Scientific Posters

Scientific Posters November 8 - 12 Dallas Convention Center Exhibit Hall Level 2 To accommodate more posters this year, there will be two sessions of scientific posters. The first session will be displayed on Sunday through Monday from 8:00 am to 5:00 pm and the second session on Tuesday and Wednesday from 8:00 am to 5:00 pm and on Thursday from 8:00 am to 3:00 pm. Presenters will be at their displays on Sunday (session 1) and Tuesday (session 2) during the time period noted at the beginning of each poster topic section. Presenters will also be available during additional hours, to be posted daily on their display boards.

SESSION 1- Sunday and Monday Topic

--· --· --·

Number 1-8 9-34 35 36-58 59-75 76-84 85-86 87-96 97-103 104-135 136 137-139

Cataract Cornea, External Disease General Medical Care Glaucoma, Iris Intraocular Inflammation, Ocular Tumor Neuro-Ophthalmology Optics, Refractions, Contact Lenses Orbit, Lacrimal, Plastic Surgery Pediatric Ophthalmology, Strabismus Retina, Vitreous Socioeconomic, Practice Management Trauma

)( 1 )(

)( 2 )(

)( J )(

)( 4 )(

)( 5 )(

)( 6 )(

x 24x

X23 X

)(22)(

)( 21 )(

)(20)(

X 19)(

x25 x

x26 x

x27 x

x28 x

x29 x

x 48 x

x47 x

x46x

X45 X

x49 x

x50x

x51 x

x 12 x

x71 x

x70 x

•

•

)( 7 )(

X8 X

)( 9 )(

X10 X

X11 X

)( 18x

)( 17 )(

X 16 X

X 15 X

X 14 X

xJO x

X 31 X

x 32x

x JJx

x34x

x35x

x36x

x 44 x

X43X

X42 X

x41 x

Xl,(j(

X39X

XJB X

X37X

x52x

x53x

x54x

x 69 x

x 68 x

X57 X

•

x55x

x56x

X57 X

x58x

x59 x

x 66 x

x 65 x

x 64 x

X6JX

x62 x

•

)( 12 )( X 1:~ X

x60x X 61 X

J<

x74 x

x75 x

x76 x

xnx

x78x

x79x

x80x

X 81 X

X B2x

x BJx

xB4x

x 96 X

x 95 X

x 94 x

XgJX

X92 X

X 91 X

X go X

XB9X

~X

X87 X

x esx

x 85 x

x97 x

x98 x

x99 x

x100x

x101x

x102x

x10Jx

x104x

x105x

x106x

x107x

x

x

x

x

x

x 114x

x113x

x112X

)(111x

x,ox

x126x

x127x

x12Bx

x129x

x1JOx

x131x

x132x

X1J!JX

x 138x

X137X

x 136x

x 135x

x 134x

x 133x

x7J

x 120

x121x

118

119

x

x122x

x 118

x12Jx

x 117

x124x

x 116

x125x

x

x 115

•

•

x10Bx X109X

SESSION 2 - Tuesday, Wednesday and Thursday

--·

Topic

Number

Cataract Cornea, External Disease General Medical Care Glaucoma, Iris Intraocular Inflammation, Ocular Tumor Neuro-Ophthalmology Optics, Refractions, Contact Lenses Orbit, Lacrimal, Plastic Surgery Pediatric Ophthalmology, Strabismus Retina, Vitreous Socioeconomic, Practice Management Trauma

140-147 148-174 175 176-199 200-215 216-225 226-228 229-240 241 -247 248- 272, 276 273 274-275

x140x

x141x

x142x

x1o43x

x1«x

x145x

)(163)(

x 162 x

)(161)(

x160x

)(159"

x 158x

x164x

x165x

x166x

x167x

x168x

x 187x

x 186x

x 185x

x184 x

)(183)(

x189x

x190x

x191x

x192x

x193x

)(210)(

lim X

)(2~

)(207)(

)(206)(

x212J<

x213x

x214x

x215x

x216x

~)(

)(234)(

llzJJX

x232x

x236x

x237x

x236x

x239x

x188x ~~~)(

•

--·

•

•

x146x

x147x

x1<48x

x149x

x150x

)(157)(

x 156x

x 155x

x 154x

x 153x

x169x

x170x

x171x

x1nx

x173x

x174x

x115x

x 182x

)(181)(

)(180)(

x 119x

)(178)(

X,nX

xnsx

•

•

x151x x 152x

x194x

x195x

x196x

x197x

x198x

)(205)(

~)(

X203X

)(202)(

X2Q1X

x217x

x218x

x219x

x220x

x221x

x222x

x223x

)(231)(

li2JOX

)(229)(

)(228)(

~bx

)(226)(

X22sX

x224x

x240x

x241x

x242x

x2o43x

x2«x

x245x

x246x

X:zsY'

)(252)(

x251x

)(250)(

X249x

x266x

x267x

x268x

x269x

x270x

x271x

"276)(

~75)(

)(274)(

)(273)(

x2nx

)(259)(

)(258)(

x257x

)(256)(

)(255)(

)(254)(

x260x

x261x

x262x

x263x

x264x

x265x

•

•

x199x X20()X

x247x )(2<48)(

119

SCIENTIFIC POSTERS CATARACT Presenters for posters 2 through 8 will attend their posters Sunday, November 8 from 3:00 to 4:30PM. Presenters for posters 140 through 147 will attend their posters Tuesday, November 10 from 3:00 to 4:30 PM. Individual attendance hours will be indi­ cated on a mock clock at each poster board.

SUNDAY POSTERS Scientific Poster 1

Glaucoma with Sutured Posterior Chamber Lens Implants

Amber A Dobler, MD, Bloomington, MN; Jonathan E Pederson, MD, Minneapolis, MN; Aaron L Nathenson, MD, Bloomington, MN The effect of transscleral sutured PCL implantation on intraocular pressure (lOP) was evaluated retrospectively in 26 eyes after IOL exchange, secondary implantation, or primary zonular dehiscence. Mean age was 64 years, with average follow-up of 32 months. Of ten eyes without glaucoma preoperatively, one with angle recession required topical beta-blocker therapy postop. In 16 eyes with glau­ coma preop, 11 were unchanged, four improved, and one worsened slightly postop. Sutured posterior chamber lens implantation does not appear to adversely affect glaucoma and may improve lOP control in selected cases.

Scientific Poster 2

Learning Phacoemulsification Surgery

Robert W Snyder, MD, PhD; Richard W Allinson, MD; Robert G Fante, MD; Michael L Stanko, MD; David C Metrikin, MD, Tucson, AZ In 1991 we reviewed the complication rate ofsenior residents learning phacoemulsification surgery and found 14.7% (20/136 total cases) vitreous loss durin~ the preceding three years. We developed a new strategy to learn phacoemulsification. This included a switch to in situ phacofragmentation of the nucleus, more attention to patient selection, special didactic lectures, and increased phaco wet lab experience. The outcomes have improved dramatically with no vitreous loss in 99 cases. This approach minimizes complications and improves the experience in learning phacoemulsification. We will present our program in detail.

Scientific Poster 3

Experience with New Shallow Peribulbar Anaesthesia

Narayanan Sivadasa Raju, MBBS, Cochin, India We studied the efficacy and safety of a new simple shallow peri bulbar anaesthetic technique in 1050 cases of cataract operations. The anaesthetic solution was injected superficially into the anterior peri­ bulbar space with a 1/2" 26 gauge needle through a transconjunctival route. Complete akinesia and anaesthesia occurred in 90% of cases, while 10% needed a second injection. The procedure was painless and no serious complications were observed. We conclude that this new technique is a simple, safe, and effective alternative to relatively difficult deep peribulbar anaesthesia.

eyes with idiopathic and 4 eyes with traumatic aniridia (3/4 wi keratoplasty and transscleraiiOL suturing). After 3-12 months, visi< had improved from 0.1 to maximally 0.6 in idiopathic and fro counting fingers to maximally 0.8 in traumatic cases. Glaucoma h; been a problem associated with trauma. Nystagmus was reduced all eyes with idiopathic aniridia.

Scientific Poster 5

Use of Scheimpftug Photography to Document Early Postcataract Surgery Posterior Capsule Opacification

Maria Susan M Lasa, MD, Rockville, MD; Manuel B Datiles Ill, MD, Bethesda, MD; Benjamin V Magno, MD, Rockville, MD; Louella L Lopez, MD, Bethesda, MD We investigated the usefulness of Scheimpflug photography in doc1 menting early posterior capsule opacification. Visual acuity, contra and glare sensitivity tests were done on 58 eyes after ECCE/IC surgery. We performed Zeiss Scheimpflug photography at the 9( meridian, and determined posterior capsule thickness and densit Multiple regression analysis showed posterior capsule thickness a~ density significantly correlated with contrast sensitivity loss (p=O.O and nighttime glare sensitivity (p=O.OS), but not with visual acuit Results suggest these tests may be useful in clinical trials ofdrugs beir developed to prevent capsule opacification.

Scientific Poster 6

Continuous Measurement of lOP During Cataract Surgery- A New Technique

Howard N Bernstein, MD, Washington, DC; Henry Starr, MD, Riverdale, MD; William B Clew, MD, Washington, DC; Siling Xiang. MD, Washington, DC; Joseph Schwartz, MD, Washington, DC lOP was continuously measured during routine cataract extraction using sterile disposable arterio-venous pressure sensors displayed o the anesthesia monitor, and videotaped for subsequent simultane01. correlation with the videotaped operation. Large fluctuations of u to 80mmHg in the closed eye were associated with scleral pi< fixation, incisional groove formation, paracentesis, and intraoculc fluid instillations. Rapid fluctuations within the 10-30mmHg ran~ occurs during 1-A and phaco, alternating with hypotony (-5.0 I +S.OmmHg). The technique is useful in developing methods I maintain positive lOP and reduce extreme fluctuations.

Scientific Poster 7

Comparison of the Hoffer-Q With Other Third Generation Formulas in 450 Eyes Kenneth J Hoffer, MD, Santa Monica, CA

The Hoffer-Q formula incorporates a new theoretical formula t

predict the position of the lens implant using a personalized anteri< chamber depth. It was compared with the Holladay and SRK­ theoretic formulas as well as the regression formulas of SRK I and SR II; all were optimized by personalization. The results will be reporte on a series of 450 eyes receiving one single implant style placed i the capsular bag by one surgeon with biometry obtained, using th same equipment, technique and technician. Results show that th Hoffer-Q was more accurate only in eyes shorter than 22.0mm, bl. equal to the Holladay and SRK-T in eyes longer than 22.0mm. Th importance of personalization of modern implant formulas will b

stressed.

Scientific Poster 4

Scientific Poster 8

Rainer Sundmacher, MD; Thomas Reinhard, MD; Christoph M Althaus, MD, Duesseldorf, Germany Aniridia is a rare condition resulting in limited vision after conven­ tional IOL surgery. Iris print contact lenses are rarely tolerated. A novel PMMA IOL (13.5 mm haptics, 11.0 mm black diaphragm, 5.0 mm optics, Morcher, D-7000 Stuttgart) was implanted into 3 selected

Scott Greenbaum, MD, Jericho, NY A randomized, prospective study of capsular rupture during resider phacoemulsificationwasperformedto evaluatetheeffectofviscoela! tic posterior to the nucleus. Following central sculpting an' hydrodissection, viscoelastic was injected under the superior capsul;

Black Diaphragm IOL for Correction of Aniridia

Preventing Posterior Capsular Tears in Resident Phacoemulsification Through Viscodissection

:j: The presenter(s) have a financial interest in the subject matter of the presentation

120

SCIENTIFIC POSTERS flap to prolapse the superior nuclear pole towards the iris plane and to increase the nuclear-capsular distance. Two-handed phacoemulsification was employed. The rate of posterior capsular tears was 1/54 with viscodissection and 6/49 without it (p=.05). Viscodissection may assist in protecting the posterior capsule, while one is learning phacoemulsification.

TUESDAY POSTERS Scientific Poster 140

Bacterial Growth is Greatly Enhanced on Silicone lntraoadar Lenses

Andrea Cusumano, MD; Massimo Busin, MD; Manfred Spitznas, MD, Bonn, Gennany To determine whether different materials used in manufacturing intraocular lenses (IOLs) can variously influence bacterial growth, we suspended silicone, hydrogel and PMMA IOLs in peptone culture medium containing a maximal growth concentration of Staphylococ­ cusepidermidis. In each of 5 cultures performed, 210Ls for each type were tested. After incubation for 5 days, all IOLs were submitted to scanning electron microscopic analysis. For each lens, bacterial counts were obtained from 20 areas (50X50 JUn each) randomly chosen on the optics surface, and averaged. The number of bacteria counted was 32 times (p
Scientific Poster 141

lntraoadar Lens Explantation from Eyes With Low-Grade Chronic Endophthalmitis (NToxic Lens Syndrome")

Massimo Busin, MD; JOrgen Schmidt, MD; Andrea Cusumano, MD; Manfred Spitznas, MD, Bonn, Gennany Eleven patients suffering from low-grade chronic endophthalmitis unresponsive to antibiotics and steroids underwent intraocular lens (IOL) explantation and removal of the capsular bag. Rapid improve­ ment of the clinical picture occurred in all cases. At the time of this review (average time after explantation=17 months; range=2 to 23 months) no eye exhibited signs of inflammation. Best-corrected visual acuity was better than or equal to 20/40 in 7 patients, between 20/40 and 20/400 in 3, and worse than 20/400 in the remaining patient. Retinal detachment occurred in 2 patients and was successfully treated, while transient hyphema was seen in 1. Removal of IOL and capsular bag from eyes with low-grade chronic endophthalmitis eliminates intraocular inflammation and leads to a satisfactory visual outcome.

Scientific Poster 142

A New Instrument for Objective Density Measurement of the Crystalline Lens Nucleus i

Philip Lempert, MD, Ithaca, NY Current methods for assessment of nuclear opacities are essentially subjective. A new instrument for lens imaging and quantitative assessment of nuclear density is presented. It uses a helium-neon laser beam configured into a uniformly narrow sheet of light of consistent intensity. Field depth encompasses the anterior segment. There is virtually no spatial distortion. A computer is used for capture of lens cross section images and measurement of light scatter solely from the nucleus. Nuclear sclerosis measurements with this instrument on 262 otherwise healthy eyes correlated significantly to visual acuity.

Scientific Poster 143

A Prospective Evaluation of the Effect of Pseudophakic Cystoid Macular Edema on Contrast Sensitivity

Hector EIbanez, MD, Cleveland, OH; Mark P Lesher, MD, Cleveland, OH; Lawrence JSingerman, MD, Beachwood, OH; Thomas A Rice, MD, Beachwood, OH; Greg FKeep, MAC., Dayton, OH We performed a prospective, double-masked evaluation of the effects of pseudophakic cystoid macular edema on contrast sensitivity in 25 patients. Eyes were classified as having no CME, transient CME, or persistent CME. Analysis of variance (ANOVA) showed a significant decrease 1) for all spacial frequencies at 8 weeks {p
Scientific Poster 144

Long-Term Results After Removal of Dislocated Intraocular Lenses from the Retinal Surface Through a Limbal Approach

Massimo Busin, MD; lbrahm Al-Naweiseh, MD; Manfred Spitznas, MD, Bonn, Gennany In a series of 13 consecutive patients, a dislocated posterior chamber IOL was removed from the retinal surface through a limbal approach after open-skv vitrectomy. In all but one patient, an IOL was reimplanted during the same surgical session (sulcus fixation over remnants of the capsular bag =7, sulcus fixation with transscleral sutures =3, anterior chamber IOL =2). No retinal or corneal compli­ cations secondary to the anterior approach could be detected over an average follow up of 19.8 months. Best corrected visual acuity was 20/40 or better in 7, between 20/40 and 20/400 in 4, and less than 20/400 in 2 patients. Visual outcome worse than 20/40 was related to pre-existing retinal disease in all cases (diabetic macular degener­ ation =3, senile macular degeneration =2, retinitis pigmentosa =1).

Scientific Poster 145

Evaluation of Operative Risk Factors in Cataract Surgery

Maurice EJohn, MD, Jeffersonville, IN Certain risk factors in cataract surgery can mean the difference between a smooth or difficult experience. We examined cataract classification based on the LOCS II System and its correlation with operative components in over 600 cases. Mature cataracts reduced the chances of removal by phacoemulsifJCation from 95% to 59%. Ability to complete capsulorhexis decreased from 91% to 67% with mature cataracts. Smaller pupils also led to more difficult surgery, including an increase in vitrectomy rate from 0.8% to 3.1 %. All correlations occurred at p<0.04.

Scientific Poster 146

Occult Retained Nuclei After Phacoemulsification

Amilia Schrier, MD; Henry D Perry, MD; Eric D Donnenfeld, MD; David 8 Nelson, MD, Rockville Centre, NY We report three cases of late postoperative uveitis (>5 months) follow­ ing phacoemulsification secondary to occult retained nuclear frag­ ments (0.5mm) in the anterior chamber. Complications included persistent uveitis, hypotony, choroidal detachments, and cystoid mac­ ular edema. Removal of the nuclear fragment resulted in prompt resolution of the complications, and improved vision in all cases. After phacoemulsification, the differential diagnosis of uveitis in the postoperative patient must include the possibility of occult retained nuclear material. Slit-lamp exam with gonioscopy is required, as a nuclear fragment may be hidden in the angle recess. Occult nuclear fragment remnants should be added to the differential of post-cataract extraction intraocular inflammation. Resolution with improvement of vision may require removal of the inciting lens fragment.

*The presenter(s) have a financial interest in the subject matter of the presentation

121

SCIENTIFIC POSTERS Scientific Poster 147

A Comparison of Non-Steroidal Anti-Inflammatory Drugs to Steroids for Postoperative Inflammation

Calvin W Roberts, MD, New York, NY Fifty patients undergoing phacoemulsification were randomly assigned to receive during the postoperative period either pred­ nisolone acetate 1% (Pred Forte) drops or diclofenac sodium 0.1% (Voltaren Ophthalmic) drops for control of inflammation. Evaluation on the first postoperative day and one and four weeks after surgery included laser cell and flare meter, slit lamp evaluation, intraocular pressure (lOP), and visual acuity. There was no significant difference in inflammation, lOP, or vision between the groups. Thus, diclofenac sodium is as effective a medication as prednisolone acetate for postoperative inflammation.

CORNEA Presenters for posters 9 through 34 will attend their posters Sunday, November 8 from 11:30 AM to 1:00 PM. Presenters for posters 148 through 174 wi II attend their posters Tuesday, November 10 from 11 :30 AM to 1:00 PM. Individual attendance hours will be indicated on a mock clock at each poster board.

SUNDAY POSTERS Scientific Poster 9

Intraoperative Application of Mitomycin C in the Treabnent of Pterygium

Shewgin Yow, MD; Hsi-Kung Kou, MD; Sue-Ann Un, MD, Kaohsiung Hsien, Taiwan To prevent the recurrence of pterygium after its excision, a piece of cotton pad soaked with 0.025% Mitomycin C was applied to the bare sclera for 3 minutes in 213 pterygia excised from 178 patients. They were followed up for 3 to 13 months (mean 8 months). There were 14 recurrences (6.57%). The complications included 2 cases of delayed conjunctival wound healing. 4 granulomas and 10 superficial punctate keratitis. This study suggests that local application of 0.025% Mitomycin C during operation is an effective and safe adjunc­ tive procedure to prevent recurrence of pterygium.

Scientific Poster 10

Carbomer Gel in Dry Eye Syndrome

Samir M AI Mansouri, MD; Khalid FTabbara, MD, Riyadh, Saudi Arabia We studied the effects of topical carbomer gel (Leo Viscous Gel) and compared it to polyvinyl alcohol in patients with dry eyes and in normal subjects. We included twenty patients in each group. The averagecornealcontacttimeof43ulofcarbomergelwas92.8(±35.7) and 36.5 (±14.2) minutes in dry eye patients and normal subjects respectively compared to 40.8 (±19.4) and 19.5 (±8.3) minutes in the polyvinyl alcohol group. The tear break up time was significantly longer in the carbomer gel compared to polyvinyl alcohol at 10', 20', and 60' (p<0.001, p<0.001, and p
Scientific Poster 11

Immunocytochemistry of Impression Cytology Specimens: A New Method for Evaluation of Conjunctival Allergy

Christophe Baudouin, MD, PhD; Francoise Brignole, MD; Nasser Haouat, MD; jacques Bayle, MD; Pierre Gastaud, MD, Nice, France We developed an immunocytochemical procedure in impression cytology specimens using monoclonal antibodies to inflammatory markers, HLADR and receptor to lgE, in order to evaluate ocular surface inflammation and/or allergy. In 300 patients, normal or suffering from various ocular surface disorders, we found that con­ junctival cells do not normally express these markers, but are induced to express them in inflammatory conditions. This test is particularly useful to detect infraclinic conjunctival inflammation, for a better diagnosis and treatment of some ocular surface disorders, such as tear deficiency, atopic conjunctivitis, or sensitization to eye drops and their preservatives.

Scientific Poster 12

Excimer Laser 193nm Trephination with "'Orientation Teeth" in Penetrating Keratoplasty

Gottfried 0 H Naumann, MD; Berthold Seitz, MD, Erlangen, Germany Decentration, •vertical tilt• and •horizontal torsion• of the graft are important for long-term postkeratoplasty astigmatism. The non-con­ tact, •non-thermal• trephination with the excimer laser provides undistorted, identical cut angles in donor and patient cornea. In 18 out of 40 patients, four •orientation teeth• (0.2 X 0.15mm) at 3/6/9/12 o'clock in the recipient (7 .5mm, 22mj, 25Hz) corresponding to four notches in the graft (7.6mm, 16mj, 25Hz) outlined by a metal mask (0.2~.09g) facilitated congruent ali~nment (•keyJkey-hole-) with the first four single sutures. Watertight wound closure and undis­ turbed wound healing were achieved.

Scientific Poster 13

Penetrating Keratoplasty in Congenital Hereditary Endothelial Dystrophy

Ali A AI- Raj hi, MD, FRCS; Aziz H Awad, MD; Antonio M Huarnan, MD, Riyadh, Saudi Arabia Thirty-six patients (48 eyes) with congenital hereditary endothelial dystrophy (CHED) underwent penetrating keratoplasty (PKP). Single PKP was done in 35 eyes, PKP was repeated twice in 8 and three times in 5 eyes, yielding a total of 66 grafts. The mean age at surgery was 13 years (range: 7 months-35 years), with a mean follow-up of 30 months (3-96 months). Grafts remained clear in 71% of corneas after single PKP and in 58% in repeated grafts. Only 31%ofthe eyes with clear grafts had 0!:20/80 vision. PKP produces a favorable outcome after the first PKP in CHED patients; however, visual results are not encouraging.

Scientific Poster 14

Corneal lntraepithelial Neoplasia (CIN): Bilateral Disease and Its Association with Contact Lens Wear Steven 8 Robin, MD, Chicago, IL; Randy JEpstein, MD, Chicago, IL;

Jonathan 8 Rubenstein, MD, Chicago, IL; S Barry Eiden, OD, Deerfield, IL; George 0 Waring Ill, MD, Atlanta, GA Thirteen patients presented with atypical CIN. Eleven were affected bilaterally and had a history of contact lens wear (5-soft, 2-hard, 4-both). All contact lens-associated lesions diminished upon cessa­ tion of lens wear. One had a pterygium resection, but in all other cases, there was no associated limbal disease. Superfecial keratec­ tomy in 4 cases disclosed the typical histopathologic findings associ­ ated with CIN. These cases extend the clinical context in which CIN is found to include an association with contact lens wear, bilateral involvement, and lack of associated limbal conjunctival lesions.

:1: The presenter(s) have a financial interest in the subject matter of the presentation

122

SCIENTIFIC POSTERS Scientific Poster 1S Sclerouveitis and Systemic Disease

Maite Sainz de Ia Maza, MD, Boston, MA; C Stephen Foster, MD, Boston, MA; Nada Jabbur, MD, New York, NY The uvea may be an inflammatory focus of some systemic diseases which may be associated with scleritis. We reviewed 172 cases of scleritis to determine whether or not uveitis was more common in patients with specific systemic diseases. There was no such associa­ tion with rheumatoid arthritis, systemic lupus erythematosus, Wegener's granulomatosis, or relapsing polychondritis. By contrast, there was an association (p
Scientific Poster 16 The Clinical and Diagnostic Use of In Vivo Confocal Microscopy in Patients with Corneal Disease

H Dwight Cavanagh, MD, PhD, Dallas, TX; james PMcCulley, MD, Dallas, TX; W Matthew Petrol!, PhD, Dallas, TX; William Anderson, Dallas, TX; Darrel Conger, Dallas, TX; RWayne Bowman, MD, Dallas, TX; Steven EWilson, MD, Dallas, TX; James VJester, PhD, Washington, DC

Confocal microscopy allows real-time viewing of all structures in the living cornea at high resolution in 4 dimensions (x,y,z,time). We report the clinical use of an instrument recently FDA-approved for diagnostic use. Quantitative images are obtained of normal epithe­ lium, basal lamina, fine nerve plexus ("beaded" and "smooth"), keratocytes, nerves, and endothelium. Clinical conditions studied include: wound healing after myopic excimer ablation; ICE syndrome; SLK; CTL-associated infiltrates (bacteria and Acanthamoeba); and Reis-Bucklers dystrophy. Based upon our experience, we believe this technology represents a unique new clinical tool for ophthalmologists.

Scientific Poster 17 Refractive Change Following Surgical Keratectomy for Treatment of Superficial Corneal Disorders

Walter EBeebe, MD; Henry Gelender, MD; jonathan Sher, OD, Dallas, TX This retrospective study examined the refractive effect of surgical keratectomy in 27 eyes undergoing surgery for treatment of superficial disorders. The study population had a mean age of 72.7 years and a mean follow-up of 28 months (range 6-50). Sixty percent of eyes showed a myopic shift (mean = 2.2D, range -0.75 to -6.00), 22% showed no change, and 18% had a hyperopia change (mean = 1.55D, range+0.75 to +3.00). Phototherapeutic keratectomy (PRK) is known to induce hyperopia. This study suggests a difference in refractive change between surgical keratectomy and PRK.

Scientific Poster 18 Pediatric Microbial Keratitis

Thomas EClinch, MD, New Orleans, LA; Florentino EPalmon, MD, Philadelphia, PA; Matthew J Robinson, MD, New Orleans, LA; Elisabeth JCohen, MD, Philadelphia, PA; Bruce ABarron, MD, New Orleans, LA; Peter RLaibson, MD, Philadelphia, PA A paucity of literature exists on the diagnosis and treatment of infectious keratitis in children. In a 5-year retrospective review, 29 microbial infections were identified in 28 patients who were 16 years old or younger. Herpetic infections were excluded. Predisposing factors included trauma (31%), contact lens use (24%), past ocular surgery (21%), severe systemic illness (21%), and exposure (17%). Gram positive cocci were the most common pathogen (52%). Fungi (17%), gram negative bacteria (22%), Acanthamoeba (4%), and Borrelia burgdorferi (4%) were also identified. The majority of infec­

tions responded well to topical therapy. Surgical intervention (10%) was less frequent than previously reported.

Scientific Poster 19 The Treatment of Perimenopausal Dry Eye Syndrome with Topical Estradiol

*

Virginia Lubkin, MD, Riverdale, NY; Philip Kramer, MD, Staten Island, NY; Robert Nash, PhD, jamaica, NY Experimental evidence suggests that ocular surface tissues are modu­ lated by sex steroids. Topicai17-B-Estradiol was tested in a double blind study on perimenopausal dry eye patients. Patients had one eye randomly assigned as a treatment eye, the other a control eye. Two groups of patients were studied; E-1 (n=6) used 0.1% while E-2 (n=8) used 0.5%. Clinical assessments of the patients revealed 83.3% of ~-1 tre~ed eyes and 87.5% of E-2 treated eyes improved. Of eyes 1mprovmg, 60% of E-1 and 71.4% of E-2 improved greater than placebo. Topical estradiol seems beneficial in the treatment of dry eye syndrome.

Scientific Poster 20 Corneal Epithelial Morphology Following Excimer Laser Photorefractive Keratectomy

Shiro Amano, MD, Musashino-shi, Japan; Kimiya Shimizu, MD, Musashino-shi, Japan; Kazuo Tsubota, MD, Ichikawa, Japan We prospectively investigated corneal epithelium of 30 myopic eyes (average age 31.7 yrs.) following photorefractive keratectomy (PRK) using a specular microscope. Central corneal epithelium showed normal epithelial pattern 3 months postoperatively in all cases. The postoperative mean epithelial cell areas were 559.2+80.9JUY12 at 1 month, and 581.3+101.6JUn2 at 3 months respectively, which were not significant!}' altered from the preoperative mean cell area of 613.7+97.5JUY1 (p>O.OS). Results suggest that the absence of Bowman's layer induced by PRK may not seriously affect corneal epithelial morphology.

Scientific Poster 21 Sjogren's Syndrome (SS) and Epstein-Barr Vitus (EBV) Infection

lkuko Toda, MD, lshikawa-shi, japan; Hiroshi Fujishima, MD, lshikawa-shi, Japan; Kazuo Tsubota, MD, lshikawa-shi, Japan; Masafumi Ono, MD, Hachiouji-shi, Japan We examined the serum antibody titers (SAn to EBV in a large series of dry eye patients (N=287); 62 SS and 225 non-SS. In SS, the mean SAT were significantly elevated to 2 X 101'1id:1.3t for EBV nuclear antigen (EBNA) and 2 X 10434±1.39 for early anti'-en (EA) (P<0.001). The SAT were not elevated in non-SS; 2 X 1o0·aat ~5 for EBNA and 2 X1O.o.a9iO.Sl for EA. EBV reactivation patterns as defined by SAT were seen in 17.7% of SS and 3.1% of non-SS. These findings suggest an association of EBV infection with SS, but not with non-SS.

Scientific Poster 22 Corneal Ulcer Therapy: Cefazolin/Aminoglycoside vs. Ciprofloxacin

Michael J Azar, MD; Regis P Kowalski, MS; jerold S Gordon, MD; Michael J Bueche, MD, Pittsburgh, PA The introduction of ciprofloxacin has prompted clinicians to recon­ sider their initial therapy for treating bacterial corneal ulcers. The in vitro antibiotic susceptibility patterns (disk diffusion) of 497 cases of bacterial corneal ulcers (1988- 1991) were reviewed, comparing the fortified combinations (cefazolin with tobramycin or gentamicin) to ciprofloxacin. This in vitro study suggests that the combination of fortified cefazolin/aminoglycoside provided broad spectrum coverage (96%, 516/535). Ciprofloxacin appeared to provide gram (-)coverage (1 00%, 15/15) but it did not cover all gram(+) organisms (75%, 49/65).

