- Email: [email protected]
Israel Ophthalmological Society
SOCIETY PROCEEDINGS
326
pain behind the right eye when moving it. Vision was 20/25, J2 partly, but gradually over a period of eight days deteriorated to 20/80, J14 partly. She could see the right side of the chart and the right side of a news column but not the left side. She was on Medrol and Chloromycetin therapy. The disc was elevated two diopters, its edges were markedly blurred and there was one linear hemorrhage superiorly. The left visual field was normal. The right field was absent above the horizontal meridian and was moderately contracted below. Complete blood count and the differential were normal. Urinalysis gave negative find ings. The agglutination series was negative. Skin tests for Toxoplasma and Histoplasma were negative and the PPD No. 1 was weakly positive. Neurologic examination, X-ray pictures of the skull and electro-en cephalogram were all normal. X-ray ex amination of the teeth and chest was nega tive but the sinus films showed a pansinusitis. At sinus operation on March 2, 1964, good drainage was provided for all sinuses except the frontals which did not seem to be in volved. After operation, antibiotic therapy was changed to achromycin and Medrol was continued. During the first four postopera tive days, vision remained the same; 24 hours later it had improved to 20/25, J 2 partly. Achromycin and Medrol therapy was reduced gradually. Sinusitis may not often cause optic neuri tis ; however, the findings in this case suggest that it was the etiologic factor.
she is myopic and shows clear central cor neas but clouding of Descemet's membrane in the periphery, as does the mother. The patient was born during the seventh month of gestation, when his mother was hospitalized for elevated blood pressure and swelling of the feet and ankles. She was also told she had high blood sugar. Birth weight was three and one-half pounds. On the third day after birth, the boy had a red rash over his entire face, involving his eyelids, which were swollen. A local doctor prescribed an eye salve which was used for 10 days. Eye examination showed vision to be: O.D., counting fingers at 10 inches; O . S , counting fingers at three inches. Tension, O.U, was soft. The extraocular muscles were normal, as was the conjunctiva. There was a diffuse haze throughout the whole of both corneas. The greatest areas of opacity were in Descemet's membrane. There was no vascularization, but there appeared to be some thinning of the central cornea and some increased curvature in the 90-degree meridian. A rough outline of the iris but no iris detail could be observed. No keratic precipitates and no anterior or posterior synechiae were present. The pupil was round, regular and reacted to light. It dilated readily. Only a red fundus reflex could be seen, best with a — 15D lens. The only perti nent physical findings were a high palate and poor teeth. Examination of other systems was noncontributory. Ralph S. Hamilton, Recorder.
HEREDOFAMILAL DYSTROPHY DR.
THOMAS
M.
CURREY
presented
an
eight-year-old Negro boy whose mother stated that his eyes were blue at birth and until one year of age when the corneas started to turn cloudy. The child's vision has decreased steadily and the corneas have be come progressively more cloudy. The boy is the third of seven children. The six siblings are healthy. Only one sister, aged 11 years, has a known visual defect;
ISRAEL OPHTHALMOLOGICAL SOCIETY Beer-Sheba, December 1-3, 1963 The annual meeting of the Israel Ophthalmological Society was held December 1-3, 1963, in Beer-Sheba, the main town of the Negev desert. The first day was devoted to
SOCIETY
PROCEEDINGS
papers dealing with preventive aspects of ophthalmology, the second to diseases of the cornea, conjunctiva and sclera, while the last day was reserved for free papers.
