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Purpose: To analyze the results of resident-performed laser in situ keratomileusis (LASIK)., Setting: Rush University Medical Center, Department of Ophthalmology, Chicago, Illinois, USA., Methods: This retrospective study comprised 44 consecutive eyes of 22 patients who had LASIK performed from August 2000 through February 2002. Based on preoperative spherical equivalent, the eyes were divided into a low myopia group (A) (-1.0 to -6.0 diopter [D]) and a higher myopia group (B) (> -6.01 D). Preoperative and postoperative spherical equivalent (SE), best corrected visual acuity (BCVA), and uncorrected visual acuity (UCVA) were measured and analyzed within each group. Patients had at least 2 follow-up visits, with the second visit occurring between 1 and 9 months postoperatively., Results: Preoperatively, the mean SE in Group A was -3.93 D +/- 1.53 (SD) and in Group B, -8.49 +/- 1.70 D. At the final visit, the SE in Group A decreased to -0.29 +/- 0.55 D and in Group B, -1.09 +/- 0.87 D. The UCVA in Group A at the final visit was 20/20 or better in 43% of eyes and 20/40 or better in 100% of eyes. In Group B, the UCVA was 20/20 or better in 31% of eyes and 20/40 or better in 75% of eyes. In all eyes, the BCVA improved by 1 line in 16% or remained the same in 84%. No eyes lost any lines of BCVA. The SE taken at the last visit was within +/-0.5 D in 69% of all eyes and within +/-1.0 D in 82% of all eyes. The incidence of patients needing retreatment in resident-performed LASIK surgery was 3 of 44 (6.8%)., Conclusions: Laser in situ keratomileusis performed by residents is a safe and effective procedure for correction of refractive error. Postoperative UCVA, refractive error, retreatment rate, and loss of BCVA were consistent with published results from nonresident surgeons. These results also exceeded the U.S. Food and Drug Administration requirements for LASIK surgery.

Purpose: To report a case of hypercupremia with deposits in both eyes on the Descemet's membrane, surface of the iris, and lens capsule associated with multiple myeloma., Method: Case report., Results: A 64-year-old white woman had metallic deposits in both eyes on the central Descemet's membrane, surface of the iris, and the anterior and posterior lens capsule. A systemic examination revealed an elevated serum copper, normal serum ceruloplasmin, and an increased level of total protein and IgG kappa gammaglobulin. Based on these results, she was diagnosed with multiple myeloma., Conclusions: Copper deposits on the Descemet's membrane, surface of the iris, and lens capsule may be the first sign of multiple myeloma.

Purpose: A major disadvantage of photorefractive keratectomy (PRK) is pain and discomfort in the first three postoperative days. We tried to assess the efficacy and safety to the cornea of a limited amount of topical tetracaine given to patients for use when needed to manage severe pain., Methods: Sixty-nine eyes of 49 patients who underwent PRK between June 21, 1996 and June 15, 1998 by a single surgeon were prospectively included. Approximately 10 drops of commercial, non-preserved 0.5% tetracaine were given to patients to use when needed to control severe pain. A bandage soft contact lens was applied. Patients were examined at 1 and 3 days after surgery, at which time corneal re-epithelization was assessed and the number of tetracaine drops used was noted. No systemic analgesic or topical non-steroidal anti-inflammatory was prescribed., Results: All eyes healed within 3 days. The mean number of drops of tetracaine used was 2.3 drops over 3 days, although in 33 eyes (48%) the patient did not use any tetracaine. There was no correlation between the attempted correction in diopters and the number of drops used. No significant difference was found in the number of drops used in the second eye of patients who had both eyes treated., Conclusions: Limited use of topical anesthetics is an effective and safe analgesic option after PRK. Use of tetracaine in this protocol did not prolong the time to re-epithelialization. Giving only a limited amount of tetracaine to patients prevents abuse and toxicity to the cornea while managing severe pain.

