Chloroquine retinopathy in the rhesus monkey.

Chloroquine was administered intramuscularly 5 days a week to rhesus monkeys for as long as 4 1/2 years. No clinical, fluorescein angiographic, or electrophysiological evidence of retinal damage was observed. Yet chloroquine/chloroquine byproduct analysis of the ocular tissues revealed an enormous binding capacity of the pigmented tissues of the eye (choroid plus RPE, ciliary body, and iris) with eventual accumulation observed in the retina. Despite the normal ophthalmic appearance and function, extensive pathological changes occurred in the retinas and choroids of these experimental monkeys. The chloroquine caused an initial dramatic effect on the ganglion cells, with the photoreceptors affected shortly thereafter. Patching degeneration of the ganglion cells and photoreceptors then progressed over several years, with the choroid and pigment epithelium ultimately deteriorating as well.

Comparative reproducibility of the digital photogrammetric procedure utilizing three methods of stereophotography.

The reproducibility of digital photogrammetry of optic nervehead photographs taken with the Zeiss fundus camera with Allen stereoseparator, the Donaldson fundus camera, and the Zeiss fundus camera with twin-prism separator were evaluated. Reproducibility of the various quantitative factors was significantly better when the two types of simultantic cups. Larger per cent errors were encountered with shallower optic cups. Substantial improvements in parameter reproducibility were obtained when finer sampling intervals were used during film digitization.

Digital measurement of pallor-disc ratio.

In an effort to quantitate optic nerve head pallor, a method has been devised to measure pallor-disc ratio using optic nerve head photographs. After electronically scanning photographs through various Wratten filters, it was observed that a red filter produces good contrast between the disc and the retinal surface, while a green filter produces good contrast between the pale area of the disc and the remaining normal-appearing nerve head. A computer program fitted an elliptical form to both the disc region of red image and the pale area of green image. Pallor-disc ratios were calculated on both area and radial bases. Reproducibility of 3.5% for the area ratios and 7% for the radial ratios were obtained.

Laser trabeculoplasty primary therapy in open-angle glaucoma. A preliminary report.

Thirty-three patients with chronic open-angle glaucoma were treated with argon laser trabeculoplasty as the primary therapeutic modality. In 18 patients (55%) successful normalization of intraocular pressure (less than 21 mm Hg) was achieved. Of these, ten patients underwent bilateral procedures and eight patients underwent unilateral treatment. The IOP was normalized within five weeks in 27 of these 28 eyes. During the follow-up period, ranging from six to 18.5 months, IOP has remained lower than 21 mm Hg in all the successfully treated eyes. In 15 patients (45%) the treatment failed to control IOP by four weeks. In these patients, only one eye was treated. Significant correlations with successful outcome included initial IOP, well-delineated angle landmarks, and date of treatment. The date of treatment was consistent with an improvement in the treatment administration over time.

Visual results and ocular complications following radiotherapy for retinoblastoma.

Between 1956 and 1974, 28 children with retinoblastoma have been irradiated with the linear accelerator at the Stanford University Medical Center. Twenty-seven children (96%) have been cured of their tumor, with follow-up ranging from 2 1/2 to 21 years. In these survivors, 50 eyes were affected. Twelve were treated by primary enucleation and 38 were irradiated. Sixteen of the 38 irradiated eyes (42%) were ultimately enucleated for recurrent tumor, neovascular glaucoma, or inability to observe the tumor through opaque media. Thus, 22 (58%) irradiated eyes were saved. Of these, five eyes had visual acuity of 20/40 or better, five had 20/50 to 20/100, nine had 20/200 to hand motion, and three had light perception or no light perception. Radiation therapy can sterilize the tumor and maintain useful vision in many children with retinoblastoma.

Chalcosis in the human eye. A clinicopathologic study.

A clinicopathologic study of eight human eyes containing intraocular copper foreign bodies was undertaken. These foreign bodies, which had been retained in the eyes from three weeks to 22 years, were analyzed by atomic-absorption spectrophotometry and x-ray diffraction to determine their chemical composition. Copper deposits in Descemet membrane, vitreous, internal limiting membrane of the retina, and fibrous capsule around the foreign bodies could be demonstrated by rhodanine, rubeanic acid, and alizarin blue stains and were correlated with clinical findings and pathologic changes. Eyes with foreign bodies containing more than 85% copper tended to show more disseminated copper deposits. Eyes with alloy containing less than 85% copper showed more localized deposits of copper. Retinal structures were well preserved, even in an eye with an intraocular copper foreign body that had been retained for 22 years.

Intraocular copper foreign bodies. Use of dexamethasone to suppress inflammation.

