Biomedical subjects
Publications and source records attributed to J T Patten.
Temporal (giant cell) arteritis is a disease of older persons that has a variety of clinical presentations. It is a major cause of blindness. The erythrocyte sedimentation rate is almost always markedly elevated. Corticosteroidss in large doses are urgently required. The diagnosis is established by biopsy of an artery. In an 80-year-old women who sudddenly became blind, the signs had been masked by low doses of steroids given for a mistake diagnosis.
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Two patients with a clinical picture identical to idiopathic ocular cicatricial pemphigoid had received long-term (six to nine years) echothiophate iodide treatment for control of glaucoma in the affected eyes after cataract extraction. Basement membrane zone staining for IgG was seen in the conjunctiva of one affected eye. Decreased or absent goblet cells, epidermalization of the conjunctiva, fibroses, and abnormal numbers of inflammatory cells were seen in both affected eyes.
Five families, four Caucasian and one Negro (14 patients) with fleck (speckled or Mouchetée) dystrophy of the cornea are presented. In each, the typical presentation of fine scattered fleck-like dystrophic lesions was found throughout all layers of the central and peripheral corneal stroma but not affecting the epithelium, Bowman's membrane, Descemet's membrane or the endothelium. Clear stroma was noted between each lesion. Visual acuity in all patients was normal or only slightly affected. Except for an occasional patient with minor photophobia, almost all patients found affected with this dystrophy were asymptomatic in regard to their corneal condition. There was no decrease in corneal sensitivity noted in any patient. All families displayed evidence of an autosomal dominant hereditary pattern and progression of the dystrophy is slow and benign in character. With the exception of one family with atopic disease, no systemic organic illness was noted by histroy in all of the families. Laboratory screening of 2 of the 5 families showed no abnormalities of any systemic metabolic disorders. The characteristic clinical picture and favorable prognosis of this condition enables one to easily differentiate this condition from other known parenchymatous corneal dystrophies. The incidence of this condition is probably much more common than the reported cases in the literature might indicate.
Central corneal perforations have traditionally been managed by conjunctival flaps, tissue adhesives, soft contact lenses, corneal patches and other conservative measures for the immediate preservation of the eye. An alternative method of treatment is immediate penetrating keratoplasty. We present the result of immediate keratoplasty for 25 eyes referred with acute central corneal perforations, 20 of herpetic origin and 5 with a chemical burn or dry eye syndrome. In all cases, the eye was successfully preserved. Twelve of 20 grafts (60%) for herpetic perforation went on to eventual clear grafts as opposed to 1 of 5 grafts (20%) in the dry eye or chemically burned patients. Significant complications encountered included cataract formation, secondary glaucoma and persistent epithelial defects; however, these should not preclude eventual restoration of good visual acuity. Penetrating keratoplasty in acutely inflamed and perforated eyes used to lead to angle closure and secondary glaucoma in a considerable number of cases, sometimes progressing to total disaster. We have shown that if enough corticosteroids are given immediately postoperatively, the risk for angle closure is not significant.
N-butyl cyanoacrylate tissue adhesive can be easily placed in the lid puncta to serve as a temporary method for punctal occlusion. Such a procedure is a useful therapeutic trial in borderline cases of keratoconjunctivitis sicca being considered for further permanent punctal occlusion or in patients where a temporary dry eye condition is expected to be resolved in the near future.
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The making of a groove in cataract surgery and the preplacement of one or more sutures into the groove has been advocated by many surgeons. An instrument that facilitates the performance of the surgical groove is introduced. This instrument, a modification of a corneal trephine, provides a neat, smooth groove of adjustable depth.
Large penetrating transorbital foreign bodies may initially appear to be of a devastating character to the ocular tissues. However, several reports of such large foreign bodies have proved to spare the eye. A case report of a large wooden foreign body with transorbital penetration into the right frontal lobe is reported. The globe remained intact and was only displaced, with a final visual acuity of 20/40. However, complete ophthalmoplegia and ptosis persisted. A low pressure hydrocephalus ensued following intracranial debridement.
Granuloma pyogenicum or telangiectatic granuloma is an unusual clinical lesion which may occur anywhere on the body, but on rare occasions presents with ocular manifestations. Its occurrence on the lids has been reported in several instances, but few cases of isolated conjunctival changes have been documented. The purpose of this paper is to present a previously unreported case of histologically proven bilateral granuloma pyogenicum of the conjunctiva and to alert other ophthalmologists as to its significance in the differential diagnosis of conjunctival masses.