Scientific poster presentations

SCIENTIFIC POSTER PRESENTATIONS The Scientific Poster Presentations will be available for inspection and study Monday through Thursday, Nov 5-8, 1979, adjacent to the Continuing Education exhibit in the center of the exhibit hall. On each poster, a schedule will indicate the one-hour period each day that the author will be in attendance. Poster 1

premature retraction, and late adhesions to the cornea, making subsequent removal of the flap treacherous. Although hydrophilic bandage lenses have widely replaced the conjunctival flap, in a number of situations they cannot adequately be fitted, or they prove ineffective in controlling the inflammatory process.

LASER IRIDOTOMY -IMPROVED METHODOLOGY WITH A NEW IRIDOTOMY LENS Robert K. Abraham, MD and

Charles Munnerlyn, PhD BY INVITATION

Encino, Calif Successful, full-thickness laser iridotomies become easier to accomplish at one session and have fewer side reactions and less energy delivered to the eye with the use of a convex lens inserted into the Goldmann fundus lens covered by antireflective coating. Using this lens, the diameter of the coagulated iridian spot becomes one half of the control setting, while its power density is increased fourfold. The lens also causes relatively more light divergence at the cornea. Thus, for a given size, energy, and time, there is less iritis and corneal reaction than would occur without the use of this lens, permitting a greater range of parameters within which to work. (The R. K. Abraham Iridectomy Lens is obtainable from Coherent, Palo Alto, Calif.)

Poster 2 A CONJUNCTIVAL BANDAGE James V. Aquavella, MD

The conjunctival bandage technique used in conjunction with a hydrophilic lens is a simple and effective surgical modality. It enables visualization of the corneal lesion, promotes healing, and is readily removed without adhesion.

Poster 3 NEAR VISION HALF GLASSES FOR USE WITH THE OPERATING MICROSCOPE Leonard H. Berger, MD Parkville, Md These spectacles have been designed for use with the operating room microscope. The superior border of the half glasses have been made concave in order to fit under the oculars of the operating room microscope. This allows the ophthalmic surgeon the versatility to use his or her maximum near vision for parts of the surgical procedure outside of the microscopic field. The spectacles have been designed for those surgeons who are presbyopic and find it difficult to use bifocals or single vision lenses with the operating microscope.

Herbert L. Blatt, MD and

Poster 4

Krikor Barsoumian, MD BY INVITATION

Rochester, NY Conjunctival flaps have been advocated for a variety of corneal lesions. In many instances, their use has been associated with poor visualization of the underlying cornea, perforation under the flap, early

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SIMPLE, AVAILABLE PSYCHOPHYSICAL TECHNIQUES PROVIDE EARLY DIAGNOSIS IN OPTIC NEURITIS Emilio C. Campos, MD BY INVITATION

Trieste, Italy

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127

Jay M. Enoch, PhD Gainesville, Fla

Fred Zwas, PhD Detroit

Optic neuritis patients describe image fading that is particularly evident at bright light levels. Repeated static perimetry and interferometric acuity tests in time reveal this phenomenon. The effect is dependent on adaptation level, and high adaptation levels serve as a provocative test. The latter reveals both residua of pathology and early phases of disease, often before subjective manifestations of anomalies are present.

Edward Glinski, DO Miamisburg, Ohio

The decay in sensitivity affects kinetic perimetry as well. The test may generally be used to follow patients of interest from a neuro-ophthalmologic point of view. The tests were used on clinical populations, with unequivocal results.

BOTH BY INVITATION

In order to better assess the visual potential of patients prior to keratoplasty, laser interferometry was used to determine if macular function was present. Fifty patients were tested prior to keratoplasty using laser interferometry. The laser visual acuity determination was compared with the best corrected postoperative visual acuity result. The conclusions from this study are (1) the poorer the patient's vision, the less reliable the laser visual acuity is of potential vision (however, some exceptions exist), (2) the better the patient's laser visual acuity, the more likelihood of achieving good postoperative vision, and (3) the poorer visual potential as determined by the laser interferometry does not always preclude a good postoperative result.

Poster 5 A NEW PIGGYBACK LENS DESIGN FOR CORRECTION FOR IRREGULAR ASTIGMATISM Patrick J. Caroline BY INVITATION

Donald J. Doughman, MD Minneapolis A new "piggyback" lens design for high or irregular astigmatism has been developed. A 14.5 Flexlens ™ has a central half-thickness circular portion cut from the anterior surface. An oxygen permeable hard lens is then fit into the circular groove. This lens design prevents displacement of the hard lens by action of the lids, the major reason why standard piggyback lens designs fail. Eighty percent of our patients have been successfully fit with all-day wear and vision of 20/30 or better. Fitting techniques, lens design, and case reports will be presented.

Poster 6 LASER INTERFEROMETRY ASSESSMENT OF VISUAL POTENTIAL PRIOR TO KERATOPLASTY John W. Cowden, MD

and

Poster 7 A NEW, LOW CONCENTRATION PREPARATION FOR MYDRIASIS AND CYCLOPLEGIA Alan R. Forman, MD Haddon Heights, NJ A new, low-concentration mixture of phenylephrine and tropicamide for mydriasis and cycloplegia has had excellent results in a controlled office practice study. One hundred consecutive, Caucasian, adult patients with no corneal or iris pathology were selected. Each patient received a single drop of the low-concentration tropicamidephenylephrine in one eye and one drop of tropicamide 1% and one drop of phenylephrine 10% in the fellow eye. The low concentration mixture dilated the pupil to an average of 7.4 mm; the standard drops in the contr()l eye dilated the pupil to an average of 7.6 mm. The difference in pupillary dilatation between the two eyes was clinically insignificant. With the potential for serious systemic side effects, ocular irritation, and drop retention associated with multiple drops, this new, low-concentration mixture of tropicamide and phenylephrine is now recommended for routine mydriasis and cycloplegia in adults.

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Poster 8

Poster 10

OPTICAL AIDS FOR CORRECTION OF IMPAIRED VISUAL ACUITY Olle Holm, MD, PhD Maud Holm BOTH BY INVITAJO N

Lund, Sweden

MICROCOMPUTER APPLICATIONS FOR THE CLINICAL OPHTHALMOLOGIST Bernard L. McGowan, MD Framingham, Mass

This poster describes (1 ) a middle-to-high power stereoscopic telescope system for use by people who would otherwise have to resort to CCTV systems at higher cost and (2) a low-power plus system that can be attached to most table lamps. Both systems have been tested by Labor Market Board authorities in Sweden.

An Apple II computer was programmed for use as a clinical tool in ophthalmology. Currently, eleven distinct programs compose the Ophthalmology Program Library (OPL). These are used in diagnostic and therapeutic situations and are based on equations in physiologic optics. Problems in intraocular lens power calculation, astigmatism control, and spectacle overrefraction with spherocylinder addition (among others) are discussed. To demonstrate the usability of such a system, programs concerned with postcataract extraction astigmatism are discussed in depth. Practicing ophthalmologists should find this system of clinical value.

Poster 9

Poster 11

WIDE-FIELD HIGH-INTENSITY LANTERN: AN AFFORDABLE NIGHT MOBILITY AID

EXTENDED WEAR COSMETIC AND PROSTHETIC SOFT CONTACT LENS

Optical aids for correction of impaired visual acuity tend to fall into two categories: simple "plus" systems for close-up work and telescopic systems for longer working distances.

Michael F. Marmor, MD

and Carroll Ault Ralph B. Shamlian 80TH BY INVITATION

Palo Alto, Calif Persons with retinitis pigmentosa are disabled by field loss as well as night blindness. Ordinary flashlights and hand lanterns do not work as night vision aids for these persons, because the narrow beam of available lanterns (typically 3°) is difficult to locate and follow. Light amplification devices (night-scopes) are extremely expensive and difficult to obtain, and they must be held in front of the eye to use. We have designed an inexpensive rechargable lantern that produces a bright 300 x20° field and can be comfortably carried with a shoulder strap. Evaluation of this new lantern shows that it enables retinitis pigmentosa patients to walk with relative ease at night.

