Scientific Posters and Exhibits

Scientific Posters and Exhibits November 11-15, 1984 Georgia World Congress Center Exhibit Hall, Level I-East Scientific posters and exhibits will be on display during Exhibit Hall hours, 8:00 am to 5:00 pm, Sunday, November II, and 8:30 am to 5:00 pm Monday, November 12, through Thursday, November 15. Poster authors will be available at their displays Sunday for two-hour periods, as noted after each poster abstract. Authors will also be available during additional hours, to be posted daily on the display board on-site. Also exhibited will be a number of late call posters, presenting the latest scientific information: abstracts for these posters will be published in the Monday, November 12, on-site edition of Argus.

115

Table of Contents Scientific Poster Abstracts

117

Scientific Exhibit Abstracts

139

116

SCIENTIFIC POSTERS Poster authors wiJI attend their posters on Sunday, November 11, during the time noted in bold type following the abstracts.

Poster I Intraocular Lens Removals: Scanning Electron Microscopy Cynthia L. Bullen, MD, J. Douglas Cameron, MD, *Virginia R. Havener, Richard L. Lindstrom, MD, Minneapolis, MN All intraocular lenses which were removed at the University of Minnesota between 1978 and 1983 were examined with scanning electron microscopy. There were 74 patients and 77 intraocular lenses. The clinical histories were reviewed; we documented type of initial surgery, intraoperative complications, best vision after surgery and interval between original surgery and IOL removal. The indications for IOL removal were documented, and IOL removal vs. IOL exchange was analyzed. Scanning electron microscopy was performed on 77 IOLs. Thirty-nine were found to be normal and 34 had definite abnormalities. These included surface cellular membranes, surface irregularities, biodegradation of haptics, cellular encasement of metal clip, and an interesting ferning pattern on the IOL surface. (9:00-11:00 am)

formulation can be devised. This allows the surgeon to evaluate formulations being offered commercially. (3:005:00 pm)

Poster ". Post KeratopJasty Acuity in Eyes with an Intraocular Lens John R. Samples, MD, Portland, OR; Perry S. Binder, MD, La Jolla, CA We prospectively studied consecutive transplants for cases with pseudophakic bullous· keratopathy, cases which underwent simultaneous cataract/lens implant surgery and cases which had secondary lens implants. Poor acuity was associated with pretransplant vitrectomy, uveitis, or cystoid macular edema, previous implant removal, and iris and/or implant manipulation at keratoplasty. Mean cylinder (2.88D), mean flat and steep K (44.75, 47.62) were used to predict implant power.

Poster 2 The Accuracy of IOL Formulas in Axial Myopes John T. Thompson, MD, A. Edward Maumenee, MD, *C.C. Baker, Baltimore, MD

Best tCUity, 20 20-20 40 20/50-20/100 < 20/200

The accuracy of the Binkhorst, Colenbrander-Hoffer and SRK formulas was evaluated in 81 patients with axial myopia (axial length ~ 24.5 mm) after ECCE and PC IOL. The standard error of the estimate (SEE) of the predicted postoperative refraction was 1.36 D for the Binkhorst, 1.23 D for the Colenbrander-Hoffer and 0.92 D for the SRK formulas. The results were compared to a new polynomial regression IOL equation for axial myopes in a prospective study of 23 axial my opes. The new formula had a SEE of 0.88 D compared to 0.97 D for the SRK formula in the same group of patients. The new formula was accurate within 1.0 D in 74 percent of axial myopes and eliminated all hyperopic errors of ~ +1.5 D. The accuracy of prediction of postoperative refraction is improved by using a different regression equation for axial myopes. (1:00-3:00 pm)

**No. Eyes

Triple Play (TP)(56)** 68% 21% 11%

Pseudophakic BK (49)** 39% 29% 32%

2% IOL (32)**

4'ii'96 31% 25%

(9:00-11:00 am)

Poster 5 Resident Experience in Learning Extracapsular Cataract Surgery *David J. Browning, MD, PhD, L. Michael Cobo, MD, Durham, NC To characterize the learning process in extracapsular cataract surgery, we studied 130 consecutive extracapsular cataract extractions (56 without IOL, 74 with posterior chamber IOL) performed by five residents starting their training. Eighty-two percent of eyes without IOL and 89 percent of eyes with IOL attained vision ~20/40 with a mean followup of 5.4 months. Prevalences of posterior capsule rupture and vitreous loss were 16 percent and 9 percent, respectively. Plotting major complications vs. when they occurred yields "learning curves" for these complications. We studied postoperative refractive errors and influence of faculty attending, both overlooked in previous reports of resident cataract surgery. Postoperative astigmatism varied widely in axis for each resident. Visual results and complications were influenced by faculty attending. (1:oo-3:00 pm)

Poster 3 Sticky Stuff James P. McCulley, MD, *Dale Meyer, PhD, *Michael Stern, PhD, Dallas, TX Development of viscoelastic substances represents a major advance in intraocular surgery. These substances must not be toxic to the corneal endothelium. Therefore, we have exposed tissue cultured corneal endothelium to various formulations. By evaluating the individual components of the formulation, inherent toxicity of the polymer and solvent make-up can be evaluated. Acceptable osmolarity (200-370 mOsm) and pH (6.0-7.5) limits have been determined. Critical ions have also been determined (Na+, CI-, HCOr , Ca++, Mg++). With short surgical exposures red-ox molecules (glutathione), glucose, or adenosine are not required. With this information, a theoretically ideal

117

*by invitation

110

urn I nf\LlVIULUlJ T

•

Poster 6 Cardiovascular Effects of Intraocular Acetylcholine *David J. Browning, MD, PhD, Samuel D. McPherson Jr., MD, Durham, NC There have been 12 case reports of bradycardia and hypotension associated with the use of intraocular acetylcholine. We therefore prospectively studied heart rate, blood pressure, and electrocardiographic rhythm strip of 20 control patients undergoing intracapsular cataract extraction (no acetylcholine) and 20 test patients undergoing intracapsular cataract extraction with anterior chamber IOL (acetylcholine). Measurements were made before lens delivery and at 1, 5, and 15 minutes post lens delivery (control group) or post acetylcholine (test group). No statistically significant effect of acetylcholine was noted. We conclude that there is no physiologic cardiovascular response to intraocular acetylcholine and that reported adverse reactions represent idiosyncratic responses. (3:005:00 pm)

Poster 7 Mechanisms of False Positive Predictions with the Laser Interferometers and the Potential Acuity Meter David L. Guyton, MD, Baltimore, MD The laser interferometers and the potential acuity meter are widely used clinically to measure potential visual acuity behind cataracts. Failure to obtain the predicted vision in spite of optically successful cataract surgery indicates a false positive prediction of retinal acuity. Macular edema causes false positive predictions with both types of instruments. Experiments in 15 patients with macular edema and optically clear eyes, using artificial pupils and a variable-luminance aCuity chart, implicate intraretinal light scattering as the cause of the discrepancy, with "washing-out" of the retinal image with full-pupil viewing. Macular scotomas in 12 patients with amblyopia and 22 patients with macular degeneration caused false positives with grating targets, an artifact of field size. (9:00-11:O0 am)

Poster 8 Placement of IOL Loops in the Ciliary Sulcus James M. McEntyre, MD, Sarasota, FL When attempting to place the intraocular lens loops in the ciliary sulcus, frequently one loop will end up in the capsular bag. Postoperatively, this results in some decentering of the IOL. This poster demonstrates a method to ensure that both loops are placed in the ciliary sulcus. (I:00-3:00 pm)

Poster 9 The Giant Cells on Lens Implants: Demonstration J. Reimer Wolter, MD, Ann Arbor, MI

A Cytopathological

Giant cells are common on intraocular lens implants and occur in three main types. They develop by fusion of macrophages and disappear when the supply of macrophages is cut off. They are indicators of macrophage activity around implants and they usually are part of a beneficial adaptation process. Giant cells serve as a protoplasmatic pool for unused macrophages and for the temporary storage

•

I-'HUllHAM

~UI-'I-'Lt.Mt.N

I

of lipids mainly. Certain materials and shapes of implants are attractive for giant cells. In cases of proper adjustment, the giant cells also disappear. But in complicated cases they represent the first step in the formation of permanent optically obstructing membranes. Absence of giant cells resulting from primary lack of a macrophage reaction on lens implants is an indication of serious trouble. Photographic documentation for these facts is supplied. (3:O0-5:O0 pm)

Poster 10 Surgical Keratometry Using the Oval Comparator ( Ovalometer) S. Percy Amoils, MD, Johannesburg, South Africa Over the last 18 months a simple ovalometer incorporated into a Zeiss surgical microscope has been used for anterior segment surgery. The light source is a circular arrangement of high intensity light emitting diodes attached to the operating microscope body. A self-illuminating ring situated in the focal plane of one eyepiece is rotated about its axis using a dial with a sterilizable cover. The oval produced is matched to that of the reflected light ring produced by the anterior corneal curvature. Utilizing the principle of concentric or superimposed ovals a reading can be made. Using the simple cosine law the amount of astigmatism can be calculated. The device allows precise suturing of cataract wounds. The author holds patent rights for this instrument and its method of usage. (9:00-11 :00 am)

Poster 11 The Natural History of Astigmatism After Cataract Extraction *Henry D. Jampel, MD, Baltimore, MD; John T. Thompson, MD, Lutherville, MD; *C. C. Baker, Walter J. Stark, MD, Baltimore, MD A computer analysis of postoperative astigmatism was performed in 101 consecutive ECCE and PC IOLs by the same surgeon. A 140 degree posterior Iimbal incision with pre-placed 9-0 silk and postplaced 10-0 ny Ion sutures was Sutures were cut after surgery in seven cases. used. Average aggregate postoperative astigmatism was 1.200 after a mean follow-up of 4.5 months. With-the-rule astigmatism initially induced by surgery rapidly decreased from the first to fourth week after surgery to a mean of 1.840. Net astigmatism then decreased gradually with a linear decay rate of 0.16D/week from the fourth to twentyfirst week, stabilizing subsequently at a mean of 0.810 against-the-rule. Computer analysis can be used to rapidly evaluate surgical results and changes in technique. (1:003:00 pm)

Poster 12 Visual Results and Complications Following Secondary Intraocular Lens Implantation *Arun Patel, MD, Baltimore, MD; Warren Fagadau, MD, Dallas, TX; Walter J. Stark, MD, A. Edward Maumenee, MD, Baltimore, MD The visual results and complications following secondary intraocular lens implantation at the Wilmer Institute were reviewed in 42 consecutive cases. Both posterior chamber and anterior chamber lenses of the Lieske, Cilco, and Multiflex type were used. Anterior

•

SCIENTIFIC POSTERS AND EXHIBITS

vitrectomy was performed in 12 cas~s. Loss of two or more lines of vision occurred in four cases, of which one was attributed to CME. The other three occurred secondary to SMD, juxtapapillary NVM, and glaucoma. Zero to two diopters of astigmatism was induced in 45 percent, two to four diopters in 38 percent, and greater than four diopters in 17 percent. Complications included intraoperative hyphema in four cases, peripheral iris capture in one case, superior haptic in wound in one case, and iridodialysis in one case. (3:00-.5:00 pm)

Poster 13 Controlled Reduction of Post Keratoplasty Astigmatism, 1984 Update Perry S. Binder, MD, La Jolla, CA Interrupted 10-0 sutures were selectively removed post keratoplasty after six weeks in 57 eyes or as early as two to three weeks in 152 eyes based on steep keratometry readings or distorted corneal meridians as determined by corneascope topography. All cases were performed ,by the same surgeon with a continuous, 16 bite 11-0 suture. In 35 eyes in which all sutures were subsequently removed, there were . no significant astigmatic shifts, which suggests this technique leaves the cornea in a stable position. Sixty-six percent of all eyes had less than three diopters of astigmatism. No. Eyes 57 145 204

1 (Mo.)

7:4 7.6 7.6

2 5-:4 4.3 4.6

3 5-:5 3.9 4.2

5-7 4.4 3.5 3.8

8-10 4.3 3.2 3.6

11-13

14-16

3.0 3.5

2.1 2.9

4.3 3T (9:00-11:00 am)

Poster 14 Astigmatic Keratotomy . G. William Lavery, MD, Minneapolis, MN

Richard

L.

Lindstrom,

MD,

Twenty human cadaver eyes underwent partial depth corneal incisions under an operating microscope equipped with a Terry keratometer. A pattern of radial and tangential incisions originated by Dr. Luis Ruiz were made with a diamond knife at 3.0, 4.0, 5.0 and 6.0 mm optical zones. Our purpose was to quantitate the change in keratometric readings induced by these incisions at different optical zone sizes. The correlation between the average delta K and the size of the optical zone was significant at the p < .001 level. Four patients with high astigmatism after intraocular surgery underwent the same keratotomy at different optical zone sizes depending on their degree of astigmatism. The effect of the keratotomies in reducing astigmatism paralleled the results from the cadaver eyes. (1:00-3:00 pm) .

119

Poster 15 Induction of HLA Class I and D Antigens in Rejected Corneal Allografts Jay S. Pepose, MD, PhD, Glendale, CA; Kathryn M. Gardner, MD, *Mark S. Nestor, Robert Y. Foos, MD, Thomas H. Pettit, MD, Los Angeles, CA We compared the distribution of HLA-ABC and HLADR antigens on freSh donor corneas, donor corneas following a 72-hour incubation in M-K media, and corneal buttons from patients with allograft rejection and with herpetic stromal keratitis. In contrast to control corneas, both HLA class I and II antigens were detected on corneal endothelium and stromal keratocytes in rejected allografts and on stromal keratocytes in herpetic corneal buttons. This suggests that a factor associated with inflammation (e.g., a lymphokine) may induce HLA antigens locally in the cornea and play an important role in both allograft rejection and viral infection. (3:00-5:00 pm)

Poster 16 Climatic Droplet Keratopathy Khalid F. Tabbara, MD, San Francisco, CA; *Robert M. Nalbandian, MD, Riyadh, Saudi Arabia Climatic droplet keratopathy is commonly seen in Saudi Arabia. A total of 42 consecutive patients with climatic droplet keratopathy were examined. Sixteen patients underwent penetrating keratoplasty and the corneal tissue was subjected to histochemical and histopathologic evaluation. The age range among the patients studied was 30 to 90 years, with a mean age of 57 years. There were 37 male patients and five female patients. The low prevalence of climatic droplet keratopathy among the Saudi women could be related to the use of the veil. Two types of climatic droplet keratopathy could be identified. One type was bilateral, with no evidence of associated corneal or ocular disease. The second type was mostly unilateral, associated with corneal scarring. Clinical, etiologic, and histopathologic differences were noted between these two entities. (9:00-11:00 am)

Poster 17 Bilateral Acute Corneal Calcification *Thomas F. Freddo, PhD, Howard Boston, MA

M. Leibowitz, MD,

A 38-year-old male with brittle juvenile-onset diabetes mellitus and severe dry eyes simultaneously developed dense calcification of both corneas over a 24-hour period. Renal function, serum calcium, and phosphorus levels were normal. This entity differed from typical band keratopathy by location of the deposits in the anterior stroma with an overlying layer of clear stroma, a normal Bowman's membrane, and its unresponsiveness to ED,{ A chelation. The calcific nature of the deposits was verified by light and electron microscopy, energy dispersive X-ray Pathophysiologic analysis, and X-ray dot mapping. mechanisms that might be operative in acute corneal calcification will be discussed. (1:00-3:00 pm)

*by invitation

120

OPHTHALMOLOGY

•

Poster 18 Clinical Evaluation of Fibronectin Eye Drops on Trophic Ulcer After Herpetic Keratitis Teruo Nishida, MD, Hyogo, Japan; *Shigenori Nakagawa, MD, *Reizo Manabe, MD, Osaka, Japan We investigated the clinical efficacy of fibronectin eye drops on trophic ulcers after herpetic keratitis in 20 eyes. Fibronectin eye drops were prepared from patients' own blood plasma and were given six times a day. These patients suffered from persistent epithelial defects which did not respond to any conventional therapy. The mean duration of epithelial defect was 61.5 days. After fibronectin treatment was started, the epithelial defects disappeared within 15.6 .:!:. 12.1i (mean.:!:. S.D.) days. This result demonstrates that fibronectin eye drops are an effective therapeutic approach to corneal trophic ulcer after herpetic keratitis. (3:00-5:00 pm)

Poster 19 Lipoxygenase Products in Ocular Inflammatory Diseases Mark B. Abelson, MD, *Salim I. Butrus, MD, *Judith H. Weston, C. Stephen Foster, MD, Boston, MA Inflammatory eye diseases can no longer be grouped according to their clinical patterns; we must understand the underlying mediator profile and direct our pharmacologic intervention at blocking specific mediators. We used HPLC to assay the tears of 21i patients with inflammatory eye diseases, including vernal conjunctivitis, ocular rosacea, and pemphigoid, and the tears of 10 normal subjects for leukotrienes (L T) and HETEs. The level of LTBIi was highest in the tears of our patients with active vernal conjunctivitis. The level of HETEs was highest in the patients with pemphigoid, despite treatment with Imuran. These lipoxygenase products have been tested in rabbit and human eyes. Lipoxygenase products play an important role in certain ocular inflammatory diseases. (9:OO-11:OO am)

