Distinct patterns of spatial frequency response by normal, recovered optic neuritis, and normal fellow eyes to a new linearly variable neutral density device.

Upon apparent recovery from optic neuropathy, structural damage to the optic nerve may remain while usual measures of visual function appear normal. To test for such damage, the logarithm of optical density to cause a pattern to disappear is read directly on the scale of our device. Patients in the first study observed the disappearance of a red Amsler grid; this Threshold Amsler Score, used jointly with acuity scores, separates normal eyes from eyes with optic neuropathies. Patients in the second study used the device to measure the disappearance of the highest contrast Vistech patterns to show that this device, used over a range of spatial frequencies, differentiates "subclinical" neuropathies (recovered optic neuritis eye; never symptomatic fellow eye to a diagnosed eye) from normal eyes. This device may measure the functional photopic brightness of the stimulus pattern; when the score from our device is higher, the range of photopic brightness for the stimulus is wider, and the retina is more sensitive to contrast.

Control of intraocular pressure in glaucomatous eyes after extracapsular cataract extraction with intraocular lens implantation.

Two hundred sixty eyes of 195 patients having extracapsular cataract extraction (ECCE) with insertion of a posterior chamber intraocular lens were studied retrospectively. Of these cases, 160 eyes had preexisting glaucoma while 100 had no ocular pathology except for cataract. Intraocular pressure decreased significantly after ECCE in both groups and slowly returned to baseline within two years. The average postoperative visual acuity was better in the control group than in the glaucoma group. Patients with glaucoma were controlled with less medication after surgery. We believe that ECCE with insertion of a posterior chamber intraocular lens can be safely performed in glaucoma patients and has a beneficial effect on the control of glaucoma.

Use of an angiotensin converting enzyme inhibitor in ocular hypertension and primary open-angle glaucoma.

We studied the effects of a new topical angiotensin converting enzyme inhibitor, SCH 33861, in lowering intraocular pressure in 20 patients with ocular hypertension or primary open-angle glaucoma. In a double-masked, four-way crossover study with placebo and timolol, SCH 33861 was well tolerated and effective in lowering intraocular pressure. The magnitude of the drug's effect in lowering intraocular pressure was less than that of timolol 0.5%.

Systemic effects of intraocular epinephrine during cataract surgery.

This paper examines the effects of intraocular epinephrine on systemic blood pressure and heart rate during cataract surgery. Sixty-two patients were studied, all of whom received an intraocular infusion of approximately 200 to 300 mL of balanced salt solution with 0.5 mL of epinephrine 1:1000. There was no statistically significant change in blood pressure or heart rate during the time of epinephrine administration. Electrocardiogram monitoring during surgery showed no changes. We believe that dilute concentrations of epinephrine administered during extracapsular cataract extraction pose little threat of systemic toxicity.

Neodymium:YAG laser therapy for pseudophakic pupillary block.

Pupillary block occurred in six patients with anterior chamber intraocular lens implants. After medical therapy failed, the Nd:YAG laser was used to break the hyaloid face in the pupillary and iridectomy apertures. Iridotomies were also produced at the sites of bulging iris. Following laser treatment the anterior chambers deepened and there were no further signs or symptoms of pupillary block. The Nd:YAG laser proved to be a useful treatment for pseudophakic pupillary block.

A double-blind, multi-centre controlled trial of 0.25% oxymetazoline ophthalmic solution in patients with allergic and non-infectious conjunctivitis.

Oxymetazoline (0.025%) ophthalmic solution, 2 drops 4-times daily, was compared with a placebo in the treatment of allergic and non-infectious conjunctivitis. In this 1 week, double-blind, multi-centre study, oxymetazoline proved significantly superior to the placebo (p < 0.001) in providing rapid and sustained clearing of inflamed conjunctiva. Overall, 84% of allergic patients treated with oxymetzoline were improved compared to 58% on placebo. Patients with non-infectious conjunctivitis exhibited a high degree of improvement (94%) compared to placebo (51%).

Evaluation of indications for cataract surgery.

The large number of cataract operations performed in the United States annually has raised questions as to the indications and methods of documentation. The criteria designed for the Physicians and Surgeons Review Organization (PSRO), the thrust of second opinions, and an evaluation of the types of cataracts producing visual impairment are discussed. The contralight test of Junker is demonstrated as a means of determining the effect of cataracts on visual acuity and could be used as an indicator of the need for surgery.

Definitive treatment of congenital larcrimal sac fistula.

The procedure we describe is believed to be a rational and effective approach to the rare but preplexing problem of congenital lacrimal sac fistula. The procedure is based on the principles of: (1) definite location of the lacrimal sac for protection of canaliculi and sac through probe insertion; (2) fastidious dissection of the tract to its base; and (3) positive testing of the suture and sac site for leakage.

Ultrastructural abnormalities in a Marfan's syndrome lens.

The surface ultrastructure of the posterior of the Marfan's syndrome lens was studied by scanning electron microscopy. All aspects of the architecture and construction of the capsule, the zonules and their insertions, the epithelium, and the lens fibers showed a sharp deviation from normal. The capsular fibrils were abnormally large and grossly granular. The zonular fibrils, similar in size and granularity to those of the capsule, contained numerous large aggregates and showed a lack of parallel orientation. The epithelial cells displayed a coarser than normal surface granularity and a lack of regularity of form and orientation. The cortical and nuclear lens fibers displayed a relatively normal surface pattern but showed poorly defined borders and interdigitating processes.