Congenital epithelial cysts of the iris stroma.

Although epithelial implantation cysts in the anterior chamber and iris have often been described, spontaneous congenital epithelial cysts of the iris stroma are not common. A cyst large enough to obstruct vision and cause amblyopia was removed surgically from a 6-month-old infant. The presence of goblet cells in th epithelium may be related to the embryologic source or the cells.

HLA in pigment dispersion and glaucoma.

Histocompatibility antigen typing was performed on 12 Caucasian patients with the pigment dispersion syndrome. Increased prevalence of HLA-B13 and Bw17 that had been observed in a previous study (Becker et al. 1977) could not be confirmed in the present study. There were no significant increases of HLA-B7 and B12 in glaucoma patients with or without the pigment dispersion syndrome. HLA-Bw35 was increased in white patients with primary open-angle glaucoma in the Greater Detroit area.

Glaucoma with trabecular melanocytosis.

A case of unilateral glaucoma with ocular melanocytosis was treated by repeated (two) trabeculectomies and iridocyclectomies at the same time to rule out malignant neoplasms. Histologic study indicated the presence of melanocytes typical of ocular melanocytosis. A review of the literature disclosed seven other cases of this kind.

The pseudoexfoliation syndrome.

A clinical and ultramicroscopic review, including discussion of both scanning and transmission microscopy of the lens in the exfoliation syndrome, suggests that the term pseudoexfoliation be retained. Involvement of the lens epithelium, and particularly, the pigment epithelium of the iris and the ciliary body epithelium are emphasized as being the likely sources of the exfoliative fibrils. A case of pseudoexfoliation syndrome in an eye with an eccentric pupil revealed that the granular material seen on the lens capsule occurs only where the iris is in contact with the lens surface and the process may even involve the central anterior capsule under proper conditions. This finding, together with the evidence of continuing deposits after intracapsular cataract extraction, suggests that the granular material is deposited from the iris and that the material formed by the lens epithelium remains within the lens capsule.

In appreciation of the contributions of Harry Searls Gradle.

The many contributions of Harry Searls Gradle (1883-1950) to ophthalmology are recalled by an author who was his protégé. A former student of Anton Elschnig's, Gradle taught unique surgical skills to those who worked directly with him. Furthermore, he lent his insights and brilliant organizational talents to the development of institutions and programs for the betterment of ophthalmic education and practice.

Results and complications of limbal trephination and subscleral trephination (trabeculectomy).

Limbal trephinations on 395 eyes were followed postoperatively for six months to 19 years. Excellent results were obtained in patients over the age of 35, particularly those in the 50 and older age group, with chronic open-angle and chronic angle-closure glaucoma. Results were poor in younger age groups and in those with secondary glaucoma, particularly where it was associated with inflammatory disease. A review of 78 limbal trephinations in individuals over 55 and 77 trabeculectomies (67 under age 55 and ten over age 55) indicated that in younger age groups the overall results were nearly the same with trabeculectomies as with limbal trephination but the subscleral operation is probably safer, especially in younger people with longer life expectancy, and permits freer use of contact lenses postoperatively.

Limbal trephination: a twenty-year follow-up.

In this series the results of limbal trephination were excellent in patients over 35 years of age, particularly those in the 50 and older age group, with chronic open-angle and chronic angle-closure glaucoma. Results were poor in younger age groups and in those with secondary glaucoma, particularly when it was associated with inflammatory disease.

Onset of the exfoliation syndrome after intracapsular lens extraction.

Two patients who had previously been operated on for cataract and had been carefully observed for evidence of the exfoliation (or pseudoexfoliation) syndrome had continuing formation of exfoliative material on the anterior surface of the hyaloid and the pupil border several years later.

Management of eye movement restriction (particularly vertical) in dysthyroid myopathy.

Sixteen cases of vertical rectus muscle myopathy in dysthyroid patients are described. In mild cases without diplopia prisms may be adequate treatment. When uncomfortable diplopia is present surgery is indicated when the muscle dysfunction has become stable. Even after surgery further contracture is often experienced, particularly after Ogura antral decompression. The amount of correction obtained by recession of a contracted muscle is greater than that following ordinary strabismus surgery so that usually only one muscle should be operated upon at a time. Care should be exercised in tenotomy of severely contracted muscles. The prognosis is excellent in dysthyroid myopathy if the patient permits the required number of surgical procedures which may be necessary.

Anterior segment metastases from an ovarian choriocarcinoma.

A 28-year old woman with ovarian choriocarcinoma developed a uveitis in her left eye. Subsequently, a mass was observed in the anterior segment of that eye together with a subconjunctival mass that appeared to extend from it. Biopsy of the subconjunctival nodule showed two different cell types consistent with the cytotrophoblastic and syncytiotrophoblastic elements typical and choriocarcinoma. No abnormalities of the posterior segment were found on careful examination. Treatment consisted of systemic chemotherapy with a variety of therapeutic agents, argon laser photocoagulation of tumor seedings in the anterior chamber angle, radiation to the eye, and finally, subconjunctival injections of methotrexate. The eye became blind and painful and was enucleated. Histopathologic examination revealed residual tumor cells in the anterior segment indicating treatment changes, but there were no abnormalities posteriorly. Choriocarcinoma metastatic to the eye has been reported infrequently, and this is the first case in which anterior segment metastases have been observed and the effects of treatment thoroughly documented.

Oculodentodigital dysplasia syndrome with angle-closure glaucoma.

A 14-year-old girl with typical oculodentodigital syndrome had been treated for chronic glaucoma for seven years. She had corneas measuring R.E.: 10 mm; L.E.: 9 mm, with narrow angles open on the right, but almost entirely closed on the left. Gonioscopic examination of the right iris revealed that the root was attached forward on the trabecular meshwork, which suggested a congenital anomaly. Peripheral iridectomies were ineffective. In a case previously studied, a 20-year-old woman with typical oculodentodigital syndrome developed typical acute angle-closure glaucoma seven years after the original examination.

Experiences with some modifications of cyclodialysis for aphakic glaucoma.

Continued attempts to improve the success rate with modifications of the cyclodialysis procedure have been made and described here. The results with a scleral pedicle insertion and with a long scleral incision parallel to the limbus were very poor. As a result of improvements in the technique of separating the ciliary body from the scleral spur by depressing the former mechanically and of using of meridional incision to avoid a scar barrier, I have returned to a modified Blaskovics procedure. Further use of this procedure with continued follow-up is planned. However, I invite you to try the various procedures described here, including Aviner's, so that we may find ways of improving our results with this potentially excellent operations, especially in aphakic glaucoma as primary procedures.