Congenital dacryocele. A collaborative review.

Fifty-four cases of congenital dacryocele from several medical centers were reviewed retrospectively. There was strong female preponderance (73%) and unilateral involvement (88%). Lacrimal sac contents could be expressed by local massage through the puncta in 21% of cases. Probing and irrigation were done under general (27.8%) or local (55.6%) anesthesia, while in other cases (16.7%), the cyst resolved before intervention. Recurrence of the dacryocele occurred in 10 patients (22%) after probing. Nasal cysts were visualized in six cases. Marsupialization of nasal cysts was necessary in four cases. In one center, after conservative therapy, 80% of cysts resolved spontaneously and 20% developed dacryocystitis. Surgical intervention is indicated in cases of dacryocystitis, cellulitis, breathing difficulty from large nasal cysts, recurrent dacryocele, and lack of its resolution after a short trial of digital massage.     

Dacryocystorhinostomy. Retrospective study of 165 cases. Indications. Technic. Results. Comparative study of 25 cases of injury with 165 cases including all etiologies

A retrospective study of 165 cases of dacryocystorhinostomy (DCR) has been performed in order to establish a relationship between the results and the delay between the initial symptoms and the DCR. The study compares the results obtained in 25 cases of DCR performed for post traumatic injury to those obtained in 165 cases of DCR performed for various etiologies (traumatic cases included). Traumatic cases are more frequent in men 19/ 25 cases (73%); infectious etiologies are more frequent in women 98/ 118 cases. The results are nearly the same for all the etiologies: 87% good results for the overall (147 cases), 88% good results for the traumatic cases (24 cases). The stenosis occurs within the first month in 72% and before the fourth month in all the cases. There is no difference in the results according to the surgical technique however the small number of each group does not allow a statistical analysis. The results are better when the delay between the initial traumatism or the first surgical repair and the DCR is more than six months (15 good results for 15 cases). The results were worse when the delay is less than 6 months (6 success for 9 cases), with p = 0.07 in the statistical analysis.     

Multifocal versus monofocal intraocular lenses. Visual and refractive comparisons.

In a unilateral prospective clinical trial, 77 cases were randomized to receive a 3M multifocal IOL or a conventional monofocal implant. Multifocal cases had better uncorrected near vision than monofocal cases at the two to four month visit. Thirty percent of the multifocal cases had near acuity J1, while only 4% of the monofocal cases had that acuity. Eighty-seven percent of multifocal cases and 71% of monofocal cases had near acuities of J1 to J3. With distance correction in place, 54% of multifocal cases had near acuities of J1 to J2, while only 28% of monofocal cases had comparable acuities (P = .04). There have been no serious postoperative complications in either group.     

Retinoblastoma in Sweden 1958--1971. A clinical and histopathological study.

This study includes all cases of retinoblastoma reported in Sweden between 1958 and 1971. The incidence of the disease was 1 per 18 000 live births. Only in six cases was there a familial history and five of these cases were bilateral. The tumour was bilateral in 37.5% of all cases. All cases with unilateral tumour had been treated with enucleation. In the bilateral cases one eye had also been enucleated and the other eye treated by local irradiation therapy. Tumour invasion into choroid was found in 29% and into the optic nerve on 11% of the cases. The mortality was only 4.5%.     

Microscopical studies of necrotising scleritis. I. Cellular aspects.

Light and electron microscopy were used to examine tissue excised during surgery from eight patients with advanced destructive scleral disease. These comprised two cases of scleromalacia perforans, three cases of anterior necrotising scleritis alone or in conjunction with other systemic diseases, and three cases in which scleritis developed following ocular surgery. It was not possible to distinguish between these three categories by histological or cytopathological criteria. All showed extensive granulomatous infiltration of the conjunctiva, episclera, and sclera by plasma cells and lymphocytes. Mast cells were abundant throughout these inflamed tissues. Examination of scleral stroma from sites in advance of the granuloma revealed active fibroblastic cells in the absence of other inflammatory cells. Fibroblastic transformation of scleral cells may be one of the earliest events in scleral degradation during necrotising disease.     

Schistosomotic choroiditis. I. Funduscopic changes and differential diagnosis.

This paper presents the results of biomicroscopy and funduscopy on five patients with hepatosplenic schistosomiasis mansoni. Fluorescein angioretinography was performed on two patients. All cases showed yellowish white multiple billateral nodules of various sizes, located in the choroidal plane. The nature and differential diagnosis of these nodules is discussed, and the suggestion is made that they represent cases of schistosomotic nodular choroiditis.     

The incidence of retinoblastoma.

Data from the Third National Cancer Survey indicate that the annual incidence of retinoblastoma in the United States is 11.0 new cases per million children under the age of 5 years. In response to a reported excess of mortality among blacks, rates were computed by race. There was a rate of 10.8 cases per million children for the whites compared to 9.8 cases per million for the blacks. Among the total of 61 newly diagnosed cases reported among residents of the survey area, the 50 unilateral cases occurred in 24 boys and 26 girls, whereas the 11 bilateral cases occurred in nine girls and only two boys. The reasons for a female preponderance among the bilateral cases remain unclear.     