327
that it could not be excluded with absolute certainty that liminal or subliminal doses of the infrared and ultraviolet sun radiation are able to induce denaturation of proteins, per haps over a considerable period and, in the PREVENTIVE OPHTHALMOLOGY end, alone or together with other adjuvant As might be expected, the first day was factors lead to cataract formation or macular chiefly spent in a discussion of preventive lesions. The necessity of wearing protective measures in glaucoma, amblyopia and retinal glasses in very sunny areas cannot, there fore, be denied categorically. detachment. A survey of the incidence of glaucoma in Israel comprised 2 , 2 0 0 people An informative report was given on the over the age of 4 0 years from various walks relationship between visual defect and road Of life (KORNBLUETH AND BLUMENTHAL). accidents. DR. SINAI stressed the importance With the use of generally accepted criteria, of night myopia which sometimes reaches up 1 . 7 3 % were diagnosed as "simple glaucoma" to three diopters, and commented on the while 0 . 8 % were diagnosed as "glaucoma danger of visual field constriction due to suspects." Those of oriental origin showed a aphakic spectacle correction. higher incidence of glaucoma than the oth PLEOPTICS ers. Interesting papers were given on the It was reported that there are about 7 , 0 0 0 amblyopes among the school children of Is methods of pleoptic training, the adjuvant rael (NAWRATZKI). Among 2 1 4 patients, use of Peilan (Meratran) as a cortico-stim6 0 % of those who started treatment between ulant, and the treatment of amblyopia by the one and five years of age had a final vision ophthalmologist remote from centers where of 6 / 1 2 or better, while only 3 0 % of those pleoptic training is in the hands of those who started treatment between six and eight highly specialized in its methods, and the years of age, had this final vision. It is ob importance of early operation in strabismus vious that children should be examined for (LESKIN, LAVIEL, SPAIER, ROMEM). The amblyopia as early as possible, and especially possibilities of preventive treatment in my before school age. Proposals to this end opia were discussed (MIESES REIF). were brought forward. CORNEAL ANATOMY AND PHYSIOLOGY A report was given of a national co-op The second day of the meeting opened erative plan for the prevention of retinal detachment which commenced in 1 9 6 0 ( M I with a paper by DR. DAVID MAURICE on re CH AELSON). In this scheme each case of ret cent developments in the anatomy and physi inal detachment and each case of preventive ology of the cornea. One main theme of the closure of a retinal hole are made notifiable, paper was the microscopic and submicroand observations made regarding the fulfill scopic structure of the corneal stroma and of ment or otherwise of expected drop in an the sclera, and its relationship to the optical nual incidence of retinal detachment in properties of the tissues. Another was the Israel's population of slightly more than pathways by which nutrients reached the 2 , 0 0 0 , 0 0 0 inhabitants. It would appear that cornea, and the relative importance of the aqueous humor and the limbal blood supply this incidence is beginning to drop. The climate of Israel is semitropical and in this respect. The absence of significant it was appropriate that the role of the sun fluid flow which could bring nutrition to the rays in the production of ocular lesions, and central corneal regions was emphasized. This the need for sun glasses should be discussed lead to a discussion of recent measurements (STEIN). The speaker expressed the opinion of the hydrostatic pressure in the corneal
328
SOCIETY PROCEEDINGS
interstitial fluid which showed that it was in a state of suction, a condition to be antici pated from the swelling pressure in the stroma. CORNEAL ANTIGENS
In a paper on corneal antigens with re lation to keratoplasty, DR. EDITH NELKEN
reported that the following antigens were found in the laborator}': blood-group spe cific antibodies antigens in human and rab bit cornea, and species-specific and organspecific antigens in human and rabbit cor nea. The individual specificity of the human cornea was demonstrated. Circulating anticorneal antibodies were found in 1 5 out of 32 patients following keratoplasty. CORNEAL DISEASES
Interesting papers were read on the treat ment of herpes cornea with IDU, relapsing marginal keratitis treated with sex hormones, marginal dystrophy of the cornea, partial keratectomy in keratitis bullosa, and a survey of the rapid decline in the incidence of tra choma in Israel, both among immigrant Jews and Arab settlers (NISSAN, GUTMAN, SAVIR, SONES, S A C H S ) . CATARACT SURGERY COMPLICATIONS
