Carl H. Ide

Retinopathy in Adolescents and Young Adults with Onset of Insulin-dependent Diabetes in Childhood

Retinal studies were done in 181 postpubescent, insulin-dependent diabetic patients who developed diabetes before the age of 20. Retinal studies included serial direct ophthalmoscopic examinations, stereoscopic fundus photography and fluorescein angiography. At the time of retinal studies, muscle biopsies also were done to measure capillary basement membrane thickness (CBMT) as an index of early microvascular changes in skeletal muscles. Assessment of clinical metabolic control, interpretation of retinal findings, and CBMT were done independently. No retinopathy was detected in patients observed continuously and known to have been in higher degrees of metabolic control. Twenty-five patients in lower degrees of control for extended periods had retinopathy. CBMT was found to be labile and to progress or regress within a year depending on the degree of control. All patients in lower degrees of control with retinopathy had increased CBMT, but if they subsequently attained and maintained a high degree of control for a year, then CBMT diminished and there was no progression of retinopathy. Our study demonstrates that a high degree of metabolic control delays, and may prevent, microvascular changes, and confirms other studies indicating that most postpubescent, insulin-dependent diabetic patients will develop retinopathy within 15 years unless a relatively high degree of control is maintained.

Orbital Apex Syndrome

A case is presented of a 16-year-old anticoagulated, immunocompromised male presenting with a blind, proptotic left eye, total ophthalmoplegia, and central retinal artery occlusion. Ophthalmic examination revealed other features of the orbital apex syndrome. Mucormycosis misdiagnosed as a traumatic orbital hemorrhage led to the patients death. In this review, differential diagnosis of the orbital apex syndrome (loss of cranial nerves II, III, IV, ophthalmic division of V, and VI) is outlined, and features, diagnosis, and treatment of mucormycosis are discussed. Although mucormycosis is most commonly seen in diabetics, it should be considered in any immunocompromised patient presenting with the constellation of features of orbital apex syndrome.

Comparative Efficacy of the β-Blockers for the Prevention of Increased Intraocular Pressure After Cataract Extraction

We conducted a randomized, double-masked study of intraocular pressure in 80 patients treated with betaxolol, levobunolol, timolol, or placebo after extracapsular cataract extraction. Intraocular pressures were measured preoperatively and early (four to seven hours) and late (20 to 24 hours) postoperatively. There was a significant mean increase in pressure from the preoperative period to the early postoperative period for the placebo group (5.35 mm Hg), betaxolol group (6.73 mm Hg), and the timolol group (3.83 mm Hg). However, the levobunolol group had a mean decrease in pressure (0.43 mm Hg). There was no significant difference between preoperative and late postoperative pressures for any of the groups. One-way analysis of covariance of the changes in pressure from the preoperative to early postoperative period showed a significant increase for the placebo and betaxolol groups compared to the levobunolol group, without significant difference between the levobunolol and timolol groups. Overall, levobunolol proved most effective in preventing an increase in intraocular pressure after extracapsular cataract extraction; timolol was partially effective.

Control of Intraocular Pressure With Apraclonidine Hydrochloride After Cataract Extraction

We conducted a randomly assigned, double-masked, controlled clinical trial to assess the efficacy of 1% apraclonidine hydrochloride in controlling postoperative intraocular pressure increases in patients undergoing extracapsular cataract extraction. Apraclonidine hydrochloride was given either one hour preoperatively or immediately after uncomplicated, extracapsular cataract extraction with posterior chamber intraocular lens implantation and compared with artificial tears given immediately postoperatively. Those who received apraclonidine hydrochloride preoperatively had significantly lower mean intraocular pressure at the first postoperative reading (P = .0005). After preoperative and postoperative apraclonidine hydrochloride, the mean early postoperative intraocular pressure was 19.8 mm Hg and 32.0 mm Hg, respectively, and 27.6 mm Hg after artificial tears. No patient who received preoperative apraclonidine hydrochloride had an intraocular pressure increase to 30 mm Hg or higher postoperatively. Nine of 20 patients (45%) who received postoperative apraclonidine hydrochloride and eight of 18 patients (44%) who received postoperative artificial tears had an increase of intraocular pressure to 30 mm Hg or higher in the early postoperative period. These differences were also highly significant (P = .0005).

