K. Nath

Gantrisin and madribon in trachoma.

ALTHOUGH the use of topical sulphonamides, as compared with antibiotics, is becoming less popular in the mass or community treatment of trachoma, the introduction of long-acting sulphonamides has renewed the interest of trachomatologists in their suitability for use in such programmes. Clinical trials with Lederkyn conducted by Bietti and Lanzieri (1957), Rochat (1958), Lanzieri and Latte (1960), Mann (1960), and Mitsui, Konishi, Kinouchi, and Kajima (1963) have shown that it was effective against trachoma and associated conjunctivitis even in small doses. As well as Lederkyn there are a number of other products (Madribon, Orisul, Bayrena, etc.) which it is claimed have similar properties, but which have not yet been put to adequate trial against irachoma. Recently, Hildenbrand (1961) reported encouraging results with combined therapy (local Gantrisin and oral Madribon tablets) in trachomatous cases. Nema, Bal, Nath, Mathur, and Shukla (1965), using Gantrisin in trachoma, obtained satisfactory results both by continuous and by intermittent schedules of treatment. The present double-blind study was therefore undertaken to assess the value of topical Gantrisin (sulphafurazole) and oral Madribon (sulphadimethoxine) tablets, alone or in combination, in trachomatous schoolchildren, using different schedules of administration.

BACTERIAL FLORA OF THE TRACHOMATOUS CONJUNCTIVA

TRACHOMA and bacterial conjunctivitis affect each other adversely. The superimposed infection not only prolongs the course of trachoma but predisposes the eye to frequent relapses. A number of reports (MacCallan, 1931; Wilson, 1935; Pages, 1951; Poleff, 1951; Feigenbaum, Gurevitch, Landau, and Shamir, 1955; Akagi, Tsutsui, Nanba, Shimizu, and Nishikiori, 1958; Larmande and Longo, 1960) on the bacterial flora of trachomatous eyes have appeared in the world literature, but the only study made in India was that of the Trachoma Control Pilot Project (T.C.P.P.) in repeated monthly surveys in 1957-58. The diagnosis of the microorganisms in the course of the survey was made by smear examination only, which is inadequate. The present culture studies were, therefore, undertaken to identify the bacterial flora of the conjunctiva in various stages of trachoma.

TRACHOMA AS AN AETIOLOGICAL FACTOR IN GLAUCOMA

TRACHOMA is one of the major causes of blindness, especially in the East. The common sequelae of corneal involvement by trachoma are only too well known, but the hypertensive aspect of the trachomatous process leading to blindness has not been adequately explored. Conflicting reports have appeared in the literature regarding the relationship of trachoma and ocular hypertension. Muller (1900), de Wecker (1900), Cuenod and Nataf (1930), MacCallan (1936), Adamantiadis (1937), Sedan (1939), Bietti (1947), and Boles Carenini and Cambiaggi (1957) have reported a higher frequency of glaucoma among trachomatous than among non-trachomatous subjects. On the other hand, Guarino (1914), Lagrange (1922), Bailliart (1928), Terson (1928), Trantas (1937), and Pasino (1957) have said that the two conditions are independent. In view of the paucity of reports from India where trachoma is rampant and poses a serious national health problem, and the inconclusive results obtained in other countries, the present work was undertaken to find the relationship between trachoma and glaucoma, if any.

CROUZON'S DISEASE AND PITUITARY DYSFUNCTION CROUZON'S DISEASE, HYPOPITUITARISM, ECTOPIA LENTIS, SECONDARY GLAUCOMA, AND IRIS ATROPHY IN A DEAF-MUTE FAMILY

Since the age of 5 he had had occasional attacks of headache which lasted for an hour or so; these attacks continued until the age of 7 and then gradually waned. He had developed very slowly and did not sit up, eat, or talk until the age of 4 years, when his first teeth also appeared. He started standing and walking at the age of 6 years. Examination.-He was a thin, underdeveloped, mentally deficient dwarf (Fig. 1), slightly deaf and with a nasal accent. He had frontal bossing (Fig. 3), parrot-nose (Figs 2 and 3), proptosis, divergent squint, shallow orbits, and a prognathous lower jaw (Figs 2, 3, and 4), the lower teeth being slightly in front of the upper teeth and the maxillae underdeveloped (Fig. 4, opposite).

COMPARATIVE THERAPEUTIC FIELD TRIALS OF G.S. 2989 AND OXYTETRACYCLINE IN TRACHOMA

G.S. 2989 Hcl (Pfizer) is a new tetracycline derivative without any generic name. In a cinico-cytological study by Nema, Nath, Bal, and Shukla (1964) on 48 trachomatous cases treated by G.S. 2989 Hcl (025 per cent. in oil) the antibiotic was found quite effective against trachoma and associated bacterial conjunctivitis. It was observed that the drug could produce 66-7 per cent. cure of trachoma after four weeks of continuous treatment. The following study was undertaken to judge the definite place and optimum concentration of G.S. 2989 in the mass treatment of trachoma.

