Earl Choromokos

Central Areolar Pigment Epithelial Dystrophy

We examined nine members of a family with a unique hereditary macular dystrophy by using stereoscopic color photography, fluorescein angiography, electroretinography, electro-oculography, dark adaptation, H-R-R color plates, and the Farnsworth-Munsell 100-hue test. The disorder was transmitted as an autosomal-dominant trait with increased penetrance and variable expression. Four of the family members, representing three successive generations, exhibited defects in macular pigmentation ranging from a 1-disk diameter excavation to a more subtle central loss of macular pigment. Only one eye with macular hemorrhage had decreased visual acuity; visual acuity in this eye was 20/25 when the hemorrhage resolved. All other retinal function studies were normal. The unusual nonprogressive areolar depigmentation of the central macula together with normal retinal functions made it impossible to classify this disorder, and indicated a new and unreported dominant macular dystrophy, central areolar pigment epithelial dystrophy.

The Inhibition of Corneal Vascularization with Aortic Extracts in Rabbits

A low molecular weight fraction of bovine aortic extract inhibited corneal vascularization and edema in rabbits when administered either subconjunctivally or topically as long as 48 hours after injury. The extract also appeared to enhance the regression of newly formed corneal vessels. Topical administration for as long as two months had no deleterious ocular side effects. Tissue culture experiments showed that analagous fractions prepared from bovine vitreous inhibit endothelial cell growth. The major growth inhibitor of corneal neovascularization was not the Kunitz bovine protease inhibitor.

Endogenous intraocular Nocardia asteroides in Hodgkin's disease.

A 60-year-old man receiving antituberculous and corticosteroid therapy for a granulomatous disease of uncertain etiology was found to have a chorioretinal mass in his right eye. Fluorescein angiography showed blockage of fluorescence by the mass and late leakage. Autopsy findings were compatible with Hodgkins disease with disseminated nocardiosis caused by Nocardia asteroides. Organisms typical of Nocardia were found in the choroid and subretinal space. The patients history, ophthalmic examination, and fluorescein angiographic findings suggested a type of chorioretinal involvement.

The Inhibition of Corneal Vascularization in Rabbits

A single subconjunctival injection of 250 microgram of a partially purified extract of bovine aorta, administered immediately before or after silver nitrate injury to the cornea, markedly inhibited corneal vascularization in the rabbit eye. We believe the active molecule is a protease inhibitor that prevents the potential source of new vessels from proliferating and invading the diseased cornea.

Cilio-Optic Vein Associated With Phakomatosis

This presentation demonstrates the fluorescein angiographic characteristics of the cilio-optic vein. These congenitally enlarged vessels appear at the disc edge and dip into the optic nerve to anastomose with branches of the central retinal vein. Fluorescein angiography shows lamellar filling of the vessels in the early choroidal phase. In one patient, these findings are demonstrated bilaterally with the use of bilateral simultaneous angiography. A second type of communication is presented, a retinociliary vein which drains the retina into the choroidal circulation. In both types presented, a branching hypofluorescent pattern extends from the disc vessel into the choroid. Our patients have evidence of a phakomatosis: neurofibromatosis or Sturge-Weber syndrome. This anomalous disc vessel should not be confused with optociliary shunt, disc neovascularization, cilioretinal artery, or arteriovenous shunt.

Choroidal Vascular Changes in Toxemia of Pregnancy

Twenty-seven patients with toxemia of pregnancy were examined during a postpartum period of two days to eight months. Five of these manifested abnormal photographic and angiographic findings including disk and retinal edema, retinal striae, deep retinal yellow-white focal lesions, choroidal nonfilling, leakage of dye from the optic disk and deep retinal lesions, and retinal pigment epithelial window defects. The location and configuration of the leakage correlated with the defects seen on color photography. The normal retinal, and predominantly abnormal choroidal vascular patterns provide evidence implicating choroidal vascular insufficiency as the primary basis for secondary retinal detachments seen in toxemia of pregnancy.

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.