Leroy G. Meshel, MD San Francisco Important unique clinical indications for extended wear gel contact lenses have been realized when they are selectively tinted. Tinted extended wear lens (TEWLs) reduce the symptoms of photophobia in aphakic persons with large or multiple colobomas or iridoplegia. Pain and photophobia are reduced when therapuetic TEWLs are worn. The chromatic abberation noted by aphakic persons is reduced. "Blacked out" TEWLs reduce diplopia caused by EOM dysfunction. We have also used these lenses successfully treating amblyopia. "Pin hole" TEWLs aid in improving visual function in patients with aniridia and traumatic astigmatism. Patients using TEWLs on "dead eyes" for cosmetics derive a psychosocial benefit from the extended wear feature of these devices.

SCIENTIFIC POSTERS Poster 12 CORNEAL EPITHELIAL HEALING AFTER PENETRATING KERATOPLASTY Roger F. Meyer, MD

and Kathryn C. Bobb BY INVITATION

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theses of loadbearing joints. The high structural strength of this ceramic, its excellent biocompatibility, and the ability to obtain a crystalline material of high refractive index solves most of the problems found in keratoprostheses. This paper describes the shortand long-term studies of aluminum oxide ceramic corneal implants and prostheses. Experimental and clinical results will be presented.

Ann Arbor, Mich Intact corneal epithelium is essential to postoperative graft transparency. Epithelial healing was studied clinically in 64 consecutive bullous keratopathy patients who underwent penetrating keratoplasty using MKstored donor corneas. Epithelium was evaluated at times of storage, surgery, and postoperative dressing changes. Average epithelial healing time was 2.7 days (range, one to 12 days). Eighteen donor corneas had intact epithelium during surgical treatment; postoperative healing time in this group averaged 1.5 days (range, one to four days). When epithelium was missing at surgery, healing time averaged 3.1 days (range, one to 12 days). Four patients experienced epithelial breakdowns after initial healing.

Poster 13 A BIO-CERAMIC CORNEAL PROSTHESIS Frank M. Polack, MD

Poster 14 SUBJECTIVE MERIDIONAL REFRACTION Lester H. Quinn, MD

and J.C. Copeland" Chester Rorie RY INVITATION

Dallas The object of this study was to find an accurate, inexpensive, and easily learned way to do a preliminary refraction. A line target with two meridians 90° apart was used. Equipment needed is plus and minus spheres and a plus 2.50 cylinder. No computer is needed to locate the axis of the patient's astigmatism. The test can be used for a preliminary refraction or a complete refraction and has the possibility to test more than one patient at a time. tDeceased

and Gunther Heimke, PhD BY INVITATION

Gainesville, Fla Replacements of opaque corneas with glass or plastic materials have been attempted for many years in cases where corneal transplants are not indicated or have repeatedly failed. For the past 20 years, methylmethacrylate has been the material of choice for corneal prostheses because of its relatively good tolerance, with the most common complication being the extrusion of the implant owing to poor fixation or melting of the corneal tissue surrounding the plastic, with subsequent ocular infection. Aluminum oxide ceramic has been tested extensively and successfully for endopros-

Poster 15 EVALUATION OF AN A-SCAN ULTRASOUND Ronald A. Schachar, MD, PhD Denison, Tex Norman S. Levy, MD, PhD Gainesville, Fla This ultrasound A-scan offers an alternative to the more expensive A-scan apparatuses for the measurement of anterior chamber and axial length of the eye. One hundred implant patients were evaluated postoperatively using this A-scan with an oscilloscope. It was found that the predicted power of the implanted intraocular lens (lOL) was within

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±l.OO diopter of the known power of the IOL. The ultrasound A-scan is available from Jedmed Instrument Company.

Poster 16 STEREOTACTIC SLIT-LAMP MICROSCOPY OF THE VITREOUS WITHOUT CONTACT LENS Kurt E. Schirmer, MD Montreal Slit-lamp microscopic examination of the fundus is possible with a Gullstrand-type microscope without a contact lens. The slit beam serves as a stereotactic guide for assessing the depth of an object within the vitreous cavity. The distance from this point to the retina can be determined during examination or vitrectomy. A high aperture laser beam is focused within the vitreous cavity on the point of target in front of the retina accurately by the slit-lamp beam, aided by the coincidence principle that relates object and image spaces. The high aperture beam coagulates the target in the vitreous in front of the retina without injury to the latter.

(2) four mirrors (minimal rotation), (3) right size for handling with fingers, (4) no handles, flanges, or forceps, and (5) useful especially for compression gonioscopy and bedside gonioscopy.

Poster 19 OPTIC NERVE CLIPPING FOR HEMOSTASIS DURING ENUCLEATION Howard Conn, MD BY INVITATION

Baltimore

I have designed an instrument for sectioning the optic nerve during enucleation that has several advantages over presently used techniques. The instrument applies a permanent tantalum clip around the optic nerve, and a built-in knife blade transects the nerve distal to the clip. In addition to providing rapid and effective hemostasis of the vessels within and surrounding the optic nerve, the device cuts only tissue that is encompassed by the clip and not extraneous structures. The instrument minimizes the rise in intraocular pressure associated with optic neurectomy. I will present my experience using this instrument in cadavers and in patients.

Poster 17 LENS IMPLANT FORCEPS Dennis Shepard, MD Santa Maria, Calif Three lens implant forceps are pictorially presented. Each is useful for implanting all styles of intraocular lenses. They are available with or without a lock or an irrigating cannula. The proper technique for holding these forceps-the "soda-straw grip," which permits lens insertion by the "dive" maneuver or "frisbee" technique-is demonstrated.

Poster 18 A NEW INSTRUMENT FOR GONIOSCOPY Walter Sussman, MD Merrick, NY A new gonioscope is presented. Its major benefits include (1) no required fluid or gel,

Poster 20 SMOOTH MUSCLE AUTOANTIBODIES IN UVEAL MELANOMA PATIENTS Larry A. Donoso, MD and Norman T. Felberg, PhD BY INVITATION

Jay L. Federman, MD Philadelphia Tumor-associated antibodies (TAA) have been reported previously in patients with uveal malignant melanoma (UMM). Twentyfour percent of normal patients have similar TAA, as do 78% of patients with metastases to the choroid. UMMs have been found to contain actin-like filaments. These filaments react with smooth-muscle antibodies (SMA) frequently found in patients who have unrelated disorders. We have found that several patients with false positive TAA to UMM cells have SMA and antiactin antibodies

SCIENTIFIC POSTERS detected by immunofluorescence and enzyme-linked immunosorbant assay, respectively. Absorption of these antibodies, using purified actin from muscle or platelets, removes this activity. Only low percentages of UMM patients have SMA ; thus, prior absorption with actin will reduce the number of false-positive controls with TAA while not interfering with the prognostic value of the antibody test.

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inflammatory reaction in the deep corneal layers centering on degenerating pieces of Descemet's membrane. The histologic findings suggested acquired autosensitivity to degenerating Descemet's membrane as a likely cause for the chronic keratitis. This study demonstrates that a granulomatous inflammatory reaction to degenerating Descemet's membrane may persist for many years in a corneal leukoma that appears free of inflammation clinically.

Poster 21 EPITHELIAL CYSTS OF THE ANTERIOR CHAMBER-TREATMENT WITH ACID INJECTIONS Darell Lumaco, MD BY INVITATIO N

Kenneth C. Swan, MD Portland, Ore Epithelial cysts of the anterior chamber may be congenital, but usually follow penetrating surgical wounds. Increased popularity of extracapsular cataract extraction through corneal incisions is resulting in a higher incidence of epithelial ingrowths along incarcerated lens capsules or exposed suture tracks. Cysts may remain small, asymptomatic, and not require treatment; however, enlargement often leads to pain and loss of vision from corneal damage and secondary glaucoma. It is our purpose to document effectiveness of chemical treatment of nine progressive cysts. Technique of aspiration, injection of trichloracetic acid, and reaspiration to collapse the cyst also will be illustrated.

