Management of submacular hemorrhage with intravitreous tissue plasminogen activator injection and pneumatic displacement

Objective

To investigate the efficacy and safety of treating thick submacular hemorrhages with intravitreous tissue plasminogen activator (tPA) and pneumatic displacement.

William Fisher Norris: A Philadelphia ophthalmologist

In 1870, William Fisher Norris returned from studies abroad to find himself at the forefront of new developments in American ophthalmology. Recognition of the specialty was just beginning and Norris was named Professor of Ophthalmology in the department just established at the University of Pennsylvania. Norris was well-qualified for the job. As a member of a prominent Philadelphia family he had the right connections. He was dedicated to the science of ophthalmology and to medical education. He was a born leader, bending his efforts toward the development of a new department, and recruiting a faculty all dedicated to the creation of a new and better specialty.     

Retinal detachments and topical ocular miotics

There is increasing suspicion that topical ocular miotic therapy in selected persons may precipitate retinal detachments. This is a rare event and probably does not occur in patients free of retinal pathology. Data supporting a possible cause and effect relationship, obtained from the National Registry of Drug-Induced Ocular Side Effects, a survey of the Retina Society, medicolegal decisions, and a review of the literature, is presented.     

Full-thickness eye wall resection of choroidal neoplasms

Sclerochorioretinal (full-thickness eye wall) resection was performed in 19 eyes with choroidal neoplasms. Thirteen of these eyes have retained useful vision, ranging from 20/25 to counting fingers. Six eyes had intraoperative and postoperative complications that have led to enucleation. During follow-up, ranging from 1 1/2 years to 6 years, none of these patients had had local or systemic metastasis. Full-thickness eye wall resection, in suitable cases, provides an alternative method of managing choroidal neoplasms.     

Update on the ophthalmic management of facial paralysis

Bell's palsy is the most common neurologic condition affecting the cranial nerves. Lagophthalmos, exposure keratopathy, and corneal ulceration are potential complications. In this review, we evaluate various causes of facial paralysis as well as the level 1 evidence supporting the use of a short course of oral steroids for idiopathic Bell's palsy to improve functional outcomes. Various surgical and nonsurgical techniques are also discussed for the management of residual facial dysfunction.     

Major FDA medical device recalls in ophthalmology from 2003 to 2015

Objective

To assess recent high-risk ophthalmic medical device recalls.

上睑下垂"W"型异体阔筋膜悬吊术的探讨

目的探讨“W”型异体阔筋膜额肌悬吊术治疗重度上睑下垂的效果。方法对58例(69眼)上睑提肌力量小于4mm的重度上睑下垂施行“W”型异体阔筋膜额肌悬吊术治疗,随访半年至5年,观察其效果。结果最后随访,Ⅰ级效果58眼,Ⅱ级效果10眼,Ⅲ级效果1眼,术后无任何并发症发生。结论“W”型异体阔筋膜额肌悬吊术创伤小、疗效好、并发症少,是目前治疗重度上睑下垂的较理想术式之一。     

Special types of muscle anomalies associated with Graves' disease

This paper discusses two cases of superior oblique paresis, two cases of cyclic hypertropias, and ten cases of large angle esotropia with high myopia. The association with Graves' disease, the treatment, and favorable prognosis in all cases is presented.     

Glutathione peroxidase activity in rat lens and other tissues in relation to dietary selenium intake

Glutathione peroxidase (E.C. 1.11.1.9: glutathione: H₂O₂ oxidoreductase) activity and selenium concentration were measured in lenses of female rats and their offspring after long-term feeding of either a selenium-supplemented ($\text{0·1 parts}\text{10}{}^6$) or selenium-deficient ($\text{<}\text{0·02 parts}\text{10}{}^6$) diet. Long-term selenium deficiency decreased lens glutathione peroxidase activity in parent rats and their offspring to 15 and 14% respectively of supplemented controls. For comparison to lens, glutathione peroxidase was also measured in liver, heart, lung, erythrocytes, kidney, adrenal, testis, and brain of the offspring. Selenium deficiency caused the enzyme to decrease most dramatically in liver (to 0) and least in brain (to 62% of selenium supplemented controls). Although glutathione peroxidase in lens was lower than that in the other organs assayed, it was among the organs more sensitive to depletion caused by selenium deficiency. A short-term selenium deficiency of 8 weeks in newborn lambs had no effect on lens glutathione peroxidase, but the enzyme in organs such as liver was dramatically decreased. Therefore, an extensive period of selenium deficiency appears necessary to affect lens glutathione peroxidase activity, which probably relates to the relatively slow turnover and slow growth of the lens. The possible role of the seleno-enzyme, glutathione peroxidase, in the prevention of cataracts and the relationship of selenium to vitamin E and sulfur-containing amino acids in this regard are discussed.     

