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Gas-liquid chromatography was employed to determine free monosaccharides in human, rat, and South American rodent Octodon degu lenses. In addition to D-glucose, D-fructose, sorbitol and myo-inositol, which were previously known to be components of lens tissue, glycerol, erythritol, threitol, ribitol, xylitol, and mannitol were also detected in the lenses of these three species. The concentrations in lenses of these three species were in the following ranges: glycerol 1.2 to 40 mumol/gm wet tissue; myo-inositol 4 to 25; and glucose, fructose, and remaining alditols 0.01 to 1.4/mumol/gm. The method is described and its applicability to analyses of free monosaccharides in other animal tissues is discussed.

A study of diabetic and nondiabetic subjects was performed to evaluate the possible association of diabetes mellitus with cataract formation. Parameters investigated included cataract incidence and type model of diabetic therapy, degree of diabetic control, duration of glucose-6-phosphate dehydrogenase (G-6-PD) activity. Diabetes mellitus was found to be correlated with posterior subcapsular cataract formation, as was duration of diabetic disease. Race, degree of metabolic control, and age of onset of disease did not appear to be correlated with cataract formation. Oral hypoglycemic agent therapy was significantly associated with posterior subcapsular cataract formation. The African variant of G-6-PD deficiency appeared to protect against cataract formation in diabetic patients. The most important overall factor in cataractogenesis proved to be age. Posterior subcapsular cataracts were associated with corticosteroid therapy, presence of diabetes mellitus, and oral hypoglycemic agent therapy.

Patients with "early" posterior subcapsular (PSC) cataracts often complain of severe visual impairment, despite maintenance of relatively good Snellen acuity. The Arden grating test of contrast sensitivity provides a simple method of evaluating visual function in a manner more nearly approximating the real visual world. This test often reveals profound loss of contrast sensitivity in patients with early PSC cataracts who maintain relatively good acuity (20/40 or better) on Snellen's test. Examination of 122 such eyes revealed wide variations in contrast sensitivity, with Arden scores showing better correlation with subjective complaints than with Snellen acuity levels. While Snellen's test measures only one end of the spatial modulation transfer function (MTF), the Arden test plates provide an overall picture of MTF and help us to better understand the effect of PSC cataracts on visual function.

Previous studies have demonstrated that ethyl alcohol ingestion affects the clinically recorded visually evoked cortical potential (VECP). However these studies have not related the possible relevance of such alcohol-induced VECP changes to visual performance. We studied the flash and pattern-reversal monopolar VECP recorded at the occiput before and after alcohol ingestion and compared the recordings with psychophysical parameters (e.g. contrast sensitivity) also measured before and after alcohol intake. Results are presented, and the potential usefulness of VECP alterations in predicting alcohol-induced effects on visual performance is evaluated. We found no clear, consistent effect of blood alcohol levels ranging from 0.05% to 0.15% on the parameters tested.

An 11-year-old black boy complained of intermittent occipital headaches with nausea and projectile vomiting. Previous skin and lung biopsy specimens were interpreted as histiocytosis X. Cranial computed tomographic scanning disclosed a mass lesion in the region of the choroid plexus of the left lateral ventricle. This was surgically removed but proved nondiagnostic despite extensive histologic examination. An ophthalmologic evaluation showed discrete, elevated, yellow-white choroidal tumors in both maculas. The ophthalmoscopic appearance, as well as ultrasonography and computed tomography, led to the diagnosis of choroidal osteomas.

The postoperative course of 141 eyes in 115 patients undergoing uncomplicated intracapsular cataract extraction was reviewed. Alpha-chymotrypsin as used in our institution did not increase the percentage of eyes developing significant postoperative ocular hypertension. Smaller amounts of enzyme and a shorter waiting period than have heretofore been advocated are adequate for clinically effective zonulysis and appear to be protective against "enzyme glaucoma." Indeed, we found that among non-diabetics, those receiving enzyme experienced a lower incidence of postoperative ocular hypertension than did those not receiving enzyme. The one factor in our series related to an increased percentage of postoperative hypertensive responses was diabetes mellitus.

The ocular findings in an eight-year-old Negro male with unilateral axial myopia and bilateral macular cysts and holes are presented. Normal psychophysical, electrophysiologic, and angiographic findings were noted despite obvious anatomic changes. The constellation of observed findings in this patient appears to be unique.

A subdural hematoma extending into the orbit through a fracture of the sphenoid bone appeared as unilateral proptosis with no neurologic abnormalities. Repeated percutaneous needle aspirations of the orbital portion of this mass provided only temporary relief of proptosis, but decompressed the intracranial portion of the hematoma adequately for prevention of neurologic manifestations. Ultrasonography correctly diagnosed the nature of the lesion and identified the bony dehiscence. Computed tomographic (CT) evaluation suggesting that a tumor might be present led to the performance of curative neurosurgery. Even when seemingly trivial, head trauma must be considered along with congenital, developmental, and neoplastic causes as a potential cause of intracranial cyst formation that can produce proptosis.