Background: The ganciclovir implant (Vitrasert; Bausch & Lomb Inc, Claremont, Calif) has been a useful device in the management of cytomegalovirus retinitis. Seven months after placement, implant exchange is often considered. However, removal may be difficult and may result in vitreous hemorrhage or intraocular dislocation., Objective: To describe a suture loop attached to the implant strut and left in the sub-Tenon space to aid in implant removal., Methods: Twenty-five eyes of 17 patients received a ganciclovir implant with an 8-0 nylon suture loop left beneath the Tenon capsule and underwent at least 6 months of follow-up. Two of these eyes subsequently had a similarly modified ganciclovir implant placed at a separate site (inferonasally) with at least 6 additional months of follow-up. Six eyes of 3 patients had the implant removed as part of an exchange and underwent at least 4 months of follow-up., Results: In the 25 eyes, there were no cases of endophthalmitis, wound leak, suture exposure, or other complications. At implant removal in the 6 eyes previously mentioned, the loop was used for traction on the implant and aided in localization of the implant strut. In these 6 eyes, there were no cases of retinal or choroidal detachment, visually significant vitreous hemorrhage, implant dislocation, or other complications., Conclusion: A sub-Tenon capsule suture loop is well tolerated and can assist in ganciclovir implant removal.

Purpose: To determine the astigmatic effect of a supero-oblique clear corneal phacoemulsification cataract incision., Setting: A university-based general ophthalmology practice., Methods: All eyes having supero-oblique phacoemulsification cataract surgery using the right hand of a single surgeon between April 17, 1997, and July 24, 1997, were prospectively included. There were 52 eyes of 52 consecutive patients. Manifest refraction was performed preoperatively and 1, 3, and at least 6 months postoperatively. A Fourier method of vector analysis was used., Results: Mean refractive error (Fourier corrected) for all eyes and all ages preoperatively was -1.422 + 0.085 x 35.85. At 6 months, it was -0.620 + 0.190 x 14.2. There was little difference between right and left eyes. Patients older than 80 years had greater induced astigmatism., Conclusion: This study provides evidence that making a supero-oblique clear corneal phacoemulsification incision while sitting in the more natural superior position does not induce a clinically important amount of oblique astigmatism.

Infectious endophthalmitis can be caused by organisms from the environment entering the eye after ocular surgery (62%) or after penetrating ocular trauma (20%) (exogenous endophthalmitis), or can result from hematogeneous spread of organisms to the eye (8%) (endogenous endophthalmitis). Endophthalmitis is the most dreaded ocular infection, and carries one of the worst visual prognoses of all ocular infections. The symptoms of endophthalmitis are blurred vision, redness, and pain. The signs include conjunctival hyperemia, anterior chamber and vitreous cell, hypopyon, lid edema, chemosis, corneal edema, reduced red reflex, and afferent pupillary defect. The main treatment is intravitreal antibiotics used in conjunction with subconjunctival, topical, and intravenous antibiotics and corticosteroids.

Background: The purpose of the microkeratome in laser assisted in situ keratomileusis (LASIK) is to create a corneal flap of desired thickness, thus exposing the stroma. The accuracy and repeatability of intended flap thickness with the current microkeratome system has not been documented. The purpose of this study was to determine the precision and consistency of creating a corneal flap thickness of 160 microns with the Moria LSK-One microkeratome (distributed by Microtech, Inc., Doylestown, PA)., Patients and Methods: The records of 93 eyes from 67 patients who underwent LASIK were reviewed. The central corneal thickness was measured at baseline. The microkeratome using a "130" footplate was used to create an intended flap 160 microns thick, and the corneal thickness was then remeasured., Results: The mean flap thickness for both eyes combined was 159 microns (S.D. = 28). There was no significant correlation between pre-flap corneal thickness or average K and the corneal flap thickness., Conclusion: This study provides evidence that the Moria LSK-One microkeratome creates reproducible LASIK flaps consistently near the intended 160 microns corneal flap thickness. This knowledge enables the surgeon to make a corneal flap with great confidence in the thickness of the excision. In addition, this study provides a clinical, in vivo model for testing corneal flap thickness.

