doi: 10.1001/archopht.1986.01050230006001pmid: N/A
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
doi: 10.1001/archopht.1986.01050230015002pmid: N/A
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
doi: 10.1001/archopht.1986.01050230016003pmid: N/A
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
doi: 10.1001/archopht.1986.01050230021005pmid: N/A
Abstract In Reply. —The comment made by Dr Quigley that "the available histopathologic evidence does not show that focused ultrasound has a more pronounced effect than cryotherapy on ciliary body structure" is incorrect and deserves further discussion.As an ocular pathologist, I agree wholeheartedly that eyes such as the one treated with FHI ultrasound should be studied thoroughly. It is somewhat ironic that if it were not for the striking morphologic changes in the ciliary body that stimulated my interest, this case would have been overlooked because the globe was submitted to the laboratory without any history, except for the comment blind and painful. Since the profound focal destruction of the ciliary body was far greater than anything I had previously observed following cryotherapy, I decided to further investigate the cause. After making several inquiries, I discovered that the patient had been treated with a new investigational form of ultrasound.If References 1. Quigley HA: Histological and physiological studies of cyclocryotherapy in primate and human eyes . Am J Ophthalmol 1976;82:722-732. 2. Ferry AP: Histopathologic observations on human eyes following cyclocryotherapy for glaucoma . Trans Am Acad Ophthalmol 1977;83:90-113.
doi: 10.1001/archopht.1986.01050230021004pmid: 3778265
Abstract To the Editor. —Recently Margo1 described the histologic effects of an unsuccessful focused ultrasound treatment for glaucoma. We should learn as much as possible from such valuable experience. For example, in this eye, why was the glaucoma not controlled? The author stated that in areas with "highly localized destruction" of the ciliary body, only the "posterior half of the pars plicata" was disorganized. Unfortunately, in the three photographs showing the pars plicata (Figs 1 through 3), two figures have little direct view of this structure and the third one (Fig 2) is too dark and set at too low a magnification to detect the details of the effect of treatment. Presumably, however, the protocol used in this eye did not destroy enough aqueous humor-forming capacity to normalize eye pressure; either the direction at which the instrument was aimed was too posterior (destroying only the posterior portion of the pars References 1. Margo CE: Therapeutic ultrasound: Light and electron microscopic findings in an eye treated for glaucoma . Arch Ophthalmol 1986;104:735-738.Crossref 2. Smith RS, Boyle E, Rudt LA: Cyclocryotherapy: A light and electron microscopic study . Arch Ophthalmol 1977;95:284-288.Crossref 3. Howard GM, DeRoetth A: Histopathologic changes following cryosurgery of the ciliary body . Am J Ophthalmol 1968;64:700-707. 4. Quigley HA: Histological and physiological studies of cyclocryotherapy in primate and human eyes . Am J Ophthalmol 1976;82:722-732. 5. Ferry AP: Histopathologic observations on human eyes following cyclocryotherapy for glaucoma . Trans Am Acad Ophthalmol 1977;83:90-113. 6. Quigley HA: Clinical application of cyclocryotherapy . Arch Ophthalmol 1977;95:714.Crossref 7. Patel A, Thompson JT, Michels RG, et al: Endolaser treatment of the ciliary body for uncontrolled glaucoma. Ophthalmology, in press.
Odom, James Vernon;Weinstein, George W.;Farber, Matthew E.;Chao, Gung-mei
doi: 10.1001/archopht.1986.01050230022006pmid: 3778266
Abstract To the Editor. —In his recent editorial, Dr Guyton1 emphasized the dangers of attending only to the accuracy of a test to assess visual function behind opacities. He indicated a strong concern with mechanisms responsible for overestimates of postoperative acuity (false-positives) and suggested recommendations for future investigations. Although we agree with Dr Guyton's basic points, we would like to suggest a change in his terminology and an expansion of his area of concern.In most scientific and medical literature, a positive test is by convention one that indicates the presence of a disease.2 A false-positive test indicates the presence of a disease when no disease is present. In ophthalmology, poor visual acuity is evidence of visual disease. By analogy, then, if one is evaluating visual function behind a media opacity, a test that predicted poor postoperative visual acuity should be termed a positive test, and a test that References 1. Guyton DL: Misleading predictions of postoperative visual acuity . Arch Ophthalmol 1986;104:189-190.Crossref 2. Fletcher RH, Fletcher SW, Wagner EH: Clinical Epidemiology: The Essentials . Baltimore, Williams & Wilkins, 1982. 3. Odom JV, Hobson RR, Coldren JT, et al: Prediction of postcataract extraction visual function: Use of 10 Hz flash VEPs . Invest Ophthalmol Vis Sci 1985;26( (suppl) ):308.