:1: The presenter(s) have a financial interest in the subject matter of the presentation

123

SCIENTIFIC POSTERS Scientific Poster 23

similar to the standard color method and allows more accurate interpretation of B & W reproductions.

John CHill, FRCS, Cape Town, South Africa Keratoplasty in highly vascularized corneas (> 16 vessels in 3 or 4 quadrants) carries a poor prognosis. T\1110 groups of these corneas undergoing keratoplasty were studied. Group 1 (N=37l received topical corticosteroids only, Group 2 (N=43) also received oral cyclosporine. Graft survival in Group 2 was significantly better (P=<0.004). In Group 2, 29 eyes received cyclosporine for six months and 14 for 12 months. Graft survival was similar (P=0.23). In severe bilateral disease, cyclosporine is indicated to prevent the high inci­ dence of early postoperative rejection allowing "immunological priv­ ilege" to be re-established.

Corneal Topographic Alterations in Normal Contact Lens Wearers

The Use of Systemic Cyclosporine to Prevent Graft Rejection in Highly Vascularized Corneas

Scientific Poster 24

Microbial Keratitis in Childhood

Oscar A Cruz, MD; Eduardo C Alfonso, MD; Hilda Capo, MD, Miami, Fl Microbial keratitis occurs infrequently in childhood. We retrospec­ tively studied 51 eyes with microbial keratitis occurring in SO children under 16 years of age. The principal risk factors were trauma (44%), prior corneal surgery (24%), and contact lens wear (14%). Systemic illness or an immunocompromised state existed in 7 of the 15 (47%) children under age 3. There was a large male preponderance (68%). Forty-four (86%) of the 51 cases were culture-positive. Pseudomonas aeruginosa (34%), staphylococcus aureus (20%), and fungi (18%) were the most common organisms isolated. Six (12%) eyes required surgery. Identification of principal risk factors may aid in early recognition and treatment.

Scientific Poster 25

Bromhexine Has No Effect on Tear Production in Patients with Sjogren's Syndrome- A Fluorophotometric Study

Martin Goebbels, MD; Evtichia Pavlidis, Manfred Spitznas, MD, Bonn Gennany The effect of oral medication with bromhexine on the tear secretion of patients with Sjogren's syndrome is still controversial. In the present study, the tear secretion of 23 consecutive dry eye patients with Sjogren's syndrome was determined by objective fluorophotometry before as well as 7 and 21 days after the beginning of oral treatment with bromhexine (48 mg/d). Tear secretion was found to be 0.2±0.21J.I/min before as well as 7 and 21 days after the beginning of treatment with bromhexine (P>0.8). Thus, within 3 weeks of treat­ ment, oral medication with bromhexine has no effect tear secretion in patients with Sjogren's syndrome.

Scientific Poster 26

A Black and White Method for Illustration and Reproduction of Corneal Pathology

Kurt G Klussmann, MD; Anthony J Viti, MD; Marian S Macsai, MD, Morgantown, WV Communication of corneal pathology by standard color drawings (Waring and Laibson, 1977) breaks down when photocopied or facsimile copies are used. Therefore, a black and white (B & W) method of illustrating corneal pathology was developed based on the standard color method. In a randomized prospective study, ten original and photocopied (B & Wand color) drawings were examined by ten ophthalmologists. There was no significant difference between interpretations (both color and B & W) of original drawings and photocopies of B & W drawings (96.0%- 97.6% correctly identified). Only 40.2% of photocopied color drawings were correctly identified (p<.OOl ). Results suggest that this B & W method conveys information

Scientific Poster 27

*

Steven EWilson, MD, Dallas, TX; Jaime Ruiz-Montenegro, MD, Dallas, TX; Carlos H Mafra, MD, Dallas, TX; J Michael Jumper, Dallas, TX; Stephen D Klyce, PhD, New Orleans, LA; Edward Mendelsohn, OD, Dallas, TX Thirty-seven normal eyes and 7 4 asymptomatic eyes that wore contact lenses (12 right PMMA, 23 rigid gas-permeable, 26 eyes daily wear soft, 13 extended-wear soft) were evaluated with computer-assisted topographic analysis (CTA). Topographic abnormalities were more common and severe in corneas that wore rigid contact lenses, but significant changes were also noted in eyes that wore soft contact lenses. A total of 10 eyes in the rigid contact lens groups had a one line decrease in best-corrected vision attributable to contact lens­ induced topographic abnormalities. This study underscores the need for all eyes in contact lens wearers to be evaluated for topographic abnormalities with CTA prior to refractive surgical procedures.

Scientific Poster 28

Mean Recurrence Time Following Pterygium Removal

lawrence W Hirst, MBBS, Woolloongabba, Australia; Allan Sebban, MBBS, Woolloongabba, Australia; David Chant, BSc, MSc, PhD, St lucia, Australia We wanted to define the optimal period of follow-up to guide future trials assessing risk of recurrence after pterygium surgery. A retrospec­ tive study of 11 0 pterygium recurrences following a variety of methods of removal was undertaken. Survival analysis revealed a mean recur­ rence time of 122±113 days. Treatment modality does not appear to influence recurrence time. There is a 97% chance of recurrences occurring within twelve months. This study indicates that a minimum of one-year follow-up for most trials of treatment for pterygium is desirable.

Scientific Poster 29

Photorefractive Keratectomy Following Undercorrected Myopic Epikeratoplasty Procedures

Joseph Colin, MD, Brest, France Five eyes had a delayed refractive regression following myopic epi­ keratoplasty; the undercorrection ranged between -8.00 and -1 0.00 diopters. Excimer laser photorefractive keratectomy was performed to achieve a full refractive correction. A dense subepithelial haze was observed in the 5 eyes. The 3 months postoperative refraction ranged between -1.000 and+ 2.500 but the spectacle corrected visual acuity reached only 0.1 to 0.2. Excimer laser photorefractive keratectomy was not a helpful means of correcting residual high myopia after myopic epikeratoplasty.

Scientific Poster 30

Bradley D Fouraker, MD; David J Schanzlin, MD; Kerry KAssil, MD, St Louis,MO The Intrastromal Corneal Ring is an investigational device designed to alter the central corneal curvature after placement in the mid-stroma of the peripheral cornea. It was successfully implanted into the non-functional eyes of ten patients. The six-month results indicate flattening by keratometry of 2.7±.9 diopters, while retinoscopy indi­ cated flattening of 2.6±.8 diopters. Minimal complications have been observed including transient peripheral haze. In three out of ten patients, minute, non-progressive deposits were noted adjacent to the rings. This procedure has many potential advantages compared to current keratorefractive procedures.

:j: The presenter(s) have a financial interest in the subject matter of the presentation

124

*

Evaluation of the Intrastromal Corneal Ring in Non-Sighted Eyes

SCIENTIFIC POSTERS Scientific Poster 31

*

Comparative Efficacy of Ganciclovir and Acyclovir in the Treatment of Herpes Simplex Dendritic Keratitis

Joseph Colin, MD, Brest, France; Serge Resnikoff, MD, Iota, Mali; Jean-Louis MAdrien, MD, Clermont-Ferrand, France Ganciclovir has been shown to be more effective than acyclovir in treating herpetic keratitis in rabbits and mice. Fifty-nine patients presenting with herpes simplex dendritic ker~titi~ were trea~ by 0.15% ganciclovir aqueous gel or 3:"' acyclovir omtment fiv~ t1m:e' daily in a multicenter open random1zed study. Compl~e ep1theh~l healing was obtained at day 7 in 58% of the eyes treated w1th acyclovir and in 68% of the eyes treated with ganciclovir, and at day 10, 68% and 76% respectively. These results show that ganciclovir tends to be more effective than acyclovir, although the difference was not statistically significant.

Scientific Poster 32

The False Promise of Suture Adjustment

Perry S Binder, MD, La Jolla, CA Adjustment (SA) of single-continuous suture (SC) following corneal transplantation is reported to provide rapid acuity recovery and reduce astigmatism. I prospectively compared 40 SA and 130 c~curr~t cases of selective suture removal (SSR). SA reduced sutures-m astig­ matism, but produced irregular sutures-in topography while reduci~g visual axis diameter (video keratography). Unpredictable topographic changes were more common following SA, making IOL calculations inaccurate. Epithelial defects and "wound cracking" with SA pr?­ duced ocular morbidity. Bilateral cases preferred SSR over SA. His­ torical results of SC and SSR demonstrate SA to be less satisfactory.

Scientific Poster 33

Keratoplasty in Children

Jean-Marc Legeais, MD; Denise Jobin, MD; M l.arbi-Cherif, MD; Gilles J Renard, MD; Yves J Pouliquen, MD, Paris, France One hundred fifty eyes ofchildren less than 15 years of age underwent keratoplasty with one to ten years' follow up. The cases were divided into three age groups (0-5, 5-10, 10-15 years). Survival analysis showed the probability of obtaining a clear graft at one year to be 25/39 (64%) with congenital opacities, 28/36 (77%) with opacities from trauma and 59/75 (77%) with acquired nontraumatic opacities. The visual benefits of corneal transplantation in selected cases in children appear to outweigh the difficulties engendered by this pro­ cedure.

Scientific Poster 34 Scleritis-~ociated

Uveitis

Maite Sainz de Ia Maza, MD, Boston, MA; CStephen Foster, MD, Boston, MA; Nada Jabbur, MD, New York, NY Uveitis may accompany scleritis. We classified the records of 172 patients with scleritis into those with and without uveitis to determine the incidence, characteristics, and significance of uveitis. Uveitis in 42% of the patients was frequently anterior, of mild intensity, and occurred late in the disease. Uveitis was associated with anterior necrotizing scleritis (p<0.0005), loss of visual.~uity (~0.05), a~ peripheral ulcerative keratitis (p<0.05). Scler1t1s assoc1ated uve1t1s should be considered a grave sign, since it indicates an extension of the inflammatory process, which may cause complications leading to visual loss.

TUESDAY POSTERS Scientific Poster 148

Videokeratography Indices to Detect •Early Keratoconus"

Varon S Rabinowitz, MD; Huying Yang, MD, PhD; Janet Elashoff, PhD; Jerome I Rotter, MD, Los Angeles, CA Since relatives of keratoconus (KO patients are at increased risk, they provide the population to test whether numeric indices derived from computer-assisted videokeratography (CAV) could identify the '"early KC" phenotype. We studied 30 KC, 30 normal, and 30 clinically normal relatives of KC with CAV. One hundred percent of KC and 20% of clinically normal relatives had increased central corneal power or an increase in inferior-superior comeal power asymmetry (greater than 2SD of normal mean). These data suggest that these CAV values are potential quantitative descriptors of "early KC."

Scientific Poster 149

Ciprofloxacin Levels in the Human Cornea After Topical Administration

Mark LMcDermott, MD; John W Cowden, MD; Theo Tran, MD, Detroit,MI Seven patients undergoing penetrating keratoplasty for pseudophakic bullous keratopathy (4), Fuchs' dystrophy (2), and keratoconus (1) received hourly 0.3% ciprofloxacin HCI topically for 10 hours prior to keratoplasty. Ciprofloxacin levels extracted from corneal buttons were determined using high performance liquid chromatography. A level of 3.1 ±2.2 mcglg (mean±SD) was present in the tissue samples. This study indicates that in corneas with an intact epithelium, freq~t dosing of ciprofloxacin topically results in stromal drug levels wh1ch exceed the MIC for most corneal pathogens.

Scientific Poster 150

Quantitative Specular Microscopy After PRK

Robert A Beldavs, MD; Keith PThompson, MD; GeofF 0 Waring Ill, MD; Dale E Reddick, MS, Atlanta, GA We obtained central specular endothelial microscopy on 15 myopic patients (-2.0 to -6.0D, ages 20-50) before and 6 months following excimer laser photorefractive keratectomy using ~ard FDA phase Ill protocol with the Summit.UV200LA 1~~nm exc1mer laser. Mean preoperative and pqstoperat1ve cell denSities were 2900 cells/mm2 and 2505 cells/mm 2 coefficient of variability was 0.375 and 0.352, and the percent he~gonality was 54.20% and 53.33%, respective~y. The change in both coefficient of variability and percent hexagonahty following PRK was not statistically significant (p>.05), but the change in cell density was significant (p<.OS).

Scientific Poster 151

Culture and Sensitivities of Infectious Endophthalmitis: A Microbiological Analysis of 302 lntravitreal Biopsies

Harold G Jensen, PhD, Oklahoma City, OK; Karl G Stonecipher, MD, Greensboro NC; J james Rowsey, MD, Tampa, FL; Ronald RKrueger, MD, Los An'geles, CA; Vernon C Parmley, MD, Ft. Lewis, WA A total of 302 patient reports were analyzed with 213 culture positive and 89 culture negatives with a culture negative rate of 29.5% (89/302). Of the culture positive patients, 230 microbial isolates, 1~ fungal isolates, and 17 mixed infections were analyzed. Gram posi­ tive were isolated in 181 cultures and gram negatives in 34 cultures. S. epidennidis accounted for 30% (54/181) of the gram positive isolates. The authors will discuss the sensitivitytrendsofthese isolates to current EVS protocols and Ciprofloxacin, culture techniques, and treatment protocols.

i The presenter(s) have a fmancial interest in the subject matter of the presentation

125

SCIENTIFIC POSTERS Scientific Poster 152

Prospective Trial Comparing the Effect of Intraoperative and Postoperative Suture Adjusbnent on Keratoplasty Astigmatism

Olivia N Serdarevic, MD, New York, NY; Gilles J Renard, MD, Paris, France; Yves J Pouliquen, MD, Paris, France We prospectively compared corneal topogr!!phy from 1 week to 6 months after PK with (cK, n=15) and without (sK, n= 15) intraoperative keratometry and suture adjustment. Surgery was performed by one surgeon (single continuous suture, Hanna trephine, 8/8.25 mm). We found significantly less ker,!!tornetric astigmatism postop_after intraop­ erative suture adjustment (cK: mean 1.5... range 0.7-3.1; sK: 5.1, range 1.8-9.6). Postop astigmatism in group sK necessitated postop suture adjustment (with increased discomfort and complication risk), result­ ing in similar mean astigmatism (1.7), but more irregular astigmatism and slower visual rehabilitation compared to the group with intraop­ erative adjustment.

Scientific Poster 153

Keratoconus in Photorefractive Keratectomy (PRK) Candidates Detected by Computer-Assisted Corneal Topography (CACT)

Anthony B Nesburn, MD, Los Angeles, CA; John Hofbauer, MD, Beverly Hills, CA; Jonathan I Macy, MD, Los Angeles, CA; Ezra Maguen, MD, Los Angeles, CA; Varon S Rabinowitz, MD, Los Angeles, CA; Shidfar Bahri, MD, Los Angeles, CA; James J Salz, MD, Los Angeles, CA We used CACT to screen for keratoconus in 146 •normal•low myopic eyes of 91 consecutive patients who presented for PRK. In 6 patients, CACT detected clinically unsuspected abnormalities. One had pel­ lucid marginal degeneration. Using Rabinowitz CACT criteria 0-S value >1.60D), 5 had mild keratoconus in one or both eyes with 1-S values of 1.62 to 6.20. Conclusions: Mild keratoconus may be more prevalent than suspected; preoperative CACT screening is recom­ mended. PRK's safety is unknown in mild keratoconus; if treated, patients should be followed as a special therapeutic subgroup.

Scientific Poster 154

Progressive Schnyder's Corneal Dystrophy

HerbertJ Ingraham, MD, Danville, PA; Henry D Perry, MD, Rockville Centre, NY; Eric D Donnenfeld, MD, Rockville Centre, NY; David D Donaldson, MD, Sarasota, FL Schnyder's crystalline dystrophy is a central anterior bilateral corneal dystrophy characterized by the deposition of crystals composed of cholesterol and other lipids. This condition is classically described as non-progressive after childhood. We present a family pedigree, including a patient first reported in 1954 and followed for 25 years with dramatic progression of the corneal condition in a dense discoid pattern of crystals. Best corrected visual acuity decreased from 20/30 to 20/80 in both eyes, and the patient now has three children, all with typical corneal involvement. Corneal biopsies submitted for light and electron microscopy was consistent with cholesterol deposition. We believethatSchnyder'sdystrophymayprogresssignificantlyovertime and the characterization of this condition as stationary may need to be reconsidered.

Scientific Poster 1 55

Lid Imbrication Syndrome: Diagnosis With Rose Bengal Staining

Eric D Donnenfeld, MD, Rockville Centre, NY; Henry D Perry, MD, Rockville Centre, NY; Amilia Schrier, MD, Rockville Centre, NY; Bruce M Zagelbaum, MD, Rockville Centre, NY; Rand Rodgers, MD, Manhasset, NY Lid imbrication syndrome is an abnormality of lid apposition in which the upper eyelid overrides the lower eyelid. We report 21 cases of this disorder, which was previously considered rare and difficult to

diagnose. Our diagnosis of lid imbrication syndrome was aided by the previously unreported finding of rose bengal staining of the upper lid tarsal conjunctiva. The conjunctival rose bengal staining is linear, contiguous with the lid margin, and co"elates with the severity of lid imbrication. We feel the rose bengal staining pattern is pathogno­ monic for this disease. Lid imbrication creates a tear film irregularity, which may masquerade as, or potentiate, a dry eye syndrome, and frequently presents as a non-specific ocular i"itation. Recognition of this disorder is facilitated by rose bengal staining of the palpebral conjunctiva and allows for appropriate management of this underdiagnosed condition.

Scientific Poster 156

Penetration of Topically Applied Ciprofloxacin and Norfloxacin into Aqueous Humor

Amilia Schrier, MD, Rockville Centre, NY; Eric D Donnenfeld, MD, Rockville Centre, NY; Henry D Perry, MD, Rockville Centre, NY; Myles E Gombert, MD, Brooklyn, NY; Taryn Aulicino, Brooklyn, NY; David B Nelson, MD, Rockville Centre, NY We evaluated the intraocular penetration of the two commercially available fluoroquinolone antibiotics. Topical Ciprofloxacin 0.3% (0 or Norfloxacin 0.3% (N) was given to 20 patients with non­ inflamed eyes prior to cataract extraction. Two drops were given 90 minutes prior and 2 drops 30 minutes prior to obtaining the aqueous humor (AH) sample. 0.1 ml of AH was aspirated from the anterior chamber. Samples were immediately stored at -70" and were then evaluated for C and N concentrations using a bioassay. Topically applied C achieved a mean level in the AH in 9 samples of0.08 uglml (range 0.02 to 0.153 uglml); 1 sample had negligible levels (<0.05 uglml). Topical N achieved a mean level in the AH of 0.08 ug/ml (3 samples); however, the remaining samples (7) had negligible concen­ trations of N. The concentrations of both fluoroquinolones (C and N) were below the MIC of most pathogenic bacteria.

Scientific Poster 157

Evaluation of Human Corneal Wound Healing With Confocal Microscopy After Excimer Laser Keratectomy

Rajesh K Rajpal, MD, Philadelphia, PA;John Essepian, MD, Washington, DC; C J Rapuano, MD, Philadelphia, PA; William Shields, Washington, DC; Daniel Kane, MD, Philadelphia, PA; Peter R Laibson, MD, Philadelphia, PA; Michael A Lemp, MD, Washington, DC The corneas of 5 patients were evaluated on consecutive exams with in vivo confocal microscopy. All patients had undergone excimer laser keratectomy and were followed between 1 and 10 weeks. The central epithelium was thickened, there was an absence of basal laminar complex, and the anterior stroma showed keratocyte (fibro­ blast) proliferation. At the junction of normal and ablated cornea, there was abrupt loss of Bowman's layer. The hypercellularity of the anterior stroma persisted through the observation period and there was disorganized collagen deposition in the anterior stroma.

Scientific Poster 158

Cataract Formation and Extraction Following Penetrating Keratoplasty

John W Reed, MD, Winston-Salem, NC; Thomas P Martin, MD, Winston-Salem, NC: Sheldon M Oberfeld, MD, University Heights, OH; Bradley G Jacoby, MD, Covington, GA; David D Yu, MD, Bethesda, MD; MAlan Dickens, MD, Winston-Salem, NC; Holly P Johnson, MD, High Point, NC The incidence of cataract formation and extraction following pene­ trating keratoplasty is important for preoperative planning and coun­ seling. The records of all 342 phakic eyes (276 patients) undergoing penetrating keratoplasty from 1979 to 1988 were reviewed. The estimated probability of having a cataract removed within two years of keratoplasty is two percent for keratoconus, 48 percent for Fuchs' dystrophy, 19 percent for herpes simplex, 33 percent for stromal

i The presenter(s) have a financial interest in the subject matter of the presentation

126

SCIENTIFIC POSTERS dystrophies, and 34 percent for corneal ulcer patients. Diagnosis, age, and the presence of mild cataract prior to keratoplasty were significant risk factors (pl) for subsequent cataract removal.

Scientific Poster 159

Exdmer Laser Keratectomy (Laser-K) - Six- and 12­ Months' Results on 200 Procedures

S Joseph Weinstock, MD; VMoss Weinstock, Toronto, ON, Canada In our first 200 consecutive laser-K procedures, the patients had a mean age of 37 years (range 19--61) and 67% were males with 30% under -3.00 (group A), 47% between -3.1 and -6.0D (group B), 20% between -6.1 and -9.00 (group 0 and 4% over -9.0D (group D). At 6 months post laser, group A had 87% within 1D and 100% within 2D of emmetropia. The percentages were 84% and 98% for group B, 62% and 95% for group C and 43% and 100% for group D. The 12-month results on refraction, visual acuity and corneal clarity will be presented.

Scientific Poster 160

The Results of Excimer Laser Keratectomy (Laser K) in Higher Myopes (Over -6.0D)

SJoseph Weinstock, MD, Toronto, ON, Canada Ninety consecutive patients with spherical equivalent greater than -6.0D had laser-K with 6-month results available on 89. Of these, 67 had preoperative refractive errors of -6.1 to 9.0D (group A) and 22 were over -9.1 D (group B). Cycloplegic refraction at 6 months revealed that in group A, 80% were within ±1 D and 93% were within ±20 of emmetropia. In group B, 55% were within ±1 D and 77% were within ±2D. Vision, refractive error and corneal clarity results at 1 year will be presented.

Scientific Poster 161

Excimer Laser Photorefractive Keratoplasty for Myopia

Linda A Ficker, MD; Arthur D M Steele, MD; Colin M Kirkness, MD; Keith Bates, MD; Andrew Milliken, MSc, london, England We report a prospective study of 81 patients who underwent excimer laser PRK for myopia (-1.50 to 10.00 diopters with up to 2.00 diopters astigmatism). They have been followed for a minimum 12 months. By 6 months, 84% achieved 20/40 unaided and 90% were within 2.00 diopters of intended correction. Mean contrast sensitivity (Pelli-Rob­ son) fell from 1.8 preoperatively to 1.5, but recovered to 1.65 by 9 months. All patients developed opacities which faded slowly after 3 months. Low myopia (<4.00 diopters) had an excellent prognosis for unaided vision, but greater myopia gave less predictable results.

Scientific Poster 162

Acute Syphilitic Interstitial Keratitis (IK) in Children

Gerald W Zaidman, MD; Philip Kwait, MD, Valhalla, NY Two children, one a newborn and the other a 13-year-old, presented with acute interstitial keratitis. The former was bilateral, the latter unilateral. Each patient had a positive VORL and a positive FTA-Abs. They were treated with systemic penicillin and topical corticosteroids. Additionally, the newborn received topical penicillin. The acute keratitis resolved within 6 weeks in both. The newborn had no sequela. The adolescent had corneal scarring and 20/100 vision. Ophthalmologists should be aware that with the increasing incidence of syphilis, more children may present with acute syphilitic IK.

Scientific Poster 163

evaluated for intraoperative problems, graft clarity, vision, and post­ operative intraocular pressure (lOP) control. Follow-up evaluation varied from 6 months to 8 years (mean 4 years). Intraoperative problems included a shallow anterior chamber in all cases, positive vitreous pressure in 6 of 17 cases, vitreous loss in 2 of 17 cases, and anterior and/or posterior synechiae in 7 of 17 cases. Fourteen of 17 grafts remained clear; 3 of 17 decompensated, 2 of which underwent repeat PK. Thirteen of 17 eyes had improved postoperative vision; 8 of 17 with 20/60 or better. Postoperative lOP was well-controlled in 15 of 17 cases. Ophthalmologists should be alerted to the likelihood of significant intraoperative problems with PK in eyes with a history of angle-closure glaucoma.

Scientific Poster 164

Long-Term Follow-Up ofTransscleral Nd:YAG Laser Cyclophotocoagulation (TSYLC) for Refractory Glaucoma After Penetrating Keratoplasty

Gerald W Zaidrnan, MD, Valhalla, NY; Andrew Bainnson, MD, New York, NY; Eric D Donnenfeld, MD, Rockville Centre, NY; Thaddeus Wandel, MD, Valhalla, NY We have used TSYLC to treat 20 cases of medically uncontrollable postkeratoplasty glaucoma. We applied 10 bursts per quadrant for either 270° or 360° 3mm from the limbus and an average energy of 5.0 joules. After an average follow-up of 36 months, 14 of 20 eyes (70%) had normal pressures (lOP = S-22mmHg). In our experience TSYLC did not cause phthisis, severe pain, lOP spikes, immediate graft failure, corneal necrosis, wound leaks or retinal detachments and proved to be an effective alternative cyclocryotherapy.

Scientific Poster 165

Increased Evaporation From the Ocular Surface With Meibomian Gland Dysfunction and Gland Dropout

William DMathers, MD, Iowa City, lA; W Matthew Petroll, PhD, Dallas, TX We developed a new device to measure the evaporation from the ocular surface. We tested 20 normal subjects, 24 with rneibornian gland dropout, and 17 with gland dropout and low Schirrners test. We found normal evaporation was 14.8±6 grns/cm2/sec (0.15:W.07 uVmin) at 30% relative humidity. Patients with gland dropout had an evaporative rate of 49.9± 21 gms/cm 2/sec (0.49±0.3uVmin) and those with dropout and low Schirmers had an evaporative rate 59.1 ±28 gms/cm 2/sec (0.52:W.23 uVmin). This study demonstrates increased evaporation associated with meibomian gland loss.

Scientific Poster 166

Superficial Keratectomy for Apical Nodular Scars in Keratoconus

John W Cowden, MD; Theo Tran, MD, Detroit, Ml Ten contact lens intolerant keratoconus patients with apical nodular scars underwent a superficial keratectomy. All resumed comfortable hard contact lens ~ovear. Visual acuity improved in three patients, remained the same in two and worsened in five patients six months postoperatively. The keratoconus progressed in five cases. Superfi­ cial keratectomy for apical nodular scarring in keratoconus may be helpful initially, but half of the patients will require penetrating keratoplasty within two years. This information may be helpful in considering the use and comparing results of excimer laser pho­ totherapeutic keratectomy for this entity.

Penetrating Keratoplasty Following Angle Closure Glaucoma

Amilia Schrier, MD, Rockville Centre, NY; Henry D Perry, MD, Rockville Centre, NY; John ASeedor, MD, New York, NY; Eric D Donnenfeld, MD, Rockville Centre, NY Seventeen consecutive penetrating keratoplasties (PK) performed in 15 eyes with previous angle closure glaucoma were retrospectively

*The presenter(s) have a fmancial interest in the subject matter of the presentation

127

SCIENTIFIC POSTERS Scientific Poster 167 Extended Wear Soft Contact Lenses Induce Corneal Epithelial Changes

Kazuo Tsubota, MD, lshikawa-shi, Japan; Masakazu Yamada, MD, Tokyo, Japan; lkuko Toda, MD, lshikawa-shi, Japan; Hiroshi Fujishima, MD, lshikawa-shi, Japan Using the specular microscope, we have investigated the corneal epithelium of 60 patients wearing contact lens more th~n 1.year and 15 myopic controls. The mean cell area of corneal ep1thel1~~ ~ 621.5±92.5 um 2 in daily hard wear (N=15), 645.8±98.1 um 1n da1ly soft wear (N=15), 634.7±38.6 um 2 in extended hard wear (N=15) which were notsignificantly different from 61 0.5±98.1 um 2 in control. Only the extended soft wear grouq (N=15) showed significantly enlarged epithelium (806.1 ±50.1 um , P<0.01) which is known to be a high risk group for corneal infection.

Scientific Poster 168 Long-Term Results of Mucous Membrane Grafting (MMG) in Ocular Cicatricial Pemphigoid (OCP)

Amd Heiligenhaus, MD; John W Shore, MD; Peter AD Rubin, MD; C Stephen Foster, MD, Boston, MA Aggressive treatment of mechanical fadors is crucial in managing OCP. We analyzed the long-term results of mucous membrane grafts (MMG) in OCP (mean follow-up 25 months) in 26 eyes (20 patients). Fifty-eight percent developed complications of the corn~l surface, resulting in visual loss in 8 eyes. Factors contributing to fa1lure were disease progression (31 %), breakthrough lashes (8%), dry eye (54%), lagophthalmos and exposure (15%), graft problems (8%), and logisti­ cal problems during the follow-up (15%). MMG appeared to be beneficial in selected cases with OCP. Individualized surgical con­ siderations related to trichiasis, keratinization, and eyelid malposition are presented.

Scientific Poster 169 Antibiotic Coverage Against Streptococcus Species in Corneal Storage Media

Lalit Dandona, MD, MPH; Verinder S Nirankari, MD; RichardS Schwalbe, PhD, Baltimore, MD Gentamicin used in corneal storage media is ineffective against Streptococcus species, frequently cultured from donor comeoscleral rims. We studied eff~eacy of vancomycin, clindamycin, erythromy­ cin, and streptomycin against Streptococcusmitis (viridans) and Strep­ tococcus pneumoniae in DexSol, OptiSol, and ProCell, containing 1oo~wml gentamicin. None of the antibiotics up to 250 ll!Vml were bactericidal at 4°C up to 7 days. Erythromycin 25~!¥ml was most effedive, reducing Streptococcus mitis inoculum size by 75-81%, 92-97%, 87-95%, and 97%, and Streptococcus pneumoniae by 50-64%, 82-88%, 82-92%, and 93-97% after 1, 3, 5, and 7 days at 4•c. Addition of erythromycin to corneal storage media may improve coverage against streptococcal contamination.