A case of bilateral oculodermal melanocytosis is presented in a Negro man. It is suggested that the term "nervus of Ota" be superseded by the more accurate and descriptive terms of "dermal melanocytosis," "ocular melanocytosis," and "oculodermal melanocytosis."

A seropositive patient with the fundus appearance of monocular luetic retinopathy is presented. Electrophysiologically, this patient shows a late-onset form of progressive tapetoretinal degeneration (retinitis pigmentosa) presenting in an extremely asymmetric manner. The differential diagnosis of luetic and other inflammatory retinopathies vs. tapetoretinal degenerations is briefly discussed. Features distinguishing unilateral retinitis pigmentosa from bilateral tapetoretinal degenerations are reviewed, and the existence of unilateral retinitis pigmentosa as a genetic entity is questioned. Prolongation of ERG- a- and b-wave implicit times is characteristic of the tapetoretinal degenerations, and normal implicit times in the fellow eye are suggested as an additional criterion for the diagnosis of unilateral retinitis pigmentosa.

A case of ultrasonically-diagnosed posterior lens capsule rupture, confirmed at surgery, is presented. The A-scan and contact B-scan findings enabling the diagnosis to be made are presented. The ability to make such a preoperative determination allows for the planning of more rational therapy, and should help improve the final visual results in such cases.

One hundred forty-seven patients, 144 with advanced cataract formation, had determinations of erythrocyte galactokinase and galactose-1-phosphate uridyl transferase performed. Significant reduction (more than 2 SDs) of one of these enzymes was found in 47.4% of patients 50 years old or less with presenile "idiopathic" bilateral cataracts, 7.1% of other patients with cataracts aged 50 years or less, and 3.8% of patients with cataracts aged 51 years or more. The differences between the group with presenile idiopathic cataracts and the other groups were statistically highly significant (P less than .001). Patients with reduced activity of galactokinase or galactose-1-phosphate uridyl transferase (presumed heterozygotes) compose about 1% of the general population, appear to be more susceptible to idiopathic presenile cataract formation, and may be more prone to secondary cataract formation after a variety of lenticular insults. Dietary restriction of milk and milk products may prevent or delay cataract formation in these individuals.

While the cataractogenic effects of corticosteroids are beyond dispute, disagreement exists concerning effects of total dose, intensity of dose, and duration of administration on cataract formation. We studied 106 adult male patients matched for age, race, and socioeconomic status. We compared posterior subcapsular (PSC) cataract formation among those with (39) and without (67) a history of systemic corticosteroid therapy. Difference in incidence of PSC opacities among patients with and without a history of corticosteroid therapy was statistically significant. However, no statistically significant correlation was found between PSC opacities and total steroid dose, weekly dose (intensity), duration of dose, or age of patient. Our findings agree with some recent literature that suggests the most important factor in steroid-induced PSC cataract formation may be variability in individual susceptibility to side effects of corticosteroids. We suggest abandoning the concept of a "safe" dose.

A father and son with pigmented paravenous retinochoroidal atrophy demonstrated the classical fundus appearance of bilateral sharply circumscribed patches of retinochoroidal atrophy and pigmentation along the retinal veins. Our patients, and the preponderance of males in previously reported cases of this disease, suggest the possibility of Y-chromosome mediated male-to-male transmission. Electrophysiologic findings in our patients included elevated dark-adaptation thresholds, slightly reduced electroretinographic amplitudes, slightly prolonged a- and b-wave implicit times, and (in Case 1) abnormal electro-oculographic ratios. These findings indicate a diffuse tapetoretinal degeneration, and suggest that pigmented paravenous retinochoroidal atrophy is another incomplete form of retinitis pigmentosa.

A case report of electrically-induced cataracts and a review of the literature is presented. Awareness of the possibility of this complication and screening of high-risk patients is stressed. The majority of cases respond well to surgery, but final visual acuity may be decreased secondary to retinal or optic nerve injury caused by the electrical current.

Lenticular reduced glutathione, diminished in all forms fo human cataract, requires flavin adenine dinucleotide as a coenzyme for glutathione reductase. Deficiency of riboflavin, a precursor of flavin adenine dinucleotide, has been believed by some to be associated with cataract formation. We evaluated the riboflavin nutritional status of healthy young adults, presenile and senile cataract patients, and young and older patients with clear lenses. We found no evidence of an association between riboflavin deficiency and early cataract formation, either idiopathic or secondary. Older cataract patients had more riboflavin deficiency. An absence of riboflavin deficiency was found in our older patients with clear lenses. The degree of riboflavin deficiency encountered in the general population does not appear to be cataractogenic.

