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Purpose: This retrospective study was undertaken to assess the occurrence of postoperative anterior chamber emulsified silicone oil after intravitreal instillation and to examine the relation between such emulsification and new postoperative glaucoma., Methods: Forty-eight consecutive eyes received intravitreal silicone oil, were followed for at least 1 year, and were evaluated postoperatively by gonioscopy on at least one occasion. Eight eyes received 1000 cs oil, and 40 eyes received 5000 cs oil from which low molecular weight contaminants were removed. All aphakic and pseudophakic eyes received an inferior iridectomy. Oil was removed in 19% of eyes during follow-up., Results: Fifty-six percent of eyes manifested anterior chamber emulsified oil postoperatively. The oil was typically identified only on gonioscopy. This complication developed in 50% of eyes receiving 1000 cs oil and 58% of eyes receiving highly homogeneous 5000 cs oil. Of the 48 eyes, new postoperative glaucoma best explained by interval angle oil emulsification developed in 5 (10%)., Conclusion: Anterior chamber oil emulsification occurred frequently, despite inferior peripheral iridectomy in aphakic or pseudophakic eyes and the use of highly purified, higher viscosity oil in 83% of eyes. In this series, new glaucoma in the setting of angle oil emulsification only developed in 10% of eyes. The glaucoma was managed medically in four of five patients.

Intravenous administration of live microorganisms to rabitts with cardiac catheters produces an experimental model of infective endocarditis. Despite the development of infected valvular vegetations, positive blood cultures, splenomegaly, and focal embolic renallesions, glomerulonephritis has not been found in these animals. In the present study, acute diffuse proliferative glomerulonephritis, featuring endothelial and mesangial proliferation, capillary occlusion, and leukocytic infiltration was produced in rabbits immunized withthe infecting agent prior to the establishment of left sided alpha-streptococcal endocarditis. Controls receiving immunization alone, immunization and sterileendocarditis, or infective endocarditis alone did not develop diffuse glomerulonephritis. Electron microscopic findings of occasional subendothelial electron-dense deposits and immunofluorescence deposition of IgG and C3 in a peripheral granular capillary pattern were consistent with an immune complex type nephritis. Decreased serum complement levels were demonstrated in those animals developing diffuse glomerulonephritis, and some animals developed circulating rheumatoid factor. In view of the morphologic findings and the necessity of preimmunization for development of glomerular changes, it is concluded that immune mechanisms play a role in the diffuse glomerulonephritis associated with this model of infective endocarditis.

One hundred thirty-four consecutive eyes with rhegmatogenous retinal detachment involving the macula were evaluated with reference to the effectiveness of systemic steroids in preventing choroidal detachment after scleral buckling surgery and in facilitating both anatomic and functional success. The occurrence of postoperative choroidal detachment was inversely related to the routine intravenous administration of steroids under antibiotic coverage beginning in the recovery room (P = 0.014). Eyes so treated were free of both clinically significant infection and extrusion. The infrequent but worrisome complication of angle closure sufficient to require choroidal tap did not occur among treated eyes. Routine steroid use may have been associated with increased preservation of acuity at the level of 20/200 or better (P = 0.043).

Of 104 consecutive patients with senile reticular pigmentary degeneration (207 eyes), 85 patients (82%) were more than 60 years old (mean age, 69.2 +/- 8.54 years). Forty-nine (47%) were men and 55 (53%) were women. Peripheral visual fields were not characteristically constricted. Although most eyes tested had visual acuities of 20/50 or better, 69 eyes (33%) had visual acuities of 20/100 or worse. A total of 136 eyes (66%) had senile macular degeneration at the time senile reticular pigmentary degeneration was first diagnosed, whereas only 43 control eyes (21%) from the same referral population also had senile macular degeneration (P less than .001). Macular degeneration was the primary cause for reduced vision when it was noted. In no instance could reduced visual acuity or constricted visual fields be attributed to the senile reticular pigmentary degeneration alone. Senile reticular pigmentary degeneration on routine ophthalmoscopy should alert the clinician to the possibility of co-existing macular degenerative disease.

Proliferative diabetic retinopathy (PDR) is uncommon in patients younger than the age of 20 and has been rarely reported. Since 1969, 14 adolescents with severe PDR have been seen, the youngest of whom was 16 years old and the oldest, 19 years old. The shortest duration of diabetes mellitus prior to diagnosis of PDR was eight years. Ten patients had a positive family history of diabetes. Thirteen patients had suboptimal metabolic control. Ten patients had some degree of azotemia, seven were hypertensive, and six had proteinuria. Ophthalmic findings included advanced neovascular and fibrous proliferation on initial classification, and rapid progression to blindness-which was most frequently secondary to traction retinal detachment. In a small retrospective study, pituitary ablation may have offered greater preservation of vision than that observed in untreated patients.

