A. Ralph Rosenthal

Ocular Manifestations of Leukemia: A Review

Ophthalmologists are familiar with the commonly observed leukemic retinopathy and orbital infiltration in patients with both acute and chronic leukemia. With the advent of more successful and aggressive chemotherapeutic regimens and more sophisticated radiation therapy, the eye is not uncommonly involved in patients who are in either meningeal or hematological relapse. In rare instances, ophthalmologic involvement may be the only manifestation of recurrence of the leukemic process. In addition, retinal microaneurysms, capillary closure, and neovascularization have been documented in individuals with chronic leukemia. This paper will review leukemic retinopathy and leukemic infiltration of the orbit. In addition, a discussion of the frequency and pathogenesis of the retinal vascular abnormalities will be presented. The clinical picture and treatment of optic nerve, choroid and iris infiltration will be discussed. Unusual ocular manifestations as the presenting sign of leukemia will also be detailed.

The Effect of Pan-Retinal Photocoagulation on Rubeosis Iridis

Fifteen eyes of 11 patients with rubeosis iridis and angle neovascularization associated with retinal vascular disorders were treated with pan-retinal photocoagulation. In seven of the 15 eyes, the new vessels on the surface of the iris and in the angle regressed after pan-retinal photocoagulation therapy for disk neovascularization; five of the remaining eight eyes that were treated prospectively demonstrated similar involution of the rubeosis iridis. In three of the five preexisting peripheral anterior synechiae regressed and angle structures previously obscured became visible. Three to 36 months after therapy, three eyes developed a few new abnormal iris and angle vessels.

The Treatment of Angle Neovascularization with Panretinal Photocoagulation

Thirty-two eyes in 28 patients with anterior chamber angle neovascularization were prospectively treated with panretinal photocoagulation. Of 17 eyes that had less than 270 degrees angle closure, with an intraocular pressure of less than 40 mm Hg prior to treatment, 16 showed complete disappearance of the angle neovascularization and stabilization of the peripheral anterior synechiae after treatment. None of the 15 patients who had angle closure of 270 degrees or greater, or an intraocular pressure of above 40 mm Hg, showed any significant improvement after treatment. These results suggest that panretinal photocoagulation offers a highly effective means of dealing with early and moderately advanced cases of angle neovascularization.

Chalcosis: A Study of Natural History

Ten patients harboring a small, intra-vitreal, copper foreign body in one eye for 4 months to 29 years have been studied clinically and electrophysiologically. Nine of the ten affected eyes had a visual acuity of 20/60 or better. Some asymmetry existed in the electrophysiologic responses of seven affected eyes as compared to the controls, but all of these responses were within the normal range. The electroretinogram was reduced in one eye but was consistent with vitreous opacification. Vitreous opacification and copper deposition in the macula were potentially serious sequelae observed in four eyes. Small, intraocular copper foreign bodies can be tolerated for long periods of time without retinal toxicity, but vitreous changes of maculopathy may necessitate intervention.

Use of platelet-fibrinogen-thrombin mixture to seal experimental penetrating corneal wounds.

A platelet-fibrinogen-thrombin mixture utilizing autologous platelets was studied for its potential to seal perforating corneal wounds. In rabbits, the mixture demonstrated sufficient adhesive properties to permit 75% of penetrating keratoplasties to remain in place without the use of sutures. All 12 grafts held initially; after 48 h three grafts extruded. In control eyes only two out of 12 (16%) of the corneal grafts remained in place. The material is simple to prepare and apply and is not toxic to the cornea. It does not cause inflammation or lid irritation. Intraocular complications observed with its use were transient anterior synechiae and retrocorneal membrane formation.

Mass Visual Screening Via Television

Videotaped programs that could be used for screening of visual acuity and of visual fields by means of broadcast television have been developed and tested. The tests are designed to be effective regardless of the size of the viewers television screen. Inevitably, false-positive and false-negative results would occur, which would have to be carefully explained at the time the tests were broadcast.

Association of Hla Antigens and Primary Open-Angle Glaucoma

HLA testing of 55 patients with primary open-angle glaucoma revealed no increased frequencies of any of 17 HLA-A and 29 HLA-B antigens. However, the subgroup with a known family history of primary open-angle glaucoma had an increase in the frequency of the HLA-B12 antigen (48%). Intrafamily studies might further define the strength and importance of this association.

Digital Photogrammetry Of The Optic Nerve Head

A digital photogrammetric method capable of providing quantitative measurements from stereophotographs of the optic nerve head has been utilized in our laboratory to study the optic cup in patients with ocular hypertension and chronic glaucoma. Studies on the reproducibi-lity of the digital photogrammetric technique of optic nerve head photographs taken with various cameras has revealed that (1) reproducibility was significantly better when simultaneous stereo-photographs were analyzed and (2) the Donaldson stereofundus camera provided the best reproducibility of the majority of geometric measurements in optic cups of various sizes. In addition, it has been determined that the shallower cups encountered larger percentage errors. Improvements in parameter reproducibility have been obtained when finer sampling intervals have been used during film digitization. An additional study comparing reproducibility of cup parameters as determined by the digital photogrammetric procedure with those values obtained from analog photogrammetry and manual analysis revealed generally superior reproducibility of the digital photogrammetric analyses in the eyes studies. Preliminary observations utilizing the digital photogrammetric procedure in a modified Zeiss model eye indicated that minor shifts in camera posi-tion did not alter the reproducibility of the technique.

A Regional Course to Update the Practicing Specialist

Four medical centers collaborated in the development of a course in ophthalmology to present new information and skills to the practicing specialist who is not associated with a medical center. The course is presented in 8 two-day sessions, scheduled Friday and Saturday, four times a year, on a two-year cycle. Thus, the participant loses only four days a year from his practice. This course differs from most of the postgraduate courses currently being offered in that it is designed to update basic specialty knowledge and skills systematically to improve health care delivery.

Experimental Aspects of Implantation of Copper in the Vitreous of the Rabbit Eye

The most frequently encountered retained nonmagnetic foreign body clinically and pathologically is composed of pure copper or copper in association with zinc [1, 2]. The difficulties and potential sequelae associated with removal of intravitreal copper fragments in contrast to the possible consequences of retention have led to a series of experiments which deal with implantation of pure and alloyed copper foreign bodies into the vitreous of the rabbit eye. An attempt will be made to use the experimental data to draw practical conclusions which bear on the clinical course and management of patients with retained intravitreal copper foreign bodies.