Recent advances in cellular immunology have enabled us to delineate numerous lymphocyte subsets and activation stages using monoclonal antibody techniques. lymphocyte subsets and activation stages using monoclonal antibody techniques. We have used a fluorescence activated cell sorter (FACS) and newer monoclonal antibodies to study lymphocyte subpopulations and activation stages of T lymphocytes in intraocular fluids and peripheral blood of uveitis patients. T lymphocytes predominated in aqueous and vitreous. A statistically significant correlation was observed between the T lymphocyte subsets in aqueous and peripheral blood. No correlation was seen between the intravitreal lymphocyte subsets and peripheral blood. Many intraocular lymphocytes are present in the aqueous secondary to a blood ocular barrier breakdown. Using an anti-interleukin-2 (IL-2) receptor monoclonal antibody as a marker for T-cell activation, activated lymphocytes were found in intraocular and peripheral blood of both idiopathic and non-idiopathic uveitis. A statistically significant correlation was found between in vivo lymphocyte activation and clinical uveitis activity. In uveitis, lymphocyte activation in the eye paralleled levels found in the blood. Systemic and intraocular lymphocyte activation occurs in both idiopathic uveitis as well as in systemic syndromes associated with intraocular inflammation. It is possible that idiopathic uveitis is a systemic disease.
The records on thirty-three patients (58 eyes) with the diagnosis of pars planitis were reviewed. The patients were divided into 4 groups: Group 1 had bilateral vitreous cells and pars plana 'snowbank' formation (13 patients, 26 eyes), Group 2 had bilateral vitreous cells and 'snowbank' formation in one eye only (8 patients, 16 eyes), Group 3 had vitreous cells and 'snowbank' formation in one eye only (8 patients, 8 eyes), and Group 4 had bilateral vitreous cells without 'snowbank' formation (4 patients, 8 eyes). Frequent findings and complications were tabulated; cystoid macular oedema was the most common cause of decreased vision. Although pars plana 'snowbank' exudates are usually present in pars planitis, they may not be necessary to make the diagnosis. An approach to therapy is outlined.
Information collected on the children of the 1970 Birth Cohort Study has been used to examine the educational performance of children who have minor defects of visual acuity. Results suggest that children with mild degrees of hypermetropia may experience difficulty learning to read but with exclusion of this group significant educational disability was not associated with minor visual defects. The significance of this finding is discussed in conjunction with information on prevalence of defects and current practice in screening and treating visual defects in school children. Some anomalies in current practice are identified.
The exfoliation syndrome has now been recognised all over the world and even in such ethnic groups as the Skolt Lapps, Navajo Indians, Australian aborigines and all major tribes of the South African Bantu. The prevalence appears rather all major tribes of the South African Bantu. The prevalence appears rather similar in those countries where population-based surveys have been conducted. The exfoliation syndrome is age-dependent. In Caucasians the prevalence is low before the age of 60 years, increasing steadily to about 8 per cent in the group aged 80 to 90 years. However, the Bantus show a 6.4 per cent prevalence in the age group 30 to 39 years. In population-corrected surveys the females show a higher prevalence of the syndrome than do the males. Familial occurrence of exfoliation and population genetics have suggested an autosomal dominant mode of heredity. Suggestions of differences in prevalence of the exfoliation syndrome in different countries and even in different areas of the same country call for further population-based even in different areas of the same country call for further population-based surveys. Recognition of exfoliation is clinically of paramount importance as 20 percent of exfoliation patients show abnormalities of intraocular pressure. Poor pupillary dilatation, fragile zonular fibres and 2 per cent lens displacement may induce difficulties in extracapsular cataract surgery with posterior chamber lens implantation. Ciliary sulcus fixation of intraocular lenses with large diameter of the haptics is recommended.
This is a long-term natural history study of 123 consecutive, nonselected patients (218 eyes) with senile retinoschisis examined periodically, while deliberately withholding all forms of treatment, for from 1 to 21 years (average, 9.1 years) so that the natural behavior and prognosis of this disease could be learned and reasonable recommendations for management could be formulated. The quadrant of maximal involvement was the inferior temporal and 74% of the lesions had posterior borders which were postequatorial. Senile retinoschisis was found to be primarily asymptomatic and nonprogressive. Current indications for treatment, treatment modalities, and complication rates published in recent literature are analysed. No case of symptomatic progressive retinal detachment occurred, but there were 14 cases of localized, nonprogressive and asymptomatic "schisis-detachment". Current indications for treatment of senile retinoschisis should be seriously reevaluated and reduced to one primary indication for treatment, namely symptomatic progressive retinal detachment.