One hundred thirty-six patients with proliferative diabetic retinopathy (PDR) in one eye and nonproliferative diabetic retinopathy (NPDR) in the fellow eye on initial examination were followed up for at least three months. Eight percent of the eyes with NPDR were eliminated from further consideration by treatment within the first three months. Proliferative diabetic retinopathy developed in 58% of the remaining eyes with NPDR, usually within two years of the initial examination. Proliferative diabetic retinopathy developed in a significantly greater percentage of diabetics who were younger than 40 years than in diabetics older than 60 years. Poor visual prognosis among eyes that initially had NPDR was associated with advanced angiopathy or exudation on initial examination and also may have been associated with the subsequent development of PDR. Neither the development of PDR nor the final visual acuity in these eyes could be correlated with vascular disease outside the eye, the degree of PDR in the fellow eye, or the presence of higher intraocular pressure in the eye with NPDR on initial examination. Forty-one percent of the eyes with unilateral PDR were eliminated from consideration by prompt treatment. Most remaining eyes with PDR also showed progressive fundus pathologic conditions.

A 13-year-old black female was referred with unilateral granulomatous uveitis and orbital inflammation of sudden onset. Hematologic, serologic, bacteriologic, and ultrasonographic studies along with high resolution CT scans of the orbits were employed to determine the diagnosis and appropriate treatment. Subconjunctival corticosteroid injection containing air prior to referral obfuscated the ultimate diagnosis of pseudotumor. The Pediatric Infectious Disease service delayed definitive treatment with systemic steroids. Differential diagnosis of granulomatous uveitis with orbital inflammation are discussed. CT scan has significantly advanced the diagnosis and management of orbital pseudotumor.

We reviewed retrospectively the records of patients referred for retinal examination and found 375 eyes (233 patients) with acquired retinoschisis. Of the 375 eyes, 85 had outer layer retinal breaks, 27 had retinal detachments, and 29 had pigmentary lines. Twenty-five of the 29 pigmentary lines (86.2%) demarcated either retinal detachment or outer retinal layer breaks.

The elderly diabetic with PDR may present with problems in differential diagnosis. The less marked tendency toward symmetry among the elderly may argue against prophylactic panretinal photocoagulation in a fellow eye, especially if the eye with PDR does not have high-risk characteristics. Anticoagulation can complicate management. Aspirin and other medications that interfere with clotting should be discontinued if possible.

The combination of unilateral proliferative diabetic retinopathy (PDR) in one eye and nonproliferative diabetic retinopathy (NPDR) in the fellow eye was observed in 10.1% of patients with PDR. Most patients were between the ages of 50 and 70 years; the majority had adultonset diabetes mellitus. Unilateral aphakia and anisometropia of greater than 1 diopter were both infrequently seen. The incidence of glaucoma was unremarkable. Unilateral elevated-but not necessarily abnormal-intraocular pressure was found in a significantly larger proportion of eyes with NPDR (20%) than with PDR (12%). Most patients had moderate to severe angiopathy or exudation in the eye with NPDR and modest PDR in the fellow eye; however, one third had moderate to severe PDR. In only 2% of the patients was visual acuity less than 20/200 on initial examination.

In Neurospora crassa, evidence has recently been obtained for a cluster of four closely-linked genes controlling the inducible enzymes catalyzing the first three reactions in the catabolism of quinic acid. Three of these genes appear to be the structural genes for the three enzymes. The fourth gene, designated qa-1, has been interpreted as having a regulatory function, since qa-1 mutants are pleiotropic types, are noninducible for the three enzymes, and form heterocaryons which complement mutants in the structural genes. The present studies were undertaken to elucidate further the nature of the regulatory role of the qa-1 locus. A number of constitutive (qa-1(C)) mutants have been obtained from certain qa-1 mutants as revertants selected for their ability to grow on quinic acid as a sole source of carbon. These qa-1(C) mutants produce high levels of all three enzymes in the absence of an inducer, map within (or very close to) the qa-1 locus, and produce a catabolic dehydroquinase (EC 4.2.1.10) which is indistinguishable, on the basis of thermolability tests, from that of wild type. In addition, when grown in the absence of an inducer, heterocaryons between wild-type (qa-1(+)) and different qa-1(C) mutants exhibit markedly different levels of constitutivity (from 5 to 50% of the particular parental qa-1(C) mutant) for catabolic dehydroquinase, one of the enzymes under qa-1 control. These overall results are interpreted as supporting the hypothesis that the qa-1(+) gene product (presumably a multimeric protein) plays only a positive regulatory role in initiating synthesis of the three quinate catabolic enzymes.