Roberto Sampaolesi

Malignant Melanoma of the Conjunctiva: Report of a Case

Malignant melanomas of the conjunctiva are extremely rare in children. The authors report an 11-year-old boy who had a nodule at the limbus in a pigmented area since early childhood. The lesion was excised and the diagnosis of atypical compound nevus was made. Five months later, the patient returned with multiple nodules in the bulbar and palpebral conjunctiva. One of the lesions was excised, and the diagnosis was malignant melanoma. He was lost for follow-up for 6 months; then he presented a large pigmented, vascularized mass protruding through the palpebral aperture. Results of systemic workup for metastatic disease were negative, and an exenteration was performed. A few months later, cervical lymphadenopathy developed followed by extensive metastatic disease.

Antiglaucomatous drugs effects on optic nerve head flow: design, baseline and preliminary report

Purpose: To determine the effect of the most frequent usedantiglaucomatous drugs on the optic nerve head flow. To see the response of the autoregulationsystem in hypertensive, preperimetric and advanced perimetric glaucomas. Materials: In thispreliminary report, optic nerve head parameters and retinal perfusion values were measured in 25healthy controls as well as in 72 glaucomatous optic nerve heads. The glaucomatous sample was dividedinto three groups: 24 eyes treated with Betaxolol, 24 with Brinzolamide and 24 treated withBrimonidine (each of these groups was conformed by 8 hypertensive glaucomas, 8 preperimetric glaucomas,and 8 perimetric glaucomas).Methods: Patients were examined with scanning laserDoppler flowmetry (wave length 638 nm), and flow, volume and velocity indices were assessedin each report. Perfusion maps were analyzed with the new SLDF software, version 3.2(automatic full field perfusion image analizer). Examinations were also performed with theHeidelberg Retina Tomograph (wave length 638 nm), using the new standard reference plane. Visualfields were performed with the Octopus 123 or 101 perimeters, programs G1x and G2, with 3 phasescompleted. Diurnal pressure curve with applanation tonometry and gonioscopy (for classification)were also performed. Results: In this preliminary report, it was found that eyes in Hypertensiveor preperimetric stages of glaucoma, seem to use their regulation systems in order to preservetheir optic nerve head circulation, while advanced perimetric glaucomas seem not be ableto preserve their optic nerve head flow. And that antiglaucomatous drugs were not able toincrease optic nerve head flow neither.Discussion: Optic nerve head blood supplies is regulated byan autoregulation system. This phenomenon may act in normals, hypertensive and preperimetricglaucomas, but it seems not be able to preserve blood flow in advanced glaucomas. Optic nervehead flow returns to normal values with treatment in glaucoma first stages, while it seems that itcould not be restored in advanced glaucomas

Large optic nerve heads: Megalopapilla or megalodiscs

Purpose: To evaluate megalopapillas in order to determine whether they constitute a different population, according to their specific features.Material: Evaluation of the optic nerve head of 405 eyes divided into 172 normal eyes, 168 pre-perimetric glaucomas (phase 3 or 4), 30 primary congenital glaucomas (children with pure congenital glaucomas operated more than once and diagnosed within the first year of age), and 35 megalopapillas.Method: The examinations were performed with the HRT (Heidelberg Retina Tomograph), using a wavelength of 680 nm and the new standard reference plane. Each examination results from the mean of 3 image acquisitions with a SD lower than n = 20. Each optic nerve head was studied in 360 degrees (segments), as well as in quadrants and octants separately (predefined segments). The visual fields wereassessed with either the Octopus 1-2-3 or the Octopus 101, programs G2 and G2x (three complete phases). The intraocular pressure was measured by means of daily pressure curves including 7 measurements with applanation tonometry at the office and the first one at 6/7 a.m. with the patient still in bed. Gonioscopic examinations were also performed for classification purposes.Results: By comparing all the stereometric parameters with the Total Area (disc area) and the Rim Volume it has been concluded that the megalopapilla group is different from both the normal control group and the glaucoma group. The disc area of the congenital glaucomas was not statistically different from the megalopapillas,but it was in terms of rim volume and other parameters.Conclusion: megalopapilla is an entity characterized by a large optic nerve head which may appear abnormal, with an increased cup, but associated with a normal rim volume, normal visual field and normal IOP. Special attention should be given to its differentiation from pseudoglaucomatous diseases.Discussion: The frequency of megalopapillas seems to be quite higher than incongenital optic nerve head anomalies, but is has been virtually ignored by the literatureworldwide so far.