On the last day of the meeting, DR. JOHN BELLOWS of Chicago opened the proceedings with a paper on postoperative complications following cataract surgery. This was fol lowed by an interesting discussion. RETINOGRAPHY
DR. AUERBACH described the clinical ap plication of retinography based on recent re search data. Introductory explanations of the electroretinogram were given, extended by the latest results obtained in his labora tory on the normal human E R G . The appli cation of these results to clinical cases was demonstrated and it was explained in gen eral in what pathologic conditions the elec trical method is of use in diagnosis and
prognosis. The necessity of making both the electroretinogram and the electro-occipitogram was stressed. VIRUS STUDIES
DR. BERNKOPF stressed that knowledge of the morphologic structure and the biochemical composition of viruses has lead to a better understanding of the processes connected with viral multiplication and of the possibili ties of a successful antiviral therapy. Treat ment of herpes corneae with I D U shows that such knowledge can lead to practical application. Studies of the morphology and biochemistry of trachoma agents have shown that they share many properties with bacteria and this explains the therapeutic success of antibacterial drugs in trachoma treatment. ONCHOCERCIASIS
DR. NEUMANN gave a review of his two and one-half years' work on onchocerciasis in Western Africa. The clinical aspects of the disease were reviewed and the ocular pathology was demonstrated with microfilaria and various tissues of the eye. The role of inflammatory vascular occlusion by the mi crofilaria in the pathogenesis of the posterior segment lesion was shown. MUCOPOLYSACCHARIDES
In a paper on mucopolysaccharides ( M P S ) of bovine pigment epithelium, DR. ELAINE
BERMAN
showed
chemically
the
presence of M P S in both the sensory layer and pigment epithelium, though in very small amounts. By pooling a number of cattle eyes, enough material can be made available for both metabolic and chemical studies. When pigment epithelium is incubated with either glucose C or S -sulfate, consider able radioactivity is incorporated into macromolecular nondialysable components. It can be demonstrated by electrophoresis on cellu lose acetate strips that glucose C is incor porated into both M P S and glycoproteins, 14
35
14
SOCIETY
PROCEEDINGS
while S -sulfate is incorporated only into MPS. 35
MISCELLANEOUS TOPICS
Interesting papers were read on the treat ment of subluxation of the lens in Marian's syndrome (RABILOVITZ), dystrophia of the inner canthus ( S A C H S ) , glass ( S A F R A ) , the prevention of malignant glaucoma ( K U R Z ) , the effect of early operation in the preven tion of abnormal sensory relationship, dou ble cerclage operation (HOWER), scleral rigidity in endocrine exophthalmos (HESS), pyocyaneous infections (LIEBLING). Familial glaucoma and the association of vernal catarrh with glaucoma were discussed by BEN-DOR. Glaucoma was found among cases of vernal catarrh treated from several months to 15 years with local steroids. The
OPHTHALMIC
329
glaucoma may have been causally associated either with the vernalis or the steroid ther apy. In a report on a family of a 40-day-old child with retinoblastoma, there were four out of five siblings suffering from retino blastoma, while the father showed in the fundus of one eye a large chorioretinal scar, probably representing a healed retinoblas toma (MARINE,
LANDAU). It was stressed
that the workup of a hereditary case, espe cially of a dominant trait, demands examina tion of all the family including the apparently healthy parents. Papers were read on hole in the optic disc (REGENBOGEN) and the use of glycerol in cataract extraction (TRAUB AND BERAR).
J . C. Michaelson, President.
MINIATURE
"Be it so," said the Curator, smiling. "Suffer me now to acquire merit. We be craftsmen together, thou and I. Here is a new book of white Eng lish paper: here be sharpened pencils, two and three—thick and thin, all good for a scribe. Now lend me thy spectacles!" The Curator looked through them. They were heavily scratched, but the power was almost exactly that of his own pair, which he slid into the lama's hand, saying: " T r y these." "A feather! A very feather upon the face!" The old man turned his head delightedly and wrinkled up his nose. "How scarcely do I feel them! How clearly do I see!" "They be bilaur—crystal—and will never scratch. May they help thee to thy River, for they are thine." Rudyard Kipling, Kim.