Poster 20 Histopathology of Human Refractive Keratoplasty *Stephen D. Baumgartner, San Diego, CA; Perry S. Binder, MD, La Jolla, CA; *Edward Y. Zavala, *Janet K. Deg, San Diego, CA Two keratophakia specimens obtained six and 12 months postoperatively demonstrated viable epithelium in the optical interfaces, disruption of the normal collagen pattern in the lenticule, and absence of keratocytes. Seven keratomileusis specimens demonstrated folds and breaks in Bowman's membrane with normal surface epithelium, and stromal lamellar pattern with moderate keratocyte repopulation. One epikeratophakia specimen was found to be hypocellular 21i months postoperatively with abnormalities in donor and recipient Bowman's membrane. Inflammation and vascularization was absent in all cases. Thicknesses of all layers in each specimen were correlated with clinical refractive results. The posterior cornea, Descemet's membrane and endothelium appeared normal. (1:00-3:00 pm)

•

PROGRAM SUPPLEMENT

Poster 21 Clinicopathologic Correlation of Penetrating Keratoplasty Failure Joseph J. Gindi, MD, Michael Buchbinder, MD, *W. Lee Wan, MD, Jeffrey B. Robin, MD, David J. Schanz lin, MD, Narsing Rao, MD, Los Angeles, CA We reviewed the pathological findings in 130 failed penetrating keratoplasty specimens received by the pathology laboratory at the Estelle Doheny Eye Foundation over the last 10 years. The tissue was examined for the presence of epithelial and stromal edema, subepithelial fibrovascular proliferation, stromal vascularization, cellular infiltration, abnormalities of Descemet's membrane, endothelial disease, and retrocorneal membranes. Clinical information was also obtained for each case, documenting the primary diagnosis, interval between keratoplasties, presumed reason for failure, presence of glaucoma, and success of repeat graft. We will discuss the various pathological findings associated with graft failure and correlate these findings with the different clinical presentations. (3:00-.5:00 pm)

Poster 22 Freeze-Fracture Study of fiJman Dysfunctional Endothelial Membranes *Barbara J. Mclaughlin, PhD, *Yuko Sasaki, MD, *Lou Boykins, Thomas Wood, MD, Audrey Tuberville, MD, Memphis, TN Pseudophakic bullous keratopathy is the more frequent reason for corneal transplantation in the United States. Altered endothelial permeability in this disorder leads to corneal edema. In an attempt to explain the mechanism of endothelial failure, freeze-fracture studies were carried out. Basal membranes show numerous vesicle fusions associated with increased pinocytotic activity or permeability. Intramembrane particles that may be related to ATPase molecules are reduced on lateral membranes and may reflect a deficient number of pump sites. Apical membranes show numerous large craters filled with aqueous humor which appear to be associated with bulk uptake of solutes or increased permeability. These findings demonstrate membrane changes associated with altered permeability. (9:OO-II:OO am)

Poster 23 Management of Floppy Lid Syndrome *Mary Beth Moore, MD, James P. McCulley, MD, Dallas, TX Little has appeared in the literature about the floppy It therefore continues to be frequently lid syndrome. misdiagnosed and poorly managed when recognized. We describe five patients (three male, two female) with this entity and the management thereof. All patients had a typical clinical presentation that, when recognized, made the diagnosis straightforward. All patients responded dramatically to conservative measures characterized by protection of the lid from eversion. These patients then underwent a surgical lid-tightening procedure that resulted in permanent correction of the anatomical abnormality and subsequent resolution of the chronic ocular surface abnormality. (1:O0-3:OO pm)

•

SCIENTIFIC POSTERS AND EXHIBITS

121

Poster 24 Identification of Common Ophthalmic Mycoses Using Plant Lectins Jeffrey B. Robin, MD, Joseph J. Gindi, MD, Narsing Rao, MD, Los Angeles, CA

Poster 27 Corneal Topographic Alteration in PERK Patients After Radial Keratotomy Penny A. Asbell, MD, New York, NY

Identification of mycotic organisms in ophthalmic infections is frequently a difficult process requiring prolonged culture times. Lectins, ubiquitous sugar-binding proteins, are now being widely used to identify various cell types. We have developed a method for differentially staining the three fungi most commonly involved in ophthalmic mycoses (Candida, Aspergillus and Fusarium). Using seven fluorescein-labeled plant lectins, we were able to rapidly and consistently identify these three organisms in both clinical smears and fixed histopathologic specimens. (3:OO-5:oo pm)

Radial keratotomy appears able to correct some degree of myopia, but results are not always predictable. Preoperative central keratometry readings do not correlate well with the correction obtained. We evaluated a greater area to determine whether peripheral corneal shape is a more accurate predictor of postoperative results. Standardization of a computerized analysis of photokeratoscope photos (30 eyes) was first done to develop methods of finding the "best fit" radius and the major and minor meridians of the cornea, and of performing crosssectional analysis of 3-D pictures. These techniques were then applied to data (40 eyes) from the PERK study. (3:005:00 pm)

Poster 25 Comparison of Optical and Ultrasonic Pachymetry in the Prospective Evaluation of Radial Keratotomy (PERK) Study William D. Myers, MD, Southfield, MI This study compares the preoperative pachymeter readings in 50 radial keratotomy patients utilizing ultrasonic and optical pachymetry. One series of measurements consists of readings utilizing the Haag-Streit optical pachymeter with the Mashima-Hedbys pin light attachment taken by the PERK surgeon. Both central and paracentral readings in the 180 degree meridian were taken. The second readings were taken by the PERK coordinator utilizing the Kremer ultrasonic pachymeter during the initial preoperative work-up. The third set of readings was taken by the PERK surgeon using the Kremer ultrasonic pachymeter in the operating room just prior to the radial keratotomy procedure. A statistical analysis was performed on the data collected above. (9:00-11:00 am)

Poster 26 Microbial Keratitis in Los Angeles 1972 - 1983 *L. David Ormerod, MD, *Deborah S. Gomez, David J. Schanz lin, MD, Ronald E. Smith, MD, Los Angeles, CA In a retrospective investigation, we evaluated 243 cases of microbial keratitis admitted to USC-LAC Medical Center and Children's Hospital of Los Angeles over an 11year period. One hundred ninety-six were culture positive. The most frequently encountered organisms were Staphylococcus epidermidis, 29 percent (often polymicrobiaJ); Staph. aureus, 23 percent; Pseudomonas aeruginosa, 17 percent; Streptococcus pneumoniae, 14 percent; other Streptococci, 17 percent; and fungi, 10 percent. Polymicrobial infections occurred in 34 percent. Distinctive microbial spectra were found in the chronic alcoholic and in early childhood. Interesting racial differences were also noted. Chronic alcoholism in adults was the most frequent predisposition. Other common predisposing factors were trauma, exposure keratitis, bullous keratopathy, dry eyes, corneal scars, topical steroids and contact lenses. This study emphasizes the complexity of causation in microbial keratitis. (1:O0-3:00 pm)

Poster 28 Acanthamoeba Keratitis - Diagnosis and Management Harry W. Buchanan IV, MD, Charles P. Adams, MD, Philadelphia, PA; Paul G. Galentine, MD, Bethesda, MD; Robert Folberg, MD, Peter R. Laibson, MD, Elisabeth J. Cohen, MD, Philadelphia, PA The protozoan Acanthamoeba has become an increasingly recognized cause of chronic ulcerative keratitis. Diagnosis and management of this infection has been difficult at best. We report two cases of Acanthamoeba keratitis seen within four months on the Cornea Service at Wills Eye Hospital. Corneal transplantation was necessary for diagnosis and therapy in both cases. There has been no evidence of recurrent disease to date. Detailed histological studies of keratoplasty specimens will be presented. Therapeutic options will be discussed. The diagnosis of Acanthamoeba keratitis must be considered in cases of chronic progressive corneal ulceration unresponsive to medical therapy. (9:00-11:00 am)

Poster 29 Effects of Radial Keratotomy on Contrast Sensitivity in the Prospective Evaluation of Radial Keratotomy (PERK) Study *Arthui' P. Ginsburg, PhD, Dayton, OH; *Eugene B. Steinberg, Atlanta, GA; *Norma Justin, New York, NY; *Patrick Mulvanny, PhD, Madison, WI; *Jan Reinig, Los Angeles, CA; *Vicki Roszka, Royal Oak, MI; *Pat Williams, Minneapolis, MN; George O. Waring III, MD, Atlanta, GA Some patients who have undergone radial keratotomy have improved visual acuity but experience difficulty with glare and reading letters on eye charts. To help quantify the effects of radial keratotomy on vision, we performed contrast sensitivity tests on both eyes of 80 patients who had radial keratotomy in one eye and no surgery in the other, and on a group of normal controls. Methods included presentations on both a television monitor and on a specially designed card. Preliminary data measured at I, 2, 4, 8, 16 and 24 cycles per degree in 17 patients showed significant differences in contrast sensitivity between eyes in eight patients, but there was no systematic trend for greater loss in either the operated or unoperated eye. (1:00-3:00 pm)

*by invitation

122

OPHTHALMOLOGY

•

•

PROGRAM SUPPLEMENT

Poster 30 Recovery of Corneal Sensation in Grafts Following Penetrating Keratoplasty Gullapalli N. Rao, MD, Rochester, NY; *Nobuo Ishida, MD, Toyko, Japan; James V. Aquavella, MD, Rochester, NY

Poster 33 Stripping of Subepithelial Fibrous Tissue for Treatment of Anterior Corneal Dystrophies Michael D. Wagoner, MD, Kenneth R. Kenyon, MD, Boston, MA

Corneal sensation was tested using the Cochet-Bonnet aesthesiometer in the graft and peripheral recipient cornea in 128 eyes of 103 patients with a postoperative period of two weeks to 18 years. Corneal sensation was correlated with the recipient age, preoperative diagnosis, regrafting, usage of contact lenses, medical status, and the use of topical and systemic medications. Significant difference (p < 0.0001) existed between the graft and the peripheral host cornea with the graft demonstrating lower values. Corneal sensation in the periphery was also found to be more impaired with recipient age and in cases of regrafting. The significance of these <,bservations and their effect on the ultimate survival of the corneal graft will be presented. (3:00-5:00 pm)

Superficial keratectomy and lamellar or penetrating keratoplasty have been advocated for the therapy of corneal dystrophies predominantly involving the epithelium and anterior stroma, in order to improve vision and/or alleviate recurrent erosions. We have treated two patients (three eyes) with Reis-Bucklers dystrophy and one patient (two eyes) with granular dystrophy with simple stripping of the central corneal epithelium and subepithelial abnormal connective tissue and produced remarkable improvement in corneal clarity with concomitant improvement in vision. As the procedure is surgically simple and safe, and as the visual recovery is accelerated, we believe it should be considered as a therapeutic alternative in selected cases of anterior corneal dystrophies. (3:O0-5:OO pm)

Poster 31 Retinoids in the Treatment of Conjunctival Keratinization Scheffer C. G. Tseng, MD, PhD, A. Edward Maumenee, MD, Baltimore, MD; Kenneth R. Kenyon, MD, Boston, MA; Walter J. Stark, MD, *Thomas T. Provost, MD, W. Richard Green, MD, Baltimore, MD

Poster 34 Peripheral Corneal Endothelial Evaluation Post Radial Keratotomy in PERK Patients Penny A. Asbell, MD, Stephen Obstbaum, MD, *Norma Justin, New York, NY

Conjunctival keratinization with loss of goblet cells and mucin deficiency are the common features of a number of ocular disorders such as xerophthalmia, various cicatricial keratoconjunctivitis, and keratoconjunctivitis sicca. Treatments in the past for these conditions have been unsatisfactory. We have used topical retinoid ointments to treat 20 patients with Stevens-Johnson syndrome, ocular pemphigoid, and superior limbic keratoconjunctivitis. With this therapy, we have observed reversal of conjunctival keratinization and regeneration of goblet cells utilizing impression cytology. Clinical symptoms were largely relieved, and visual acuity improved. Topical retinoid treatment appears to be efficacious in treating surface disorders with keratinization. (9:00-11:O0 am)

Poster 32 An Analysis of Preoperative vs. Intraoperative Pachymetry in Radial Keratotomy Richard A. Villasenor, MD, Delaware F. Harris II, MD, Mission Hills, CA Preoperative pachymetry and intraoperative pachymetry were utilized in determining corneal thickness and depth of blade settings prior to radial keratotomy procedures. Ultrasonic pachymetry was employed in all cases following the PERK protocol criteria for measuring central and paracentral corneal thickness. Comparison data obtained from preoperative vs. intraoperative pachymetry revealed no significant clinical difference, providing intraoperative measurements were taken promptly so as to negate the possibility of the dehydrating effect on the cornea caused by microscope lighting. (1:00-3:00 pm)

The question of possible endothelial damage secondary to radial keratotomy (RK) is still unanswered. Wide-field specular microscopy was performed in 15 PERK patients six to 12 months post RK in one eye, comparing the center and mid-periphery (under the RK scars) with comparable areas in the un operated eye. Manual evaluation showed an average central reading in the RK eyes of 2769 mm 2 .:!:. 438 SO, compared with 2692 mm 2 .:!:. 464. The average midperipheral readings were 2719 .:!:. 367 (RK) and 2699 .:!:. 362. There was no significant difference (p > 0.5) between groups in any area. We will present computerized analysis and later studies after the second (control) eye itself underwent RK. (9:O0-11:O0 am)

Poster 35 Radial Keratotomy - Computer Predictability Frederic B. Kremer, MD, Philadelphia, PA This poster briefly reviews the use of multiple regression analysis to determine the factors which influence the result of radial keratotomy surgery. These factors are used in a computer program which applies the relative influence of each of the factors. The computer program is oriented for rapid data entry and data output so that it can be used as an aid when performing radial keratotomy surgery either preoperatively or intraoperatively. The author receives a royalty for the program. (1:00-3:00 pm)

Poster 36 Morphological Variation of the Diabetic Corneal Endothelium Richard O. Schultz, MD, *Mamoru Matsuda, MD, *Richard W. Yee, MD, *Henry F. Edelhauser, PhD, Milwaukee, WI Specular microscopy (SM) and pachymetry of the central cornea were performed to evaluate the endothelium in patients 40-75 years old who had type II diabetes for a 10-year duration without evidence of proliferative

•

SCIENTIFIC POSTERS AND EXHIBITS

retinopathy or other ocular pathology. Computer assisted morphometry (CAM) was performed to determine cell size and cell shape parameters. A significant increase in the coefficient of variation and the number of five- and sevensided cells as well as a significant decrease in the number of hexagonal cells and the figure coefficient was noted (p < 0.05). These morphologic changes suggest an unstable monolayer with regard to the diabetic corneal endothelium. These changes are only detected with SM and CAM, emphasizing endothelial cell density alone may not reflect endothelial abnormality. 0:00-5:00 pm)

Poster 37 T-Tape Lid Closure John R. Welch, MD, *Philip Weber, *Diane Wilkinson, Greeley, CO Application of T-tape for lid closure provides better protection than a standard eye patch alone. The T-tape is especially helpful in preventing corneal exposure after local akinesis of the orbicularis in pre- and postop cataract extraction, for lid immobilization in the treatment of corneal injuries, and for lid immobilization in overfiltering trabeculectomies. (9:00-11:00 am)

Poster 38 Graft Clarity and the Endothelium in Keratoplasty: A Review Richard L. Abbott, MD, Robert G. Webster, MD, J. Chandler Berg, MD, San Francisco, CA Factors affecting graft clarity have been reported in numerous studies over the past two decades. More recently, with the help of the clinical specular microscope, information has been learned regarding the fate of the endothelium in clear grafts during the immediate and late postoperative period. This poster presents a compilation of data related to the determinants of graft clarity and the nature of endothelial cell loss following keratoplasty. Questions that remain yet unanswered will also be presented to provide a stimulus for further research in this area. (1:O0-3:O0 pm)

Poster 39 ConjWlCtival Crystals in Alport's Syndrome Michael C. Buchbinder, MD, Los Angeles, CA; Joseph J. Gindi, MD, Beverly Hills, CA; David J. Schanzlin, MD, Narsing Rao, MD, Los Angeles, CA Alport's syndrome, a triad of hereditary nephritis, nerve deafness, and lens abnormalities, has been associated with a constellation of other ocular lesions. We have observed conjunctival crystalline deposits' in two brothers with this syndrome. Conjunctival specimens were processed for light and electron microscopy and demonstrated foci of calcium crystals surrounded by giant cells and areas of elastotic degeneration. To our knowledge, such deposits have not previously been described in this condition. (3:005:00 pm)

123

Poster 40 Bilateral Acanthamoeba Keratitis Harry S. Geggel, MD, Richard A. Thoft, MD, C. Stephen Foster, MD, *Ann S. Baker, MD, Boston, MA; *G. S. Visvesvara, PhD, Atlanta, GA We managed a case of bilateral Acanthamoeba (A.) keratitis associated with corneal melting in a young Indian woman who used soft contact lenses. The diagnosis was only suspected on seeing amoeba in corneal sections. Freeswimming protozoa were seen in the anterior chamber, and A. castellanii and A. polyphaga grew from the graft. Serum immunofluorescence was I :128 for A.c. and A.p. In vitro amoebocidal levels were obtained only with ketoconazole (25 ",g/mJ) and possibly miconazole. Despite aggressive therapy, a severe keratitis marked by an anterior stromal ring infiltrate recurred in both grafts. Repeat grafts have remained clear. Management will be outlined. (9:00-11:00 am)