Prevalence of retinitis pigmentosa and allied disorders in Denmark. III. Hereditary pattern.

A national epidemiological study revealed 1301 prevalent cases of retinitis pigmentosa (RP) in the Danish population on January 1, 1988. The corresponding number of 974 families were analyzed with respect to Mendelian inheritance groups. Thirty families, comprising 6.9% of the prevalent RP-cases, were categorized with an autosomal dominant inheritance pattern. In 187 families, 22.6% of RP-cases, autosomal recessive heredity was encountered. X-linked heredity was found in 45 families, 10.8% of the RP-cases. Simplex RP-cases comprised 562 persons (43.2% of RP-cases). About a fourth of the non-systemic X-linked cases were females. Half of these had an age at onset after 30 years, but a third had their first RP-symptoms before age 18 years. A representative fraction of parents to non-systemic autosomal dominant, autosomal recessive, X-linked, and simplex cases were evaluated concerning their age at the time they had their first affected child. Mothers of the male simplex cases were of statistically significant higher age than mothers of the other inheritance groups. This may imply a high rate of new mutations among simplex cases, especially on the X-chromosome.     

人工晶体的取出

报告３２例人工晶体取出的经验。取出的原因是人工晶体脱位、持续性非感染性葡萄膜炎，大泡性角膜病变，人工晶体表面膜形成，葡萄膜炎－－青光眼－－前房出血综合征，细菌性眼内炎、人工晶体度数不当和青光眼。     

Electroretinogram in cone dystrophy.

Electroretinograms (ERGs) in 10 cases of cone dystrophy were studied with special respect to log(bp/bs) that represents the log of photopic ERG amplitude divided by scotopic ERG amplitude. Photopic ERGs were either greatly diminished or nonrecordable, and scotopic ERGs showed either normal or reduced amplitudes. All cases had a low value of log(bp/bs), less than the lower normal limit, indicating significantly greater impairment in cone function than in rod function. These results have proved log(bp/bs) to be helpful in confirming the diagnosis of cone dystrophy especially in cases with recordable photopic ERG and reduced scotopic ERG. Among other ERG parameters, the photopic ERG b-wave implicit time that was determined with averaging and digital amplification of the responses in 4 cases showed prolongation in 3 cases while normal in one case. Oscillatory potentials were nonrecordable or barely recordable in all cases.     

Results of keratoprosthesis.

The technique of keratoprosthesis was used in 21 cases of severe and intractable forms of keratopathy during the past 3 1/2 years. The results in terms of visual acuity were satisfactory in more than half the cases. Significant problems that occurred after this procedure included the diagnosis and management of glaucoma, vitreitis, and retroprosthetic membrane. There were no instances of extrusion of the keratoprosthesis nor were there any cases of endophthalmitis. However, one case developed necrosis of the tissue around the optical cylinder on the eyelid after surgery. Although its use is limited to only some forms of keratopathy, keratoprosthesis seems to offer a solution in cases where no other treatment is available.     

Retinal detachment. A study of a population-based patient material in Sweden 1971-1981. III. Surgical results

Surgical results and complications were studied retrospectively in 590 cases of retinal detachment in a population-based material of 538 patients. Of the 590 cases 96.3% were operated upon, and 22.9% of these underwent one or more re-operations. The technique used was cryo- or photocoagulation (100%) + scleral buckling or an encircling band (96%) + drainage of subretinal fluid (80%). The surgical complications were intraocular bleeding (13%), choroidal detachment (7%), and proliferative vitreo-retinopathy (5%). All complications were significantly more frequent after re-operations. Complete re-attachment was achieved in 78.1%. The re-attachment rate was significantly lower in aphakic cases (66.7%) than in phakic non-traumatic cases (80.8%). The visual acuity in re-attached cases was better than 0.5 in 33.7% and better than 0.1 in 72.2%.     

Ocular jellyfish stings.

BACKGROUND: Corneal stings from the sea nettle (Chrysaora quinquecirrha) indigenous to the Chesapeake Bay are usually painful but self-limited injuries, with resolution in 24 to 48 hours. METHODS: Five patients who developed unusually severe and prolonged iritis and intraocular pressure elevation after receiving corneal sea nettle stings were followed for 2 to 4 years. RESULTS: Decreased visual acuity, iritis, and increased intraocular pressure (32 to 48 mmHg) were noted in all cases. Iritis responded to topical corticosteroids and resolved within 8 weeks. Elevated intraocular pressure responded to topical beta blockers and oral carbonic anhydrase inhibitors. Mydriasis (4 of 5 cases), decreased accommodation (2 of 5 cases), peripheral anterior synechiae (2 of 5 cases), and iris transillumination defects (3 of 5 cases) also were noted. Mydriasis and decreased accommodation persisted for 5 months in 1 case and for more than 2 years in another. One patient has chronic unilateral glaucoma. Visual acuity returned to normal in all cases. CONCLUSIONS: The precise relationship between sea nettle venom and the observed clinical responses is not known. Corneal jellyfish stings usually produce a brief and self-limited reaction, but they do have the potential for long-term sequelae.     