In an attempt to prevent the intense inflammatory response to intravitreal copper foreign bodies in the rabbit eye, varying dosages of dexamethasone sodium phosphate were administered daily via the subconjunctival route. The steroid appeared to behave systemically and had similar effects in both the injected and the noninjected eyes. Its effect was similar also regardless of the concentration of copper within the foreign body. Nine days of dexamethasone therapy prevented a substantial number of copper foreign bodies from becoming totally encapsulated during that time. Furthermore, a delay in the onset of the inflammatory response to the foreign body was noted. In a few instances, inflammation was completely suppressed during the entire course of therapy.

Experimental siderosis in the rabbit: correlation between electroretinography and histopathology.

An iron foreign body was placed into the vitreous cavity of 22 rabbits' eyes. The electroretinographic (ERG) changes over a-15-week period were recorded. These changes were compared to those in a group of 12 normal rabbits and a group of 5 animals in whom a sham operation was performed. Twelve eyes were enucleated during this period and examined histopathologically. Histopathologic and functional changes in siderosis were both progressive in time, but the ERG values were more consistent among the 22 animals than the morphologic changes. Iron oxidation (Fe0 leads to Fe2 leads to Fe3) was found and suggested to be the mediating factor of the direct iron cytotoxic effect on the retina.

Cataract and survival in an elderly nondiabetic population.

Follow-up ranging between 6 and 8 years of the survival of a cohort of 473 elderly nondiabetic subjects randomly selected from a small English town showed an age- and sex-adjusted association between nuclear cataract at the time of baseline examination and decreased survival (P = .002). Comparing those with and without nuclear cataract, the adjusted relative hazard for death was 1.52 (95% confidence interval, 1.15 to 1.99). This effect remained virtually unchanged when also adjusted for whether the subject reported ever having been a smoker.

The early phase in Leber hereditary optic atrophy.

Clinical, ophthalmoscopic, perimetric, and color vision tests and visual evoked responses were recorded in symptomatic and asymptomatic eyes in five members of a family with Leber hereditary optic atrophy. The presymptomatic eyes showed abnormalities in the retinal nerve fiber layer. Optic nerve dysfunction was found before central vision failed. The appearance of degenerating retinal nerve fibers, particularly in the papillomacular bundle, was documented photographically in the weeks after the onset of visual symptoms. Treatment with prednisone and hydroxocobalamin did not reverse or halt serious impairment of vision.

Iris angiography and aqueous photofluorometry in normal subjects.

Iris angiography and photofluorometry of the aqueous were performed on 44 normal subjects equally distributed between 15 and 65 years of age. Hemoglobin AIc determinations were performed in 20 of these persons. Leakage from the pupillary margin was present in 20% of the eyes studied. In all cases of leakage, the dye faded quickly after the initial peak concentration. No leakage was observed from radial iris vessels. Photofluorometric readings of the aqueous 60 minutes after injection increased significantly with age. Hemoglobin AIc measurements were observed to correlate significantly with aqueous fluorescein concentration. Both these observations may reflect an altered permeability of biologic membranes associated with aging.

Association of HLA antigens and primary open-angle glaucoma.

HLA testing of 55 patients with primary open-angle glaucoma revealed no increased frequencies of any of 17 HLA-A and 29 HLA-B antigens. However, the subgroup with a known family history of primary open-angle glaucoma had an increase in the frequency of the HLA-B12 antigen (48%). Intrafamily studies might further define the strength and importance of this association.

Histochemical localization of intraocular copper foreign bodies.

Alizarin blue, rhodanine, and rubeanic acid stains cytochemically localized copper in rabbit eyes harboring intravitreal copper foreign bodies of varying copper composition. Local deposition presented in small amounts in areas adjacent to the foreign body (fibrous capsule, adjacent retina, and surrounding macrophages). The localized pattern was more frequent with the 60% copper alloy, when the foreign body was encapsulated or shiny, and when the aqueous copper concentration was normal. The generalized pattern of copper deposition revealed moderate to marked amounts of copper within the following multiple intraocular structures: (1) the posterior cortex of the lens, (2) the vitreous cavity, either in free-floating macrophages or in macrophages on the surface of the retina, (3) the retina, either within monocytic macrophages, Müller cells, or extracellularly in granular clumps, and (4) the fibrous capsule around the foreign body. Copper in several eyes was observed within macrophages that were clustered around the central retinal vessels within the optic nerve. The generalized pattern was frequent with the pure copper foreign body, when the copper foreign body was tarnished, and when copper concentration of the aqueous humor was elevated. There was a direct toxic effect of copper on the lens in the form of local opacification in the posterior cortex but no clinical or histochemical evidence of a Kayser-Fleisher ring or a sunflower cataract.

The effect of pan-retinal photo-coagulation on rubeosis iridis.