Scientific Poster 170 Efficacy of a Disinfectant Wipe Technique Against Adenovirus 8 on Tonometer Tips

Anisa B Threlkeld, MD; John W Froggan, MD; Oliver D Schein, MD; Michael S Fonnan, MS, Baltimore, MD A disinfectant wipe technique for tonometer tips was tested with a quantitative viral assay. Adenovirus 8 in serum was dried onto Goldmann and pneumotonometer tips. Inocula were standardized to quantities measured in clinical oc~lar specim!"s (8.4X10 1_-2.5X1~ PFU/ml). Tested tips were: unw1ped, dry-w1ped, and w1ped w1th isopropyl alcohol, iodophor, HzOz, and water. In triplicate experi­ ments, adenovirus was recovered from unwiped and dry-wiped tips, but not from tips wiped with any disinfedants or water. Disinfectant

wiping is effective, in part by mechanical action, and may be an alternative to soaking techniques.

Scientific Poster 1 71 Recurrence Rate Following Simple Excision and Sliding Conjunctival Flap for Primary Pterygium

John McCoombes, BMedSc, Woolloongabba, Australia; Lawrence W Hirst, MD, Woolloongabba, Australia; Graham P Isbell, MBBS, 00, Queensland, Australia Recurrence rates after primary pterygia removal range from 2% to 60%. A surgical procedure with a low recurrence rate is still to be defined. A modification of Barraquer's simple excision and a sliding flap of superior paralimbal conjunctiva for primary pterygium was used in 258 consecutive primary pterygium removals by one surgeon over approximately a five-year period. Chart review and slitlamp examination in 222 patients (follow-up one year) disclosed a recur­ rence rate of 3.2% and no complications. This compares very favor­ ably with all other published results.

Scientific Poster 1 72 Pterygium and Pseudopterygium Recurrence Rate Following Combined Treatment- Eight-Year Retrospective Study

Moshe Eshkoly, MD, Rishon Lezion, Israel; Joseph Turetz, MD, Rishon Lezion, Israel; David Krakowsky, MD, Rishon Lezion, Israel; Joseph Zadok, MD, Rishon Lezion, Israel; Pinhas Nemet, MD, Bnei Brak, Israel Seeking an optimal method to treat pterygium and pseudoptery_gium, we retrospectively reviewed 424 eyes (out of 721) operated dunng an 8-year period. A bare sclera technique excision was fol!owed ~ 3 consecutive sessions of 600 rads a week of P-rays, comb1ned with 6 weeks of topical thio-tepa and dexamethasone treatment. The recur­ rence rate of 386 pterygia and of 38 pseudopterygia was 10.6% and 13.1 %, respectively. Low incidence of complication rate (2.1 %) was detected. This combined procedure is a safe and effective treatment for pterygium and pseudopterygium.

Scientific Poster 1 73 Quantification of Corneal Wound Healing After Photorefractive Keratectomy Using Digitized Scheimpflug Images

Marc Bosem, MD; Perry S Binder, MD; Robert N Weinreb, MD, La Jolla,

CA

The successful clinical application of excimer laser photorefractive keratectomy (PRK) is dependent upon a minimal corneal wound healing response. This response has been detected clinically as a reticular haze; however, no quantitative measure has been available. Digitized anterior segment Scheimpflug images were obtained before and after PRK in ten patients. All postoperative corneas displayed a non-homogeneous white disc-shaped pattern in the ablated area, ranging in depth from 20% to 50% of corneal thickness. The corneal response to PRK and wound healing methods can be quantitatively assessed with this technique.

Scientific Poster 1 74 Nasal Mucosa Grafting and Azathioprine May Control Ocular Cicatricial Pemphigoid on a Long-Term Basis

Alexander A Bialasiewicz, MD; Wemer FOrster, MD; Holger Busse, MD, Munster, Germany OCP is a systemic autoimmune disease, primarily involving the eye, causing blindness due to corneal damage from aberrant lashes, kerato­ pathy from inflammatory cell produds, a keratinized tarsal conjunc­ tiva and a dry eye. We have treated 11 patients (15 eyes) with a combined approach ofsymblepharolysis, lamellar keratectomy, nasal mucosa grafting and systemic Azathioprine chemotherapy. Eval~a­ tion of goblet cells and tear film stability were done. Pa~n and fore1gn body feeling subsided, and symblephara only recurred m two eyes of

*The presenter(s) have a financial interest in the subject maHer of the presentation

128

SCIENTIFIC POSTERS patient non-compliant for Azathioprine. Ocular motility was regained. One patient required keratoplasty l chaud. Nasal mucosa grafting may be beneficial in OCP when accompanied by Azathio­ prine therapy.

GENERAl Presenters for poster 35 will attend their poster Sun­ day, November 8 from 3:00 to 4:30 PM. Presenters for poster 175 will attend their poster Tuesday, November 10 from 3:00 to 4:30PM. Individual atten­ dance hours will be indicated on a mock clock at each poster board.

SUNDAY POSTERS Scientific Poster 35

Systemic Drug Toxicity in Immunosuppressive Therapy of Ocular Inflammatory Disease

C Stephen Foster, MD; Richard RTarnesis, MD, Boston, MA We reviewed drug toxicity among 116 patients with ocular inflamma­ tory diseases treated with corticosteroids (CS) and immunosuppressive drugs (10). Reversible bone marrow suppression and nausea were the most common side effects of ID. Twenty-three percent of patients receiving cyclosporine had significantly elevated serum creatinine levels. Elevated liver enzymes occurred in 23% of methotrexate­ treated patients. Azathioprine or dapsone had high relative risk of producing reversible major toxic reactions requiring discontinuation of therapy compared to other treatment groups. Ten percent of patients taking CS developed steroid-induced fractures.

TUESDAY POSTERS Scientific Poster 175

Ophthalmologic Findings in Patients Treated With All-Trans Retinoic Acid

Richard M Fenton, MD, Columbia, MD; Rafael Caruso, MD, Bethesda, MD; Marc D deSmet. MD, Bethesda, MD; Malcolm A Smith, MD, Bethesda, MD; David G Poplack. MD, Bethesda, MD; Robert B Nussenblatt. MD, Bethesda, MD

Retinoids show promise in treating solid tumors and acute pro­ myelocytic leukemia. Five pediatric patients in a phase I study of all-trans retinoic acid (RA) were treated and followed for ophthalmo­ logic changes. Two (6 yr, 80mlifm2/d; 7 yr, 60mlifm 2/d) developed papilledema, tritan color vision defects, elevation of the dark adapta­ tion rod threshold (2;0.Siog units), and decrease in contrast sensitivity (S1.65; Pelli-Robson) without clinical symptoms. In both, papilledema resolved after discontinuing RA. Periodic stereoscopic fundoscopy and psychophysical testing is recommended for pediatric patients treated with RA.

GlAUCOMA Presenters for posters 36 through 58 will attend their posters Sunday, November 8 from 3:00 to 4:30PM. Presenters for posters 176 through 199 will attend their posters Tuesday, November 10 from 3:00 to 4:30 PM. Individual attendance hours will be indi­ cated on a mock clock at each poster board.

SUNDAY POSTERS Scientific Poster 36

Effect of Provoked Vasodilation on Glaucomatous Visual Field Defects lutz E Pillunat, MD; Gerhard Klang, MD, Ulm, Gennany

In an attempt to evaluate a vasospastic component in the origin of glaucomatous visual field defects, 20 normal-pressure glaucoma patients (NPG) and 20 primary open...ngle glaucoma patients (POAG) were examined. Visual field testing was performed during breathing of normal air and during breathing of increased inspiratory carbon dioxide concentrations (6%). By provoked vasodilation (C()z -breath­ ing), the mean visual field defect in the 30-2 program (Humphrey field analyzer) decreased significantly in NPG patients by 31 %and by20% in POAG patients (Wilcoxon-test p
Scientific Poster 37

Topical Medication With Timolol 0.5% Causes a Transient Decrease in Tear Production- A Fluorophotometric Study

Martin Goebbels, MD; Manfred Spitznas, MD, Bonn, Gennany The effect of topical medication with betabloclcers on tear secretion is still controversial. Using objective fluorophotometry, the tear secre­ tion of 24 patients with bilateral primary open...ngle glaucoma was determined before as well as 7 days, 14 days, and 4 to 7 months after the beginning of topical medication with timolol 0.5% (OU; b.i.d.). Before treatment, tear secretion was found to be normal (1.1 ±O.S.ufmin). Seven days after the beginning of treatment, tear secretion had decreased signifiCantly (0.7±0.4JI,I/min; p<0.01 ). How­ ever, 14 days (1.2±0.4.ufmin), and 4-7 months (1.1±0.5.ufmin after the beginning of treatment, tear secretion did not significantly differ from pretreatment values.

Scientific Poster 38

Internal Sclerectomy With an Automated Microtrephine for Complicated Glaucoma

*

Bradford j Shingleton, MD, Boston, MA; Reay H Brown, MD, Atlanta, GA; E Randy Craven, MD, Denver, CO; Mark C Kuperwaser, MD, Boston,MA Development of a filtering bleb is often compromised in eyes with complicated glaucoma. We performed an internal sclerectomy with a microtrephine via a limbal paracentesis in 34 eyes with complicated glaucoma (mean 2.3 previous operations). No conjunctival incision was required. Mean lOP was 32.6mmHg preop and 18.7mmHg postop (including failures; mean follow-up 9.0 months). An lOP S19mmHg was achieved in 53% of eyes; S 25mmHg in 65%. Addi­ tional surgery was required in 35%. This fast procedure, requiring simple equipment, may improve filtering success in eyes with com­ plicated glaucoma.

i The presenter(s) have a financial interest in the subject matter of the presentation

129

SCIENTIFIC POSTERS Scientific Poster 39

Long-Tenn Outcome of Repeat Argon Laser Trabeculoplasty in Uncomplicated Glaucoma

Ronald P S~o~~endris, MD; Anup K Khatana, MD; MarkS Juzych, MD; Dong H Shin, MD, PhD, Detroit, Ml The safety and long-term efficacy of repeat argon laser trabeculoplasty (RAl has been controversial. We have investigated RAlT [retreat­ men! over 180") in 75 consecutive phakic COAG patients who had previously undergone primary 360" and were uncontrolled on maxi­ mal medications. Success, defined as an lOP QOmmHg, a 3mm reduction from baseline, and no further laser or incisional surgery was seen in 25 eyes (33%) after 19±12 (3-43) months (lOP 22.9±13.7 before vs. 16.0±6.1mmHg after, p=.0001). Twenty-six eyes (35%) had limited success, with lOP control for 15±8 (4-31) months before incisional surgery (8), additional RAlT (11 ), or lOP failure (7). Twenty-four eyes (32%) were early failures by lOP criteria, eventually requiring glaucoma surgery in 15 cases. An lOP spike above 3mmHg at one hour was seen in 10 eyes (13%). RAlT can be an effective tool with lasting effect in uncomplicated glaucoma.

n

Scientific Poster 40

Mitomycin C Trabeculectomy in a Darkly Pigmented Population: Results From a Developing Country

john J Michon, MD; R Ramakrishnan, MD; R Krishnadas, MD; Alan l Robin, MD, Baltimore, MD We studied mitomycin C-assisted trabeculectomy to measure its effects in darkly pigmented individuals and its utility as a method of filtration surgery in developing countries. Eighty-two glaucomatous eyes with a variety of d_iagnoses from patients in southern India underwent surgery. The success rate was 91% as defined by intraocu­ lar pressure of 20mmHg or less with at least three months follow-up. The complication rate was comparable to standard trabeculectomy. These results suggest the utility of adjunctive mitomycin C in darkly pigmented people, a group generally thought to have a poorer prog­ nosis for successful filtration surgery.

Scientific Poster 41

Intraocular Pressure-Dependent Retinal Vascular Change in Adult COAG Patients With and Without Diabetes Mellitus

ClarkS Tsai, MD; Dong H Shin, MD, PhD; Chaesik Kim, BSEE; Monica Allen, Samir Sharma, Gerald P Rosen, Detroit, Ml We previously reported age and systemic hypertension to be negative determinants of intraocular pressure (IOP)-dependent retinal arterial caliber change in adult chronic open-angle glaucoma (COAG) patients. The present study investigated the influence of diabetes (OM) on lOP-dependent retinal arterial caliber change after lOP reduction for a minimum of 2 weeks from 31.6±7.4 to 18.1 ±3 .OmmHg in 17 COAG patients (mean age, 62.3±8.3) with DM and from 34.0±5.4 to 17.3±3.0mmHg in 23 COAG patients (mean age, 60.0±8.4) without DM. The mean decrease of retinal arterial caliber in diabetics (2.93±2.00J.U11) was significantly smaller (P=0.035) than that in nondiabetics (4.46±3.55J.U11) and was smaller than 3.4J.Ull, the 95% Cl upper bound of variability for the measurement. Therefore, DM is another negative determinant of lOP-dependent retinal arterial caliber change and thus of retinal circulation autoregulation.

Scientific Poster 42

Correlation Between Optic Disc Cupping and Visual Field Changes

analysis and automated static perimetry twice 31±25 weeks apart while on therapy. Improvement of MD was seen in 80% of 19 eyes with optic disc cupping reversal (by greater than the upper bound of 95% of total variability) and mean lOP change from 22.9±7.6 to 18.1 ±6.1 mmHg, but only in 22% of 9 eyes with cupping progression and mean lOP change from 22.3±5.9 to 21.5±5.6mmHg. Mean deviation change was also significantly greater in the eyes with reversal than progression (1.78±2.45 vs• ..0.51±0.84 dB, P = 0.002) and correlated significantly with disc rim area change (r=0.579, P=0.001 ). Thus, patients with cupping reversal are more likely to show improvement of VF than those with cupping progression.

Scientific Poster 43

Mary Ann E Uoyd, MD, los Angeles, CA; George Baerveldt, MD, los Angeles, CA; Dale K Heuer, MD, los Angeles, CA; DonaldS Minckler, MD, los Angeles, CA; Martha B lee, PhD, los Angeles, CA; Teresa Sedlak, los Angeles, CA; James F Martone, MD, MPH, New York, NY; Paul P lee, MD, JD, los Angeles, CA Fifty-five patients with medically uncontrollable, non-neovascular glaucomas associated with aphakia, pseudophakia, or failed filters have been enrolled in an ongoing prospective clinical trial comparing 350mm 2 and 500mm 2 Baerveldt implants (27 and 28 patients, respec­ tively). With success defined as 6 S final lOP s 21 mmHg without reoperation or devastating complication, 12-month life-table success rates were 74% and 82% for the 350mm 2 and 500mm 2 implants, respectively. These results do not significantly differ (p=0.20, log rank test). Complications occurred more frequently with the larger implant.

Scientific Poster 44

Combined Oculodennal Melanocytosis and Klippei-Trenaunay-Weber Syndrome with Congenital Glaucoma

Chaiwat Teekhasaenee, MD, Bangkok, Thailand; Sorot Wutthipan, MD, Bangkok, Thailand; Robert Ritch, MD, New York, NY Oculodermal melanocytosis (ODM, Nevus of Ota) is characterized by hyperpigmentation of the eye and the facial skin in the distribution ofthe trigeminal nerve. Of 231 consecutive Thai patients with ODM, five (2.16%) also had Klippei-Trenaunay-Weber syndrome. All but one had bilateral ocular melanocytosis. Hyperpigmented open angles with numerous iris processes were common. Eight of the nine hyperpigmented eyes developed congenital glaucoma. The combi­ nation of these two syndromes appears to represent a manifestation of a more general defect of embryonic neural crest development and strongly predisposes to the development of congenital glaucoma.

Scientific Poster 45

"'Tug Suture," Trabeculectorny, Where the Drainage Can Be Adjusted By the Surgeon in the Six Weeks Post Surgery

Eugene A Fernandes, MD, Edmonton, AB, Canada With drainage procedures, the postoperative pressure is not predict­ able. For periods of 6 to 30 months, 55 eyes had trabeculectomy with release suture to the scleral flap and one "Tug" suture which was used to open the drain for up to six weeks after surgery. There were 3 eyes with pressure failure. The other 52 were satisfactory. Results suggest that scleral flap wound healing with "Tug" suture is a useful addition to the standard suture release trabeculectomy.

Dong H Shin, MD, PhD; ClarkS Tsai, MD; Chaesik Kim, BSEE; MarkS Juzych, MD; John H Zeiter, MD; Beverly McCarty, COA, ST; Detroit, Ml Correlation between changes of optic disc cupping and mean devia­ tion (MD), a visual field (VF) global index, was investigated in early to moderate COAG patients who underwent computerized optic disc :j: The presenter(s) have a financial interest in the subject matter of the presentation

130

*

Preliminary Results of the 350mm2 versus the 500mm2 Baerveldt Implant Clinical Trial

SCIENTIFIC POSTERS Scientific Poster 47 Would Topical Anesthesia Influence Tonometric Values of Intraocular Pressurel

Christophe Baudouin, MD, PhD; Gilles Tisserand, MD; A Elbouyermani, MD; Florence Negre, MD; Pierre Gastaud, MD, Nice, France In order to evaluate the influence of topical anesthesia on values of lOP, intraocular pressure (lOP) was measured in 175 patients using non-contact tonometer, with and without anesthesia. One and five minutes after instillation of one drop of oxybuprocain, lOP was significantly lowered (from 15.69 to 14.82 and 13.03 respectively, p<0.0001). In some patients, lOP was lowered by 6 to 8 mmHg. This phenomenon was not related to mechanical compression of the eyeball. It could be responsible for an underestimation of tonometric values of lOP, and may account for some low pressure glaucomas or for unexplained campi metric alterations in glaucomatous patients.

Scientific Poster 48 Effect of the Tightness of Scleral Flap Closure on the Outcome of Trabeculectomy and Its Complications

Joseph G Feghali, MD; Kurt G Klussmann, MD; Anthony J Viti, MD, Morgantown, WV In a prospective study of the effect of tightness of scleral flap closure on the outcome of trabeculec~omy, 42 eyes of 42 con~tive patients with glaucoma were random1zed between closure w1th 2 (Group A) or 4 sutures (Group B). laser suture lysis was performed within 2 weeks from surgery, if lOP was higher and the bleb size smaller than expected for the corresponding period. Baseline characteristics of the 2 groups were comparable. Average follow-up was 9 months (range 3-18). Mean lOP on latest follow-up was 14.1mmHg in Group A, and 14.9 in Group B, with or without medication. A good filtering bleb with lOP reduction 0.1). There was no difference in the incidence of shallow anterior chamber on the first postoperative day, or the incidence of accelerated cataract between the 2 groups. Tight­ ness of scleral flap closure does not affect the intermediate outcome of trabeculectomy or its complications.

Scientific Poster 49 Marked Generational Differences in Ocular Biometric Parameters in a Chinese Population

Sek Jin Chew, MD, New Orleans, LA; Roger W Beuerrnan, PhD, New Orleans, LA; Herbert EKaufman, MD, New Orleans, LA; Robert Ritch, MD, New York. NY Refractive errors, anterior chamber depths, and axial lengths were determined in 336 randomly selected normal Chinese subjects aged 10 to 70. linear regression showed that young persons were signifi­ cantly more myopic (p<0.0001 ), had deeper anterior chambers (p<0.0001) and greater axial lengths (p<0.0001) than older ones. Angle closure glaucoma has been reported to be more common than open angle glaucoma among Chinese persons. We suggest that the increasing shift toward axial myopia in this population may lead to a gradually decreasing incidence of angle-closure glaucoma. There may also be a concomitant increase in primary open angle glaucoma and pigmentary glaucoma.

Scientific Poster 50 Reproducibility of Optic Nerve Head Topography With a New Confocal Laser Scanning System

Robert D Fechtner, MD, Louisville, KY We examined the optic nerve head of 10 normal eyes and 10 glaucomatous eyes using a new confocal laser topographic scanning system (TopSST'1. Five images were acquired for each eye through an undilated pupil. The standard deviation of the height measure­ ments for each pixel was calculated. The mean standard deviation of the height measurement was 26.911ffi for normal eyes and 29.611ffi for

glaucomatous eyes. This instrument is simple to operate and offers a rapid and reproducible method to measure and document the topog­ raphy of the optic nerve head.

Scientific Poster 51 Apraclonidine and Acetazolamide Affect Intraocular Pressure After Extracapsular Cataract Extraction

Richard M Feist, MD, Iowa Oty, lA; David J Palmer, MD, Glencoe, IL; Richard Fiscella, Pharm D, Chicago, IL In a prospective, randomized, double-masked study comparing Apraclonidine, Diamox, and no treatment on lOP effects after ECCE and PC IOL implantation, patients were assigned to one of three groups: 1) Apraclonidine 1%, 1 hr pre-op and immediately post-op, 2) Acetazolamide (Diamox) 500 mg SR capsule, immediately post-op, and 3) Control (no meds). Baseline, 3 hr, and 24 hr lOPs were recorded. At 3 hrs, the mean lOPs of groups 1 and 2 were reduced, while group 3 mean lOP was significantly elevated. By 24 hrs, the mean Control group lOP remained significantly elevated.

Scientific Poster 52 Internal Revision of Glaucoma Filtration Surgery with Thermocauterization

Federico AMaestre, MD; jacqueline Littzi, MD; Richard JSimmons, MD; Ben 8 Mahan, MD; Robert A Lytle, MD; Thomas JSmith, MD, Boston,MA Twenty patients who had failed filtration surgery underwent an inter­ nal revision with thermocauterization. The average number of pre­ operative glaucoma medicines was two. Mean preoperative lOP was 21.6mmHg and mean final visit lOP was 11.5, a drop of SO%. With a mean follow up of 6 months, 16 eyes (80%) had functioning blebs, 4 eyes (20%) failed. The average number of post-op gl~a medicine was 0.4 and 5-FU administered was 51.5 mgs. No patients were on more medicine post-op than pre-op. Postoperative shallow anterior chambers occurred in 5 eyes (25%). Internal revision with thermocoagulation is a gentle procedure that can help re-establish filtration in selected cases.

Scientific Poster 53 Comparative Study ofTrabeculectomy with 5-Fiuorouracil in Uveitic Glaucoma and Primary Open Angle Glaucoma

Mieko Hayashi, MD; Toru Ueda, MD; Akira Okubo, MD; Tadahiko Tsuru, MD; Kunitoshi Ohara, MD, Kawachi, Japan We reviewed 16 consecutive eyes with uwitic glaucoma (UG) (7 sarcoidosis, 5 Behcet's disease, and 4 idiopathic) and 40 age-matched eyes with POAG that underwent tr~ulectomy with 5-F~. Mean follow-up periods were 16 months 1n UG and 19 ~s 1n PO~G. Life table analysis revealed success (IOPS20mmHg Without medica­ tion) rate as 59% in UG and 80% in POAG at 12 months (p>0.05), and 30% and 58%, respectively at 24 months (p>0.05). Postopera­ tively, cataract progressed signifiCantly in UG (p<0.01) and 4 eyes (25%) needed cataract extraction, while no POAG eyes underwent cataract surgery.

Scientific Poster 54 Encapsulated Filtering Blebs After Trabeculectomy

Felicity AQuansah, MD, Mt. Laurel, NJ; Raymond Harrison, MD, New York, NY; Maurice H Luntz, MD, New York. NY Encapsulated filtering blebs are a complication of glaucoma surgery and can be associated with substantial elevations of intraocular pressure from ten days to eight weeks postoperatively. We retrospec­ tively reviewed 214 trabeculectomies. Encapsulation developed in 13%of75 trabeculectomies with limbus-based conjunctival flaps, 6% of 62 trabeculectomies with fornix-based flaps and none of 77 fornix­ based trabeculectomies combined with cataract extraction. The

*The presenter(s) have a financial interest in the subject matter of the presentation

131

SCIENTIFIC POSTERS results suggest that this complication occurs more commonly in trabeculectomies with limbus-based flaps.

Scientific Poster 55

Perioperative Use of 5-Fiuorouracil in High-Risk Trabeculectomy

Lumina P Lanigan, FRCS, MD; jorg P EStunner, MD; Roger A Hitchings, FRCS, London, England Multiple postoperative injections of5-Fiuorouracil (5-FU) improve the success of filtration surgery, but are associated with complications. A study of perioperative sponge application of 5-FU (50 mgfml X 5 min.) was carried out on 21 high-risk patients undergoing trabeculectomy. No toxic complications were seen. Mean preoperative intraocular pressure (lOP) was 31 mmHg and mean postoperative lOP at 2 months was 15mmHg with 1 failure, 3 qualified and 17 complete successes (Miami criteria). Early results suggest that perioperative 5-FU appli­ cation may be as effective as postoperative injections.

Scientific Poster 56

Effect of Nimodipine, a Centrally Active Calcium Channel Blocker, on Spatial Contrast Sensitivity in Normal Tension Glaucoma

Swaraj Bose, MD; jody R Piltz, MD; Michael E Breton, PhD, Philadelphia, PA The use of calcium channel blockers to treat normal tension glaucoma (NTG) is currently under investigation. We evaluated the effect of an acute dose oforal nimodipine on spatial contrast sensitivity using PelIi Robson charts in 8 patients with NTG and in 10 age- and sex-matched controls. There was a significant increase in log contrast sensitivity 2 hours after nimodipine compared to placebo in NTG (nimodipine: 1.54±.44, placebo: 1.39±.47, p:::0.02) and in controls (nimodipine: 1.82±.17, placebo: 1.64±.13, p:::0.01 ). These results suggest that calcium channel blockers may improve visual function in NTG and in controls.

Scientific Poster 57

Central Visual Field Changes Associated With Glaucomatous Acquired Pits of the Optic Nerve

Leon F Cashwell jr, MD; jerry G Ford, MD, Winston-Salem, NC An acquired pit of the optic nerve (APON) was identified in 86 eyes (65 patients) during glaucoma evaluations: lower half of optic nerve head (n=73); upper half (n=13). Among the seven eyes not having had APONs at previous examinations, hemorrhage was observed at the site of the later APON in three. Automated static threshold perimetry (Humphrey visual field analyzer; 30-2 program) showed markedly depressed sensitivity at the appropriate central nasal point in 82 (95.3%) eyes: 75 associated with a diffuse depression of the appropriate nasal quadrant; seven being isolated findings.

Scientific Poster 58

Reopening of Closed Filtering Blebs Using the Neodymium:YAG Laser

Younghyun Oh, MD, Loma Linda, CA; Ljay Katz, MD, Philadelphia, PA The Nd:YAG laser has been used to reopen filtration fistula in ten patients in which the sclerostomy had become occluded internally after filtering surgeries. In six often patients, filtration was successfully re-established, initially reducing the mean intraocular pressure from 26.5mmHg to 8.6mmHg, with average lOP of 13.5mmHg at 7 months after laser. Nine patients were on considerably fewer glaucoma medications. The VAG laser can be successfully used to reopen the fistula by the internal approach in carefully selected patients who already had well-established filtering blebs.

TUESDAY POSTERS Scientific Poster 176

Comparison of Combined Cataract and Glaucoma Surgery by the Planned Extracapsular and Phacoemulsification Techniques

Bradford j Shingleton, MD; Lawrence C jacobson, MD; Mark C Kuperwaser, MD, Boston, MA lOP control in combined cataract and glaucoma surgery is not well­ established. We reviewed 41 ECCE/101/trabeculectomy and 43 phaco/101/trabeculectomy procedures to compare success in lOP control. Mean follow-up was 15±7 months. The mean reduction in lOP at final follow-up for the phaco group was 6.1±4.7mmHg com­ pared to 3.2±5.4mmHg for the ECCE group (P<0.01). Twenty-six phaco eyes had clinically apparent filtering blebs compared to 5 ECCE eyes (P<0.0004). There was no significant difference in visual acuity improvement or reduction in glaucoma medication requirements between the 2 groups. Results suggest that combined cataract and glaucoma surgery with phacoernulsification may be associated with greater lOP reduction and enhanced bleb formation than with the planned extracapsular technique.

Scientific Poster 1 77 Glaucomatous Optic Disc Hemorrhages

jost BJonas, MD; Liang Xu, MD; Gottfried 0 H Naumann, MD, Erlangen, Germany This study evaluates optic disc hemorrhages in different glaucoma types. Stereo optic disc photographs of 1342 eyes were examined. Hemorrhages occurred most often (P<0.01) in Normal-Pressure-Glau­ coma eyes (6.1 %), followed by eyes with primary open-angle glau­ coma (POAG) and moderately elevated lOP (p
Scientific Poster 178

Pituitary-Hypothalamic Dysfunction in Axenfeld-Rieger (AR) Syndrome

ChaiwatTeekhasaenee, MD, Bangkok, Thailand; Rajala Rajatanavin, MD, Bangkok, Thailand; Jarernpi n jenjitranant, MD, Bangkok, Thailand; Chawalit Preeyasombat, MD, Bangkok, Thailand; Robert Ritch, MD, New York, NY Pituitary reserve was evaluated in 33 patients with AR syndrome, 29 of whom had glaucoma. All had facial bone anomalies. Two patients with short stature had a definite GH deficiency and 3 others (normal stature) had a subnormal reserve response following insulin-induced hypoglycemia. ACTH reserve was subnormal in 7 patients. Gonad­ otropin-releasing hormone stimulation testing demonstrated subnor­ mal FSH reserves, but normal LH reserves in 5 patients. Eight patients had abnormal CT scans (5 empty sella, 2 small pituitary, 1 microadenoma). Various abnormalities of pituitary hormone produc­ tion appear to be common in patients with AR syndrome.

Scientific Poster 1 79

Transscleral Nd:YAG Cyclophotocoagulation in Eyes With Uncontrolled Intraocular Pressure Following Molteno Implantation

Stephen P Schumann, MD; john R Lynn, MD; Ronald L Fellman, MD; Richard j Starita, MD, Dallas, TX Eyes with functioning Molteno implants may develop lOPs which are too high to prevent further glaucomatous damage. Twenty eyes of nineteen patients underwent Nd:YAG cyclophotocoagulation at a

:j: The presenter(s) have a financial interest in the subject matter of the presentation

132

SCIENTIFIC POSTERS mean of 18 months following Molteno implantation (range 0.5-56 months). Five eyes required retreatment. Mean preoperative lOP of 26.7mmHg (range 1S--40) decreased to 16.3mmHg(range 9-28), with an average follow-up of 10.6 months (range 6-25). Ninety percent of eyes achieved an lOP between 9 and 20mmHg with an average of 1.2 medications. Three of fifteen eyes (20%) with initial visual acuity of 20/200 or better lost 2 or more Snellen lines. Nd:YAG cyclophotocoagulation is an effective treatment option in eyes with uncontrolled lOP following Molteno implantation.

