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Proceedings of the New England Ophthalmological Society
VOL. 69, NO. 4
MEETINGS, CONFERENCES, SYMPOSIA
content of undergraduate teaching should proceed. The second portion of the presenta tion was devoted to a discussion of the var ious électives offered in ophthalmology at the different medical schools in the United States. It was apparent that these teachers were dedicated to teaching and employed a range of audiovisual devices, including slides, film strips, exhibits, and computers. It seems evident that with this meeting the AUPO has entered maturity and will play a significant role in undergraduate and gradu ate education. In addition to the sharing of ideas and the opportunities to observe teach ing methods at other institutions, it provides for exchange of audio-visual material and a strengthening of the teaching of ophthalmol ogy. The next meeting will be held January 6-9, 1971, at the Camelback Inn, Scottsdale, Arizona. Frank W. Newell PROCEEDINGS O F T H E N E W ENGLAND OPHTHALMOLOGICAL SOCIETY The 510th meeting of the NEOS was held December 17, 1969, at Boston, Massachu setts. The morning clinical session was chaired by Dr. C. H. Dohlman. Dr. J. M. Caroll found that of the dry eye diseases, keratitis sicca is the most common and re sponds well to conservative medical manage ment. He found scierai lenses helpful in the management of Stevens-Johnson syndrome, but found mucous membrane grafts and other surgery to be contraindicated in ocular pemphigus. Dr. David Miller found that corneal con tact lenses remain the treatment of choice for keratoconus. Once the corneal deformity be comes so great that the corneal lenses will not remain in place, sceral lenses are tried. Scierai lenses are considered a success if the patient's wearing time is four hours in, out for one hour, and in another four hours. Eighty percent of their fitting trials have
689
been successful. If the fitting is unsuccess ful, keratoplasty is indicated. The success rate of keratoplasty is 90%. Thinning of the corenea is no longer their criteria for the date of the keratoplasty, but rather the date is set by the failure of the contact lenses. Dr. Boruchoff documented cases of con genital familial recurrent erosions which scarred to the extend that keratoplasty was indicated. Successful keratoplasty is interest ing since the patient must utilize his own ep ithelium. Doctor Kuwabara believes that the primary pathology in recurrent erosion is a deficiency of the epithelial cell to secrete a good basement membrane which has good adhesive qualities. Doctor Greyson pointed out the difficulty of a differential diagnosis between congenital familial recurrent ero sion and Maurice-Buckler corneal dystro phy. M-B dystrophy is known to do well with keratoplasty. Doctor Richards outlined the management steps in bullous keratopathy, the final step being a penetrating kerato plasty. The success of conjunctival flaps for indolent corneal ulcers was documented fur ther, this time by Doctor Wiedman. A case of photocoagulation keratopathy which took several months to resolve was re ported by Dr. Ross Fisler. The etiology seems to be either an aqueous overheating, fostered by Doctor Fisler, or a direct corneal light effect after some corneal edema; the latter championed by Doctor Liebowitz. A recurrent herpes keratitis case proved disastrous when steroids were used without antibacterial or anti-viral coverage. Doctor Langston believes sterodis to be appropriate in selected cases of this disease, but the po tential viral and bacterial complications must be guarded against. Hydrophilic contact lenses were tried on several diseases by Dr. P. Rosenthal. They made bullous keratopathy patients comfort able but did not change the bullae. Two pa tients with chronic corneal ulcers showed good healing with the lenses. One StevensJohnson patient had immediate improvement with the lenses.