Poster 41 A One-Handed Manual Irrigation/Aspiration Syringe for Anterior Segment Microsurgery Wesley K. Herman, MD, Dallas, TX A human engineered, disposable, one-handed irrigation/aspiration syringe has been developed and patented by the author (US Patent No. 4,424, 055). This syringe allows bimanual intraocular coordination without expensive high technology instrumentation. Suction and reverse suction are at the surgeon's fingertip control, ergonomically providing proprioceptive precision and immediate response. State of the art surgery can therefore be offered worldwide and without the dependence on high technology facilities and equipment. (1:OO-3:OO pm)

Poster 42 In Vitro Allogeneic Transplantation of tilman Corneal Endothelium: Electron Microscopic Observations *Jamie G. Lopez, Michael S. Insler, MD, Delmar R. Caldwell, MD, New Orleans, LA Corneal endothelial cells obtained from neonates were subcultured onto adult human corneas that had been denuded of endothelium. Prior to subculturing, the adult corneal buttons were maintained in organ culture for 24-36 hours, in the presence of five percent Dextran, to minimize stromal edema. Subsequently, neonatal endothelial cells were seeded, in low numbers, onto the intact Descemet's membrane of the corneal buttons; the buttons were then cultured under standard conditions. Endothelial con fluency occurred, on the average, by the 26th day of culture and endothelial cell mitosis was observed to playa predominant role in this attainment of confluency. Morphological analysis of the cultures is provided by both transmission and scanning electron microscopy. (3:00-5:00 pm)

*by invitation

124

OPHTHALMOLOGY

•

•

PROGRAM SUPPLEMENT

Poster 43 The Effect of Keratoplasty on Visual Function in Patients with Keratoconus Mark J. Mannis, MD, *Karla Zadnik, Chris A. Johnson, PhD, Sacramento, CA

Poster 116 Phosphate Buffer Decreases the Mitotic Activity of the Corneal Epithelium Peter A. Rapoza, MD, Baltimore, MD; Leon G. Partamian, MD, Lakewood, CA

Visual complaints often precede an acuity decrease in keratoconus. We studied seven keratoconic patients with unilateral keratoplasty and comparable acuity in both eyes. Standard clinical evaluation was performed. Contrast sensitivity functions with and without a glare source were obtained by measuring contrast thresholds after optimal contact lens correction. Results indicate that contrast sensitivity functions were distinctly abnormal in unoperated keratoconic eyes. This abnormality was eliminated by keratoplasty. Glare did not significantly affect visual pe rformance. Findings were confirmed in a pair of identical twins with keratoconus. Our data confirm that contrast sensitivity is impaired in keratoconus and that keratoplasty improves not only Snellen acuity but contrast sensitivity as well. (9:O0-11:O0 am)

The mitotic activity of intact and freeze-injured corneal epithelium of 60 Dutch-belted rabbits was assessed following the application of 0.1 M sodium phosphate buffer (PB), 0.25 percent timolol maleate in 0.1 M phosphate buffer (T -PB), or no topical treatment. The solutions were free of Timoptic's (Merck, Sharp lie Doh me) preservative, benzalkonium chloride. The basal mitotic activity of uninjured corneal epithelium was reduced 55 percent by PB and 40 percent by T-PB (p < .01). The miotic activity of injured corneal epithelium was reduced 67 percent by PB and 64 percent by T-PB (p < .01). No statistically significant difference was found between PB and T-PB treated corneas. Unexpectedly, we have concluded that phosphate buffer, free of timolol maleate or benzalkonium chloride, impairs mitosis in the intact and regenerating corneal epithelium. (9:00-1J:OO am)

Poster 411 Purification of AJpha-GaJactosidase Isoenzymes in Normal and Macular Dystrophy Tissue Culture *Kirk M. Morgan, MD, Cleveland Heights, OH; William E. Bruner, MD, *Thomas R. DeJak, Cleveland, OH; Walter J. Stark, MD, *Elaine Young, PhD, Baltimore, MD Alpha-galactosidase has been previously shown (Bruner, et al., 1983) to have decreased specific activity, Km, and Vmax in macular dystrophy corneal tissue. These observations lead one to suspect that an abnormal enzyme or enzymes are present in macular dystrophic cornea. Ion exchange chromatography was employed to purify the alphagalactosidase isoenzymes from normal and macular dystrophy corneal tissue culture cells. The normal sample eluted as one peak, while the macular sample showed six peaks of activity. These findings indicate the possible presence of abnormal isoenzymes of alpha-galactosidase in macular corneal dystrophy. (I:OO-3:OO pm)

Poster 115 Diagnosis of Ocular Herpes Simplex Virus (HSV) by Tissue Culture Plus Specific Staining V. K. Raju, MD, Ivan R. Schwab, MD, *James E. McClung, Morgantown, WV The most sensitive technique available to detect HSV is tissue culture (TC) isolation of virus. However, it is relatively slow and may take up to seven to ten days for a final determination in specimens with low infectivity. We evaluated tissue culture (TC) biotin-avidin (BV) fluorescent antibody (FA) method to detect HSV of the eye in 20 patients. This method needed only 26 hours for completion and its sensitivity is comparable to the long-term TCcytopathic effect method. Our procedure used a short-term tissue culture (24h) of corneal scrapings then stained with biotin linked HSV antibody and avidin-fluorescein conjugate. High binding affinity of biotin to avidin and multiple attachment of biotin to the antibody molecule produced a quality of fluorescence superior to that of the conventional FA technique. (3:OO-5:OO pm)

Poster 117 Corneal Epithelial Dendritiform Figures Tom Tooma, MD, Geoffrey Crawford, MD, Philip Newman, MD, George O. Waring III, MD, Atlanta, GA While corneal epithelial dendritiform lesions often represent herpes simplex epithelial keratitis, other corneal diseases manifest this clinical picture. We present 29 cases with epithelial lesions shaped like dendrites that were examined during a four-month period at the Emory University Cornea Clinic. The group consisted of 16 cases of recurrent herpes simplex epithelial keratitis, one of primary herpes simplex epithelial keratoconjunctivitis, four of herpes zoster keratitis, two related to contact lens wear, two healing epithelial defects, one due to recurrent erosion from an epithelial basement membrane dystrophy and three epithelial mucous plaques. We describe the distinguishing features of each type of corneal dendritiform figures and present a guide to accurate differential diagnosis. (l:OO3:00 pm)

Poster 118 Gentamicin, Tobramycin, Amikacin, and Netilmicin Levels in Tears *Fay L. Woo, MD, *Anthony Johnson, MD, Michael lnsler, MD, *William J. George, PhD, New Orleans, LA The treatment of bacterial keratitis continues to be a subject of controversy as newer antibiotics are introduced, and different routes of administration are studied. Peak and trough tear and serum concentrations were determined in 28 human volunteers undergoing intravenous gentamicin, tobramycin, amikacin, and netilmicin therapy. While effective serum concentrations were achieved, tear levels were subtherapeutic. The mean peak tear concentrations were 0.40 mcg/ml, 0.51 mcg/mI, 1.68 mcg/ml, and 0.29 mcg/ml for gentamicin, tobramycin, amikacin, and netilmicin respectively. These levels did not approach the minimum inhibitory concentrations for Pseudomonas and raise some concern regarding risk benefit ratio of intravenous antibiotic for bacterial keratitis. (3:OO-5:OO pm)

•

SCIENTIFIC POSTERS AND EXHIBITS

Poster 49 Correlative Microscopy of fiJman Radial Keratotomy *Edward Y. Zavala, San Diego, CA; Perry S. Binder, MD, La Jolla, CA; *Janet K. Deg, *Stephen D. Baumgartner, San Diego, CA One radial keratotomy (RK) specimen performed for post keratoplasty astigmatism demonstrated epithelial plugs within shallow incisions without - damage to recipient endothelium. A second RK specimen was performed for keratoconus which demonstrated delayed wourid healing and incision depths up to 80 percent. The third specimen was obtained with a microkeratome in an undercorrected case which demonstrated epithelium lining the wounds and active fibroblasts at the base of each incision. A fourth case was obtained following two 16 RK incisions. Ocular surface abnormalities, fragmentation in Bowman's layer and delayed wound healing were evident. In none of the cases was there evidence of endothelial cell damage. Neovascularization of the peripheral wound occurred in only one case. (9:00-11:00 am)

Poster 50 The .Use of Ocular Surface Impression Cytology in Assessing Ocular Surface Disease J. Daniel Nelson, MD, *Jacqueline Wright, St. Paul, MN The use of cellulose acetate filter material to remove cells from the ocular surface has been termed ocular ' surface impression cytology. This method has been used to assess goblet cell densities in various ocular surface disease states to aid in diagnosis as well as prior to corneal transplant surgery to assess the ocular surface status. This method has also proved valuable in diagnosing and differentiating between various dry eye states such as keratoconjunctivitis sicca and ocular pemphigoid. The technique of impression cytology will be demonstrated pictorially and examples of its specific uses in assessing the ocular surface will be shown. (1:OO-3:00 pm)

Poster 51

The Centennial of the Discovery of Local Anesthesia Robert M. Feibel, MD, St. Louis, MO

This year we celebrate the centennial of the discovery of local anesthesia by a young ophthalmologist, Car I Koller (1857-1944). Many ophthalmologists are unaware that local anesthesia is probably the most notable contribution of ophthalmology to modern medicine. The circumstances of this discovery will be related, with emphasis on the rapid spread of this technique over the world, and the incredible enthusiasm with which it was accepted. Also to be noted are the little-known facts of Koller's emigration to America and his 50 years of practice in New York City. (3:00-5:00 pm)

Poster 52 Malignant Hyperthermia and the Ophthalmic Surgery Patient Mary O'Hara, MD, Donald D. Bode Jr., MD, San Antonio, TX Malignant hyperthermia is an intraoperative medical emergency. Although infrequently encountered by ophthalmologists, it has been observed to have a higher than usual incidence in ptosis and strabismus surgery. All

125

ophthalmic surgeons must, therefore, be knowledgeable in the diagnostic features of this disorder and be prepared to initiate immediate resuscitative measures to prevent catastrophe. Two recent events of malignant hyperthermia presenting during eye surgery are reported. Critical steps in the recognition, diagnosis and management of this entity are discussed. (9:00-11:00 am)

Poster 53 88 Gun Related Ocular Injuries - An Underestimated Public Health Hazard John A. Hoepner, MD, *Michael J. Zettel, Syracuse, NY; *Andrew Mattaliano, MD, Buffalo, NY We have reviewed 47 cases of BB gun injuries to the eye and orbit. The injuries ranged from transient corneal edema to perforation of the globe, retained intraorbital foreign bodies, intracranial foreign bodies, and sympathetic ophthalmia. Our data suggested the number of BB gun injuries may be greater than has been previously reported. Commentary is made on the difficulty in recovering retrospective BB gun injury data due to common coding inaccuracies, the increased power of these weapons currently classed as BB guns, laws regulating BB gun sale and usage, and suggestions of injury prevention. (1:00-3:00 pm)

Poster 54 Special Tissue Stains in Ocular Histopathology William C. Lloyd III, MD, Marilyn C. Kincaid, MD, *Carmen Berlanga, San Antonio, TX Several histologic stains are used in ocular pathology which are invaluable not only in highlighting histological abnormalities, abnormal deposits, and organisms, but also in providing greater contrast between different types of tissue. Ophthalmologists often submit surgical specimens to general pathologists unfamiliar with these stains. Comparison photomicrographs demonstrate the unique advantages of special stains to ordinary H &: E preparations. We advocate that specimens be submitted with specific staining recommendations to aid in diagnosis. Special stains are also superior for teaching and lecture purposes. (3:00-5:00 pm)

Poster 55 Nursing Management of Sleep, Pain, and Emotional Distress in Corneal Ulcer Patients Receiving Frequent Eye Drops *Linda J. Vader, *Desiree Blake, *Mary Hunter, Ann Arbor, MI; *Sara Machowsky, Flourtown, PA; *Marlene CroceBurgess, Bellmawr, NJ This study was designed to collect information regarding sleep patterns and to plan interventions for persons on the short interval eye drop program for corneal ulcer disease. The subjects were persons from the Kellogg Eye Center at the University of Michigan who agreed to participate in the study. The researchers assessed sleep deprivation and planned care to assist with the comfort level of these persons related to issues of sleep, pain, and emotional distress. The plan included regular rest and activity, diversion, pain relief, and relaxation exercises. Data from control and experimental groups will be compared to determine the effect of sleep deprivation on both groups, and the degree to which the intervention

*by invitation

126

OPHTHALMOLOGY

•

•

PROGRAM SUPPLEMENT

program made a difference to their level of comfort during the treatment program. (9:00-11:00 am)

electron microscopy photographs will be presented. (9:oo11:00 am)

Poster 56 Hyperlipidemia and the Eye Robert J. Schechter, MD, Los Angeles, CA; Ronald N. Gaster, MD, Long Beach, CA; *Eric Del Piero, MD, Orange, CA

Poster 59 Evaluation of the Krupin-Denver Valve in Normotensive and Glaucomatous Beagles Robert M. Mandelkorn, MD, Pittsburgh, PA; *Don A. Samuelson, PhD, *Glenwood G. Gum, DVM, *Kirk N. Gellatt, DVM, Gainesville, FL; Kenneth W. Olander, MD, PhD, Milwaukee, WI; Thom J. Zimmerman, MD, New Orleans, LA; *C. T. Bradley, Hattiesburgh, MS

New studies have confirmed previously held impressions that serum lipid levels have a profound effect on morbidity and mortality. The eye is the sole organ in the body through which the blood itself and the microvasculature can be directly observed. Many of the hyperlipidemias have specific ophthalmoscopic correlations. A new, previously undescribed complication of lipemia retinalis may lead to blindness. This finding is explained, and it is shown how this clinical picture is a specific consequence of the optical properties of the molecular size of the lipids involved. The appropriate ophthalmological management of these cases, including the role of vitrectomy, is described. (1:00-3:00 pm)

Poster 57 Intraocular Lens Implantation in Ocular Hypertensives, Glaucoma Suspects and Patients with Chronic Open-Angle Glaucoma Linda Civerchia, MD, Alvan Balent, MD, Ft. Lauderdale, FL We have performed extracapsular cataract extraction and posterior lens implantation in 68 eyes of 50 patients classified as ocular hypertensives (30/68), glaucoma suspects (21/68), glaucoma (21/68), or unclassified (7/68). We found that 85.3 percent (58/68) required the same or less glaucoma medication postoperatively to attain good control of intraocular pressures. The addition of one medication was required in 11.7 percent (8/68), and two medications were required in 2.9 percent to control tensions. Overall, 83.8 percent (57/68) attained visual acuity of 20/40 or better postoperatively. We conclude that open-angle glaucoma is not a contraindication to lens implantation. (3:00-5:00 pm)

Poster 58 Histopathology of Trabeculectomy Specimens in Chronic Open-Angle Glaucoma Mohamed H. Emarah, MD, Cairo, Egypt; *Luc Missotten, MD, Leuven, Belgium; *Osama Elbassiouny, MD, Cairo, Egypt We studied the ultrastructure of the trabecular tissue of 90 glaucomatous eyes, using light and electron microscopy, special attention being given to Schlemm's canal and pericanalicular tissue. The materials were obtained by a trabeculectomy surgical procedure practiced by the authors in which the fashioned scleral-based flap was excised along the line of scleral spur to ensure the presence of Schlemm's canal and trabecular tissue in the excised specimens. Trabecular specimens obtained at autopsy from non-glaucomatous eyes of similar age groups were used as a control. The postmortem specimens were also utilized to study the architecture of the inner trabecular meshwork employing the wet replica technique advocated by Vrabec in 1974. Our technique of handling the trabecular tissue to obtain best histopathological specimens will be discussed. Interesting histopathological findings and well-illustrated

The Krupin-Denver valve was implanted in two normotensive and six glaucomatous beagles following the surgical procedure that is identical in man. All dogs were evaluated serially by gonioscopy, tonometry and tonography prior to and after surgery. The valves were also evaluated by in vitro perfusion using different perfusates. Valves failed in four glaucomatous dogs and remained functional in two normotensive and two glaucomatous eyes up to one year after implantation. All valve failure occurred within four months after implantation. Histological examination by light and scanning electron microscopy revealed that the lumen of each failed valve was occluded by fibrinous material and/or inflammatory cells. One valve tested in vitro was found to be defective. (1:O0-3:00 pm)

Poster 60 The Effects of Topically-Applied Beta-Aminopropionitrile After Glaucoma Filtration Surgery in Humans Louise C. Moorhead, MD, Robert H. Stewart, MD, Richard L. Kimbrough, MD, Jess A. Smith, MD, Bobbie J. Fowler, Houston, TX Beta-aminopropionitrile (BAPN) is a powerful inhibitor of collagen maturation which acts on Iysyl oxidase during collagen cross-linking. It was tested topically to improve results of filtration surgery by decreasing the tensile strength of the obstructing scar tissue. Participating in the study, were 30 patients falling into four groups: neovascular glaucoma, aphakic glaucoma, previously failed surgery, and black or Hispanic patients needing initial surgery. BAPN fumarate ointment (20 percent w/w) was given four times a day for one month, then twice a day for two more months. The only side effect has been some stinging immediately after instillation in some patients. Eighteen month followup data will be presented. (3:00-5:00 pm)