Background and Objective: This study was conducted to determine preoperative predictors of postoperative visual acuity in patients with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis and retinal detachment., Patients and Methods: The study design was a retrospective chart review of 38 eyes in 33 patients with AIDS and CMV retinitis who had retinal reattachment surgery by pars plana vitrectomy with the use of silicone oil tamponade. Factors considered included: preoperative visual acuity, macular attachment status and CMV activity at the time of surgery, and length of time from diagnosis of retinal detachment to surgical repair., Results: Retinal reattachment was achieved in 37 of 38 eyes. Mean interval from surgery to best corrected visual acuity (VA) was 9 weeks. The mean best corrected post-op VA was 20/70. Approximately half of the patients died within 7 months of the surgery. There was good correlation between preoperative VA and best attained postoperative VA (Spearman's: r = 0.5139, P = 0.001). The interval from retinal detachment to surgery, and best attained postoperative VA did not correlate (Spearman's: r = 0.2339, P=0.158). The lack of macular CMV retinitis correlated well with postoperative VA (P = 0.0066, Wilcoxon rank-sum test)., Conclusions: Preoperative visual acuity and macular attachment status correlates with better postoperative visual acuity results, whereas early surgical repair of retinal detachment does not.

Purpose: To determine whether propranolol can decrease surgical tremor and anxiety in residents performing ocular microsurgery without impairing patient or physician safety., Methods: In this randomized, double-masked, crossover study, 5 third-year ophthalmology residents ingested a capsule containing either propranolol, 40 mg, or placebo 1 hour prior to performing ophthalmic microsurgery. All residents were healthy men under age 30 years. Prior to commencement of the study, all participants had successfully been administered a test dose of propranolol without side effects. The study took place over a 10-week period. At the conclusion of each case, both the resident and attending surgeon observer independently completed a form grading, on a sliding scale: (1) amount of overall tremor; (2) amount of tremor during placement of the first 3 sutures after lens or nucleus extraction; (3) anticipated difficulty of the case; (4) actual difficulty with the case; and (5) anxiety (surgeon only). In addition, the type of procedure performed, complications encountered, and surgeon side effects were recorded. The data were analyzed with a 2-way analysis of variance for unbalanced data., Results: A total of 73 surgical cases were performed; the surgeons were administered propranolol for 40 cases and placebo for 33. As judged by the resident surgeon, there was a highly significant effect of propranolol in decreasing anxiety (P = .0058), reducing surgical tremor overall (P < .0001), and reducing tremor while placing the first 3 sutures following lens extraction (P < .0001). There was no treatment-by-surgeon interaction for any of the measures. Complications and difficulty of the case, as judged by both the resident and attending surgeons, were not significantly different in the propranolol versus placebo groups (P > .05). There were no side effects reported or observed in any of the surgeons., Conclusions: Propranolol, 40 mg, administered 1 hour prior to surgery, significantly decreases tremor and anxiety in the surgeon without untoward effects to the surgeon and the patient. However, it is unknown whether decreased tremor and anxiety improved surgical outcome.

Background and Objective: To determine, using autopsy eyes, whether diode laser energy adjustments are indicated in patients with thin sclera., Materials and Methods: In the laboratory, the superior 180 degrees of sclera at the limbus was dissected to the level of barely visible anterior uvea and the opposite 180 degrees of sclera served as the control in three human cadaver eyes. A contact G-probe was placed at the limbus, and settings of a diode laser were increased in increments from 1.0 to 9.0 J at 4 burns per setting in each location., Results: On gross examination, circular hypopigmented lesions were seen in the ciliary body (CB) beginning at 3.0 J in thin sclera and at 5.0 J in normal sclera. On light microscopic examination of thin scleral sections, CB damage began at 2.9 J and CB/ciliary body epithelium (CBE) damage occurred beginning at 3.5 J. In normal sclera, minimal CB/CBE changes occurred at 6.0 to 7.5 J. No scleral damage was visible in either the experimental or the control groups., Conclusion: Cycloablation energy adjustments are indicated on eyes with abnormally thin sclera to achieve similar histologic end points using the diode laser.