Poster 22 GRANULOMATOUS INFLAMMATION TO DEGENERATING DESCEMET'S MEMBRANE Roger F. Meyer, MD J. Reimer Wolter, MD Ann Arbor, Mich We present a histopathologic study of a cornea in which dense scarring resulted from disciform keratitis during childhood, following systemic varicella infection. Fifteen years later, penetrating keratoplasty was performed. Histopathologic examination of the excised corneal button revealed granulomatous

Poster 23 DIGITAL INFRARED REFLECTANCE OF CHOROIDAL MELANOMA Samuel Packer, MD and

K. Schneider, MD RY INVITATlON

Hong-Zen Lin, MD and

M. Feldman BY IN VITATION

Manhasset, NY Melanin selectively absorbs light in the infrared (IR) range and has been the basis for using IR film for the photography of pigmented lesions. We placed an infrared sensor in the plane of a fundus camera. The signal was converted to an electronic impulse and visualized on an oscilloscope. This eliminated the photographic process, but allowed IR reflectance to be in a digital form . We could then quantitate the differences in the reflectance between pigmented lesions and control sites . We studied 14 choroidal melanoma , 28 choroidal nevi, and several metastatic tumors. An increased IR absorption was ob· served in choroidal melanoma and suspicious choroidal nevi.

Poster 24 KERATOPLASTY-NEW INSTRUMENTS FOR DONOR CORNEAS Frederick S. Brightbill, MD Brad Calkins BY INVITATION

Madison, Wis

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Three new instruments are presented: 1. The first is a new concept in the design of a block for use with hand-held corneal trephines using the endothelial punch technique for cutting donor buttons. Teflon or Delrin (acetal resin, Dupont) blocks contain four wells of varying base curves. Centering targets in the well bases have been designed for more central punching of grafts. The surgeon places the excised corneoscleral rim into each well to select the best fit.

2. A new forceps has been designed specifically for retrieving corneoscieral rims from MK media bottles. The double-pronged crossaction teeth and longer handle provide assured first attempt retrieval of the donor tissue. 3. A new "see-through" universal handle corneal trephine for use with disposable O.25-stepped blades will be introduced and the advantages over other designs demonstrated. Instrument prototypes have been developed in conjunction with the Storz Instrument Co, St Louis.

Poster 26 THE OPERATING KERATOMETERHOW TO MAKE IT WORK FOR YOU Thomas V. Cravy, MD Santa Maria, Calif Operating keratometers are becoming increasingly available and important to the ophthalmic surgeon . Several of the early workers in the field of surgical keratometry have advocated their specific techniques and precise amounts of over-correction in the keratometrically controlled wound closure. Since each surgeon represents a unique surgical variant, the broad application of general concepts has little specific application . A common sense, workable approach for the addition of operative keratometry to one's routine surgery will be presented. With this approach, each surgeon can use the operating keratometer as a monitoring and selfteaching device to improve his or her own surgical technique and reduce the incidence of undesirable astigmatism.

Poster 25 SCANNING ELECTRON MICROSCOPY OF FUCH'S ENDOTHELIAL DYSTROPHY

Poster 27

John W. Cowden, MD

CLINICAL-SPECULAR MICROSCOPIC CORRELATIONS IN CORNEAL DISEASE

and

Bruce H_ Koffler, MD

Clifford V. Harding, PhD

Michael Lemp, MD Washington , DC

BY IN VITATI ON

Detroit The endothelial surface of ten corneal buttons obtained from patients with Fuch's endothelial dystrophy was examined by scanning electron microscopy. There was great variability in size, shape, and concentration of the corneal guttata. Two distinct types of guttata were observed . The largest type had a flat broad surface with a slight central depression, while the smaller ones were more rounded. Of particular interest was the consistent lack of endothelium centrally in the patients with corneal decompensation. These corneal specimens reveal a spectrum of changes in Fuch's endothelial dystrophy that may explain the development of corneal edema and decompensation related to the loss of endothelium.

AY IN V ITATION

Over the past decade, the clinical specular microscope has become increasingly important to the corneal subspecialist. We have used this instrument to study changes in endothelial number and morphology in clinical situations not reported previously in the literature. These range from corneal structural alterations seen in cases of Descemet's membrane scrolls, and keratoconus with and without hydrops, to changes in the endothelium following graft rejection , recurrent herpes simplex infections, anterior vitreous touch syndrome, and Chandler's syndrome. For comparison , each specular photograph will be matched with a cor· responding slit-lamp photograph . Proposed mechanisms in interpreting each specular photograph will be discussed.

SCIENTIFIC POSTERS Poster 28 ULTRASTRUCTURAL MANIFESTATIONS OF PRIMARY KERATOCONUS Frank Kretzer, PhD Ralph M. Stanifer, MD

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efficient manner. This modified spatula allows one to quickly and easily change the direction from which the loops are engaged around the 360 0 of a PK wound while maintaining an unobstructed operative field . The spatula is available from Edward Weck and Company.

Charlotte Levy ALL BY INV ITATI O N

Houston The lesions in human primary keratoconus were examined by light and electron microscopy (EM). The latter involved classic fixation protocols, scanning EM, cytochemistry with ferritin-conjugated, anticollagen moieties, and cryomicrotomy. The data suggest the following: 1. In the lesion sites. basal epithelial cells

adjacent to breaks in Bowman's layer flatten and secrete products that contact anterior keratocytes whose cytoplasm contains abundant rough endoplasmic reticulum. 2. The diameter of the collagen fibrils in the stromal lamellae remain constant, although fibrillar center-to-center distance decreases.

3. Preliminary results indicate that collagen III appears around the activated keratocytes. 4. There is no change in the basement membrane under the epithelial cells, in Descemet's membrane, or in the number or cytologic architecture of endothelial cells.

Poster 29 CONTINUOUS SUTURE TIGHTENER James P. McCulley, MD Stanford , Calif Tightening and burying the knot of a 10-0 nylon continuous suture in a penetrating keratoplasty (PK) or cataract wound is difficult to accomplish without traumatizing the suture. Forceps crush the suture and are cumbersome to use. Hooks do not slide free of the suture readily and may, therefore, break it. A modified round iris spatula, made by shortening to 50 mm the end of those commercially available, allows one to pull individual loops taut, slide hooks free, and tighten adjacent loops in succession, atraumatically and in a controlled mechanically

Poster 30 WOUND STRENGTH AND VASCULARIZATION OF CORNEAL TRANSPLANTS James P. McCulley, MD and Joseph A. Eliason, MD RY INVITATION

Stanford, Calif Selection of suturing technique in a post keratoplasty (PK) procedure is often based on habit and not on the relative advantages and disadvantages of 10-0 nylon interrupted (IS) vs continuous (CS) sutures as they relate to the host cornea. These are not well defined, and controversy exists as to the characteristics of wound healing with a CS vs ISs with the knots buried. This led us to compare these two techniques in PKs in rabbits. Wound tightness and apposition with both techniques was equal at days 1, 2, and 7 as measured by blow-out pressure. Wound strength at day 14, however, was significantly greater with ISs. Also, blood vessels bridged wounds with ISs significantly easier than those sutured with a CS. These findings substantiate that PKs with ISs heal more rapidly, but also vascularize more easily. The status of the host cornea and general surgical goals should suggest the optimal suturing technique in each individual case.

Poster 31 ROSE BENGAL: USES, ABUSES, AND A NEW METHOD OF APPLICATION W. Stanley Muenzler, MD and James L. Dunagin, MD BY INVITATION

Oklahoma City

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Rose bengal is one of the most specific and, therefore, most useful dyes in external disease. It is not used as frequently as it could be, possibly because (1) it is not readily available, (2) it burns, (3) it is messy, and (4) its use is not well understood. The solution to these problems includes the description of a previously unreported rose bengal strip.

Poster 34 FILAMENTARY KERATITIS AFI'ER PENETRATING KERATOPLASTY Walter M. Rotkis, MD BY INVITATION

S. Lance Forstot, MD Denver John W. Chandler, MD Seattle

Poster 32 PEDIATRIC PHOTOGRAPHY PLATFORM R. Michael Nisbet, MD

and Michael W. Foxworth BY INVITATION

Galveston, Tex A compatible rigid support platform was designed to facilitate ocular photography of small subjects such as infants or experimental animals. The platform is versatile, because it is compatible with either the fundus camera or the photo slit lamp. (Available from Zeiss.)

