanation of this anomaly of the fetal fissure in time, it would have closed nerve was offered by Scheie and Adler, the over, leaving no papilla at all. Cases of this epitome of which follows: As you recall, nature have been reported by Krause and after the optic vesicle is formed (four-mm. Retze (as cited by Scheie and Adler). A case midway between this extreme and stage), the fetal fissure develops (4.5 mm. that of hypoplasia was reported by Ridley.2 stage). This runs ventrolaterally from the The nerveheads in this patient were very front of the vesicle to the optic stalk. Simultaneously mesoderm with primitive small and cupped. A few threadlike vessels blood channels invades the fetal fissure, and were seen emerging from the discs, but only the vessels later form the hyaloid vascular one of these appeared to contain blood. 110 Fulton Street, East (2). system. Later on (17-mm. stage), after the inner layer of the optic vesicle has developed I wish to acknowledge the help of Dr. Otis S. and cell types have become differentiated, Lee and Mr. Lee Allen in preparing this case report. REFERENCES
1. Scheie, H. G., and Adler, F. H.: Aplasia of the optic nerve. Am. J. Ophth., 26:41-70, 1941. 2. Ridley, H.: Aplasia of the optic nerves. Brit. J. Ophth., 22:669-671, 1938.
STREPTOMYCIN IN EALES'S DISEASE PETER SYKOWSKI,
M.D.
Schenectady, New York
Recently, Woods 1 presented a paper on the therapeutic action of streptomycin and promizole in clinical ocular tuberculosis in which he described his results in two cases of hemorrhagic retinitis or Eales's disease. The results were absorption of hemorrhages and improvement in the visual acuity. Earlier, Schultz and Grunwell2 described a case of recurrent retinal periphlebitis treated with parenteral streptomycin but without improvement.
Recently, I 3 presented a case of retinal tu berculosis in which, after therapy with strep tomycin, the retinal hemorrhages disappeared and the visual acuity improved. It was as sumed—though not proved—that streptomy cin was of value in the treatment of retinal tuberculosis. The object of this paper is to present a brief follow-up of this case and to present another case of Eales's disease treated with streptomycin. REPORT OF CASES CASE 1
This is a follow-up report on A. B., a 32year-old white man, seen in July, 1947, who experienced vitreous hemorrhages in both