ACCESSORY CONJUNCTIVAL FOLDS: SO-CALLED EPITARSUS

THE condition of an accessory fibro-fleshy conjunctival fold between the bulbar and palpebral conjunctiva has attracted the attention of several workers (Blasius, 1835; von Graefe, 1863; von Harlan and de Schweinitz, 1895; Schapringer, 1899; Denig, 1900; Herbert, 1901; Campbell, 1901; Oeller, 1904; Robertson, 1906; Adamiick, 1907; Tyson, 1913; Shoemaker and Alt, 1914; Wibaut, 1926; Taborisky, 1928; Lloyd, 1931; Satnam Singh and Grover, 1960; Ayoub, 1963). Often the fold is triangular, with its base in the fornix and the apex, or with the narrower end either free or attached at a short distance from the margin of the lid. The existence of multifarious names for the condition and manifold theories of its causation shows that its exact pathogenesis has not been understood. The frequent occurrence of the condition in Northern India has given us an opportunity to study the condition in detail and has enabled us to give a correct nomenclature and describe its aetiopathogenesis.

CIRCULAR SLIDING BY LATERAL POLE IN CASES OF CATARACT.

ACCORDING to present conceptions the only ideal method of extracting an immature senile cataract with forceps is by sliding by the upper pole with or without a round pupil, thus avoiding all trauma to the vitreous face. Previously, Nath (1964) had described a method of delivering slippery cataracts by forceps, in which a prior indirect zonulotomy is done in the lower part by tapping, and subsequently the slippery lens is delivered by catching the upper pole with the tips of Arrugas forceps, making direct and indirect zonulotomy manceuvres. Thus a round-pupil upper-pole delivery is effected in cases of slippery cataracts. It was thought that if the same principle of prior zonulotomy were applied in other cases of senile cataracts a roundpupil lateral-pole delivery could be effected through the routine superior section, which may be more convenient. In the beginning no more than the academic aspects were thought of, but subsequently it was discovered that the method could be valuable, in reserve, in cases with low intra-ocular tension and in those having only a moderately dilated pupil. Success in this technique has often made us wonder if it is really worth while using alpha-chymotrypsin in most of the cases, as most of the anterior zonules can be severed by this technique and the lens may be extracted by any pole thereafter. This is what we actually do with alpha-chymotrypsin where total zonulotomy is brought about by zonulolysis.

CYST OF THE INCARCERATED IRIS FIRST REPORT OF COMPLICATION FOLLOWING CATARACT EXTRACTION

IRIS incarceration following cataract extraction is a fairly common accident, which occurs in 1 to 3 per cent. of cases. If the operator fails to attend to it promptly, it may lead to an eccentric pupil, iritis, shallow anterior chamber due to a leaking wound, secondary glaucoma, sympathetic ophthalmitis, and so on, especially if ballooning of the iris is present, giving rise to constant irritation. Other small incarcerations, which may be inadvertently left at the time of operation or may occur on the first or second post-operative day, look very innocent in the beginning and are usually discovered at the first dressing. They are more likely to occur when a complete or broad iridectomy has been done, and the operator may ignore them if everything else appears normal. The spontaneous formation of a cyst in one of these incarcerated portions of the iris has not hitherto been reported, although intra-ocular cystic growths from the iris are frequently seen, the majority of them after cataract operations. Some resemblance to the present case may be seen in a case reported by Charamis and Sfalgako (1935), in which an epithelial iris cyst in the anteriorchamber grew out through the section after a combined extraction.

FORCEPS EXTRACTION OF SLIPPERY LENSES IN CASES OF CATARACT.

IN about one-fifth of all cataracts that come to this hospital for extraction the lens capsule is slippery, so that when one tries to grip it with forceps by the conventional methods, the forceps slip and it is not possible to apply any traction. About 75 per cent. of these cases are Morgagnian cataracts and the rest are intumescent cortical senile cataracts. The technique described below makes it possible to effect a round-pupil upper pole delivery with forceps in these cases with slippery capsules and the method is also useful in cases of senile cataract.

MULTIPLE CANALICULAR CYSTS

CANALICULAR CYSTS, although not very rare, have been frequently reported in the literature. Duke-Elder (1952) mentioned four such cases (Santos Fernandez, 1913; Torres Estrada, 1931; Wilson, 1936; Vittadini, 1937), and others have been reported by Rubert (1934) and Sokolowski (1962). Ours is the first case to show three canalicular cysts simultaneously, and our patient had probably harboured the cysts for the longest period on record.