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Memphis Eye Ear, Nose and Throat Society
SOCIETY PROCEEDINGS Edited by DON.Î
M E M P H I S EYE EAR, NOSE AND T H R O A T SOCIETY
} J. LYLE,
M.D.
ripheral fields were normal. On gonioscopy the forward convexity of the iris was much more pronounced and there were more an terior synechias. The intraocular pressure S P O N T A N E O U S T E N S I O N CONTROL I N NAR was 32 mm. Hg. ROW-ANGLE GLAUCOMA The extreme seriousness of the disease in her only eye was explained to the patient but DR. ALICE R. DEUTSCH presented Mrs. A. C , aged 60 years, who had been under she refused not only surgery but even addi observation since 1950. At this time she gave tional tests or any change in treatment. She the history of having had glaucoma for was not heard of again until September, many years and being under medical care in 1956. At this time she returned because her Oklahoma City. After an operation on the vision suddenly blurred. There was a ciliary right eye, an extended inflammation had re flush, the cornea was steamy and the pupil sulted in complete loss of vision in this eye. dilated. The tension was 94 mm. Hg but she For the left eye she had used one-percent claimed not to have any pain. Even at this pilocarpine three times a day for about three stage she would not consent to go to the years. hospital. Diamox (500 mg.) was given; On examination the left eye was found Mecholyl (20 percent) and Prostigmin (five to have a very shallow anterior chamber percent) solutions were instilled alternately with localized obliterating tags in the cham every 10 minutes. The tension dropped to 35 ber angle, visible on gonioscopy. The pupil mm. Hg in two hours and to 24 mm. Hg in was narrow and did not react to light. In three hours. At this time the cornea was spite of the narrow pupil the disc was easily clearer, the posterior corneal surface was visualized and appeared normal. She saw studded with pigment deposits, and the pupil 20/20 without any correction and with an was not contracted. She was asked to return adequate add she saw J l . The peripheral and the next day and to continue the Diamox central fields were normal and the intraocu (250 mg. every six hours) and pilocarpine lar pressure equalled 18.8 mm. Hg. The (two percent every four hours) until her right eye had a scar following corneoscleral return. trephination, a dense pupillary membrane, She was not heard of until December, and a complicated cataract. The tension was 1957. At that time her complaints were of a very soft. There was no light perception gradual impairment of distant vision. The present. cornea was clear, the posterior corneal sur In spite of the fact that she was carefully face was completely covered with fine pig instructed concerning the condition of her ment dots ; the anterior chamber was very left eye she did not return until May, 1954. shallow; the iris was atrophie especially in At that time she said that she had no com a sector temporal and above. The pupil was plaints, that she did use her drops regularly, dilated and fixed. A posterior cortical cata and that the reason for her return visit was ract and a nuclear cataract were present. the loss of her reading glasses. The whole iris transilluminated when exam The external appearance of the left eye ined with the slitlamp and the mesodermal was unchanged and the disc was normal. layer was extremely thinned, especially tem The vision was still 20/20 without correc poral and above. tion. The blindspot showed an increase in its On gonioscopy the atrophie areas reached vertical diameter. Otherwise central and pe- to the iris root, but the angle area was not
SOCIETY PROCEEDINGS open and no depression in the configuration of the iris was seen in the most atrophie sector, usually seen in the sector correspond ing to an effective peripheral iridectomy. Her vision equalled 20/40 with a — 1.0D. ^ — 0.5D. cyl. ax. 10° and with an adequate add she still saw J3. The disc apparently had a good color and no pathologic cupping. The intraocular pressure equalled 15 mm. Hg. Her only medication was one-percent pilocarpine, three times daily. Diffuse and sector-shaped iris atrophy following glaucomatous attacks has been widely seen; occasionally localized periph eral iris atrophies, especially in connection with deep iris crypts, have shown remedial effects equal to peripheral iridectomies. However, in all these cases at least a part of the chamber angle was found to be open. In the case presented the chamber angle seems to be completely closed and an improvement of the out-flow mechanism hardly could ex plain the spontaneous reduction in tension. The question therefore arises: if a simul taneous atrophy of the ciliary body and de creased formation of aqueous in combina tion with an almost complete loss of fluid ex change from the iris surface could be the cause of the (probably only temporary) re duction of the intraocular pressure. Tonographic studies would be essential for evalu ation of the presently existing hypotension and an explanation of its possible origin.