Haemangiopericytoma.

Three cases of orbital haemangiopericytoma are presented. In one the tumour recurred after 22 years and in another after 4 months. Metastasis to the breast, which occurred in the third case, is probably the first to be reported. The management of the cases is discussed. The clinical importance of the haemangiopericytoma lies in its potentially malignant behaviour.     

Optic disc drusen. Communication 1. The possibilities of diagnosis

The study enrolled 63 patients (108 eyes) suspected for optic disc drusen (ODD). ODD were found in 45 patients (83 eyes). Ophthalmoscopic study determined only visible superficial drusen, which accounted for 36.4% of all the found cases. The autofluorescence technique could reveal mainly superficial or shallow drusen in 70.1% of cases and differentiate pseudodrusen. The most reliable and sensitive diagnostic method was B-scanning that determined ODD in 100% of cases. However, B-scanning could not differentiate true drusen from pseudodrusen.     

Keratoconjunctivitis artefacta.

Six cases of keratoconjunctivitis caused by self-inflicted injury are described. The diagnosis is suggested by the combination of the characteristic sharply delineated lesions localised in the more accessible inferior and nasal quadrants of the bulbar conjunctiva and cornea, together with the unconcerned attitude of the patient and other psychological features. Secondary post-traumatic erosions, infections, and allergies may complicate the clinical appearances, and other functional eye disturbances including corneal anaesthesia may be detected. In all cases the eye condition resolved with a sympathetic but authoritative approach avoiding direct accusation. Avoidance of feelings about bereavement or sexual relationships were directly related to the onset of symptoms in 3 cases. In some patients the psychological mechanism seemed inaccessible and they continued to produce new self-inflicted diseases with considerable physical and psychological morbidity. These more intractable cases need psychiatric investigation but usually resist referral.     

巩膜切开术治疗严重眼外伤脉络膜上腔出血

目的评价巩膜切开术治疗严重外伤眼脉络膜上腔出血的疗效。方法对18例（18眼）因严重眼外伤致脉络膜上腔出血行巩膜切开联合玻璃体切除术治疗。在睫状体平坦部做巩膜切口,必要时于赤道前做放射状巩膜切口引流脉络膜上腔积血,然后行玻璃体切除术,术终眼内填充气体或硅油。结果经睫状体平坦部切口脉络膜上腔积血引流充分者11眼;7眼需要另外做放射状巩膜切口引流,其中3眼完全复位,4眼部分复位。2眼因合并脉络膜破口,术后硅油进入脉络膜上腔。2眼因眼球萎缩而摘除眼球。结论巩膜切开术可以有效引流眼外伤所致脉络膜上腔出血。有脉络膜破口的出血性脉络膜脱离是治疗的难点,预后差。     

Intravitreal hyaluronic acid injection. A long-term clinical evaluation.

Healon-H was used in the treatment of seven cases of complicated retinal detachment. A permanent re-attachment was achieved in two cases. No serious ocular complications have been encountered after a follow-up of 4 1/2 years.     

The dural shunt syndrome. I. Management of glaucoma

The authors present four cases of the dural shunt syndrome in which shallowing of the anterior chamber or rubeosis developed. All patients were female, ranging in age from 66 to 79 years, exhibiting elevated intraocular pressure (IOP), decreased extraocular movements, injected tortuous episcleral vessels, and proptosis. The authors managed these four cases with laser iridotomy, gonioplasty, panretinal photocoagulation, or medical treatment. It is important to recognize associated findings in patients with shallow anterior chambers and elevated IOPs so that a diagnosis of a dural shunt is considered and appropriately treated. Theories on the mechanisms of increased IOP in the dural shunt syndrome and the management of various types of glaucoma in four different cases are reviewed.     

Uveal melanoma in teenagers and children. A report of 40 cases.

A review of 3706 consecutive patients with uveal melanoma revealed that 40 patients (1.1%) were age 20 years or younger at the time of diagnosis. The youngest patient was age 6 years but the majority of patients (78%) were between 15 and 20 years old. The tumor occurred in the iris in 5 cases (12%) and in the posterior uvea in 35 cases (88%). The mean largest tumor dimension and thickness was 10 mm and 5 mm, respectively. In all cases, the diagnosis of uveal melanoma was suspected before referral, and misdirected treatment was avoided. The tumor was initially treated by enucleation in 24 cases (60%), local resection in 7 (18%), plaque radiotherapy in 3 (8%), and observation in 6 (15%). Secondary treatment was required in 7 cases in the form of enucleation (4 cases), ablative laser (1 case), plaque radiotherapy (1 case), and exenteration (1 case). The mean follow-up period was 68 months (median, 48 months) from the time of treatment, and only one patient died of metastases (from a massive ciliochoroidal melanoma 33 months after treatment). The remainder of the group of young patients are alive and healthy. Cumulative survival rates show that 96% of young patients with uveal melanoma survive at the 5-year period.