Biomedical subjects
Publications and source records attributed to A R Rosenthal.
HLA testing of 55 patients with primary open-angle glaucoma revealed no increased frequencies of any of 17 HLA-A and 29 HLA-B antigens. However, the subgroup with a known family history of primary open-angle glaucoma had an increase in the frequency of the HLA-B12 antigen (48%). Intrafamily studies might further define the strength and importance of this association.
Ten patients harboring a small, intra-vitreal, copper foreign body in one eye for 4 months to 29 years have been studied clinically and electrophysiologically. Nine of the ten affected eyes had a visual acuity of 20/60 or better. Some asymmetry existed in the electrophysiologic responses of seven affected eyes as compared to the controls, but all of these responses were within the normal range. The electroretinogram was reduced in one eye but was consistent with vitreous opacification. Vitreous opacification and copper deposition in the macula were potentially serious sequelae observed in four eyes. Small, intraocular copper foreign bodies can be tolerated for long periods of time without retinal toxicity, but vitreous changes of maculopathy may necessitate intervention.
Thirty-two eyes in 28 patients with anterior chamber angle neovascularization were prospectively treated with panretinal photocoagulation. Of 17 eyes that had less than 270 degrees angle closure, with an intraocular pressure of less than 40 mm Hg prior to treatment, 16 showed complete disappearance of the angle neovascularization and stabilization of the peripheral anterior synechiae after treatment. None of the 15 patients who had angle closure of 270 degrees or greater, or an intraocular pressure of above 40 mm Hg, showed any significant improvement after treatment. These results suggest that panretinal photocoagulation offers a highly effective means of dealing with early and moderately advanced cases of angle neovascularization.
Four medical centers collaborated in the development of a course in ophthalmology to present new information and skills to the practicing specialist who is not associated with a medical center. The course is presented in 8 two-day sessions, scheduled Friday and Saturday, four times a year, on a two-year cycle. Thus, the participant loses only four days a year from his practice. This course differs from most of the postgraduate courses currently being offered in that it is designed to update basic specialty knowledge and skills systematically to improve health care delivery.
A platelet-fibrinogen-thrombin mixture utilizing autologous platelets was studied for its potential to seal perforating corneal wounds. In rabbits, the mixture demonstrated sufficient adhesive properties to permit 75% of penetrating keratoplasties to remain in place without the use of sutures. All 12 grafts held initially; after 48 h three grafts extruded. In control eyes only two out of 12 (16%) of the corneal grafts remained in place. The material is simple to prepare and apply and is not toxic to the cornea. It does not cause inflammation or lid irritation. Intraocular complications observed with its use were transient anterior synechiae and retrocorneal membrane formation.
Between 1956 and 1974, 28 children with retinoblastoma have been irradiated with the linear accelerator at the Stanford University Medical Center. Twenty-seven children (96%) have been cured of their tumor, with follow-up ranging from 2 1/2 to 21 years. In these survivors, 50 eyes were affected. Twelve were treated by primary enucleation and 38 were irradiated. Sixteen of the 38 irradiated eyes (42%) were ultimately enucleated for recurrent tumor, neovascular glaucoma, or inability to observe the tumor through opaque media. Thus, 22 (58%) irradiated eyes were saved. Of these, five eyes had visual acuity of 20/40 or better, five had 20/50 to 20/100, nine had 20/200 to hand motion, and three had light perception or no light perception. Radiation therapy can sterilize the tumor and maintain useful vision in many children with retinoblastoma.
Videotaped programs that could be used for screening of visual acuity and of visual fields by means of broadcast television have been developed and tested. The tests are designed to be effective regardless of the size of the viewer's television screen. Inevitably, false-positive and false-negative results would occur, which would have to be carefully explained at the time the tests were broadcast.
Chloroquine was administered intramuscularly 5 days a week to rhesus monkeys for as long as 4 1/2 years. No clinical, fluorescein angiographic, or electrophysiological evidence of retinal damage was observed. Yet chloroquine/chloroquine byproduct analysis of the ocular tissues revealed an enormous binding capacity of the pigmented tissues of the eye (choroid plus RPE, ciliary body, and iris) with eventual accumulation observed in the retina. Despite the normal ophthalmic appearance and function, extensive pathological changes occurred in the retinas and choroids of these experimental monkeys. The chloroquine caused an initial dramatic effect on the ganglion cells, with the photoreceptors affected shortly thereafter. Patching degeneration of the ganglion cells and photoreceptors then progressed over several years, with the choroid and pigment epithelium ultimately deteriorating as well.