Poster 61 A Goniotomy Lens for the Operating Microscope Michael Taravella, MD, Badrudin Kurwa, MD, Galveston, TX A modified four-mirror lens is described that can be used for performing a goniotomy with a standard operating microscope. This allows a stereoscopic, variable magnification, controlled view of the angle structures and the site of entry of the operative blade simultaneously. The lens is light enough to prevent collapse of the globe and small enough to allow limbal entry of the goniotomy knife. (9:00-11:O0 am)

•

SCIENTIFIC POSTERS AND EXHIBITS

127

Poster 62 Levobunolol: A Beta-Adrenoceptor Antagonist Effective in the Treatment of Glaucoma Frank Berson, MD, Boston, MA; *Reed Bouchey, Detroit, MI; Alfonse Cinotti, MD, Newark, NJ; *Donald Cinotti, MD, Jersey City, NJ; Howard Cohen, MD, San Francisco, CA; *Robert David, MD, Beer Sheba, Israel; David Epstein, MD, Boston, MA; *John Esters, Biloxi, MS; Robert Foerester, MD, Colorado Springs, CO; Miles Galin, MD, New York, NY; *Orna Geyer, MD, Tel Aviv, Israel; William Grant, MD, Newark, NJ; Ivan Jacobs, MD, North Plainsfield, NJ; Michael Kass, MD, St. Louis, MO; Jonathan Lass, MD, Cleveland, OH; Jin Lee, MD, Detroit, MI; *Manuel Ober, MD, Furth, West Germany; Leon Partamian, MD, Lakewood, CA; *Armin Scharrer, MD, Furth, West Germany; Dong Shin, MD, PhD, Detroit, MI; David Silverstone, MD, New Haven, CT

to five applications with four pulses per application were delivered to the iridectomy site. The age range varied from 5~ to 87 years. Scanning electron microscopy was performed on iridectomy specimens excised three hours to ten weeks after laser treatment. Electron microscopy revealed mostly full thickness laser perforations of the iris, without evidence of inflammation. Tissue excised within a few days of laser treatment showed fibrinous material and red cells at the edges of the applications. (9:00-11:00 am)

We compared the ocular hypotensive efficacy and systemic and ocular safety of levobunolol, 0.5 percent and 1.0 percent, b.i.d., with 0.5 percent timolol in two long-term double-masked studies in approximately ~OO subjects with glaucoma or ocular hypertension. Subjects received the test medication for up to 20 months. Both concentrations of levobunolol reduced mean lOP 7-9 mm Hg for up to 20 moriths, similar to timolol. Slight decreases in mean heart rate and blood pressure were observed. No unexpected adverse systemic or ocular reactions were reported. The results of these studies suggest that levobunolol may be an effective therapy for the treatment of glaucoma. (These studies were conducted at 12 sites in Germany, Israel and the US, under the sponsorship of Allergan Pharmaceuticals, Inc.) (1:00-3:00 pm)

Early glaucomatous visual field loss involves relatively small areas of the visual field. Detection of these defects demands a comprehensive examination of the entire visual field. Scrutiny of established scotomata over time does not require routine reexamination of the entire visual field. High-resolution user-defined programs have been developed on the Octopus computerized perimeter to perform quantitative analysis of specific areas of interest, allowing more sensitive follow-up of the glaucomatous process. We report the results of the longitudinal study of more than 100 patients using specially designed programs to demonstrate the advantages of this technique. (1:00-3:00 pm)

Poster 63 Modem Goniosynechialysis for the Treatment of Synechia! Angle-Closure Glaucoma David G. Campbell, MD, Atlanta, GA; Angela Vela, MD, Galveston, TX A new and successful technique for goniosynechialysis is described. The essentials of the technique include: use of the chamber deepening procedure to provide a wide, safe entrance to the angle; use of sodium hyaluronate to hold the deepened configuration and to stop and localize bleeding, thus maintaining visibility; use of an irrigating cyclodialysis spatula to aid in holding the deepened chamber and in stopping bleeding; and direct visualization of the angle. Four cases with severe synechial angle-closure of one year's duration or less were cured with return to normal lOPs. Range of follow-up was 7 to 15 months. The procedure should be considered for patients with significant short-term synechial angle-closure glaucoma. (3:00-5:00 pm)

Poster ~ Histopathology of Neodymium:YAG Laser Iridectomy in Humans Merlyn M. Rodrigues, MD, PhD, Potomac, MD; George L. Spaeth, MD, Marlene Moster, MD, Philadelphia, PA; *Gunter Thomas, *Joseph Hackett, Bethesda, MD Peripheral iridectomies using the Nd:YAG laser (LASAG mode!) were performed on patients with primary open-angle and narrow-angle glaucoma, and nonglaucomatous controls. The laser was set in the multimode for a spot size of 50 Jl ,an exposure time of 12 nanoseconds, and a power setting of 5-9 mJ. Between two

Poster 65 Adaptive Computerized Perimetry in Glaucoma Joseph Caprioli, MD, Philadelphia, PA; William R. Whalen, MD, Littleton, CO; George L. Spaeth, MD, *Joan M. Slagle, Philadelphia, PA

Poster 66 Superior Diagnostic Capabilities of Strategies in Automated Perimetry Richard P. Mills, MD, Seattle, WA

Interactive

Test

A source of frustration in interpretation of automated fields is the frequent lack of adequate information to assign an abnormal screening field to a diagnostic category. Further visual field testing must therefore be done following screening. Three threshold-related screening strategies of different complexity and patient interaction were evaluated on 75 eyes at the Dicon AP2000 perimeter, using quantitative Goldmann perimetry as a standard. The ''hillof-vision" was the most useful, the "central 30 + peripheral" was the least useful, and the "two-zone threshold" was intermediate in providing diagnostically important information. However, the more complex strategies resulted in higher false alarm rates and were more timeconsuming. (3:00-5:00 pm)

Poster 67 Levobunolol: Effect on Aqueous Flow, Outflow Facility, Uveoscleral Flow and Episcleral Venous Pressure *Gary D. Novack, PhD, Irvine, CA; Michael E. Yablonski, MD, *Greg Harmon, MD, New York, NY We evaluated the acute effects of instillation of 0.5 percent levobunolol in one eye in 15 subjects with ocular hypertension. Fellow eyes received vehicle and served as a control. Aqueous flow was measured by fluorophotometry Preliminary and total outflow facility by tonography. analysis showed a unilateral decrease of up to ~O to 50 percent in aqueous flow, 20 to 30 percent decrease in lOP, and no effect on either true outflow facility, episcleral venous pressure or uveoscleral outflow. Slight contralateral aqueous flow and lOP decreases were observed in the

*by invitation

128

OPHTHALMOLOGY

•

vehicle-treated eye. The results of this study suggest that LBUN lowers lOP primarily via a decrease of aqueous humor production. (9:00-11:00 am)

Poster 68 Suprachoroidal Hemorrhage Following Filtration Procedures Jon M. Ruderman, MD, David G. Campbell, MD, Thomas Harbin, MD, Atlanta, GA We present ten patients, nine having undergone previous ocular surgery, who developed suprachoroidal hemorrhage within the first four days following filtration. Seven of the patients were aphakic, and five were (or had been) high myopes. Pain was not necessarily a presenting symptom, and three patients developed a hemorrhage as late as four days postoperatively. Our findings demonstrate that suprachoroidal hemorrhages present in a variable fashion following filtration surgery and that their incidence (2 percent overall) may be much higher than previously appreciated, especially in those patients who have had prior ocular surgery (approximately 5 percent). Prevention, pathophysiology and successful treatment are discussed. U :00-3:00 pm)

Poster 69 Early Loss of Central Visual Acuity in Glaucoma *James E. Pickett, MD, Stuart A. Terry, MD, Patrick S. O'Connor, MD, San Antonio, TX Central visual acuity tends to be maintained until late in the course of glaucoma. Eight patients with glaucoma (five females and three males) between the ages of 25 and 79 were found to have decreased central vision with associated centrocaecal scotomas early in their course. Five had chronic open-angle, two pigmentary, and one juvenile glaucoma. A Marcus Gunn pupil was present in all five of the patients not on miotics. The majority lost central acuity at pressures under 30 mm Hg. Other causes were carefully ruled out. The scotomas were principally centrocaecal in nature, but two also involved the superior arcuate, and one the inferior arcuate area. Four patients had vision less than 20/200. Decreased vision can be a relatively early finding in glaucoma. (3:00-5:00 pm)

Poster 70 Histologic and Physiologic Sequelae of YAG Laser Posterior Capsulotomy in the Primate Model *Julia Haller Yeo, MD, Baltimore, MD; Warren Fagadau, MD, Dallas, TX; W. Richard Green, MD, *Mahmood Farazdaghi, Harry A. QUigley, MD, *Peter McDonnell, MD, Walter J. Stark, MD, A. Edward Maumenee, MD, Baltimore, MD Extracapsular cataract extraction and posterior chamber IOL implantation were performed on 14 primate eyes with development of capsular opacification. Two eyes, one treated with 100 mJ and one with 1000 mJ of YAG energy in 2-10 mJ deliveries, were enucleated at one hour, three hours, one day, three days, one week, three weeks and one month. lOP and tonography were monitored pre- and post-Y AG. Eyes were examined with light, scanning, and transmission EM. lOP rises over 15 mm Hg occurred in eight eyes, resolving by one day. Primates, like humans, appear to be subject to VAG-induced lOP spikes, whether because of capsular debris clogging the meshwork, toxicity

•

PROGRAM SUPPLEMENT

of IOL-released substances, or direct angle damage. Discussion will deal both with these possibilities and with histological sequelae of YAG capsulotomies in the primate model. (9:00-11:00 am)

Poster 71 Clinical Application of a Self-Tonometer for Home Tonometry *Ran C. Zeimer, PhD, Jacob T. Wilensky, MD, Chicago, IL; David K. Gieser, MD, Wheaton, IL; *Marek T. Mori, Chicago,IL Home tonometry has been advocated by leading ophthalmologists for diagnosis and monitoring of glaucoma. This procedure, however, has had only limited application, mostly due to the lack of an adequate instrument. We have developed a self-tonometer that can be given to patients for a limited period, during which time they obtain diurnal curves of their intraocular pressure. The method has proved safe and has yielded results with a reproducibility comparable to that of the applanation tonometer. We have found that home tonometry detects pressure spikes that would have been missed with standard office tonometry. We will discuss the implication of the home tonometry results on the management of our patients. U:00-3:00 pm)

Poster 72 A New Gonioscopy Lens for the Gradatioo of Trabecular Meshwork Pigmentation *John W. Boys-Smith, MD, New Orleans, LA; David G. Campbell, MD, *Wendell D. Woods, PhD, Atlanta, GA Using pigment separated from the posterior pigment layer of the human iris passed through a two micron Nucleopore filter, a six density pigment scale (0, 1, 2, 3, 4, 5) was developed to grade the degree of pigmentation within the human trabecular meshwork. Laquer pigments representing the gradations were then incorporated as a scale withirt an Ocular Instruments three-mirror lens so that the human trabecular meshwork and the scale could be simultaneously viewed through the gonioscopy mirror using the same illumination. The authors feel the lens will be useful to document total pigmentation and distribution of pigmentation in the various glaucomas, to follow the course of pigmentary glaucoma, and to further our knowledge of LTP by..comparing the effect of the laser on varying degrees of pigmentation within the trabecular mesh. (3:00-5:00 pm)

Poster 73 Problems in the Diagnosis and Management of Cyclodialysis Clefts *L. David Ormerod, MD, George Baerveldt, MD, Ronald L. Green, MD, Los Angeles, CA Cyclodialyses from trauma or surgery involving angle structures may cause profound persistent hypotony. As they may be large and multiple, assessment is the key to management. However, a shallow anterior chamber may preclude gonioscopy. We shall report our experiences with Healon, used both to delineate the cleft and to give access for argon laser photocoagulation. Fluorescein instillation with sclerotomy and the ultrasonic investigation of clefts may also be useful. Recommendation for a comprehensive approach to the medical and surgical management of the cyclodialysis cleft will be made. These include argon laser

•

SCIENTIFIC POSTERS AND EXHIBITS

129

photocoagulation, cyclodiatherm"y, various cyclopexy surgeries, cryoablation and anterior scleral buckling procedures. This discussion will be based upon our experience as well as analysis of the international literature. (9:00-11:00 am)

models and cross-tabulation analysis was performed to assess the validity of each. Life table analysis and ANOV A techniques were used to determine the prognostic implications of tumor diameter, elevation, location, volume, and patient age at diagnosis. (9:00-11:00 am)

Poster 74 Gonioscopy: A New System of Recording Observations Angela Vela, MD, Galveston, TXj David G. Campbell, MD, Atlanta, GA

Poster 77 Endogenous Bacillus Cereus Panophthalmitis Claude L. Cowan Jr., MD, *Willis Madden, MD, Washington, DC

Gonioscopic assessment of the anterior chamber angle has gained a dramatic resurgence since the introduction of laser surgery and other modern approaches to trabecular surgery. Numerous classifications and diagrams have been suggested in the past to describe gonioscopic findings. This exhibit will illustrate a new system we developed for documenting gonioscopic observations. The combined use of a simple diagram and a color code (similar to drawing a retina or cornea) offer the following advantages: a standardized means of recording clinical data, a simple and practical system of documenting gonioscopic findings, a more accurate method of following pathology, and more elaborate and detailed recordings for the researcher. (1:003:00 pm)

Over the past seven years we have had the opportunity to treat three cases of endogenous Bacillus cereus panophthalmitis. Ocular features of infection with this organism include severe pain, chemosis, proptosis, corneal infiltration and ring abscess, subretinal exudation, retinal hemorrhages, and perivasculitis. The process becomes rapidly fulminant and may be accompanied by fever and leukocytosis. Ophthalmologists should be cognizant of the apparent susceptibility of drug abusers to B. cereus infections and should consider this organism in any severe, rapidly evolving intraocular infectious process. (1:O0-3:00 pm)

Poster 75 fiJman Monoclonal Antibodies to Melanocytic Tumors Narsing A. Rao, MD, *Alan D. Sampson, MD, *Ashraf Imam, PhD, *Ana Maria Z. Lopez, MD, *June Kan-Mitchell, PhD, *Malcom S. Mitchell, PhD, Los Angeles, CA Human-mouse hybrid cells were prepared by fusion of murine myeloma cells with lymphocytes obtained from lymph nodes of a patient with cutaneous melanoma. The hybridoma clones synthesized monoclonal IgG, which preferentially bound to epithelioid cells of cutaneous melanoma. In order to better define the use of this monoclonal IgG as a marker for ocular melanomas, we studied six uveal melanomas, six conjunctival melanomas The and six nevi by immunohistochemical technique. epithelioid cells in all melanomas stained positively. The spindle B cells of uveal melanomas showed variable staining patterns. None of the nevi stained positively. We conclude that the above technique may be a useful adjunct to morphologic analysis of cell type and an indicator of malignancy. (3:00-5:00 pm)

Poster 76 Cobalt Plaque Therapy for Ocular Melanoma: Prognosis for Survival Based upon Tumor Size and Location *Jonathan Javitt, MD, Philadelphia, PAj Robert M. Ellsworth, MD, David Abramson, MD, Bartett Haik, MD, New York, NY Local radiotherapy by cobalt plaque is an alternative to enucleation in the treatment of ocular melanoma. This study presents the prognostic factors for survival in a series of 132 patients treated with cobalt plaque therapy in one center over 15 years and followed by a single examiner. Patients were followed at six-month intervals, and B-scan ultrasonography was used to measure tumor diameter and elevation. Tumor location was graded according to the nine-point scale currently in use at AFIP. Tumor volume was estimated according to three different geometric

Poster 78 Treatment of Metastatic Bacterial Successful Endophthalmitis with Systemic Antibiotics Alone *Lisa G. Wohl, MD, Mark J. Greenwald, MD, Chicago, IL Metastatic bacterial endophthalmitis in two children with meningitis and septicemia resolved completely following treatment with intravenous antibiotics alone. N. meningitidis was the pathogen in one case and P. aeruginosa in the other. The pseudomonas infection did not respond to therapy until the dosage of amikacin was adjusted to provide optimal serum drug levels. Analysis of these and previously reported cases and review of theoretical considerations suggest that systemic antibiotics are uniquely valuable in this type of endophthalmitis, and that intraocular antibiotic injection and vitrectomy should not be performed routinely for metastatic infection. (3:00-5:00 pm)

Poster 79 Otanges in central Field Contrast Sensitivity Following Cyclosporine Therapy for Uveitis *Kent E. Higgins, PhD, Robert B. Nussenblatt, MD, Alan G. Palestine, MD, Chi-Chao Chan, MD, *Francisco de Monasterio, MD, *Patricia Mercer, Bethesda, MD The critical assessment of various therapeutic regimens for intraocular inflammatory disease requires more standardized forms of evaluation. We report here the loss in central field resolution in such patients and subsequent improvement following cyclosporine therapy. Conventional visual acuity measurements were supplemented by spatial contrast sensitivity testing using a forced-choice procedure to minimize spurious test-retest changes in visual resolution. (1:O0-3:O0 pm)

*by inv ita tion

130

OPHTHALMOLOGY

•

Poster 80 Oxygen Free Radicals and Ocular Tissue Injury David S. Hull, MD, *Keith Green, PhD, Augusta, GA Phagocytes in inflammatory lesions produce reactive oxygen species which include the super-oxide anion, singlet oxygen, hydroxyl radical, and hydrogen peroxide. These oxygen species are useful for killing microorganisms, but they may damage surrounding tissues. Cornea endothelial cells exposed to oxygen free radicals show a decreased pumping function and cellular damage. Exposure of iris tissue to oxygen free radicals results in increased vascular permeability. The potential damaging effect of prolonged intraocular inflammation on anterior segment structures and corneal endothelial cells as mediated by free radicals will be shown, and pharmacological approaches to protect tissues against free radical damage will be explained. (1:00-3:00 pm)

