Iatrogenic inferior rectus palsy.

We examined two patients who developed unilateral inferior rectus muscle palsy following inferior oblique myectomy. Surgical exploration showed a normal inferior rectus muscle and tendon in both patients. Surgical correction consisted of inferior rectus resection in one patient and inferior rectus resection combined with an ipsilateral superior rectus recession in the other. We propose inadvertent excision of the lateral portion of the inferior rectus muscle during inferior oblique myectomy as the probable mechanism of inferior rectus injury.

Clinicopathologic observations of a silicone posterior chamber lens in a primate model.

A primate model was used to compare a silicone intraocular lens (Elastic Lens, STAAR Surgical) and a conventional polymethylmethacrylate/polypropylene lens. Tolerance and stability of silicone lenses within the eye were tested.

New techniques of viscosurgery with phacoemulsification.

Sodium hyaluronate is a valuable aid for phacoemulsification and intraocular lens insertion. Procedures such as anterior capsulotomy, polishing the capsule, lens adjustment, incision closure, and conversion to planned extracapsular cataract extraction are facilitated when sodium hyaluronate is used. A new method of removing it from the eye is presented.

Rapidly progressive proptosis secondary to Burkitt's lymphoma. Origin in the ethmoidal sinuses.

A case of unilateral proptosis secondary to Burkitt's lymphoma occurred in the ethmoidal sinuses. Involvement of the skull and paranasal sinuses by Burkitt's lymphoma may masquerade initially as an infectious process delaying diagnosis and treatment. The tumor's rapid growth and dramatic response to therapy with the potential for long-term remission and cure emphasize the need for prompt diagnosis and treatment.

Behavioral disturbance following intraocular lens implantation.

A 26-year-old man with mycosis fungoides and dense bilateral cataracts underwent cataract extraction and intraocular lens implantation. The first day postoperatively, the patient attained 20/100 visual acuity with the intraocular implant, without additional visual corrections. On seeing himself in the mirror for the first time in several months, thereby becoming aware of his distorted facial features and unsightly skin, he became transiently depressed. Simple reassurance and emotional support helped ameliorate his symptoms. Previous reports of behavioral disturbances following cataract extraction have emphasized the role of sensory deprivation in triggering aberrant behavior patterns. In this reported case, the rapid visual rehabilitation afforded by an intraocular lens implant resulted in a transiently depressed state in a patient with severe eczematous mycosis fungoides.

Anaerobic orbital cellulitis.

A 10-year-old boy with orbital cellulitis died seven weeks after admission to the hospital despite intensive surgical intervention and medical therapy. We isolated many anaerobic bacteria from the orbit, frontal sinus, and epidural space. Orbital cellulitis, which often occurs by direct extension from infected paranasal sinuses, commonly affects children and young adults, and is a potentially lethal disease, if left untreated. Heightened awareness of the role of anaerobes in chronic sinusitis and of the possibility of an anaerobic orbital cellulitis may lead to the identification of more cases. Penicillin G appears to be the first drug of choice in cases with suspected anaerobic orbital cellulitis. Chloramphenicol and clindamycin should be considered, if treatment with penicillin fails. Antibiotics alone should not be considered as a panacea, and surgical drainage is often the most compelling consideration.

Bayes' theorem in ophthalmologic computer diagnosis.

Computers are being investigated as diagnostic aids in many fields of medicine. Models employing Bayes' theorem, a statistical formula, commonly are used to supply valuable information on the likelihood of each disease in the differential diagnosis to help the clinician make the diagnosis. However, knowledge of elementary decision analysis is beneficial to help understand the current and potential uses of these models. We discussed Bayes' theorem as an introduction to decision analysis. Moreover, we described a Bayesian model for the differential diagnosis of leukocoria to illustrate the application of computers to ophthalmologic diagnosis.

Intraocular lens power formulas.

We have developed a FORTRAN digital computer program to evaluate intraocular lens power for any thin lens and combination of corneal curvature and axial length. Partial derivatives of the power with respect to cornea power, axial length, and lens position allow estimation of error in power of the lens. These derivatives are computed along with power of the lens for six far points which may be changed with the program running. The program is written for remote access so that an ordinary telephone and portable terminal provide the ability to compute lens power.

Slit-lamp examination of the bedridden patient.

Slit-lamp examination of bedridden patients is facilitated by using a stretcher with the patient lying prone and holding the head erect.

Congenital bilateral horizontal gaze palsy in a brother and sister.

A man of 21 years and his sister aged 20 years had congenital bilateral horizontal gaze palsy. Convergence was normal but the vestibulocephalic and oculocephalic reflexes were absent. Aplasia of the paramedian zone of the pontine tegmentum, on a familial basis, is postulated as the cause.

Hemoglobin A1 and diabetic retinopathy.

The levels of the minor hemoglobin A1 components were measured in a consecutive series of 102 diabetic patients who were extensively studied for signs of diabetic retinopathy. We found a statistically significant relationship between metabolic control, as reflected by the hemoglobin A1 level, and the severity of diabetic retinopathy in patients with diabetes diagnosed before 30 years of age (P less than or equal to .001). We did not demonstrate a significant correlation between metabolic control and the severity of retinopathy in patients with diabetes diagnosed after the age of 30 years. We found significantly more severe retinopathy among patients with longer duration of the disease, in men, in whites, in diabetics diagnosted before 30 years of age who were treated with lower insulin doses, and in obses patients with the onset of diabetes after the age of 30 years.

Metabolic control in diabetic patients. Effect of insulin-secretory reserve (measured by plasma C-peptide levels) and circulating insulin antibodies.

We measured circulating hemoglobin A1 (HbA1) and fasting plasma C-peptide concentrations in 100 diabetic patients. Pancreatic insulin reserve showed a negative correlation with HbA1 concentrations in nonobese, insulin-treated patients but not in obese patients, whether they were treated with insulin, oral agent, or diet alone. Patients with fasting C-peptide concentrations above 0.1 pmol/ml had significantly better metabolic control than did those with lower values. Anti-insulin antibodies were measured in 37 patients. There was no correlation between metabolic control and the affinity constants or binding capacities of these antibodies.

Medical therapy of metastatic meningococcal endophthalmitis.

We treated a 15-year-old girl who had meningococcal meningitis and metastatic endophthalmitis with large doses of intravenously administered penicillin G. The patient promptly improved with this therapy, and the visual axis completely cleared during the subsequent five months.