Scientific Poster 180

Pupillary Effects of Dapiprazole and Dilute Pilocarpine in Patients with the Pigmentary Dispersion Syndrome

William l Haynes, MD; H Stanley Thompson, MD; A Tim Johnson, MD, PhD; Wallace l M Alward, MD, Iowa City, lA We compared the effects of 0.5% dapiprazole HC1 and 1/6% pilo­ carpine on the pupils of 16 eyes with the pigmentary dispersion syndrome (PDS) and 16 control eyes. In the PDS group, both medi­ cations resulted in significant pupillary constriction from baseline within one hour after dosing (mean = 1.57±0.25mm for dapiprazole vs. 2.43±1.10mm for pilocarpine). Amplitude of pupil constriction was also significantly decreased by both medications (mean decrease = 0.74±0.33mm for dapiprazole vs. 1.06±0.41mm for pilocarpine). Visual side effects were minimal for both medications. Clinical implications will be discussed.

Scientific Poster 181

Variability in the Detection of Glaucomatous Progression of the Optic Disc with Serial Stereoscopic Photographs

Anne l Coleman, MD, los Angeles, CA; Alfred Sommer, MD, Baltimore, MD; Cheryl Enger, MS, Baltimore, MD; Harry L Knopf, MD, St. louis, MO; Robert l Stamper, MD, San Francisco, CA; Joseph Caprioli, MD, New Haven, CT; DonaldS Minckler, MD, Los Angeles, CA; Harry A Quigley, MD, Baltimore, MD To simulate the potential value offollow-up stereoscopic photographs on glaucoma suspects, 2 glaucoma specialists and 2 general ophthal­ mologists evaluated 25 optic discs for progression by comparing their drawings of the optic nerve to follow-up photographs, comparing serial stereoscopic photographs, and comparing another examiner's drawings to follow-up photographs. Use of serial photographs improved sensitivity for one glaucoma specialist. The other specialist's sensitivity was high for all evaluations (61 %-72%). Serial photographs did not consistently improve sensitivity of the exam by the general ophthalmologists over that obtained from their own drawings or those of other examiners.

Scientific Poster 182

Contact Neodymium:YAG Cyclophotocoagulation in the Treatment of Refractory Glaucoma

Gina F Gladstein, MD, New York. NY; Michael Morris, MD, New York. NY; Gerald Dunham, MD, Somerville, NJ Contact Neodymium: VAG cyclophotocoagulation was used to lower intraocular pressure (lOP) in 94 eyes with refractory glaucoma. The number of laser applications was determined by the preoperative lOP. Seventy-seven percent of eyes achieved an IOPS25mmHg; 7% lost two or more lines ofacuity; and 1%developedhypotony. The average drop in lOP was 16.6mmHg. The mean follow-up was 12.5 months. This new modality should be considered an effective treatment for refractory glaucoma.

Scientific Poster 183

lntraoallar Pressure Reduction With a New Prostaglandin Analogue PhxA41 in Patients With Ocular Hypertension Suryanarayanan Nagasubramanian, MBBS, PhD, Kent, England; Roger A Hitchings, FRCS, london, England; G P Sheth, MBBS, MS, London, England In a randomized, double-masked, placebo
Scientific Poster 184

Contact Transscleral Nd:YAG for Treatment of Refractory Pediatric Glaucoma Mark Phelan, MD; Francis Y Falck. MD, PhD; Eve J Higginbotham, MD;

Gregory l Skuta, MD; Paul R Lichter, MD; Thomas B Klein, MD, Ann Arbor,MI We retrospectively studied nine pediatric patients (mean age 7 .3±4.6 years) treated with Nd:YAG contact transscleral cyclophotocoagula­ tion for refractory glaucoma. Mean preoperative lOP was 33.9±4.3mmHg. In three eyes requiring two treatments, mean post­ operative lOP was 18.2±8.4mmHg. In four eyes requiring three treatments, mean lOP was 13.0±5.5mmHg. Overall mean reduction in lOP was 48.0±6.3%. We conclude that laser cycloablation effec­ tively lowers lOP in pediatric patients but often requires repeated treatment sessions.

Scientific Poster 185

Risk Factors for the Development of Encapsulated Filtering Blebs: The Role of 5-FU and Surgical Glove Powder

Younghyun Oh, MD, loma linda, CA; l Jay Katz, MD, Philadelphia, PA

The effect of surgical glove powder and 5-fluorouracil on the devel­ opment of encapsulated blebs were studied in 148 cases that under­ went trabeculectomy. Eyes were randomized into four groups based on use of 5-fluorouracil and types of surgical glove. The overall incidence of encapsulated bleb was 11.2%. The group that received 5-fluorouracil had a lower incidence (8.0%) than the control group

(16.7%). The subgroup in which powder-free gloves were used in conjunction with 5-fluorouracil had the lowest incidence of encapsu­ lated bleb (2.6%), compared to the other subgroups (12.0-17.9%) (p=0.01).

Scientific Poster 186

Is a Smaller Phaco Wound Associated With Better Filtration in Combined Cataract and Glaucoma Surgery With 5-FUl

lawrence M Hurvitz, MD, Sarasota, Fl Sixty-nine patients underwent phacoiiOL/trabeculectomy with sub­ conjunctival 5-FU injections. Forty-eight had a 7mm wound with a hard PMMA IOL. The other 21 patients had a 4.2mm wound with a foldable silicone IOL. Mean pre-op lOP/I rneds were 20.fi/2.1, and 20.3/2.4 for the 7mm and 4.2mm wounds respectively. There was no difference between the groups at one year. Average lOP was 14mmHg on 0.4 meds, with 88% visible blebs. A smaller wound did not produce better filtration results.

*The presenter(s) have a financial interest in the subject matter of the presentation

133

SCIENTIFIC POSTERS Scientific Poster 187 Suprachoroidal Expulsive Hemorrhage: Long-Term Follow-Up

George LSpaeth, MD; Karin A 8aez, MD, Philadelphia, PA Fifteen patients had suprachoroidal expulsive hemorrhage (SEH) at the time of glaucoma surgery. All15 were followed for a minimum of five years. Four eyes were markedly worse following the SEH, losing six or more lines of vision in all cases due to retinal detachment. The other 11 had neither further complication nor further loss. When an SEH does not cause immediate loss of the choroid or retina or postoperative retinal detachment, the SEH itself does not doom an eye to poor vision.

Scientific Poster 188 Hyaluronic Acid in Exfoliation Syndrome

*

Thomas D Fitzsimmons, MD, Stockholm, S~Neden; Per Fagerholm, MD, PhD, Stockholm, S~Neden; Anders 1-Uirfstrand, MD, DrMedSci, Uppsala, S~Neden; Mona Schenholm, M5, Uppsala, S~Neden Exfoliation material is thought to consist of fibrillar material sur­ rounded by an acid mucopolysaccharide gel of unknown type. Three lenses and one cornea from cadavers with exfoliation syndrome were examined histochemically for the presence of hyaluronic acid (HA), using a new stain specific for HA. All three lenses showed HA coating the fibrillar material and lens surface. The cornea displayed heavy staining in the epithelium, anterior stroma, and endothelium. A primary overproduction of HA in exfoliation syndrome may decrease the facility of outflow-a possible mechanism of exfoliation glau­ coma.

Scientific Poster 189 Krupin Eye Valve With Disk for Filtration Surgery

Theodore Krupi n, MD, Chicago, IL; Jon M Ruderman, MD, Chicago, IL; Lisa F Rosenberg. MD, Chicago, IL; Marianne E Feitl, MD, Danville, PA; Martin 8 Wax, MD, SL Louis, MO; Michael A Kass, MD, St. Louis, MO; Allan E Kolker, MD, SL Louis, MO; Carl 8 Camras, MD, Omaha, NE; Jeffrey M Liebmann, MD, New York, NY; Robert Ritch, MD, New York, NY; Janet 8 Serle, MD, New York, NY; Robert A Schumer, MD, New York, NY; Steven M Podos, MD, New York, NY; Paul L Kaufman, MD, Madison, WI; Todd W Perkins, MD, Madison, WI An oval Silastic disk (13 by 18mm) has been fabricated for the episcleral plate of a posterior shunt filtration device (Hood Labora­ tories, Pembroke, MA) to promote a large area of encapsulation. The anterior chamber tube contains a pressure-sensitive slit-valve on the disk surface with the disk attached to the sclera between two adjacent rectus muscles. The early postoperative chamber depth (scale 4+ to 0) was maintained by the valve (3.4±0.2). Preoperative intraocular pressure (38±2mmHg) in 50 eyes was reduced (15.9±1.5) at a mean of 14 months (range 12 to 24) after surgery. Intraocular pressure was :S19mmHg in 81% of eyes, 60% without medications.

Scientific Poster 190 Pattern Visual Evoked Potential (PVEP) Spatial Tuning Defects in Glaucoma Patients With Optic Nerve Asymmetry

Sieglinde Freed, M5, Denver, CO; John A Santoro, MD, Thomton, CO; Edward Hagen, PhD, Thornton, CO; Lynn Hellerstein, PhD, Englewood, CO Early detection of glaucoma requires identification of damage before visual impairment occurs. PVEP testing was used to examine 76 glaucoma patients with optic nerve asymmetry with acuities of 20/30 or better. We compared anatomic variations to PVEP spatial tuning deficit sensitivity. 72.6% of eyes with high CID ratios showed spatial tuning anomalies compared to 28.2% of eyes with low CID ratios and only 0.6% of normal subjects (P=.0056). Findings suggest PVEP spatial tuning defects are sensitive indicators of optic nerve dysfunc­ tion, appearing to identify abnormalities before acuity is affected.

Scientific Poster 191 Ab Externo Photoablative Filtration Surgery With the Excimer Laser for the Treatment of Primary Open-Angle Glaucoma

Carlo ETra~~erso, MD; Ugo Murial do, MD; Enrico Gandolfo, MD; Giovanni A Calabria, MD; Mario Zingirian, MD, Genova, Italy We have performed photoablative filtration surgery on 35 patients affected by uncontrolled primary open-angle glaucoma. A 193nm argon fluoride excimer laser was used to photoablate a rectangular area at the limbus under a conjunctival flap. At a median follow-up of 11 months (range 4-17) mean lOP is 14(±6) with 30 (87%) patients :S18mmHg on no medications. Complications included photoabla­ tion of the conjunctiva (2 cases) and flat anterior chamber (one case). Our data support the efficacy and safety of photoablative filtration surgery for primary open-angle glaucoma.

Scientific Poster 192 Trabeculectomy Combined With Transscleral Sutured Posterior Chamber Lens in the Management of Glaucoma in Aphakia

Fathi EI-Sayyad, FRCS; Magdi Helal, MD; Zakaria EI-Sherif, MD; Mohamad Akef EI-Maghraby, MD; Mohamed Alaa, MD, jeddah, Saudi Arabia Twenty-nine unilateral aphakic patients with uncontrolled glaucoma underwent combined trabeculectomy, vitrectomy and transscleral sutured posterior chamber intraocular lens. Postoperatively, all patients received a total of 50mg subconjunctival injections of 5-Fiu­ orouracil. The mean age was 50.6 years with mean follow-up time of 12 months. The mean preoperative lOP was 30.3mmHg (50=5.97) with postoperative mean reduction of 12mmHg (p<0.005). Mean preoperative vision was 20/50 (range 20/30-20/1 00) and mean post­ operative vision was 20/70 (range 20/30-20/200).

Scientific Poster 193 The Effect of Contact Transscleral Cyclophotocoagulation on Supportive Elements of Sutured Posterior Chamber Lenses

EdwardS Lim, MD; Kerry D Solomon, MD; Randol W Hooper, MD; Joseph R Gussler, MD; Woodford S Van Meter, MD, Lexington, KY A human cadaver model for transsclerally sutured posterior chamber lenses (PCLs) was developed to evaluate the effect of contact trans­ scleral VAG cyclophotocoagulation (TYCPC) bursts on buried poly­ propylene sutures and PCL haptics. In the energy range of 4 to 10 watts, sutures buried beneath partial thickness scleral flaps were consistently disrupted above 6 watts. Deformation of the PCL haptic occurred. To avoid lens displacement, TYCPC should not be per­ formed in the quadrant of the PCL haptics and transscleral sutures. Detailed analysis, posterior photographs (Miyake) and scanning elec­ tron microscopy will illustrate these effects.

Scientific Poster 194 The Heidelberg Retina Tomograph -A New Instrument for the Three-Dimensional Assessment of the Optic Nerve Head

Klaus Rohrschneider, MD; Reinhard 0 W 8urk, MD; Friedrich E Kruse, MD; Hans E VOicker, MD, Heidelberg. Germany To quantify three-dimensional disc morphology in glaucoma, a new instrument was developed. The HRT needs only 1.6 seconds for disc measurement through undilated pupil. Coefficient of variation was 5.5% for cup area, 8.5% for rim area, and 7.7% for cup volume (five repeated measurements in each of 20 patients). The SD for a single pixel was 32~. Comparison with a similar confocal technique (laser tomographic scanner) showed a mean difference of 0.006mm2 for rim area. Therefore, HRT improves measurement modalities with comparable accuracy.

t: The presenter(s) have a financial interest in the subject matter of the presentation

134

SCIENTIFIC POSTERS Scientific Poster 195 A Clinical Comparison of Semiconductor Diode versus Nd:YAG Cydoablation

Michael W Ulbig, MD; Dominic AMcHugh, FRCS; Peter A Hamilton, FRCS, London, England The advent of infrared lasers has allowed their use in transscleral cyc:loablation for refractive glaucoma. A trial was performed to compare the ocular hypotensive and inflammatory effects ofthe diode laser (810nm) and the Nd:YAG laser (1064nm). Twenty eyes were randomized to each group. Lowering of intraocular pressure did not significantly differ in both groups. Postoperative hyphema or fibrin­ ous anterior uveitis only occurred in the Nd:YAG group. Results suggest that the diode laser has a less marked inflammatory effect.

Scientific Poster 196 5-Fiuorouradl (5-FU) in Young Patients. A Two-Year Follow-Up Study

jOrg P EStOnner, MD; David C Broadway, MD; Roger AHitchings, MD, London, England To determine the effectiveness of 5-FU-injections following trabeculectomy in young patients, 92 patients were analyzed retro­ spectively. Forty-six ofthe cases were performed without and 46 with postoperative 5-FU injections. The 2 groups were matched for major risk factors. By life-table analysis, there was no significant difference in the success rates (IOPS21mmHg without medications) after 24 months follow-up (64.1% without 5-FU vs 62.5% with 5-FU). In the young, despite 5-FU, the development of outflow obstruction may cause long-term failure. Methods to prevent this late complication need to be developed.

Scientific Poster 197 Computer-Generated Color-Coded Topographic Maps and Three-Dimensional Displays of the .~~Hill of Vision"

Peter LGuth, PhD, Annapolis, MD; Margaret BUsecki, MD, Aurora, CO; Robert W Enzenauer, MD, Aurora, CO; FMichael Cornell, MD, Aurora, CO; Monte S Dirks, MD, Aurora, CO Automated static perimetry has largely replaced Goldman kinetic perimetry for visual field testing in glaucoma patients. However, the representation of static thresholds with "grey scale" print-outs does not necessarily make the data easier to interpret. Color-coded (by hand) print-outs of the Octopus visual fields permit easier "single­ glance" assessment of the visual field. Computer-generated color­ coded topographic maps of the "hill of vision," not unlike corneal topography, allow improved visualization of the data. Beyond this, computer-generated three-dimensional display on a video display terminal was even better in allowing immediate subjective apprecia­ tion of the shape characteristics represented by the visual threshold data.

Scientific Poster 198 The Influence of Pupillary Dilation on the Visual Field Indices of Glaucoma Patients on Miotics

Keith VRundle, Santa Ana, CA; Hennan LRundle, MD, Santa Ana, CA; Dale K Heuer, MD, Los Angeles, CA; Mary Ann EUoyd, MD, los Angeles, CA; Martha B Lee, PhD, Los Angeles, CA; George Baerveldt. MD, Los Angeles, CA; james FMartone, MD, New York, NY; DonaldS Minckler, MD, Los Angeles, CA Twenty-four glaucoma patients on miotic therapy underwent Hum­ phrey Field Analyzer program 30-2 before and after puJ.'!illary dilation. With mean pupillary area (PAl increasing from 2.0mm2 to 20.4mm 2, the average mean deviation (MD) and corrected pattern standard deviation (CPSD) change was +1.30 dB and -0.51 dB, respectively. Statistically significant correlations were observed between both undilated PA (-0.40, p=0.03) and undilated MD (-0.37, p=0.05) versus the changes in CPSD, which suggest that pupillary dilation of glau-

coma patients on miotic therapy may enhance the recognition of focal scotomas with automated threshold perimetry.

Scientific Poster 199 Comparison of 5-FU, Mitomycin, and 5-FU with Mitomycin as Adjuncts in Combined Cataract and Trabeculectomy Surgery

Carol JZiel, MD; Murray A.Johnstone, MD, Seattle, WA

Seventy-two patients underwent cataract extraction combined with trabeculectomy. Forty patients (group 1) were treated with postop 5-FU, 12 patients (group 2) were treated with mitomycin, and 20 patients (group 3) were treated with mitomycin and postop 5-FU. All groups had significantly lower lOP postop than preop. Group 3 had significantly lower postop lOP compared to groups 1 and 2 at 1, 3, and 6 months postop. These results suggest that adjunct antifibrosis agents with combined surgery result in a reduction in lOP. The combination of mitomycin and 5-FU resulted in the lowest postop lOP.

INTRAOCULAR INFLAMMATION, OCULAR TUMOR Presenters for posters 59 through 75 will attend their posters Sunday, November 8 from 1:15 to 2:45 PM. Presenters for posters 200 through 215 will attend their posters Tuesday, November 10 from 1:15 to 2:45 PM. Individual attendance hours will be indi­ cated on a mock clock at each poster board.

SUNDAY POSTERS Scientific Poster 59 Ocular Toxoplasmosis Presenting as a Disk Mass in a Patient With AIDS

Ahmad MMansour, MD; M Kevin Harmon, MD, Galveston, TX We present a patient with AIDS and optic disc tumor. Funduscopy revealed a large whitish fungating lesion covering the optic disc. Hypodense lesions in the basal ganglia and frontoparietal lobe were present by CT scan. Serum and cerebrospinal fluid anti-Toxoplasma titers were repeatedly negative. Despite anti-Toxoplasmic chemo­ therapy, the patient died. Toxoplasmic cysts were noted pathologi­ cally in the retina, optic nerve, and optic chiasm. Toxoplasmosis needs to be included in the differential of posterior pole mass lesions in AIDS regardless of negative serology.

Scientific Poster 60 Plaque Radiotherapy in the Management of Retinoblastoma: Use as a Primary and Secondary Treatment

Caroll Shields, MD, Philadelphia, PA; Jerry AShields, MD, Philadelphia, PA; Patrick De Potter, MD, Philadelphia, PA; Silvana Minelli, MD, Sao Paolo, Brazil; Carlos Hernandez, MD, Philadelphia, PA; Luther Brady, MD, Philadelphia, PA Of 400children with retinoblastoma, solitary plaque radiotherapy was used as treatment in 103 cases. In 31 cases (30%), it was used primarily, while in 72 cases (70%) it was secondarily used after failure of other methods. The mean tumor base was 7mm and thickness 4mm. Vitreous seeds were apparent in SO cases (48%). Follow-up (38 months mean) showed tumor control in 90 cases (87%) and recurrence in 13 cases (13 %). Final visual outcome was functional in 64 cases (62%) and nonfunctional (primarily from foveal retinoblas­ toma) in 37 cases (36%).

:1: The presenter(s) have a financial interest in the subject matter of the presentation

135

SCIENTIFIC POSTERS Scientific Poster 61

Scientific Poster 66

Sheridan Lam, MD, Chicago, IL; Howard H Tessler, MD, Chicago, IL.; Byron LLam, MD, Deerfield, IL; Jacob T Wilensky, MD, Chicago, IL We report three cases of sympathetic ophthalmia (SO) after Nd:YAG cyclotherapy; two had noncontact cyclotherapy and one had contact cyclotherapy. All patients had previous cataract extractions but no filtering surgery in the exciting eye. Clinical features included chronic iridocyclitis, choroidal folds, Dalen-Fuchs nodules, and optic disc edema. Combined with two previous reports, the incidence of SO at our institution thus far is 5.8% (4/69) and 0.67% (1/150) after noncon­ tact and contact Nd:YAG cyclotherapy, respectively. This incidence is high compared with other ocular procedures. Patients must be followed closely after Nd:YAG cyclotherapy.

Vera Kowal, MD; Jurij Bilyk, MD; Peter AD Rubin, MD; Boston, MA Orbital lymphomas are rarely associated with central nervous system (CNS) lymphomas. We have treated four patients with unusual orbital manifestations of CNS lymphomas. Presentations have included: cranial nerve palsies, orbital mass, extraocular muscle infiltration, sphenocavernous sinus syndrome, and central retinal artery occlu­ sion. The diagnosis of lymphoma was established following orbital biopsy in three patients. Diagnostic lumbar punctures with flow cytometry had a limited role. Systemic diagnoses included: Human T
Sympathetic Ophthalmia After Contact and Noncontact Neodymium:YAG Cyclotherapy

Scientific Poster 63

Iris Bombe in Patients With Uveitis

Raymond L DeBarge, MD, Rockville, MD; Richard M Fenton, MD, Bethesda, MD; Marc D de Smet, MD, Bethesda, MD; Robert B Nussenblatt, MD, Bethesda, MD Iris born~ with angle closure glaucoma can be a devastating process in uveitic eyes. Five cases requiring urgent surgical intervention were reviewed. Four initially underwent peripheral iridectomy (PI) with the Argon and/or Nd:YAG laser. Twoofthefour patients required repeat laser treatment and eventual surgical iridectomies. Uveitic patients with posterior synechiae greater than 270° without inflammation should be treated with prophylactic laser Pl. With inflammation and angle closure, laser PI can be attempted; however, a high rate of closure should be expected and early surgical PI is recommended.

Scientific Poster 64

lndocyanine Green (ICG) Angiography in the Differentiation of Choroidal Melanoma from Choroidal Metastases

JayS Duker, MD; Carmen A Puliafito, MD; Arnold M Kroll, MD, Boston, MA Differentiating an amelanotic choroidal melanoma from a solitary choroidal metastasis can be a difficult clinical undertaking. We investigated the role of indocyanine green (ICG) angiography in differentiating these two tumors. ICG angiography was performed in 7 melanocytic tumors of the choroid (4 melanomas, 3 suspicious nevi) and 3 choroidal metastases. In 7 out of 7 of the melanocytic tumors, a well-defined network of large choroidal vessels was visible early in the angiogram. In contrast, in 3 of 3 choroidal metastases, a promi­ nent paucity of large choroidal vessels was seen. ICG angiography appears to be useful in differentiating amelanotic choroidal melano­ mas from choroidal metastases and may, in fact, be diagnostic.

Scientific Poster 65

Second Tumor Types in Retinoblastoma Survivors

Deborah L Kletzky, MD; lan W Mclean, MD, Washington, DC To determine whether the distribution of second tumors in retinoblas­ toma survivors differs from that in an age-matched normal population (SEER study), we reviewed all cases of tumors secondary to retinoblas­ toma from the Registry of Ophthalmic Pathology, Columbia-Presby­ terian Hospital, Late Effects Study Group and published literature (335 total). The increased risk for carcinomas was 2.6X at unirradiated sites and 18.5X at irradiated sites, for melanomas 13.1 X, for soft tissue sarcomas 33.3X, and for osteogenic sarcomas 130X. Retinoblastoma survivors have a 3.6X increased risk of developing breast or gastroin­ testinal carcinomas.

Unusual Orbital Manifestations of Central Nervous System Lymphomas

Scientific Poster 67

Choroidal Invasion of Retinoblastoma Metastatic Potential and Clinical Risk Factors

Carol LShields, MD; jerry A Shields, MD; Patrick De Potter, MD; Karin A Baez, MD; jacqueline Cater, PhD, Philadelphia, PA A review of 289 eyes enucleated for retinoblastoma revealed that 67 eyes (23%) had histopathologic evidence of choroidal invasion. Those patients with choroidal invasion (with or without optic nerve invasion) were more likely to develop metastases than those without choroidal invasion (p=0.0001). The clinical factors predictive for choroidal invasion from retinoblastoma included intraocular pressure >22mmHg (p=0.04) and iris neovascularization (p=0.007). The his­ topathologic factors associated with choroidal invasion included optic nerve invasion (p=0.002) and poorly differentiated retinoblastoma (p=0.003).

Scientific Poster 68

Metastatic Prostate Carcinoma to the Optic Canal

Jorge Kattah, MD; Georgia A Chrousos, MD; Joan T Roberts, MD; Martin P Kolsky, MD, Washington, DC Five male patients with metastatic prostate carcinoma to the bone presented with unilateral or bilateral profound visual loss resulting from optic nerve compression at the canal. High dose IV methrlpred­ nisolone and radiation treatment resulted in recovery of usefu vision in three patients who were treated early. The mechanism of the optic neuropathy was elucidated by neuro-imaging in all patients and by pathologic examination in two patients.

Scientific Poster 69

AI OS Ophthalmic Manifestations in Spain

juan Cano-Parra, MD; Manuel Diaz-Liopis, MD; Alfredo Adan Civera, MD; Jacobo Gonzalez, MD; GEMU Study Group, Valencia, Spain We studied 547 patients with AIDS in stage IV (CDC) in nine different hospitals between january 1990 and December 1991 to study the epidemiology ofthe systemic and ophthalmic manifestations in Spain, in order to compare it with the epidemiological findings published in Europe and the U.S.A. We found that the AIDS risk factors, and the associated systemic and ophthalmic manifestations are statistically different (p=0.001) from those of the U.S. population. We found a greater number of intravenous drug users (54.6%), with an increased incidence of systemic tuberculosis (32%) and Candida endophthalm­ itis (3%). By contrast, homosexual males represented a smaller per­ centage (23.7%) of cases, with an accompanying decrease in the incidence of Kaposi's sarcoma (6%), CMV retinitis (12%) and con­ junctival or lid Kaposi's sarcoma (0.4%).

*The presenter(s) have a financial interest in the subject matter of the presentation

136

SCIENTIFIC POSTERS Scientific Poster 70

Plaque Radiotherapy for Juxtapapillary Choroidal Melanoma: Experience in 79 Cases

Patrick De Potter, MD; Carol LShields, MD; jerry AShields, MD; Carlos Hernandez, MD; Luther Brady, MD; Sung Bok Cha, MD, Philadelphia, PA We report our experience with 79 patients with juxtapapillary choroi­ dal melanoma treated with plaque radiotherapy. The mean follow-up was 58 months (12-135 months range). There was tumor regression in 66 cases (84%) and tumor recurrence in 13 cases (16%). Radiation retinopathy was found in 52 patients (71 %) and radiation papillopathy in 27 (36%) at average of 19 and 23 months post-treatment respec­ tively. The final visual acuity was
Scientific Poster 71

Clinical Analysis of Human T-Lymphotropic Virus Type I (HTLV-1) Uveitis

Koichi Yoshimura, MD, Kurume, japan; Manabu Mochizuki, MD, Kurume, Japan; Norio Miyata, MD, Miyazaki, japan Clinical feature ofhuman T-lymphotropic virus type I(HTLV-ll uveitis, an idiopathic uveitis in HTLV-1 carriers, was analyzed. In a total number of 91 patients with HTLV-1 uveitis (34 males and 54 females), 81% of cases exhibited an intermediate uveitis characterized by moderate vitreous opacities accompanied by mild iritis and retinal vasculitis, while an intermediate uveitis was seen in 28% of seroneg­ ative patients with idiopathic uveitis, and the difference was statisti­ cally significant. The HTLV-1 uveitis was unilateral (57%) or bilateral (43%) and responded well to the topical or systemic therapy with corticosteroids. Thirteen cases (one male and 12 females) had a previous history of Graves' disease before the onset of uveitis.

Scientific Poster 74

Postoperative Ocular Aspergillosis

Khalid FTabbara, MD; Abdullah AI jabarti, MD; Abdulkarim AI Muhanna, MD, Riyadh, Saudi Arabia We studied five cases of postoperative fungal endophthalmitis. Three patients underwent extracapsular cataract extraction with posterior chamber IOL implantation, and two underwent PKP. Patients devel­ oped postoperative signs of infection seven to 15 days after surgery. Culture grew Aspergillus lumigalus from aqueous or vitreous speci­ mens. The outcome on each patient was evisceration or enucleation despite intensive intravenous and intravitreal antifungal agents. Aspergillus endophthalmitis is a serious and devastating ophthalmic coinpfication of modem microsurgical surgery.

Scientific Poster 75

..,Low-Penetranc:e" Retinoblastoma Associated With a Deletion of Exon 4 of the RB Gene

Terry LSchwartz, MD, Morgantown, WV; T Michael Nork. MD, Morgantown, WV; Linn MMangano, MD, Morgantown, WV; Thaddeus P Dryja. MD, Boston, MA We report a four-generation pedigree of "low-penetrance" retinoblas­ toma due to an inframe deletion of exon 4 of the retinoblastoma gene. Ten of 61 family members had retinoblastoma (8 unilateral, 2 bilat­ eral). Eighteen members underwent fundus examination; 17 of those had genetic testing; 9 had the deletion (2 with retinoblastoma, 1 with probable regressed retinoblastoma, 6 without retinoblastoma). One of the carriers with a normal eye exam had a cutaneous melanoma. This mutation appears to be one cause of "low penetrance" retino­ blastoma reported by Macklin (Am. j. Hum. Genet. 12:1-43, 1960) and suggests that the mutant allele in this family codes for a protein with weak tumor-suppressive activity.

TUESDAY POSTERS

Scientific Poster 72

Scientific Poster 200

Navin Sakhuja, MD, New Delhi, India; Satpal Garg, MD, New Delhi, India; Prem KKhosla, MS, New Delhi, India; J C Sarnantray, MD, New Delhi, India; Lov KSarin, MD, Wynnewood, PA Amoebiasis is widely prevalent in India and retinochoroiditis is one of its manifestations. In the past, the diagnosis has usually been established by stool examination, which is of doubtful significance in tropical countries. We conducted a study to establish the validity of this etiology, on SO patients and 30 controls, who were evaluated serologically (lgG and lgM) by ELISA and IHA, and for cysts in stool. We found no difference in the two groups in all three tests. Our findings suggest a need to reconsider entamoeba as an etiological agent for retinochoroiditis.