401
was 20/25 and J l . Vision of the left eye was 2/200 eccentrically. The peripheral field was normal but there was a large central scotoma. In the macula there was a yellowish white lesion two to three disc diameters in size, elevated three diopters. The mass was smoothly rounded, but the surface was crinkled. The borders were fairly clearly demarcated. The retinal vessels passed over the mass unchanged, except for being ele vated. When seen two months later, the mass was larger, the borders less regular, and there was a dark spot of deep hemor rhage at the upper medial border. It was felt that the lesion was a degenera tive one of vascular origin. Continued ob servation and photographs at monthly or longer intervals were advised. Treatment was thought to be useless. Eugene A. Vaccaro, Secretary Eye Section. SWISS OPHTHALMOLOGICAL SOCIETY September 26-28, 1958 La Chaux de Fonds,
Switzerland
SURGERY
DR. H. HEINZEN (Zurich), A. RICCI AND H. DUBLER (Geneva) AND R. DUFOUR
(Lausanne) presented a film illustrating the Meyer-Schwickerath method of photocoag ulation and reported their experience in DR. P H I L I P MERIWETHER LEWIS pre sented E. D. McC, a white man, aged 77 more than 50 cases, which included macular years, who was first seen on April 7, 1958, holes, peripheral retinal tears, degenerative complaining of a blind spot before his left zones, circumscribed detachments, periphleeye which he had first noticed about seven bitis and tumors. Success ensued in 34 cases, months previously. Shortly after that he had failure in eight, and 11 cases were still a heart attack and was confined to his bed under observation. and home for several months. Recently he DR. W. BAMERT AND DR. P. WAGNER thought that the vision had become worse. (St. Gall) analyzed their series of 100 la Examination showed the eye findings to mellar corneal grafts, which they have found be negative externally and the media clear. therapeutically useful in reconstructing the Vascular sclerosis was rather marked in corneal stroma, but of less value optically. both eyes. Except for the sclerosis the right DR. B. CAGIANUT (Zurich) discussed the fundus was normal. Vision of the right eye differential diagnosis of neurofibromatosis VASCULAR LESION OF MACULA
M E M P H I S EYE EAR, NOSE AND T H R O A T SOCIETY
} J. LYLE,
M.D.
ripheral fields were normal. On gonioscopy the forward convexity of the iris was much more pronounced and there were more an terior synechias. The intraocular pressure S P O N T A N E O U S T E N S I O N CONTROL I N NAR was 32 mm. Hg. ROW-ANGLE GLAUCOMA The extreme seriousness of the disease in her only eye was explained to the patient but DR. ALICE R. DEUTSCH presented Mrs. A. C , aged 60 years, who had been under she refused not only surgery but even addi observation since 1950. At this time she gave tional tests or any change in treatment. She the history of having had glaucoma for was not heard of again until September, many years and being under medical care in 1956. At this time she returned because her Oklahoma City. After an operation on the vision suddenly blurred. There was a ciliary right eye, an extended inflammation had re flush, the cornea was steamy and the pupil sulted in complete loss of vision in this eye. dilated. The tension was 94 mm. Hg but she For the left eye she had used one-percent claimed not to have any pain. Even at this pilocarpine three times a day for about three stage she would not consent to go to the years. hospital. Diamox (500 mg.) was given; On examination the left eye was found Mecholyl (20 percent) and Prostigmin (five to have a very shallow anterior chamber percent) solutions were instilled alternately with localized obliterating tags in the cham every 10 minutes. The tension dropped to 35 ber angle, visible on gonioscopy. The pupil mm. Hg in two hours and to 24 mm. Hg in was narrow and did not react to light. In three hours. At this time the cornea was spite of the narrow pupil the disc was easily clearer, the posterior corneal surface was visualized and appeared normal. She saw studded with pigment deposits, and the pupil 20/20 without any correction and with an was not contracted. She was asked to return adequate add she saw J l . The peripheral and the next day and to continue the Diamox central fields were normal and the intraocu (250 mg. every six hours) and pilocarpine lar pressure equalled 18.8 mm. Hg. The (two percent every four hours) until her right eye had a scar following corneoscleral return. trephination, a dense pupillary membrane, She was not heard of until December, and a complicated cataract. The tension was 1957. At that time her complaints were of a very soft. There was no light perception gradual impairment of distant