Methicillin-Resistant Staphylococcus Epidermidis Blepharitis

Blepharoconjunctivitis caused by methicillin-resistant strains of Staphylococcus epidermidis occurred in two hospitalized patients, a 74-year-old man and a 19-year-old man. Both strains were resistant to multiple courses of topical antibiotic therapy. Successful treatment in both cases depended upon antibiotic sensitivity testing. These methicillin-resistant strains of S. epidermidis, like methicillin-resistant strains of Staphylococcus aureus, demonstrated almost complete cross-resistance to cephalosporins despite apparent sensitivity on Kirby-Bauer disk sensitivity testing. Topical vancomycin was curative in one case. In the other case, treatment with topical gentamicin, intravenous cefoperazone, and oral rifampin led to resolution of the symptoms.

Ocular complications of tangier disease

Tangier disease, or familial high-density lipoprotein deficiency, is an inherited disorder resulting in tissue deposition of excessive cholesterol esters. Although associated corneal clouding has been reported to produce little visual impairment, this patient with Tangier disease had corneal clouding, decreased corneal sensation, and cicatricial ectropion and experienced slowly progressive marked visual impairment. All ocular cases of Tangier disease are reviewed. Ectropion and incomplete eyelid closure may precede corneal clouding and should be recognized as signs associated with Tangier disease. The combination of exposure keratopathy and corneal infiltration can cause significant visual impairment.

Prolonged Complementary Chromatopsia in Users of Video Display Terminals

Induced prolonged complementary chromatopsia in four subjects (two men, 26 and 34 years old, and two women, 34 and 45 years old) was documented by abnormal responses to pseudoisochromatic color plates 30 minutes after cessation of monochrome video display terminal use. This phenomenon was unrelated to preexisting color vision anomalies, known ocular disease, or drug use, and defines a specific phenomenon probably related to afterimages. All four patients missed AOH-R-R plate 3 after using the video display terminal. One patient also had a delayed response to plate 6. One patient patched one eye before using the video display terminal and noted that the complementary chromatopsia occurred only in the unpatched eye.

Predicting Visual Acuity after Cataract Surgery Using the Blue Field Entoptoscope and Projected Slides

A new method allows accurate testing of visual function behind mild-to-moderate cataracts or capsular opacities. Patients were asked to compare the number of corpuscles visualized with the blue field entoptoscope with a series of projected slides having progressively fewer drawn corpuscles. To standardize the equipment, the test was performed on 69 patients with varying degrees of macular impairment. Of the patients who selected 120 corpuscles or more, 89% had visual acuities of 20/40 or better, and those who selected 100 corpuscles or less, 82% had visual acuities of 20/50 or worse. The percentages were higher for age-related macular degeneration (ARMD) patients (100 and 85%) than for diabetic patients (33 and 75%). The same apparatus was then used to predict the potential visual acuity in 56 preoperative cataract or YAG-capsulotomy patients. Of the 23 patients with a preoperative acuity of 20/200 or better and who selected 120 corpuscles or more, 100% were 20/40 or better postoperatively.

Punctal Stenosis—Caused by Idoxuridine or Acrodermatitis Enteropathica?-Reply

In Reply. —We would like to thank Drs Cherry and Falcon for bringing this point to our attention and are grateful for their interest in our article. Looking through the chart, however, we find that idoxuridine was first used on Nov 8, 1963, and then only in the left eye. This therapy was continued through the month. The records show that probing of both inferior canaliculi was unsuccessfully attempted on April 20, 1964. Since the punctal obstruction was bilateral, whereas idoxuridine was used only for the left eye, and since it appeared five months after the use of idoxuridine and not two to three weeks as reported after idoxuridine toxicity, we believe that the punctal stenosis in our patient represents a sequela of acrodermatitis enteropathica and is not due to idoxuridine toxicity.