Foreign body sensation and pain after corneal transplantation may be caused by epithelial filaments. In a closely followed group of patients, 12 of 49 (25%) had filaments. (Another group in a second in sitution had a similar incidence.) The time of onset was two to nine weeks after surgical treatment. Sex distribution was equal. Recipients' ages varied from 23 to 71 years. Only nine patients were symptomatic, and they had filaments originating in host cornea; the three asymptomatic patients had filaments in donor tissue. Interrupted nylon sutures were used in three, and running nylon sutures, in the others. The filaments resolved with patching, artificial tears, or bandage soft contact lenses.

Poster 35 CYTODIAGNOSIS OF OPHTHALMIC LESIONS

Poster 33 HEALING PROCESSES IN HUMAN CORNEAL ENDOTHELIUM GullapaJli N. Rao, MD

and William R. Waldron BY INVITATIO N

Rochester, NY Corneal endothelium of patients who have had cataract extraction with intraocular lens implantation and the graft endothelium of clear corneal transplants were studied using a specular microscope. The observations were made at different time intervals during the postoperative period. The observations were analyzed in terms of morphologic features as well as cell density. The observations confirmed that two mechanisms of healing exist in human corneal endothelium: one is by sliding and spreading of the remaining cells; the other, by mitotic replication.

Joel G. Sacks, MD

and G. Berry Schumann, MD Polly A. Spinnler, CT Mary Helen Leitzinger, RN AL L BY INVITATION

Cincinnati

Ophthalmic cytodiagnosis is a rapid, simple laboratory procedure in evaluating disease involving the cornea, the conjunctiva, the eyelid, and the adnexa. Cellular specimens were collected using sterile technique and consisted of direct scrapings of various ophthalmic lesions . Specimens were prepared by the Papanicolaou method, which we consider far superior to the WrightGiemsa stain for cellular detail, especially in demonstrating viral inclusion cells and dysplastic cell changes. Over the past 12 months, we have examined over 50 cellular

SCIENTIFIC POSTERS specimens from patients with inflammatory (acute, chronic, and allergic), infectious (bacterial, viral, and fungal), premalignant, malignant, and metabolic abnormalities of the eye.

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Poster 38 ENDOTHELIAL CELL DENSITY AFrER POSTERIOR CHAMBER LENS IMPLANTATION John A. Stanley, MD and Robert R. Anderson, MD

Poster 36

BY INVITATION

A CORNEAL ENDOTHELIAL PROTECTOR Ronald A. Schachar, MD, PhD Denison, Tex Protection of the corneal endothelium is of primary concern in anterior segment surgery. A uniquely designed four-pronged cannula that is placed through the cornea maintains the depth of the anterior chamber with either air or balanced salt solution. The prongs extend into the anterior chamber so that objects cannot come in contact with the corneal endothelium.

Poster 37 A NEW TECHNIQUE FOR THE REMOV AL OF CHOYCE-STYLE ANTERIOR CHAMBER LENSES THROUGH A KERATOPLASTY INCISION Edward L. Shaw, MD BY INVITATION

Phoeniz, Ariz With the increasing use of anterior chamber lenses, we are beginning to see significant complications owing not only to original faulty lens manufacture but also from the inherent design of the lens. When these complications lead to irreversible corneal edema, which is believed to result from chronic persistent problems, the lens must be removed in association with a corneal transplant. A new technique is described in which the anterior chamber lens is removed through the keratoplasty incision without the need for a separate surgical wound. By avoiding this extra step of an external incision, we believe greater safety may be attained for the immediate postoperative period.

San Francisco Steven P. Shearing, MD Las Vegas Endothelial cell loss was determined on 50 patients after extracapsular cataract extraction and posterior chamber lens implantation procedures. All procedures were done by the same surgeon and the average followup time was one year. Comparative cell density was measured on fellow eyes having other types of intraocular lenses after extracapsular surgery and on an age-matched control group of aphakic eyes. Endothelial photographs and corneal thickness were recorded on every patient, using the same integrated specular microscope and pachometer. The study reports endothelial cell density and thickness in the first group of patients receiving the Shearing lens implant.

Poster 39 LACRIMAL COMPLICATIONS IN TRACHOMA Khalid F. Tabbara, MD BY INVITATION

San Francisco Arthur A. Bobb, MD Dhahran, Saudi Arabia Trachoma, a chronic chlamydial inflammatory disease, continues to be the most frequent cause of preventable blindness in the world. Among 124 consecutive eyes with severe trachoma, 47 (38%) had evidence of canalicular obstruction (one or more canaliculus), 23 (19%) had nasolacrimal duct obstruction, 7 (6%) had dacryocystitis, 3 (3%) had fistulous tracts connecting to the lacrimal sac, and 2 (2%) had dacryocystocele. Fifteen (12%) of the eyes had a Schirmer test of less than 5 mm. Punctal occlusion

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secondary to trachomatous scarring was observed in eight (6%) cases and served a good purpose in patients with dry eyes secondary to cicatrization_ Fifteen tarsoconjunctival and three lacrimal sac biopsy specimens were obtained at the time of surgical treatment for correction of entropion or dacryocystorhinostomy. Management of the dry eye syndrome in patients with trachoma will be discussed.

Poster 40 CONTROL OF IATROGENIC ASTIGMATISM

Sixty-four aphakic transplants with a 0.5-mm larger donor button and running 10-0 nylon suture were evaluated in the first three months postoperatively. Visions with sutures in place are (1) keratoplasty and cataract, 20/ 50-; (2) keratoplasty and intraocular lens, 20/100+; (3) aphakic bullous keratopathy, 20/ 200; and (4) aphakic bullous keratopathy and soft lens, 20/80. Keratoplasty with cataract extraction patients and aphakic bullous keratopathy patients fit with soft lenses postoperatively have the earliest visual rehabilitation in aphakic corneal transplants. Larger donor buttons and soft lenses reduce the prolonged visual recovery associated with equal-size donor buttons.

Clifford Terry, MD BY INVITATION

Fullerton, Calif New techniques in cataract surgery to reduce astigmatism will be demonstrated. This will include the adjustable slip knot, the quantitative keratometer, and other surgical techniques.

Poster 43 A READILY AVAILABLE 30-GAUGE IRRIGATOR FOR ANTERIOR SEGMENT SURGERY Thomas O. Wood, MD Memphis

Poster 41 A LOW-COST MK CHAMBER FOR CORNEAL STORAGE AND VIEWING Donald E. Ward Ezra Maguen, MD BOTH BY INVITATION

Anthony B. Nesburn, MD Los Angeles An economical corneal storage and viewing chamber will be presented. The design of the chamber has been improved to provide the user with a cost-effective system for evaluation of donor corneal endothelium. Design factors will be presented. Photography of donor tissue using the chamber and currently available equipment will be included.

A 3D-gauge disposable needle is used to prepare this irrigator. The end of the needle is severed with a pair of large scissors. The needle is then bent approximately 4 mm from the end with the proximal end of a needle holder. The needle is then attached to the desired irrigating solution. This is an excellent irrigating instrument for corneal transplant work and irrigating the anterior chamber after wound closure in cataract surgery.

Poster 44 COMPUTER DIAGNOSIS FOR RETINOBLASTOMA Albert S. Leveille, MD BY INVJTATION

Karl J. Fritz, MD and

Poster 42 EARLY VISUAL REHABILITATION IN APHAKIC KERATOPLASTY Thomas O. Wood, MD Memphis

Walter M. Jay, MD BY INVI'l'ATION

Chicago

Computers have the potential to become important diagnostic aids in medicine. We have designed a computer program appli-

SCIENTIFIC POSTERS cable to differential diagnosis in ophthalmology. The computer program utilizes Bayes' rule. This rule reverses conditional probabilities allowing computation of the probability of a disease, given the signs and symptoms. Further, the program refines its diagnostic skills with a known diagnosis combined with the associated signs and symptoms. We have applied this program to aid in the differential diagnosis of leukocoria. We will describe the theory and application of this program.

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fundus camera. Advantages of the technique include ease of portability, easy maneuverability, and relative low cost (compared to a photo slit lamp). The exhibit will demonstrate the method of goniophotography and provide photographic examples. Instructional handouts will be available.

