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Nashville Academy of Ophthalmology and Otolaryngology
SOCIETY PROCEEDINGS Edited by DONJ :.D J . L Y L E , M . D .
NASHVILLE ACADEMY O F OPHTHALMOLOGY AND OTOLARYNGOLOGY March 20, 1950 DR. FOWLER HOLLABAUGH, RETROLENTAL
presiding
FIBROPLASIA
D R . H E N R Y CARROLL S M I T H said that, in
his experience since 1945, 5 or 6 infants, born prematurely, have developed retrolental fibroplasia. This condition, as we all know, was first described and given its name by T e r r y in 1942. T e r r y ' s concept was that it was a membranous condition, coming from the tunica vasculosa lentis and the remnants of the hyaloid canal. Reese and others sub scribed to T e r r y ' s belief a n d efforts were made to incise the membrane and thus re store vision.
brane formed and some vision was retained. T h e patient presented by D r . Smith was born after six and one-half months' gesta tion. It weighed three pounds, six ounces at birth. T h e mother had had no unusual ill nesses during pregnancy. W h e n the infant was 11 weeks of age, the parents noticed that the pupil of the left eye was smaller than that of the right eye and, shortly after ward, they observed a grayish-white pupil lary reflex.
T h e first examination was made January 6, 1950, when the baby was four months of age. T h e right eye was apparently normal, with a good fundus reflex; however, the anterior chamber seemed a little shallow. T h e left eye presented a somewhat con stricted pupil, shallow anterior chamber, a clear lens, and a grayish-white membrane occupying the space immediately posterior to Observing all premature infants at T h e the lens. Johns Hopkins Hospital, D r . William C. One month later, examination of the right Owens and D r . Ella U . Owens found that eye showed a grayish fold extending from the condition which was thought to be the periphery of the retina below to the caused by an independently formed mem equator of the lens. T h e right eye at this brane was really a retinal change. T h e in time seemed to possess greater dimensions fants possessed normal optic fundi at birth. than the left; apparently, the left eye was At an average of about four weeks after retarded in development. T h e r e were a few birth, dilatation of the veins and increased posterior synechias on the temporal pupil tortuosity of the retinal arteries appeared. lary margin of the left eye. O n e month later, Shortly after this, localized or generalized there h a d been no apparent progress of the edema of the retina was found and the tissue condition in either eye. developed a grayish-green color. T h e vitreous Owens and Owens reported ( A M E R I C A N became cloudy and proliferating fibrous J O U R N A L OF O P H T H A L M O L O G Y , 32:1631 bands extended forward from the retina (Dec.) 1949) a form of therapy which is into the vitreous. T h e so-called retrolental based upon the theory that a metabolic ab membrane grew from fusion of these vitre normality in the infant itself may be the ous bands and the peripheral folds of the cause of the disturbance. swollen, elevated retina. T h e progress of the These investigators based their studies disorder was usually finished by the end of upon the knowledge that the main physio the fifth month. After the membrane was logic difference between premature and fullcomplete, all vision was lost. I n rare cases of term infants is the defective fat metabolism retrolental fibroplasia, only a partial mem- of the premature ones. Because of this de-
SOCIETY PROCEEDINGS
feet, premature infants have been fed diets which were low in fat and high in protein. Such a diet would be deficient in vitamin E. Vitamin A, which is usually administered in natural fish-liver oil, increases the vitamin-E requirement of the infants; and iron which is administered because anemia de velops in premature infants is known to destroy vitamin E. Reduction of available vitamin E affects tissue oxidation. Since it is known that the retina has a higher rate of respiration than that of almost any other tissue, it seems reasonable to assume that lack of vitamin E might lead to development of retinal dis ease. I need only to refer you to the recent report of Owens and Owens for their re sults after supplementing vitamin E in the diet of premature infants. No doubt, many therapeutic measures will be proposed as investigation into this blinding condition proceeds. Discussion. Dr. Herbert Duncan stated that he had seen three cases of retrolental fibroplasia at the Nashville General Hos pital. One case developed glaucoma and the eye had to be enucleated. Dr. Philip Lyle stated that, in making a diagnosis, toxoplasma should be considered. Morris Adair, Secretary-Treasurer.
