Biomedical subjects
Publications and source records attributed to J D Morin.
Successful management of glaucoma to prevent blindness depends upon early recognition of the condition. This article details the early signs and symptoms of glaucoma so that prompt referral for care and treatment may be facilitated.
To determine the influence of age at onset of primary infantile glaucoma, 15 patients whose glaucoma was present at birth were compared with 24 children in whom glaucoma developed between birth and age 3 months. Of the 29 eyes investigated in the former group 60% had a corneal diameter more than 1.5 mm greater than normal at the time of diagnosis, and 50% of the 22 eyes reassessed 5 years later had a visual acuity of less than 6/60; an average of 2.0 surgical procedures had been required to control the intraocular pressure. Of the 46 eyes in the latter group only 35% had a corneal diameter more than 1.5 mm greater than normal at the time of diagnosis, and of the 45 eyes reassessed 5 years later only 20% had a visual acuity of less than 6/60; an average of 1.3 operations had been required to control the intraocular pressure. Primary infantile glaucoma should be classified as either present at birth or developing between birth and age 3 months since the prognosis is so closely related to age at onset.
In 25 patients with ocular hypertension and open angles timolol maleate lowered the intraocular pressure (IOP) of 71% of the 49 eyes treated, keeping it below 22 mm Hg during 4 years of therapy. However, the IOP tended to drift upward by 2 to 4 mm Hg per year, especially during the first and third follow-up periods (1 year and 2 years long respectively). Thus, patients should be examined every 3 months after an adequate response to therapy is achieved. In this series of patients there was a slight visual loss in about 38% of patients, but it was probably related to increasing age. Field loss occurred in four patients in spite of a good response to therapy. Increased cupping of the optic disc occurred in six patients, four of whom had had a pretreatment IOP of 30 mm Hg or greater. Timolol therapy was well tolerated by the patients, being virtually symptom-free. However, special care would be needed in treating patients with asthma, bradycardia or congestive heart failure.
In 105 patients with infantile esotropia who initially underwent corrective surgery between 5 and 24 months of age successful alignment of the eyes (to within 10 prism diopters of orthophoria) was associated with a higher prevalence of fusion and stereopsis and a lower prevalence of dissociated vertical deviation (DVD). Fusion was most frequent in the patients whose eyes were successfully aligned by 9 months of age, occurring in 92%. Inferior oblique overaction and amblyopia were less frequent when the initial operation had been performed before 12 months of age. Latent nystagmus, DVD, inferior oblique overaction and amblyopia were interrelated in a complex fashion.
Of 51 patients with congenital glaucoma, 13 had unilateral and 38 bilateral disease. Pressure was controlled at 8 to 24 mm Hg in 76 of the 89 affected eyes. Forty-one of these 76 eyes had visual acuity poorer than 6/15 (20/50); optic nerve damage as shown by visual field testing was the cause in 20, and medial opacities, including irregular corneal astigmatism, was the cause in 15. In only six eyes did the poor vision result from anisometropic amblyopia.
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We studied the healing of trabeculectomies in rabbits with photographs, fluorescein filtration and histological sections. Initially all except 1 developed proven filtration. However, vigorous fibroblastic proliferation (and collagen production) from the subconjunctiva, uvea and sclera combined to close off the fistula by day 14. Groups of eyes treated with 8 mg of prednisolone injected subconjunctivally at operation showed slightly delayed wound healing but by day 30 there was little difference between treated and untreated groups. The steroid treated eyes had complications ranging from endophthalmitis in 1 eye to tissue necrosis in 3 eyes.
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In glaucomatous eyes, contrary to normal eyes, the blind spot size is not correlated with the disc or cup size, and the size of the optic disc, cup and optic rim also varies. The variation in area of the glaucomatous optic disc correlates with variation in area of the optic cup. The rim width and total rim area in glaucomatous eyes are decreased. In glaucoma the upper, lower and nasal rim widths are about the same, whereas the smallest rim width occurs temporally. Thus, clinically cupping in glaucoma eyes need not be vertically oval.
A traumatic macular hole has never been seen immediately after the causal accident. We examined a case of macular hole within half an hour of the injury and photographed it within three hours. We comment on the genesis of traumatic macular edema.
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We examined the eyes of 50 patients with nevus flammeus of the face (port wine stain). Of 26 patients with nevus flammeus involving the area of both the first and second sensory branches of the trigeminal nerve, 4 had glaucoma and 8 were glaucoma suspects. Because the age at which glaucoma develops is uncertain, these patients require periodic ocular assessment. When the nevus flammeus involved the area of V1 alone or V2 alone, there was no associated glaucoma.
The port-wine stain, a relatively rare subgroup of capillary hemangiomas, usually involves the face and in children it may be associated with glaucoma. A series of 50 patients with facial port-wine stains had ocular examination at The Hospital for Sick Children, Toronto. When the facial areas supplied by both the ophthalmic and maxillary divisions of the sensory branch of the trigeminal nerve were involved (26 patients) there was about a 45% chance of diagnosing glaucoma, either as "true" glaucoma (with visual loss and raised intraocular pressure) or as "glaucoma suspect" (without visual loss). Involvement of the area supplied by either division alone was not associated with glaucoma.
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