Poster 47 ARGON LASER IRIDOTOMY: TECHNIQUE IN BLACK PATIENTS Richard L. Litwin, MD Berkeley, Calif

Poster 45 THE "ON-LINE" COMPUTER IN THE GLAUCOMA LABORATORY Charles Kurtzman BY INVITATION

Houston

Kenneth T. Richardson, MD Anchorage, Alaska The Glaucoma Service and Research Laboratory (GSRL) of the Department of Ophthalmology at Baylor College of Medicine accepts patients from referring physicians for intensive diagnostic study. The data from diagnostic testing, automated medical history, and family history information is stored and processed by an "on-line" computer system. This serves as a "nerve center" of the laboratory, handling a wide variety of tasks including scheduling, communications, and reporting. The GSRL serves as a model for future health care delivery systems, especially in areas of chronic disease, by using current technologies and allied health care personnel to optimize data quality and cost-effectiveness.

Poster 46 GONIOPHOTOGRAPHY Frank L. Lazenby BY INVITATION

Michael Roth, MD Augusta, Ga The purpose of this exhibit is to help popularize the technique of goniophotography using the Koeppe lens and the Kowa

Perforating the deeply pigmented iris of a black patient requires a totally different laser technique from that advocated for eyes of white patients. In Caucasians, good results have been obtained using laser burns of long duration, with preliminary laser burns to prepare the iridotomy bed. This technique has not been effective in the eyes of black patients. In black patients, numerous small, brief, high-energy density laser burns can be used to create an iridotomy in almost every case. Avoidance of corneal edema by careful attention to detail will permit enough laser burns to be produced at any site on the iris, resulting in perforation.

Poster 48 STEREO-DISC PHOTOGRAPHY Bernard L. McGowan, MD and

David A Eister BY INVITATION

Framingham, Mass A simple system for obtaining magnified stereoscopic images of the optic disc is presented. A pair of slides are made with a fundus camera using a x2 magnifier. Viewed through 12.00 diopter cataract spectacles on a light table, they present a three-dimensional picture of the optic disc. The slide pairs are a permanent part of the patient's record, more accurate than hand drawings. Changes in the disc can be observed when subsequent stereoscopic pairs are compared. This method, intentionally not so sophisticated as others, should prove useful to a wide number of ophthalmologists by virtue of its simplicity.

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138 Poster 49

PRESSURE RELEASING CONDUIT FOR GLAUCOMA John Lawrence Norris, MD and Edward E. Schmitt, PhD RY INVITATION

San Francisco

Norman S. Levy, MD, PhD Gainesville, Fla It is frequently difficult to maintain the anterior chamber pressure during intraocular surgery by raising or lowering the level of the reservoir of fluid. A valve is described that maintains the intraocular pressure at a constant, predetermined level independent of the level of the fluid reservoir.

Drainage conduits of many types have been devised to control intractable intraocular pressure elevation without notable success. A unique silicone conduit has been used in a rabbit model to control lOP. The special features of the conduit and the method of insertion into the eye are the subject of this poster presentation.

Poster 52 GONIOPLASTY FOR ANGLE-CLOSURE GLAUCOMA Richard J. Simmons, MD Boston Richard L. Kimbrough, MD Houston

Poster 50 VALVE IMPLANTATION FORCEPS

and

Robert Ritch, MD New York

C. Davis Belcher III, MD

This forceps has been devised to facilitate insertion of the Krupin-Denver eye valve in glaucoma surgery . The tip of the instrument, when closed, consists of a cylinder, the inside diameter of which equals that of the outside of the valve tail. This provides orientation of the valve during the insertion process and does not distort the valve by compression, which were the drawbacks of the Arruga cross-action capsule forceps used previously for this procedure. The forceps is manufactured by Week Instrument Co, Research Triangle Park, NC .

A technique we call gonioplasty has been used successfully for three years in the management of primary angle-closure glaucoma and unique types of angle-closure glaucoma. Fifteen patients have been treated with this new modality and followed with repeated gonioscopy, tonometry, and, in selected cases, photography.

Poster 51 A VALVE TO CONTROL INTRAOCULAR PRESSURE DURING INTRAOCULAR SURGERY Ronald A. Schachar, MD, PhD and Steve Meyer, MD Les Schachar, MD BOTH BY INVITATION

Denison, Tex

BY INVITATION

Boston

The technique is based on the use of the argon laser to alter the peripheral configura· tion of the iris by contracture of the peripheral iris with the argon laser. A narrow anterior chamber angle is converted to a wide anterior chamber angle by retraction of the iris with the laser burn. Early iridotrabecular synechias are also broken with this technique. Selected cases treated with the new mo· dality have been subacute angle-closure glaucoma, chronic angle-closure glaucoma, and nanophthalmos with angle-closure glaucoma. Other potential uses for this technique are also being studied in a controlled clinical investigation and are briefly described. When properly applied, gonioplasty has a lasting effect and is clinically significant in preventing angle closure in selected cases.

SCIENTIFIC POSTERS Poster 53

139

Poster 55

COMPARISON OF FIVE METHODS OF CATARACT EXTRACTION IN PATIENTS WITH GLAUCOMA George L. Spaeth, MD

and

ACUTE PHASE REACTANTS (INCLUDING C REACTIVE PROTEIN) IN CRANIAL (TEMPORAL) ARTERITIS Joseph Eshaghian, MD James Goeken, MD

TharmaIingam Sivendran, MD

BOTH BY INVITATION

Iowa City

Effie Poryzees BOTH BY INVITATION

Philadelphia

Patients with severe primary open-angle glaucoma who also required cataract extraction were treated by trabeculectomy followed later by intracapsular cataract extraction (ICC E) or by ICCE combined with one of the following: trabeculectomy, iridencleisis, trabeculotomy, or partial punch sclerectomy_ This study reports the results of these procedures in 75 patients, 15 in each category. The course of intraocular pressure following surgery, the frequency of complications, and the final results in terms of control of lOP and visual acuity will be discussed. Each of the combined cataract-glaucoma procedures carried a risk of complication greater than that associated with standard ICCE in the nonglaucomatous eye. In patients with seriously uncontrolled glaucoma or advanced glaucomatous damage, a trabeculectomy, followed later by cataract extraction, is often the preferred procedure.

Poster 54 SINGLE-FRAME STEREO GONIOPHOTOGRAPHY Jacob T_ Wilensky, MD Chicago A technique for obtaining single-frame stereo photographs of the anterior chamber will be illustrated. A House-Urban beam splitter was attached to an operating microscope or slit lamp. An automated camera was then attached to the beam splitter. Representative goniophotographs taken through this system will be displayed. Most of the equipment is available from Zeiss.

The C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are acute phase reactants. The role of the ESR has extensively been studied in cranial arteritis. The CRP has received little attention in cranial arteritis. Seventeen patients with biopsy-proved cranial arteritis and 17 control patients with negative biopsy results had CRPs and ESRs. Among seven patients with cranial arteritis, six had positive CRPs before taking corticosteroids. Among ten other patients with cranial arteritis, eight had negative CRPs while taking corticosteriods. In some arteritis patients, the CRP was a better indicator of the activity of the vasculitis; in others, the ESR was the better indicator. The CRP was positive despite an ESR as low as 13 mm/hr and was negative despite an ESR as high as 87 mm/hr. Among the 17 control patients, eight had positive CRPs and nine did not. We conclude that a titered CRP is a valuable adjunct in the routine evaluation and follow-up of patients suspected of having cranial arteritis. Like the ESR, however, the CRP is a nonspecific test.

Poster 56 A "MINI-PROBE" FOR USE IN DACRYOCYSTORHINOSTOMY SURGERY Martin Bodian, MD Brooklyn, NY A flexible metal "mini-probe," 37 mm long and 0.5 mm in diameter, with rounded tips, has been devised for placement of Silastic stents during a dacryocystorhinostomy (DCR), when indicated. Thin (1 mm wide) Silastic tubing is threaded on one end of the probe. During the DCR, before closure of

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SCIENTIFIC POSTERS

anterior flaps, the probe enters a punctum and is brought out through the wound, drawing the tubing with it. The tube is removed from the probe. The other end of the tubing is then placed on the probe and is similarly brought through the opposite lacrimal punctum and canal. The ends of the tube are tied together and brought into the nose, and the nCR is completed.

lated operations will be shown. Photographs of patients with membrane formation, before and after excision, will be shown, and the use of Silastic tubing to maintain a patent ostium, demonstrated. This technique provides an excellent opportunity to document and study intranasal changes occurring after nasolacrimal drainage system surgery.