Carol LShields, MD; jerry AShields, MD; Patrick De Potter, MD, Philadelphia, PA We report 155 consecutive cases of enucleation and primary hydroxyapatite implantation performed for uveal malignant mela­ noma (100 cases), retinoblastoma (40 cases), blind painful eye (11 cases), and other tumors (4 cases). Over a mean period of 20 months follow up (6-31 months, range), there have been no cases of orbital infection, implant extrusion or implant migration. Three cases of conjunctival erosion occurred and were repaired. Small-degree, rapid prosthesis motility was present in all cases. Large-degree motil­ ity was present in most sockets that had the peg placed.

Amoebic Retinochoroiditis- Is It an Entityl

Scientific Poster 73

Block Excision of Benign Tumors of the Iris and Ciliary Body -Clinicopathological Report on 12 Patients

Volker Rummell, MD; G 0 H Naumann, MD, Erlangen, Gennany Benign tumorsofthe anterior uvea clinically often resemble malignant melanomas. Twelve (9 females, 3 males, mean age: 46.8 yrs.) of 47 patients with tumors of the iris and ciliary body treated with block excision and tectonic corneoscleral graft presented with histologically proven benign tumors (7 rnelanocytic nevi, 3 adenomas of the ciliary epithelium, 1 mesectodermal leiomyoma, 1 schwannoma). Long­ term visual acuity after surgery was better than 20/40 in 7/12 patients. No recurrence was noted and no enucleation was necessary. Results indicate that block excision may be the treatment of choice for circumscribed tumors of the anterior uvea involving the angle.

Hydroxyapatite Implant: AMotility Implant With Few Problems

Scientific Poster 201

Fuch's Heterochromic Irido-Cyclitis Revisited

Jan RFearnley, FRCS, FCOphth; A RRosenthal, MD, leicester, England

Seventy-eight patients with Fuch's heterochromic iridocyclitis (FHIC) were reviewed (42 male, 36 female). Six cases were Indian and 72 Caucasian. Sixty-seven cases were unilateral and 11 bilateral. Most presented between the second and fourth decades with blurring of vision or floaters; only 8 gave any history of discomfort. To date, 51 have developed cataracts with 31 undergoing cataract extraction; and 15 have developed glaucoma, 7 of whom required filtration surgery. Choroidoretinaf scarring was only found in 5 cases. Unusual modes of presentation and complications will also be presented.

1: The presenter(s) have a financial interest in the subject matter of the presentation

137

SCIENTIFIC POSTERS Scientific Poster 202

Radiotherapy for Nasolacrimal Tract Epithelial Cancer

Robert H Sagerman, MD, Syracuse, NY; Anna KFariss, MD, Syracuse, NY· Chung T Chung, MD, Syracuse, NY; Gerald A King, MD, Syracuse, NY; Hae Sook Yuo, MD, San Francisco, CA; Peter D Fries, MD, San Francisco, CA The majority of reported cases of nasolacrimal tr~ tumors are malignant, are of epithelial origin and are treated surg1cally. Local recurrence has been common and less than half can be controlled. We have treated four such patients (poorly differentiated squamous cell- 2, anaplastic- 1, mucoepidermoid- 1) wi~ a definitive cour~ of irradiation. The primary tumor was controlled m each. Metastatic cervical adenopathy developed in two, and was controlled with subsequent irradiation, but one died of widespread metastases. Three remain free of cancer at 13, 5 and 2 years.

Scientific Poster 203

Infectious Origin of Chronic Iritis in Lyme Disease

Reinhard 0 W Burk, MD, Heidelberg, Germany; Christian BOhm, MD, Heidelberg, Germany; VPreac-Mursic, PhD, Munich, German~; M Maiwald, MD, Heidelberg, Germany; Hans EVOicker, MD, He1delberg, Germany , Despite the likelihood of the association of ocular fi~ings and Lyme borreliosis, only a few reported cases can be consider~ to be of proven spirochetal origin. Because of a dense prepup1llary m~­ brane, we performed a sector iridectomy and membranec~omy In a patient with Lyme disease seroconversion. lgG concentratiOns of B. burgdorferiwere 593 U (EIA, ~orm<~OO) from serum and. 42U. from aqueous humor. Borrelia spec1es was 1solat~ from the exc1sed t1.ssue. The cultivation was successful in MKP-med1um after prolonged mcu­ bation. Recurrent iritis in Lyme disease might be of infectious rather than immunological origin.

Scientific Poster 204

The Effect of Subconjunctival .,Dynamite" on Blood Pressure

Michael Morris, MD; ScottS Weissman, MD, New York, NY Acute hypertensive crisis has been report~ after topic~l u~ of 10% phenylephrine. We evaluated the systemic hypertensive Side effect of subconjunctival (sc) "dynamite" injection (O.lcc of a mixture of 0.4% homatropine, 0.5% phenylephrine and 1% procaine) for poste­ rior synechiolysis in 10 non-hypert~sive adults. N.o pati~texhibited a significant blood pressure elevation at any post-Injection measure­ ment interval (performed every 5 minutes for 1 hour), and synechioly­ sis was achieved in two patients (20%). Sc "dynamite" was a safe method for posterior synechiolysis in non-hypertensive adults.

Scientific Poster 205

Clinical Manifestations and Outcome of Vogt-Koyanagi-Harada Syndrome in Children

Khalid F Tabbara, MD, Riyadh, Saudi Arabia; Pamela S Chavis, MD, Riyadh, Saudi Arabia; William R Freeman, MD, La Jolla, CA Vogt-Koyanagi-Harada (VKH) syndrome is rare in children. We decided to study the clinical manifestations and visual outc?me among 11 children with VKH. The age range was 5-14 years w1th a mean age of 10 years. All patients had pan uveitis and three patients had exudative retinal detachment. The follow-up period ranged from two to seven years and a mean of 3.7 years. Despite optimal medical therapy, only 5 (22.7%) out of 22 eyes had a final visual acuity_ of 20/50 or better. VKH in children appears to follow an aggress1ve course and may lead to blindness.

*

Scientific Poster 206

High Dose Cisplatin-VP,, Chemotherapy for Retinoblastoma Failing Conventional Treabnent

Susan H Senft, MD; Kwesi Sackey, MD, Riyadh, Saudi Arabia Retinoblastoma, neuroblastoma, and medulloblastoma are embryo­ nal tumors of neuroectodermal origin. Applying this rationale, a proven neuroblastoma/medulloblastoma chemotherapeutic c~.bi­ nation was adopted. Three children (ages two to seven) fa1hng conventional radiotherapy/chemotherapyfor retinoblastoma received monthly five-day infusions ofCisplatin/VP16 until disease was arrested or toxicity occurred (monitored throug~ rena! parameters, ~ectro­ lytes, CBC, audiograms). Tumor regre551on (evidenced b_y shnnkage, translucency, disappearance of lesions) has remained dunng a follow­ up ranging six months to two years. One patient expired seconda?' to unrelated diarrhea/vomiting; two others have no recurrence. Th1s regimen offers an alternative in challenging cases.

Scientific Poster 207

Psychophysical and Electroretinographic Evaluation of Inactive Vogt-Koyanagi-Harada Syndrome

Gabriela Berumen, MD; Lourdes Arellanes, MD; Juan M Jimenez-Sierra, MD; Edna Angel, MD, Mexico City, Mexico Some authors consider that patients with Vogt-Koyanagi-Harada (VKH) have a favorable visual outcome. We prospectively reviewed the retinal function in 8 patients with inactive VKH. Average period without inflammation was 18 months, with visual acuity ranging from light perception to 20/20. All patients underwent color vision tests, electroretinogram, contrast sensitivity and visual fields. Our findings reflect a severely decreased retinal fundion in all patients. We conclude that, although the residual visual acuity might be satisfac­ tory, the retinal fundion is severely impaired.

Scientific Poster 208

Treatment of Severe Ocular Behcers Disease With Cyclosporine

Scott M Whitcup, MD, Bethesda, MD; Eugene C Salw Jr, MD,

Arlington, VA; Marc D deSmet, MD, Bethesda, MD; Robert B Nussenblatt, MD, Bethesda, MD Behcet's disease may cause profound ocular inflammation and blind­ ness. We retrospectively reviewed 19 patients with severe Behcet's uveitis treated with cyclosporine. The mean follow-up on cyclospor­ ine treatment was 50.9 months, with initial doses ranging from 2.7 to 10.9mWKg. Eleven of 19 patients (58%) had sta~i lization ?" im~rove­ ment of visual acuity in both eyes. Cyclospor1ne was d1scontmued because of side effects in three patients that included renal toxicity, hypertension, and neurologic symptoms. Cyclosporine is an effective treatment for some patients with ocular Behcet's disease.

Scientific Poster 209 Herpetic Uveitis

Carmen I Santos, MD, Rio Piedras, PR Uveitis in herpetic ocular disease is usually associated with corneal stromal disease. Nine patients are reported with a clinica! pi~re of: anterior uveitis, elevated intraocular pressure and sector1al1ns atro­ phy. Intractable glaucoma developed in. three patien~ leading to rapid and severe visual loss. Only two ~Ients ~ad prc;v1ous ~eal herpetic disease; all had positive herpes VIrus ant1body t1ters. Fmdmgs suggest that uveitis without corneal involvement may be a. more frequent manifestation of ocular herpetic disease than. prev1ously thought, and that associated glaucoma may be a devastating compli­ cation.

The presenter(s) have a financial interest in the subject matter of the presentation

138

SCIENTIFIC POSTERS Scientific Poster 21 0

Treabnent of Chronic Cystoid Macular Edema in Idiopathic Uveitis

David KScales, MD; EMitchel Opremcak, MD, Columbus, OH Cystoid macular edema (CME) remains a major determinant of vision in weitis. We prospectively treated 22 eyes with chronic CME (6 months' duration) due to idiopathic uveitis with a subtenon injection of triamcinolone (40mglml), followed by oral nonsteroidal (NSAID) for 12 weeks. All eyes \!~~ere followed for one year. CME resolved in all eyes, averaging 3.41ines of visual improvement. The recurrence rate was 50% (N=11 ), all resolved following re-injection. Subtenon triamcinolone with NSAID maintenance appears to be useful in treating chronic CME in idiopathic uveitis.

Scientific Poster 211

Endogenous Infectious Uveitis

Khalid FTabbara, MD, Riyadh, Saudi Arabia We studied 23 cases with chronic uveitis who were treated with topical and systemic steroids only. Systemic and careful laboratory assessment of their uveitis revealed the association with systemic infections. The causes included 1 case Serratia infection, 8 cases syphilis, 5 cases brucellosis, 1 case borreliosis, 6 cases tuberculosis, and 2 cases leprosy. While uveitis secondary to autoimmune disor­ ders may respond to steroids or immunosuppressive therapy, such treatment without antimicrobial coverage may prove to be devastating in infectious diseases.

Scientific Poster 212

The Association of HLA-88, 851, DR2 and Multiple Sclerosis in Pars Planitis

Susan MMalinowski, MD; Jose S Pulido, MD; Nancy EGoeken, PhD; James C Folk, MD, Iowa City, lA Human leukocyte antigen (HLA) profiles of 39 pars planitis (PP) patients were evaluated. PP patients demonstrated increased frequen­ cies of HLA-B8 (35.9% versus 19.7%; p=0.024), HLA-B51 (23.1% versus 11 .8%; p=0.049) and HLA-DR2 (66.7% versus 28.0%; p<0.0001) compared to 431 controls. HLA-DR2 has been associated with multiple sclerosis (MS). The frequencies were unchanged after exclusion of five subjects who subsequently developed MS. These findings suggest a strong immunogenetic predisposition in PP, and further support an association between PP and MS.

Scientific Poster 213

Concentric Folds as a Sign of Metastatic Choroidal Tumors

David W Johnson, MD; Kenneth RHovland, MD, Den\'er, CO In an attempt to assess the clinical significance of multiple choroidal folds in intraocular tumors, 28 metastatic choroidal tumors, 66 cho­ roidal melanomas, and 8 benign choroidal tumors were reviewed retrospectively. Eight (28%) of the metastatic turnors demonstrated multiple concentric choroidal folds along the posterior edge of the tumor, whereas none of the choroidal melanomas or the benign choroidal tumors shoi!Yed this phenomenon. When present, these folds may be a helpful clinical sign in the differential diagnosis of intraocular tumors.

Scientific Poster 214

Uveitis During Pregnancy and Postpartum

Pamela SChavis, MD; Khalid FTabbara, MD; Ali AAI-Rajhi, MD; M Zafer Wafai, MD, Riyadh, Saudi Arabia Twoenty patients were examined and followed for 27 pregnancies. Uveitis diagnoses included anterior (4), Behcet's (3), panuveitis (3), Vogt-Koyanagi-Harada's (3), Peripheral (2), Iridocyclitis (2), Sarcoid­ osis, Tuberculosis, and Toxoplasmosis. Patients were aged 17-33 years (mean 24 years) and followed 17-109 months (mean 70

months). Exacerbations were common and analyzed by pregnancy months. Visual acuity was maintained or improved in 25/27 pregnan­ cies and worsened in 2/27 pregnancies. Postpartum exacerbations occurred within six to eight weeks of delivery. Despite maternal medication use, fetal and infant morbidity was minimal.

Scientific Poster 215

Digitallndocyanine-Green Video-Angiography of lntraoa.dar Tumors

David RGuyer, MD, Boston, MA; Evangelos S Gragoudas, MD, Boston, MA; Sara Krupsky, MD, Boston, MA; jason S Slakter, MD, New York,

NY; John ASorenson, MD, New York, NY; Ephraim Friedman, MD, Boston, MA; Lawrence AYannuzzi, MD, New York. NY Digital indocyanine-green (ICG)video-angiography(ICG-V) produces high-resolution images of choroidal pathology. We studied 35 intraocular tumors to determine if ICG-V is useful diagnostically. Certain tumors were found to have characteristic ICG patterns: pigmented choroidal lesions blocked ICG fluorescence (13 cases), choroidal hemangiomas demonstrated marked hyperfluorescence (6 cases), metastatic lesions showed variable patterns (7 cases), and choroidal osteomas (3 cases) revealed unique small vessels in early frames. ICG-V was found useful in evaluating tumors with overlying hemorrhages. Our findings suggest that ICG-V may be useful in the diagnosis of intraocular tumors.

NEURO-OPHTHAlMOlOGY Presenters for posters 76 through 84 will attend their posters Sunday, November 8 from 11 :30 AM to 1:00 PM. Presenters for posters 216 through 225 will attend their posters Tuesday, November 10 from 11 :30 AM to 1:00 PM. Individual attendance hours will be indicated on a mock clock at each poster board.

SUNDAY POSTERS Scientific Poster 76

Incidence of Nonarteritic Anterior Ischemic Optic Neuropathy

Lenworth NJohnson, MD, Columbia, MO; Anthony C Arnold, MD, Los Angeles,CA This population-based study was undertaken to obtain information on the age-sex-and race-specific incidence of nonarteritic anterior isch­ emic optic neuropathy (NAION). During a 1-year period for the state of Missouri and a 6-month period for Los Angeles County, ophthal­ mologists reported the number of new cases of optic neuropathy that they evaluated. The estimated mean annual incidence rates (MAIRs) for definite cases of NAION per 100,000 population 50 years and older were 2.n for men of 2.39 for women. The estimated MAIRs were 13.1 for American Indians, 2.76 for Whites, 0.91 for Blacks, and 0.27 for Hispanics. The estimated MAIRs by gender and by race increased with age. The high relative risk for development of NAION among American Indians (48X) and Whites (lOX) as compared with Blacks (3X) and Hispanics (unit risk) suggest possible genetic predis­ position.

*The presenter(s) have a financial interest in the subject matter of the presentation

139

SCIENTIFIC POSTERS Scientific Poster 77 Dilated Orbital Veins in Pseudotumor Cerebri

John G McHenry, MD; Laurie L.au-Sickon, AAS; Thomas C Spoor, MD, Detroit,MI We have found another abnormality of orbital blood flow in pseudotumor cerebri (PTC). Dilated collateral veins between the superior and inferior ophthalmic veins were seen on B-scan in 12 of 35 patients with PTC, as opposed to 1 of 29 controls (p=0.002). None of these patients had proptosis, elevated intraocular pressure, or arterialization of conjunctival vessels. All patients had normal CT scans and elevated intracranial pressure (ICP). We believe that increased ICP pressure leads to decreased flow within the cavernous sinus, causing dilated veins.

Scientific Poster 78 Transethmoidal Optic Canal Decompression in Indirect Optic Nerve Trauma

Leonard A Levin, MD, PhD; Michael P Joseph, MD; Joseph F Rizzo Ill, MD; Simmons Lessell, MD, Boston, MA We previously reported 14 cases oftraumatic optic neuropathy treated with transethmoidal canal decompression. We now report a total of 27 patients, and are able to quantify factors relating to outcome with this intervention. Overall, acuity was improved (mean 6.9±1.4 lines, p<0.0001 ). CT-visible canal fractures did not correlate with outcome (p>0.04). A trend toward poorer outcome was observed with delayed decompression (approximately 1 line/day). Older patients did worse, as did those with poorer initial acuity. Implications for clinical practice will be discussed.

Scientific Poster 79 Anterior Ischemic Optic Neuropathy Associated With Serum Antiphospholipid Antibodies

Kenneth W Houchin, MD, Lorna Linda, CA; Susan C Benes, MD, Columbus, OH; J Roger Edson, MD, Minneapolis, MN; Marilyn C Kay, MD, Milwaukee, WI; J S Winterkorn, MD, PhD, New York, NY; Jonathan D Wirtschafter, MD, Minneapolis, MN Serum antiphospholipid antibodies, including the lupus anticoagu­ lant, have been associated with monocular transient visual loss and retinal artery/vein occlusion. We present 17 cases of nonarteritic anterior ischemic optic neuropathy (NAION) associated with serum anti-phospholipid antibodies and without concurrent collagen-vascu­ lar disease. Rapid bilateral involvement, recurrent systemic thrombo­ sis, stroke, cranial neuropathy, migraine, or spontaneous second-trimester abortion in an NAION patient suggests anti­ phospholipid antibodies. Because patients with antiphospholipid antibodies may be at risk for life-threatening thrombotic events, recommendations will be presented for laboratory evaluation of NAION patients with a suggestive clinical history.

Scientific Poster 80 Unilateral Ptosis in Elderly Patients With Bilateral Partial Oculosympathetic Defects Hitoshi Okabe, MD; Kazunori Kamio, MD; Makoto Tarnai, MD, Sendai,

Japan

Unilateral ptosis and apparently •normal• pupil is an unusual associ­ ation in oculosympathetic paresis. We describe four elderly, 61-79, patients with these findings who were eventually documented to have bilateral partial oculo-sympathetic defects, pre- and postganglionic, by pharmacological testings. All4 patients had negative Tensilon test and no other neuro-ophthalmological signs. The involved lid ele­ vated by topical Phenylephrine 1% from supersensitivity. Bilateral pupils dilated equally, dramatically to Phenylephrine 1 %, moderately to Tyramine 5%, and poorly to Cocaine 5%. Bilateral masked idio­ pathic partial sympathetic paresis should be considered as a cause of unilateral ptosis with apparently •normal• pupils in elderly patients.

Scientific Poster 81 Correlation of PVER Acuity and Snellen Acuity

Osamu Katsumi, MD; Mehul C Mehta, MD; Tatsuo Hirose, MD, Boston, MA The objective PVER acuity is known to correlate well with Snellen acuity (SA) in normal subjects. We also investigated if this relation exists in visually impaired patients. Data from 261 consecutive patients were analyzed. 76.7% of eyes with critical check (CO, the smallest check that produced definite PVER, of 10 min. showed ~0/50. Among 43 eyes with CC of 80 and 160 min, 81.4% showed St\<20/400. Correlation was good between the two in patients, except for those with optic nerve disease in whom the correlation was poor. Certain precautions are warranted in judging objective PVER acuity in patients.

Scientific Poster 82 Differentiation of Optic Neuritis and Anterior Ischemic Optic Neuropathy

Leonard A Levin, MD, PhD; Joseph F Rizzo Ill, MD; Simmons Lessell, MD, Boston, MA Optic neuritis (ON) and anterior ischemic optic neuropathy (AION) may overlap clinically. We used neural networks to see if this artificial intelligence technology could help improve clinical acumen in differ­ entiating these disorders. A neural network was trained on 116 cases of •definite• ON or AION, and tested on another 178 cases. The network agreed with expert clinicians in 99.1% of ON and 65.3% of AION. Middle-age and disk atrophy contributed to diagnostic confu­ sion. Pain, youth, and hypertension had classical associations, while sex and visual field were sometimes misleading.

Scientific Poster 83 White-Noise Field Campimetry- A Screening Method for Detection of Glaucomatous Damage

Ulrich Schiefer, MD, Tubingen, Gennany; Christa Ulrich, MD, Leipzig, Gennany; Wulff-Dieter Ulrich, MD, Leipzig, Gennany; Helmut Wilhelm, MD, Tubingen, Gennany; Frank Rohrwacher, MD, Leipzig, Gennany; Eberhart Zrenner, MD, Tubingen, Gennany Sufficient treatment ofglaucoma requires early detection of functional defects. In contrast to conventional grid perimetry (GP), noise field campimetry (NFO enables patients to perceive their scotomas imme­ diately while looking at the white-noise field on a VDU. In 129 of 173 glaucomatous eyes, GP and NFC concordantly showed both, normal or either pathological results, respectively. In 32 cases NFC was pathologic while GP was normal. The opposite constellation occurred in only 12 eyes (p<0.0005; McNemar test). These results render NFC a fast screening method detecting circumscribed glauco­ matous field defects.

Scientific Poster 84 Ischemic Neuro-Ophthalmological Complications of Cerebral and Cardiac Catheterization

Darin K Bowers, MD; Robert F Saul, MD; Stephen EThurston, MD, Danville,PA Neuro-ophthalmological deficits occasionally occur following intra­ arterial cerebral and cardiac angiography. Out of 9,000 cumulative cases performed over eight years, twenty patients sustained neurolog­ ical defiCits within 12 hours of the procedure and which lasted at least 24 hours. Thirteen patients sustained prominent ischemic neuro-oph­ thalrnological deficits. Retinal and vertebrobasilar syndromes pre­ dominated. Clinical sparing of the anterior and middle cerebral artery territories suggests that smaller emboli are responsible. Retinal embolicinfarction,homonymoushemianopias,andgazepalsieswere the predominant signs encountered. Visual field loss tended to persist, whereas efferent deficits improved on follow-up.

; The presenter(s) have a financial interest in the subject matter of the presentation

140

SCIENTIFIC POSTERS TUESDAY POSTERS Scientific Poster 216

Pseudocysts Following Optic Nerve Sheath Decompression in Pseudotumor Cerebri

John G McHenry, MD; Thomas C Spoor, MD; Laurie Lau-Sickon, AAS, Detroit,MI Using ultrasonography, we observed optic nerve sheath-orbital pseudocyst formation in 9 eyes following sequential, bilateral optic nerve sheath decompression for pseudotumor cerebri. Only one of the fellow eyes showed orbital-arachnoid pseudocysts. All of the eyes with pseudocyst formation showed a greater improvement in mean deviation on Humphrey visual field than the fellow eye (range 0.53 to 23.97 dB, mean 7.18 dB). The cysts can also be demonstrated on MRI with Gadolinium enhancement. We believe pseudocyst forma­ tion helps maintain the patency of the fistula and the success of the operation.

Scientific Poster 217

Intermittent versus Continuous Patient Monitoring During Automated Perimetry

Lenworth N johnson, MD, Columbia, MO; Ali Aminlari, MD, Hershey, PA; joseph W Sassani, MD, Hershey, PA A prospective, randomized study involving 156 subjects was under­ taken to determine the effect of intermittent (JM) versus continuous patient monitoring (CM) on visual field reliability indices during Humphrey Program C30-2 test. The CM and IM subjects had similar diffuse depression and localized visual field defects with there being no difference (P0!:0.41) in the mean deviation (MD), pattern standard deviation (PSD), and short-term fluctuation (SF). The mean fixation loss (6.9%), false-positive (1 .8%) and false-negative (5.8%) errors for IM were not different from the mean FL (7.8%), FP (3.1%) and FN (5.0%) for CM (P0!:0.24). CM does not appear necessary for all patients. The study also noted that FL varied directly with FP, while FN and SF varied directly with PSD and inversely with MD, not only for glaucoma, but also for other disorders producing visual loss (PS0.001).

Scientific Poster 218

North Carolina's Dominant Flocculopathy

Kent Wilson Small, MD; Stephen Pollock. MD; Jeffrey M Vance, MD, PhD, Durham, NC "Vestibulocerebellar ataxia• is a rare, autosomal dominant disease with unusual ocular motility findings. We examined the ocular motility of 18 family members from two different kindreds and found 11 affected individuals. The age of onset of the disorder was from 31-60 years old. Ataxia, vertigo, diplopia, oscillopsia, and tinnitus were common complaints. Although a variety of eye movement abnormalities have been described in this disease, the most prominent and consistent ocular findings in our patients were 1) abnormal smooth pursuits, 2) inability to suppress the vestibulo-ocular reflex (VOR), and 3) gaze-evoked nystagmus. These findings discretely localize the abnormality to the cerebellar flocculus.

Scientific Poster 219

Serum Antibody Production to Botulinum-A Toxin

R Michael Siatkowski, MD, Key Biscayne, FL; Anna Tyutyunikov, MD, PhD, Pittsburgh, PA; Albert W Biglan, MD, Pittsburgh, PA; Christine Genovese, PhD, Pittsburgh, PA; JohnS Kennerdell, MD, Pittsburgh, PA Production of serum antibodies may lessen the effectiveness of Botu­ linum-A toxin. We utilized a sphere-linked immunodiagnostic assay to detect specific antibodies to Botulinum-A toxin in 34 sera samples from 27 patients. Eighteen were treated for essential blepharospasm, Sel/en for hemifacial spasm, and two for spasmodic torticollis. Anti­ bodies were detected in eighteen patients (67%). There was no

correlation between antibody production and clinical diagnosis, response, number of injections, or total dose of drug. Variation in antibody production is more likely a reflection of individual immune responsiveness.

Scientific Poster 220

Computerized Tomography of the Pituitary Gland and Sella Turcica in Patients With Axenfeld-Rieger (AR) Syndrome

ChaiwatTeekhasaenee, MD, Bangkok. Thailand; Rajata Rajatanavin, MD, Bangkok. Thailand;Jarernpinjenjitranant, MD, Bangkok. Thailand; Chawalit Preeyasombat, MD, Bangkok. Thailand; Robert Ritch, MD, New York, NY Thirty-three patients with AR syndrome underwent computerized tomography (thin-slice direct coronal plane section coupled with intravenous or intrathecal injection of contrast material) of the pitu­ itary gland and sella turcica. Pituitary size was measured and exten­ sion of the suprasellar cistern into the sella turcica determined. Five patients had findings compatible with empty sella syndrome. Two others had an abnormally small pituitary. One patient had a microadenoma of the anterior pituitary. The five patients with ESS had various abnormalities of pituitary reserve function. ESS appears to be common in patients with AR syndrome.

Scientific Poster 221

Visual Acuity in Pseudotumor Cerebri

John G McHenry, MD; Thomas C Spoor, MD, Detroit, Ml We performed optic nerve sheath decompressions on 112 eyes with worsening mean deviation on Humphrey visual field. Fifty-two eyes had visual acuity of 20/20 or better. Forty had visual acuity between 20/25 and 20/40 and 20 eyes had visual acuity worse than 20/40. Of 52 patients with 20/20 or better vision, 33 showed improvement in mean deviation, while only 8 of 20 patients with visual acuity of less than 20/40 improved (p=2.03). Mean deviation is a better indication of optic nerve function than visual acuity in pseudotumor cerebri.

Scientific Poster 222

Neuroanatomic Pathway of Alternating Skew on Lateral Gaze and Its Relationship to Superior Oblique Overaction

Latif M Hamed, MD; Bernard LMaria, MD, Gainesville, FL To test the hypothesis that cervico-medullary lesions are responsible for alternating skew on lateral gaze (ASLG), we investigated a series of 50 children with brain tumors, six of whom had ASLG. All six showed neoplastic involvement at the level of the cervico-medullary junction. Knowing that 1) ASLG mimics superior oblique overaction (SOOA), 2) SOOA is frequently found in patients with meningomyelocele, and 3) meningomyelocele is uniformly associ­ ated with Arnold-Chiari type II with cervico-medullary region abnor­ malities, we propose that ASLG and SOOA associated with meningomyelocele have similar neuroanatomic pathways.

Scientific Poster 223

Metastatic Tumors of the Optic Nerve: Case Reports and Discussion

San jay Logani, MD; Robert S Hepler, MD; Anthony C Arnold, MD; John G Frazee, MD, Los Angeles, CA Malignant tumors metastatic to the optic nerve are rare, but when encountered they are management dilemmas. Conventional therapy involves radiation without hope of cure. Two cases, one involving orbital optic nerve and the other involving optic nerve posterior to the canal, were treated effectively by means other than conventional radiation therapy. These tumors were resected neurosurgically, reducing risk of extension into the chiasm and opposite optic nerve. In addition, this definitive approach was used for palliation and to prolong life.

*The presenter(s) have a financial interest in the subject matter of the presentation

141

SCIENTIFIC POSTERS Scientific Poster 224

Loss of PVER Spatial Tuning in Optic Nerve Disease

Osamu Katsumi, MD; Ryohei Wajima, MD; Mehul C Mehta, MD, Boston,MA Abnormally delayed peak or reduced amplitude of pattern reversal VER (PVER) is useful in diagnosis but not specific to optic nerve diseases. Analysis of the amplitude-spatial frequency relationships obtained from PVER appears to offer more specific and useful infor­ mation in optic nerve disease. The areas under the PVER amplitude­ check size function curves (area of spatial tuning) from 31 eyes with optic nerve diseases were calculated and compared with those obtained from 26 normal eyes. The area of spatial tuning was2 significantly smaller in patients compared with the normals (6.0±5.3 and 13.48±8.132 units, respectively; P=O.OOOS), proving a sensitive and objective clinical measure of optic nerve disease.

Scientific Poster 225

Long-Tenn Results in the Fellow Eye After Optic Nerve Sheath Fenestration for Idiopathic Intracranial Hypertension

J Kevin McKinney, MD, MPH; Randy H Kardon, MD, PhD; Jeffrey A Nerad, MD, Iowa City, lA We reviewed 43 cases of idiopathic intracranial hypertension who underwent unilateral optic nerve sheath fenestration (ONSF) from a lateral approach. Visual fields, disc edema, and central visual func­ tion were graded in both eyes to ascertain the effect of surgery on the fellow optic nerve. Postoperatively, 3 had recurrence of disc edema in the fellow eye, one of whom required ONSF in the fellow eye for visual field loss 80 months after the initial surgery. Results indicate that unilateral ONSF does not permanently protect all fellow eyes and requires careful follow-up.