Late endophthalmitis, due to Propionibacterium acnes, developed in three patients following uncomplicated extracapsular cataract extraction and posterior chamber intraocular lens (PC-IOL) insertion. Cultures from the capsular bag yielded P. acnes in all three. With topical anesthesia and through an anterior chamber paracentesis, culture specimens were taken from and clindamycin irrigated into the capsular bag. Filtered 100% oxygen was introduced into the anterior chamber in two; the third also received an injection of gentamicin and dexamethasone into the capsular bag. After treatment, two patients received oral antibiotics; one received hyperbaric oxygen therapy. Visual acuity was improved and inflammation reduced in all three. However, after treatment, ocular toxic effects due to clindamycin were suspected in one. This approach offers several clear advantages, including topical anesthesia, outpatient management, elimination of the need for vitrectomy, and retention of the intraocular lens (IOL).

Purpose: Considerable attention has been focused on the chemopreventive properties of fenretinide against carcinogen-induced rodent mammary cancer. Less is known about its direct antitumor effects. The combination of tamoxifen and fenretinide is more effective than tamoxifen or fenretinide alone in prevention of rat mammary cancer. However, the combined toxicity of tamoxifen plus fenretinide in humans is unknown. Therefore, we performed a phase I/II trial in women with estrogen receptor (ER)-positive or progesterone receptor (PR)-positive, previously untreated metastatic breast cancer., Patients and Methods: Groups of three patients received tamoxifen 20 mg/d, or tamoxifen plus fenretinide 100, 200, 300, or 400 mg/d. Patients who received fenretinide enjoyed a 3-day "drug holiday" every 4 weeks. Serum levels of fenretinide and its major metabolites were monitored. Patients were monitored for known toxicities of tamoxifen and vitamin A analogs, as well as for response., Results: There were no significant adverse effects on renal, hepatic, hematologic, or lipid values. Nyctalopia, photophobia, cheilitis, and pruritus were not observed. Improvement or stabilization of disease occurred in 12 of 15 patients., Conclusion: We conclude that tamoxifen administered with fenretinide is nontoxic. Phase III trials of tamoxifen versus tamoxifen plus fenretinide are warranted.

We describe a young man in whom endophthalmitis caused by Moraxella catarrhalis developed 5 years after glaucoma filtering surgery. The infection responded to treatment with broad-spectrum antibiotics, and 2 months after presentation the visual acuity had returned to 20/50. To our knowledge this is the first report of late-onset endophthalmitis due to M. catarrhalis complicating glaucoma filtering surgery.

To evaluate the efficacy and safety of high-dose intravenous acyclovir combined with oral zidovudine as suppressive therapy for cytomegalovirus retinitis in patients with AIDS, a single-arm, outpatient, open-label, phase II pilot study was performed. Between July 1989 and July 1990, 12 men with AIDS, cytomegalovirus retinitis, and salvageable vision received intravenous acyclovir, 10 mg/kg of body weight every 8 h, and oral zidovudine after successful induction therapy with intravenous ganciclovir, 5 mg/kg every 12 h for 14 days. Patients were evaluated weekly. Ten of 12 patients were followed to the time of retinitis progression; two were withdrawn from the study because of concomitant life-threatening infection. The median duration of acyclovir and zidovudine therapy before retinitis progression occurred was 32 days. None of the eight uninvolved eyes in the 10 evaluatable patients developed cytomegalovirus retinitis during study participation. These data suggest that high-dose intravenous acyclovir with zidovudine provides some benefit in suppressing cytomegalovirus retinitis.

Many ocular emergencies seen in children can be managed easily by the pediatrician. However, it is necessary to be comfortable with the definitions, etiologies of disease, important points in history taking, physical examination and laboratory evaluation and to know when referral is necessary. This paper outlines a number of the more common ocular emergencies seen in children.

A polarographic oxygen sensor in contact with the palpebral conjunctiva makes a measurement of oxygen tension related to that in the underlying capillary bed but not equal to it. A mathematical analysis based on the equation describing oxygen diffusion in an oxygen-consuming tissue indicates that the measured oxygen tension will be 5-10 torr below that in the capillary bed.