COLLEGE O F PHYSICIANS OF PHILADELPHIA SECTION ON OPHTHALMOLOGY
October 20, 1949 DR. PERCE DELONG, chairman MENINGIOMA OF THE TUBERCULUM SELLAE DR. BENJAMIN M. CHAMBERS (by invita tion) said that patients with tumors in the region of the optic chiasm often are seen first by ophthalmologists because of disturb ances in vision. Meningiomas in this region arise from the arachnoid villi of the meninges
1447
covering the circle of sinuses surrounding the sella diaphragm. The majority of me ningiomas arise from the tuberculum sellae or the sulcus chiasmatis. Meningiomas are primarily fibroblastic in structure, are slow growing and do not invade the brain. Prog nosis after complete removal of the tumor is good. When located in the region of the tuberculum sellae, visual-field defects may be the only significant finding. These defects may be variable, depending on the exact location of the tumor, the location of the chiasm, and the size and direction of growth of the tumor. On X-ray examination, the sella turcica is usually normal; there may be erosion of the anterior clinoid processes and the tubercu lum sellae. Pneumo-encephalography may in dicate filling defects in the chiasmal cistern. In considering the differential diagnosis of tuberculum-sellae meningiomas, one must rule out tumors of the hypophyseal stalk, craniopharyngiomas, suprasellar adenomas, tumors of the pituitary gland, meningiomas of the lesser and greater wing of the sphenoid, aneurysms of the internal caro tid or of the anterior part of the circle of Willis, and optochiasmatic arachnoiditis. On August 1, 1949, a 43-year-old white salesman was admitted to the Graduate Hos pital with a history of progressive loss of vision in the left eye for five years and in the right eye for six months. There was no other complaint. The past history was es sentially negative. On admission, visual acuity was: O.D., 6/30, correctible to 6/15 ; O.S., light percep tion. Fundus examination of the right eye revealed the disc margins to be slightly blurred, the color slightly pale with the pallor more marked on the temporal side. The left disc margins were very sharp and the color very pale. Visual fields, on August 3rd, of the right eye revealed an irregular contraction involving mainly the inferior nasal quadrant. The remainder of the oph thalmic, somatic, and neurologic examina tion was normal. A Barany test suggested
NASHVILLE ACADEMY O F OPHTHALMOLOGY AND OTOLARYNGOLOGY March 20, 1950 DR. FOWLER HOLLABAUGH, RETROLENTAL
presiding
FIBROPLASIA
D R . H E N R Y CARROLL S M I T H said that, in
his experience since 1945, 5 or 6 infants, born prematurely, have developed retrolental fibroplasia. This condition, as we all know, was first described and given its name by T e r r y in 1942. T e r r y ' s concept was that it was a membranous condition, coming from the tunica vasculosa lentis and the remnants of the hyaloid canal. Reese and others sub scribed to T e r r y ' s belief a n d efforts were made to incise the membrane and thus re store vision.
brane formed and some vision was retained. T h e patient presented by D r . Smith was born after six and one-half months' gesta tion. It weighed three pounds, six ounces at birth. T h e mother had had no unusual ill nesses during pregnancy. W h e n the infant was 11 weeks of age, the parents noticed that the pupil of the left eye was smaller than that of the right eye and, shortly after ward, they observed a grayish-white pupil lary reflex.