OPTICS, REFRACTION CONTACT LENSES Presenters for posters 85 through 86 will attend their posters Sunday, November 8 from 3:00 to 4:30 PM. Presenters for posters 226 through 228 will attend their posters Tuesday, November 10 from 3:00 to 4:30 PM. Individual attendance hours will be indi­ cated on a mock clock at each poster board.

SUNDAY POSTERS Scientific Poster 85

The Public Self-Refractions

*

C Norton Sims, MD, Fort Myers, FL Self-refracting instruments have not been available to assist in vision screening programs. At a health fair, 208 people (ages 49-85) sub­ jectively refracted themselves (with or without glasses) using two newly developed vision screeners based on the optimal off-axis cylinder principle. The refractive errors were computer demon­ strated. After a brief explanation, 84% improved their VA (1-6 lines Snellen chart) and 98% reported confidence in their results and performance. The average refraction time/person was 20 sec­ onds/eye. Results suggest that such instruments may simplify the refraction technique and improve vision screening programs.

Scientific Poster 86

Steven B Siepser, MD, Paoli, PA An infrared camera was used to determine maximum physiologic pupillary diameters of eyes in the dark. There was no correlation between pupillary aperture and axial length, keratometry or lens power (P=O.OOJ). There was a -.4018 correlation coefficient of age to pupillary aperture (P=.0013) consistent with previous studies. The normal distribution of pupillary aperture revealed that 36% of the population had pupils greater than 5mm in minimal light (P=.0013). This statistically significant group may need to be excluded from patients receiving small optical zone intraocular lenses.

TUESDAY POSTERS Scientific Poster 226

The Morphologic Features of Human Excimer Laser Photoablation

Perry S Binder, MD, La Jolla, CA; Janet A Anderson, PhD, San Diego, CA; Mike ERock, San Diego, CA; Michael P Vrabec, MD, Burlington, VT; Lee T Nordan, MD, La Jolla, CA; Richard LUndstrom, MD, Minneapolis, MN; James V Aquavella, MD, Rochester, NY We performed microscopic studies of 10 human specimens obtained 3-11 months following phototherapeutic keratectomy using fluences from 115-180 mj/cm2 for H. simplex (2), H. zoster (1), adenoviral scars (1 ), non-healing epithelial defect (1 ), refractive anisometropia (3), band keratopathy (1) and 1 unknown indication. All cases failed to achieve therapeutic goals due to inadequate laser depth, scar/dis­ ease recurrence, or refractive regression. Epithelial attachment com­ ponents were reformed (Collagen IV & VII, beta-4 integrin and fibronectin). We describe morphological findings using high voltage and conventional TEM, SEM, light microscopic and immunohisto­ chemical studies to describe healing following PTK.

Scientific Poster 227

Argon Laser lridoplasty in the Marian Syndrome

Natalio J Izquierdo, MD; Elias I Traboulsi, MD; Irene H Maurnenee, MD, Baltimore, MD Five patients with ectopia lentis as part of the Marfan syndrome (mean = 34 years) had argon laser iridoplasty. Laser burns were placed in concentric arcs in the quadrant where widening of the pupillary space was desired. Laser settings were: 100 micra for spot size, 0.1 second for exposure duration and 1OOOmW for power (mean number of burns = 29). Visual acuity improved by an average of 4 lines. Widening of the aphakic pupillary space is produced by peripheral shrinkage of the iris and further dislocation of the lens as zonules break due to transmitted heat. This permits better aphakic optical correction and improvement in visual acuity.

Scientific Poster 228

Pathogens in Corneal Ulceration Associated With Disposable Contact Lenses

Michael Nissen, MD; Mark George Speaker, MD, PhD; MarkS Milner, MD; Mahendra K Shah, MSc; Dorene M Soo-Hoo, New York, NY During 1990 and 1991, 91 of 212 corneal ulcers managed at our institution were associated with contact lenses. Forty-one of 91 involved extended wear contact lenses (EWSCLs). Fifty-nine percent (24) involved conventional EWSCLs; the remainder (17) involved disposable EWSCLs. In patients using conventional EWSCLs, Gram­ negative pathogens were isolated from 8 of 15 (53%) culture-positive patients. However, in patients \'1/earing disposable EWSCLs, Gram­ positive organisms were isolated from 7 of 9 (78%) culture-positive patients. Disposable EWSCLs are associated with a shift in the pre­

t: The presenter(s) have a financial interest in the subject matter of the presentation

142

*

The Measurement of Maximal Physiologic Pupillary Dilation by Infrared Pupillometry

SCIENTIFIC POSTERS dominant pathogens causing keratitis from Gram-negative to Gram­ positive bacteria.

ORBIT Presenters for posters 87 through 96 will attend their posters Sunday, November 8 from 3:00 to 4:30PM. Presenters for posters 229 through 247 will attend their posters Tuesday, November 10 from 3:00 to 4:30 PM. Individual attendance hours will be indi­ cated on a mock clock at each poster board.

SUNDAY POSTERS Scientific Poster 87 Periocular Findings in AIDS

Ahmad M Mansour, MD, Galveston, TX We reviewed the periocular findings in a large population (pool of 330) with HIV infection followed in one medical center. Around 6% of the series had positive periocular findings. In 1% of the series, the periocular findings were the first manifestation of HIV infection or AIDS. We report the first case of basal cell carcinoma in HIV-infected individual involving the eyelid. Orbital findings included: lymphoma and cellulitis. Adnexal findings included: Kaposi's sarcoma, zoster ophthalmicus, molluscum contagiosum, bacterial folliculitis, mada­ rosis, psoriasis, basal cell carcinoma, and chalazion.

Scientific Poster 88 Bone Scan Assessment of the Vascularity of Hydroxyapatite Ocular Implants

*

Arthur C Perry, MD, La Jolla, CA An artificial eye may be directly coupled to a buried hydroxyapatite ocular implant to produce excellent motility. This coupling is made via a peg placed in a hole drilled into the ocular implant. Prior to drilling this motility peg hole, it is important to assess the vascular ingrowth into the implant. This assessment is made by using a 99Tc bone scan. These bone scans show varying degrees of vasculariza­ tion. A proposed method ofgrading thevascularity,O, 1+, 2+, 3+, 4+ is demonstrated.

Scientific Poster 89 Skin Hyperpigmentation Following the Use of Alkalinized Local Anesthetics

Kevin Hinshaw, MD; Allen M Putterman, MD; Richard Fiscella, MPH; lawrence M Solomon, MD, Chicago, IL We report two cases of significant skin hyperpigmentation occurring 4 to 6 weeks following injection with alkalinized lidocaine which was given to decrease injection-related pain. These patients were success­ fully treated with 15% azelaic acid (dicarboxylic acid), a topical dermatologic bleaching agent. We no longer use alkalinized anes­ thetics and have not encountered this complication in any patient before or since their use. A dermatologic consultation determined that because skin hyperpigmentation occurred at the site of injection, the hyperpigmentation was secondary to chronic inflammation from occultly precipitated anesthetic.

Scientific Poster 90 Free Graft Enhancement Utilizing Orbicularis Muscle Mobilization

mobility. The extensive innervation and blood supply allow the orbicularis to be mobilized without compromise. Six patients under­ went orbicularis oculi mobilization prior to graft placement for peri­ ocular defects following wound dehiscence, trauma, and tumor resection. One patient underwent canthal tendon reconstruction utilizing auricular cartilage prior to orbicularis mobilization. The range of follow up was three months to six years. All grafts remained viable with improved function and appearance.

Scientific Poster 91 Intraoperative Tissue Expansion in Eyelid Reconstruction

Ira B Wallace, MD, Bala Cynwyd, PA; Allan E Wulc, MD, Philadelphia, PA; StevenS Greenbaum, MD, Philadelphia, PA Intraoperative tissue expansion (ITE) with the universally available Foley catheter is a simple and relatively inexpensive means of provid­ ing immediate additional tissue for reconstruction in oculoplastic surgery. ITE gains approximately 30% more anterior lamellar tissue than would otherwise be available for reconstructive purposes. Our technique employs a 10 cc Foley Catheter which is inserted into the planned flap and rapidly expanded twice over 11 minutes, with approximately one minute intervening between expansions. We present our technique and review our experience and results in 29 consecutive patients, emphasizing the increase in the amount of available tissue.

Scientific Poster 92 Orbital Manifestations in Acquired Immunodeficiency Syndrome

Steven M Gilberg, MD, Miami, FL; Jan W Kronish, MD, Delray Beach, FL; David TTse, MD, Miami, FL; Kevin R Scott, MD, Arlington, VA Over a three-year period, we managed 7 male patients with AIDS or human immunodeficiency virus seropositivity ranging from 27 to 56 years of age with neoplastic or infectious orbital diseases. Presenting symptoms included orbital pain, proptosis, diplopia, eyelid swelling, epiphora, and orbital apex syndrome with a high incidence of visual loss. Two patients had non-Hodgkins lymphoma while the remainder had orbital aspergillosis, orbital cellulitis with abscess, infiltrating squamous cell carcinoma, and adenoid cystic carcinoma of the lacrimal gland. Four patients had concurrent and contiguous paranasal sinus involvement. This series demonstrates a wide spec­ trum of orbital diseases that may occur in AIDS patients and an associated high ocular morbidity.

Scientific Poster 93 Reclassification of Orbital Pseudotumors and Lymphoid Tumors

lan W Mclean, MD, Washington, DC; Michael A Piacentini, MD, Washington, DC; Miguel N Burnier, MD, Washington, DC; Dey N Shah, MD, Bethesda, MD; Chi-Chao Chan, MD, Bethesda, MD; Robert B Nussenblatt, MD, Bethesda, MD Orbital lymphoid infiltrates are difficult to classify. Fifty-one cases, 40 previously classified as pseudotumor and 11 as lymphoma, were studied immunohistochemically to determine if B
Thomas C Naugle Jr, MD, New Orleans, LA; Mark R Levine, MD, Beachwood, OH; Gregory S Carroll, MD, Kenner, LA Full thickness grafts in periorbital reconstruction have had may limi­ tations including poor viability, contraction, depression, and poor ; The presenter(s) have a financial interest in the subject matter of the presentation

143

SCIENTIFIC POSTERS Scientific Poster 94 Use of Collagen Shields for the Prophylactic Treabnent of Keratopathy Related to Eyelid Plastic Surgery Procedures

Steven Fagien, MD, Boca Raton, FL Porcine derived collagen corneal shields have proven to be an effective adjunct for the ophthalmic and ophthalmic plastic practice. Eyelid surgical procedures (especially the upper eyelid) which involve the use of sutures extending to the conjunctival surface have been noted to cause significant keratopathy in an occasional patient. Porcine derived collagen corneal shields were used for the prophy­ lactic treatment against keratopathy in 50 consecutive procedures where a Mueller muscle conjunctival resection was performed for the correction of blepharoptosis. None of these 50 eyes developed keratopathy. Patient comfort was superior and overall "recovery" from surgery was expedited.

Scientific Poster 95 A Combined Procedure for Entropion Repair: Marginal Rotation and Lateral Tarsal Suspension

Stephen L Bosniak, MD, New York, NY; Jeffrey Schiller, MD, Staten Island, NY Thirty-six patients with involutional entropion were treated with marginal rotation and lateral tarsal suspension. Eleven of them had undergone previously attempted surgical correction without success. Thirty-five of the patients had no postoperative recurrence of entro­ pion. Follow-ups were from 6 months to 6 years. This procedure corrects lid margin and lateral canthal tendon laxity, compensates for involutional enophthalmos, repairs lower lid retractor disinsertions, prevents migration of the preseptal orbicularis muscle and prevents tarsal rotation.

Scientific Poster 96 Hydraulic Orbital Injection Injuries

John 8 Holds, MD, St. Louis, MO; Richard L Anderson, MD, Salt Lake City, UT; james R Patrinely, MD, Houston, TX; Paul L Zimmerman, MD, Salt Lake City, UT A high-pressure stream from mechanical equipment may inject gas or liquids deep into the orbit with few initial signs. Aggressive surgical debridement as employed in the extremities for the treatment of injection injuries is not possible in the orbit. Five patients with orbital injection injuries from farm and industrial equipment are presented. The injury manifested with a spectrum of signs from acute inflamma­ tion with tissue necrosis and compressive visual loss to late chronic inflammation with tissue necrosis and compressive visual loss to late chronic inflammation with a pseudotumor-like course. A manage­ ment schema is presented for these difficult injuries.

TUESDAY POSTERS Scientific Poster 229 Epidemiology of Traumatic Orbital Hemorrhages

John M Ramocki, MD; Thomas C Spoor, MD; john G McHenry, MD; Detroit,MI A review of 68 consecutive cases of traumatic retrobulbar hemor­ rhages are presented. The majority of cases had orbital fractures (88%). History of assault (82.3%) with a blunt object, and ethanol abuse was common (73.5%). Thirty-nine cases required lateral can­ thotomy and cantholysis. Twenty-nine patients were managed expec­ tantly. Patients treated emergently consistently had significant recovery of vision in the absence of other vision-compromising factors. Fifty-five percent of patients requiring canthotomy had asso­ ciated ocular injuries. Overlying traumatic optic neuropathy was evident in 10 patients. Megadose corticosteroids allowed for rapid visual return in these cases.

Scientific Poster 230 The Acute Management of Periorbital Burns

Donald A Hollsten, MD; William L White, MD, Ft. Sam Houston, TX Periorbital burns present the ophthalmologist with extremely difficult therapeutic decisions. The visual status and health of the periorbital structure may be harmed as periorbital problems are often overlooked by burn surgeons. At Brooke Army Medical Center, a flow sheet has been developed to assist in the management of patients with severe periorbital burns. This template assists in patient management and serves as an educational tool for other physicians who participate in the management of these patients. Only one corneal perforation has occurred since this template was instituted in 1987. This contrast with an average of two perforations per year prior to that time. Details of the template are presented.

Scientific Poster 231 Real-Time Intraoperative 3-D CT Localization: An Aid for Orbital Surgery

Mami Iwamoto, MD; Craig A Vander Kolk, MD; Nicholas T Iliff, MD; Neil R Miller, MD; S james Zinreich, MD, Baltimore, MD A real-time computer-assisted position sensor correlated to 3-dimen­ sional (3-d) computed tomographic scans has been developed to provide accurate intraoperative localization in orbital surgery. Dynamic 3-d images or simultaneously exhibited axial, coronal and sagittal views are displayed on a high resolution monitor in real time with localization of the sensor tip to within 1.5mm. We have utilized this tool to monitor precise surgical position in 4 cadaver orbits and 6 patients undergoing surgery for roof and floor fractures, craniofacial deformity, fibrous dysplasia, dysthyroid orbitopathy, and orbital tumor. The system greatly aids decisions regarding extent of surgery and guides symmetry of reconstructions. Current and future applica­ tions are discussed.

Scientific Poster 232 Invasive Squamous Carcinomas ArisinJl from Asymptomatic Choristomatous Epithehal Cysts of the Orbit

John B Holds, MD, St. Louis, MO; Richard L Anderson, MD, Salt Lake City, UT; Nick Mamalis, MD, Salt Lake City, UT; Marilyn C Kincaid, MD, St. Louis, MO; Ramon L Font, MD, Houston, TX Orbi~l cysts are common orbital masses arising at bony suture lines. Mass1ve enlargement or extraorbital extension of these benign choristomas may occur. We present two cases in which the epithelial lining of asymptomatic and unsuspected orbital choristomatous cysts underwent malignant degeneration to produce invasive squamous carcinomas. The unusual origin and clinical presentation of the lesions caused a delay in diagnosis and therapy in both cases. Both patients underwent complete resection of their tumors via orbital exenteration with craniofacial resection. Metastatic workup was negative in both. Since most orbital choristomatous cysts are removed at an early age, the incidence of malignant transformation may be higher than previously thought.

Scientific Poster 233 Temporalis Fascia Suspension for Repair of Severely Retracted Lower Eyelids

Stephen L Bosniak, MD, New York, NY; Tim McDevitt, MD, New York, NY; Jeffrey Schiller, MD, Staten Island, NY Twelve patients with severe lower eyelid retraction secondary to thyroid ophthalmopathy, lower lid blepharoplasty, longstanding facial palsy, and congenital eyelid retraction were treated with tem­ poralis fascia suspension of their lower lids. Eight of these patients needed concomitant staggered free skin grafts to the lower lids. These patients had previously undergone recession of the lower lid retrac­ tors, lateral tarsal suspension, and/or free skin grafting without success.

:j: The presenter(s) have a financial interest in the subject matter of the presentation

144

SCIENTIFIC POSTERS Excellent results were obtained in eleven of twelve cases. Follow-ups were from three months to five years.

Scientific Poster 234

Treabnent of Multiple Molluscum Contagiosum Lesions of the Eyelids With Nitrous Oxide Cryotherapy

David S Bardenstein, MD, Shaker Heights, OH Patients with AIDS have an increased frequency of Molluscum con­ tagiosum infection of the eyelids. Frequently, these lesions are mul­ tiple and refractory to treatment. In this setting, the usual modalities have an increased risk of damage to underlying structures or scarring. Focal modalities, such as laser, can disseminate viable virus particles. We have used a nitrous oxide gas cryotherapy system with small diameter ophthalmic probes to treat these lesions with almost total success. None of the ten patients treated showed lid complications. In addition, the procedure can be performed with topical anesthesia. This appears to be a safe and effective method for treatment of these lesions.

Scientific Poster 235

Predictive Value of Preoperative Visual Field Testing With Lids Taped Up in Blepharoptosis Patients

Geoffrey M Kwitko, MD, Tampa, FL Blepharoptosis is known to cause loss of superior visual field. Pr~p­ erative perimetry with eyelids taped up is ~ommc;>nly used to pr~1ct if ptosis. surgery will restore the superior v1sual f1eld. A prospective study was done to determine the accuracy of this predictive technique. Preoperative visual fields with and without eyelid taping were com­ pared to the postoperative visual field in 2! eyes. In 48%, ~e preoperative taped visual field accurately pred1cted the postoperative result; however, in 52% the postoperative visual field was substan­ tially better than the preoperative taped visual field.

Scientific Poster 236

Nasopharyngeal Carcinoma With Orbital Invasion

Wen-Ming Hsu, MD, Taipei, Taiwan Nasopharyngeal carcinoma (NPC) with orbital invasion !s. a rare condition. Due to the improvement of treatment modahtles, the survival rate of NPC is high enough to allow an ophthalmologist encounter cases of orbital invasion of this tumor. Ten cases of NPC with orbital invasion (9 males, 1 female, age ranged from 32 to 78 years old) were reviewed. One patient presented with eyelid tumor, 3 cases presented with exophthalmos as the first manifestation in this series. The symptoms included: proptosis, diplopia, visual impair­ ment, orbital pain. Palliative treatment with radiotherapies. were given to all patients. During 4 to 51 months follow-up per1od, 3 patients died, one was lost from follow-up, 6 are still alive.

ScientifiC Poster 238

Management of Dermolipomas

Constance LFry, MD; Charles RLeone Jr, MD, San Antonio, TX Dermolipomas are congenital choristomas involving the super­ otemporal conjunctiva and fornix. We report a series of 54 patients seen between 1970 and 1990. Eight patients had an associated lateral canthal deformity, five patients had coexisting lirnbal dermoids and three patients had osteomas. Forty-five patients underwent surgical excision of the dermolipomas; there were two complications. One patient developed a restrictive symblepharon requiring a mucous membrane graft, and the other had mild ptosis, which did not require treatment. Techniques for conservative removal of dermolipomas and reconstructing the lateral canthal deformity will be described.

Scientific Poster 239

Complications of Hydroxyapatite Orbital Implants and Their Management

Donald Fox. MD, New York. NY; Richard D Lisman, MD, New York, NY; Elizabeth Ault Brinker, MD, La Crosse, WI; David Nelson, MD, Canton, OH; Stephen Soli, MD, Rydel, PA We have treated or followed 62 patients with hydroxyapatite implants. The most common complications are conjunctival dehiscences. Most of these dehiscences actually do have a thin covering of conjunctiva over the hydroxyapatite and do not need to be closed. Other com­ plications include a) corneal melt following evisceration if the cornea is left intact; b) early extrusion of the peg; c) failure to vascularize within 10 months following the procedure; d) failure to develop a conjunctival lined tract at the peg site. None of these findings have proven to be difficult management problems.

Scientific Poster 240

High Resolution Magnetic Resonance Imaging (MRI) of Lacrimal Drainage System Disorders

Peter A D Rubin, MD; Jurij Bilyk, MD; John W Shore, MD; Francis C Sutula. MD; Hong-Ming Cheng, PhD, Boston, MA We have applied high resolution MRI surface coil Imaging of the lacrimal drainage apparatus to. diagno~ ~l~stic, ln.flammatory, and obstructive disorders. Prec1se detail wtth thts techmque perm1ts localization within the canaliculus. This has proven effective in imaging primary lacrimal papillomas with canalicular extension, inverting papillomas of maxillary origin, and distinguishing localized ethmoidal mucopyoceles from primary lacrimal sac abscesses. MRI tissue-specific properties also help distinguish lacrimal.sac ~ucoceles from soft tissue neoplasms. In selected cases, MRI tmag~ng of the lacrimal system provides important information not available with other imaging modalities.

Scientific Poster 237

A Review of 247 Orbital Tumors in Children Over a 60-Year Period

Sylvia RKodsi, MD, Rochester, MN; Debra JShetlar, MD, Houston, TX; RJean Campbell, MD, Rochester, MN; George BBartley, MD, Rochester, MN; James A Garrity, MD, Rochester, MN The medical records and pathology specimens from 247 consecutive patients aged 18 years or younger who underwent a biopsy. for an orbital mass at our institution from 1932through 1991 wererev1ewed. The most common tumors were cysts (19.8%), vascular lesions (19.8%), optic nerve or meningeal neoplasms (16.2%), inflammatory masses (11.3%), and rhabdomyosarcoma (9.7%). The overall preva­ lence of malignant tumors was 17%. The findings of our study will be compared with previous reports.

; The presenter(s) have a financial interest in the subject matter of the presentation

145

SCIENTIFIC POSTERS PEDIATRIC OPHTHALMOLOGY, STRABISMUS Presenters for posters 97 to 103 will attend their post­ ers Sunday, November 8 from 11 :30 AM to 1:00 PM. Presenters for posters 241 through 247 will attend their posters Tuesday, November 10 from 11:30 AM to 1:00PM. Individual attendance hours will be indi­ cated on a mock clock at each poster board.

SUNDAY POSTERS Scientific Poster 97 Vertical Strabismus Analyzer i

Dian-Xiong Shi, MD, Detroit, Ml Based on a review of 726 cases, the sliding chart is designed to easily make a correct diagnosis of paretic muscle and also to graphically show the pattern of greatest deviation and explanations ofdysfunction of the related muscles. There are 6 windows on each side (RHT on one side, LHT on the other side) of chart. The first 4 windows show HT increases in side gaze, across upper or lower field, head tilt and the paretic muscle and malfunction of its 4 related muscles. The 5th window exhibits the greatest deviation patterns vs. movement limits in 8 diagnostic positions. The last window graphically displays the dysfunction of 4 related muscles when the paretic eye is fixating.

Scientific Poster 98 Three-Dimensional Computed Tomographic Imaging in the Assessment of Craniofacial Anomalies Saad EI-Naggar, MD; Marilyn T Miller, MD; Diana DeSantis, MD; Mahmood Mafee, MD; John Polley, MD, Chicago, IL Technological advances in computer image analysis have made possible reconstruction of three-dimensional (3D) images from com­ puted tomography. Three-dimensional computed tomography imag­ ing allows the clinician to define more accurately normal and pathologic anatomy involving the skull and the orbit in particular. It also helps planning operative treatment. This poster reviews the basic concept involved in three-dimensional computed tomographic imag­ ing, and demonstrates its potential in the diagnosis and management of craniofacial anomalies.

Scientific Poster 99 Automated Measurement of Ocular Deviation in a Large Number of Gaze Positions Craig A McKeown, MD, Boston, MA; Steven MArcher, MD, Ann Arbor, Ml; Mark C Kuperwaser, MD, Boston, MA Conventional prism and cover testing measures ocular deviation in relatively few gaze positions and fails to describe the rate of change of deviation between measured points. With this automated tech­ nique, the patient superimposes haploscopic targets using a computer's mouse. Horizontal and vertical deviations are measured in a large number of well-defined gaze positions. The stored data is plotted as a three-dimensional surface. This technique offers new insight into the manner in which incomitant strabismus varies over the field of gaze as well as its evolution over time and response to therapy.

Scientific Poster 1 00 Treabnent of Choroidal Neovascularization Associated with Optic Disc Drusen in Children

Richard M Lipman, MD; Thomas S Stevens, MD; George H Bresnick, MD; Clare F Hutson, MD, Madison, WI Subretinal neovascular membranes are an unusual complication of optic disc drusen. Treatment results are unreported. We report four cases in children ages seven through thirteen. Preoperative visual acuities ranged from 20/40 to hand motions. Final acuities ranged from 20/25 to 20/200. In all cases the subretinal fluid, which either involved or threatened the fovea, has resolved rapidly without recur­ rences after two months to three years of follow-up. Treatment of children with this condition is possible but not proven to be better than observation.

Scientific Poster 1 01 Epibulbar Dermoids in Children - Surgical Management and Prognosis of 20 Lesions

Berthold Seitz, MD; Leonard M Holbach, MD; G 0 H Naumann, MD, Erlangen, Germany Surgical procedures in 18 patients (2 months - 16 years, 39% GOLDENHAR's syndrome) with epibulbar dermoids included lamel­ lar sclero-keratectomy (11 limbal dermoids), lamellar dissection fol­ lowed by lamellar graft (3 corneal dermoids), subtotal excision (5 lipodermoids), and modified "en bloc excision" (one recurrent limbal dermoid with iris incarceration). No recurrence has been observed (mean follow up 4.5±3.1 years). Mean visual acuity was 20/60, mean spherical equivalent +2.1±1.9 diopters, mean astigmatism 2.6±3.8 diopters (corneal topographic analysis). Epibulbar dermoids require early and differentiated surgical approach and adequate postoperative management to avoid amblyopia.

Scientific Poster 1 02 Iris Nodular Nevi: Clinical and Histologic Characterization

Benjamin H Ticho, MD; Marilyn B Mets, MD; Kevin Hinshaw, MD; Mordechai Rosner, MD; Mark 0 M Tso, MD, Chicago, IL Iris melanosis is an infrequently reported condition with multiple verrucous excrescences distributed diffusely in the iris. We report 16 Hispanic patients with bilateral iris nodules, and describe associations with congenital bilateral cataract, neurofibromatosis, congenital pto­ sis, Peters' anomaly, posterior embryotoxin, high myopia, and oculodermal melanocytosis. In two families, 9 members were noted to have bilateral iris nodules. We present the first detailed light and electron microscopic findings of familial bilateral iris melanosis. Based on the characteristic clinical and histologic appearance, we propose the term "iris nodular nevus" (INN) be used.

Scientific Poster 1 03 The Oculocardiac Reflex During Strabismus Surgery as a Predictor of Vasovagal Episodes During Postoperative Adjusbnent Richard W Hertle, MD; Sule Ziyland, MD; David B Granet, MD, Philadelphia, PA An oculocardiac reflex (OCR) during strabismus surgery may be predictive of a significant vasovagal response at adjustment. We studied 43 patients undergoing adjustable suture surgery and deter­ mined the presence of an intraoperative OCR and postoperative vasovagal response. Twenty-eight percent (12/43 patients) had a vasovagal response during adjustment. Ninety-one percent of patients with a positive OCR (1 0/11 patients) and 6% without an OCR (2/32 patients) had an adjustment-related vasovagal response. A positive intraoperative OCR during adjustable strabismus surgery should alert clinicians to prepare for postoperative vasovagal responses at adjustment.

:t The presenter(s) have a financial interest in the subject matter of the presentation

146

SCIENTIFIC POSTERS TUESDAY POSTERS Scientific Poster 241 Nystagmus Characteristics in Congenital Achromatopsia

Irene Gottlob, MD; Robert D Reinecke, MD, Philadelphia, PA Nystagmus with achromatopsia is difficult to differentiate from other nystagmus forms. Eye movement recordings of 16 patients with achromatopsia (age 0.5 to 68 years) showed low amplitude (1 to 5°), oblique nystagmus, and one patient showed a change from oblique to vertical nystagmus. Younger patients showed pendular while older patients had jerk nystagmus. In seven patients, the eyes oscillated out of phase. Head nodding was recorded in all children. Achromatopsia can be differentiated from infantile nystagmus by eye movement recordings, but distinction from spasmus nutans may be difficult.

Scientific Poster 242 Posterior Polymorphous Dystrophy Associated With Asymmetric Astigmatism and Amblyopia in Children

Patrick ADeRespinis, MD, Staten Island, NY; Lauren C Rispoli, MD, Newark, NJ; Joseph D Napolitano, MD, Newark, NJ Posterior polymorphous dystrophy (PPMD) has been implicated in the development of keratoconus in adults. We present three young children with amblyopia caused by anisometropic astigmatism in the eye with the more significant amount of PPMD. Case histories, photographs and corneal modeling color graphics are used to corre­ late the results. We postulate that the endothelial changes of PPMD may represent a spectrum of refractive surface changes throughout a person's life.

Scientific Poster 243 Diagnosis of Congenital Owlar Anomalies by High-Resolution Magnetic Resonance Imaging

Kameran Lashkari, MD, Kansas City, MO; Merrill LStass-lsem, MD, Overland Park. KS; Hong-Ming Cheng, PhD, Boston, MA T\Yelve eyes of patients (ages 4 months-6 years) suspected to have congenital ocular anomalies and ten control eyes were studied by surface-coil MRI. High-resolution images were obtained which clearly delineated the anatomy of anterior and posterior segments and intraorbital optic nerve. Correct diagnosis was made in every case which included anophthalmia, microphthalmus (with and without cyst), optic nerve hypoplasia and aplasia. High-resolution MRI is a new diagnostic modality which is useful in eyes with media opacity and may reduce the need for examination under anesthesia.

Scientific Poster 244 Computer Quantitation of the Classic Lancaster Test

John F Hatch, MD; Caleb Gonzalez, MD, New Haven, CT We are introducing a computer-based Lancaster test which projects red/green stripes onto a screen in the diagnostic positions at 2.4 meters using an LCD panel and an overhead projector. The subject, wearing red/green goggles, controls the green stripe using a 3-button mouse. The computer calculates the horizontal, vertical, and torsional devi­ ations. Coefficient of variation of repeated measurements (n=1 00) in subjects with prismatically induced horizontal deviations was 1.2% and in vertical ones, 4.5%. Preliminary pattern of responses in SO palsy subjects have shown clinical validity, including torsional mea­ surements.