We analyzed 22 sickle cell trait hyphemas. Fourteen of the 22 eyes were adequately controlled with medical therapy alone, ie, the intraocular pressure averaged less than 25 mm Hg during consecutive 24-hour periods and there were no repeated transient rises of IOP above 30 mm Hg. Surgery was performed in eight eyes, because of inadequate medical control. Thirteen of the 14 medically treated eyes had acceptable levels of IOP within the first 24 hours; only one of the eight surgically treated eyes had adequate control during the first 24 hours. This suggests that control during the first 24 hours portends a good prognosis, while lack of control during that period predicts continued difficulty managing the IOP. This seems to be important in view of previous experience that suggests that these eyes do not tolerate minimal to moderate elevations in IOP as well as those of patients without sickle cell anemia.

Endophthalmitis caused by Moraxella nonliquefaciens developed five years after trabeculectomy in a 67-year-old man and 15 months after trabeculectomy in a 62-year-old women. Symptoms in both cases included pain, inflammation, and decreased visual acuity. Aggressive treatment with antibiotics and corticosteroids led to resolution within a few days.

Aqueous fluorophotometry has proved to be a useful indicator of changes in the blood-aqueous barrier after surgical, immunologic, or laser manipulations. Previously used fluorescent tracers have been unable to follow rapid changes continuously in the blood-aqueous barrier. Fluorescein-labeled homologous serum albumin, however, provides extremely stable and high plasma levels of fluorescence due to active renal reabsorption with very low levels in the normal aqueous because of its high molecular weight. This feature allows prolonged, continuous, and highly sensitive monitoring of the blood-aqueous barrier before, during, and after a manipulation. The usefulness of this technique is demonstrated in a model that has been well studied with other methods: the response to argon laser iris photocoagulation.

Computed tomography (CT) is useful in detecting metallic intraocular foreign bodies. Magnetic resonance imaging (MRI) is a technique that might allow the detection and localization of nonmetallic intraocular foreign bodies. We performed CT and MRI scans on ten freshly enucleated sheep eyes, eight of which contained nonmetallic intraocular foreign bodies of wood, glass, plastic, or rock. Computed tomography correctly detected seven of eight foreign bodies, while MRI detected all eight of the foreign bodies. Computed tomography is necessary to determine the presence of a metallic foreign body, but when the CT scan is negative, MRI may still detect small nonmetallic foreign bodies.

An animal model demonstrates that the acute inflammation seen after neodymium: YAG (Nd:YAG) capsulotomy is related to the presence of disrupted tissue suspended in the aqueous, rather than to the mechanical insults by the repeated shock waves. Seven rabbits were treated in the lens cortex of one eye with 20 bursts of 4 pulses, 24 mJ each, and followed fluorophotometrically using albumin labelled with fluorescein. This allowed transmission of shock waves to the anterior segment without releasing debris in five eyes that showed no inflammation. Two eyes with inadvertent capsular rupture showed marked blood-aqueous barrier breakdown. This suggests the use of a capsulotomy technique that relies on discission rather than pulverization of the membrane and avoids the thicker portions of the membrane when possible.

Bandage soft contact lenses are an effective therapy for patients with a variety of corneal diseases. These patients often require accurate measurement of the intraocular pressure, necessitating movement or removal of the contact lens for slit-lamp Goldmann applanation tonometry. Intraocular pressure was measured in 21 normal, healthy volunteers, using a pneumatonometer (Alcon). A therapeutic soft contact lens (Plano T) was then placed on the eye and the pneumatonometer was used to remeasure the intraocular pressure through the contact lens. The average intraocular pressure without the contact lens was not statistically different from the intraocular pressure with the contact lens. These data suggest that pneumatonometry is an effective way to assess the intraocular pressure in patients wearing bandage contact lenses, thus eliminating the need to manipulate the lens solely for the purpose of intraocular pressure determination.

Three patients had choroidal nevi with a single, large, overlying, hypopigmented lesion. In one case, this lesion was observed to enlarge for seven years, although the nevus, itself, did not. All of the hypopigmented lesions showed mild hyperfluorescence early in the fluorescein angiogram and intense staining in the later phases. These lesions were probably large drusen that developed on the surface of the nevi.

