- Email: [email protected]
New England Ophthalmological Society
626
AMERICAN JOURNAL OF OPHTHALMOLOGY
spots. Papilledema was seen in two cases and a branch arterial occlusion in another. Homocystinuria with J. William Cline, M.D.
consanguinity.
Twelve patients were positive for homo cystinuria by chromatography and supervoltage electrophoresis in three generations of a family in which 27 members were tested. Two instances of consanguinity were pres ent. Four patients had spontaneous disloca tion of the lenses at age 30 years. Eight posi tive patients, less than 30 years of age, had no demonstrable abnormalities. Ten early in fant deaths and three deaths from thromboembolic phenomena occurred. Mental re tardation, malar flush, fine, fair hair, and shuffling, ducklike gait were not present in this pedigree. Recessive transmission is sug gested by the high concentration of positive patients in this family with double consan guinity. Plastic correction of sunken upper lid. G. Thomas Kiffney, Jr., M.D. Two cases were reported of supratarsal depression following orbital injury with a resultant enophthalmic appearance. These were cosmetically improved by the insertion of a silicone sponge under the skin in the de pressed area. Silicone was of advantage in that it could be shaped to match the contralateral supratarsal area and was easier to use than muscle fat and other materials. Follow-up examination one year after sur gery showed good cosmetic results with no adverse reaction to the silicone sponge. Samuel D. McPherson, Jr. N E W ENGLAND OPHTHALMOLOGICAL SOCIETY The 499th meeting of the New England Ophthalmological Society was held on Wednesday, January 17, 1968. President Earl Seale turned the meeting over to David G. Cogan, who moderated the morning and afternoon presentations. John Reed and A.
APRIL, 1968
Macmillan, Jr., opened the meeting with a bizarre complication of a radiologic proce dure. A 64-year-old man, who had recurrent squamous cell carcinoma, presented with right fifth and sixth nerve palsies. In an ef fort to determine the exact location and the possibility of intraorbital involvement, 2 cc of 2% Xylocaine, and 2 cc of 50% water-sol uble Hypaque were injected retrobulbarly into the muscle cone, with no unusual resis tance. Shortly, the patient reported decreased vision in the right eye and showed an en larged pupil. X-rays revealed the radiopaque material had entered the subdural space of the optic nerve, ran along the optic nerve, down over the planum, and along the clivus down to the foramen magnum. Within 20 minutes, the material was completely evacu ated from the region of the optic nerve; however, 40 minutes later it still was in evi dence along the clivus. The patient had rather severe mid-brain problems; however, these cleared within an hour, and within 24 hours the patient had returned to his prior condition. The case beautifully documented the hazards of a routine retrobulbar injec tion. Shirley Wray and James D. C. Gowans presented an elderly woman patient with giant cell arteritis with the initial symptom of polymyalgia rheumatica. W. J. Collis pre sented an elderly woman with occult tem poral arteritis, discovered at the time of pro posed cataract surgery. Giant cell arteritis was then discussed by the guest of honor, S. P. Meadows, from Queens Square, Lon don. He emphasized the systemic and nonocular manifestations of the disease, as well as the critical and sometimes life-saving neces sity of treatment of this disorder. Wadi A. Bardawil, of St. Margaret's Hospital, Dor chester, Massachusetts, discussed the general pathology, emphasizing the biopsy specimens from various organs in the body of a patient with giant cell arteritis. Simmons Lessel presented an illustrative case of ocular myopathy. A 48-year-old woman first evidenced an exotropia at age 33
VOL. 65, NO. 4
627
MEETINGS, CONFERENCES, SYMPOSIA
years; at age 48 years, the ocular myopathy had progressed until the eyes were immobile
W unm {feis WAS QtmL E U I M mcroscopy of this case by Dr. Kuwabara showed a bizarre mitochondrial appearance. The mitochondria, in cross-section, appeared as a circularly plowed field. There was also an increase in the number of mitochondria. A case of congenital ocular motor apraxia was presented by William Collis and dis cussed by David G. Cogan. Toichiro Kuwabara presented the struc ture and ultrastructure of the optic nerve. His surprising findings included the fact that a single Schwann cell provides the myelin wrappings of several optic nerve fibers. At the termination of a Schwann cell's myelin wrappings, prior to the subse quent ones, a small point exists on an optic nerve fiber where no myelin is present. It is Kuwabara's contention that these infrequent points represent the occasional "unmyelinated" nerve fiber found by other investiga tors. Astrocytes are identified in the optic nerve by their cytoplasmic activity under the electron microscope. David G. Cogan and Robert Efron pre sented demonstrations and discussion of vi sual agnosia. Cogan considered most of the profound visual agnosia patients as having bilateral parietal involvement. Cogan showed a movie of a patient with spatial agnosia (space blindness). Robert Efron presented a 24-year-old man who had suffered a massive overdose of carbon monoxide. After the ac cident, the patient was reported as totally blind for a period of several weeks. Vision then returned, but with striking peculiarities. The patient could not name any object, al though his vision was at least 20/100. The
patient could name the objects, however, when they were placed in his hand, and
was use
IB.
