Barton L. Hodes

Ultrasonographic diagnosis of choroidal malignant melanoma.

During the past two decades, improvements in the resolution and reliability of instrumentation and techniques have allowed A- and B-scan ultrasonography to join direct visualization, fluorescein angiography, and radioactive phosphorus testing as primary diagnostic modalities in the evaluation of intraocular neoplasms. Because overlying opacities have no effect on the examining ultrasonographic frequencies, ultrasound has the unique ability to depict the nature of intraocular pathology when the media are optically opaque. Physics, history, instrumentation and techniques are described, and criteria for diagnosis of uveal malignant melanomas by standardized A-scan and B-scan methods are discussed and illustrated.

Congenital Glaucoma Associated With Cutis Marmorata Telangiectatica Congenita: Two Case Reports

Two cases of cutis marmorata telangiectatica congenita are described in association with nevus flammeus and congenital glaucoma. Approximately 65 cases have been reported and the association with nevus flammeus and congenital glaucoma has only been reported in one of those cases. Unlike the glaucoma associated with nevus flammeus of Sturge-Weber, this type of congenital glaucoma appears to be associated with an abnormal filtration angle rather than an increased episcleral venous pressure.

Visual disturbances in migraine

Abnormal visual sensations are the most common and characteristic features of migraine. In some patients, they are the only features. The major visual disturbance associated with migraine is scotoma; less common are distortions in size, shape, and color of viewed objects; photophobia; and diplopia and polyopia. Sudden loss of vision occurs in retinal migraine, and paralysis, usually of the third nerve, in ophthalmoplegic migraine. Paresis also may be found with cluster headache.

Phacoanaphylactic endophthalmitis: echographic diagnosis of phacoanaphylactic endophthalmitis.

A sixty-year-old black diabetic female developed a severe postoperative endophthalmitis eight days after unplanned extracapsular cataract surgery. Gram stain of a diagnostic vitreous aspirate showed no organisms, and culture of the aspirate was negative for bacteria and fungi. A- and B-scan ultrasonography showed the presence of intra-vitreal lens fragments; the diagnosis of phacoanaphylactic endophthalmitis was made and intensive steroid therapy was instituted early in the course of the disease. Resorption of the lens fragments in association with gradual diminution of the inflammatory process was documented by serial echograms of the eye. The vitreous ultimately cleared and the patient regained useful vision. Ultrasonography is recommended as an essential part of the diagnostic evaluation of any patient with postoperative endophthalmitis especially with a history of extracapsular surgery.

Ocular Hypertensive Response to Therapy

To the Editor. —I have recently observed an ocular hypertensive response to topically administered dexamethasone that was greater in magnitude and more abrupt in onset than any previously reported in the literature. I thought I might share this with the readership of theArchives. A highly myopic 45-year-old man was first seen in December 1974 with a retinal detachment in his right eye. This detachment was successfully repaired, with restoration of normal vision. Several months after the surgery, the patient was seen again, this time for a change of glasses. Results of his entire examination at that time were normal with the exception of his considerable myopia and evidence of the successful scleral buckling procedure. Although his intraocular pressure was 20 mm Hg in both eyes, the heads of both optic nerves appeared somewhat saucerlike and raised the suspicion of possible glaucomatous excavation. In an attempt to at least define

Common eye problems

In his introduction, Dr Hodes points out that primary care physicians may be more responsible for counseling patients with eye problems than they realize, even though ophthalmologists may be providing treatment. The symposium articles deal with four of the most common eye problems which physicians encounter in office practice: cataract. glaucoma, migraine related to the eye, and the appropriate use of contact lenses, including the information patients need to know.

Using Ultrasound in Ophthalmologic Diagnosis

Ultrasonography has become an essential tool in ophthalmology. B-scans give cross-sectional display of tissues, while quantitative A-scans demonstrate internal tissue texture. The technique can confirm a diagnosis, distinguish between alternative diagnoses, or detect disease not otherwise demonstrable by noninvasive means.

Glaucoma. Some practical considerations on a common disease.

Chronic simple glaucoma and acute glaucoma are totally different in pathogenesis, symptoms, and treatment. Chronic simple glaucoma is asymptomatic until late in its course, and only by appropriate screening by primary care physicians can the incidence of irreversible visual loss due to this disease be reduced. The symptoms and signs of acute glaucoma are so characteristic that recognition is usually easy and treatment can be begun early enough to prevent permanent angle damage and secondary glaucoma.

The fundus of the eye.

Even in healthy eyes, the appearance of the fundus is subject to great variation owing to individual differences in amount and distribution of pigments. How much melanin and hemoglobin are present in an area or a structure determines the coloration of that part of the fundus and the visibility of the underlying structures.