Kari Karjalainen

CATARACT FORMATION DURING MIOTIC TREATMENT FOR CHRONIC OPEN-ANGLE GLAUCOMA

Of the various side-effects of miotics the lenticular changes have received fairly little attention. There are two reports in the literature of transient clouding of the lenses associated with use of di-isopropyl fluorophosphate locally (Kreibig, 1954; Harrison, 1960). The glaucoma patient of Kreibig, aged 59 years, developed posterior cortical cataract after daily administration of DFP for several weeks. The lenticular opacities disappeared almost completely after the drug had been discontinued. The patient of Harrison was a girl, (aged 13 years, who after daily application of 0.025 per cent DFP to both eyes for esotropia developed anterior subcapsular cataracts after 3 months of treatment. The lenses cleared completely in 3 weeks after the treatment had been discontinued. Similar lenticuliar changes have been described by Muller and others (1956) in five glaucoma patients. Anterior cortical cataract had developed in one patient after pilocarpin for 18 months, in one after Mintacol for 9 months, and in three after the use of pilocarpin, Prostigmin, Mintacol and Dory1 in combination. Recently Axelsson and Holmberg (1966), in a carefully conducted study presented at the meeting of Scandinavian ophthalmologists in Stockholm in June, 1965, called attention to the development of cataracts in glaucoma patients after long-term administration of echothiophate (phospholine iodide). To the best of our knowledge similar observations have not been reported before. Since both phospholine iodide and demecarium bromide have been readily employed in the treatment of chronic open-angle glaucoma at the Helsinki University Eye Hospital this study was undertaken to determine the lenticular

HLA-compatible donor cornea for prevention of allograft reaction

Our series comprises 80 penetrating grafts. Of the recipient corneas 36 were vascularized. Of the donor corneas 48 were fresh and 32 were cryopreserved. As prophylaxis, we gave topical and systemic prednisolone, combined, in heavily vascularized cases, with azathioprine. Corneal donor-recipient pairs were divided into three groups according to HLA histocompatibility. In Group I (0–1 mismatch) the rate of allograft reaction was 1 in 27, in Group II (2–4 mismatches) it was 4 in 19, and in the untyped Group III 9 in 34. Even when the prognosis was poor, a well-matched donor cornea (Group I) greatly improved the chances of success; when the corneal bed was vascularized, the well-matched donor corneas had a failure rate of 1 in 13, whereas in untyped pairs it was 7 in 18. The importance of possible presensitization is discussed. Das Untersuchungsmaterial umfaßt 80 Augen nach penetrierender Keratoplastik. In 36 Fällen fand sich die Empfängerhornhaut vaskularisiert und in 44 avaskulär. 48 der Spenderhornhäute waren frisch und 32 eingefroren. Prophylaktisch wurde Prednisolon lokal und systematisch kombiniert mit azathioprine in stark vaskularisierten Fällen verabreicht. Die Spender-Empfänger-Paare wurden gemäß ihrer Histokompatibilität in drei Gruppen eingeteilt. Bei bester Übereinstimmung war das Verhältnis der Allograftreaktion 1 zu 27, in Gruppe II mit 2–4 fremden Antigenen war sie 4 zu 19 und in Gruppe III ohne Bestimmung der HLA-Antigene war sie 9 zu 34. Spenderhornhaut mit guter Übereinstimmung, d.h. 0–1 fremdem Antigen scheint recht zuverlässig auch in Fällen mit schlechter Prognose. In vaskularisierter Empfänger-Hornhaut und Spender mit guter Übereinstimmung war das Verhältnis der mißlungenen Transplantationen 1 zu 13 und bei nicht typisierten Paaren 7 zu 18. Die Rolle einer Präsensibilisierung wird diskutiert.

Exfoliation syndrome in enucleated haemorrhagic and absolute glaucoma.

Abstract. Occurrence of exfoliation syndrome was studied in 172 eyes enucleated for haemorrhagic and absolute glaucoma in 1962–82, using histopathological techniques. Exfoliation was found in 33% of haemorrhagic glaucoma cases and in 22% of absolute glaucoma. In patients over 70, exfoliation was found in 53% of the haemorrhagic cases and in 46% of the absolute glaucoma cases. Capsular glaucoma may provoke haemorrhagic glaucoma and may lead to blindness and enucleation of eye with or without vascular catastrophe.

Corneal endothelium in Marfan syndrome A clinical and specular microscopic study

Abstract. Marfan syndrome is classified as a heritable disorder of connective tissue, and it has been assumed to be an inborn error of protein metabolism particularly in collagen or elastin. We examined 41 Marfan syndrome patients and found in the corneal endothelium guttata‐formation, considerable cell pleomorphism, non‐reflecting endothelial black spots and in some cases abnormal looking endothelial cells. The relation of pathological endothelium to lens subluxation, axial length and other corneal findings is discussed.

Long-term maintenance of therapeutic response to lovastatin in patients with familial and non-familial hypercholesterolemia: a 3-year follow-up.

