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Symposium on Ocular Therapy, Vol. 6
278
AMERICAN JOURNAL OF OPHTHALMOLOGY
physician who was directly in charge of her activi ties. He immediately countermanded the possible use of S-fluorouracil in place of sodium fluorescein. To the best of our knowledge, there has never been a fatal accident from the use of I.V. fluorescein (Stein, M. R. and Parker, C. W.: Reactions following intravenous flu orescein. Am. J. Ophthalmol. 72:861, 1971,) though it is estimated that approximately 1,000 injections are given each working day throughout the world. The literature is con fusing. Almaric recorded a fatal myocardial infarction and two cardiac arrests (cases 20 and 21) are reported. This remarkable rec ord should not lull the medical profession into a false sense of security. Intravenous injections are never an innocuous procedure. Though delegated to technicians, primary re sponsibility remains with the physician. Fluorouracil sounds and reads somewhat like fluorescite. It is packaged in a white carton with blue print as is fluorescein (Fig ure). Neither is marked "dangerous." The active ingredient of each is included in 10-ml disposable vials. Fluorouracil, an antimetabolite, according to the enclosed literature which comes with the material, is to be ad ministered slowly in an intravenous infusion while the patient is closely watched for signs of toxicity, primarily nausea and vomiting. It is our impression that over 10 ml of concen trated fluorouracil given rapidly through an intravenous route such as is routinely per formed in fluorescein angiography could in all likelihood- cause instantaneous death. It is recommended that 5-fluorouracil be labeled with a warning on the carton. All technicians, nurses, residents and clinicians should check and double check before inject ing fluorescein. Thomas D. Duane, M.D. Philadelphia, Pennsylvania
FEBRUARY, 1974
BOOK REVIEWS SYMPOSIUM ON OCULAR THERAPY, vol.
6.
Edited by Irving Ff. Leopold. St. Louis, C. V. Mosby, 1973. Clothbound, 112 pages, table of contents, index, 14 black and white figures. $17.50 This volume comprises material presented at the Drug Symposium of the American Academy of Ophthalmology and Otolaryngology and the Association for Research in Vision and Ophthalmology joint meeting held in Dallas in September 1972. As in previous editions, selected subjects in ocular therapeutics are covered. Material not covered in earlier symposia is presented with emphasis on providing current infor mation at fundamental and practical levels. The content of the individual chapters is quite variable: in some, the results of pre viously unreported studies are presented while in others, reviews or results of sur veys are offered. Rather detailed references are provided in most selections. A major thorough review of reported problems associated with carbonic anhydrase inhibitors is presented with an attempt made to reach some conclusions regarding their origin, significance, and prevention. The re view on systemic anti fungal chemotherapy in treatment of intraocular infections is timely and includes the pharmacology and clinical uses of amphotericin B and flucytosine as well as problems of diagnosis and methods of treating intraocular fungal infections. The value of newly developed drugs against ocular herpes simplex is discussed with emphasis on their relative potential value in treatment of dendritic, recurrent, and deep herpes keratitis. Therapy of per sistent corneal changes in epidemic keratoconjunctivitis with topical corticosteroids is considered in another chapter. New approaches in the medical treatment of glaucoma are discussed. The sustained re lease pilocarpine Ocusert system is compared to the application of 2% pilocarpine drops four times a day with regard to their effects
VOL. 77, NO. 2
BOOK REVIEWS
on intraocular pressure and pupillary diam eter in a group of patients with open-angle glaucoma. In another chapter the possible value in the administration of diphenylhydantoin for the treatment of optic neurop athies in an initial trial in 50 patients with glaucomatous field loss is reported. The results of a survey of university hos pitals in the United States to determine how widely radionuclides are used in ocular diag nosis and therapy are presented along with a review of techniques and results of use of various isotopes in intraocular and orbital tumor scanning. In another section, the cur rent problems and prophylaxis of ophthalmic neonatorum are reviewed. Other chapters deal with ocular changes in drug abusers and the placebo effect of therapy (which the author considers to be the method of action of acupuncture). The reduction of water inflow into the eyes of rabbits with injection of digoxin is reported along with a brief review of cardioglycosides