Metabolic, pediatric, and systemic ophthalmology (New York, N.Y. : 1985)最新文献

This is a cumulative clinical study of the effect of topical guanethidine sulfate solution. Two hundred fifty-six cases of patients with lid retraction secondary to thyroid orbitopathy or trauma were treated with guanethidine sulfate 5-10% solution before surgical intervention was considered. Eighty-five percent of thyroid-related lid retraction responded to guanethidine sulfate, whereas only 67% of the traumatic or iatrogenic cases responded to guanethidine sulfate. None of the patients showed overt reaction to guanethidine sulfate. The conservative management of lid retraction with topical guanethidine sulfate is relatively safe and mostly effective and should be considered before surgical intervention is considered.

We present a case of bilateral, primary, localized, corneal amyloid deposition with a unique appearance not, to our knowledge, previously described. The patient was a 73-year-old white man who complained of glare. Best corrected visual acuity was 20/25 in both eyes. Slit lamp examination revealed subepithelial/anterior stromal white-gray deposits in the peripheral cornea in both eyes. The corneal surface was smooth with no elevated areas. Superficial corneal scrapings showed focal deposits of an amorphous, glass-like material below the epithelial surface and within Bowman's membrane, which stained with Congo red. We examined the amyloid deposits using the confocal microscope to obtain high magnification images in vivo. The confocal microscopic views showed intercellular, cotton candy-like, fibrillar amyloid material scattered throughout the anterior stroma. The use of this instrument may permit clinical diagnosis of this rare disorder without the need for biopsy.

This report gives an overall view on the aspect of numerous diseases and symptom complexes affecting both eyes and teeth. The knowledge of these disorders enables the ophthalmologist to suspect and recognize certain types of dental malformation and enables the dentist to discover certain eye defects. Moreover, it is important that clinicians be aware that simultaneous eye and tooth defects may be the indication of possible disturbances in other, apparently unrelated, organs or systems. Because such disorders are frequently hereditary conditions, their early detection will aid in the diagnosis and treatment of other affected family members. This may also help the parents to cope with the disease and be of benefit to the infants because a cure may be forthcoming.

A prospective study on the effect of ECCE + IOL implantation on the course of diabetic retinopathy (DR) in 59 eyes showed that in one to three years following surgery, progression of DR, including the development of newly formed one, occurred in 28.8% of the eyes. This was more marked in patient with IDDM (IDDM-46%, NIDDM-24%) as well as in eyes with pre-operative BDR (pre-operative BDR-62.5%, no pre-operative BDR-16.3%). Final visual acuity was better in eyes without pre-operative DR as well as in eyes that did not show progression of the retinopathy.

Certain metabolic eye disorders may be caused by nutritional factors, and others may be treated by nutritional adjustments or withdrawal of certain elements in the diet, and sometimes the inclusion of certain drugs. Occasionally a metabolic eye disease is drug induced. Quite often, certain addition or subtraction to or from the patient's regimen may influence the progress of the metabolic eye disease.

A retrospective study was done for 95 eyes of Egyptian children in whom I.O.L. implantation was performed between 1985 and 1986 to treat unilateral cataract due to trauma or congenital or aphakia. The average range of follow up period was three to four years old. It was revealed that I.O.L. In traumatic cataract gave the best results (as regards the visual acuity with minimal complications) especially with anterior chamber lenses and still the secondary implantation of A.C. lenses had to some extent better results than that of primary A.C. lenses. In congenital cataract, P.C. lenses gave the worst results. Again, the older the age of the children, the better the results of I.O.L. implantation.

The metabolic stress in both pregnancy and diabetic mellitus being endocrine mediated, it has always been feared whether a patient with an underlying retinopathy will progress into the more difficult proliferative stage with the coming of pregnancy. Admittedly, this important question has been answered differently by different investigators. However, much of these studies has been only impressive statistical analysis of large number of cases without any laboratory or clinical investigations being undertaken alongside to ascertain into the role of all endocrine hormones. We have tried to fill this omission here in this study. From this study we have come to believe that there is no factual evidence of deleterious relationship between the onset of pregnancy and the underlying diabetic retinopathy. Matter of factly, our study show that pregnancy may actually provide respite from developing further complications. Here, the hormone prolactin may play an important protective role.

Sickle cell disease patients are known to manifest different types of ocular problems. These problems include proliferative and non-proliferative retinopathies, and refractive errors. The distribution of these pathologic and refractive problems among the sickle cell genotypes is analyzed according to the individual genotypes. Data collected from a total of 63 sickle cell disease patients who responded to the questionnaires shows that fifty-six percent (35) are males and forty-four percent (28) are females. The genotype distributions are: SS, 55% (34); SC, 33% (21); S-Thal, 11% (7); while 2% (1), is AS-genotype. Overall findings show that severe ophthalmic abnormalities were reported by approximately 90% of the respondents with sickle cell disease. The majority of sickle cell disease patients in this research show consistent susceptibility to both fungal and bacterial infections with varying degree of refractive errors. It is observed that refractive errors are prevalent in SC and S-Thal sickle cell genotypes, while the severity of anemia and painful crises are more prevalent in SS and S-Thal genotypes. Systemic ocular problems are also prevalent among the SC and S-Thal disease genotypes.

We studied 257 patients scheduled for cataract surgery for possible correlation with systemic diseases, blood chemistry, and environmental exposure. We found that posterior subcapsular cataract appeared in patients 10 years younger on average than those with other types of cataract. Nuclear cataract patients had higher blood levels of uric acid and creatinine and lower blood levels of calcium. We suggest capsular insult as a possible pathophysiological explanation for cataract formation in young age groups (as well as diabetes) and a toxic effect of blood metabolites in patients with renal failure, resulting in earlier and more prevalent sclerosis of lens fibers. No effect of smoking or of exposure to sunlight on the distribution of various types of cataracts was noted.

Several types of hypopigmentation in humans are called albinism. The phenotype for different types of albinism varies according to the amount of pigment in the hale, skin and iris, the reduction in visual acuity and the degree of nystagmus and strabismus. Cutaneous and ocular melanin pigment can range from complete absence throughout the lifetime of the individual to the development of nearly normal levels, including the ability to tan. Visual acuity ranges from 20/40 to 20/400, and visual development in an affected infant is slower than normal. Foveal hypoplasia and altered routing of the optic nerves are found in all types of albinism and are the most constant feature of this condition. The demonstration of optic track misrouting by visual evoked potential studies provides the critical diagnostic procedure for questionable cases of albinism, and this is the single definitive diagnostic test to confirm a diagnosis of albinism.