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Flattened anterior chamber or absence of a formed anterior chamber is a complication of cataract surgery generally believed to be associated with a high incidence of aphakic glaucoma. While the incidence of vitreous loss, iris prolapse, and ocular infections has been reduced by refinements in anesthesia, wound closure, and antibiotic therapy, the occurrence of flat chamber still remains a problem. Postoperative flat chamber, with its attendant danger of aphakic glaucoma, has been of great concern to the ophthalmic surgeon. Czermak1in 1897 recognized microscopically the closure of the chamber angle in aphakic glaucoma. A correlation between peripheral anterior synechiae and aphakic glaucoma was noted by Troncoso2in 1934. Kronfeld and Grossman,3McLean,4and, later, Meyer and Sternberg5indicated the relationship of delayed formation of the anterior chamber, peripheral anterior synechiae, and aphakic glaucoma. Sugar6attributed the delayed re-formation of the anterior chamber to poor

A statistical survey of 183 patients treated for perforating ocular injuries at Cook County Hospital appeared in 1945. In the same year, at The Johns Hopkins Hospital, 172 such injuries were studied, and another large series in 1953. Perforating injuries involving the cornea and sclera comprised 8.5 percent of all hospital admissions to the Ophthalmologic Service at the Cook County Hospital from January, 1952, through De­ cember, 1953. During this period, 92 pa­ tients were hospitalized and treated for corneoscleral lacerations. The present report is based on a study of 292 patients with this type of injury admitted to the Cook County Hospital in the seven-year period from 1947 through 1953. Of this number, 115 eyes were treated during the last three years. Analysis of cases was undertaken to esti­ mate the importance of some aspects of the injury to the final visual results. Medical and surgical methods of therapy were evaluated. Perforating wounds involving intraocular foreign bodies have been excluded from the studies. Improved end-results in this more recent group of 115 cases may be partly at­ tributed to the introduction of newer thera­ peutic agents and the refinements of surgical technique.

For a long time the striking clinical pic­ ture resulting from a carotid-cavernous fistula has been recognized as the manifesta­ tion of a communication between the carotid artery and the cavernous sinus. About 75 percent of the occurrences are attributable to known trauma, as was our case, and the remaining 25 percent appear to have a spontaneous origin secondary to a vascular lesion.' In Locke's cases of pulsating exophthalmos, 77 percent were traumatic in origin, and, of these, 94 percent had a carotid-cavernous fistula. Head injuries, gun­ shot wounds, and so forth, are responsible for the traumatic type;· sclerosis of the arterial wall with resultant weakness causes the spontaneous ones.

To the Editor. —During a 48-hour period, I saw two patients who had been using the new Ocuserts to control their glaucoma. They complained that while riding along expressways, they were almost involved in disastrous accidents. The Ocusert, which wandered under the upper lid, temporarily came over the cornea, while these persons were driving and blinking. One of them almost crashed into another car when he could not see temporarily. I think this complication of the use of Ocuserts is worth bringing to the attention of our ophthalmologic colleagues.

Color atlas of anterior segment eye diseases , Color atlas of anterior segment eye diseases , دانشگاه علوم پزشکی ایران

THE CONSTANT search for new synthetic mydriatic and cycloplegic drugs as substitutes for homatropine and atropine continues to stimulate the investigator. Most recently, cyclopentylate (Cyclogyl) 1 and its allied chemicals* have met with some degree of success as short-acting cycloplegic replacements for homatropine. Other similar-acting agents, 5 whose initial effectiveness proved illusory, have, however, attained limited, though valuable, purposes in the ophthalmological armamentarium. Several such drugs are hydroxyamphetamine (Paredrine), phenylephrine (Neo-Synephrine), eucatropine (Euphthalmine), and Dibutoline. 6 There is no adequate long-acting synthetic cycloplegic substitute for atropine. Only BL 139 7 (β-β-diphenyl-γ-dimethylaminovaleramide) approaches the efficacy of atropine in its autonomic ganglion-blocking action and its cycloplegic-mydriatic effect. However, it has not been made available. Oxyphenonium (Antrenyl), as a potential substitute for atropine, came to our attention during the clinical study of its systemic administration, because of its side-reactions—dryness of the mouth and pupillary dilation. The prolonged cycloplegic and mydriatic action of this