in ophthalmology. The final chapter is devoted to a discus sion of drug interactions. This is an im portant subject on which increasing emphasis is rightly being placed. The possible mecha nisms and patient factors in drug interac tion are presented. Of particular use to the ophthalmologist are tables on the interaction of antibiotics and on corticosteroid interac tions, acetazolamide interactions, and aspirin interactions. In this edition, the fundamental purpose for publication of the symposium has been maintained; that is, to make available clearly written, up-to-date fundamental and practical aspects of ocular therapy in a single source. The usefulness of the book is enhanced by a complete accurate index. Philip P. Ellis PROBLEMS AND TREATMENT OF CONTRACTED SOCKETS, EXENTERATED ORBITS, ALKALI
BURNS. Edited by Pierre Guibor and Henry P. Gougelman. New York, Inter continental Medical Book Corporation,
279
1973. Clothbound, 177 pages, table of con tents, index, 136 black and white figures, approximately 50 color plates. $15 This is a collection of selected papers by 11 ophthalmologists and 13 ocularists from the Fifteenth Annual Meeting of the Ameri can Society of Ocularists. The publication has three sections: contracted sockets, exenter ated sockets, and alkali burns. Each includes chapters on problems and treatment, case presentations, and discussion of these sub jects, and alternate papers from the ophthal mic plastic surgeon and ocularist. Approximately 60% of the book is photo graphs and illustrations, 25% of which are in color. Several photographs are poorly re produced, but nearly all are easily discernible because of their large size with usually only two on a page. Interspersing color and blackand-white prints helps maintain the reader's interest. The contracted socket section gives a de tailed presentation of treatment with pres sure conformers. It discusses multiple etiolo gies and types of contracted sockets as well as various devices for pressure treatment. It also introduces several new experimental pressure conformers. The book only touches on the surgical treat ment of contracted sockets with one presen tation on treatment of the totally contracted socket. That presentation also describes a clever stapling instrument to secure grafts to implant material. However, the various ap proaches, procedures, and complications in surgically treating the other different types of contracted sockets are omitted. Also, there is no mention in this section of the technique and instrumentation for obtaining mucous membrane and skin grafts. The second section gives a relatively com plete coverage of exenterated orbits, listing the various illnesses requiring exenteration and explaining the techniques and advantages of the various exenteration procedures. The participants also engage in an inter esting controversy concerning the significance of the lack of motility of the eye and eyelids
AMERICAN JOURNAL OF OPHTHALMOLOGY
physician who was directly in charge of her activi ties. He immediately countermanded the possible use of S-fluorouracil in place of sodium fluorescein. To the best of our knowledge, there has never been a fatal accident from the use of I.V. fluorescein (Stein, M. R. and Parker, C. W.: Reactions following intravenous flu orescein. Am. J. Ophthalmol. 72:861, 1971,) though it is estimated that approximately 1,000 injections are given each working day throughout the world. The literature is con fusing. Almaric recorded a fatal myocardial infarction and two cardiac arrests (cases 20 and 21) are reported. This remarkable rec ord should not lull the medical profession into a false sense of security. Intravenous injections are never an innocuous procedure. Though delegated to technicians, primary re sponsibility remains with the physician. Fluorouracil sounds and reads somewhat like fluorescite. It is packaged in a white carton with blue print as is fluorescein (Fig ure). Neither is marked "dangerous." The active ingredient of each is included in 10-ml disposable vials. Fluorouracil, an antimetabolite, according to the enclosed literature which comes with the material, is to be ad ministered slowly in an intravenous infusion while the patient is closely watched for signs of toxicity, primarily nausea and vomiting. It is our impression that over 10 ml of concen trated fluorouracil given rapidly through an intravenous route such as is routinely per formed in fluorescein angiography could in all likelihood- cause instantaneous death. It is recommended that 5-fluorouracil be labeled with a warning on the carton. All technicians, nurses, residents and clinicians should check and double check before inject ing fluorescein. Thomas D. Duane, M.D. Philadelphia, Pennsylvania
FEBRUARY, 1974
BOOK REVIEWS SYMPOSIUM ON OCULAR THERAPY, vol.
6.