The mini-probe is simpler to handle and less traumatic than other devices used for the same purpose. Poster 59 Poster 57 CHANGE FLOW CHART FOR LACRIMAL WORKUP Albert Hornblass, MD New York Lacrimal secretion and excretion are important parts of an evaluation when patients complain of tearing. A lacrimal workup with a flow chart incorporating the following will be demonstrated: (1) Schirmer's test, (2) Jones' dye test, (3) Hornblass' saccharine taste test, (4) fluorescein test, (5) canalicular irrigation, (6) tear break-up time, and (7) dacryocystography. This flow chart will enable the practitioner to evaluate and diagnose lacrimal tearing problems quickly. Copies of this flow chart will be available.

TECHNIQUE FOR EVALUATING EFFECTIVENESS OF ANESTHETIC SOLUTIONS FOR ORBICULARIS AKINESIA John Lyman, MD BY INVITATION

Kenneth C. Swan, MD Portland, Ore Effective akinesia of eyelid and extraocular muscles is essential for safe intraocular surgery under local anesthesia. The positions of the ear of a rabbit following injections at a specific site provides a simple, objective laboratory method for evaluation of rate of onset, completeness, and duration of nerve VII blockage. The technique will be illustrated, and studies of the comparative effectiveness of several anesthetics with and without vasoconstrictors and hyaluronidase will be summarized. Some clinical applications will be presented.

Poster 58 INTRANASAL PHOTOGRAPHY FOR EV ALUATION OF NASOLACRIMAL SURGERY Malcolm N. Luxenberg, MD

and Frank L. Lazenby BY INVITATION

Augusta, Ga The fundus camera can be used to visualize the intranasal structures, the opening of dacryocystorhinostomy operative sites, and the position of Jones tubes after nasolacrimal surgery. The camera system provides excellent illumination and magnification, which permit evaluation of fine structural changes and early visualization of abnormalities that may lead to operative failure. Cases demonstrating normal nasal ostia after dacryocystorhinostomy and re-

Poster 60 LINING AN EXENTERATED ORBIT WITH PERIOSTEUM COMPARED WITH A TEMPO RALlS FLAP OPERATION David Sevel, MD, PhD BY INVITATION

New Orleans Following exenteration of the orbit, filling the orbital cavity with temporalis muscle and its overlying fascia is time consuming, results in a hollow temporal fossa and chew· ing problems, and allows for extension of the orbital malignancy. An original, relatively simple method for lining an exenterated orbit is described. Use is made of the periosteum of the forehead. The two methods are compared and contrasted in a series.

SCIENTIFIC POSTERS Poster 61

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Poster 63

MINIATURIZED INTRAOCULAR ELECTROMAGNET

CONTACT LENS FOR VITREOUS SURGERY

Yale L. Fisher, MD

Helmut Kilp, MD

and

Klaus Heimann, MD ROTH BY INVITATION

Norman Pickering

Walter H. Stern, MD San Francisco

BY INVITATION

New York

A battery-operated, miniaturized, intraocular electromagnet has been designed for manipulation and extraction of small, intraocular, magnetic foreign particles, using bimanual microscopic techniques. Designed for trans pars plana vitrectomy procedures, the probe of the magnet is 0.89 mm in diameter and 21.0 mm long. Overall dimensions of the hand-held casing are 12x2 cm. A small, finger-controlled microswitch on the casing permits activation of the magnet. The instrument is useful in manipulating small, magnetic foreign particles away from the surface of the retina when formed vitreous has already been removed by vitrectomy. Transfer of the foreign particle to forceps is accomplished in safer regions of the globe under direct visualization.

Poster 62 SCLERAL WINDOW FOR PRACTICE VITRECTOMY Timothy Holekamp, MD Columbia, Mo A scleral window for practice vitrectomy surgery in an autopsy eye has been developed. This window is inserted without sutures in less than one minute and provides a watertight seal even to high pressures. It may be placed in the cornea for realistic practice surgery or at the equator for an excellent view of pars plana incisions and closures from within the eye. The latter function may facilitate development of design improvements for vitrectomy instrumentation and technique. Optical quality is sufficient to provide high-quality photographs.

A self-adhering glass and plastic contact lens for vitreous surgery has been developed. The lens is designed in various diameters and with various prismatic strengths to allow visualization of the entire retina, including the retinal periphery. The superior optical properties of the lens, combined with the lack of need for a skilled assistant to hold the lens in place, makes it a valuable adjunct in vitreous surgery.

Poster 64 CENTRAL SEROUS RETINOPATHY AND MACULAR DEGENERATION James D. Kingham, MD Tucson, Ariz Several types of lesions cause a serous elevation of the macula. Among these are central serous choroidopathy, senile macular degeneration with serous detachment of the macula and subretinal blood and fibrous metaplasia, and Best's vitelliform foveal dystrophy. Four patients were seen with a central serous retinal detachment and a dense subretinal exudate with a fluid level that obscured choroidal fluorescein transmission. There was late fluorescein filling of the central serous detachment. There was no evidence of retinal pigment epithelial detachment and no neovascularization. In two of the four cases followed for five years, the subretinal exudate resolved, and serial photographs demonstrate the evolution of geographic atrophy of the retinal pigment epithelium. This represents an unusual form of senile macular degeneration.

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142

The pathophysiologic mechanism for these lesions is discussed.

Poster 67 AN EXPLANATION FOR THE BENEFICIAL EFFECTS OF PHOTOCOAGULATION John J. Weiter, MD

Poster 65 THE NATURAL HISTORY OF SENILE MACULAR DEGENERATION Alan S. Nakanishi, MD Stockton, Calif Gilbert W. Cleasby, MD John L. Norris, MD San Francisco and

Steve J. Eckstein BY INVITATION

Stockton, Calif Using color prints, prints of fluorescein angiograms, and prints of histopathologic sections, this poster will depict the natural history of senile macular degeneration in its different stages. The transition from nonexudative to the exudative stage will be shown.

and

Ralph Zuckerman, PhD BY INVITATfON

Boston

Oxygen concentration across the retina was determined. The significant finding was that the photoreceptors account for the majority of retinal oxygen consumption. Hence, the photoreceptors gate oxygen transport from the choroid to the inner retina and, as a consequence of autoregulation, could influence inner retinal blood flow. We offer this as an explanation for the retinal vascular vasoconstriction seen in states of photoreceptor degeneration, such as retinitis pigmentosa. Such degeneration of the photoreceptors would allow more choroidal oxygen to diffuse through the outer retina and reach the inner retina. Also, the beneficial effects of photocoagulation could possibly be secondary to destruction of the oxygenconsuming photoreceptors.

Poster 66 SURGICAL TREATMENT OF MACULAR HOLES CAUSING RETINAL DETACHMENT Harold Weiss, MD Detroit Macular holes are an uncommon ca use of retinal detachment. Trauma and high myopi a are the conditions in which macular holes most often cause significant retinal detachment. When necessary, macular holes can be treated by various combinations of diathermy, cryopexy, photocoagulation, explants, implants, slings, plombs, and vitrectomy. Over the past year, we have successfully treated three patients with macular holes causing significant retinal detachment with a small, 3-mm silicone explant and transpupillary xenon photocoagulation. This procedure is easy to perform . It requires minimal surgical manipulation and, therefore, involves minimal risk to posterior ocular structures compared with other procedures described in the literature. The three cases and the surgical procedure will be illustrated and described.

Poster 68 ADAPTOR FOR FINK-WEINSTEIN SYRINGE TO BE USED WITH IRRIGATION-ASPIRATION HANDPIECE John J. Alpar, MD Amarillo, Tex The irrigation-aspiration handpiece of the Kelman phacoemulsification machine is a well-engineered instrument. If the FinkWeinstein syringe is modified, it can be used with the handpiece. The modification consists of two adaptors. One fits the irrigation chamber of the. syringe and is supplied with a lock. The other adaptor fits the aspiration chamber intake. Two short tubes can be used instead of the long tubing. The Fink-Weinstein syringe can be. filled with filtered balanced salt solution, or the solution itself can be passed through a filter attached to the end of the syringe. A 05-. or 0.7-mm opening aspiration tip can be used to provide the proper amount of irrigation and aspiration to evacuate the cortex without danger to the

SCIENTIFIC POSTERS posterior capsule and without mechanical failures, which may occur with the larger and expensive machine.

