Krypton laser-induced lens opacity as a complication of retinal photocoagulation.

Lens opacification is a well-documented complication of argon laser photocoagulation, particularly in eyes with preexisting cataracts. In eyes with media opacity, the krypton laser is frequently used for its superior penetrating qualities. To date, lens opacification from krypton application has not been documented. We report such a case in a cataractous eye with a vitreous hemorrhage undergoing panretinal photocoagulation. Factors previously implicated in the etiology of laser-induced lens damage were not present. The opacities were similar to those produced by the argon laser. We present a mechanism for understanding laser-induced lens damage and speculate on the difference between the interaction of argon versus krypton laser energy with lens constituents.

Anterior segment ischemia: a complication of retinal detachment repair in a patient with sickle cell trait.

Anterior segment ischemia (ASI) is a dreaded complication of retinal detachment surgery particularly in patients with predisposing factors such as sickle cell disease. We report a case of ASI after scleral buckling in an otherwise healthy black patient with sickle cell trait. Conditions of relative hypoxia intraoperatively from either anesthesia or surgical manipulation may precipitate vasoocclusive phenomena in these normally asymptomatic patients. Since the incidence of sickle cell trait in the black population in the United States is 8.5%, we recommend these patients have a preoperative sickle test followed by hemoglobin electrophoresis with quantification if positive. The presence of sickle cell trait should alert the surgeon to the risk of ASI, and factors predisposing to hypoxia should be minimized when possible.

Quantitative measures of neurological function in chronic neuromuscular diseases and ataxia.

Interexaminer and intraexaminer reliability were determined for 30 quantitative measures of neurological function, including sensory threshold, tendon reflexes, maximum isometric strength, and timed tests and coded ratings of functional ability, in patients with Charcot-Marie-Tooth disease (n = 30), idiopathic polyneuropathy (n = 16) and spinocerebellar degeneration (n = 30). Five of 6 sensory and reflex measures had interexaminer reliability greater than 0.80 when the neurologists' examinations were 1 h apart; 2 of 7 achieved this level when the examinations were separated by 1 month. Interexaminer reliability between physical therapists was greater than 0.80 for 19 of 20 measures of strength and functional ability. Intraexaminer reliability coefficients greater than 0.80 were found for 13 of 24 sensory and reflex measures, 28 of 30 isometric strength measures, 24 of 30 timed tests and 5 of 6 coded ratings of functional ability. Electro-oculography, oral diadochokinetic syllable rates, hand and foot accelerometry, and tracings of sine and square waves were examined as quantitative indices of ataxia for patients with spinocerebellar degeneration. Of 11 measures of ataxia, only the oral diadochokinetic syllable rate test had acceptable reliability.

Double-blind controlled trials of Cronassial in chronic neuromuscular diseases and ataxia.

We report three 12-month, double-blind, three-phase studies comparing the effect of placebo and 40 mg and 100 mg IM daily of purified bovine brain gangliosides (Cronassial) in chronic neuromuscular diseases. Thirty patients with Charcot-Marie-Tooth disease, 16 with idiopathic polyneuropathy, and 30 with spinocerebellar degeneration had neuromuscular function measured monthly by quantitative testing of motor and sensory function, coordination, and electrophysiologic factors. Analysis of these studies, and of longer term (up to 2 years) open studies of 100 mg daily of Cronassial in 67 patients failed to show therapeutic efficacy of Cronassial. Statistical power calculations indicated that five of the 37 measures had greater than a 70% chance of detecting a 20% difference in the rate of progression of the active-drug and placebo groups. A number of measures significantly improved during prolonged placebo treatment, suggesting that the placebo effect has a strong influence on "objective" measures of neuromuscular function.

Congenital corneal staphyloma: clinical, radiological, and pathological correlation.

A 2-year-old child was referred because of a prominent blind left eye with an opaque cornea. Although extraocular extension of a retinoblastoma was an initial diagnostic possibility, computed tomography (CT) showed only a large globe with a corneal staphyloma. Because of the cosmetically unacceptable appearance the involved eye was enucleated. The clinical, CT, and histopathological features of congenital corneal staphyloma are discussed, as well as the possible pathogenic mechanisms.

Pathologic examination of ciliary body melanoma treated with proton beam irradiation.

Proton beam irradiation is one of the radiotherapeutic techniques currently used to manage uveal melanomas. Although this therapeutic modality has been in use for a decade and although nearly 500 patients have been so treated, there are only two published reports of the pathologic examination of these eyes. Key features found on pathologic examination of our patient's enucleated eye included vascular alterations in the tumor's blood supply, lymphocytic infiltrates, and lipoidal degeneration of tumor cells. The interval from therapy to enucleation in our patient was much longer than in the several previously reported cases, a factor allowing for the development of a more cumulative radiation effect on the tumor. The extent and degree of radiation-induced necrosis in our patient's tumor were more profound than in previous reports.

Clinical significance of transient visual phenomena in the elderly.

To evaluate the significance of transient visual phenomena in the elderly patient, a retrospective study of 43 patients over 40 years of age (mean, 58) presenting between 1971 and 1982 was conducted. Historical, clinical and diagnostic features were collated and analyzed by computer. The study revealed that 31 patients were diagnosed as migraine and 12 as vertebrobasilar insufficiency based on features identified in this review. Follow-up was obtained in 90% of the patients with a mean follow-up of 2.4 years. In general, prognosis proved to be excellent, with two deaths of cardiac origin and an 81% incidence of remission or symptomatic improvement of the visual events. No retinal or cerebral strokes were observed and TIAs occurred in only 9% of the population. This study suggests that transient visual phenomena in the elderly are benign.

Normal intraocular pressure during enucleation for choroidal melanoma.

A simple surgical technique for maintaining normal intraocular pressure during enucleation of eyes with a malignant melanoma of the choroid consists of making an incision into the anterior chamber through clear cornea with a microvitreo-retinal blade, followed by the introduction of a No. 21-gauge scalp vein needle or a No. 23-gauge sidewall-holed needle attached to a closed system filled with balanced salt solution. Measurements of pressure fluctuations during five enucleations are given. Such a system maintains the anterior chamber and keeps fluctuations in IOP to a minimum. This may be important in preventing hematogenous dissemination of tumor cells, resulting in metastatic disease.

Exacerbation of senile macular degeneration following cataract extraction.

Six eyes in four patients had hemorrhagic detachment of the retinal pigment epithelium following cataract extraction. All eyes had evidence of nonexudative senile macular degeneration preoperatively as manifested by drusen or alterations in the retinal pigment epithelium, or both. Postoperatively, all eyes had evidence of a subretinal neovascular membrane manifested by the presence of subretinal hemorrhage or by evidence on fluorescein anglography. We believe cataract extraction may cause changes in the choroidal hemodynamics that allow pre-existing new blood vessels to leak or bleed, or induces the formation of choroidal neovascularization in a predisposed eye.

Geographic atrophy of the retinal pigment epithelium. A manifestation of senile macular degeneration.

Eleven patients with geographic atrophy of the retinal pigment epithelium secondary to senil macular degeneration are differentiated from central areolar choroidal sclerosis. Although these lesions appear morphologically similar to central areolar choroidal sclerosis, they differ strikingly in age of onset, family history, association with senile disciform macular degeneration, and pathologic features.