690
AMERICAN JOURNAL OF OPHTHALMOLOGY
The afternoon session at the Museum of Science was also chaired by Doctor Dohlman. Dr. D. Miller found that the majority of aphakic patients have a cornea which shows greater than 3 % thickening. Doctor Lemp and associates have found the conjunctival mucous to be the cornea's natural wetting agent. The mucous is produced prin cipally from the conjunctival goblet cells. The authors developed an experimental model that compared salt solution, a protein solution, Meibomian gland secretions, and conjunctival mucous. Only the mucous showed complete wetting of the model. They conclude that mucous acts as a surfactant and detergent and is located as an absorbed layer on the cornea. Dr. H. Leibowitz and Dr. J. Elliott pre sented their clinical trails of Imuran in keratoplasties. Carefully selected patients who had previously unsuccessful grafts, and now had heavily vascularized corneas and a poor prognosis for conventional keratoplasty, were used. Their white blood counts were followed and when the leukopenia reached 4,000, the Imuran was stopped until the white count increased. The keratoplasties had a 50% success rate. Dr. A. Boruchoff objected to the study on the grounds that he believes the immune reaction to be a rare cause of failure in corneal grafting. He at tributes most failures, even in vascularized corneas, to inadequate surgical technique. Dr. H. H. Slansky and associates illus trated the effectiveness of EDTA in pre venting corneal perforations in experimental corneal ulcers in rabbits. They found a sig nificant decrease of corneal perforations in the treated, as compared to the control rab
APRIL, 1970
bits. The success of EDTA is attributed to its collagenase inhibitory effect. Doctor Dohlman and associates found artificial cor neal epithelium (contact lenses cemented di rectly to Bowman's membrane) to be effec tive in preventing extensions of corneal ul cérations. He showed several illustrative cases to prove this point and explained the good results by noting that the contact lenses prevented the collagenase from contacting the corneal stroma. He emphasized that while stromal ulcération does not progress behind the contact lenses, healing does not occur either. Doctor Webster presented their work on corneal prostheses. Although the first pros thesis was placed 115 years ago, only re cently have definitive clinical successes been reported. They have found the prognosis for corneal prostheses (which is combined with a corneal transplant) to be good in trauma, keratoconus, corneal dystrophies and corneal edema. Poor results have been found in al kali burns, Stevens-Johnson syndromes, rosacea keratitis, pemphigus and heat injuries. Dr. Merrill Greyson of the University of Indiana School of Medicine was the guest speaker. He comprehensively covered the dermatologie and collagen diseases which have corneal problems as part of their mani festations. The frequency of such associa tions commits all ophthalmologists to have a working knowledge of dermatology. Dr. I. W. Abrahams of Meriden, Con necticut, discussed the ophthalmic public heelth problems of Afghanistan in the eve ning session. Robert D. Reinecke Recording Secretary
MEETINGS, CONFERENCES, SYMPOSIA
content of undergraduate teaching should proceed. The second portion of the presenta tion was devoted to a discussion of the var ious électives offered in ophthalmology at the different medical schools in the United States. It was apparent that these teachers were dedicated to teaching and employed a range of audiovisual devices, including slides, film strips, exhibits, and computers. It seems evident that with this meeting the AUPO has entered maturity and will play a significant role in undergraduate and gradu ate education. In addition to the sharing of ideas and the opportunities to observe teach ing methods at other institutions, it provides for exchange of audio-visual material and a strengthening of the teaching of ophthalmol ogy. The next meeting will be held January 6-9, 1971, at the Camelback Inn, Scottsdale, Arizona. Frank W. Newell PROCEEDINGS O F T H E N E W ENGLAND OPHTHALMOLOGICAL SOCIETY The 510th meeting of the NEOS was held December 17, 1969, at Boston, Massachu setts. The morning clinical session was chaired by Dr. C. H. Dohlman. Dr. J. M. Caroll found that of the dry eye diseases, keratitis sicca is the most common and re sponds well to conservative medical manage ment. He found scierai lenses helpful in the management of Stevens-Johnson syndrome, but found mucous membrane grafts and other surgery to be contraindicated in ocular pemphigus. Dr. David Miller found that corneal con tact lenses remain the treatment of choice for keratoconus. Once the corneal deformity be comes so great that the corneal lenses will not remain in place, sceral lenses are tried. Scierai lenses are considered a success if the patient's wearing time is four hours in, out for one hour, and in another four hours. Eighty percent of their fitting trials have
689