Vascular hamartomas in childhood may occur in isolation, or in a more generalized form with both cutaneous and visceral involvement. Many isolated hamartomas require no active intervention, but those arising around the eye may seriously compromise developing vision, either by obscuring the visual axis, or by modifying the refractive status of the involved eye. Therefore, lesions in this site demand vigorous treatment if sight-threatening complications are to be avoided. We report our experience in treating 15 children using local steroid injections to accelerate regression of such vascular hamartomas. Seven of the children (46.7%) showed complete regression of their hemangiomas, and only two (13.3%) showed no response to the injections. Intralesional steroid injection seems to be a relatively effective, safe, and nondisfiguring method of dealing with periocular vascular malformations.
The internist or family medicine consultant can have an important role in the management of endophthalmitis. Even though intraocular antimicrobial therapy is the most effective method of treatment, the consultant can assist in the selection of systemic antibiotic agents and in the monitoring of systemic side effects of the treatment. In addition, the consultant can be called on to evaluate patients with endogenous endophthalmitis for systemic involvement. The joint efforts of the ophthalmologist and consultant should allow optimal treatment in an attempt to improve the visual prognosis for these devastating ocular infections.
The general and ocular signs in patients with deletion of the short arm of chromosome 5 (cri du chat) and ring chromosome 14 have been reported previously in the literature. Ophthalmic changes recorded in the latter anomaly are scanty. We describe a patient with the combined chromosomal anomaly--a deletion of part of the short arm of chromosome 5 and a ring chromosome 14 which hitherto has not been reported.
Three patients are described who presented with acute painful proptosis, ptosis and ophthalmoplegia. Orbital cellulitis was initially diagnosed in all cases, but there was no therapeutic response to antibiotics. A dramatic improvement occurred with steroids. All patients had, or developed abnormal thyroid tests and CT Scans showed thickened ocular muscles. This is an unusual presentation of thyroid ophthalmopathy.
Norrie's disease is an X-linked disorder with congenital blindness. Carriers are clinically healthy, so that they are only identifiable when they are daughters of affected males, or mothers to affected males in whose families other males have Norrie's disease. Daughters of carriers have an á priori 50 per cent risk of being carriers themselves. We have recently found close linkage between the genes for Norrie's disease and the DXS7 locus, characterised by a DNA restriction fragment length polymorphism (RFLP), L1.28. In three informative families we show that this RFLP can help to delineate carriers from those of their female relatives who are homozygous for the normal gene.
Scanning electron microscopy of primate anterior uveal methylmethacrylate vascular casting has revealed a complex, multifaceted, highly anastomotic vasculature. The anterior and long posterior ciliary arteries interconnect to form three collateral vascular circles: the episcleral circle; the intramuscular circle; the 'major' arterial circle. Located at the iris root, the 'major' arterial circle is the most discontinuous with its circumferentially oriented vessels frequently ending in iris and ciliary process arterioles. The ciliary process microvasculature is also highly complex, with two types of arterioles: anterior and posterior. Anterior arterioles possess focal constrictions near their origins and supply capillaries to the anterior regions and margins of the major ciliary processes. Posterior arterioles are less constricted and supply the minor ciliary processes and the central portions of the major processes. These findings, and the demonstration of multiple other channels, suggest several mechanisms by which blood can be shunted between and around the major and minor ciliary processes. In addition, we illustrate the use of scanning electron microscopy of methacrylate luminal castings to demonstrate alterations of the ciliary microvasculature in response to both pharmacologic and surgical stimuli. Quantitative studies of methacrylate castings may allow future localisation of the sites of vasomotor substance activity and improve our understanding of the role of blood flow in aqueous humour production.
Twenty four cases in whom occlusive disease of the carotid artery was proven by digital subtraction angiography or direct carotid arteriography were studied. In five cases venous stasis retinopathy was evident ophthalmoscopically. Fluorescein angiography was abnormal in 19 cases. The abnormalities found were microaneurysms (16 cases); slow arteriovenous transit time (8 cases); macular oedema (8 cases); leakage from the arterioles (3 cases); disc new vessels (4 cases). The differences between this retinopathy and diabetic retinopathy are discussed.
Bacterial infection may be responsible for mild self-limiting disease, chronic disease or acute and devasting ocular destruction. This paper and those that follow deal with some of the clinical forms of disease which are encountered, the bacteria responsible, the mechanism of invasion and the natural defences and clinical management, including selection and delivery of antibiotics.
This study analyses the management of ptosis associated with minimal levator function in 105 cases over an eight-year period. A 96 per cent success rate has been recorded which parallels previous authors' results. Clinical indications and relevant pathology are detailed with early identification and graded operative intervention postulated as suitable management for most cases. The overall success rate depended on the use of autogenous fascia lata, delaying its use until after the age of four, and adopting a bilateral approach whenever possible. Stored fascia lata was used in infants and in certain acquired unilateral cases.