could also use his auditory sense to identify objects. He could not tell the difference, in a picture, between a man and a woman. In deed, he could not even identify himself in a mirror. There was a mild constriction of his peripheral visual field; however, this was in adequate to account for his perceptual diffi culties. Movement of an object was neces sary to initiate fixation. The patient was un able to identify objects on the basis of their shape. He was able to identify their color, size, and darkness. When the shape of ob jects was varied by a ratio of 8.7 to 1, they still appeared identical to the patient, even though the area of the two guards was iden tical. Cogan reported a patient with severe visual agnosia who is now completing her Ph.D. degree. The guest of honor, S. P. Meadows, re ported unusual modes of presentation of pi tuitary adenomas, stressing the unlikely field changes which were occasionally found. D. G. Cogan concluded the meeting with a film of a patient with periodic alternating nystagmus. The nystagmus usually appears with cerebellar disease, but is not specific in any way to the pathology regarding that en tity. The patient presented had this condition congenitally; however, patients have been seen who had this as a result of pinealoma and other neoplastic processes. The interval between nystagmus is approximately 20 sec onds ; the nystagmus beats for approximately one to two minutes, reversing direction in each cycle. Robert D. Reinecke, M.D. Recording Secretary
AMERICAN JOURNAL OF OPHTHALMOLOGY
spots. Papilledema was seen in two cases and a branch arterial occlusion in another. Homocystinuria with J. William Cline, M.D.
consanguinity.
Twelve patients were positive for homo cystinuria by chromatography and supervoltage electrophoresis in three generations of a family in which 27 members were tested. Two instances of consanguinity were pres ent. Four patients had spontaneous disloca tion of the lenses at age 30 years. Eight posi tive patients, less than 30 years of age, had no demonstrable abnormalities. Ten early in fant deaths and three deaths from thromboembolic phenomena occurred. Mental re tardation, malar flush, fine, fair hair, and shuffling, ducklike gait were not present in this pedigree. Recessive transmission is sug gested by the high concentration of positive patients in this family with double consan guinity. Plastic correction of sunken upper lid. G. Thomas Kiffney, Jr., M.D. Two cases were reported of supratarsal depression following orbital injury with a resultant enophthalmic appearance. These were cosmetically improved by the insertion of a silicone sponge under the skin in the de pressed area. Silicone was of advantage in that it could be shaped to match the contralateral supratarsal area and was easier to use than muscle fat and other materials. Follow-up examination one year after sur gery showed good cosmetic results with no adverse reaction to the silicone sponge. Samuel D. McPherson, Jr. N E W ENGLAND OPHTHALMOLOGICAL SOCIETY The 499th meeting of the New England Ophthalmological Society was held on Wednesday, January 17, 1968. President Earl Seale turned the meeting over to David G. Cogan, who moderated the morning and afternoon presentations. John Reed and A.
