Anthony Donn

Wide Field Specular Microscopy: Clinical and Research Applications

Through the use of a scanning mirror system, the field of view has been expanded to as much as 0.9 mm in diameter. Both contact and non-contact specular microscopy are possible, each having advantages. In a research application, wound healing in rabbit endothelium is documented by time lapse photography. The study demonstrates the capability to return to an area of interest provided there is a landmark. Clinical applications and advantages over conventional specular microscopy are discussed.

Wide-Field Specular Microscopy

Specular microscopy offers a unique opportunity to study living cells in vivo at high magnification. Many live cells may, of course, be observed in vitro, but in vivo the only live cells that can be seen are red blood cells flowing through capillaries or, with difficulty, endothelial cells in superficial blood vessels.

Ultrastructural variation in granular dystrophy of the cornea.

Corneal deposits of granular dystrophy were studied in six corneas from five patients. Two additional corneas from two patients with lattice dystrophy were used for comparison. The diagnoses were confirmed by light and electron microscopy. Three types of ultrastructural features were distinguished in the electron-dense rodshaped deposits of granular dystrophy, i.e., Type 1 with homogeneous structure, Type 2 with fibrillar constituents, and Type 3 with a moth-eaten or sponge-like appearance. In polarization microscopy of Congo-red stained sections, the Type 2 tended to show an increased birefringence without green dichroism, while the other types were less birefringent than the stroma. Three different components were found immediately around the deposits, i.e., 1. normal collagen fibrils, 2. finely filamentous substance, and 3. areas of thin fibrils (70–100 Å in diameter). While the second component appeared non-specific, the third component was found only in two corneas, superimposed on the lesions of granular dystrophy, and showed light and electron microscopic characteristics of the lesions of amyloid as well as of lattice dystrophy. Die Hornhautablagerungen bei der granulären Dystrophie konnten an Hand von 6 Präparaten von 5 Patienten untersucht werden. Zwei weitere Hornhäute von 2 Patienten mit gittriger Hornhautentartung wurden zum Vergleich untersucht. Die klinischen Diagnosen wurden durch licht- und elektronenmikroskopische Untersuchungen bestätigt. Unter den elektronen-dichten, stäbchen-artigen Ablagerungen der granulären Entartung konnten 3 Typen unterschieden werden: Typ 1 mit homogenem Bau; Typ 2 mit fibrillären Bestandteilen und Typ 3 mit einem schwamm-artigen Aussehen. Der Typ 2 zeigte im Kongorot gefärbten Schnitt unter dem Polarisationsmikroskop vermehrte Doppelbrechung, aber keinen grünen Dichroitismus. Die Ablagerungen vom Typ 1 und 3 drehten das polarisierte Licht weniger als das Hornhautparenchym. Um diese Ablagerungen herum fanden sich drei verschiedene Hornhautbestandteile: 1. normale Kollagen Fasern, 2. eine feine faserige Substanz, und 3. Gebiete von dünnen Fasern (70–100 Å im Durchmesser). Der zweite Bestandteil ist nicht spezifisch. Der dritte Bestandteil war nur in 2 Präparaten zu sehen. Es ist den Ablagerungen der granulären Entartung aufgepfropft und zeigt sowohl licht- als auch elektronenmikroskopische Eigenheiten, die für das Amyloid und die gittrige Entartung charakteristisch sind.

Multiple myeloma presenting as vortex crystalline keratopathy and complicated by endocapsular hematoma.

The crystalline keratopathy of multiple myeloma may involve the corneal epithelium, but has not previously been described in a vortex epithelial distribution. Endocapsular hematomas have been described in the period immediately after extracapsular cataract extraction, but not later on or in association with systemic disease. We report a pseudophakic patient who developed a vortex epithelial crystalline keratopathy as a presenting sign of multiple myeloma, and who subsequently developed a spontaneous endocapsular hematoma.

Inhibition by aminopyrine of adrenocortical activation caused by pyrogenic reaction.

Summary Intravenous administration of typhoid vaccine to human subjects produced adrenocortical activation, as measured by increases in levels of circulating 17-OH-corti-costeroids. Suppression of the pyrogenic effect of the vaccine by aminopyrine prevented adrenocortical response, without blocking certain other systemic reactions.

The Physiology of the Eye.

Many practicing ophthalmologists will not read this book because it is not clinical. This is unfortunate, for in one volume Professor Davson provides a simple yet thorough exposition of ocular physiology, a background essential for the practice of knowledgeable ophthalmology today. The book presents a well-organized review of the principles of eye physiology, and it incorporates the significant results of recent investigations into this established framework. The arrangement simplifies the subject and adds to our understanding. Although this is a second edition, the book can more properly be considered a new one. As is pointed out in the preface, it is 15 years since the first edition was written; and in the interval there have been tremendous advances in some aspects of eye physiology. Thus the new edition is 50% larger than the first, mostly because of the expanded sections on vegetative physiology and biochemistry and on mechanisms of vision.