Poster 81 Posterior Ciliary Artery Obstruction Secondary to Metastatic Breast Carcinoma *Jeffrey G. Odel, MD, Julian J. Nussbaum, MD, Daniel W. Steen, MD, Detroit, MI Choroidal filling defects are caused by two basic mechanisms: obstruction of the posterior ciliary arteries, and congenital absence of choroidal tissue. A 32-year-old woman with metastatic breast carcinoma was noted to have delay in papillary and peripapillary choroidal filling on fluorescein angiography. Orbital CT scan and ultrasonography confirmed the presence of a mass lesion involving the right optic nerve and orbit. We believe that this is the first reported case of delayed filling of the posterior ciliary arterial circulation due to orbital and peripapillary tumor compression. (3:00-5:O0 pm)

Poster 82 Ocular Parasitic Infestation in Thailand *Chaiwat Teekhasaenee, MD, Robert Ritch, MD, New York, NY Parasitic infestation is one of the major medical problems in tropical countries. In Thailand, gnathostomiasis, angiostrongyliasis and cysticercosis are the three most common ocular parasitic infestations. Up to 46 percent of patients affected by cystercercosis may have ocular involvement, resulting in severe fulminant granulomatous inflammation leading to fibrous proliferation and eventual blindness. At present no antiparasitic drugs are available, and successful treatment depends entirely on early complete surgical removal. Increasing world travel and influx of refugees from tropical nations demand greater awareness of ocular parasitology. (9:OO-11:OO am)

Poster 83 Uncommon Causes of Altitudinal Visual Field Loss Marilyn C. Kay, MD, Milwaukee, WI Monocular altitudinal visual field loss commonly occurs from retinal vascular occlusive disease or ischemic optic neuropathy. Systemic vasculopathies, cardiac arrythmias or valvular disease, and carotid occlusive disease must be ruled out in some cases. However, pituitary neoplasms, intracranial carotid artery lesions, and retinal

•

PROGRAM SUPPLEMENT

dystrophies can present in the same way. Cases will be presented to illustrate pertinent details of the history and clinical findings pointing to such uncommon etiologies. U:OO-3:OO pm)

Poster 84 Carotid Cavernous Fistula After Carotid Endarterectomy *Gary Cowan, MD, Robert Lesser, MD, New Haven, CT After carotid endarterectomy with a Fogarty catheter, two patients developed carotid cavernous fistulae. Carotid cavernous fistula formation could be secondary to either perforation of the arterial wall or tearing of the intracavernous branch of the internal carotid artery. Repair of the carotid cavernous fistula by detachable balloon catheter is discussed. (3:O0-5:O0 pm)

Poster 85 Ocular and Systemic Abnormalities Associated with Morning Glory Syndrome William E. Jackson, MD, *Sieglinde Freed, Denver, CO The term "morning glory syndrome" is currently used to describe a clinical complex encompassing a primarily congenital, possibly hereditary optic nerve anomaly associated with other ocular and systemic abnormalities. This syndrome has been shown to be most usually limited to the eye. However, recent studies have illustrated that morning glory syndrome may be associated with such systemic abnormalities as sphenoidal encephalocele. We will present a review of the current literature and functionally analyze the incidence of retinal detachment, preretinal gliosis, and increased production of fibrovascular tissue as well as systemic involvement, utilizing fluorescein angiography, computerized tomography, photography, ultrasonography and electrophysiology. (9:00-11:00 am)

Poster 86 Temporal Arteritis in Blacks G. Robert Lesser, MD, *Jeffrey Rapkin, MD, *Donald Moore, MD, *Jeffrey Odel, MD, Detroit, MI Giant cell arteritis (temporal arteritis) has not been reported in black patients in the ophthalmic literature. We will present our experience with temporal arteritis in blacks at our institution, providing precise laboratory, pathologic and funduscopic documentation. (l:OO-3:OO pm)

Poster 87 Complications from Retrobulbar Injection W. Sanderson Grizzard, MD, Tampa, FL; Scott E. Pautler, MD, Lutz, FL In 1983 at the American Academy of Ophthalmology, we presented a poster on retrobulbar injections into the optic nerve sheath. We believed this complication was more common than generally reported and we asked the question, "Has this ever happened to you?" We received and are still receiving replies from many ophthalmologists and our The technique for hypothesis has been confirmed. retrobulbar injection which resulted in this complication was the combination of the Atkinson method (eye looking superonasally) and a sharp, disposable needle. The results of

•

131

SCIENTIFIC POSTERS AND EXHIBITS .

our survey and a safer technique .of retrobulbar injection will be presented. 0:00-5:00 pm)

Poster 88 Postkeratoplasty Corneal Ulcers and Bandage Lenses Gullapalli N. Rao, MD, Eddie M. Garcia, MD, James V. Aquavella, MD, Rochester, NY Two

hundred eighty-five cases of penetrating where hydrophilic bandage lenses were used were analyzed. Corneal ulcers were noted in 26 of these eyes. Staph. aureus, pseudomonas aeroginosa, klebsiella pneumoniae, serratia marcescens and E. coli were isolated from these ulcers. Despite appropriate treatment with antibiotic regimen, deleterious effects were noted on the corneal transplants leading to visual loss. The preoperative condition of the host eyes, topical medications, and location of ulcer determined the ultimate outcome of the graft and visual acuity. The recognition of special risk factors for the development of infection in corneal grafts needs emphasis. (9:00-11:00 am) keratopla~ty

Poster 89 Simulated Subjective Refractometry *Michael A. Henningsen, David L. Guyton, MD, Baltimore, MD Teaching subjective refraction techniques ("refractometry") is enhanced by having the student experience the effect of each lens change "through the eyes of the patient." A projector, positioned behind the phoropter, projects a visual acuity chart through the phoropter onto the far wall. "Vnknown" refractive error is simulated by attaching trial lenses to the lens barrel of the projector, and the student progressively clears the projected image as he or she learns the standard steps of subjective refractometry. The focus sensitivity of each lens change can be varied, if desired, by stopping down the projection system. This simulation, which uses equipment readily available in most ophthalmology offices, has proven useful for both demonstration and practice. (1:oo-3:00 pm)

Poster 90 Scanning Electron Microscopy of Never-Worn Soft Contact Lenses *Janet K. Deg, San Diego, CA; Perry S. Binder, MD, La Jolla, CA Various hydrogels were prepared for scanning electron microscopy by critical point drying using CO 2, freon or air drying with or without alcohol dehydration. The lenses revealed unexpected surface deformities which resembled deposits reported on used contact lenses. Gas pockets and surface wrinkling were more prominent with 'C02 processing compared with freon processing. Air drying produced granular formations and/or crystalline structures randomly dispersed over both surfaces. No single technique was Individual polymers reacted universally acceptable. differently to different techniques of processing. It is important to develop dependable processing methods to accurately identify and evaluate lens surface contamination. (3:00-5:00 pm)

Poster 91 Clinical Applications of Contrast Sensitivity Testing William E. Jackson, MD, *Sieglinde Freed, Denver, CO Currently, the contrast sensitivity test is a sensitive, broad spectrum test of visual function. In clinical practice, it can serve as an "early warning" system . for visual disorders. Its use in differential diagnosis is also promising, but will depend upon the development of procedures that assess contrast sensitivity in the presence of some stressor of visual function. Use of contrast sensitivity methods in conjunction with the ERG and VEP will be covered as well as a review of contrast sensitivity testing in relation to cataract formation, glaucoma and optic neuritis. We will provide examples of dysfunction curves as they relate to these disease entities, as well as examine newer applications for this testing in areas of low-vision patient assessment and military pilot performance simulation. (9:00-11:00 am)

Poster 92 Corneal Toxicity Secondary to Scleral Lens Preparation for Eyelid Surgery Gil A. Epstein, MD, Mark Feldman, MD, Fort Lauderdale, FL Scleral contact lens protectors rarely cause complications. A case of severe corneal toxicity secondary to prolonged chemical exposure is presented. The lenses had been soaked in phenolated sterilizing solution for two weeks. Proper methods of sterilization to avoid this complication are described. (1:O0-3:OO pm)

Poster 93 Local Flaps for Periorbital Reconstruction Russell S. Gonnering, MD, Milwaukee, WI Although most ophthalmologists are familiar with classic methods of full-thickness lid reconstruction, techniques for closure of partial-thickness or extra marginal defects are less well known. With the utilization of frozen section controlled excision of periorbital malignancies, such defects are increasingly common. Although skin grafts will provide closure of such defects, in many situations a better functional and aesthetic result will occur with the use of an appropriate local flap. Knowledge of the rhomboid, the bilobed and various other rotation or transposition flaps is exceedingly useful in the clinical management of such situations. 0:00-5:00 pm)

Poster 94 Use of an Autogenous Fascia Lata Wrapped Sphere in Enucleation Michael J. Hawes, MD, Denver, CO Following enucleation with isolation of the rectus muscles, a sphere is wrapped in autogenous fascia lata femoris and placed in Tenon's capsule. The rectus muscles are sewn to the fascia lata. Advantages of the procedure include: improved motility of the prosthesis; improved stability of the implant, with less likelihood of extrusion or migration; ability to place a large implant with improved volume replacement; and physiologic location of the implant. (9:00-11:00 am)

*by invitation

132

OPHTHALMOLOGY

•

Poster 95 Fine Needle Aspiration in Orbital Diagnosis Jean Edwards Holt, MD, *G. Richard Holt, MD, *lbrahim Ramzy, MD, San Antonio, TX The technique of needle aspiration of orbital masses using high-pressure suction techniques has been very helpful in making a diagnosis. With the cooperation of the histopathologist, this procedure can yield a rapid diagnosis in a variety of conditions including neoplasms, infections and other masses of unknown origins. Prompt and proper surgical and/or medical therapy can then be carried out. We will present a review of the conditions where this procedure is helpful, the technique for performing needle aspiration, and methods of handling the specimen once it is obtained from the orbit. (1:O0-3:00 pm)

Poster 96 Systemic Cis-Platinum and Doxorubicin Olemotherapy for Basal Cell Carcinoma of the Eyelids and Periorbital Tissues Malcolm N. Luxenberg, MD, *Troy H. Guthrie Jr., MD, Augusta, GA

Six patients, ages 65 to 68 years, with histologically proven basal cell carcinoma involving the eyelids and/or periorbital tissues, were treated with systemic cis-platinum and doxorubicin chemotherapy. All patients had refused surgery or would have required extensive disfiguring procedures with possible loss of ocular function or had medical problems contraindicating surgery. Two patients had received no treatment, two had prior extensive surgery and two had undergone previous surgery and radiation therapy. All had residual or recurrent tumors at the time treatment was started. Systemic chemotherapy induced a partial or complete response in all patients and none have required maintenance chemotherapy. The duration of remissions ranges from two to 36 months. (3:00-5:00 pm)

Poster 97 Three-Dimensional-Like Localization of Foreign Bodies in Orbital Region *S. James Zinreich, MD, James B. Aguayo, MD, *Roger Hatfield, *Arthur Rosenbaum, MD,Baltimore, MD Traumatic consequences to the ocular system are expected to be assessed expeditiously and accurately. In recent years, X-ray computed tomography has provided extraordinary means for detection and localization of foreign bodies. Localization, however, has largely been confined to imaging in the axial plane. The object of the communication is to assess the role of a new "threedimensional" CT reconstruction mode (Siemens Medical Systems) in improving evaluation of foreign bodies. An in vitro bovine model and patient applications will be presented. (9:00-11:00 am)

Poster 98 Ptosis as a Symptom of Adnexal and Orbital Tumors Steven J. Laukaitis, MD, Robert B. Wilkins, MD, Houston, TX Ptosis may be the presenting symptom of patients with orbital and adnexal tumors. This may be a therapeutic embarrassment if surgical repair of the ptosis is attempted as the initial treatment of choice. This poster will

•

PROGRAM SUPPLEMENT

demonstrate case histories of ptosis as the initial presenting symptom of patients with adnexal and orbital tumors. Anatomic drawings will be utilized to explain the various specific mechanisms of ptosis and the angular displacement of orbital contents due to the tumor. (1:O0-3:O0 pm)

Poster 99 Visual Field Defects from Ptosis, a Stimulus for Lid Retraction John V. Linberg, MD, *Stephen Powell, MD, Morgantown, WV A series of ballasted soft contact lenses were manufactured with the upper portion rendered opaque and a sharp horizontal edge separating the clear and opaque areas. When placed on the eye these lenses simulated the optical effects of mild to severe ptosis in normal volunteers. The Goldmann perimeter was used to document a progressive peripheral superior field loss with increasing ptosis. Photographs demonstrated progressive retraction of the upper eyelids, as increasing unilateral ptosis was optically simulated with the contact lens series. These data document a visual field loss with ptosis and suggest a reflex that elevates both upper lids in response to superior field loss. (3:00-5:00 pm)

Poster 100 Basal Cell Carcinoma of Eyelids: Most Frequent Indicator of Systemic Malignancy Ralph E. Wesley, MD, Nashville, TN; John W. Collins, MD, Lexington, KY Basal cell carcinoma (BCC) is both the most frequent ophthalmic cancer as well as the most common cancer in humans. BCC occurs as a multi focal process in persons with sun exposure and susceptible skin type. The poster illustrates that persons found to have eyelid BCC are likely to have other unsuspected extraocular foci, since the disease is a systemic dermal malignancy. Areas most likely to have additional foci are illustrated and highly susceptible individuals are identified. (9:00-11:00 am)

Poster 101 Clinicopathologic Correlation of Mucolipidosis-l Ramesh C. Tripathi, MD, PhD, Chicago, IL; Gerhard W. Cibis, MD, Kansas City, MO; Brenda J. Tripathi, PhD, Chicago, IL; *David J. Harris, MD, Kansas City, MO In three cases of mucolipidosis-l with characteristi<;: ocular and systemic manifestations, age dependent variation in accumulation of lipid (lamellar) vs. mucopolysaccharide (granulo-amorphous) inclusion material is evident in the rapidly evolving corneal epithelium of this fatal, neuraminidase deficiency disorder. Single membrane-bound vesicles with lamellar lipid inclusions predominate in the basal cells. The vesicles enlarge in the wing and superficial cells to contain more granulo-amorphous material and relatively fewer lamellar inclusions, thereby resembling the storage vesicles in fixed cells of the retina and cornea. This indicates that the lipid defect is a basic developmental one and the predominant accumulation of mucopolysaccharide material occurs subsequently. (1:OO-3:O0 pm)

•

133

SCIENTIFIC POSTERS AND EXHIBITS

Poster 102 Contact Lens Management After cOngenita1 .Cataract at the Hospital for Sick Children (Toronto) Henry P. Brent, MD, Maria Arstikaitis, MD, Toronto, Ontario

Poster 105 Ophthalmologic and Electroretinographic Findings in Hurler's, Hunter's and Sanfilippo's Syndromes Irene H. Ludwig, MD, *Rafael C. Caruso, MD, Muriel I. Kaiser-Kupfer, MD, *Joseph Muenzer, MD, Bethesda, MD

Eighty babies operated for congenital cataracts were fitted with daily wear contact lenses under general anesthesia, and were followed to monitor fit, refractive correction and compliance with patching regimen. Keratometry and A-scan ultrasound were performed sequentially in some patients. The aphakic eyes were found to change rapidly, requiring refitting of lenses for proper fit and optical correction. Full-time contact lens wear was achieved in virtually all patients, but the alternate-day occlusion in unilateral aphakia proved difficult for parents, and required substantial moral support. (3:00-5:00 pm)

Complete ophthalmologic examinations were conducted as a part of the baseline evaluation of three Hurler's, three Hunter's and five Sanfilippo's syndrome patients (ages three to 14) participating in a clinical trial to evaluate the possible beneficial effect of amniotic membrane implantation. Ophthalmoscopic findings included disturbances of the peripheral RPE and arteriolar narrowing. After 30 minutes of dark adaptation, Ganzfeld ERGs recorded under anesthesia showed subnormal rodmediated responses and, to a lesser extent, subnormal conemediated responses, similar to findings in a rod-cone dystrophy. These findings correlated with the clinical assessment of vision and the degree of neurologic impairment. An additional II patients will participate in this study. (3:00-5:00 pm)

Poster 103 Animal Model for Amblyopia Research J. Allen Gammon, MD, Atlanta, GA; *Ron Boothe, PhD, Seattle, WA; *Jim Wilson, PhD, *Margaret Tigges, PhD, Atlanta, GA . Amblyopia remains a common complication encountered during the treatment of monocular congenital cataracts. An animal model has been developed to investigate monocular cataract treatment methods. Six: infant monkeys underwent lensectomy shortly after birth. The aphakic eye was corrected with a high plus, continous wear soft contact lens in four animals. In two of these animals, the unoperated eye was continuously occluded. At six months of age, monocular visual acuity was tested behaviorally and documented improved, but not normal vision in the optimally treated aphakic eyes. Electrophysiological and neuro-anatomical studies will be completed and compared to treatment paradigms and known visual function in these experimental animals. (9:00-11:00 am)

