Quantitative studies of visual field loss and cupping of the optic disc Their relevance to the management of chronic simple glaucoma.
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Biomedical subjects
Publications and source records attributed to J Gloster.
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In addition to the uptake of palmitate by the isolated perfused guinea-pig heart, there was a substantial release of longer chain fatty acids into the perfusate amounting to about 50% of the uptake of palmitate. Both the uptake of palmitate and the release of other fatty acids was diminished in the presence of 95% N2. The specific activity of myocardial palmitate was increased under 95% N2. No significant difference in the distribution of radioactivity between the different myocardial fatty acids occurred between 95% O2 and 95% N2.
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The extent of cupping was measured from optic disc photographs of 300 patients with ocular hypertension and suspected or established chronic simple glaucoma, and their visual fields were recorded. The incidence of field defects increased as the vertical cup:disc ratio increased, a value of 0-70 for this ratio being a particularly useful guide to the presence or absence of field loss. There was a significant correlation between the extent of cupping and the size of the visual field. The vertical cup:disc ratio was the most useful quantitative index of cupping.
Serum immunoglobulins and antinuclear antibodies were estimated in 225 patients, including cases of chronic simple glaucoma, "low tension glaucoma", and ocular hypertension. The results showed that, while the mean levels of immunoglobulins Ig A and Ig M were not significantly higher in patients with glaucoma than a control series of normal adults, the mean level of Ig G was higher in those with chronic simple glaucoma. There was no clear relationship between Ig G levels and the severity of the disease as judged by the visual fields and optic disc changes. Antinuclear antibodies were found in a larger proportion of patients with chronic simple glaucoma and ocular hypertension as compared to the normal population, but there was no correlation with the severity of the disease. The incidence of other non-organ-specific and organ-specific autoantibodies was not significantly different from that of the control group. Although these results suggest an association of raised levels of Ig G and a higher incidence of antinuclear antibodies in patients with glaucoma, the evidence is insufficient to suggest that disorders of the immune system have an aetiological significance in chronic simple glaucoma.
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1. The incorporation and washout of [1-14C]palmitate in the subcellular fractions of toad, chick and guinea-pig hearts has been studied at warm and cold temperatures. 2. Maximal FFA radioactivity generally occurred in the microsomal fraction. Washout of radioactivity in chick and guinea-pig hearts virtually ceased in the cold, while in the toad it was only moderately affected. 3. The microsomal esterification process was temperature dependent. It was most active in the guinea-pig and least active in the toad.
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Repeated photography of the optic disc is helpful in the management of 1. patients with glaucoma, especially those who do not give reliable results on visual field testing, and 2. patients with ocular hypertension. The changes to be looked for are; a) any increase in the size of the cup, b) any decrease in the width of the rim of tissue between the edge of the cup and the edge of the disc, c) the occurrence of small haemorrhages on the disc, d) changes in the course of vessels on the disc.
Chronic administration of chlorphentermine to rats resulted in a reduction of body weight compared to a normal control group. The weight of the heart, liver, kidney, and spleen was less in the treated group while the weight of the lungs was increased significantly. There was no change in the ratio of right ventricular to left ventricular weight in the rats treated with chlorphentermine, supporting the views that this drug does not cause pulmonary hypertension. Biochemical analysis showed that the increase in the weight of the lungs was due to the accumulation of phospholipid. All classes of phospholipid were affected, but particularly phosphatidyl choline, the tissue concentration of which increased nine times. Chlorphentermine also increased the proportion of palmitate present in pulmonary phosphatidyl choline. Histological examination of the lung after treatment with chlorphentermine showed evidence of this drug-induced lipidosis. No conclusion can as yet be reached as to the mechanism involved in the accumulation of phospholipid in the lung after chlorphentermine.
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Slit-lamp examination and stereoscopic fundus photography were found to be helpful in differentiating between physiological and glaucomatous cupping of the disc. Vertical ovalness of any cup in the disc should raise the suspicion of glaucoma, and the magnitude of the vertical cup: disc ratio is of particular significance.
During the perfusion of isolated rat hearts with [1 - 14C]palmitate or [1 - 14C]oleate the rate of incorporation of label into lipids is greater in the microsomal fraction, less in the mitochondrial fraction, and least in the cell sap fraction. The degree of esterification is greatest in the microsomal fraction and greater for oleate than for palmitate. There is an early and high degree of labeling of phospholipid in the microsomal fraction. The specific activity of mitochondrial free fatty acids is higher than that of microsomal or cell sap free fatty acids.
Chronic hypoxia had widespread effects on myocardial metabolism. In understanding these effects, it is necessary to take account of the indirect ways in which hypoxia may act on the heart. Two such important indirect actions are those which follow the development of pulmonary hypertension and anorexia. The experimental design reported here enables one largely to distinguish the effects of pulmonary hypertension and anorexia from the rest. Using such a design, we have presented a number of diverse aspects of myocardial metabolism under conditions of chronic alveolar hypoxia induced by a low atmospheric pressure.