APRIL, 1968
Macmillan, Jr., opened the meeting with a bizarre complication of a radiologic proce dure. A 64-year-old man, who had recurrent squamous cell carcinoma, presented with right fifth and sixth nerve palsies. In an ef fort to determine the exact location and the possibility of intraorbital involvement, 2 cc of 2% Xylocaine, and 2 cc of 50% water-sol uble Hypaque were injected retrobulbarly into the muscle cone, with no unusual resis tance. Shortly, the patient reported decreased vision in the right eye and showed an en larged pupil. X-rays revealed the radiopaque material had entered the subdural space of the optic nerve, ran along the optic nerve, down over the planum, and along the clivus down to the foramen magnum. Within 20 minutes, the material was completely evacu ated from the region of the optic nerve; however, 40 minutes later it still was in evi dence along the clivus. The patient had rather severe mid-brain problems; however, these cleared within an hour, and within 24 hours the patient had returned to his prior condition. The case beautifully documented the hazards of a routine retrobulbar injec tion. Shirley Wray and James D. C. Gowans presented an elderly woman patient with giant cell arteritis with the initial symptom of polymyalgia rheumatica. W. J. Collis pre sented an elderly woman with occult tem poral arteritis, discovered at the time of pro posed cataract surgery. Giant cell arteritis was then discussed by the guest of honor, S. P. Meadows, from Queens Square, Lon don. He emphasized the systemic and nonocular manifestations of the disease, as well as the critical and sometimes life-saving neces sity of treatment of this disorder. Wadi A. Bardawil, of St. Margaret's Hospital, Dor chester, Massachusetts, discussed the general pathology, emphasizing the biopsy specimens from various organs in the body of a patient with giant cell arteritis. Simmons Lessel presented an illustrative case of ocular myopathy. A 48-year-old woman first evidenced an exotropia at age 33
VOL. 65, NO. 4
627
MEETINGS, CONFERENCES, SYMPOSIA
years; at age 48 years, the ocular myopathy had progressed until the eyes were immobile
W unm {feis WAS QtmL E U I M mcroscopy of this case by Dr. Kuwabara showed a bizarre mitochondrial appearance. The mitochondria, in cross-section, appeared as a circularly plowed field. There was also an increase in the number of mitochondria. A case of congenital ocular motor apraxia was presented by William Collis and dis cussed by David G. Cogan. Toichiro Kuwabara presented the struc ture and ultrastructure of the optic nerve. His surprising findings included the fact that a single Schwann cell provides the myelin wrappings of several optic nerve fibers. At the termination of a Schwann cell's myelin wrappings, prior to the subse quent ones, a small point exists on an optic nerve fiber where no myelin is present. It is Kuwabara's contention that these infrequent points represent the occasional "unmyelinated" nerve fiber found by other investiga tors. Astrocytes are identified in the optic nerve by their cytoplasmic activity under the electron microscope. David G. Cogan and Robert Efron pre sented demonstrations and discussion of vi sual agnosia. Cogan considered most of the profound visual agnosia patients as having bilateral parietal involvement. Cogan showed a movie of a patient with spatial agnosia (space blindness). Robert Efron presented a 24-year-old man who had suffered a massive overdose of carbon monoxide. After the ac cident, the patient was reported as totally blind for a period of several weeks. Vision then returned, but with striking peculiarities. The patient could not name any object, al though his vision was at least 20/100. The
patient could name the objects, however, when they were placed in his hand, and
was use
IB.
could also use his auditory sense to identify objects. He could not tell the difference, in a picture, between a man and a woman. In deed, he could not even identify himself in a mirror. There was a mild constriction of his peripheral visual field; however, this was in adequate to account for his perceptual diffi culties. Movement of an object was neces sary to initiate fixation. The patient was un able to identify objects on the basis of their shape. He was able to identify their color, size, and darkness. When the shape of ob jects was varied by a ratio of 8.7 to 1, they still appeared identical to the patient, even though the area of the two guards was iden tical. Cogan reported a patient with severe visual agnosia who is now completing her Ph.D. degree. The guest of honor, S. P. Meadows, re ported unusual modes of presentation of pi tuitary adenomas, stressing the unlikely field changes which were occasionally found. D. G. Cogan concluded the meeting with a film of a patient with periodic alternating nystagmus. The nystagmus usually appears with cerebellar disease, but is not specific in any way to the pathology regarding that en tity. The patient presented had this condition congenitally; however, patients have been seen who had this as a result of pinealoma and other neoplastic processes. The interval between nystagmus is approximately 20 sec onds ; the nystagmus beats for approximately one to two minutes, reversing direction in each cycle. Robert D. Reinecke, M.D. Recording Secretary