doi: 10.1001/archopht.1986.01050230023007pmid: N/A
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract To the Editor. —The use of colored caps—red for mydriatic drugs and green for miotic drugs—has been an industry standard and has simplified patient direction and understanding. It would be helpful if each category of medication, eg, β-blockers, steroids, antibiotics, and tear replacements, were assigned a specific colored cap.
doi: 10.1001/archopht.1986.01050230023008pmid: 3778267
Abstract To the Editor. —I read with interest the article in the Archives entitled "Optic Neuropathy in Systemic Lupus Erythematosus" by Jabs et al1 and totally concur with their statement that "in virtually any patient, particularly young women, who develop any type of optic neuropathy, whether unilateral or bilateral, the possibility of SLE [systemic lupus erythematosus] must be considered, and an appropriate history, examination, and serologic studies may be required." I believe, but cannot yet document, that this entity is much more common than we believe and may be a presenting manifestation of an autoimmune disease years before the appearance of convincing clinical signs, symptoms, and serologic abnormalities.I have had excellent success restoring vision in patients with both suspected and known autoimmune disease and visual loss due to an optic neuropathy with pulse dosage of megadose intravenous methylprednisolone.2 Similar success has been reported by others.3 I suggest References 1. Jabs DA, Miller NR, Newman SA, et al: Optic neuropathy in systemic lupus erythematosus . Arch Ophthalmol 1986;104:564-568.Crossref 2. Spoor TC: Treatment of optic neuritis with megadose corticosteroids. J Clin Neuro Ophthalmol, in press. 3. Dutton J, Burde LR, Klingele T: Autoimmune retrobulbar neuritis . Am J Ophthalmol 1982;94:11. 4. Braughler J, Hall E: Current application of 'high-dose' steroid therapy for CNS injury . J Neurosurg 1985;62:806.Crossref
doi: 10.1001/archopht.1986.01050230023010pmid: 3778268
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract To the Editor. —In ophthalmic laser surgery, contact lenses are employed to allow the visualization of internal features of the eye and their exposure to carefully controlled laser irradiation. The contact lenses are modifications of designs that were originally developed for slit-lamp biomicroscopy. The danger of portions of the laser beam being reflected back from a contact lens has been well recognized, and antireflection coats are used on the first surface of all laser-treatment lenses.Despite the presence of front surface coatings, uncomfortable "flashback" reflections of bright aiming beams occur when portions of the beam return to enter the viewing microscope. On other occasions, significant portions of light are observed to be reflected back into the room. These bright reflections occur most noticeably in lenses that have two or more mirrors. The design of four-mirrored lenses appears to allow the greatest chance of flashback reflections of substantial portions of the
Jabs, Douglas A.;Miller, Neil R.
doi: 10.1001/archopht.1986.01050230023009pmid: N/A
Abstract In Reply. —We fully agree with Dr Spoor's letter that intravenous pulse methylprednisolone may be highly useful in the treatment of autoimmune disorders. This form of therapy has been used successfully in uncontrolled studies of patients with SLE, particularly lupus nephritis, and other autoimmune diseases. Indeed, patient 4 in our study was treated with this form of therapy, with a prompt response in her clinical picture.We add two notes of caution, however. The first is that the effect of pulse corticosteroids may be short lived and that subsequent daily corticosteroid or immunosuppressive treatment may be required. This is particularly true for chronic diseases such as SLE. The second is that complications of this treatment have been observed in as high as 56% of patients so treated.1 The most serious of these have been life-threatening dissemination of occult infection,1 cardiac arrest,2 and sudden death.3 These References 1. Garrett R, Paulus H: Complications of intravenous methylprednisolone pulse therapy , abstracted. Arthritis Rheum 1980;23:677. 2. Stubbs SS, Morrell RM: Intravenous methylprednisolone sodium succinate: Adverse reaction reported in association with immunosuppressive therapy . Transplant Proc 1973;5:1145-1146. 3. Bocanegra TS, Castaneda MO, Espinoza LR, et al: Sudden death after methylprednisolone therapy . Ann Intern Med 1981;95:122.Crossref
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