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• Seven cases are reported, believed to be the first in the literature, in which iris nodules are verified in the complete spectrum of essential iris atrophies. This feature appears late in the course of the disease as small yellow nodules that progressively increase in number and gradually become dark brown. The differential diagnosis of multiple iris nodules includes neurofibromatosis, melanomas, inflammatory nodules, and developmental anomalies such as iridocorneal dysgenesis.

• Patients with chronic glaucoma had a carefully scheduled series of intraocular pressure measurements before and after taking acetazolamide for one week at the following dosages: none, 500 mg of sustained-release capsules once a day, 500 mg of capsules twice a day, and 250 mg of tablets four times a day. A capsule taken once a day, which is better tolerated than one taken twice a day by some patients, offers a substantial pressure-lowering effect that lasts at least 23 hours, although the magnitude of the pressure lowering is less than with higher dosages. One capsule twice a day appears to be as effective in the regulation of IOP as one tablet four times a day. The 45% reduction in outflow pressure is achieved with an acetazolamide serum concentration in the range of 15 to 20 μg/mL.

• Rapid intraoperative choroidal effusion and flattening of the anterior chamber occurred during glaucoma filtering surgery in four young patients with prominent episcleral vessels, elevated episcleral venous pressure, and advanced openangle glaucoma. Two of these four patients had Sturge-Weber syndrome. Intraoperative release of suprachoroidal fluid (SCF) through a posterior sclerotomy facilitated reformation of the anterior chamber and repositioning of the iris and ciliary body. Posterior sclerostomy performed prior to opening the anterior chamber minimized the above-mentioned untoward series of events. Analysis of SCF and serum demonstrated considerable differences in total protein and individual immunoglobulin levels; this appears to be a manifestation of molecular sieving at the level of the choriocapillaris. Choroidal detachment and postoperative serous retinal detachment are manifestations of this phenomenon.

• Twenty-two patients with open-angle glaucoma were given weekly courses of methazolamide at different dosages. Mean intraocular pressure reductions of 3.3, 4.3, and 5.6 mm Hg were achieved at dosages of 25 mg, 50 mg, and 100 mg of methazolamide every eight hours, respectively. Maximal intraocular pressure lowering was still present nine to ten hours after administration.The mean reduction in outflow pressure for all eyes receiving a daily dosage of 300 mg was only 31%, but this included eyes (17% of the total) that demonstrated less than 13% reduction in outflow pressure, despite similar methazolamide serum levels.Eight patients subsequently received acetazolamide, 250 mg four times a day for a week. The effect of this dosage of acetazolamide on pressure was between the effects of 50 and 100 mg of methazolamide three times daily.

• Buttons obtained by trephination from both eyes of a 44-year-old myopic man with pigmentary glaucoma were studied by light and electron microscopy. Although clinically both eyes exhibited heavy pigmentation of the trabecular meshwork in the whole circumference, microscopically the trabecular meshwork of the left eye contained more pigment granules than that of the right eye, which appeared relatively acellular with collapse of the trabecular sheets. In both eyes endothelial cells covering the trabecular sheets were filled with pigment and showed various stages of degeneration. The intertrabecular spaces contained free pigment granules as well as cell debris. These observations suggest that plugging of the trabecular spaces by pigment and cell debris together with fragmentation and collapse of trabecular sheets contribute to the decrease in the facility of outflow that occurs in pigmentary glaucoma.(Arch Ophthalmol 95:1015-1025, 1977)

Since Claude Bernard1 first discovered glycogen in 1857, it has been recognized as the principle storage form of carbohydrate in animal tissues and has been found to occur in more or less abundance in nearly all types of animal cells. Recently Kuwabara and Cogan2 described the distribution of histochemically demonstrable glycogen in the retina and showed its synthesis in vitro. The amount of glycogen varied widely in different species and appeared to be inversely proportional to the vascularity of the retinas. This species variation prompted further study into retinal glycogen metabolism and has resulted in the present report on the activity of phosphorylase and of uridine diphosphoglucose (UDPG) glycogen synthetase in the retina.Evidence from various sources3-8 now suggests that the UDPG pathway (an irreversible reaction acting in conjunction with amylo-1,4→1,6 transglucosidase or branching enzyme) is responsible for glycogen synthesis in the body and that phosphorylase activity (effecting

• Eighteen patients undergoing glaucoma filtration surgery underwent specular microscopic examination 1 day prior to surgery and 4 to 6 months after surgery. Patients were evaluated postoperatively for the presence of iridocorneal or lenticular-corneal touch, anterior chamber depth, and inflammation. Ten eyes that maintained their anterior chamber following glaucoma filtration surgery did not have a significant decrease in corneal edothelial cell density. However, eight eyes that developed a shallow anterior chamber with iridocorneal touch had a mean (± SD) decrease of 265 ± 185 cells (12.4%) peripherally and 250 ± 243 cells (11.6%) centrally in corneal endothelial cell count. None of the patients with iridocorneal touch developed corneal edema after a mean follow-up of 44.4 ± 18.0 months. Iridocorneal touch after glaucoma filtration surgery is associated with loss of endothelial cells yet appears to be well tolerated by the cornea.

• We present 12 cases of pupillary block associated with extracapsular cataract extraction and posterior chamber intraocular lenses. In one case, pupillary block occurred despite the presence of a surgical iridectomy. The other 11 patients did not have a surgical iridectomy performed. We recommend that a surgical iridectomy or laser iridotomy be performed in all patients who undergo extracapsular cataract extraction with the implantation of posterior chamber intraocular lenses. Ophthalmologists need to be vigilant in watching for the development of pupillary block in these patients, since pupillary block is not a benign event and serious visual loss or disability may occur.

The authors have prepared a text directed to the specialist physician as a guide to the evaluation and management of the pediatric glaucomas as well as to the nonophthalmic physician to alert him to these syndromes. The text, short for the book's 213 pages and 253 illustrations, is well written and lucid, especially in discussing the principles of diagnosis, evaluation of the optic nerve, and the histopathology of these congenital glaucomas. The reader will not find more than an introduction to the clinical syndromes described, but the text is well referenced.Syndromes are included which are rarely seen in children, as primary angle closure glaucoma, essential iris atrophy, and pigmentary glaucoma that are, in this reviewer's opinion, introduced at the expense of more detail in the pediatric syndromes. The surgical therapy section is particularly good on the examination under anesthesia and on goniotomy, describing the authors' technique in detail. Other

Discusses the treatment for Fuchs' corneal dystrophy and cataracts.