Scientific Poster 245 Ophthalmic Features of Minimal Pigment Oculocutaneous Albinism

C Gail Summers, MD; Richard AKing, MD, Minneapolis, MN Minimal pigment albinism, a type of tyrosinase-related albinism that is diagnosed by normal tyrosinase activity in one parent and abnor­ mally low activity in the other, has been recently described in the

genetics literature. We report the ocular findings in eight patients. Snellen acuity ranged from 20/50 to 20/200. Iris pigment was variably reduced, and transillumination varied from minimal to marked. All had foveal hypoplasia and absence of melanin pigment in the fundus. Parental tyrosinase activity is required to identify this new type of albinism with heterogeneous ocular features.

Scientific Poster 246 Management of Stage 4 Retinopathy of Prematurity (ROP)

Tatsuo Hirose, MD; Osamu Katsumi, MD; Mehul C Mehta, MD; JayS Duker, MD; Charles LSchepens, MD, Boston, MA Management of stage 4 ROP is often difficult because of the short clinical course. Scleral buckling works, but spontaneous regression also can occur. We retrospectively studied 38 eyes with stage 4 ROP. T~oYenty-four eyes underwent scleral buckling on a non-random basis with retinal reattachment in 15 (62.5%); nine of the 24 progressed to stage 5 (37.5%). Fourteen eyes without scleral buckling resulted in regression in six (43%); eight progressed to stage 5 (57%). In both treated and untreated groups, severity of plus disease was a signifiCant factor for progression to stage 5.

Scientific Poster 247 Traction Sutures in the Management of fixed Divergent Strabismus

Richard Gregson, DPhil, CHB, MB; John P lee, MD, London. England Transcutaneous traction sutures were used together with supramaxi­ mal lateral rectus recession to correct fixed divergent strabismus in eleven patients (2-63 years). In eight, the diagnosis was chronic 3rd nerve palsy. The sutures were left in situ for 6 weeks and were well-tolerated. All patients gained considerable improvement in posi­ tion, and some improvement in motility of the affected eye. The surgical technique and indications for the use of the traction sutures are described. The minimum follow-up was six months.

RETINA, VITREOUS Presenters for posters 104 through 135 will attend their posters Sunday, November 8 from 1:15 to 2:45 PM. Presenters for posters 248 through 272 and poster 276 will attend their posters Tuesday, Novem­ ber 10 from 1:15 to 2:45 PM. Individual attendance hours will be indicated on a mock clock at each poster board.

SUNDAY POSTERS Scientific Poster 1 04 Vitrectomy for Diabetic Macular Heterotopia

Yukihiro Sato, MD; Hiroyuki Shimada, MD; Shinichi Aso, MD; Mizuo Matsui, MD, Tokyo, Japan In 1987, Packer reported on 4 vitrectomies for diabetic macular heterotopia (Arch Ophthalmol 105:1987). We performed 15 such vitrectomies (group 1), compared visual prognosis and postoperative complications with those of 88 macular detachment cases (group II). Visual acuity better than 20/200 was achieved in 93% of group I and 48% of group II (p<0.002), better than 20/40 in 47% of group I and 10% of group II (p
*The presenter(s) have a financial interest in the subject matter of the presentation

147

SCIENTIFIC POSTERS Scientific Poster 1 OS Surgical Management of Massive Subretinal Hemorrhage

An.man Sivalingam, MD; Jay L Fedennan, MD, Wynnewood, PA We present our experience with 12 cases of massive hemorrhagic retinal detachment (at least 10-15 disc diameters) secondary to mac­ ular degeneration with 6 months' to 6 years' follow-up. Two out of three patients with posterior retinotomies had severe premacular fibrosis; however, by using a large peripheral retinotomy in 9 cases there was superior access to the subretinal space. This allowed complete removal of clot and scar with fewer complications. In the latter group vision improved from light perception to finger count­ ing-20/400 level in 6 of the 9 cases.

Scientific Poster 1 06 Twig Retinal Vein Occlusion

John M Pach, MD; Dennis M Robertson, MD, Rochester, MN We report three patients with macular branch retinal vein occlusion in which occlusion of one or more small venous twigs was caused by a relatively large caliber retinal arteriole coursing through the macula approximately one disc diameter from the fovea. Clinical findings included parafoveal edema, exudates, and microaneurysm formation. Fluorescein angiography demonstrated capillary dilatation, microaneurysms, and late staining of the retina distal to the AV crossing. Follow-up was 10, 44,and 55 months. Complete resolution of the edema and exudates occurred in two eyes. In one eye, the edema and exudates increased, although the visual acuity remained unchanged. Parafoveal telangiectasis is most likely to be confused with twig vein occlusion.

Scientific Poster 1 07 Electrophysiological Layer-by-Layer Analysis of Aphakic Cystoid Macular Edema

Yozo Miyake, MD; Kensaku Miyake, MD, Nagoya, Japan We compared a- and b-waves and oscillatory potentials (OPs) of focal macular ERG (MERGs) of 29 patients with aphakic cystoid macular edema (CME) to those of their normal fellow eyes. MERGs were classified into three types. Type 1 (10 eyes): reduced OPs; type 2 (9 eyes): reduced OPs and b-wave; and type 3 (1 0 eyes): reduced OPs, a- and b-waves. The mean visual acuity was 0.55 (type 1), 0.31 (type 2), and 0.12 (type 3). Results indicate that the middle retinal layer is disturbed in all affected eyes, as well as the outer layer in some eyes (type 3). Remission ofCME resulted in significant recovery of MERGs, even in type 3 eyes.

Scientific Poster 108 Enlarged Blind Spot and Optic Nerve Characteristics in Retinitis Pigmentosa

Gustavo EColi, MD, Los Angeles, CA; John R Heckenlively, MD, Los Angeles, CA; Richard A Stein, MD, Kansas City, KS Optic nerve abnormalities in retinitis pigmentosa (RP) have not been well-described. We studied the optic disc appearance and kinetic perimetry in 51 0 RP patients; we found that an enlarged blind spot is commonly observed in early RP, and persists into later stages. Optic disc changes include: abnormal shape (25.9%), diffuse (12.4%) and sectoral pallor (36.2%), granules (19%), white ring on disc edge (15.3%), drusen (4.3%), blurred margin (6.3%), redundant (2.5%), and thickened nerve fiber layer (20%). Results suggest that the optic nerve is affected at an early stage in RP, and is commonly associated with an enlarged blind spot.

Scientific Poster 1 09 Treatment of Retinal Detachment Due to Posterior Breaks

Richard M Feist, MD; Jose S Pulido, MD; Chittaranjan V Reddy, MD; James C Folk, MD; Bernard F Godley, MD, Iowa City, lA A review of preoperative fundus drawings revealed 44 of 665 patients (6.6%) with retinal breaks at or posterior to the equator. Final visual acuity was 20/50 or better in 22 (50%) of these patients. Persistence or early recurrence of detachment occurred in 0 of 18 eyes treated with both vitrectomy and buckling procedure, 3 of 16 eyes treated with buckling, 1 of 3 eyes treated with vitrectomy, and 3 of 7 eyes treated with pneumatic retinopexy. These results suggest the reattach­ ment rate with detachments from posterior breaks may be lowest with pneumatic retinopexy and highest with a combination of vitrectomy and buckle.

Scientific Poster 11 0 Multi-Center Evaluation of Perfluoroperhydrophenanthrene in the Management of Complex Vitreoretinal Surgery

Scientific Poster 111 Characterization of Functional Changes in Patients with Best's Vitelliform Macular Dystrophy

Kameran Lashkari, MD, Kansas City, MO;Trudi R Grin, MD, Overland Park, KS; Fernando Acosta, MD, Boston, MA Twenty eyes of ten patients with Best's disease and age-matched controls were studied with static and kinetic microperimetry using the scanning laser ophthalmoscope in an attempt to explain the well-rec­ ognized disparity between visual function and clinical appearance. Eyes with vitelliform and early scrambled-egg changes revealed foveal fixation with patchy areas of relative scotoma (30% contrast). Eyes with advanced disease manifested patchy areas of dense (100% contrast) and relative scotoma, islands of vision and poor fixation. Visual function deficits were explained by scotomas an other factors including metamorphopsia.

Scientific Poster 112 The Role of Aminoglycosides in the Empiric Therapy of Bacterial Endophthalmitis

John M DeVaro, MD; Sean P Donahue, MD, PhD; Brian H Jewart, MD; Lisa M Karenchak; AndrewW Eller, MD, Pittsburgh, PA Aminoglycosides can cause retinal toxicity. The antibiotic suscepti­ bilities ofall bacterial isolates obtained at one institution were studied (n=ll2). EVS patients were excluded. Staphylococcus epidermidis (65%), Streptococcus spp (13%), diphtheroids (11 %), gram negative bacteria (GNB, 6%), and Staphylococcus aureus (5%), were the most common isolates. Vancomycin provided the best coverage against gram positive organisms (1 00%). GNB were equally susceptible to amikacin, ceftazidime, and gentamicin (100%). A two-drug combi­

:j: The presenter(s) have a financial interest in the subject matter of the presentation

148

*

Nalin J Mehta, MD, New Orleans, LA; Gholam A Peyman, MD, New Orleans, LA; Walid A Alturki, MD, Jeddah, Saudi Arabia; Multicenter Vitreon® Study Group To study the efficacy of the liquid perfluorocarbon per­ fluoroperhydrophenanthrene (Vitreon®) in the management of com­ plex retinal detachments and posteriorly dislocated lenses, 305 patients underwent procedures utilizing this substance as either an intraoperative or short-term vitreous substitute. The intraoperative reattachment rate exceeded 99%. In 38 patients in whom per­ fluoroperhydrophenanthrene remained temporarily inside the eye, no complications were attributed specifically to short-term use. The overall reattachment rate at most recent follow-up was 90%. This study demonstrates the safety and efficacy of per­ fluoroperhydrophenanthrene in surgical management of complex retinal pathology.

SCIENTIFIC POSTERS nation was necessary to cover all possible bacterial agents of endophthalmitis. Ceftazidime may be an adequate substitute fOf aminoglycosides in this COfnbination.

Scientific Poster 113 The Mechanism of Posterior Pole and Optic Nerve Injury as a Result of Blunt Ocular Trauma

Kenneth JWald, MD; john JWeiler, MD; Francois De Iori, MD; Sanford Chen, MD, Boston, MA We have analyzed the deformation forces on the globe during non­ penetrating impact to determine the mechanism of posterior pole and optic nerve injury. Modem techniques of film motion analysis were applied to recordings of ocular impact experiments perfOfmed in the 1960s. A case repOft demonstrating optic nerve head elevation ("invulsion") and Bruch's membrane ruptures as a consequence of blunt trauma is presented. The experimental data demonstrate an extreme flattening of the posterior globe and an inward motion of the optic nerve moments after ocular impact. A general theory of poste­ rior pole injury after trauma may be suggested.

Scientific Poster 114 Extracorporeal Membrane Oxygenation Causing Unilateral Retinal Vasculopathy in Neonates

TerriL Young, MD; Graham EQuinn, MD; Stephen Baumgart, MD; David BSchaffer, MD, Philadelphia, PA Extracorporeal membrane oxygenation (ECMO) comprises venoarter­ ial cardiopulmonary bypass therapy for the rescue of full Of near term neonates with intractable respiratory failure. After instituting ECMO, !flere is ~sually per~nent ligation of both the right carotid artery and Internal jugular vem. We have observed left eye fundus abnOfmali­ ties, including retinal hernOfrhages and exudates, venous tortuosity, and asymmetric temPOfal vascular development in 6 out of 27 neo­ nates either while receiving ECMO or within a two-week period after coming off bypass. The proposed mechanism for this unilateral vasculopathy is a hyperperfusion and/Of reperfusion injury.

Scientific Poster 115 Optic Neuritis Treatment Trial (ONTT): Follow-Up Visual Field Information

John LKeltner, MD, Davis, CA; Chris AJohnson, PhD, Davis, CA; Roy W Beck, MD, Tampa, FL; John 0 Spurr, MAMBA, Sacramento, CA; Optic Neuritis Study Group, Tampa, FL The ONTI Visual Field Reading Center classified the defects in all of the visual fields performed on the first 381 ONTI patients followed for one year. After one year, the visual fields of 58.2% of patients overall returned to nOfmal, including: 71.4% of those with central defectsatbaseline,68.4%withnervefiberbundledefects,66.7%with three-quadrant defects, 62.7% with altitudinal defects, 61.9% with chiasma! defects, 52.8% with diffuse defects, and 42.9% with periph­ eral rim defects. The prognosis (Of recovery is dependent on the severity of visual loss, but is generally good regardless of the pattern of the initial visual field defect.

Scientific Poster 116 . Clinical Study of Venous Abnormalities in Diabetic Retinopathy

Yukihi ro Sato, MD; Akie Kamala, MD; Mizuo Matsui, MD, Tokyo, Japan The Wisconsin Epidemiologic Study reported the rate of venous

beading in nonproliferative diabetic retinopathy (Ophthalmology 94:1389, 1987), but no paper has repOfted the rate of venous abnor­ malities in preproliferative retinopathy (PPDR). We studied 225 PPDR eyes and 79 with proliferative retinopathy (PDR) fOf venous abnor­ malities. Fifty-six eyes (18%) had venous abnOfmalities: 8% PPDR, 49% PDR. Among these eyes, 96% showed beading, 25% looping and 4% duplication. All eyes with looping Of duplication had PDR.

Thus, the rate of venous abnormalities in PPDR may be low and, with looping Of duplication, there is an extremely high probability of PDR.

Scientific Poster 117 Retinal Detachment With Atopic Dermatitis Similar to Traumatic Retinal Detachment

Chitoshi Oka, MD, Kumamoto City, Japan; Hidenao ldeta, MD, Kumamoto City, Japan; Hiroshi Nagasaki, MD, Kururne Oty, Japan; Akira Hirose, MD, Kumamoto City, Japan; Ken Watanabe, MD, Kumamoto Oty, Japan; Junji Nakalake, MD, Kumamoto Oty, Japan; Kouichi Shinagawa, MD, Kumamoto Oty, Japan The cause of retinal detachment with atopic dermatitis (ADRD) remains uncertain. Comparing 25 eyes of ADRD to 36 of traumatic retinal detachment (TRD), we found similar characteristics. Retinal breaks at vitreous base borders characterized by trauma occurred in 76.0% of ADRD and 75.0% of TRD. Irregular round traumatic holes intheequatOfial zone occurred in 20.0%ofADRDand 47.2%ofTRD. Objective signs of contusion outside of the retina appeared in 52.0% of ADRD. We concluded that self-inflicted ocular contusion by rubbing the eyes can cause ADRD.

Scientific Poster 118 Occurrence of Retinal Detachment From Lattice Degeneration of the Retina

Kiwamu Sasaki, MD, Kumamoto City, Japan; Hidenao ldeta, MD, Kumamoto City, Japan; Sumiyoshi Tanaka, MD, Kurume Oty, Japan; Akira Hirose, MD, Kumamoto City, Japan; Chitoshi Oka, MD, Kumamoto City, Japan; Ken Watanabe, MD, Kumamoto Oty, Japan; Junji Nakalake, MD, Kumamoto Oty, Japan The risk of retinal detachment (RD) from lattice degeneration (LATI has been estimated at 3% to 4% maximum. We studied the incidence and estimated the risk of developing RD. Among 1,840,000 residents of Kumamoto, Japan, 110 developed RD associated with LAT in 1990. The prevalence of LATin Kumamoto was 9.5% in a previous study. We calculated age-specifiC incidence (I) and cumulative incidence (0 of RD from LAT: C was 5.2% at age 80, higher than previously estimated.

Scientific Poster 119 Perfluorocarbon Liquids in the Management of Dislocated Lenses

Jean-Francois Korobelnik, MD; Laurent Nabet, MD; Eric Frau, MD; D Chauvaud, MD; J-M Legeais, MD; Yves JPouliquen, MD, Paris, France After posteriOf lens dislocation, there are often complications such as glaucoma, retinal detachment and uveitis. A new technique, using perfluorocarbon liquids (PFCL), should be recommended because it is consistently effective. After vitrectomy, perfluorodecalin is injected into the vitreous cavity. PFCL allows the lens to float behind the iris. Lens extraction can be associated with trabeculectomy, and anterior chamber lens implantation. We present a prospective study of 15 cases operated according to this technique. Visual acuity was pre­ served and ocular tension was controlled in cases of preoperative hypertony.

Scientific Poster 120 Clinical and Basic Studies on Endogenous Fungal Endophthalmitis

Masaaki Nakagawa, MD; Minoru Tanaka, MD, Urayasu, Japan To determine safer and mOfe effective concentration of antifungal drugs in irrigating solution during vitrectomy, experimental and clin­ ical studies were carried out. Clinical observation of 31 cases (53 eyes) of this disease revealed that 28 cases out of 31 patients had indwelling IVH, and vitrectomy was performed fOf 13 cases, 19 eyes using irrigating solution containing 5Q-200~ml Fluconazole (FCZ) with success. This concentration of FCZ was determined by animal experiments. Early vitrectomy using irrigating solution of relatively

*The presenter(s) have a financial interest in the subject matter of the presentation

149

SCIENTIFIC POSTERS high dose of FCZ is safe and more effective in managing fungal endophthalmitis.

Scientific Poster 125

Scientific Poster 121

Joseph M Googe, MD; Michael Bessler; John C Hoskins, MD; James H Miller, MD, Knoxville, TN Fluorescein angiography is often beneficial in the preoperative eval­ uation and management of many retinal vascular diseases. However, vitreous blood or opacities may prevent fluorescein studies prior to vitrectomy. We have modified an intraocular light source and oper­ ating microscope to easily perform intraoperative fluorescein angioscopy. This allows more effective placement of endolaser tJ:ler­ apy. In addition, this procedure is particularly useful in the localiza­ tion and removal of subfoveal neovascular membranes.

Visual Acuity in Hispanic Patients With Retinitis Pigmentosa

jesus F Garcia-Cosio, MD; Hugo Quiroz-Mercado, MD; Kathia Oliver Fernandez, MD; Juan M jimenez-Sierra, MD, Mexico City, Mexico There is practically no data on retinitis pigmentosa (RP) in the Hispanic population. We retrospectively reviewed 194 consecutive RP patients (385 eyes) to determine which factors influence visual acuity (VA) in our population. Hereditary pa~s were determined in 36_1 ~e;-. macular status in 329, foveal status 1n 290 and lens charactenst1cs 1n 338. Diminished VA was associated with age (p
Scientific Poster 122

Low Frequency of Congenital Toxoplasma Gondii (TG) Infection in the Erexim Region of Rio Grande Do Sui, Brazil

Peter D Glasner, MD, Bethesda, MD; Claudio Silveira, MD, Erexim, Brazil; Mario E Camargo, MD, Sao Paulo, Brazil; Myung Kim, MD, Sao Paulo, Brazil; Robert B Nussenblatt, MD, Bethesda, MD; Rubens Belfort Jr, MD, Sao Paulo, Brazil; Richard A Kaslow, MD, Bethesda, MD In Erexim, the frequent finding of multiple siblings with ocular toxo­ plasmosis (on suggests that retinochoroiditis may be a common sequela of postnatally acquired TG infection. To determine the incidence of congenital TG infection, 283 cord bloods (CB) and 106 lgG+ sera of infants (newborns to 12m.) were tested for anti-tox­ oplasma lgM antibodies by reverse lgM-ELISA. Two (0.7%) of CB specimens and none of the infants tested positive. Congenital infec­ tion is infrequent and an improbable explanation for the greater than 17% prevalence of OT reported in this region.

Scientific Poster 123

Electrophysiological, Psychophysical and Angiographic Findings in Stargardt Disease

Elena Ponce..Qrozco, MD; Ricardo Ramos, MD; Edna U Angel Munoz, MD; Juan M jimenez, MD; Eladio Garcia V, MD, Mexico City, Mexico Forty-three patients with macular •beaten bronze,. and •bull's-eye,. appearance, associated with fleck-like lesions were studied with electrophysiology and psychophysical tests. Average age was 15.7 years. Onset of symptoms was present in the first and second decade; best corrected visual acuity was less than 20/100, low myopia was common. Angiography revealed retinal pigment epithelium atrophy. The ERGs photopic and scotopic b-wave were normal to subnormal.

Scientific Poster 124

Retinal and Other Manifestations in lncontinentia Pigmenti (Bioch-Sulzberger Syndrome)

Morton F Goldberg, MD; LCDR Peter H Custis, MD, Baltimore, MD lncontinentia Pigmenti is a rare X-I inked disease that is lethal, in utero, in affected males. All females have a characteristic dermatosis, and systemic manifestations occur in 35% of cases. Significant ocular abnormalities include changes ofthe retinal vasculature and pigment epithelium, optic nerve atrophy, strabismus, and pseudoglioma. Rel­ atively few cases of ocular manifestations have been reported. We describe the findings in nine patients from five unrelated families. Of particular interest is the three-year angiographically documented retinal vascular remodelling and spontaneous involution of neovascu­ lar changes in one child. For the first time, we also report foveal hypoplasia as a finding in one patient.

Intraoperative Fluorescein Angioscopy :j:

Scientific Poster 126

The Human Optic Nerve Microcirculation

Andrzej W Fryczkowski, MD, PhD, Columbus, OH Angioarchitecture of 50 human optic nerves (ON) were studied using combination of histological, radiological, vascular casts and SEM techniques. Collateral, pial and central retinal artery (CRA} branches participate in formation of the peripheral, periaxial and axial capillary networks. Types of vascularization found: peripheral (100%), periax­ ial (77%) and axial (30%). Capillariesdiametervaried from 7 microns in lamina cribosa to 12 microns in periaxial network. CRA and its anastomoses have importance for anterior ON circulation. Recurrent choroidal and branches from Zinn-Haller circle contribute to retro­ laminar part of anterior ON.

Scientific Poster 127

Visual Function, Course and Outcome of Basal Laminar Drusen Combined With Vitelliform Macular Detachment

Salomon Y Cohen, MD, Fontenay sous Bois, France; Isabelle Meunier, MD, Creteil, France; Gisele Soubrane, MD, Chennevieres sur Mame, France; Agnes Glacet-Bemard, MD, Creteil, France; Gabriel J Coscas, MD, Paris, France Clinical data for 19 patients with basal laminar drusen (BLD) com­ bined with bilateral vitelliform macular detachment were analyzed, to define their outcome (mean follow-up 24 months). Mean final visual acuity NA) was 20/40 in the 26 eyes without subretinal new vessels (SNV). In 9 (81 %) out of 11 eyes without SNV, blue-yellow dyschromatopsia and contrast sensitivity dysfunction was found. SNV were observed in 12 eyes (31%) with a mean final VA of 20/200. These results suggest that visual prognosis for BLD is worse than was originally thought.

Scientific Poster 128

North Carolina Macular Dystrophy Maps to Chromosome 6q

Kent W Small, MD, Durham, NC; james Weber, PhD, Marshfield, WI; Allen Roses, MD, Durham, NC; Jeffrey M Vance, MD, PhD, Durham, NC; Margaret Pericak-Vance, PhD, Durham, NC North Carolina macular dystrophy (NCMD) is an autosomal dominant macular dystrophy causing impaired central vision from birth and is present in a single large family. We have initially reported mapping NCMD to chromosome 6 using 98 family members (68 affected). Now we have examined 243 members of this family with 96 individ­ uals affected. Three Marshfield microsatellites, MFD 131, 171, and 97, located at 6q14-16.2 were very tightly linked to the NCMD locus. By haplotype analysis the genetic order is 6cen-MFD131-MFD171­ MFD97 -NCMD. Locating and characterizing the NCMD gene may be an important step in understanding this group ~f dominant maculopathies as well as age-related macular degeneration (AMD).

:1: The presenter(a) have a financial interest in the subject matter of the presentation

SCIENTIFIC POSTERS Scientific Poster 129

Scientific Poster 133

David M Brown, MD; Thomas AWeingeist, MD; Alan EKimura; MD, Edwin MStone, MD, PhD, Iowa City, lA Fifteen affected members of an autosomal dominant pedigree are described who have marked vitreous syneresis and progressive retinal pigment epithelial (RPE) atrophy. Common findings include night vision problems, progressive visual field loss, and tractional rhegmatogenous retinal detachments (9 patients). Thinning or "ero­ sion" of the RPE in younger patients permits visualization of choroidal vessels. Advanced cases demonstrate equatorial areas devoid of RPE with extensive posterior atrophy in older patients. Electroretinogra­ phy demonstrates a diffuse rod-cone dysfunction. Unlike Stickler syndrome, patients have no epiphyseal dysplasia, orofacial anoma­ lies, or other systemic manifestations.

Alice T Lyon, MD; Felipe ITolentino, MD; HMacKenzie Freeman, MD; Milagros Arroyo, MD; Ruth MLiberfarb, MD, PhD; Boston, MA Retinal detachment in the Marfan Syndrome is poorly understood and not well-described in the literature. We reviewed 24 retinal detach­ ments in 17 Marfan's patients repaired between 1960 and 1990. Bilateral detachments were present in 11/17 (62%) and ectopia lentis in 22/24 (92%). Multiple operations were required in 13/24 (54%). The overall reattachment rate was 17/24 (71%). Vision was better than or equal to 20/100 in 12/24 (SO%). However, 5/24 (21%) were LP and one patient was NLP. Approximately 13% each were 20/200 to 20/400 and CF to HM.

Erosive Vitreoretinopathy- A New Clinical Entity

Scientific Poster 130

Progressive Nuclear Sclerosis After Vitrectomy for Full-Thickness Mawlar Holes

John TThompson, MD; Bert MGlaser, MD; Hillary Kliss; Raymond N Sjaarda, MD, Baltimore, MD Progressive nuclear sclerosis (NS) develops in some eyes following vitrectomy. Lens changes were studied prospectively in 44 eyes with full thickness macular holes treated with vitrectomy, 16% C3fa gas bubble and transforming growth factor-beta. 14/44 eyes (32%) had progressive NS after 3 months. 30/44 eyes (68%) followed 3-17 months had progressive NS with 100% showing progression after 8 months. Posterior subcapsular cataracts developed in 3/44 eyes (6.8%). Progressive NS developed in 4/1 0 eyes (40%) <60 years and 26/34 eyes (76%R60 years (p=.023). The rate of progression was greater than comparable eyes with vitrectomy for idiopathic epiretinal membranes and may be related to the long-acting intraocular gas bubble.

Scientific Poster 131

Morphometric Analysis of Pars Plana Development in Man

Richard J Hairston, MD; Albert MMaguire, MD; Susan Vitale; W Richard Green, MD, Baltimore, MD A morphometric analysis of 204 fetus, infant and child eyes was performed to correlate the development of the pars plana with post­ conceptional age and with axial length. At full-term, the mean pars plana width and axial length were 1.87mm (sd=0.48) and 17.7mm (sd=1.9) respectively. Pars plana width and axial length were strongly correlated (correlation coefficient 0.918). After 62 weeks post-con­ ception, all eyes had a pars plana length greater than 3mm, suggesting pars plana vitreous surgery can be performed safely after this age.

Scientific Poster 132

Comparison of Examination Techniques in the Diagnosis of a Posterior Vitreous Detachment

Edward MStroh, MD, Brookline, MA; john j Weiter, MD, PhD, Boston, MA; Alipio de Sousa-Neto, MD, Boston, MA; Sanford Chen, MD, Boston, MA; Sheldon M Buzney, MD, Boston, MA

Evaluation of the vitreoretinal interface is important in the manage­ ment of numerous disorders. We prospectively studied the vitreoreti­ nal interface in 200 eyes using biomicroscopy, clear and yellow +78D lenses, Goldmann contact lens and B-scan ultrasonography. A Weiss's ring was present in 27.5%, and condensation of the anterior vitreous was present in 91.3% of the 152 eyes with a posterior vitreous detachment (PVD). Goldmann and +78D lenses were diagnostic of a PVD in 96.1% and 97.4% respectively. Visualization ofthe poste­ rior hyaloid face was easier with the clear versus yellow lens. These results show that careful examination of the vitreous appears equiva­ lent to ultrasonography in diagnosing a PVD.

Retinal Detachment in the Marian Syndrome

Scientific Poster 134

Fluorescein Angiographic Findings in the Vogt-Koyanagi-Harada (VKH) Syndrome

james RBrinkley Jr, MD, Laguna Hills, CA; Pravin U Dugel, MD, Los Angeles, CA; Narsing A Rao, MD, Los Angeles, CA Forty-three patients with VKH were divided into four stages of disease: acute, recovery, chronic, and relapse. The fluorescein angiographic features of each stage were related to the demographic, ophthalmo­ scopic, and clinical findings. The fluorescein angiogram was often an important aid to diagnosis. In the acute stage, the most frequent angiographic findings were pooling of dye under the sensory retina, focal retinal pigment epithelial (RPE) leaks, and disc leakage. In the recovery and chronic phases, the most frequent angiographic findings were window defect, alternating hyper- and hypofluorescence, and subretinal neovascular membranes.

Scientific Poster 135

lndocyanine-Green Angiography of Poorly Defined Choroidal Neovaswlar Membrane

Sara Krupsky, MD, Brookline, MA; Ephraim Friedman, MD, Boston, MA; David RGuyer, MD, Boston, MA; johanna MSeddon, MD, Boston, MA; Evangelos SGragoudas, MD, Boston, MA As digital indocyanine green angiography (ICGA) provides enhanced imaging of the choroidal vasculature, we evaluated the additional information gained by ICGA in 40 eyes with choroidal neovascular membranes (CNVM), which were poorly defined on fluorescein angiography (FA). ICGA better delineated the CNVM or confirmed the existence of CNVM in 15 (37.5%) and 10 (25%) of the eyes respectively. In 3 (7.5%) of the eyes, ICGA identified CNVM which were not observed by FA. We conclude that ICGA can provide useful information for the management of eyes with poorly defined CNVM.

TUESDAY POSTERS Scientifit Poster 248

Path~enetic Mechanisms in Diabetic Anterior Hyaloadal Fibrovaswlar Proliferation

Pedro Francisco Lopez, MD; Stephen JSaxe, MD; Hans Grossnildaus, MD; Thomas M Aaberg, MD; HMichael lambert, MD, Atlanta, GA The pathogenetic evolution of diabetic anterior hyaloidal fibrovascu­ lar proliferation is poorly understood. Clinicopathologic examination of ten enucleated eyes with diabetic anterior hyaloidal fibrovascular proliferation uniformly revealed neovascularization of the vitreous base. Five of seven aphakic or pseudophakic eyes had neovascularization extending from the vitreous base to become con­ tinuous with rubeosis irides. Tractional stripping of the ciliary epithe­ lium, as well as traction detachment of the ciliary body, may have contributed to hypotony or fibrin formation in some of the eyes. The pathogenesis of the rubeosis irides is discussed.