326
pain behind the right eye when moving it. Vision was 20/25, J2 partly, but gradually over a period of eight days deteriorated to 20/80, J14 partly. She could see the right side of the chart and the right side of a news column but not the left side. She was on Medrol and Chloromycetin therapy. The disc was elevated two diopters, its edges were markedly blurred and there was one linear hemorrhage superiorly. The left visual field was normal. The right field was absent above the horizontal meridian and was moderately contracted below. Complete blood count and the differential were normal. Urinalysis gave negative find ings. The agglutination series was negative. Skin tests for Toxoplasma and Histoplasma were negative and the PPD No. 1 was weakly positive. Neurologic examination, X-ray pictures of the skull and electro-en cephalogram were all normal. X-ray ex amination of the teeth and chest was nega tive but the sinus films showed a pansinusitis. At sinus operation on March 2, 1964, good drainage was provided for all sinuses except the frontals which did not seem to be in volved. After operation, antibiotic therapy was changed to achromycin and Medrol was continued. During the first four postopera tive days, vision remained the same; 24 hours later it had improved to 20/25, J 2 partly. Achromycin and Medrol therapy was reduced gradually. Sinusitis may not often cause optic neuri tis ; however, the findings in this case suggest that it was the etiologic factor.
she is myopic and shows clear central cor neas but clouding of Descemet's membrane in the periphery, as does the mother. The patient was born during the seventh month of gestation, when his mother was hospitalized for elevated blood pressure and swelling of the feet and ankles. She was also told she had high blood sugar. Birth weight was three and one-half pounds. On the third day after birth, the boy had a red rash over his entire face, involving his eyelids, which were swollen. A local doctor prescribed an eye salve which was used for 10 days. Eye examination showed vision to be: O.D., counting fingers at 10 inches; O . S , counting fingers at three inches. Tension, O.U, was soft. The extraocular muscles were normal, as was the conjunctiva. There was a diffuse haze throughout the whole of both corneas. The greatest areas of opacity were in Descemet's membrane. There was no vascularization, but there appeared to be some thinning of the central cornea and some increased curvature in the 90-degree meridian. A rough outline of the iris but no iris detail could be observed. No keratic precipitates and no anterior or posterior synechiae were present. The pupil was round, regular and reacted to light. It dilated readily. Only a red fundus reflex could be seen, best with a — 15D lens. The only perti nent physical findings were a high palate and poor teeth. Examination of other systems was noncontributory. Ralph S. Hamilton, Recorder.
HEREDOFAMILAL DYSTROPHY DR.
THOMAS
M.
CURREY
presented
an
eight-year-old Negro boy whose mother stated that his eyes were blue at birth and until one year of age when the corneas started to turn cloudy. The child's vision has decreased steadily and the corneas have be come progressively more cloudy. The boy is the third of seven children. The six siblings are healthy. Only one sister, aged 11 years, has a known visual defect;
ISRAEL OPHTHALMOLOGICAL SOCIETY Beer-Sheba, December 1-3, 1963 The annual meeting of the Israel Ophthalmological Society was held December 1-3, 1963, in Beer-Sheba, the main town of the Negev desert. The first day was devoted to
SOCIETY
PROCEEDINGS
papers dealing with preventive aspects of ophthalmology, the second to diseases of the cornea, conjunctiva and sclera, while the last day was reserved for free papers.
