Kenneth C. Swan

Extraocular Muscle Surgery in Early Infancy - Anatomical Factors

The dimensions and topographical anatomy of 26 eyes from 14 neonates and infants were measured and photographed with special attention to the insertional position of the extraocular muscles. Additional measurements were made in histologic preparations of 12 normal infant eyes. Although the diameters of the neonatal eyes were found to be about 70% of the adult eyes, the volumes of the globes were only about half, and the surface areas even less. The insertions of the rectus muscles were about 2 mm nearer to the cornea than in emmetropic adult eyes, but some were close to or at the equator. The posterior segments of the neonatal eyes were much less developed than the anterior, so that the oblique insertions, as compared to the adult eye, were closer to each other, to the horizontal meridian and to the posterior pole. In some neonatal specimens the inferior oblique insertion was so close to the optic nerve that tenotomy at that point would have jeopardized some of the posterior ciliary vessels and nerves. The dramatic postnatal growth of the eye occurs in the scleral segment; there is minimal corneal growth. About half of the total lifetime increase in the diameters, volume and total surface area of the human eye occurs in the first six months of life. In the six-month-old specimens the volume of the globe and the surface area of the sclera had almost doubled as compared to the neonatal eyes.(ABSTRACT TRUNCATED AT 250 WORDS)

Definition of Anomalous Retinal Correspondence

In a recent article on ocular terminology, Lancaster, speaking for the American Committee on Optics and Visual Physiology, presented definitions* of anomalous retinal correspondence and related phenomena. One definition described an anomalous retinal correspondence as a condition in which the fovea of one retina and an eccentric element of the other acquired a common visual direction; that is, became corresponding retinal points. A review of the literature reveals this simple definition to be in common usage. Unfortunately, such a functional relationship between the fovea of the fixating eye and a peripheral retinal area in the squinting eye can be demonstrated in few patients with anomalous retinal correspondence. Moreover, attempts to use the definition as a criterion for diagnosis have misled some ophthalmologists to believe the anomaly rare. This fact is exemplified by a comparison of 100 cases of esotropia selected at random from admissions to the State University of Iowa Clinics in 1935 with 100 consecutive cases admitted in 1942. Of the 1935 group, only three were suspected of having some anomaly of correspondence, whereas a definite diagnosis of anomalous retinal correspondence was made in 73 percent of the 1942 group. New criteria for diagnosis and improved methods of examination account for the discrepancy rather than does an increased incidence of the anomaly. In 1935, the orthoptist used an illuminated Brewster-Holmes type of prism stereoscope so adjusted that when one target was fixated by the fovea of the nonsquinting eye, the other target stimulated that peripheral retinal area of the squinting eye which, according to the aforementioned definition, could become a functionally corresponding point. Correspondence was considered abnormal only if the two objects

Late Wound Separation after Cataract Extraction

Many years after cataract extraction, blunt trauma ruptured limbal wounds in five eyes. Filtrations followed minor trauma in three patients, and occurred spontaneously in two others. Limbal wounds do not regain the tensile strength of adjacent normal stroma and may be further weakened by tissue incarcerations, vascularization, and other defects. Histologic studies after cataract extraction also reveal minimal collagen bridging of the stromal wound in some human eyes. Diagnosis and clinical significance are discussed.

Retrocorneal Pigment Proliferation after Cataract Extraction

Retrocorneal pigment proliferation after cateract extraction is not rare. Downgrowths proliferate from fragments of iris pigment or peripheral iris in the corneal wound edges and occur slowly. Vision is affected if the central cornea is involved. Preventive measures include minimizing iris trauma and irrigating pigment fragments from the cornea and incision during surgery. In the study presented, patches of dislodged iris pigment epithelium were observed in 22 eyes. Lace-like downgrowths occurred in 18 eyes of 14 patients.

Unintentional Filtration after Cataract Surgery

The eyes of an 81-year-old man were obtained three and ten days after intracapsular extractions had been made through limbal incisions under limbal-based flaps of conjunctiva and Tenons capsule. The wounds were closed with 7-0 chromic collagen. Before death from bronchopneumonia, the patient developed bilateral filtrations in association with violent coughing spells. In both specimens, the healing processes of the conjunctiva and Tenons capsule were advanced, confining the escaping aqueous humor to the subepithelial tissues of the flap. In contrast, the stromal wounds were still inert in accordance with our earlier observations that these wounds are precariously weak during the first two weeks after surgery. In cataract surgery, flaps including both conjunctiva and Tenons capsule should be prepared and closed to support the slower healing stromal wound. Prevention of filtrations is not a simple matter of using many sutures. This patients eyes demonstrated that improperly placed or too tightly tied sutures may be directly responsible for leaking wounds.