Poster 104 Clinical Applications of the Visual Evoked Potential in Infants and Small Children William E. Jackson, MD, *Sieglinde Freed, Denver, CO This presentation will illustrate and review current trends in the study of maturation of flash and patternreversal YEP response in full-term infants and small children. Covered will be an explanation of flash and pattern-reversal YEP values as they relate to: development of visual function, recording and stimulus parameter variability, classification of normal and abnormal response, and inter subject fluctuation. Specifically addressed with regard to the flash YEP will be transitional states of infant response and the utilization of sine wave and Gaussian modulated light. Exploration of the pattern-reversal YEP will include examination of the foveal contrast mechanism, restriction of the stimulus field, estimates of acuity as a function of check size and YEP comparison with acuity data. (1:00-3:00 pm)

Poster 106 Intraoperative Adjustment of Eye Muscle Sutures Robert H. Bedrossian, MD, Vancouver, WA In 76 operations for horizontal strabismus, sutures were adjusted under anesthesia. In 69 the postoperative horizontal deviation was within 10 prism diopters of orthotropia six months after surgery. Three patients had 12 prism diopters of residual esotropia after being straight in the initial postoperative period. Only four operations resulted in unsatisfactory correction. The appropriate adjustment of eye muscle sutures under anesthesia can improve the results of strabismus surgery and may eliminate the need for adjusting sutures when the patient is awake after anesthesia. It expands the use of adjustable muscle surgery to include children. (9:00-11:00 am)

Poster 107 Clinical Trial of a New Method For Amblyopia Screening Michelle Berger, MD, Belton, TX; *Argye Hillis, PhD, Richard D. Cunningham, MD, Louis W. Adams, MD, Temple, TX Much insight into amblyopia has been gained in recent years, and most authorities advocate early treatment. We are currently conducting a screening program using a binocular viewing device first described at ARVO in 1982. Screening is coordinated through the pediatrics department in a large multispecialty clinic. Approximately 2,500 children of ages two to five are screened each year, at every visit to the clinic. Some children will be tested repeatedly, helping establish the validity of this device. Eight months' experience of the program is reported in evaluation of a safe, quick, and effective method of amblyopia screening that can be performed routinely in pediatricians' offices. (1:00-3:oo pm)

*by invitation

134

OPHTHALMOLOGY

•

Poster 108 Visual Outcome in Very Low and Low Birth Weight Pre matures J. Allen Gammon, MD, Atlanta, GAj *Zeeba Najak, MD, Dunwoody, GAj *B. Dunbar, PhD, *B. Sweeney, Atlanta, GA Visual outcome and the functional status of the nervous system was compared in prematures less than 1,000 grams (Gp. A), and pre matures greater than 1,000 but less than 1,500 grams (Gp. B) at three years of age. Visual handicaps were identified in 33 percent of A and 28 percent of B. Four of 51 infants (7.8 percent) with birth weights less than 1,000 grams were blind from retinopathy of prematurity (ROP), while only two of 58 infants (3.lj. percent) with birth weights greater than 1,000 grams but less than 1,500 grams were blind from ROP. A statistically significant relationship between intraventricular hemorrhage and strabismus was observed. (3:00-5:00 pm)

Poster 109 The Remote Krimsky Test: A Simple Quantitative Test of Ocular Alignment Norman N. K. Katz, MD, Washington, DC A simple technique for objective measurement of ocular alignment at near fixation is described which utilizes the principles of planar deviometry described by Krimsky. The patient is allowed to fixate on a near target situated at a known distance. A penlight held in the frontal plane of the patient corresponding to the fixation device is centered in the pupil of the deviated eye. The ocular deviation in prism diopters can easily be computed by applying Prentice's law. This test is especially advantageous in large angle strabismus and in infants and children who object to a cover or prism close to the face. This test also avoids some errors inherent in the Hirshberg test. (9:00-11:00 am)

Poster 110 The Importance of Refractive Correction of Hyperopia During Occlusion Therapy for Amblyopia Richard T. Scholz, MD, David L. Guyton, MD, Baltimore, MD It has been shown that amblyopic eyes do not accommodate fully under monocular conditions. Should a +1.50 hyperopic amblyopic eye be fully corrected during occlusion of the sound eye? Eighteen hyperopic amblyopes were located for whom reliable pre- and postocclusion visual acuities were available. Improvement in visual acuity (on a logarithmic scale) per month of occlusion was plotted as a function of uncorrected spherical refractive error. Patients with full hyperopic correction improved more quickly than patients without full refractive correction. This difference was highly significant, suggesting not only that the full refractive correction should be prescribed, but also that a bifocal lens may be beneficial during occlusion therapy. (1:00-3:00 pm)

Poster III Subretinal Nematode: An Unusual Etiology of Uveitis and Total Retinal Detachment This poster has been withdrawn.

•

PROGRAM SUPPLEMENT

Poster 112 Dynamic Amsler Grid Testing with Personal Computer Thomas A. Hanscom, MD, Santa Monica, CAj *Scott Foxman, MD, Los Angeles, CA Most patients with subretinal neovascularization cannot be treated because they do not present for evaluation when symptoms first appear. Daily home Amsler grid testing has been suggested for patients at risk of developing subretinal neovascularization. Twenty-five patients with various macular disorders were given Amsler grid sheets to study periodically, with appropriate instructions. These patients were surveyed 15 to lj.5 days later. A high degree of confusion concerning the purpose of the Amsler grid test was found. To improve compliance and reliability of Amsler grid testing, a method for dynamic Amsler grid tesing using a television screen and home personal computer was devised. Results of computerized Amsler grid testing in 25 patients will be shown. (9:00-11:00 am)

Poster 113 Octopus Sargon Foveal Static Thresholds and Focal Electroretinography in Cystoid Macular Edema Wesley K. Herman, MD, *David G. Birch, PhD, Warren R. Fagadau, MD, William S. Harris, MD, *David T. Disbrow, Dallas, TX

™

Patients with fluorescein angiographic positive pseudophakic and/or post- Y AG CME were studied during acute and convalescent phases of CME using Octopus 201 central field programs and temporally related focal electroretinography, each encompassing the central four degrees of fixation. Foveal static thresholds were mapped at a resolution o).~ degree to .1 degree, and transmitted from the Octopus to a microcomputer, where handshake software was used to aid in presentation and analysis. Standards for these techniques in age-matched pseudophakic normals will be presented and the clinical implications of our findings will be discussed. Application of our techniques in the investigation of other macular diseases will be introduced. (1:00-3:00 pm)

™

Poster 114 Ocular Involvement in Patients with Fungal Infections: A Pathologic Study *Peter J. McDonnell, MD, *Jan M. McDonnell, MD, Reay H. Brown, MD, W. Richard Green, MD, Baltimore, MD We reviewed the findings of 133 consecutive autopsies of patients who died with fungemia or with invasive fungal infection. Fungal infection was seldom diagnosed antemortem, and only 2lj. patients (18 percent) had documented fungemia. Ocular involvement occurred in Ilj. patients (candida II, aspergillus two, and cryptococcus one). The eye was the fifth most commonly involved organ at autopsy in patients with candida infection. Ocular involvement occurred with a statistically significantly higher frequency in patients with Candida tropicalis than with Candida albicans infections (p < 0.05). Although only about ten percent of patients with fungal infections had ocular involvement, all those with ocular lesions had widely disseminated infection. Ophthalmologic examinations are indicated in patients at risk for fungal infections. (3:00-5:00 pm)

•

SCIENTIFIC POSTERS AND EXHIBITS

Poster 115 Myopic and Non-Myopic Aphakic Retinal Detachment: Time Interval and Location of the Breaks Enrique S. Malbran, MD, Ricardo Dodds, MD, *Ricardo Hulsbus, MD, *Cristian Dodds, MD, *Daniel Charles, MD, *Fernando Car ide, MD, Buenos Aires, Argentina Among 471 aphakic detachments after ICCE, 318 eyes with non-complicated aphakia (no vitreous loss) were reviewed. Breaks were oral (58 percent), equatorial (32 percent) and non-detected (six percent). Myopic eyes showed: oral (50 percent) and equatorial (38 percent); nonmyopic eyes showed: oral (71 percent) and equatorial (19 percent). The time interval of aphakia and RD was, for myopic and non-myopic: within six months, 40 percent and 18 percent; within one year, 58 percent and 29 percent; within two years, 73 percent and 55 percent; and more than two years, 27 percent and 45 percent. Results showed a significant prevalence for: equatorial breaks in myopic eyes vs. non-myopic eyes (p < 0.005), and earlier detachments for myopic eyes vs. non-myopic eyes (p < 0.005). Equatorial breaks on both types of eyes seem to show earlier detachments. (9:00-11:O0 am)

Poster 116 Acute Glaucoma Secondary to Otoroidal Detachments During Scleral Buckling Vinod Lakhanpal, MD, Stanley S. Schocket, MD, Baltimore, MD Seven normotensive eyes of six patients seen between 1978 and 1983, requiring scleral buckling for retinal detachment, developed acute intraocular pressure elevation of 60 mm Hg or more during surgery. Pressure rise was seen in all eyes after isolation of recti, but before scleral buckling or sub retinal fluid drainage. Medical management failed to lower pressure and paracentesis, vitreous tap, choroidal and subretinal fluid drainage resulted in large hemorrhagic choroidal detachments without significant pressure lowering effect, necessitating termination of surgery in all eyes. Documentation of choroidal detachments was done with ultrasonography and CT scan in postoperative period. Three eyes became inoperative. Guidelines to prevent and treat this complication will be discussed. (1:00-3:00 pm)

Poster 117 Amphotericin Clearance in Vitrectomized Vs. NonVitrectomized Eyes Bernard H. Doft, MD, Pittsburgh, PA; *Jay Weiskopf, MD, Sewickley, PA; *Ingrid Nilsson-Ehle, MD, Lund, Sweden; *Lemuel Wingard Jr., MD, Pittsburgh, PA Ocular clearance of Amphotericin B after direct intravitreal injection was studied in a rabbit model using unmodified phakic eyes, Candida infected eyes, aphakic eyes, and aphakic vitrectomized eyes. Using high pressure liquid chromatography to assess drug level, the half lives of drug disappearance after single ten microgram intravitreal injections were 9.1, 8.6, 4.7, and 1.4 days respectively. The disappearance slope for vitrectomized eyes was significantly different from all non-vitrectomized eyes with p < .001. The clinical significance of the more rapid clearance of drugs from vitrectomized vs. non-vitrectomized eyes will be discussed. (3:00-5:00 pm)

135

Poster 118 Uveal Neovascularization at the Ora Serrata and Pars Plana *Fawaz W. Kaba, MD, W. Richard Green, MD, Baltimore, MD Thirty eyes with uveal neovascularization at the ora serrata, pars plana and pars plicata were studied histopathologically. Chronic retinal detachment of traumatic or other etiologies was the most frequent associated feature and was present in about 65 percent of the cases. In two eyes the neovascularization took the form of an angiomatous lesion. Other associated findings included peripheral drusen, choroidal rupture, and proliferative diabetic retinopathy. Uveal neovascularization at the ora serrata should be considered both in the differential Dx of vitreous hemorrhage, especially in eyes with chronic retinal detachment, and in peripheral retinal angiomatous lesions. (9:00-11:O0 am)

Poster 119 Arterial Oxygen Levels as a Risk Factor for Photochemical Retinal Damage in the Surgical Eye Patient Leonard M. Parver, MD, Washington, DC; *William T. Ham, PhD, Richmond, VA; *Rosemary Mitchard, *Charles R. Auker, PhD, Washington, DC The indirect ophthalmoscope, slit lamp biomicroscope, and operating microscope are among some of the commonlyused ophthalmic instruments known to be capable of producing photochemical retinal injury. Photochemical retinal damage has been implicated as the cause of solar retinopathy and has been suggested as a possible contributing factor in aphakic cystoid maculopathy. Increased blood oxygen levels have been shown to substantially decrease the threshold for photochemical injury in animal experiments. We have measured blood oxygen levels in 25 ophthalmic surgical patients undergoing general anesthesia. Eighty percent of these patients showed_ elevated blood oxygen levels, ranging from 13 to 90 percent. The implications of these elevated oxygen levels on photochemical injury will be discussed. (1:00-3:00 pm)

Poster 120 A New Self-Adhering Surgical Contact Lens J. Alan Rappazzo, MD, Chandler, AZ; *Randy V. Campo, MD, Phoenix, AZ Numerous surgical contact lenses have been developed. They differ in materials, optical properties, and anchoring and irrigating modes. We have developed an inexpensive fundus contact lens which is self-adherent, permits a panoramic view of the posterior segment, requires no irrigation and does not interfere with current instrumentation for vitrectomy. It has facilitated the surgical treatment of vitreoretinal pathology in numerous cases at several institutions. (3:00-5:00 pm)

Poster 121 1be Bardet-Biedl Syndrome Everett Ai, MD, Jon Portis, MD, Susan H. Day, MD, San Francisco, CA The Bardet-Biedl Syndrome consists of a pigmentary retinopathy, mental deficiency, obesity, hypogenitalism, and polydactyly. The presence of extra digits, the most striking

*by invitation

136

OPHTHALMOLOGY

•

systemic manifestation of this syndrome, may be overlooked due to prior surgical correction. Patients presenting with pigmentary retinopathies should be specifically questioned for a history of polydactyly and examined for surgical scars on the hand. A correct diagnosis has significant implications because of the possible association of endocrine and renal lesions which may require treatment. We present a series of cases of the Bardet-Biedl Syndrome in which a correct diagnosis would have been facilitated had a history of polydactyly been taken. (9:00-11:00 am)

Poster 122 An Improved Method for Utilizing Morphometry in Fovea Centralis *Kenneth Brizzee, MD, Covington, LA; Thomas Stafford, MD, Evanston, IL Qualitative and quantitative evaluation of any relevant animal model of spontaneously developing involutional maculopathy can be enhanced by a technique to provide sequential coronal sections of the entire foveal area of the histopathologic specimen to be studied. Optimal cytologic detail is obtained with early fixation of the foveal tissue with mixed aldehydes, imbedding in epoxy resins, sectioning with broad glass knives, and staining with Toluidine blue. Serial sections are cut at I I"m thickness in the coronal plane beginning with the choriocapillaris and extending through the outer nuclear layer. A grid reticule 88 I"m square in conjunction with an oil immersion objective (540X) is used to count the component cells or structures in each of the tissue layers in the central fovea. (1 :00-3:00 pm)

Poster 123 Augmentation of Local Anesthesia During Retinal Detachment Surgery Calvin E. Mein, MD, *Ronald Holweger, MD, Floyd M. Cornell, MD, Aurora, CO A simple, safe, and highly effective technique of administration of supplemental intraoperative local anesthesia during retinal detachment surgery is presented. Despite being safer than general anesthesia, the effect of local anesthesia wears off during prolonged operative procedures. The surgeon often resists giving further retrobulbar injections for fear of globe perforation when working with a patient that is fully draped. The use of a blunt 19 gauge needle to administer two percent xylocaine during the operative procedure will be shown. This provides safe, effective local anesthesia and allows local anesthesia to be used even in prolonged cases without patient discomfort. (3:00-5:00 pm)

Poster 124 Actin Distribution in Excised Fibrovascular Tissue from Retrolental Fibroplasia H. Kaz Soong, MD, Tatsuo Hirose, MD, Kenneth R. Kenyon, MD, Andrew W. Eller, MD, Boston, MA Actin, the contractile protein, is associated with cell contraction in both muscle and non-muscle tissues. Using the fluorescent derivative of the mushroom toxin, phallacidin, which specifically binds to filamentous actin, we demonstrate the distribution of this protein in retrolental fibrovascular tissue excised during open-sky

•

PROGRAM SUPPLEMENT

vitrectomy in human infants with retrolental fibroplasia. Actin stress fibers are abundant and generally oriented in parallel bundles, consistent with the development of contractile forces along these fibers. Transmission electron microscopy corroborates the contractile nature of the excised tissue, which in turn can ultimately lead to retinal traction. (9:00-11:00 am)

Poster 125 Visualization of Actin Filaments in Retinal Rod Photoreceptors by Light Microscopy Lucian V. Del Priore, MD, PhD, Baltimore, MD; *William W. Carley, PhD, New Haven, CT; *Aaron Lewis, PhD, *Watt W. Webb, PhD, Ithaca, NY Actin has been visualized by light microscopy in toad rod photoreceptors by utilizing a fluorescently-Iabeled derivative of phalloidine, a potent phallotoxin that specifically binds to and stabilizes F-actin. We have confirmed the presence of F-actin filaments extending from the calyceal processes surrounding the base of outer segments to the supranuclear region of rods in Bufo Marinus. Our techniques provide a unique view of the threedimensional organization of these intracellular filaments that have not previously been visualized in the light microscope. Actin has also been localized at the junction of the inner and outer segment in a transverse filamentous band. The numerous filaments connecting discs to the plasma membrane observed by EM are not labeled in our experiments. (1:00-3:00 pm)

Poster 126 Inadvertent Intravitreal Lidocaine Injection: A Case Report and Experimental Investigation Melvin I. Freeman, MD, Seattle, WA; Isaac Boniuk, MD, Edward Okun, MD, St. Louis, MO; Pei-Fei Lee, MD, Albany, NY Accidental intraocular injection of local anesthetic solutions are a rare occurrence, though sporadic case reports appear in the ophthalmic literature. A case report with long-term follow-up of the accidental intravitreal injection of two percent lidocaine hydrochloride at the time of intraocular surgery is presented. Electroretinographic, tonographic, and histologic studies of intravitreal lidocaine injections in an experimental animal model correlate the clinical observations with the physiological and anatomical findings. (3:00-5:00 pm)