We examined nine patients with amniotic band syndrome who had systemic and ocular pathologic deformities. The most common ocular malformations were congenital corneal leukomas or acquired corneal opacities secondary to exposure and eyelid colobomas. The eyelid defects appeared to be extensions of facial clefts in these patients and were often located adjacent to the corneal opacities. Other anomalies included microphthalmos, strabismus, and hypertelorism. One patient had the typical peripheral and facial stigmata of the amniotic band syndrome in association with a coloboma of the left iris and retina.

In patients with multifocal choroiditis, presumed ocular histoplasmosis syndrome (POHS) is often diagnosed. However, POHS typically is not associated with inflammatory activity in the ocular media. A group of patients had a pattern of multifocal choroidal spots reminiscent of POHS with active signs of inflammation in the anterior and vitreous chambers. Of the 28 patients, 43% were black. In addition to inflammation, many patients had peripapillary atrophy (39%) or diskiform macular scars (32%). Of those with diskiform scars, 33% were black. Systemically, 32% of the patients were presumed to have sarcoidosis; 29%, tuberculosis; 11%, syphilis; and 28%, no etiology. In some cases, treatment of the underlying disease resulted in improvement of the ocular findings. Inflammatory pseudohistoplasmosis syndrome appears to be a nonspecific response to a number of uveitic syndromes, including sarcoidosis, tuberculosis, and syphilis.

Eleven patients, aged 4 to 18 years, who were admitted to the hospital with the diagnosis of traumatic hyphema were placed on 24-hour cardiac (Holter) monitors. Ten of the 11 patients had episodes of bradycardia and bradyarrhythmias. Blood pressures monitored during the same period showed that the bradycardia was not hemodynamically significant. Cardiac monitoring was repeated on six patients 3 months later, and nocturnal cardiac rhythms were compared; the minimum heart rates immediately following the eye injury were significantly lower (p = .03) than those measured 3 months later. While these data do not establish a relationship between bradyarrhythmias and the frequently-observed occurrence of somnolence, it does appear that episodes of bradyarrhythmias represent a common physiologic response to traumatic hyphema, and they can be expected to resolve spontaneously.

In 16 rabbits with bilateral corneal burns, indomethacin was administered topically to one eye on each day after the lesion was made to determine the effect of a prostaglandin inhibitor on the corneal neovascular response to experimental thermal burns. Comparison of the two eyes showed a reduction of both hyperemia and neovascularization in indomethacin-treated eyes during the first five days after injury. Histologic observations during this period showed a reduction in polymorphonuclear cell infiltration in the treated corneas. Inhibition of prostaglandin synthesis by indomethacin apparently led to a reduction in the inflammatory response and the subsequent corneal neovascularization.

Pain is one of the classically described symptoms of postoperative bacterial endophthalmitis, and has been thought to be a useful and early warning symptom. Three cases, however, of culture-proved endophthalmitis presented without pain. Detection of abnormal physical findings suggested the diagnosis in each case, and led to the appropriate microbiologic evaluation and therapy. Early and frequent postoperative ocular inspection is the responsibility of the ophthalmologist. Exclusive reliance on symptoms experienced by the patient in the postoperative period is insufficient if complications such as endophthalmitis are to be diagnosed and treated optimally.

Six eyes with persistent corneal epithelial defects of various etiologies were treated in a randomized, prospective, double-masked study to evaluate the effect of fibronectin on corneal epithelial wound healing. Study eyes received homologous human fibronectin (300 micrograms/ml), mixed with gentamicin and artificial tears, 4 times a day. Control eyes received the mixture of gentamicin and artificial tears. If no healing occurred after 2 weeks, the drug was unmasked and where control drops had been given, the mixture containing fibronectin was administered in open-label fashion. All 4 eyes in diabetic patients had successful epithelial healing when treated with the fibronectin solution. The 2 remaining corneas, which had defects secondary to a thermal injury and a presumed infectious etiology, did not heal with fibronectin.