Fifteen eyes of 11 patients with rubeosis iridis and angle neovascularization associated with retinal vascular disorders were treated with pan-retinal photocoagulation. In seven of the 15 eyes, the new vessels on the surface of the iris and in the angle regressed after pan-retinal photocoagulation therapy for disk neovascularization; five of the remaining eight eyes that were treated prospectively demonstrated similar involution of the rubeosis iridis. In three of the five preexisting peripheral anterior synechiae regressed and angle structures previously obscured became visible. Three to 36 months after therapy, three eyes developed a few new abnormal iris and angle vessels.

One year in an eye casualty clinic.

A survey of patients visiting the eye casualty clinic of the Leicester Royal Infirmary was conducted during a one-year period. Demographic and clinical data were collected for 6576 patients. Data were recorded by both medical and clerical personnel during each patient visit. In addition to reporting the main demographic variables in the study, the most common diagnoses and occupations were analysed separately. The main diagnoses fell into two groups: trauma and acute infection/inflammation. The frequency of eye trauma in males was twice that in females. Trauma in adults was strongly influenced by occupation. Common occupations presenting with eye injury were press and machine tool operators, motor vehicle and aircraft mechanics, metal and sheet metal workers, construction and general labourers, electricians, welders, bus/lorry drivers and painter/decorators. Infections were in general distributed evenly throughout the population. The most common infection reported was acute conjunctivitis.

Early fundus fluorescein angiographic findings and sequelae in traumatic retinopathy: case report.

A 44-year-old man involved in a minor road traffic accident developed traumatic retinopathy in both eyes. We present the unusual early angiographic findings and the late sequelae of persistent ring scotomata. The previous work on the retinal pathophysiology is reviewed, and we suggest that the total clinical picture in traumatic maculopathy may often be a combination of the 'angiopathic retinal trauma' of Purtscher and the 'commotio retinae' of Berlin, that is, a combination of haemodynamic forces leading to vascular damage in the nerve fibre layer and of direct mechanical forces leading to photoreceptor destruction.

Family studies in glaucoma.

Two groups of patients with a family history of chronic open-angle glaucoma were compared with a normal population of 5919 individuals studied during the Bedford Glaucoma Survey. The mean screening intraocular pressure was significantly raised in both groups with a family history of chronic open-angle glaucoma. The prevalence rate of a raised intraocular pressure was 3.81 times that found in the normal population. This relationship was maintained when age-dependent prevalence rates were evaluated. No correlation between raised intraocular pressure and type of familial involvement could be determined. A 10- to 12-year follow-up of one group with a family history for open-angle glaucoma (101 patients) showed that 3% developed confirmed glaucoma, while an additional 5.9% were diagnosed as suspected chronic open-angle glaucoma. A letter survey of this group showed that 9 out of 63 respondents knew of additional family members who developed glaucoma over this 10-12-year period.

Chickenpox chorioretinitis.

Chickenpox infection in an adult was complicated by peripheral chorioretinitis and treated with oral acyclovir. Similarities of this case to the recently proposed mild type of acute retinal necrosis syndrome are discussed.

Cataract surgery in Fuchs' heterochromic iridocyclitis.

Eighteen eyes in 17 patients with Fuchs' heterochromic iridocyclitis underwent cataract extraction with or without intraocular lens implantation (17 extracapsular and one intracapsular). Intraoperative complications included hyphaema, poor pupillary dilatations, and localised zonule dehiscence with vitreous loss. Only four eyes developed a marked anterior uveitus (two pseudophakic and two aphakic) which resolved within 2 weeks with topical steroids. Three eyes developed a rise in intraocular pressure (IOP) to more than 30 mm Hg on the first postoperative day. In all three eyes the IOP returned to normal off all therapy within 1 week. In one of three eyes preoperative glaucoma was made worse following surgery. Visual acuity testing revealed that 15 eyes (83.3%) achieved 6/12 vision or better. Lamellar macular hole, pre-existing macular scar, and pre-existing retinal detachment accounted for the poor visual result.

Recent trends in the registration of blindness and partial sight in Leicestershire.

A study is reported of all new registrations for blindness and partial sight in the county of Leicestershire, England, for the years 1965, 1975, and 1985. The number of new registrations for blindness has risen considerably over this period, but the increase is shown to be attributable to changes in the age structure of the population and under-registration in 1965. The number of new registrations for partial sight has also increased over the study period but by significantly more than would be expected, even after changes in the population structure are allowed for. The registration rates for Leicestershire when analysed by age, sex, and cause are shown to be broadly in line with available national figures. Registration rates for macular degeneration and glaucoma are increasing in both males and females, and rates for cataract are at a significantly higher level for women than for men.