The 3-year efficacy of lovastatin alone or in combination with colestipol was evaluated in 54 patients with type 2 hyperlipoproteinemia (22 non-familial and 32 familial hypercholesterolemic patients). A sufficient and sustained reduction in LDL cholesterol was achieved in non-familial hypercholesterolemia with lovastatin alone (average dose 74 mg/day, range 40-80 mg/d), whereas combination therapy with lovastatin 80 mg/d and colestipol (average dose 11.9 g/d, range 5-20 g/d) was required in familial hypercholesterolemia. The percentage changes from baseline at 3 years in serum LDL cholesterol, HDL cholesterol and total triglycerides were in the lovastatin-only group -53%, +10% and -15%, respectively, and in the two-drug group -58%, +22% and -18%, respectively. A subgroup analysis in patients with non-familial hypercholesterolemia indicated that the lipid-modifying effects of lovastatin were similar in type 2A and 2B phenotypes, except for a greater triglyceride lowering effect in type 2B. The lovastatin-alone regimen was well tolerated, whereas addition of colestipol caused subjective side effects in many patients. Serious side effects or discontinuations due to therapies did not occur. Both therapies caused slight but significant increases (within normal limits) in average serum transaminase levels. After 36 months a significant rise of 1.7 kg in mean body weight was observed in the lovastatin-only group. The ophthalmological follow-up did not reveal any cataractogenic effect attributable to treatment during the 3.8-year follow-up period.

HLA‐B 12 AND HLA‐B 27 ANTIGENS AND SUSCEPTIBILITY TO THE CORNEAL ALLOGRAFT REACTION

Our series comprised 100 penetrating corneal transplantations: 36 cases with HLA‐B 12 and/or B 27 antigen in the recipient and, as controls, 64 cases without these antigens. The cornea was vascular in 44% of the HLA‐B 12/B 27 group and in 40% of the controls.

RETINAL AND VISUAL FIELD CHANGES IN CHLOROQUINE RETINOPATHY

The literature has brought forward quite a number of retinopathy cases due to long term chloroquine treatment, as reviewed e. g. by Voipio (1966). In Finland chloroquine has been used over ten years in therapy of collagenous diseases. Nevertheless, in our country only one case has been described as having complications of this kind (Voipio and Reissell 1963, Voipio 1963). Because of this we feel that there is reason to bring to notice 12 new cases and the findings that have come to light within a period of two years when examining patients who have been treated with chloroquine for over a long time. W e especially wish to call attention to the two patients whose visual field was found to be dramatically constricted.

CATECHOLAMINE‐CONTAINING AND ACETYLCHOLINESTERASE‐POSITIVE NERVE FIBRES IN THE RABBIT CONJUNCTIVA

The innervation of the rabbit conjunctiva was investigated histochemically. Nerves containing acetylcholinesterase (AChE) were demonstrated using a copper thiocholine technique. Sympathetic nerve fibres were demonstrated using either the formaldehyde‐induced fluorescence (FIF) or glyoxylic acid induced fluorescence (GIF) method. In addition, GIF and AChE‐reactions were performed consecutively for the demonstration of fluorescent and AChE‐positive nerves in the same specimen.

Suprasellar meningioma 47 years after bilateral retinoblastoma

Abstract. Development of an additional primary tumour, a suprasellar meningioma, is reported 47 years after successful treatment of bilateral retinoblastoma. The left eye of the patient was enucleated at the age of 1.5 years and the left orbit radiated with a total dose of 1200 rads. The right eye was treated by orthovoltage radiation only at the age of 4 years, the total dose being 5100 rads. The right eye became blind and phthisical, and it was enucleated at the age of 42 years. No active retinoblastoma was found. At the age of 48 years a large suprasellar meningioma was diagnosed and partially removed.

Über l-Epinephrin-Behandlung bei Glaucoma simplex

Die Wirkung des l-Epinephrins wurde unter Anwendung des Applanationstonometers sowie der Tonographie bei 48 Patienten an 86 Augen mit Glaucoma simplex studiert. Von den Patienten waren 28 Frauen und 20 Männer, und das durchschnittliche Alter des ganzen Materials betrug 62,7±1,6 Jahre. Die Beobachtungszeiten wechselten von 4–49 Monaten. In den 86 Augen des gesamten Materials konnte eine Erniedrigung des intraocularen Druckes mit 6,6±1,4 mm Hg in den rechten und 6,1±1,9 mm Hg in den Unken Augen festgestellt werden. Die entsprechende Verbesserung der Abflußwerte betrug 0,07±0,022 und 0,095±0,018 (Tabelle 1). In der Gruppe der Patienten unter 60 Jahren war der Effekt des Epinephrins auf den Druck und Abfluß deutlich besser als in der älteren Gruppe (Tabelle 2), auch schienen Männer besser als Frauen auf die Therapie zu reagieren (Tabelle 3). Bei einer Aufteilung des Untersuchungsmaterials nach den Beobachtungszeiten wurden bei Epinephrinbehandlung statistisch signifikante Veränderungen 6 und 12 Monate nach Einsetzen der Therapie ermittelt. Danach erwies sich die statistische Signifikanz der Veränderungen geringer (Tabelle 4). The effect of l-epinephrine has been studied in 86 eyes with chronic simple glaucoma of 48 patients by means of applanation tonometry and tonography. There were 28 females and 20 males in the material and the average age of the patients was 62.7±1.6 years. The patients had been followed up varying from 4 to 49 months. After epinephrine the average fall of the intraocular pressure in the right eye of the patients was 6.6±1.4 mm Hg and 6.1±1.9 mm Hg in the left eyes. The corresponding improvements of the outflow facility measured 0.07±0.022 and 0.095±0.018 (Table 1). The patients aged 60 years or less showed better response to epinephrine than the patients aged 61 years or more (Table 2) and the male patients appeared to respond better than the females (Table 3). When the material was divided according to the follow-up periods statistically significant improvemets were noted after 6 and 12 months on epinephrine whereas the statistical significance in groups followed for 24, 36 and over 36 months were of smaller statistical significance (Table 4).