Interobserver and intraobserver variability in the detection of glaucomatous progression of the optic disc.

PURPOSE: To evaluate the potential value of obtaining follow-up stereoscopic photographs on glaucoma suspects in identifying progressive optic nerve damage. METHODS: Nineteen sets of stereoscopic optic disc photographs, reflecting one eye from each of 19 patients at two time points, were selected from the records of subjects enrolled in the Glaucoma Screening Study. By consensus, three experts judged 13 of these eyes to have progressive glaucomatous optic nerve damage. Four other ophthalmologists who were masked to the expert panel evaluation then assessed glaucomatous progression in the same eyes. They were asked to evaluate glaucomatous progression in three ways: first, by drawing the optic nerve head appearance from initial stereoscopic photographs and later comparing their own drawings to follow-up stereoscopic photographs; second, by comparing serial stereoscopic photographs directly; and third, by comparing drawings of the optic nerve head made by another examiner to the follow-up photographs. RESULTS: Neither sensitivity nor specificity was consistently better for serial stereoscopic photographs than for drawings. Individual ophthalmologist agreement rates with the expert panel's determinations of progression were 23-62% when examiners compared their own drawings to follow-up photographs, 54-71% when examiners compared serial stereoscopic photographs, and 38-85% when comparing another ophthalmologist's drawings to follow-up photographs. CONCLUSION: Baseline stereoscopic photographs of the optic nerve head did not substantially improve recognition of progressive glaucomatous optic nerve damage when compared with the use of baseline drawings of the optic nerve head made from photographs in subjects who developed visual loss in the interim.

Recurrent uveitis after influenza vaccination.

A 77-year-old woman had complicated cataract surgery with resultant uveitis. Four months after an apparently complete recovery, she was vaccinated with influenza vaccine. Within two weeks, she had a recrudescence of her inflammation accompanied by cystoid macular edema and reduced vision. We discuss the mechanisms of this reaction.

An unusual case of painful ophthalmoplegia in a patient with rheumatoid arthritis.

A 43-year-old woman with long-standing rheumatoid arthritis and systemic lupus erythematosus had pain and horizontal diplopia. Clinical symptoms were consistent with inflammation of the right superior oblique tendon sheath, but a computed tomographic scan showed no pathology. Treatment with systemic corticosteroids reduced the symptoms, but the patient was left with a persistent muscle imbalance.

Surgical therapy of a Pseudomonas corneal ulcer in a diabetic.

A 30-year-old white woman with diabetes was seen with a Pseudomonas corneal ulcer. The ulcer progressed despite appropriate antibiotics, and the patient was treated with surgical debridement. Pseudomonas infections in a compromised host are discussed.

Clinical and immunologic responses in patients with viral keratoconjunctivitis.

Of 120 individuals suffering from follicular conjunctivitis, with or without keratitis, 56 had epidemic keratoconjunctivitis caused by adenovirus type 8. The remaining 64 patients had keratoconjunctivitis produced by several different viruses, including herpes simplex, adenoviruses types 3, 7, 8, 16, 21, and 29, and others. Positive viral cultures were difficult to obtain after the first week of illness in most viral infections. Serologic tests were far more successful in indetifying causative agents. Hemagglutination-inhibition tests in adenovirus infections proved to be fast, accurate, and more sensitive than other serologic tests. Among the epidemic and nonepidemic adenovirus groups, the degree of corneal involvement in the infections appeared to be correlated with the level antibody against the infectious agent. Patients with low antibody titers had more severe keratitis than those with high titers. This correlation was true for both the epidemic and non epidemic patients.