143

J. Charles Casebeer, MD Flagstaff, Ariz

and J. Carlos Acuna R., MD Campeche, Mexico Sergio Morales J. Parral, Mexico

Poster 69 A NEW POSTERIOR CHAMBER CAPSULAR LENS IMPLANT DESIGN AND TECHNIQUE OF IMPLANTATION AFTER EXTRACAPSULAR CATARACT EXTRACTION Aziz Y. Anis, MD Lincoln, Neb This lens is a planoconvex lens with two kidney-shaped side loops. This configuration makes them compressible. This lens is meant to be implanted in the capsular bag, the loops engaging in the equator. The capsulectomy is triangular with the apex at the 6-o'clock position. After the extraction is completed, the lens, loaded in a plastic sleeve made from Steridrape, is introduced into the anterior chamber between the two preplaced sutures and passed into the capsular bag to reach the equator at the 6o'clock position. The lens edge is supported at the 12-o'clock position with an irrigating cannula, and the sleeve is withdrawn releasing the lens within the capsular bag.

J.H. Slade, MD Adelaide, Australia ALL BY INVITATION

Surgical Eye Expeditions, International (SEE) is a nonprofit, humanitarian organization designed to provide surgical eye care to patients in areas where such care is not available. SEE provides the mechanism for qualified clinical ophthalmologists to go on short-term (weekend) expeditions with a sophisticated ophthalmic surgical unit and team to screen patients rapidly for surgically correctable eye disease and perform necessary surgery on location. There are now seven SEE chapters on three continents.

Poster 71 NEW TECHNIQUE OF ANTERIOR CHAMBER LENS IMPLANTATION Frederick R. Carriker, MD M. Kathleen Carriker, MD Phoenix, Ariz

and Richard G. Carriker, MD BY INVITATION

Omaha Poster 70 SURGICAL EYE EXPEDITIONS, INTERNATIONAL William H. Crockett BY INVITATION

Harry S. Brown, MD Santa Barbara, Calif

and E.A. Archilla, MD Bogota, Colombia F.C. Morfin, MD Ensenada, Mexico BOTH BY INVITATION

A new method of anterior chamber lens implantation is presented that uses a new suture technique and a sutured plastic flap. The advantages are (1) causes less eye trauma, (2) eliminates stripping of Descemet's membrane, (3) eliminates endothelial damage, (4), allows repeated placement of lens without damage to the cornea, (5) creates an air pocket in the anterior chamber, preventing collapse of the anterior chamber, and (6) allows more accurate placement of the lens. A movie and slides will demonstrate the surgical technique. A review of 100 procedures of cataract surgery will demonstrate fewer complications with the plastic flap.

SCIENTIFIC POSTERS

144

Poster 75

Poster 72 A PNEUMATIC IRRIGATIONASPIRATION DEVICE FOR EXTRACAPSULAR CATARACT EXTRACTIONS Robert Scott Dotson, Jr, MD

HUMAN CATARACT COMPLICATA: CLINICOPATHOLOGIC CORRELATION Joseph Eshaghian, MD Nancy Rafferty, PhD

BY INVITATION

Memphis An irrigation-aspiration device has been designed and contructed for use in extracapsular cataract surgery. This machine differs from previous such instruments in that it is entirely nonelectric. It is considerably more compact and portable than comparable machines and requires only a compressed gas source for power. Low gas pressures are required for operation of the instrument, and, therefore, virtually any small compressor or gas cylinder can be used as a power source. Vacuum lines are not required , since aspiration force is generated directly from the pressure source via a miniature hydraulic device.

Poster 73 A PIGTAIL NEEDLE FOR TRANSIRIDECTOMY SUTURING OF THE BINKHORST 4-LOOP LENS Robert C. Drews, MD Clayton, Mo This needle is easily converted to a pigtail shape using a forming pliers . The technique for forming and using this suture guide are illustrated . The BIF-4 needle is available from Ethicon .

Poster 74

William Goossens ALL BY INVITATION

Iowa City Complicated cataracts of the posterior subcapsular zone may be associated with a number of systemic conditions. Cataracts from patients with corticosteroid use, retihitis pigmentosa, Turner's syndrome, and myotonic dystrophy were examined clinically and pathologically after intracapsular cataract extraction. Two types of posterior subcapsular opacities were observed: one type had multiple watery vacuoles; the other type was a more "plaque-like" or solid-appearing opacity clinically. The morphologic counterpart (by light and electron microscopic examinations) of the vacuolar opacity is liquefactive necrosis with aberrantly migrated cells growing into the cataract. In the plaque-like opacity, the lens fibers are disorganized into round globules. The clinical significance is that the vacuolar-liquefied posterior subcapsular cataract may be more easily removed by extracapsular methods than the plaque-like opacity; however, the proliferative cells in the vacuolar type are probably the source of a secondary membrane, which may require discission.

Poster 76 INEXPENSIVE, BALANCED IRRIGATION-ASPIRATION SYSTEM FOR EXTRACAPSULAR CATARACT SURGERY

SEVENTH BIENNIAL CATARACT SURGICAL AND IOL CONGRESS

Austin I. Fink, MD

Jared M. Emery, MD Houston

William B. Blesser, PhD

The poster describes the Seventh Biennial Cataract Surgical and IOL Congress sponsored by the Cullen Eye Institute, Baylor College of Medicine, Houston. This meeting is to be held in Houston, Sept 27 through Oct 1, 1980. There were approximately 200 scientific papers presented at the last Congress.

and

David M. Hay, MS BOTH BY INVITATION

Brooklyn, NY

Decreased morbidity using aspiration techniques for cataracts in children and in adults has fostered the development of a number of instruments that attempt to simplify this operative procedure. Extracapsular cataract intraocular lens surgery has

SCIENTIFIC POSTERS also provided an impetus for similar instrument development, because instruments currently available may be costly, offer a technique that is difficult to learn, and may often induce severe complications. We have developed an irrigation-aspiration system which is inexpensive, simple to · operate, and uses an overload valve to insure pressure control. Preliminary experiences with this system will be described.

145

with a fully developed statistical package allowing a wide range of statistical analysis to be performed on the data. Mechanisms for checking and insuring data accuracy have been added to the office system.

Poster 79 INTRAOCULAR CUTTING BOARD David J. McIntyre, MD Bellevue, Wash

Poster 77 FIELD MAGNIFIER, SMALL MICROSCOPIC CLIP-ON Jerre Minor Freeman, MD Memphis A simple clip-on bifocal-like lens has been designed to attach to the underside of each operating microscope ocular. This allows the surgeon to have the broader field around the eye in sharp focus when looking outside the microscope oculars. Its size is small, and its out-of-the-way position obviates the need for sterilization after each use.

A coaxial instrument has been devised that provides a resilient surface against which a discission knife may be used for incising iris or tough postinflammatory membranes. The coaxial feature provides simultaneous gravity-fed infusion. The intraocular cutting board provides an alternative to various types of scissors.

Poster 80 PREOPERATIVE ULTRASOUND MEASUREMENT OF ANTERIOR CHAMBER DIAMETER

Poster 78 COMPUTERIZATION OF IOL RESEARCH DATA Manus C. Kraff, MD and

Donald R. Sanders, MD BY INVITATION

Howard L. Lieberman, MD Chicago The method used presently for collecting research data in our office practice will be described. Over 50 separate variables are being collected on all patients, including patient identification information, visual results and complication data, and preoperative and postoperative ultrasonography, keratometry, and specular microscopy. Information is transcribed from patient records to data sheets and is typed directly into an office teletype-43 terminal connected by acoustic couplers to a major university computer. The system is equipped with an editing mode to allow rapid updating and addition. The system had been made compatible

Lyle Moses, MD Beachwood, Ohio Incorrectly sized anterior chamber (A C) pseudophakos may cause complications. "White-to-white" and the Kelman "dipstick" are indirect measurements and potentially inaccurate. In the method presented here, a cylindric cup with deflecting prism is placed over the cornea. Ultrasound beam is deflected across the AC. Digital readout of the actual AC diameter is made to within 0.01 mm, a Polaroid photograph of the oscilloscope screen is taken and direct measurement of photograph corresponds to readout. . Preoperative· gonioscopic examination rules out angle pathology. The intraocular lens length should be verified before insertion . At surgery, and postoperatively, gonioscopic verification of proper placement of feet should be done. Results include no scleral pressure or erosion, global tenderness, corneoscleral distortion (high astigmatism), iris tucks, chafing, tears, or bleeding.