Arden grating test scores were obtained for 100 normal subjects under standardised testing conditions. While previously published ranges of interocular conguity were corroborated, a significant increase in test scores with increasing age was noted. This effect of age has not been previously reported. Physiological considerations suggest that such age dependency might have been expected. It is suggested that ranges of normal values be established for each of several age groups.

Contact B scan photographs of a patent surgically created subarachnoid-orbital shunt are presented. Clinical evidence of cessation of shunt function corresponded with disappearance of demonstrable fluid drainage by ultrasonography.

Red cells and the lens of the eye are non-nucleated cells; moreover, they have metabolic similarities. Cataracts develop in childhood in homozygotes for galactosaemic abnormalities, which can be detected by biochemical measurements in red blood-cells. It has not been determined whether heterozygotes for these defects are at greater risk for cataract development later in life. Similarly, riboflavin deficiecy for which the erythrocyte is a sensitive indicator, has been associated with cataracts in animals. Red-cell studies were carried out in 22 patients, aged under 50, with cataracts. Heterozygosity for galactokinase deficiency was detected in 5 patients, for galactose-uridyl transferase in 2, and evidence of an erythrocytic deficiency of riboflavin in 8. Even when Black subjects were excluded from analysis because of their high incidence of polymorphism for galactokinase, these findings are significantly different from those expected from population surveys and suggest that many patients with presenile cataracts have a biochemical abnormality which can be detected by examination of red blood-cells and which may be corrected by dietary restrictions or supplements.

The relative advantages and disadvantages of radiographic and ultrasonic studies in foreign body detection and localization are discussed. The value of ultrasonography in finding radiolucent orbital foreign bodies and its clear superiority in the localization of foreign bodies with respect to the walls of the eye is demonstrated by several examples. The information concerning the state of the lens, vitreous, and retina in such traumatized eyes which is obtained by ultrasonography represents a very important additional benefit of such study.

Patients with various macular and optic nerve abnormalities underwent Snellen acuity, transient VER acuity, and Arden grating testing. Snellen acuity was the coarsest of the 3 evaluations, generally falling after Arden scores and VER acuity had already undergone significant degradation. The Arden gratings appeared to be the most sensitive of the 3 tests, equalling VER performance in optic nerve diseases and surpassing it in macular diseases. Variations in results between the different tests are generally understandable if one considers the functions tested by each and the anatomical derangements caused by the diseases in question. The Arden grating test appears to be an excellent and sensitive screening test for central visual disturbances.

A case of true hematic cyst of the orbit in a 10-year-old girl, apparently resulting from birth trauma, is presented. Ultrasonic and clinical features believed to aid the examiner in correctly diagnosing such a lesion are presented. While apparently unique among reported cases, "congenital" hematic cysts of the orbit undoubtedly occur occasionally and the possibility of this entity should be considered in appropriate circumstances.

A-scan ultrasonographic measurements of the differences between nerve and dural diameters of the retrobulbar optic nerve were made in 55 eyes of 30 patients with endocrine orbitopathy. This measurement was found to be enlarged in all cases. Extraocular muscle thickness measurements were also made ultrasonically in these eyes, and the degree of intervaginal distension was found to increase with increasing extraocular muscle involvement. These findings were consistent whether the patients were hyperthyroid, hypothyroid, or euthyroid clinically, and the findings occurred in the absence of any detectable functional optic nerve compromise. The cause of this subdural perineural enlargement remains unknown.

Blue field entoptoscopy (BFE) has been described as an effective method for evaluating macular function in patients with dense cataracts. We evaluated 150 preoperative cataract patients with BFE, and found the commercially-available instrument (MIRA BFE 100) to be accurate in patients with 20/400 or better preoperative acuity. There was a high percentage of false negative BFE results in patients with dense cataracts, and light flash VER testing was found to correlate better with attainable postoperative acuity in these patients.

Ultrasonography is the most effective diagnostic modality for locating and delimiting cystic orbital lesions, and may often provide an accurate tissue diagnosis. A case is presented demonstrating the ability of ultrasonography to aid in the percutaneous aspiration of selected orbital cystic lesions.

Two patients with vitelliform macular lesions, normal EOG Arden ratios, and no family history of Best's vitelliform dystrophy are presented. Their findings are compared with those in 10 similar reported cases, and a common, nongenetic aetiology is suggested for all. The several names given to this identical fundus picture by different authors are examined and are seen to be inappropriate. A common, descriptive terminology for all such lesions is suggested.

A retrospective review of hospital records reveals that over 90% of recurrent bleeds in traumatic hyphema occur at night. It is postulated that rapid eye movement (REM) sleep, with its displays of saccadic virtuosity, is the major reason for the nocturnal prevalence of such recurrent hyphemas. Theoretical considerations suggesting a more rational therapy of traumatic hyphema are presented and clinical trials are suggested.