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Clinical, ophthalmoscopic, perimetric, and color vision tests and visual evoked responses were recorded in symptomatic and asymptomatic eyes in five members of a family with Leber hereditary optic atrophy. The presymptomatic eyes showed abnormalities in the retinal nerve fiber layer. Optic nerve dysfunction was found before central vision failed. The appearance of degenerating retinal nerve fibers, particularly in the papillomacular bundle, was documented photographically in the weeks after the onset of visual symptoms. Treatment with prednisone and hydroxocobalamin did not reverse or halt serious impairment of vision.
An iron foreign body was placed into the vitreous cavity of 22 rabbits' eyes. The electroretinographic (ERG) changes over a-15-week period were recorded. These changes were compared to those in a group of 12 normal rabbits and a group of 5 animals in whom a sham operation was performed. Twelve eyes were enucleated during this period and examined histopathologically. Histopathologic and functional changes in siderosis were both progressive in time, but the ERG values were more consistent among the 22 animals than the morphologic changes. Iron oxidation (Fe0 leads to Fe2 leads to Fe3) was found and suggested to be the mediating factor of the direct iron cytotoxic effect on the retina.
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The value of orbital CCT scans was studied by grouping the CCT scans of 196 patients into clinical diagnostic categories. In 83% of patients with suspected Graves' ophthalmopathy, CCT confirmed the diagnosis. The CCT scan differentiated patients with Graves' disease from those with orbital pseudotumour or malignancies. The CCT scan was positive in 92% or patients with proven orbital malignancies. In 73% of patients with proptosis of unknown aetiology, and in 56% of patients with ocular motility problems, the CCT scan led to the diagnosis. The CCT scan ruled out orbital mass lesions in cases of optic neuritis, optic atrophy or vascular malformations. The greatest value of the CCT scan was in the localization and determination of the size and shape of various orbital lesions and in the accurate follow-up of those lesions utilizing serial scans.
Of a randomly selected sample of 40 patients with chronic simple glaucoma 11 were identified as having failed to comply adequately with medical advice. Noncompliers were more likely: to be men, to have had no other medical disorder but glaucoma, not to rank glaucoma as most troubling if they had another illness, to have experienced side effects from the treatment, and not to have appreciated the association between glaucoma and blindness. Detailed clinical study revealed that several interrelated psychosocial factors contributed to noncompliance.
The reproducibility of digital photogrammetry of optic nervehead photographs taken with the Zeiss fundus camera with Allen stereoseparator, the Donaldson fundus camera, and the Zeiss fundus camera with twin-prism separator were evaluated. Reproducibility of the various quantitative factors was significantly better when the two types of simultantic cups. Larger per cent errors were encountered with shallower optic cups. Substantial improvements in parameter reproducibility were obtained when finer sampling intervals were used during film digitization.
A clinicopathologic study of eight human eyes containing intraocular copper foreign bodies was undertaken. These foreign bodies, which had been retained in the eyes from three weeks to 22 years, were analyzed by atomic-absorption spectrophotometry and x-ray diffraction to determine their chemical composition. Copper deposits in Descemet membrane, vitreous, internal limiting membrane of the retina, and fibrous capsule around the foreign bodies could be demonstrated by rhodanine, rubeanic acid, and alizarin blue stains and were correlated with clinical findings and pathologic changes. Eyes with foreign bodies containing more than 85% copper tended to show more disseminated copper deposits. Eyes with alloy containing less than 85% copper showed more localized deposits of copper. Retinal structures were well preserved, even in an eye with an intraocular copper foreign body that had been retained for 22 years.
In an attempt to prevent the intense inflammatory response to intravitreal copper foreign bodies in the rabbit eye, varying dosages of dexamethasone sodium phosphate were administered daily via the subconjunctival route. The steroid appeared to behave systemically and had similar effects in both the injected and the noninjected eyes. Its effect was similar also regardless of the concentration of copper within the foreign body. Nine days of dexamethasone therapy prevented a substantial number of copper foreign bodies from becoming totally encapsulated during that time. Furthermore, a delay in the onset of the inflammatory response to the foreign body was noted. In a few instances, inflammation was completely suppressed during the entire course of therapy.
Fifteen eyes of 11 patients with rubeosis iridis and angle neovascularization associated with retinal vascular disorders were treated with pan-retinal photocoagulation. In seven of the 15 eyes, the new vessels on the surface of the iris and in the angle regressed after pan-retinal photocoagulation therapy for disk neovascularization; five of the remaining eight eyes that were treated prospectively demonstrated similar involution of the rubeosis iridis. In three of the five preexisting peripheral anterior synechiae regressed and angle structures previously obscured became visible. Three to 36 months after therapy, three eyes developed a few new abnormal iris and angle vessels.