Edited by Irving Ff. Leopold. St. Louis, C. V. Mosby, 1973. Clothbound, 112 pages, table of contents, index, 14 black and white figures. $17.50 This volume comprises material presented at the Drug Symposium of the American Academy of Ophthalmology and Otolaryngology and the Association for Research in Vision and Ophthalmology joint meeting held in Dallas in September 1972. As in previous editions, selected subjects in ocular therapeutics are covered. Material not covered in earlier symposia is presented with emphasis on providing current infor mation at fundamental and practical levels. The content of the individual chapters is quite variable: in some, the results of pre viously unreported studies are presented while in others, reviews or results of sur veys are offered. Rather detailed references are provided in most selections. A major thorough review of reported problems associated with carbonic anhydrase inhibitors is presented with an attempt made to reach some conclusions regarding their origin, significance, and prevention. The re view on systemic anti fungal chemotherapy in treatment of intraocular infections is timely and includes the pharmacology and clinical uses of amphotericin B and flucytosine as well as problems of diagnosis and methods of treating intraocular fungal infections. The value of newly developed drugs against ocular herpes simplex is discussed with emphasis on their relative potential value in treatment of dendritic, recurrent, and deep herpes keratitis. Therapy of per sistent corneal changes in epidemic keratoconjunctivitis with topical corticosteroids is considered in another chapter. New approaches in the medical treatment of glaucoma are discussed. The sustained re lease pilocarpine Ocusert system is compared to the application of 2% pilocarpine drops four times a day with regard to their effects
VOL. 77, NO. 2
BOOK REVIEWS
on intraocular pressure and pupillary diam eter in a group of patients with open-angle glaucoma. In another chapter the possible value in the administration of diphenylhydantoin for the treatment of optic neurop athies in an initial trial in 50 patients with glaucomatous field loss is reported. The results of a survey of university hos pitals in the United States to determine how widely radionuclides are used in ocular diag nosis and therapy are presented along with a review of techniques and results of use of various isotopes in intraocular and orbital tumor scanning. In another section, the cur rent problems and prophylaxis of ophthalmic neonatorum are reviewed. Other chapters deal with ocular changes in drug abusers and the placebo effect of therapy (which the author considers to be the method of action of acupuncture). The reduction of water inflow into the eyes of rabbits with injection of digoxin is reported along with a brief review of cardioglycosides in ophthalmology. The final chapter is devoted to a discus sion of drug interactions. This is an im portant subject on which increasing emphasis is rightly being placed. The possible mecha nisms and patient factors in drug interac tion are presented. Of particular use to the ophthalmologist are tables on the interaction of antibiotics and on corticosteroid interac tions, acetazolamide interactions, and aspirin interactions. In this edition, the fundamental purpose for publication of the symposium has been maintained; that is, to make available clearly written, up-to-date fundamental and practical aspects of ocular therapy in a single source. The usefulness of the book is enhanced by a complete accurate index. Philip P. Ellis PROBLEMS AND TREATMENT OF CONTRACTED SOCKETS, EXENTERATED ORBITS, ALKALI
BURNS. Edited by Pierre Guibor and Henry P. Gougelman. New York, Inter continental Medical Book Corporation,
279
1973. Clothbound, 177 pages, table of con tents, index, 136 black and white figures, approximately 50 color plates. $15 This is a collection of selected papers by 11 ophthalmologists and 13 ocularists from the Fifteenth Annual Meeting of the Ameri can Society of Ocularists. The publication has three sections: contracted sockets, exenter ated sockets, and alkali burns. Each includes chapters on problems and treatment, case presentations, and discussion of these sub jects, and alternate papers from the ophthal mic plastic surgeon and ocularist. Approximately 60% of the book is photo graphs and illustrations, 25% of which are in color. Several photographs are poorly re produced, but nearly all are easily discernible because of their large size with usually only two on a page. Interspersing color and blackand-white prints helps maintain the reader's interest. The contracted socket section gives a de tailed presentation of treatment with pres sure conformers. It discusses multiple etiolo gies and types of contracted sockets as well as various devices for pressure treatment. It also introduces several new experimental pressure conformers. The book only touches on the surgical treat ment of contracted sockets with one presen tation on treatment of the totally contracted socket. That presentation also describes a clever stapling instrument to secure grafts to implant material. However, the various ap proaches, procedures, and complications in surgically treating the other different types of contracted sockets are omitted. Also, there is no mention in this section of the technique and instrumentation for obtaining mucous membrane and skin grafts. The second section gives a relatively com plete coverage of exenterated orbits, listing the various illnesses requiring exenteration and explaining the techniques and advantages of the various exenteration procedures. The participants also engage in an inter esting controversy concerning the significance of the lack of motility of the eye and eyelids