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Ocular Pharmacology and Therapeutics: Problems of Medical Management
500
BOOK REVIEWS
treatment is the improvement of vision by lessening the excursion and rapidity of the nystagmic movements, particularly impor tant for distance vision. The means at our disposal are: 1. Optical (a) Correction of refractive errors by lenses, (b) tinted lenses or con tact lenses for albinos or aniridia and (c) the use of prisms. Prisms may be used for two purposes: (1) to induce forced con vergence by means of equal prism base out before each eye (some cases respond, as if a check-rein has been tightened on the nys tagmic movements) ; (2) prism base in same direction before each eye to rotate the eyes together to right or left to take advan tage of a neutral zone of lesser movement present in some cases. These prisms of equal strength base right or left have the effect of moving the neutral zone to eyes front, thus relieving the head turning pres ent in these cases. The strength of prisms for practical purposes is limited to eight prism diopters. 2. Medical treatment is rarely indicated although sedatives and tranquilizers have been tried with the idea of slowing down hyperactivity. Muscle stimulants have been used in those cases wherein muscle weak ness is thought to be a factor. 3. Pleoptics and orthoptics may be used but no results are given to show benefits to be gained. 4. Surgical treatment, (a) Nystagmic excursions may be lessened by setting op posing muscle attachments behind the equa tor or rarely by detaching the muscles per manently from the globe and suturing them to the orbital periosteum; (b) the eyes may be rotated permanently to the right or left by resection-recession of the muscles of each eye in order to place the neutral zone of least nystagmus into the eyes front posi tion (this procedure is indicated when the neutral zone is far to one side) ; (c) the latter procedure may be used also to rotate the eyes in the direction of the rapid com ponent of biphasic nystagmus (in effect, an
attempt is made to balance the slow and quick components by weakening the basic slow component and strengthening the cor rective quick component) ; (d) in many cases the surgical intervention may need to be planned to correct a combined strabismus and nystagmus. For one who reads Spanish this will be a valuable contribution to his understand ing of the mechanism and treatment of ocu lar nystagmus. An extensive bibliography is appended. J. Wesley McKinney. ANESTHESIA
IN
CLINICAL
OPHTHAL
Deryck Duncalf, M.D., and David H. Rhodes, Jr., M.D. Baltimore, Williams & Wilkins Company, 1963. 168 pages. Price: $8.50. Dr. Duncalf and Dr. Rhodes have done a fine job in preparing this up-to-date text on anesthesia in ophthalmology. Note worthy are the sections on the effect of an esthesia on intraocular pressure and on the oculocardiac reflex. Of particular interest to clinical ophthalmologists is the discussion of what to do for such anesthetic complica tions as cardiac arrest (closed cardiac mas sage). Especially helpful, too, are the ex cellent illustrations on the techniques of in jection of anesthetics. Thomas H. F. Chalkley. MOLOGY.
OCULAR TICS:
PHARMACOLOGY AND
THERAPEU
PROBLEMS OF MEDICAL MANAGE
MENT. Edited by Samuel J. Kimura, M.D., and Ernest K. Goodner, M.D. Philadelphia, F. A. Davis Company, 1963. 276 pages, index, 5 illustrations, cloth binding. Price: $8.00. Major advances in pharmacology and therapeutics have provided the ophthalmolo gist with new methods for clinical manage ment of his patients. To review some of these advances carefully, a postgraduate course was undertaken at the University of
BOOK REVIEWS California School of Medicine in San Fran cisco. Four therapeutic problems were given detailed consideration: uveitis, oph thalmic infections, diabetes and the use of antimetabolites in viral infections. The lec tures and discussions of this recent course on therapeutic advances were taped. The tapes were carefully edited and are now available in a small volume. Each section is well marked with headings which make it easy for one to refer to a specific subject, if he desires a quick reference. Although there were many contributors, the style is rather consistent throughout due to the excellent editing. The presenta tions are not only by ophthalmologists but also include metabolic experts (Dr. Forsham), antibiotic specialists (Dr. Brainerd), proficient medical physicists (Dr. John H. Lawrence) and Dr. Jawetz, pro fessor of microbiology, Dr. Reigelman, pro fessor of pharmacy at California and Dr. Arnold Welch, professor of pharmacology, Yale University School of Medicine. The subject matter is handled briefly and succinctly. Not all of the accounts are followed by detailed references but each of them is quite practical. The discussions point out the unknown areas and do not hesitate to demonstrate where our knowl edge is limited. It is quite apparent that there are some diseases in which we are un able to influence the course with any known therapy. As in all brief texts, there are some omissions, even in the subjects which are covered.
501
In the discussion of intraocular infec tions, the pros and cons of prophylactic therapy are touched upon but not com pletely clarified. It is obvious that the defin itive answer on this subject is not availa ble. Most of the conclusions were drawn on the basis of experience obtained in other regions of the body. Many of the current antibiotics are not included. There is very little mention of the newer penicillins such as Methicillin, Oxacillin, and their possible use in intra ocular infections. There is no mention of the role of Vancomycin or Kanamycin for the control of intraocular infections. It is quite enjoyable reading the discus sion of the management of viral diseases and the banter and repartee that follows. The first fourth of the book deals in de tail with specific and nonspecific manage ment of uveitis. Almost all forms of infec tious conjunctivitis and keratitis are han dled in the second section. The third section deals with diabetes. It does not simply point out our inability to control the ocular vas cular involvement associated with diabetes mellitus but discusses in detail the possible etiologic mechanisms and the potential in fluence of hypophyseal or hypothalamic area disturbance on the course of retinopathy, as well as other current therapeutic approaches. All are challenged, some de fended.