Complications associated with aphakic contact lenses.

Complications associated with rigid contact lenses are more frequent in aphakia. The limited dexterity of older patients not only may prove an insurmountable barrier to the mastery of daily contact lens insertion and removal, but also may produce significant direct eye trauma, its seriousness determined by the integrity of the cataract wound. Since prolonged wear of aphakic contact lenses is the rule rather than the exception, the risk of irreversible corneal changes such as vascularization and erosions is greater. A poorly fitted aphakic contact lens that does not permit adequate oxygenation of all corneal areas makes such complications even more likely to occur. Decreased corneal sensitivity associated with cataract surgery permits continued wear of a poorly fitted lens, which does not allow the cornea to recover between wearing periods. Detection of keratoconjunctivitis sicca, more prevalent in the older age group, may prevent the associated complications of corneal erosion, iritis, and infection. Complications of aphakic contact lenses can be controlled by patient instruction, appropriate contact lens adjustments, and regularly scheduled follow-up examinations.     

The clinical characteristics of presumed choroidal nevi observed in green light

Thirty-two patients with presumed choroidal nevi were examined and photographed in both white and green light. Twenty-one lesions disappeared or became markedly attenuated when viewed with green light. The remaining 11 lesions did not disappear when viewed with green light. Many of these nevi demonstrated visual field defects and fluorescein angiographic abnormalities. The clinical applications of green light ophthalmoscopy and photography are discussed.     

Survey on the use of intraocular lenses

A birth of interest in lens implantation occurred especially in the United states in 1974. This coincides with the beginning of four major American lens manufacturers. This interest expoded in 1975 and 1976 and seems to be continuing to grow. Only a few surgeons have stopped implants, most of them after having done ten or less. Half of the surgeons now doing implants have done 25 or less, while 40% have performed a series of 25 to 200. Intracapsular lens styles were the most often used, and the Worst Medallion lens was by far the most popular. Medical Workshop was the leading supplier of lens implants. Accounting for 25%, and European lenses were more often used (61%). The majority of surgeons beginning lens implants after 1974 used either American lenses exclusively or both sources. The majority of lenses used were designed by Binkhorst and Worst. Only 4% of lenses implanted were done secondarily, but one third of the surgeons have performed this procedure; more do them as their experience grows. An overall visual acuity of 20/40 or better postoperatively was found in 83.8% of cases. Significant lens power errors were rare but increased with increasing experience. One third of the surgeons have reported removing a lens implant at a rate of 0.8%, but only 3% of the surgeons have reported removing an eye with a lens implant at a rate of 0.05%.     

Early development of selenium-induced cataract: slit lamp evaluation

The purpose of our research was to document early lenticular changes preceding cataract formation in rats receiving an elevated dose of selenium. The following stages were observed after selenium injection: Stage 1 (13-24 hr post-injection), formation of posterior equatorial subcapsular cataract (PESC); Stage 2 (24-72 hr), decline of the PESC, development of a prominent 'washer' shaped change in the refraction of the cortex, and first appearance of swollen fibers around the nucleus; Stage 3 (three to five days), appearance of bilateral dense central nuclear cataracts and further development of perinuclear swollen fibers; Stage 4 (five to 10 days), some nuclear cataracts became more opaque and/or angular. The results are consistent with the hypothesis that the initial site of action of selenium in nuclear cataract formation is not in the lens nucleus. Rather, selenium causes early changes outside the nucleus, which are followed by nuclear cataracts.