SCIENTIFIC POSTERS

146 Poster 81

EVALUATION OF LOCAL ANESTHETIC AGENTS AS DETERMINED BY A NEW PRESSURE-SENSITIVE SPECULUM Richard K. Parrish II, MD BY INVITATION

George L. Spaeth, MD and

C. William Hargens, PhD RY INVITATWN

Philadelphia A wire speculum of the type proposed by Barraquer has been equipped with a strain gauge so that pressure exerted on the speculum can be accurately measured. The sensitivity of response can be varied. The speculum can be used when performing intraocular surgery and will alert the surgeon if .the facial nerve block should be inadequate or should wear off during the surgical procedure. The instrument, by providing quantitative measurement, is also valuable in the investigation of local anesthetic agents. The results of such an investigation of time of onset, depth, and duration of facial nerve block, using several of the currently available anesthetic agents, will be reported.

Poster 82 COMPARISON STUDY OF AMERICAN- VS RUSSIANMANUFACTURED SPUTNIK LENSES, FROM 1973 TO 1976: LATE COMPLICATIONS Richard A. Perritt, MD Chicago After my visit to Fyodorov's clinic in 1973, I implanted 100 sputnik lenses. Since 1976, because of the difficulty of obtaining more from Medexport, USSR, I implanted approximately 600 of the American-type Fyodorov lenses. In order to prevent posterior loop dislocation (4), I asked CILeO to increase the length of the struts by 0.5 mm, with posterior angulation at 10°. The late visual results varied from 20 / 30 to 20 / 20. Late complications (after nine to 12 months) included corneal decompensation,

iritis, iridocyclitis, secondary glaucoma, and cystoid macula edema. Reference will be made as to whether Supramid or Prolene loops were used. All patients received antiprostiglandins before, during, and after surgery, for a period of four to six months postoperatively. Mydriacyl 0.25<)70 to 0.50')70, topical and systemic corticosteroids, Adsorbonac 2% and 5%, sterile glycerine, and hair dryer aids were of no appreciable benefit. A comparison will be made between the 100 Fyodorov Russian-manufactured lenses and the last 100 American-manufactured Fyodorov-type sputnik lenses.

Poster 83 REPRODUCIBILITY OF AUTOMATED VS NONAUTOMATED VISUAL FIELDS Henry A. Scimeca, MD Willingboro, NJ The purpose of this poster is to show how a computerized visual field tester (Octopus) and a noncomputerized visual field tester (Goldmann) can define moderate glaucoma defects in a specific patient on a number of occasions. Without knowing the preexisting visual field, the examiner will obtain the best visual field possible with the Goldmann perimeter. On the same day, the automated visual field apparatus (Octopus) will obtain the visual fields in the same patient. On another occasion, a second examiner will repeat the field and the automated visual field will again be used. This poster will be able to show the ability of the patient to reproduce his or her own visual fields on the automated perimeter, and the results of the nonautomated fields will be compared with themselves as well as with the computerized field.

Poster 84 THE SOCIETY OF MILITARY OPHTHALMOLOGISTS Richard M. Evans, MD John P. Shock, Jr, MD David E. Shacklett, MD San Antonio, Tex

SCIENTIFIC POSTERS The Society of Military Ophthalmologists enables military ophthalmologists to exchange ideas on scientific and administrative aspects of patient care with ophthalmologists in all the military services_ Some aspects of military ophthalmology, residency training programs, and the activities of the society will be presented.

Poster 85

147

histamine levels were determined using the enzymatic isotopic assay technique. Tears from patients with inflammatory disease and from normal patients were significantly different from tears from the vernal conjunctivitis group (P <.01). Vernal conjunctivitis is unique among ocular inflammatory conditions studied in that it is the only one consistently accompanied by high-tear histamine levels. We postulate an abnormality of histamine pathways in vernal conjunctivitis.

OCULAR FINDINGS IN VIETNAM RPWS-1965 TO 1973 Col Thomas J. Tredice, MC, USAF Brooks AFB, Tex James W. Klein, MD Grosse Points Woods, Mich

Poster 87 BASAL CELL CARCINOMA IN YOUNG ADULTS John V. Linberg, MD

United States Air Force aviators were held captive in Vietnam longer than in any previous conflict in which the United States has been involved (1965 to 1973).

Richard L. Anderson, MD

A project to evaluate the short- and longterm medical effects of captivity on these airmen is being carried out at the USAF School of Aerospace Medicine (USAFSAM). This poster will report the ocular findings in USAF repatriated prisoners of war (RPWs) in Vietnam. A total of 227 RPW patients were examined in the ophthalmology branch at USAFSAM. As in previous captivities, the most serious ocular condition noted was nutritional amblyopia. A comparison of our findings with previous conflicts will be made.

BY INVITATION

Poster 86

and Roger I. Ceilley, MD Iowa City Basal cell carcinoma in young adults is frequently overlooked and misdiagnosed. We present five cases of basal cell carcinoma occurring in the teens and early 20s in which delayed diagnosis resulted in extensive eyelid and canthal involvement. Three patients (four eyelids) required a total or near total lid reconstruction. Two patients required large lateral canthal and cheek reconstructions. One patient required brow and forehead reconstruction. All had sclerosing tumors. Only two patients had basal " cell nevus syndrome. We advocate careful observation and biopsies of all suspicious eyelid and periorbital lesions, regardless of the patient's age.

TEAR HISTAMINE LEVELS: A CLINICAL SURVEY Mark B. Abelson, MD Andover, Mass Mathea R. Allansmith, MD Boston We have previously shown that histamine was routinely present in normal tears and elevated in vernal conjunctivitis. The present study was undertaken to determine whether this vasoactive amine is elevated only in vernal conjunctivitis or in all inflamed eyes. A total of 169 tear samples from 146 patients, representing 51 external eye inflammations, were examined. Tear

Poster 88 SEROLOGIC STUDIES IN DRY EYE PATIENTS S. Lance Forstot, MD and Joseph Z. Forstot Carlos M. Arroyave Eng M. Tan

ALL RY INVITATION

Denver

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SCIENTIFIC POSTERS

Most patients with dry eye syndrome have no clinical symptoms of connective tissue disorders (CTD). Recently, serum antibodies have helped in the diagnosis of less typical cases of Sjogren's syndrome (SS). The incidence of SS in "dry eye" patients is unknown but is believed to be low. Thirty-eight patients diagnosed with keratoconjunctivitis (KCS) were screened for the presence of antinuclear antibodies (ANA) and rheumatoid factor (RF). ANA and RF were each positive in 61 % (23) of the KCS patients. At the time of ophthalmologic examination, 76% (29) had no associated disease. Of these patients , 79')Il (20) were ANA positive. None of the ANA-negative patients had an associated systemic illness. Seven young female patients with severe xerostomia and no CTD, all ANA positive, had Sjogren antibodies. In summary, there was a high incidence of serologic abnormalities in patients with KCS. Th positive RF or the presence of Sjogren antibody may represent an early subclinical form of rheumatoid arthritis or Sjogren's sicca complex in a young patient population.

Poster 89 A GLASS INTRAOCULAR LENS Kenneth R. Barasch, MD and Stanly Poler, MS BY INVITATION

New York

Sincp 1~ 4 9 nearly all intraocular lenses have been made with polymethylmethacrylate optics and metal, nylon, polypropylene, or Supramid haptics. Chemical or gas sterilization is required , and serious questions have been raised regarding the inertness of these implants in ocular tissues. This paper describes a glass and polyimide intraocular lens and insertional system. It is autoclavable, insuring sterility and a residue-free implant surface. Glass is known historically for its biologic inertness, and both glass and polyimide have been demonstrated to be nontoxic through a series of alboratory techniques. Clinical data have been collected and will be presented .