been successful. If the fitting is unsuccess ful, keratoplasty is indicated. The success rate of keratoplasty is 90%. Thinning of the corenea is no longer their criteria for the date of the keratoplasty, but rather the date is set by the failure of the contact lenses. Dr. Boruchoff documented cases of con genital familial recurrent erosions which scarred to the extend that keratoplasty was indicated. Successful keratoplasty is interest ing since the patient must utilize his own ep ithelium. Doctor Kuwabara believes that the primary pathology in recurrent erosion is a deficiency of the epithelial cell to secrete a good basement membrane which has good adhesive qualities. Doctor Greyson pointed out the difficulty of a differential diagnosis between congenital familial recurrent ero sion and Maurice-Buckler corneal dystro phy. M-B dystrophy is known to do well with keratoplasty. Doctor Richards outlined the management steps in bullous keratopathy, the final step being a penetrating kerato plasty. The success of conjunctival flaps for indolent corneal ulcers was documented fur ther, this time by Doctor Wiedman. A case of photocoagulation keratopathy which took several months to resolve was re ported by Dr. Ross Fisler. The etiology seems to be either an aqueous overheating, fostered by Doctor Fisler, or a direct corneal light effect after some corneal edema; the latter championed by Doctor Liebowitz. A recurrent herpes keratitis case proved disastrous when steroids were used without antibacterial or anti-viral coverage. Doctor Langston believes sterodis to be appropriate in selected cases of this disease, but the po tential viral and bacterial complications must be guarded against. Hydrophilic contact lenses were tried on several diseases by Dr. P. Rosenthal. They made bullous keratopathy patients comfort able but did not change the bullae. Two pa tients with chronic corneal ulcers showed good healing with the lenses. One StevensJohnson patient had immediate improvement with the lenses.
690
AMERICAN JOURNAL OF OPHTHALMOLOGY
The afternoon session at the Museum of Science was also chaired by Doctor Dohlman. Dr. D. Miller found that the majority of aphakic patients have a cornea which shows greater than 3 % thickening. Doctor Lemp and associates have found the conjunctival mucous to be the cornea's natural wetting agent. The mucous is produced prin cipally from the conjunctival goblet cells. The authors developed an experimental model that compared salt solution, a protein solution, Meibomian gland secretions, and conjunctival mucous. Only the mucous showed complete wetting of the model. They conclude that mucous acts as a surfactant and detergent and is located as an absorbed layer on the cornea. Dr. H. Leibowitz and Dr. J. Elliott pre sented their clinical trails of Imuran in keratoplasties. Carefully selected patients who had previously unsuccessful grafts, and now had heavily vascularized corneas and a poor prognosis for conventional keratoplasty, were used. Their white blood counts were followed and when the leukopenia reached 4,000, the Imuran was stopped until the white count increased. The keratoplasties had a 50% success rate. Dr. A. Boruchoff objected to the study on the grounds that he believes the immune reaction to be a rare cause of failure in corneal grafting. He at tributes most failures, even in vascularized corneas, to inadequate surgical technique. Dr. H. H. Slansky and associates illus trated the effectiveness of EDTA in pre venting corneal perforations in experimental corneal ulcers in rabbits. They found a sig nificant decrease of corneal perforations in the treated, as compared to the control rab
APRIL, 1970
bits. The success of EDTA is attributed to its collagenase inhibitory effect. Doctor Dohlman and associates found artificial cor neal epithelium (contact lenses cemented di rectly to Bowman's membrane) to be effec tive in preventing extensions of corneal ul cérations. He showed several illustrative cases to prove this point and explained the good results by noting that the contact lenses prevented the collagenase from contacting the corneal stroma. He emphasized that while stromal ulcération does not progress behind the contact lenses, healing does not occur either. Doctor Webster presented their work on corneal prostheses. Although the first pros thesis was placed 115 years ago, only re cently have definitive clinical successes been reported. They have found the prognosis for corneal prostheses (which is combined with a corneal transplant) to be good in trauma, keratoconus, corneal dystrophies and corneal edema. Poor results have been found in al kali burns, Stevens-Johnson syndromes, rosacea keratitis, pemphigus and heat injuries. Dr. Merrill Greyson of the University of Indiana School of Medicine was the guest speaker. He comprehensively covered the dermatologie and collagen diseases which have corneal problems as part of their mani festations. The frequency of such associa tions commits all ophthalmologists to have a working knowledge of dermatology. Dr. I. W. Abrahams of Meriden, Con necticut, discussed the ophthalmic public heelth problems of Afghanistan in the eve ning session. Robert D. Reinecke Recording Secretary