Bacterial or sterile endophthalmitis was induced in rabbits. The vitreous glucose levels were then assayed. Severe intraocular inflammation, whether bacterial or sterile, resulted in marked lowering of vitreous glucose as compared to control levels. Moderate or mild inflammation failed to reduce the vitreous glucose. These data suggest that determination of vitreous glucose is not of value in the differentiation of bacterial from sterile endophthalmitis.

Alkali burns of the cornea were made bilaterally in 16 albino rabbits. The eyes were then treated four times a day in a masked fashion with a solution either of fibronectin (250 micrograms/ml) plus gentamicin (1.5 mg/ml) or of gentamicin (1.5 mg/ml) plus hydroxypropyl methylcellulose (Tears Naturale). The eyes were examined daily in a masked manner for evidence of a corneal epithelial defect. On days 6-14, the fibronectin-treated eyes had more healed corneal defects (p less than 0.05, McNemar's test for matched pairs) than the control eyes. Fibronectin aided the healing of corneal alkali burns by decreasing the peeling back of the healing epithelium and by allowing re-epithelialization if peeling back had occurred. These properties of fibronectin helped to preserve a stable, intact corneal surface.

A standard Clark electrode has been modified to continuously monitor the PO2 in a thin, disk shaped reservoir membrane mounted on the electrode membrane surface. In vitro tests were conducted to determine the proportionality constant between the rate of change of reservoir PO2 and the flux of O2 out of the reservoir. The device was then used to determine the corneal O2 uptake on proptosed eyes of previously sacrificed rabbits. Our average measured uptake at 20 degrees C, 1.7 microliter/cm2.hr, agrees with the value 2.3 microliters/cm2.hr calculated from a diffusion analysis of the cornea utilizing literature values of the parameters at 37 degrees C for the three component layers of the cornea when they are adjusted for temperature to 20 degrees C.

A 56-year-old woman with a 12-year history of systemic lupus erythematosus presented with severe optic-disc swelling and blepharitis. At the same time, she developed acute pancreatitis and ultimately died of gram-negative sepsis. Although it appeared that the ocular and systemic disorders were manifestations of lupus, her serum antinuclear antibody and complement levels remained normal throughout her hospital course. Optic neuritis may be secondary to lupus, but the diagnosis is difficult to make when the serology is negative.

Mixtures of carbon dioxide and oxygen are commonly used in the treatment of central retinal artery obstruction to improve retinal oxygenation. While oxygen alone causes retinal vasoconstriction, it is thought that the carbon dioxide balances this effect, even causing a net vasodilatation. To test this hypothesis, normal, healthy volunteers were given 100% oxygen, a mixture of 95% oxygen and 5% carbon dioxide, and a mixture of 5% carbon dioxide in air to breathe. The caliber of large, fluorescein-filled retinal arteries and veins was then measured using computer processing of digitized television images. The marked decrease in arterial and venous caliber caused by 100% oxygen was not reversed by the subsequent addition of 5% carbon dioxide. Moreover, 5% carbon dioxide in air did not cause substantial vasodilatation of the retinal vasculature. The efficacy of adding 5% carbon dioxide to oxygen to treat retinal vascular obstructive diseases is questioned.

Coats' disease is characterized by vascular anomalies in the retina that are usually associated with exudates. In the absence of treatment the disease almost always progresses toward loss of vision and, often, loss of the eye. This report describes three patients in whom some of the retinal lesions apparently regressed spontaneously; only two other such patients are mentioned in the literature. These patients may have had a form of Coats' disease that has a better prognosis than usual for the eye.

Dermal elastic tissue in fetal skin was evaluated by light microscopy using three different staining techniques. Postmortem skin was obtained from the abdominal wall of 45 fetuses ranging in age from 8 to 42 weeks. Elastic fibers were first detected in skin from fetuses of 22 weeks and, with increasing gestational age, appeared to increase in quantity and complexity. Skin from fetuses older than 32 weeks had a well-developed network of elastic fibers throughout the dermis. There was no diminution of dermal elastic tissue during the latter part of the sixth lunar month as had been reported in a previous study.