*The presenter(s) have a financial interest in the subject matter of the presentation

151

SCIENTIFIC POSTERS Scientific Poster 249

Retained Intraocular BB and Shotgun Foreign Bodies

William FMieler, MD, Milwaukee, WI; John Suson, MD, Milwaukee, WI; David FWilliams, MD, St Louis, MO Over a 13-yeartime span (1978--91), a total of143 patients(145 eyes) with retained intraocular foreign bodies (IOFBs) were assessed and treated. Eleven (8%) injuries were sustained with a BB or shotgun. Only one gun-injured eye achieved a final visual acuity (VA) better than 20/200, while 80 of 134 eyes (66%) with other IOFBs had final VA of 20/50 or better, and 88% were 20/200 or better. Eight (73%) patients injured by a gun were less than 18 years of age, compared with 17% of the other cases. Six (55%) gun injuries were either enucleated or phthisical, in contrast to 5% of other injuries. BB and shotgun ocular injuries occur in a younger population and carry a very guarded prognosis.

Scientific Poster 250

Ocular Findings Following Bone Marrow Transplanta\ion

Bradley JStuckenschneider, MD; William FMieler, MD, Milwaukee, WI Ocular abnormalities were noted following whole body irradiation and systemic chemotherapy for bone marrow transplantation. Sev­ enty-two patients (34 adults, 38 children) were followed for an average of 18 months following transplant for various malignancies. Fourteen patients (19%) died. In adults, occlusive microvascular retinopathy developed in 4 patients; other conditions included intraretinal hem­ orrhages (6), infectious retinitis (2), cataracts (8), dry eyes (4), and optic atrophy (1). A variety of conditions or symptoms were seen in 26 of the children (68%), including cataract (7), and intraretinal hemorrhage (4), though occlusive microvascular retinopathy was not seen. The majority of eyes retained excellent visual function.

Scientific Poster 251

Real Time Intraocular Pressure Monitoring During Scleral Buckling Surgery

Thomas W Gardner, MD; David A Quillen, MD; George W Blankenship, MD; Wayne KMarshall, MD, Hershey, PA Scleral buckling can increase intraocular pressure (lOP). We mea­ sured realtime lOP in 16 eyes with a pars plana infusion cannula connected to an electronic pressure transducer. lOPs during scleral depression and cryopexy increased up to 210mmHg. Central retinal artery closure occurred at lOPs ranging from 48 to 11 OmmHg. lOPs exceeding retinal perfusion pressures developed in 10 patients, for periods ranging from 6 to 402 sec. (x=123). These data suggest that scleral buckling can cause high lOP elevations, and may temporarily impair ocular perfusion.

Scientific Poster 252

Hematologic Correlates with Non-Infectious AIDS Retinopathy

Richard FSpaide, MD; Faith Chang, MD; Susan Kessler, MD; David O'Bryant, MD; Robert Ross, MD; Donald H Bernstein, MD, New York, NY T~ovelve AI OS patients without infectious retinitis, six with cotton wool spots (CWS) and six without, had an extensive hematologic survey to investigate correlates with retinal microvascular disease, a condition that may predispose the retina to the development of cytomegalovirus retinitis. Factors generally associated with CWS, such as circulating immune-a>mplexes, anti-cardiolipin antibodies, and decreased T-cell helper/suppressor ratios ~overe found in the majority of patients in both groups. Using linear discriminant analysis an increased sedimenta­ tion rate (SR) was the best predictor of CWS (p=0.0011 ). The SR may be an important adjunct in evaluating retinal microvascular disease in AIDS patients.

Scientific Poster 253

Accidental Skin Punctures During Ophthalmic Surgical Procedures

David G Callanan, MD; William ESmiddy, MD, Miami, FL Accidental skin punctures occur in 1.7% to 3% of general surgical procedures, placing medical personnel at risk of contracting HIV (Human Immunodeficiency Virus) infection. The incidence in 18,353 ophthalmic surgical cases was 0.24% over a two-year period. The sharp instrument had already been used on the patient in 73% of cases, and the worker injured themselves in 80% of cases. Although there were no documented HIV seroconversions of involved personnel, there is a low risk in ophthalmic surgery justifying suggested precau­ tions.

Scientific Poster 254

The Extent of Posterior Vitreous Detachment Associated With Macular Holes Determines the Size and Location of Epiretinal Membrane

Mary BLansing, MD; Bert M Glaser, MD; Alan J Gordon, MD; Betty R Klein, MD; Raymond N Sjaarda, MD; John TThompson, MD, Baltimore, MD Intraoperative observations regarding the pathoanatomy of the vitre­ ous and its relation to the epiretinal membrane (ERM) and the macular hole (MH) were made in 98 patients with stage 2, 3, and 4 MH who underwent vitrectomy. Thirty-two percent of 59 eyes with stage 2 and 3 MH had an ERM. The ERM was restricted to an area of localized vitreofoveal detachment. Sixty-nine percent of eyes with stage 4 MH - had an extensive ERM and a complete posterior vitreous detachment (PVD). The PVD may determine the extent of ERM in eyes with MH.

Scientific Poster 255

Pattern VER Latency Correlates With Visual Acuity and Severity of Retinopathy of Prematurity

Helen AMintz-Hittner, MD; Thomas C Prager, PhD; FrankL Kretzer, PhD, Houston, TX Eighty infants (143 eyes), who weighed 540-1645 grams at birth, developed stages 2-4a, had intact CNS documented by CAT scans, had no surgical intervention, and underwent electrophysiologic test­ ing at greater than three years. By multiple linear regression analysis, pattern VER latency using 20/100 checkerboards (normal :S121 msec, mean 128, range 98--163) correlated with visual acuity (p=0.0001) and ROP severity as quantified by active ROP staging (p=0.0006), macular ectopia (p=0.0008), and vessel traction (p=0.001). These data suggest that pattern VER latency reflects inner retinal function which can be impaired by distortion.

Scientific Poster 256

Multiple Gestation Analysis of Stage S Retinopathy of Prematurity

Kenneth J Wald, MD; Tatsuo Hirose, MD; Sanford Chen, MD; Osamu Katsumi, MD; Ruth M Lieberfarb, MD, PhD; Mehul C Mehta, MD, Boston,MA Stage 5 retinopathy of prematurity (ROP) in multiple gestation sibships was studied to determine the concordance of this disease. For non­ identical sibships, the concordance was 30% (6/20); for identical twins, 50% (2/4). Excluding sibships with differences in birth weight or quantity of postnatal oxygen exposure, the concordance was 40% (6/15) and 100% (2/2), respectively. Of twin pairs with discordant disease, twin B(the second born of a vaginal delivery) developed Stage 5 ROP in 83% (10/12), p=.001). The high concordance of Stage 5 ROP in multiple gestation sibships may suggest a family predilection.

; The presenter(s) have a financial interest in the subject matter of the presentation

152

SCIENTIFIC POSTERS Scientific Poster 257 Fluorescein Angiographic Characteristics of Pseudomacular Holes in Epiretinal Membranes

Scientific Poster 261 Alternatives to Retrobulbar Ethanol for Blind Painful Eyes

Betty RKlein, MD; Bert M Glaser, MD; Robert P Murphy, MD; Raymond N Sjaarda, MD; John TThompson, MD, Baltimore, MD Fluorescein angiograrns from 39 eyes with pseudomacular holes were evaluated. Twenty-five (64%) showed hyperfluorescence in syn­ chrony with choroidal fluorescence. The transmission defect was punctate in 6 (15%) eyes and patchy but smaller than the pseudohole in 14 (36%). Diffuse hyperfluorescence filled the pseudohole in 5 (13%) eyes. The remaining 14 (36%) showed no hyperfluorescence. Macular edema occurred around the pseudohole in 9 (25%) eyes. After epiretinal membrane peeling, the transmission defects disap­ peared in two and diminished in 3 eyes. This transmitted fluorescence may represent reversible localized attenuation of foveal xanthophyll by traction within the epiretinal membrane.

Gainesville, FL; Frank A Nesi, MD, Southfield, Ml; GeoffieyJ Gladstone, MD, Southfield, Ml Retrobulbar ethanol is a time-honored method for controlling pain in patients' blind eyes. There is little available information on its mech­ anism of action or evaluation of the therapeutic properties of similar compounds, except chlorpromazine (Thorazine R). Retrobulbar chlorpromazine has been successfully used for permanent ocular pain control in France and Russia for more than 15 years. We present a series of 10 cases of retrobulbar chlorpromazine and review of its mechanism of action, as well as a review of more than 60 other compounds with similar properties.

Scientific Poster 258 New Macular Photostress Device Indicates Recovery Time Differences With and Without Macular Edema and Between Drusen and Macular Degeneration

Scientific Poster 262 lndocyanin-Free Dye-Enhanced Diode laser Photocoagulation of Subfoveal Choroidal Neovascularization

David A Newsome, MD, New Orleans, LA; Paul A Blacharski, MD, Colton, CA; ClayS Hinrichs, New Orleans, LA We have developed a new hand-held macular photostress device with a built-in timer that determines the recovery endpoint. With normal persons, we found little age-related increase in the mean response times until after the mid-fifth decade. In 36 diabetic patients, patients without macular edema (n=17) had more rapid photostress recovery times than those with macular edema (n=19; p<.OS). In 194 persons with macular degeneration, the recovery times were significantly prolonged for all ages over 51 (p<.OOOl). With drusen only (n=72), times were normal.

Scientific Poster 259 Initial Experience With an Eight-Month lntravitreal Sustained Release Ganciclovir Implant for CMV Retinitis*

JayS Duker, MD, Boston, MA; Rajiv Anand, MD, Dallas, TX; Thomas J Smith, MD, Boston, MA A surgically implanted, sustained release device for the treatment of cytomegalovirus (CMV} retinitis has been developed. Initial devices had a four-month supply of ganciclovir. Newer devices with an eight-month supply of ganciclovir are now available. As part of a randomized clinical trial, we implanted five eight-month devices in the eyes of five AIDS patients. Four of the five eyes (80%) showed regression of the retinitis. One eye has been activity-free for more than six months. No extraocular manifestations of CMV have been detected in these patients. One retinal detachment and one case of postoperative bacterial endophthalmitis occurred and were success­ fully treated.

Scientific Poster 260 Is There a Distinctive Personality Profile in Patients With Central Serous Retinopathyl

Matthew AThomas, MD, St. Louis, MO; jane Darger, PhD, Ladue, MO Many investigators believe central serous retinopathy (CSR) patients have distinctive personality characteristics. We evaluated 30 patients aged 18-50 years (with angiographically documented CSR) with a standard personality profile assessment instrument, the Millon Clinical Multi-Axial Inventory, and compared them to 39 age-and-gender­ matched controls. The CSR patients did nol have significantly ele­ vated scores on any of the 20 subscales. On the Compulsive Conforming scale, the mean CSR score was significantly lower than the control group (75.5 vs. 83.7, p=0.09). Our data do not support the concept of a distinctive personality profile in CSR patients.

Kevin LWaltz, MD, Royal Oak. Ml; George AWilliams, MD, Royal Oak, Ml; Stacia H Goldey, MD, Gainesville, FL; Curtis EMargo, MD,

David R Guyer, MD; Sara Krupsky, MD; Wendall C Bauman, MD; Eleanore M Ebert, MD; Evangelos S Gragoudas, MD, Botton, MA lndocyanine-Green (ICG) dye-enhanced diode laser photocoagula­ tion is a potential technique to treat choroidal neovascularization (CNVM) with less energy and more precision. We performed a pilot study on 10 subfoveal CNVM. The CNVM was closed in 8 of10 (80%) cases. The median refracted vision preoperativelywas2()'130 (ranae: 20/40-CF) and postoperatively was 20/200 (range: 20/100-20/200). Four of ten (40%) eyes had improved or unchanged vision. The median follow-up period was three months. Dye-e1hanc:ed photoco­ agulation may allow treatment of subfoveal CNVM with less immedi­ ate vision loss than conventional photocoagulation.

Scientific Poster 263 Perfluorodecalin (PFD) as Postoperative Short-Term Substitute in the Treatment of Giant Retinal lean

Vito De Molfetta, MD, Milan, Italy; Stefano Zenoni, MD, Milan, Italy; Paolo Vinciguerra, MD, Milan, Italy; Ferdinanda Bottoni, MD, Monza. Italy; Giorgio Bailo, MD, Monza, Italy; Maurizio Sborgia. MD, Monza. Italy; Paolo Arpa, MD, Monza. Italy; &nanuela Bertazzi, MD, Monza. Italy To avoid postoperative "compartmentalization" of the vitreous cavity which can accelerate the occurrence of postoperative proliferative retinopathy (PVR), seven eyes with giant retinal tears, grade B PVR, were managed with vitrectomy, PFD injection and six-day-supine positioning after surgery until PFD/Fiuid exchange. Follow-up ranged from 0.5 to 5 mos. (median 2.5). All the retinas remained attached with no reinterventions. Visual acuity improved in all eyes. Final visual acuity was 20/40 or better in four eyes, 20/200 in one and 5/200 in 2. Automated visual field testing, performed in 2 patients with good visual acuity, revealed no significant differences between the oper­ ated-on eye and the contralateral eye used for comparison.

Scientific Poster 264 Factors Influencing the Progression and Regression of Diabetic Retinopathy in Type I Insulin-Dependent Diabetes

Douglas LHolmes, MD; William Ejackson, MD; H Peter Chase, MD; Salish KGarg, MD, Den\ler, CO Two hundred seventy-seven subjects with Type I diabetes mellitus were evaluated longitudinally for retinal changes over a mean of 2.7 years. The multistate Markov Model was used to analyze the influ­ ences of age, gender, duration of diabetes, cigarette smoking, systolic and diastolic blood pressures, cholesterol levels and longitudinal

*The presenter(s) have a financial interest in the subject matter of the presentation

153

SCIENTIFIC POSTERS glycohemoglobin values on the progression and/or regression of retinopathy. A longer duration of diabetes, higher mean glycohemoglobin and higher diastolic blood pressure were all asso­ ciated with an increased risk of progression and a decreased chance of regression of retinopathy (multivariate analyses, p<0.01).

Scientific Poster 265

Congenital Hypertrophy of the Retinal Pigment Epithelium: Diagnostic Value in Familial Adenomatous Polyposis

Arturo Santos, MD; luis Morales, MD; Everardo Hernandez, MD; Virgilio Morales, MD; Juan M Jimenez, MD; Hugo Quiroz, MD; Arturo Panduro, MD, Mexico City, Mexico Familial adenomatous polyposis (FAP) is an autosomal dominant disorder with a malignant potential of 100%. Congenital hypertrophy of the retinal pigment epithelium (CHRPE) has been described as a potential clinical marker in FAP. Forty-one members of a large kindred with a documented history of FAP were divided into four categories based on the colonoscopic findings. All subjects received a complete ophthalmologic examination. All members with docu­ mented FAP showed at least four CHRPE lesions, and 20% of members at risk showed changes indistinguishable from those found in the affected members. The sensibility of the CHRPE as a marker for FAP in this family was 100%, and the specificity was 91.89%. The CHRPE was a significative phenotypic marker in predicting the presence or development of adenomatous polyps in this kindred.

Scientific Poster 266

Treatment of Proliferative Diabetic Retinopathy­ How Much is Enoughl

Venkat M Reddy, MD; Rene A Zamora, MD; R Joseph Olk, MD, St. louis,MO We quantitated the total area of retinal ablation leading to regression of proliferative diabetic retinopathy in 294 eyes of 182 patients. Two hundred seventy-five eyes (93.5%) responded to either panretinal photocoagulation (PRP) alone (76.5%) or in combination with panreti­ nal cryotherapy (17%). An average of 1 .6+0.9 treatments led to clinical regression. Nineteen eyes (6.5%) failed to regress and even­ tually required vitrectomy with endophotocoagulation. The amount of retinal ablation leading to regression in eyes with two retinopathy risk factors (RRF) was not statistically different from that in eyes with three RRF; however, significantly more retinal ablation was needed for regression in eyes with four RRF when compared to eyes with two RRF (p=0.005) and three RRF (p=0.04). Type 1 diabetes (p=O.OOOl) and duration of diabetes (p=0.001) were other factors associated with a need for greater retinal ablation.

Scientific Poster 267

Comparison of Ultrasonographic Techniques in the Diagnosis of Posterior Vitreous Detachment

Alipio de Sousa-Neto, MD; Edward M Stroh, MD; John J Weiler, MD, PhD; Sanford Chen, MD; Sheldon M Buzney, MD, Boston, MA The diagnosis of a posterior vitreous detachment (PVD) is important for the management of manr disorders. Ultrasonographic criteria of a PVD requires imaging o the posterior hyaloid interface. This interface is more difficult to assess in eyes with clear media than in eyes with a bloodstained posterior hyaloid. We studied 200 eyes with c~ear .media using open- and closed-lid 8-scan ultrasonography and btomtcroscopy to evaluate the accuracy and advantages of the differ­ ent techniques. Although open lid ultrasonography showed better resolution in all cases, the incidence of corneal abrasion was 2%, and four patients could not tolerate the examination. Closed-lid ultra­ sonography missed four cases of a PVD (2.5%). Preoperative open lid ultrasonography should be considered if the diagnosis of a PVD is equivocal by other techniques.

Scientific Poster 268 "Squash-Ball" Retinal Detachments: Anatomic and Visual Results

Harald LJ Knorr, MD; Jost 8 Jonas, MD; Gottfried 0 H Naumann, MD, Erlangen, Germany Retinal reattachment rates and visual results were analyzed in 26 consecutive traumatic retinal detachments after squash ball injury in comparison to 500 idiopathic consecutive rhegmatogenous retinal detachments. Typical criteria of this traumatic group are, e.g., larger extended, giant tears with rolling up ofthe retina, chain ofholes mostly temporal above with small bridges, grades C or D of proliferative vitreoretinopathy, and vitreous hemorrhage. Anatomic reattachment achieved 86% in the traumatic, 91% in the idiopathic group (p=0.1 ). However, 24 months' follow-up indicate significantly worse visual results in the squash ball group (p<0.05). The reasons are macular detachment, macular pucker, proliferation of RPE and retinal detach­ ment involving anterior and posterior eye segment.

Scientific Poster 269

Absence of Proliferative Vitreoretinopathy (PVR) in lnferotemporal Juvenile Dialysis (ITJD)

Andres Padilla-Ailhaud, MD; Judy Ardila, MD; Arturo Santos, MD; Juan M Jimenez, MD, Mexico City, Mexico To the best of our knowledge, there is no data about the frequency of PVR in postoperative cases of retinal detachment (RD) associated with ITJD. We reviewed the postoperative results of 102 eyes from 86 consecutive patients with RD associated with ITJD operated between 1984 and 1991. In all cases, extensive cryoretinopexy was used in addition to several types of indentation elements. After initial proce­ dure, the rate of reattachment was 92.15% (94 eyes); eight eyes required more than one procedure. Final rate of anatomical success was 97% (99 eyes). The average follow-up was nine months. None of the cases showed evidence of PVR. These results indicate that the risk factors for PVR in rhegmatogenous RD (extensive cryotherapy, large breaks, and chronic RD) do not induce PVR in RD secondary to ITJD. The possible pathophysiology is discussed.

Scientific Poster 270 Automated Detection of Microaneurysms in Color Fundus Photographs

Robert C Scott, MD; Vladimir Kozousek, MD; Peter Gregson, PhD, Halifax, NS, Canada Subjective grading of fundus photographs in diabetic retinopathy has significant inter- and intra-grader variability. We have developed an automated image analysis system which detects microaneurysm& in digitized images of color fundus photographs. The green color plane is first extracted, and after masking the vessels, a series of algorithms extracts the microaneurysm& and displays their size and location. Based on a trial of photographs from 10 diabetic patients, we have obtained a sensitivity of 76% and specificity of 72%. This new technique has significant potential for clinical use.

Scientific Poster 271 Retinal Microvascular Abnormalities and Immunologic Status in the Acquired Immunodeficiency Syndrome (AIDS)

Kumar Rao; Pravin U Dugel, MD; Elisa N Marinelli, MD; Narsing A Rao, MD, los Angeles, CA Whole mount trypsin digest studies were performed to determine the incidence and type of microvascular abnormalities in 40 eyes of 21 AIDS patients without CMV retinitis, and in 30 eyes of 17 AIDS patients with CMV retinitis. A pericyte to endothelial cell ratio of at least 4:1 was found in 25 eyes (83%) with CMV retinitis and 4 eyes (1 0%) without CMV retinitis. Other microvascular abnormalities included ghost vessels, capillary drop-out, and microaneurysm&. We

:1: The presenter(s) have a financial interest in the subject matter of the presentation

154

SCIENTIFIC POSTERS conclude that microvascular abnormalities in AIDS patients is directly related to immunologic status as determined by the T-cell ratio, duration of AIDS, and opportunistic infections.

Scientific Poster 272

Clinical, Angiographic and Ultrasound Findin!P' in Recessive Rod-Cone Dystrophy With Progress1ve Atrophic Macular Lesion

Edna U Angei-Munoz, MD; Ricardo Ramos, MD; Cecilio Velasco, MD; Eladio Garcia V, MD; Elena Ponce, MD; juan MJimenez, MD, Mexico City, Mexico Eleven patients with macular •coloboma•-like lesions associated with generalized rod-cone dystrophy were studied with angiography and ultrasound. Average age was 24 years. Onset of symptoms occurred after the second decade. Ultrasound showed 22.5mm of anteroposterior diameter in average, macular staphyloma 4.Smm in average and 2.04mm in depth. Angiography revealed a lesion bigger than the clinical picture. Low myopia and exotropia \'\lel'e common, nystagmus was absent. Results suggest a variant of rod-cone dystro­ phy between Leber's Congenital Amaurosis and Retinitis Pigmentosa with progressive posterior staphyloma.

Scientific Poster 276

Peripheral Retinal Vascular Pattern as a Risk Factor for Proliferative Sickle Retinopathy

Alan D Penman, FRCS, FCOphth, Kingston, Jamaica; John FTalbot, FRCS, Sheffield, England; Elaine LChuang, MD, Miami, FL; Alan C Bird, MD, FRCP, London, England; Graham RSerjeant, MD, FRCP, Kingston, Jamaica Detection of treatable proliferative sickle retinopathy (PSR) requires early identification of eyes at risk. We believed that the peripheral retinal vascular pattern on fluorescein angiography was an important ocular determinant of the development of PSR. We reviewed more than 2000 angiograms from 440 subjects in a large cohort study of sickle cell disease which was started in 1973. Following diagnosis at birth, children have had annual fluorescein angiograms since the age of 6, and the oldest are now 18. We have developed a new classifi­ cation of peripheral retinal vascular changes in sickle cell disease, and have identified a particular vascular pattern which is strongly associ­ ated with the subsequent development of PSR, particularly in SC subjects. Inter-observer agreement using this classification has been good, and we believe it has useful clinical applicability in the identi­ fication of eyes at risk of developing PSR.

SOCIOECONOMICS, PRACTICE MANAGEMENT Presenters for poster 136 will attend their poster Sun­ day, November 8 from 11 :30 AM to 1:00 PM. Pre­ senters for poster 273 will attend their poster Tuesday, November 10 from 11 :30 AM to 1:00 PM. Individual attendance hours will be indicated on a mock clock at each poster board.

SUNDAY POSTERS Scientific Poster 136

Academic Retrieval System Without Extra Data Entry

Donald A Frambach, MD, Los Angeles, CA Numerous computerized database management systems have been developed so that selected patient records can be retrieved to incor­ porate into clinical studies. These systems require extra data entry and, therefore, are not universally employed. Our system requires no

extra data entry. After the dictated notes are transcribed, off-the-shelf software is used to index the wordprocessing documents. Searches of this index (by any combination of words) take only seconds. Typical initial visit clinic notes consume 5 kbytes of disk space so that 40,000 records fit on an inexpensive 200 Mbyte hard drive.

TUESDAY POSTERS Scientific Poster 273

The Cataract Appropriateness Project

Paul P Lee, MD, Los Angeles, CA; Lee Hilbome, Santa Monica, CA; Caren Kamberg, Santa Monica, CA; Joanne Tobacman, MD, Iowa City, lA Cataract surgery continues to be the largest component of Medicare procedure expenditures. RAND and the Academic Medical Center Consortium (AMCC) evaluated the appropriateness and necessity of cataract surgery. A multidisciplinary physician expert panel graded possible clinical scenarios for appropriateness for cataract surgery. The clinical ratings were then applied to 1000 charts from AMCC centers. Preliminary data from the first 150 records indicate that documentation of functional defects due to the cataract is lacking in 42%. Of the 58% of charts with functional and ophthalmic documen­ tation, only 1 (1 %) was inappropriate.

TRAUMA Presenters for posters 137 through 139 will attend their posters Sunday, November 8 from 11 :30 AM to 1:00PM. Presenters for posters 274 through 275 will attend their posters Tuesday, November 10 from 11 :30 AM to 1:00 PM. Individual attendance hours will be indicated on a mock clock at each poster board.

SUNDAY POSTERS Scientific Poster 137

Retinal Folds in Terson's Syndrome

MariAnn Z Keithahn, MD, St. Paul, MN; Steven R Bennett, MD, £dina, MN; Douglas Cameron, MD, Minneapolis, MN; William FMieler, MD, Milwaukee, WI A retinal fold surrounding the macula has been reported in the •shaken baby syndrome... It has been suggested that this fold may be charac­ teristic enough to allow courtroom testimony substantiating shaking. We report two cases of adults with Terson's syndrome with paramacu­ lar folds. In both cases, there was a retinal fold surrounding the macula with a membrane arising from the apex of the fold. In one case, electron microscopy of this membrane demonstrated internal limiting membrane. We conclude that pararnacular fold may be seen in adults with Terson's syndrome and are not pathognomonic of shaking.

Scientific Poster 138

Major League Baseball Eye Trauma

Bruce MZagelbaum, MD, Albertson, NY; PeterS Hersh, MD, New York, NY In 1990, there were an estimated 37,000 sports and recreational eye injuries; baseball accounted for 17.3% of those injuries. The authors conducted a one-year prospective study of all eye injuries among Major League Baseball players, including spring training, regular season, playoffs and World Series. All major league team trainers, physicians, and ophthalmologists participated. The most common injury incurred was corneal abrasion. However, more serious eye

*The presenter(s) have a financial interest in the subject matter of the presentation

155

SCIENTIFIC POSTERS injuries were seen. A high percentage of eye trauma occurred in players wearing contact lenses. We present the epidemiology of Major league Baseball eye trauma, and its usefulness in injury pre­ vention.

Scientific Poster 139

Diagnosis and Management of Cyclodialysis Clefts

Shashi K Dharma, MD; Evan B Dreyer, MD, PhD; A Robert Bellows, MD; B Thomas Hutchinson, MD; Trexler M Topping, MD, Boston, MA Eight cases of cyclodialysis cleft were reviewed. Two were inadver­ tent secondary to cataract extraction, and six resulted from trauma (blunt or penetrating). Three of these cases initially presented as diagnostic dilemmas. Although laser photocoagulation was attempted in 7/8 patients, it was generally successful only in smaller clefts (less than 2 clock hours). Direct cyclopexy was successful in all remaining patients, and it may be appropriate as an initial therapy in larger clefts. Pitfalls in diagnosis, as well as laser and surgical inter­ vention for this condition, will be discussed.

TUESDAY POSTERS Scientific Poster 274

Ocular Injuries Treated by US Military Ophthalmologists During Operation Desert Shield/ Desert Storm Thomas H Mader, MD, Olympia, WA; Jaime V Aragones, MD, Rochester, Ml; lynn E Hicks, MD, Mobile, AL; James A Hazlehurst, MD, Chico, CA; leslie P fox, MD, Puyallup, WA; Arthur C Chandler Jr, MD, Durham, NC; Gregory B Webster, MD, APO New York, NY; joe f Arterberry, MD, louisville, KY; Stuart R farris, MD, DeRidder, lA; james D Kingham, MD, Sarasota, fl; Martin C Seremet, MD, Chesapeake, VA; Casimir Napora, MD, Bethesda, MD; RoderickS Kent, MD, St. Maries, ID; Andrea Scalisa, MD, Portsmouth, VA; Bettina Bass Meekins, MD, New Bum, NC; Robert B North, MD, Treasure Island, CA; Charles Aronson, MD, ft. Carson, CO; David R Pernelli, MD, Millville, Nj; Mark J Fitzmaurice, MD, Madisonville, KY; BrianT Nolan, MD, lexington, KY; Jeffrey Heier, MD, Aurora, CO; Emil Stein, MD, Clarksville, TN We retrospectively reviewed ocular injuries, treated by US Army and Navy ophthalmologists, which occurred during Operation Desert Shield/Storm. During Desert Shield, 20 patients (23 eyes) suffered serious ocular trauma, as compared to 155 (193 eyes) in Desert Storm. Shield injuries were all accidental, with no enucleations. During Desert Storm, fragmentation injuries accounted for 77% of ocular injuries. During Desert Storm, 33 enucleations were performed, 94% from fragmentation injuries. Iraqi, US, and Allied military, and Iraqi civilians accounted for 32%, 30%, 16%, and 10% respectively of Desert Storm ocular injuries.

Scientific Poster 275

Visually Evoked Cortical Potentials and Contrast Sensitivity Findings in Moderate to Severe Traumatic Brain Injury

Sieglinde freed, MS, Denver, CO; lynn Hellerstein, PhD, Englewood, CO; john A Santoro, MD, Thornton, CO; Rebecca Hutchins, PhD, Boulder, CO; Marcy Rose, PhD, Denver, CO Assessment of visual loss from brain injury constitutes a formidable diagnostic challenge. Visually evoked cortical potentials (VECP) and contrast sensitivity (CS) studies were obtained for normals and 96 head-injured patients to ascertain accuracy, reproducibility, and effi­ cacy of these methods. 86.5% of VECP abnormality scores correlated significantly with injury severity and clinical disability ratings (SD=1.89-2.56). 82.3% of head-injured patients showed CS losses compared to 0.3% of normals (P<0.001 ). Findings show that these tests are well-tolerated and give reliable information for assessment of visual pathway injuries. •

*

The presenter(s) have a financial interest in the subject matter of the presentation

156