Poster 127 A New Needleholder for Scleral Buckling Surgery G. Robert Hampton, MD, Albany, NY A new needleholder for use during scleral buckling surgery was developed. It features a stout angled jaw offset 40 degrees from center line to firmly hold a large needle. It is different in that a round locking handle permits easy rotation for suturing in awkward positions, either backhand or forehand. The design is very comfortable to use and has proven safe and efficient. An example will be available for inspection. The author has no proprietary interest in the development or marketing of this instrument, and no financial interest in the Storz Instrument Company. (9:0011:00 pm)

•

SCIENTIFIC POSTERS AND EXHIBITS

Poster 128

The Anatomy of Scleral Encircling Buckles in Vitrectomized

Eyes: CT Scanning *Michael J. Harris, MD, Reay H. Brown, MD, Baltimore, MD

The current approach to the management of proliferative vitreoretinopathy includes a vitrectomy to relieve anteroposterior traction and to facilitate segmentation and removal of epiretinal tissue; however, a broad encircling band is still necessary to support the retina in the area of the vitreous base, an area not approachable by vitrectomy techniques. In order to better understand the relationship between the size and shape of the encircling band and its effect on the internal anatomy of the eye, we placed a variety of encircling bands around vitrectomized, autopsy eyes and studied the internal anatomic relationships by CT scanning. (1:00-3:00 pm)

Poster 129 Branching Patterns of Human Retinal Vessels: Order vs. Length *Gynette Master, MD, James Price, MD, PhD, *Frank J. Holly, PhD, Lubbock, TX A Horton analysis was used to study the mathematical relationship between vessel branch order and vessel length. An exponential or semilogarithmic relationship was found between vessel length and vessel number in any given order or branch order, the general equation being Log y = a + b. These results, either by linear regression or direct comparison, agree with those observed among diverse delivery/drainage systems. Thus, restrictions exist on the development of networks that are placed by the requirements of space and function in the volume supplied or drained by the network. Through the study of normal systems such as these, an understanding of abnormal processes can be achieved since networks must adjust to meet the demands of fluid distribution in the system. (3:005:00 pm)

Poster 130 Purtscher's Retinopathy Secondary to Acute Pancreatitis in Oironic Renal Failure L. A. Minor, PhD, MD, Farmington Hills, MI; M. S. Cox, MD, Royal Oak, MI The funduscopic appearance of Purtscher's retinopathy can be seen in a variety of clinical settings including acute pancreatitis. We present here a 33-year-old male with a history of renal failure secondary to focal segmental membranoproliferative glomerulorephrosis with nephrotic acute pancreatitis with chronic syndrome, and hypertriglyceridemia, exhibiting this clinical entity. The fundus shows mUltiple patches of cotton wool exudate and small flame-shaped hemorrhages distributed. in a generally radial fashion around the optic nerve head, suggesting retinal microembolization as an etiology. Two types of microemboli can be produced in acute pancreatitis: fat emboli due to the action of lipase on omental fat to form fatty acids, and granulocyte emboli due to the action of trypsin on complement C5 to form C5a. (9:00-11:00 am)

137

Poster 131 Olromosomal Analysis of Pineal Blastoma with 13 Deletion Patrick L. Murphy, MD, Royal Oak, MI; *Christie Franchi, Farmington Hills, MI . Patients with chromosomal deletion of 13 and retinoblastoma are usually seen with bilateral ocular involvement. The pineal gland with its vestigial origin has the potential for malignant transformation. The cell type in the pineal is similar to that seen in retinoblastoma. Chromosomal analysis performed on pineal lobe blastoma in patients with retinoblastoma and 13 deletion showed chromosomal deletion in pineal lobe blastoma. (1:00-3:00 pm)

Poster 132 Does Topical Phenylephrine HCI 10 Percent, Tropicamide I Percent, or Proparacaine HCI Percent Affect Retinal Macular Blood Flow? Fane L. Robinson, MD, *Benno L. Petrig, Stephen H. Sinclair, MD, *Charles E. Riva, Juan E. Grunwald, MD, Elliot B. Werner, MD, Philadelphia, PA As part of an investigation of the effect of various drugs on the retinal circulation, we studied the acute effect of the above three drugs on macular capillary blood flow in six healthy volunteers, using the Blue Field Simulation Subjects Technique (J. Opt. Soc. Am. 70:1234, 1980). adjusted the number and speed of computer simulated leukocytes moving on a CRT screen to match those of entoptically perceived leukocytes. Five percent NaCI was used as a control drop. We found no significant difference in leukocyte speed between the control drop and the tested drugs. The calculated minimum percentage change in blood flow detectable by this technique for these subjects was approximately 10 percent (p < 0.05). We thus conclude that none of these drugs affected macular blood flow by more than this amount. (3:00-5:00 pm)

Poster 133 The Efficacy of Cyclosporine in Treating Retina-S AntigenInduced Uveitis *Gerald Striph, MD, Bernard Doft, MD, *Bruce Rabin, MD, PhD, *Bruce Johnson, MD, Pittsburgh, PA Retina-S antigen (RSA) uveitis was induced in guinea pigs to determine the efficacy of cyclosporine (C) and corticosteroid (S) therapy. Sixteen days after footpad injection of 15 ug bovine RSA, animals were treated with C, S, C+S, or left untreated (U). Biomicroscopic evaluation, graded 0 to 4 by a masked retinal specialist, revealed group mean vitreous cell +/- SEM to be: C: 0.75+/-0.13; C+S: 0.60+/-0.13; S: 1.6+/-0.39; U: 2.29+/-0.47. Only the C and C+S groups showed significantly (p < 0.05) less vitreous cell compared to group U. Histopathologic examination was also performed by a masked ocular pathologist. The relevance of these data to the treatment of human uveitis will be discussed. (9:00-11:00 am)

*by inv ita tion

138

OPHTHALMOLOGY

•

•

PROGRAM SUPPLEMENT

Poster 134 Transvitreal Focused Ultrasound - Surgical Therapy for Embolic Retinal Artery Occlusion Michael T. Trese, MD, Royal Oak, MI

Poster 137 Ancient Indian Ophthalmology *K. S. R. Krishna, MD, Vijayawada, India; V. K. Raju, MD, Morgantown, WV

Focused ultrasound was used to emulsify cholesterol, platelet aggregates and calcified material from human carotid vessel specimens removed at endarterectomy. Embolic material was then injected into a cat model and treated with vitreous surgery and transvitreal focused ultrasound. Such treatment resulted in emulsification of the embolic material without histologic vessel wall destruction. This suggests that direct surgical therapy may be available for fresh retinal vascular emboli which do not respond to conservative therapy. (1:00-3:00 pm)

This poster will present Hindu contr ibutions to modern ophthalmology. Emphasis will be given to the famous Indian surgeon Susruta, who practiced cataract surgery many years before Christ, and the first to describe cataract as an opacity of the lens. Susruta taught . the foundations of surgery based on anatomical dissections, and practiced aseptic surgery long before the Hippocratic era. Several translations of Sanskrit manuscripts, depicting ophthalmic procedures, will be exhibited. It is expected that this poster will be attractive to all, especially those wishing to acquaint themselves with the heritage of ophthalmology. (1:00-3:00 pm)

Poster 135 Examination of the Vitreous: A Comparison of Biomicroscopy Using the Goldmann and El Bayadi Kajiura Lenses John J. Weiter, MD, PhD, Sheldon M. Buzney, MD, Boston, MA; *Hideki Furukawa, MD, Asahikawa, Japan; *Hiroyuki Hirokawa, MD, Felipe Tolentino, MD, Clement L. Trempe, MD, *R. Elna Rapp, Boston, MA Vitreous examinations using the three-mirror Goldmann vs. the pre-set El Bayadi lenses were performed on 200 patient eyes. Eyes were evaluated for the presence of posterior vitreous detachment (PVD), vitreous traction, liquefaction, lacunae, and cells. Disagreement was found in 10 percent of variables studies. Comparison studies were also performed in 20 animal eyes with altered vitreous and the results confirmed histologically. Despite the advantage of higher magnification and ability to study peripheral vitreous, cataract and vitreous degeneration made recognition of PVD difficult with the Goldmann lens. The El Bayadi lens optimizes kinetic study and slit illumination, affording easier recognition of PVD. These two techniques appear to be complementary in a complete vitreous examination. (3:00-5:00 pm)

Poster 136 Work-Related Eye Injuries G. Richard Cohen, MD, Brookline, MA; Gerald W. Zaidman, MD, Richmond, VA We retrospectively studied 21 patients admitted to the Medical College of Virginia for work-related eye injuries between 1972 and 1982. This comprised 7.7 percent of all eye injury admissions. Patients suffered blunt or penetrating injuries with penetrating injuries having a poorer prognosis. Twenty out of 21 patients did not wear protective eyewear. The average per patient cost related to their ocular injuries was $2,934, with an average hospital stay of 6.4 days. In contrast, the one patient who did wear protective eyewear had costs of only $350 and a one-day hospital stay. Prf)tective eyewear is important in lessening the severity of injury as well as decreasing the financial and psychological burden to the patient, hospital and employer. (9:00-11:00 am)

Poster 138 Oloroidal Rupture Samuel Gartner, MD, Paul Henkind, MD, PhD, Joseph B. Walsh, MD, Bronx, NY Thirty-four eyes in 33 patients with a history of ocular trauma and the fundus picture of choroidal rupture were studied and 31 had fluorescein angiography. The age of injury was ascertained in 20 patients; the average was 22 years. Histological study of three globes showed splits in Bruch's membrane with glial and connective tissue scars between the edges and not bare sclera. In the first few decades of life, while Bruch's membrane is thin and elastic, when it is split by injury the edges spring apart to produce the fundus picture of choroidal rupture. All 34 eyes had wide open breaks in Bruch's membrane but only five developed choroidal neovascularization. (3:00-5:O0 pm)

Poster 139 Intraocular Air on CT Scanning: A Distinct Picture and Pathognomonic Sign of Penetrating Eye Injuries Marcia Denise Carney, MD, *James L. Combs, MD, Robert S. Weinberg, MD, Richmond, VA Information obtained on the initial evaluation of eye injuries plays a crucial role in determining subsequent management. With the development of fourth generation computerized tomography, the ophthalmologist is now provided with an additional tool to further aid this evaluation. We describe the CT findings of five patients with either blunt, sharp or high velocity missile eye injuries who demonstrate the distinctive picture of intraocular air : on the computerized axial tomograms. This pathognomonic' sign of a penetrating injury to the eye aided in the decision to subsequently explore the globe and render the appropriate repair. (9:00-11:00 am)

SCIENTIFIC EXHIBITS Exhmit I Laser Photocoagulation for Macular Edema in Branch Vein Occlusion: Results of a Multi-Center Randomized Clinical Trial Branch Vein Occlusion Study Group

ophthalmocinematography and their pathogenesis is elucidated by laboratory experiments, high speed cinematography and light and electron microscopy. The management of traumatic retinal breaks, retinal detachments and the pharmacologic treatment of intraocular proliferation is presented.

The Branch Vein Occlusion Study is a muiti-center, controlled, clinical trial designed to answer several questions regarding the management of complications of branch vein occlusion, one of which will be discussed in this exhibit: Is blue-green argon laser photocoagulation useful in preventing visual loss in eyes with branch vein occlusion and macular edema reducing vision to 20/40 or worse? Comparing treated patients to control patients for all 139 cases entered, the gain of at least two lines of vision at two consecutive visits was significantly greater in the lasertreated patients (p = .00033, log rank test).

Exhibit .5 AIDS: The Disease and its Ocular Manifestations The Macula Society, Coordinator: Henry J. Kaplan, MD, Atlanta, GA; Allen Kreiger, MD, Robert Y. Foos, MD, Los Angeles, CA; *Elizabeth Zeigler, MD, San Diego, CA The acquired immune deficiency syndrome (AIDS) is defined as a severe opportunistic infection or Kaposi's sarcoma in a patient under 60, with a defect in cellular immunity and no associated immunosuppressive disease or chemotherapy. The cellular immune defect in AIDS is a preferential destruction of T helper (T H) and T cytotoxic cells, with an increase in T suppressor (T s) cells (i.e., a reversal of the T HITS ratio). The abnormalities of immune function observed are lymphopenia, decreased in vivo and in vitro T-cell function and polyclonal B cell activation. Among the prominent ocular manifestations of AIDS are Kaposi's sarcoma, cotton wool spots and infectious retinitis (most frequently, CMV). The incidence, appearance, pathogenesis and histopathology of these lesions will be presented.

Exhibit 2 The Electroretinogram in Prognosis of Central Retinal Vein Occlusion Roland Sabates, MD, Felix N. Sabates, MD, King Y. Lee, MD, Matthew C. Ziemianski, MD, Kansas City, MO Identifying the patient at risk to develop neovascular glaucoma following a central retinal vein occlusion (CRVO) remains an enigma. In this prospective study we have found a reliable electroretinogram (ERG) pattern which has been almost 100 percent predictive of patients who will go on to develop neovascular glaucoma. One hundred patients who presented with a CRVO were evaluated with a complete ocular examination including electroretinography. They were followed at monthly intervals and evaluated with specific emphasis on the development of rubeosis iridis. All the patients who had an ERG bla wave amplitude ratio less than one eventually developed rubeosis.

Exhibit 6 RP Foundation Fighting Blindness *Fran Denman Counihan, Baltimore, MD The RP Foundation Fighting Blindness supports research at 12 centers internationally to find the cause, prevention and treatment of retinitis pigmentosa and other retinal degenerations. The exhibit will focus on where our research projects are located and what they are studying. Free literature will be distributed to interested physicians.

Exhibit 3 Pseudoretinitis Pigmentosa Vinod Lakhanpal, MD, Stanley Schocket, MD, Baltimore, MD This exhibit discusses some of the uncommon causes of pseudoretinitis pigmentosa. Patients with retinopathy of prematurity, retinal detachments, uveal effusion syndromes, ocular trauma, siderosis bulbi, reticulum cell sarcoma, vascular occlusion, and various drug toxicities, including deferoxamine (DesferaJ), will be presented, showing fundus photographs, fluorescein angiography, and neurosensory studies. Sequential photographs of Desferal toxicity will be presented and guidelines to work-up of· pseudoretinitis pigmentosa will be highlighted.

Exhibit 7 Diabetic Retinopathy: A Rational Approach To Management Based Upon Pathogenesis George H. Bresnick, MD, Madison, WI; Everett Ai, MD, Patrick Coonan, MD, San Francisco, CA The purpose of this exhibit is the development of a rational approach to the management of diabetic retinopathy based upon current understanding of the mechanisms that underlie clinical progression. This information will be integrated into a systemic approach that will be displayed in the form of a treatment algorithm. The exhibit will also include audiovisual graphics to display the sequence of clinical progression, histopathologic correlates and the goals and techniques of treatment.

Exhibit 4 Otaracteristics, Pathogenesis and Treatment of Retinal Breaks and Detachments Caused by Contusion and Penetrating Trauma Morton S. Cox Jr., MD, Livonia, MI; Michael T. Trese, MD, Royal Oak, MI; W. Richard Green, MD, Baltimore, MD This exhibit presents the clinical spectrum of retinal breaks and detachments caused by blunt and penetrating ocular trauma. The breaks are illustrated by indirect

139

*by inv ita tion

140

OPHTHALMOLOGY

•

Exhibit 8 Ophthalmic Photographer's Society Annual Photographic Exhibit *Martin F. Chrobak, San Francisco, CA; *Thomas Egnatz, Indianapolis, IN; * Alan Frohlichstein, Park Ridge, IL; *Kenneth G. Julian, Indianapolis, IN; *Joan Gonzales, Everett Ai, MD, San Francisco, CA; *Terry George, Baltimore, MD The Society presents a large group of photographs selected by a panel of photographers and ophthalmologists as representing the best work submitted by its members. The exhibit features a print and a stereo slide division, each containing many categories encompassing the wide range of diagnostic and documentary photographic applications in ophthalmology.

Exhibit 9 Most Useful and Newest Aids for Low Vision Gerald E. Fonda, MD, *Lois Fonda, Livingston, NJ; Joel Kraut, MD, Brookline, MA; David Karan, MD, Flushing, NY The most useful visual aids which benefit more than 95 percent of all low vision patients who can be helped will be presented. Types of spectacle and nonspectacle magnifiers will be shown with their indications and contraindications for maculopathy of the aged and tunnel vision. Newest developments in half-eye, bifocal and trifocal and telescopic aids will be available for demonstration.

Exhibit 10 Resources for Low Vision and Blind Patients American Foundation for the Blind, *WiIliam F. Gallagher, *Susan J. Spungin, *Mary Ellen Mulholland, *Robert O'Donnell, *Debra Budick, New York, NY; Gerda Dymsza, Atlanta, GA Strategies that assist low VISIon patients and their families to cope with everyday problems arising from visual impairment and blindness will be presented. Highlights include award-winning self-help programs for older persons experiencing visual loss; a slide-tape presentation and workbook for parents of visually impaired pre-school children; a text on low vision assessment, function and impact; a publication on adaptations for older low vision patients still living in their own homes; "Visually Impaired Babies as Patients," a monograph for hospital and clinical personnel; and the Directory of Agencies Serving the Visually Handicapped in the United States. The exhibit is presented by the American Foundation for the Blind, serving the needs of the visually impaired, in cooperation with more than 700 private and public agencies throughout the nation.