327
that it could not be excluded with absolute certainty that liminal or subliminal doses of the infrared and ultraviolet sun radiation are able to induce denaturation of proteins, per haps over a considerable period and, in the PREVENTIVE OPHTHALMOLOGY end, alone or together with other adjuvant As might be expected, the first day was factors lead to cataract formation or macular chiefly spent in a discussion of preventive lesions. The necessity of wearing protective measures in glaucoma, amblyopia and retinal glasses in very sunny areas cannot, there fore, be denied categorically. detachment. A survey of the incidence of glaucoma in Israel comprised 2 , 2 0 0 people An informative report was given on the over the age of 4 0 years from various walks relationship between visual defect and road Of life (KORNBLUETH AND BLUMENTHAL). accidents. DR. SINAI stressed the importance With the use of generally accepted criteria, of night myopia which sometimes reaches up 1 . 7 3 % were diagnosed as "simple glaucoma" to three diopters, and commented on the while 0 . 8 % were diagnosed as "glaucoma danger of visual field constriction due to suspects." Those of oriental origin showed a aphakic spectacle correction. higher incidence of glaucoma than the oth PLEOPTICS ers. Interesting papers were given on the It was reported that there are about 7 , 0 0 0 amblyopes among the school children of Is methods of pleoptic training, the adjuvant rael (NAWRATZKI). Among 2 1 4 patients, use of Peilan (Meratran) as a cortico-stim6 0 % of those who started treatment between ulant, and the treatment of amblyopia by the one and five years of age had a final vision ophthalmologist remote from centers where of 6 / 1 2 or better, while only 3 0 % of those pleoptic training is in the hands of those who started treatment between six and eight highly specialized in its methods, and the years of age, had this final vision. It is ob importance of early operation in strabismus vious that children should be examined for (LESKIN, LAVIEL, SPAIER, ROMEM). The amblyopia as early as possible, and especially possibilities of preventive treatment in my before school age. Proposals to this end opia were discussed (MIESES REIF). were brought forward. CORNEAL ANATOMY AND PHYSIOLOGY A report was given of a national co-op The second day of the meeting opened erative plan for the prevention of retinal detachment which commenced in 1 9 6 0 ( M I with a paper by DR. DAVID MAURICE on re CH AELSON). In this scheme each case of ret cent developments in the anatomy and physi inal detachment and each case of preventive ology of the cornea. One main theme of the closure of a retinal hole are made notifiable, paper was the microscopic and submicroand observations made regarding the fulfill scopic structure of the corneal stroma and of ment or otherwise of expected drop in an the sclera, and its relationship to the optical nual incidence of retinal detachment in properties of the tissues. Another was the Israel's population of slightly more than pathways by which nutrients reached the 2 , 0 0 0 , 0 0 0 inhabitants. It would appear that cornea, and the relative importance of the aqueous humor and the limbal blood supply this incidence is beginning to drop. The climate of Israel is semitropical and in this respect. The absence of significant it was appropriate that the role of the sun fluid flow which could bring nutrition to the rays in the production of ocular lesions, and central corneal regions was emphasized. This the need for sun glasses should be discussed lead to a discussion of recent measurements (STEIN). The speaker expressed the opinion of the hydrostatic pressure in the corneal
328
SOCIETY PROCEEDINGS
interstitial fluid which showed that it was in a state of suction, a condition to be antici pated from the swelling pressure in the stroma. CORNEAL ANTIGENS
In a paper on corneal antigens with re lation to keratoplasty, DR. EDITH NELKEN
reported that the following antigens were found in the laborator}': blood-group spe cific antibodies antigens in human and rab bit cornea, and species-specific and organspecific antigens in human and rabbit cor nea. The individual specificity of the human cornea was demonstrated. Circulating anticorneal antibodies were found in 1 5 out of 32 patients following keratoplasty. CORNEAL DISEASES
Interesting papers were read on the treat ment of herpes cornea with IDU, relapsing marginal keratitis treated with sex hormones, marginal dystrophy of the cornea, partial keratectomy in keratitis bullosa, and a survey of the rapid decline in the incidence of tra choma in Israel, both among immigrant Jews and Arab settlers (NISSAN, GUTMAN, SAVIR, SONES, S A C H S ) . CATARACT SURGERY COMPLICATIONS