John E. Harris — II. The Clinician

John E. Harris was born in Toledo, Ohio on December 27, 1913 and received his early education there. In 1936 he enrolled in the Graduate School of the State University of Iowa. It was here that John Harris and William Hart, as graduate students, and Kenneth C. Swan, as a resident in Ophthalmology, worked in adjacent laboratories in an isolated corner of the University Hospital in Iowa City. A lasting friendship was established, along with an interest in ophthalmic research. Later, all three were to become Professors and Chairmen of Ophthalmology Departments in American medical schools. John Harris received his Ph.D. in Biochemistry, then carried out research at the State University of Iowa and University of Pennsylvania. This was followed by four years in the Army. In 1946 he joined the Department of Ophthalmology at the University of Oregon Medical School, where Dr. Kenneth Swan had become Chairman. Dr. Harris continued his investigative work as a Research Associate while completing requirements for the degree in medicine, which he received in 1950. Although he devoted considerable time to research, John Harris had the outstanding scholastic record of his medical school class and was elected to the honorary medical society, Alpha Omega Alpha, in his third year.

Toxicology of the Eye.

This modestly priced book provides comprehensive, up-to-date coverage of the increasingly important subject of ocular toxicology. The author is an experienced teacher and investigator who is highly qualified to prepare this text because he has made important contributions in the fields of ocular pharmacology and toxicology. The major portion of the book is concerned with concise discussions of the various toxic substances. In these discussions, the author includes some mechanisms of action and properly differentiates fact from theory and clinical impression. Although most of the agents are listed in alphabetical order, there are some groupings of agents under such headings as miotics. These groupings facilitate use of the book as a reference and also help the reader to compare the toxicity of one agent with that of similar agents. The groupings appear in cross references in the index, along with the substances, symptoms, signs, and sources. There is also a

Textbook of Ophthalmology.

This is the seventh edition of a moderately priced and popular text on ophthalmology written specifically for the medical student and general practitioner. For this purpose, it is highly recommended. In the preface, Dr. Adler pays tribute to Giffords concept that this type of text should not be merely an abstract of the larger texts intended for ophthalmologists. The present edition contains a great deal more material than the original volumes prepared by Gifford, but, as a result of Adlers conciseness and the extensive use of illustrations, it is still a compact, easy to read book. Adler omits the rarities and emphasizes those conditions which should be within the scope of knowledge of every medical student. Enough anatomy, physiology, and pathology are presented to provide the student with an understanding of the pathogenesis and the principles of management of eye disease and diseases affecting vision. In this new edition, Adler

The Year Book of Ophthalmology: 1961-1962 Year Book Series.

This compact volume begins with a 25-page article on keratoplasty by Sir Benjamin Rycroft and is similar to previous volumes with this exception. The Year Book of Ophthalmology , as in the past, consists of abstracts of articles selected from the world literature by the editor. These abstracts differ from the usual type in that some excellent illustrations and tables are published, and there are discussions of each article by the editor and his associates. The material is organized into a series of relatively short chapters which permit a busy clinician to read a section at a time. A bound volume of this type requires more time and effort to prepare than simple abstracts; therefore, most of the articles reviewed in the current volume were published prior to the middle of 1961. The book is especially recommended for those practicing ophthalmologists who do not have ready access to a medical library

Medical Pharmacology (Principles and Concepts).

Practicing ophthalmologists frequently have asked me to recommend a readable textbook of modern general pharmacology. In a few instances, these ophthalmologists have wanted to prepare for State Board Examinations, but for the most part, the requests have come from clinicians concerned with maintaining a working knowledge of the therapy prescribed for their patients by internists and other physicians; further, they have wanted enough basic understanding of pharmacology to properly classify and evaluate the bewildering array of new analgesics, sedatives, muscle relaxants, and other drugs which may have usefulness or potential dangers for the patient with ophthalmic disease. Medical Pharmacology by Goth is recommended to ophthalmologists for these specific purposes. The subject material is nicely organized in concise chapters, each followed by literature references. The author is primarily concerned with general principles and the more important agents and developments. He has not cluttered his text with factual details or highly technical