Irving H. Leopold.
BOOK REVIEWS
treatment is the improvement of vision by lessening the excursion and rapidity of the nystagmic movements, particularly impor tant for distance vision. The means at our disposal are: 1. Optical (a) Correction of refractive errors by lenses, (b) tinted lenses or con tact lenses for albinos or aniridia and (c) the use of prisms. Prisms may be used for two purposes: (1) to induce forced con vergence by means of equal prism base out before each eye (some cases respond, as if a check-rein has been tightened on the nys tagmic movements) ; (2) prism base in same direction before each eye to rotate the eyes together to right or left to take advan tage of a neutral zone of lesser movement present in some cases. These prisms of equal strength base right or left have the effect of moving the neutral zone to eyes front, thus relieving the head turning pres ent in these cases. The strength of prisms for practical purposes is limited to eight prism diopters. 2. Medical treatment is rarely indicated although sedatives and tranquilizers have been tried with the idea of slowing down hyperactivity. Muscle stimulants have been used in those cases wherein muscle weak ness is thought to be a factor. 3. Pleoptics and orthoptics may be used but no results are given to show benefits to be gained. 4. Surgical treatment, (a) Nystagmic excursions may be lessened by setting op posing muscle attachments behind the equa tor or rarely by detaching the muscles per manently from the globe and suturing them to the orbital periosteum; (b) the eyes may be rotated permanently to the right or left by resection-recession of the muscles of each eye in order to place the neutral zone of least nystagmus into the eyes front posi tion (this procedure is indicated when the neutral zone is far to one side) ; (c) the latter procedure may be used also to rotate the eyes in the direction of the rapid com ponent of biphasic nystagmus (in effect, an
attempt is made to balance the slow and quick components by weakening the basic slow component and strengthening the cor rective quick component) ; (d) in many cases the surgical intervention may need to be planned to correct a combined strabismus and nystagmus. For one who reads Spanish this will be a valuable contribution to his understand ing of the mechanism and treatment of ocu lar nystagmus. An extensive bibliography is appended. J. Wesley McKinney. ANESTHESIA
IN
CLINICAL
OPHTHAL
Deryck Duncalf, M.D., and David H. Rhodes, Jr., M.D. Baltimore, Williams & Wilkins Company, 1963. 168 pages. Price: $8.50. Dr. Duncalf and Dr. Rhodes have done a fine job in preparing this up-to-date text on anesthesia in ophthalmology. Note worthy are the sections on the effect of an esthesia on intraocular pressure and on the oculocardiac reflex. Of particular interest to clinical ophthalmologists is the discussion of what to do for such anesthetic complica tions as cardiac arrest (closed cardiac mas sage). Especially helpful, too, are the ex cellent illustrations on the techniques of in jection of anesthetics. Thomas H. F. Chalkley. MOLOGY.
OCULAR TICS:
PHARMACOLOGY AND
THERAPEU
PROBLEMS OF MEDICAL MANAGE
MENT. Edited by Samuel J. Kimura, M.D., and Ernest K. Goodner, M.D. Philadelphia, F. A. Davis Company, 1963. 276 pages, index, 5 illustrations, cloth binding. Price: $8.00. Major advances in pharmacology and therapeutics have provided the ophthalmolo gist with new methods for clinical manage ment of his patients. To review some of these advances carefully, a postgraduate course was undertaken at the University of
BOOK REVIEWS California School of Medicine in San Fran cisco. Four therapeutic problems were given detailed consideration: uveitis, oph thalmic infections, diabetes and the use of antimetabolites in viral infections. The lec tures and discussions of this recent course on therapeutic advances were taped. The tapes were carefully edited and are now available in a small volume. Each section is well marked with headings which make it easy for one to refer to a specific subject, if he desires a quick reference. Although there were many contributors, the style is rather consistent throughout due to the excellent editing. The presenta tions are not only by ophthalmologists but also include metabolic experts (Dr. Forsham), antibiotic specialists (Dr. Brainerd), proficient medical physicists (Dr. John H. Lawrence) and Dr. Jawetz, pro fessor of microbiology, Dr. Reigelman, pro fessor of pharmacy at California and Dr. Arnold Welch, professor of pharmacology, Yale University School of Medicine. The subject matter is handled briefly and succinctly. Not all of the accounts are followed by detailed references but each of them is quite practical. The discussions point out the unknown areas and do not hesitate to demonstrate where our knowl edge is limited. It is quite apparent that there are some diseases in which we are un able to influence the course with any known therapy. As in all brief texts, there are some omissions, even in the subjects which are covered.
501
In the discussion of intraocular infec tions, the pros and cons of prophylactic therapy are touched upon but not com pletely clarified. It is obvious that the defin itive answer on this subject is not availa ble. Most of the conclusions were drawn on the basis of experience obtained in other regions of the body. Many of the current antibiotics are not included. There is very little mention of the newer penicillins such as Methicillin, Oxacillin, and their possible use in intra ocular infections. There is no mention of the role of Vancomycin or Kanamycin for the control of intraocular infections. It is quite enjoyable reading the discus sion of the management of viral diseases and the banter and repartee that follows. The first fourth of the book deals in de tail with specific and nonspecific manage ment of uveitis. Almost all forms of infec tious conjunctivitis and keratitis are han dled in the second section. The third section deals with diabetes. It does not simply point out our inability to control the ocular vas cular involvement associated with diabetes mellitus but discusses in detail the possible etiologic mechanisms and the potential in fluence of hypophyseal or hypothalamic area disturbance on the course of retinopathy, as well as other current therapeutic approaches. All are challenged, some de fended.
Irving H. Leopold.