vision. The present. cornea was clear, the posterior corneal sur In spite of the fact that she was carefully face was completely covered with fine pig instructed concerning the condition of her ment dots ; the anterior chamber was very left eye she did not return until May, 1954. shallow; the iris was atrophie especially in At that time she said that she had no com a sector temporal and above. The pupil was plaints, that she did use her drops regularly, dilated and fixed. A posterior cortical cata and that the reason for her return visit was ract and a nuclear cataract were present. the loss of her reading glasses. The whole iris transilluminated when exam The external appearance of the left eye ined with the slitlamp and the mesodermal was unchanged and the disc was normal. layer was extremely thinned, especially tem The vision was still 20/20 without correc poral and above. tion. The blindspot showed an increase in its On gonioscopy the atrophie areas reached vertical diameter. Otherwise central and pe- to the iris root, but the angle area was not
SOCIETY PROCEEDINGS open and no depression in the configuration of the iris was seen in the most atrophie sector, usually seen in the sector correspond ing to an effective peripheral iridectomy. Her vision equalled 20/40 with a — 1.0D. ^ — 0.5D. cyl. ax. 10° and with an adequate add she still saw J3. The disc apparently had a good color and no pathologic cupping. The intraocular pressure equalled 15 mm. Hg. Her only medication was one-percent pilocarpine, three times daily. Diffuse and sector-shaped iris atrophy following glaucomatous attacks has been widely seen; occasionally localized periph eral iris atrophies, especially in connection with deep iris crypts, have shown remedial effects equal to peripheral iridectomies. However, in all these cases at least a part of the chamber angle was found to be open. In the case presented the chamber angle seems to be completely closed and an improvement of the out-flow mechanism hardly could ex plain the spontaneous reduction in tension. The question therefore arises: if a simul taneous atrophy of the ciliary body and de creased formation of aqueous in combina tion with an almost complete loss of fluid ex change from the iris surface could be the cause of the (probably only temporary) re duction of the intraocular pressure. Tonographic studies would be essential for evalu ation of the presently existing hypotension and an explanation of its possible origin.
401
was 20/25 and J l . Vision of the left eye was 2/200 eccentrically. The peripheral field was normal but there was a large central scotoma. In the macula there was a yellowish white lesion two to three disc diameters in size, elevated three diopters. The mass was smoothly rounded, but the surface was crinkled. The borders were fairly clearly demarcated. The retinal vessels passed over the mass unchanged, except for being ele vated. When seen two months later, the mass was larger, the borders less regular, and there was a dark spot of deep hemor rhage at the upper medial border. It was felt that the lesion was a degenera tive one of vascular origin. Continued ob servation and photographs at monthly or longer intervals were advised. Treatment was thought to be useless. Eugene A. Vaccaro, Secretary Eye Section. SWISS OPHTHALMOLOGICAL SOCIETY September 26-28, 1958 La Chaux de Fonds,
Switzerland
SURGERY
DR. H. HEINZEN (Zurich), A. RICCI AND H. DUBLER (Geneva) AND R. DUFOUR
(Lausanne) presented a film illustrating the Meyer-Schwickerath method of photocoag ulation and reported their experience in DR. P H I L I P MERIWETHER LEWIS pre sented E. D. McC, a white man, aged 77 more than 50 cases, which included macular years, who was first seen on April 7, 1958, holes, peripheral retinal tears, degenerative complaining of a blind spot before his left zones, circumscribed detachments, periphleeye which he had first noticed about seven bitis and tumors. Success ensued in 34 cases, months previously. Shortly after that he had failure in eight, and 11 cases were still a heart attack and was confined to his bed under observation. and home for several months. Recently he DR. W. BAMERT AND DR. P. WAGNER thought that the vision had become worse. (St. Gall) analyzed their series of 100 la Examination showed the eye findings to mellar corneal grafts, which they have found be negative externally and the media clear. therapeutically useful in reconstructing the Vascular sclerosis was rather marked in corneal stroma, but of less value optically. both eyes. Except for the sclerosis the right DR. B. CAGIANUT (Zurich) discussed the fundus was normal. Vision of the right eye differential diagnosis of neurofibromatosis VASCULAR LESION OF MACULA