Optic nerve head behavior in Posner-Schlossman syndrome

Purpose: To analyze the effect of glaucomatocyclitic crisis on the optic nerve head, as well as its consequent structural and hemodynamic changes. To evaluate the surgical indication for Posner-Schlossman syndrome.Materials and methods: Four Posner-Schlossman syndrome cases were evaluated for an analysis of the phenomena occurring in the optic disc by means of retinal confocal tomography and Scanning Laser Doppler Flowmetry, and their correlation with visual function as measured with automated computerized perimetry. In all cases the images were obtained in the mediate period after the attack, while in case 1, measurements were performed in the immediate and mediate periods before, during and after the attack.Results: Significant differences were found between optic nerve head parameters and retinal flow measurements in the different phases evaluated. No permanent optic nerve head damage was demonstrated in any of the cases studied, except for case 4 (Posner-Schlossman syndrome associated with traumatic glaucoma). All the variables analyzed returned to normal values after remission of the acute rise in intraocular pressure.Conclusions: During the attacks of ocular hypertension the optic nerve head experiences significant morphologic changes and hemodynamic variations; nevertheless since they are transient, they fail to cause permanent damage. There was only one case, in which there was optic disc damage and visual field loss. It can be concluded that surgery should be restricted to those cases with severe and disabling symptoms (relative surgical indication) or to cases with progressive optic neuropathy with visual field loss, when the syndrome is associated with glaucoma (absolute surgical indication).

Congenital Glaucoma: Light and Scanning Electron Microscopy of Trabeculectomy Specimens

Until 1968, we treated congenital glaucoma with goniotomy according to Barkan’s technique. With this method, we achieved favorable results in 65 % of the cases (in some after three goniotomies). Since 1969, we consider trabeculotomy according to Harms’ technique the surgical procedure of choice in congenital glaucoma. Our first results were published in 1972 (13). At present we have been able to control the intraocular pressure in 96 % of our cases (120 cases followed from 1 – 9 years).

Episcleral Venous Pressure

We were able to make all these measurements of episcleral venous pressure, thanks to the generosity of our colleague Dr. R. Brubaker of the US Institute of Health who gave us the equipment and showed us how to use it.

Congenital anomalies of the optic nerve head – review

Purpose: To show the topographic features and specific measurements of the different optic nerve head congenital anomalies.Material: Confocal tomography was performed to the following optic nerve head congenital anomalies: Morning Glory Syndrome, Optic Disc Coloboma, Peripapillary Staphylomas, Megalopapilla, Optic Disc Pit, Tilted Disc Syndrome and Pseudopapilla.Methods: Examinations were performed with the Heidelberg Retina Tomograph (long wave: 680 nm), using the new standard reference plane. Each eye was also examined with fundus biomicroscopy.Results: The examinations with confocal tomography show great differences and specific features in each anomaly. Topographic data and stereometric measurements are showed for each case.Conclusion: Confocal tomography is able to demonstrate and separate the different optic nerve head anomalies, and the measure O. N. H. parameters.

Prof. Marc Amsler and the Cantonal Hospital Eye Clinic, Zurich.

Prof. Marc Amsler was an outstanding teacher of ophthalmology and a highly creative clinician, investigator and designer of instruments and surgical procedures. Well known for his design of the Amsler grid, he also conducted investigations into anterior chamber puncture and the aqueous humor in uveitis. In this biographical sketch the author recalls his experience working with Prof. Amsler in Zurich in 1955, during which time the author made important discoveries regarding the increased permeability of the blood-aqueous barrier in exfoliation syndrome.

The Role of Pachimetry

When Goldmann built his tonometer, he specified that the measurement obtained was for a normal cornea of 525 mm. As pressure readings moved away from this number, they became less trustworthy.

Ocular Embryology with Special Reference to Chamber Angle Development

We will leave aside the discussion of the two most widely accepted theories regarding the mechanism by which the chamber angle is formed: whether it results from atrophy and resorption [1] or from cleavage and separation into layers [2].