Glaucomatous and glaucoma-like optic neuropathy.

Firstly, the more distinctive features of the morphology and semeiology of the normal optic disk and peripapillary region are discussed. The authors then outline the principal morphological and functional characteristics of glaucomatous optic neuropathies. An appropriate description of the optic disorders which may resemble glaucoma follows. This section reviews separately the vascular disorders considered the most significant from the point of view of frequency and clinical scope, and non-vascular disorders of a heterogeneous nature (toxic, inflammatory, degenerative, malformative and compressive). Finally, the dangers of diagnostic confusion in such cases are mentioned and the most pertinent clinical characteristics for the differentiation between glaucomatous and glaucomatous-like forms are discussed.

Glaucoma after vitreo-retinal surgery with silicone oil injection: epidemiologic aspects.

PURPOSE: To evaluate the prevalence of glaucoma after pars plana vitrectomy with silicone oil injection and to determine the different clinical forms. METHODS: Authors have carried out a retrospective longitudinal study on patients who underwent pars plana vitrectomy with silicone oil injection from 1981 to 1995. The examined population consists of 301 patients (301 eyes), with an age ranging from 8 to 85 years, affected by retinal detachment and proliferative vitreoretinopathy. RESULTS: The prevalence of the secondary glaucoma has been 18.5%. In all cases glaucoma was caused by trabecular meshwork obstruction due to silicone oil emulsification. The glaucoma has been more frequent after surgery for recurrent rhegmatogenous retinal detachment with fibrous PVR (52.86%) and for particular forms of rhegmatogenous retinal detachment (giant tears, multiple breaks, pseudophakia) with incipient PVR (30%). CONCLUSION: Glaucoma after intravitreal silicone oil injection for complicated retinal detachments is a relatively frequent complication mostly when surgery needs endophotocoagulation, endodiatermy and lensectomy.

Trends in cataract surgery in Milan (Italy) from 1956 to 1987. Relationship to age and visual acuity.

In order to test whether the mean age at cataract surgery has changed over the course of the last 30 years, a hospital series of 5443 patients undergoing cataract extraction between 1956 and 1987 is reviewed. All cases attended the same University Eye Clinic of Milan and most were resident in the same geographical area. Cases with macular or optic nerve diseases were excluded. Results show that mean age at cataract surgery progressively increased from 67.5 to 71.5 years (slope = +0.096 years of age per year, p = 0.0001) as did visual acuity at surgery (patients with visual acuity levels greater than or equal to 1/10 at time of cataract surgery rose from 3.2% to 47.9%). These results can be interpreted in terms of a change in age composition of the Italian population, improved access to health services for the elderly, and an improvement in surgical and rehabilitation techniques.

Nedocromil sodium and astemizole, alone or combined, in the treatment of seasonal allergic conjunctivitis. A multicentre double blind clinical trial.

Two hundred and seven patients with active symptoms of allergic conjunctivitis were studied in a four-week multicentre double blind, double dummy, clinical trial comparing efficacy and safety of nedocromil sodium eye drops with oral astemizole, placebo, and the combined active treatments. Clinical signs were evaluated by clinicians after 1, 2 and 4 weeks, while symptoms were recorded by patients on daily diary cards. Overall opinions were recorded at the end of treatment. Nedocromil sodium eye drops and astemizole, alone or combined, significantly reduced ocular symptoms when compared to placebo (diary card total symptom score and patients' opinion). In the clinicians' opinion nedocromil sodium alone or combined (but not astemizole alone) significantly decreased ocular symptoms when compared to placebo. All treatments were safe and well tolerated, drowsiness being the most frequent side effect observed in patients treated with astemizole. These results indicate the effectiveness of nedocromil sodium eye drops in the treatment of seasonal allergic conjunctivitis.

Recurrences of isolated leukemic hypopyon in a child with acute lymphoblastic leukemia.

The authors report follow-up observations for a case of isolated leukemic uveopathy that was first diagnosed in an 11-year-old girl shortly after cessation of treatment for acute lymphoblastic leukemia (ALL). Prior therapy for the complication included systemic antiblastic chemotherapy and low doses of radiation (3.9 Gy) to the affected eye. In July 1979, 2 months after chemotherapy was stopped for the second time, she presented with recurrent leukemic hypopyon in the left eye and was treated again with antiblastic chemotherapy followed in 1 year by high-dose (20 Gy) local irradiation. After a third recurrence, which was diagnosed as pre-B/B-cell ALL with a variable position of maturation arrest, enucleation was performed. The patient remains in complete remission for 26+ months after an additional course of systemic chemotherapy. This case illustrates the difficulty of eradicating leukemic cells from the eye with conventional treatment but suggests that a relapse in this site is not necessarily an ominous prognostic sign.

Lentes de contato e algumas ocupaçöes / Contact lenses and some occupations

Em algumas atividades, o uso de lentes de contato pode acarretar riscos. A adesäo a lente de partículas suspensas no ambiente ou a absorçäo de vapores irritantes pela estrutura porosa do metacrilato podem causar lesöes na córnea, que sofre hipoestesia local induzida pela própria lente. Em ambientes quentes e secos, em situaçöes de descompressäo brusca e durante o uso de capacetes com ventilaçäo forçada, poderá verificar-se adesäo da lente a córnea, formaçäo de bolhas gasosas entre a lente e a córnea ou desprendimento repentino das lentes, respectivamente. As radiaçöes infravermelhas, em particular, seletivamente absorvidas pelas lentes, podem elevar a temperatura das mesmas, provocando sua adesäo a córnea. A umidificaçäo das lentes antes da remoçäo previne possíveis alteraçöes epiteliais de importância. Essas alteraçöes, por outro lado, säo reversíveis, com a rápida regeneraçäo do epitelio. O uso oportuno de protetores filtrantes é recomendável para os trabalhadores expostos a raios infravermelhos ou arcos elétricos