T h e first examination was made January 6, 1950, when the baby was four months of age. T h e right eye was apparently normal, with a good fundus reflex; however, the anterior chamber seemed a little shallow. T h e left eye presented a somewhat con stricted pupil, shallow anterior chamber, a clear lens, and a grayish-white membrane occupying the space immediately posterior to Observing all premature infants at T h e the lens. Johns Hopkins Hospital, D r . William C. One month later, examination of the right Owens and D r . Ella U . Owens found that eye showed a grayish fold extending from the condition which was thought to be the periphery of the retina below to the caused by an independently formed mem equator of the lens. T h e right eye at this brane was really a retinal change. T h e in time seemed to possess greater dimensions fants possessed normal optic fundi at birth. than the left; apparently, the left eye was At an average of about four weeks after retarded in development. T h e r e were a few birth, dilatation of the veins and increased posterior synechias on the temporal pupil tortuosity of the retinal arteries appeared. lary margin of the left eye. O n e month later, Shortly after this, localized or generalized there h a d been no apparent progress of the edema of the retina was found and the tissue condition in either eye. developed a grayish-green color. T h e vitreous Owens and Owens reported ( A M E R I C A N became cloudy and proliferating fibrous J O U R N A L OF O P H T H A L M O L O G Y , 32:1631 bands extended forward from the retina (Dec.) 1949) a form of therapy which is into the vitreous. T h e so-called retrolental based upon the theory that a metabolic ab membrane grew from fusion of these vitre normality in the infant itself may be the ous bands and the peripheral folds of the cause of the disturbance. swollen, elevated retina. T h e progress of the These investigators based their studies disorder was usually finished by the end of upon the knowledge that the main physio the fifth month. After the membrane was logic difference between premature and fullcomplete, all vision was lost. I n rare cases of term infants is the defective fat metabolism retrolental fibroplasia, only a partial mem- of the premature ones. Because of this de-
SOCIETY PROCEEDINGS
feet, premature infants have been fed diets which were low in fat and high in protein. Such a diet would be deficient in vitamin E. Vitamin A, which is usually administered in natural fish-liver oil, increases the vitamin-E requirement of the infants; and iron which is administered because anemia de velops in premature infants is known to destroy vitamin E. Reduction of available vitamin E affects tissue oxidation. Since it is known that the retina has a higher rate of respiration than that of almost any other tissue, it seems reasonable to assume that lack of vitamin E might lead to development of retinal dis ease. I need only to refer you to the recent report of Owens and Owens for their re sults after supplementing vitamin E in the diet of premature infants. No doubt, many therapeutic measures will be proposed as investigation into this blinding condition proceeds. Discussion. Dr. Herbert Duncan stated that he had seen three cases of retrolental fibroplasia at the Nashville General Hos pital. One case developed glaucoma and the eye had to be enucleated. Dr. Philip Lyle stated that, in making a diagnosis, toxoplasma should be considered. Morris Adair, Secretary-Treasurer.
COLLEGE O F PHYSICIANS OF PHILADELPHIA SECTION ON OPHTHALMOLOGY
October 20, 1949 DR. PERCE DELONG, chairman MENINGIOMA OF THE TUBERCULUM SELLAE DR. BENJAMIN M. CHAMBERS (by invita tion) said that patients with tumors in the region of the optic chiasm often are seen first by ophthalmologists because of disturb ances in vision. Meningiomas in this region arise from the arachnoid villi of the meninges
1447
covering the circle of sinuses surrounding the sella diaphragm. The majority of me ningiomas arise from the tuberculum sellae or the sulcus chiasmatis. Meningiomas are primarily fibroblastic in structure, are slow growing and do not invade the brain. Prog nosis after complete removal of the tumor is good. When located in the region of the tuberculum sellae, visual-field defects may be the only significant finding. These defects may be variable, depending on the exact location of the tumor, the location of the chiasm, and the size and direction of growth of the tumor. On X-ray examination, the sella turcica is usually normal; there may be erosion of the anterior clinoid processes and the tubercu lum sellae. Pneumo-encephalography may in dicate filling defects in the chiasmal cistern. In considering the differential diagnosis of tuberculum-sellae meningiomas, one must rule out tumors of the hypophyseal stalk, craniopharyngiomas, suprasellar adenomas, tumors of the pituitary gland, meningiomas of the lesser and greater wing of the sphenoid, aneurysms of the internal caro tid or of the anterior part of the circle of Willis, and optochiasmatic arachnoiditis. On August 1, 1949, a 43-year-old white salesman was admitted to the Graduate Hos pital with a history of progressive loss of vision in the left eye for five years and in the right eye for six months. There was no other complaint. The past history was es sentially negative. On admission, visual acuity was: O.D., 6/30, correctible to 6/15 ; O.S., light percep tion. Fundus examination of the right eye revealed the disc margins to be slightly blurred, the color slightly pale with the pallor more marked on the temporal side. The left disc margins were very sharp and the color very pale. Visual fields, on August 3rd, of the right eye revealed an irregular contraction involving mainly the inferior nasal quadrant. The remainder of the oph thalmic, somatic, and neurologic examina tion was normal. A Barany test suggested