Exhibit 11 Management of and Information for the Low Vision Patient *Lorraine H. Marchi, New York, NY; Frank J. Weinstock, MD, Canton, OH; George K. Kambara, MD, Los Angeles, CA The exhibit features National Association for Visually Handicapped (NAVH) large print (18 point) books, newsletters for children and adults, and other NAVH information publications. NA VH pamphlets for the professional and lay person will be available for inspection, including new booklets on children's eye diseases and a

•

PROGRAM SUPPLEMENT

professional guide for adult low vIsIon patients. Useful visual aids will be displayed, including the Big Eye lamp with extra lens, and the Visualtek Voyager closed-circuit TV and their large print computer, which is compatible with the Apple computer and other commercial devices.

Exhibit 12 The GIRO-MIRAGE Variable Focal Molecular Lens - The Potential Impact on Ophthalmology Seymour P. Kern, MD, Newport Beach, CA

™

A proprietary electronically controlled variable focal lens with clear spherical optics is described. Focus is controlled from a few centimeters to infinity in a continuous mode. No perceptible change in geometry, displacement, chemistry or temperature occurs. Control of cylinder, prism, axis and light transmission are future possible refinements. Energy required is virtually nil. A prototype optic meniscus measures 6 mm in diameter but can be made any size. Integration into intraocular lenses, contact lenses, eyeglasses, microscopes, cameras, etc., is also proposed, along with a remotely controlled programmable .pJicroprocessor and micro power supply. (GIRO-MIRAGE M = Gradient Index of Refraction Optics Molecular Index of Refraction Accommodative Gradient Effect).

Exhibit 13 Contact Lens Association of Ophthalmologists, Inc. Paul R. Honan Jr., MD, Lebanon, IN; Herve M. Byron, MD, Englewood, NJ; *Marie S. Salassi, New Orleans, LA The Contact Lens Association of Ophthalmologists features education about contact lenses and intraocular lenses. Members of the association will be present for consultation. Videotapes containing information regarding contact lens and intraocular lenses will be shown. Literature concerning these subjects will be available at the booth.

Exhibit 14 Cosmetic Blepharoplasty Norman Shorr, MD, Beverly Hills, CA; Henry Baylis, *Marty Failor, MD, Los Angeles, CA; *Kevin Perman, Washington, DC; *Joel Kopelman, MD, New York, *Stuart Seiff, MD, Los Angeles, CA; *Toby Sutcliffe, Seattle, WA

MD, MD, NY; MD,

Cosmetic blepharoplasty differs from functional blepharoplasty in both the approach to the patient and the surgical technique. Ophthalmologists, who have generally concentrated on functional blepharoplasty, frequently avoid cosmetic surgery because of inexperience. They may be unprepared to deal with the cosmetic patient's expectations and goals. However, the training of the ophthalmologist makes him or her well-suited to learn both the surgical technique and the management of complications of cosmetic blepharoplasty. This exhibit will illustrate with videotapes the surgical technique of cosmetic blepharoplasty and cosmetic eyebrow elevation, the preparation, preoperative and postoperative management of the cosmetic patient.

•

SCIENTIFIC POSTERS AND EXHIBITS

Exhibit 15 Basic Techniques in Ophthalmic Plastic Surgery David B. SolI, MD, *Riva Lee Asbell, Philadelphia, PA The exhibit will include the basic techniques and principles of Z-plasty, W-plasty, rhomboid flaps, transposition flaps, and dermabrasion used in the eye area. Emphasis will be on techniques that can be performed by the general ophthalmologist. Patient photographs, surgical diagrams, and videotapes of surgical procedures will be included.

Exhibit 16 Ptosis Update Frank A. Nesi, MD, Southfield, MI; Byron C. Smith, MD, Stephen Bosniak, MD, New York, NY; Alan M. Mindlin, MD, Pontiac, MI; Lawrence B. Katzen, MD, Lake Worth, FL; *J. T. LiVecchi, MD, Scranton, PA We present a series of videotapes and pictorial displays illustrating surgical repair of ptosis by four different "state of the art" procedures. The authors have prepared four 10-minute videotaped surgical procedures in conjl:lnction with four professionally illustrated pictorial displays for each procedure. The four procedures include: levator aponeurosis surgery, MulIers muscle tarsal conjunctival resection, modified Fasanella-Servot procedure, and frontalis suspension.

Exhibit 17 Surgical Repair of the Severed Medial Canthal Tendon This exhibit has been withdrawn.

Exhibit 18 A Comparison of Viscoelastic Materials Used in Intraocular Surgery David B. SolI, MD, Philadelphia, P A The protective properties, advantages and disadvantages, and complications of using various viscoelastic agents including chondroitin sulfate, chondroitin sulfate in combination with a biogenetically engineered low molecular weight sodium hyaluronate, and high molecular weight sodium hyaluronate will be compared. Comparison of endothelial protection, as well as other intraocular effects, such as postoperative intraocular pressure elevation and clearance of the substance from the eye, also will be presented using illustrative graphs, photomicrographs, and statistical charts. A videotape also will be shown.

Exhibit 19 1be Eye Bank Association of America Eye Bank Association of America, *Donna Oiland, Seattle, WA This exhibit explains through pictures and captions the history, growth and future of the Eye Bank Association of America. The EBAA membership comprises the majority of eye banks in the United States. Each member eye bank is a non-profit organization which serves its community or region by encouraging people to pledge and ultimately donate their eyes at death. The eye banks collect, process

141

and evaluate, and distribute corneas for transplant, and supply whole eyes and specific eye tissues for a variety of research and education projects.

Exhibit 20 1be Corneal Dystrophy Foundation Douglas Koch, MD, Houston, TX; *Steve Waldrop, Kingwood, TX This exhibit will feature information about the Corneal Dystrophy Foundation, a non-profit organization founded to promote research and patient education in the .corneal dystrophies. Informational materials highlighting the activities of the Foundation and patient education brochures will be provided.

Exhibit 21 Survey of Eye Disease in the Kingdom of Saudi Arabia Khalid F. Tabbara, MD, San Francisco, CA; Ihsan Badr, MD, Riyadh, Saudi Arabia; David Paton, MD, Beverly Hills, CA; *Dennis Ross-Degnan, Riyadh, Saudi Arabia; Robert Meaders, MD, Bethesda, MD Eye diseases are a major health problem in Saudi Arabia. The King Khaled Eye Specialist Hospital is conducting a national survey whose objective is to accurately determine the prevalence of visual loss and blindness, and to determine the prevalence of the major causes of ocular disorders. This survey will help to develop a plan for the prevention of blindness and curtailment of serious eye disorders in Saudi Arabia and in other developing countries. During the study, a team of ophthalmologists assisted by support personnel will examine 18,000 citizens. The survey sample is a random stratified sample utilizing modified techniques of area sampling from the entire population. The survey is currently in progress and the data entered into field computers. The methodology and results will be presented.

Exhibit 22 Maintenance of Corneal Endothelial Cell Integrity with Intraocular Balanced Salt Solutions *Henry F. Edelhauser, PhD, Milwaukee, WI; *Michael Stern, PhD, *R. Roehrs, PhD, O. J. Lorenzetti, PhD, *J. M. de Faller, Fort Worth, TX Short- and long-term surgical procedures have been shown to benefit from improved formulations of intraocular balanced salt solutions. Compositions which mimic the ionic and nutrient constituents of aqueous humor demonstrated improved endothelial cell integrity, as shown in isolated perfused human corneas and following cataract and vitrectomy surgery. Specular microscopy, measurements of corneal thickness, and scanning and transmission electron microscopy have been used to document the endothelial cell and corneal changes that occur following the use of various intraocular irrigating solutions. The results of this evaluation suggest that the best irrigating solution contains the necessary extracellular ions plus glutathione, dextrose and bicarbonate.

*by invitation

142

OPHTHALMOLOGY

•

Exhibit 23 Anterior Segment Complications of Laser Therapy Vinod Lakhanpal, MD, Verinder S. Nirankari, MD, Stanley S. Schocket, MD, R. D. Richards, MD, *Emery Billings, Baltimore, MD This exhibit discusses anterior segment complications secondary to argon and Nd:Y AG laser therapy. Indications of treatment included diabetic retinopathy, senile macular degeneration, open- and closed-angle glaucomas, pupillary block glaucoma, pseudophakos with posterior capsule opacification, and vitreous strands with cystoid macular edema. Complications seen were corneal erosion, keratitis, endothelial burns, pupillary block glaucoma, herniation or rupture of vitreous face, lenticular burns, hits and cracks on internal ophthalmoplegia, pseudophakos, anisocoria, vermiform iris movements, and loss of accommodation. These complications will be highlighted by individual presenta tions and photographic illustrations.

Exhibit 24 Liposomes and the Eye Jay L. Federman, MD, Philadelphia, PAj *Michael W. Fountain, PhD, *Robert P. Lenk, PhD, *Marc J. Ostro, PhD, Princeton, NJj Larry A. Oonoso, MD, PhD, Philadelphia, PA This exhibit will focus on the role of Iiposomes in ophthalmology. The interaction of synthetically produced, biodegradable Iiposomes and ocular tissues at a cellular level will be demonstrated. Special emphasis will be placed on the use of this new technology as it relates to diagnosis and treatment of ocular diseases.

Exhibit 25 Betaxolol in the Treatment of Glaucoma: Multiclinic Trials Robert C. Allen, MD, Atlanta, GA Betaxolol, a topical beta-blocker, has been studied in more than 1,000 patients by 30 United States investigators. When compared with Timolol in masked trials there was no statistically significant difference in the magnitude and duration of lOP lowering and Betaxolol caused less reduction in pulse rate. Transient stinging on instillation is the most frequent ocular side effect of Betaxolol. Systemic effects have been minimal and we are enthusiastic about its safe use in patients with COPD and asthma. Another advantage of Betaxolol is its excellent additivity with epinephrine as well as other anti-glaucoma medications. Multicenter studies with more than 350 patients over the past three years will be presented to document the safety and efficacy of long-term Betaxolol therapy.

Exhibit 26 A The Pan American Association of Ophthalmology: Tradition of Achievement Warren R. Fagadau, MD, Dallas, TXj H. Dunbar Hoskins, MD, Mill Valley, CA The Pan American Association of Ophthalmology, founded in 1939 under the auspices of the American Academy of Ophthalmology, is the largest international association of ophthalmologists in the world today. The PAAO takes great pride in its creation and continuous sponsorship of many outstanding educational programs, and

•

PROGRAM SUPPLEMENT

has played a major role in improving the level of ophthalmic care for the people of the western hemisphere and throughout the world. Our scientific exhibit will outline past achievements, current projects and long-range goals of the organization.

Exhibit 27 Joint Commission 00 Allied Health Personnel in Ophthalmology Robert L. Stamper, MD, St. Paul, MNj Peter Y. Evans, MD, Washington, DCj Alfonse A. Cinotti, MD, Newark, NJ Information regarding certification of ophthalmic medical assistants will be displayed. A supply of brochures will be available for distribution and will contain information regarding education, certification, continuing education and accreditation of courses for allied health personnel in ophthalmology.

Exhibit 2& American Israeli Ophthalmological Society Albert Hornblass, MD, New York, NYj Peter Ballen, MD, New Hyde Park, NYj Stephen Kutner, MD, Atlanta, GA The American Israeli Ophthalmological Society is devoted to increasing cooperation and communication with our Israeli colleagues. The exhibit will highlight our recent scientific exhibits and conferences, including the International Laser Conference held in Jerusalem in 1984. This year's exhibit will show new laser techniques and advancements in Israel. The scientific exhibit will include films of new eye operations developed in conjunction with our Israeli colleagues. Various eye armor used in Israel for the prevention of injuries will be shown.

Exhibit 29 Natiooal Society to Prevent Blindness *Jack L. Wallace, *Lydia Maguire, New York, NY The exhibit illustrates major facets of the Society's programs to further the prevention of blindness, highlighting its services to children and adults on eye health and safety.

Exhibit 30 Reflectioos of Professiooal Ophthalmic Nursing *Kenda K. Shoemaker, Portland, ORj *Virgina Stack" Hillsboro, ORj *Frances Caramella, Portland, OR Direct reflections of professional ophthalmic nursing are seen as the nurse acting as the patients' advocate and functioning as an educator, consultant, researcher and administrator. An ophthalmic nurse utilizes the science of nursing coupled with the art of caring for human beings in Clinical nursing nursing assessment and intervention. decisions are made with the collaboration of allied health care professionals and are directed toward achieving maximum therapeutic and rehabilitative goals for the ophthalmic patient. This exhibit, sponsored by ASORN, Inc., is dedicated to promoting excellence in ophthalmic nursing.

•

SCIENTIFIC POSTERS AND EXHIBITS

Exhibit 31 International Eye Foundation Appropriate Development Assistance Programs J. H. King Jr., MD, Robert H. Meaders, MD, Bethesda, MD Appropriate development assistance in the field of ophthalmology by the United States and other countries must be done in a systematic fashion. Studies of the nature and extent of eye disease and blindness should first be examined in detail, and a logical, simple countrywide program developed considering the resources available or attainable by the country or region concerned. Different phases in the development of countrywide systems are set forth, with text and field pictures showing procedures geared to the varied conditions and levels of personnel and facilities in certain areas of assistance.

Exhibit 32 Precise Recording of Ocular Motility in Space and on Earth Using Soft nArtificial Landmark" Contact Lenses Leroy G. Meshel, MD, Daly City, CA; *Robert V. Kenyon, PhD, *Lawrence White, PhD, Cambridge, MA Corneal contact lenses were worn in space for the first time on November 29, 1983, by four Space lab I scientist astronauts. The lenses were not designed to improve visual acuity, but to permit exquisite recording of eye movements in an attempt to understand the function of the vestibular otolith response to weightlessness, and possibly the etiology of "spacesickness," which has affected approximately 50 percent of astronauts. This exhibit will describe the design, production and use of these new "artificial landmark" lenses now used in space and earth laboratories to precisely record eye movements by visual photographic electrical and infrared sensors. Spacelab I vestlbular-ocular experiments will be highlighted.

Exhibit 33 National OIildren's Eye Care Foundation National Children's Eye Care Foundation, Washington, DC This exhibit will present materials designed to educate the public, through ophthalmologists, on proper pediatric eye care. The message conveys the importance of vigilance to symptoms and prompt treatment.

Exhibit 34 Eye Care, Inc.: Serving the Visually Neglected Eye Care, Inc., *E. Timothy Carroll, Washington, DC

143

Exhibit 35 Helen Keller International Integrated Eye Care and Blindness Prevention Programs in Developing Countries Louis D. Pizzarello, MD, *John H. Costello, New York, NY; Alfred Sommer, MD, Baltimore, MD; Maynard B. Wheeler, MD, Newington, CT; *Edward A. Glaeser, *Margaret C. Bay Idon, New York, NY Helen Keller International will deal with efforts to curb the high incidence (35 million cases) of i:>lindness in developing countries, where up to 80 percent of vision loss is avoidable. The HKI exhibit will: demonstrate strategies for the integration of primary eye care as a component of primary health care in poorer nations; illustrate and describe research and programs for the prevention and control of xerophthalmia, major cause of blindness among young children; delineate methods for the treatment and cure of trachoma and trichiasis, conjunctivitis, and traumainduced blindness; and outline initial efforts to reduce the backlog of unoperated cataracts in the third world (now estimated at 16 million cases).

Exhibit 36 Computer Teaching of Strabismus *Dorothy K. Hartman, Henry S. Metz, MD, Rochester, NY This exhibit will demonstrate a computer program designed to teach strabismus. Clinical strabismus problems will be presented on a microcomputer and a demonstration given on how the "student" interacts with the program.

Exhibit 37 Data Processors: Their Role in Data Base Collection For Clinical Re~arch Robert C. Della Rocca, MD, *Martin Gersten, *Arthur L. Millman, MD, *Steven Gilbard, MD, Janet Roen, MD, New York, NY The immense storage capacity of data processors provides a powerful tool for prospective and retrospective clinical research. An example is presented demonstrating a simple method for data collection from an oculoplastics and orbital clinic. Highlights of the system include the creation of: worksheets comprehensively profiling oculoplastic and orbital clinical entities for input; computer-generated output of diads and triads of suspected associations of incidence, signs, symptoms, systemic disease, laterality, treatment, surgery and outcome without exhaustive chart review; and a method of computer-controlled prospective double blind studies.

Eye Care, Inc., is a non-profit organization. Our booth contains visual explanations of our work. Volunteers man the booth to disseminate other information 6n our project in Haiti.

*by invitation

144

OPHTHALMOLOGY

•

Exhibit 38 Interactive Computer Controlled Video Instruction in Ophthalmology . George Hilts, MD, Badrudin Kurwa, MD, *Mark Horton, MD, Galveston, TX This exhibit will be a hands-on demonstration of "interactive video instruction" for teaching neuroophthalmology. A computer is set up to teach lessons in neuro-ophthalmology; it accesses various segments of a videotape containing pre-recorded clinical pathology (eye movement disorders, in this instance), and thereby teaches the student. Depending on the student's answers, the program provides further remedial learning or more advanced material. The system is being developed for medical students and residents to complement their clinical experience. It is particularly valuable for demonstration of "disorders of movement," which cannot be taught as easily with still photographs. The entire system will be provided by the authors.

•

PROGRAM SUPPLEMENT