On the last day of the meeting, DR. JOHN BELLOWS of Chicago opened the proceedings with a paper on postoperative complications following cataract surgery. This was fol lowed by an interesting discussion. RETINOGRAPHY
DR. AUERBACH described the clinical ap plication of retinography based on recent re search data. Introductory explanations of the electroretinogram were given, extended by the latest results obtained in his labora tory on the normal human E R G . The appli cation of these results to clinical cases was demonstrated and it was explained in gen eral in what pathologic conditions the elec trical method is of use in diagnosis and
prognosis. The necessity of making both the electroretinogram and the electro-occipitogram was stressed. VIRUS STUDIES
DR. BERNKOPF stressed that knowledge of the morphologic structure and the biochemical composition of viruses has lead to a better understanding of the processes connected with viral multiplication and of the possibili ties of a successful antiviral therapy. Treat ment of herpes corneae with I D U shows that such knowledge can lead to practical application. Studies of the morphology and biochemistry of trachoma agents have shown that they share many properties with bacteria and this explains the therapeutic success of antibacterial drugs in trachoma treatment. ONCHOCERCIASIS
DR. NEUMANN gave a review of his two and one-half years' work on onchocerciasis in Western Africa. The clinical aspects of the disease were reviewed and the ocular pathology was demonstrated with microfilaria and various tissues of the eye. The role of inflammatory vascular occlusion by the mi crofilaria in the pathogenesis of the posterior segment lesion was shown. MUCOPOLYSACCHARIDES
In a paper on mucopolysaccharides ( M P S ) of bovine pigment epithelium, DR. ELAINE
BERMAN
showed
chemically
the
presence of M P S in both the sensory layer and pigment epithelium, though in very small amounts. By pooling a number of cattle eyes, enough material can be made available for both metabolic and chemical studies. When pigment epithelium is incubated with either glucose C or S -sulfate, consider able radioactivity is incorporated into macromolecular nondialysable components. It can be demonstrated by electrophoresis on cellu lose acetate strips that glucose C is incor porated into both M P S and glycoproteins, 14
35
14
SOCIETY
PROCEEDINGS
while S -sulfate is incorporated only into MPS. 35
MISCELLANEOUS TOPICS
Interesting papers were read on the treat ment of subluxation of the lens in Marian's syndrome (RABILOVITZ), dystrophia of the inner canthus ( S A C H S ) , glass ( S A F R A ) , the prevention of malignant glaucoma ( K U R Z ) , the effect of early operation in the preven tion of abnormal sensory relationship, dou ble cerclage operation (HOWER), scleral rigidity in endocrine exophthalmos (HESS), pyocyaneous infections (LIEBLING). Familial glaucoma and the association of vernal catarrh with glaucoma were discussed by BEN-DOR. Glaucoma was found among cases of vernal catarrh treated from several months to 15 years with local steroids. The
OPHTHALMIC
329
glaucoma may have been causally associated either with the vernalis or the steroid ther apy. In a report on a family of a 40-day-old child with retinoblastoma, there were four out of five siblings suffering from retino blastoma, while the father showed in the fundus of one eye a large chorioretinal scar, probably representing a healed retinoblas toma (MARINE,
LANDAU). It was stressed
that the workup of a hereditary case, espe cially of a dominant trait, demands examina tion of all the family including the apparently healthy parents. Papers were read on hole in the optic disc (REGENBOGEN) and the use of glycerol in cataract extraction (TRAUB AND BERAR).
J . C. Michaelson, President.
MINIATURE
"Be it so," said the Curator, smiling. "Suffer me now to acquire merit. We be craftsmen together, thou and I. Here is a new book of white Eng lish paper: here be sharpened pencils, two and three—thick and thin, all good for a scribe. Now lend me thy spectacles!" The Curator looked through them. They were heavily scratched, but the power was almost exactly that of his own pair, which he slid into the lama's hand, saying: " T r y these." "A feather! A very feather upon the face!" The old man turned his head delightedly and wrinkled up his nose. "How scarcely do I feel them! How clearly do I see!" "They be bilaur—crystal—and will never scratch. May they help thee to thy River, for they are thine." Rudyard Kipling, Kim.