Faculty Bibliography

Toxicology tends to be excellent bed-time reading for the insomniac, but this book, a record of the proceedings of the First Congress of the International Society of Ocular Toxicology, held June 7, 1988, proves otherwise. Exceptional in its diversity, the material in this book was originally published as Lens and Eye Toxicity Research in 1989. "... an excellent, if somewhat scattered, overview of current thought in ocular toxicology." The book is organized into seven sections: "Test Models," "Cornea," "Anterior Chamber," "Lens," "Retina," "Phototoxicity," and "Side Effects of Drugs and Physical Agents." There is an additional section entitled "Addendum to Section 5 [Retina]." One wonders why this single chapter did not simply follow its abstract, which was included in the "Retina" section. The chapters follow a variety of formats and styles, with some providing brief overviews of the authors' work and the majority of others offering detailed explications of the experiments performed

Acute and long-term effects of contact transscleral semiconductor diode laser cyclophotocoagulation were studied in rabbits. Immediately following cyclophotocoagulation, light microscopy revealed coagulation necrosis of the ciliary pigmented and nonpigmented epithelia and stroma; destruction increased in relation to power. There was architectural disruption with higher energy levels. The findings with diode and continuous-wave contact neodymium-YAG lasers were similar. In rabbits treated and followed up for 6 weeks there was a decrease in intraocular pressure during the observation period (P less than .05, paired Student's t test). The gross and light microscopic examination revealed focal atrophy and fibrosis of the ciliary processes, with pigment-laden macrophages on the ciliary processes and in the outflow pathways. Higher energy levels caused lens capsule damage and vitritis. The diode laser produced ciliary destruction similar to the continuous-wave contact neodymium-YAG laser in rabbits, with significant intraocular pressure lowering during the 6-week follow-up.

Advanced glaucoma in 140 eyes of 136 patients was treated with contact transscleral continuous wave neodymium:YAG (Nd:YAG) laser cyclophotocoagulation (CYC) with a sapphire-tipped probe. The anterior edge of the probe was placed 0.5 to 1.5 mm posterior to the limbus, using 7 to 9 W of power for 0.7 seconds with 32 to 40 applications, sparing the 3 and 9 o'clock meridians. Patients were studied prospectively. The mean preoperative intraocular pressure (IOP) of 36.7 +/- 0.97 mmHg decreased to 21.2 +/- 0.99 mmHg (P = 0.004) after treatment (mean follow-up, 3.2 +/- 0.35 months) for a mean decrease in IOP of 15.5 +/- 1.21 mmHg and a mean percent decrease of 39%. Forty-one eyes were followed 6 or more months (mean, 6.7 +/- 0.25 months). The CYC reduced IOP to 25 mmHg or less in 71% of eyes, to 22 mmHg or less in 62% of eyes, and to 19 mmHg or less in 49% of eyes. Maximum lowering of IOP occurred 1 week to 1 month after treatment and remained at that level through 6 months of follow-up. Retreatment was required in 11% of patients; only one patient was retreated more than once. Four patients treated with 9 W of power developed IOPs below 5 mmHg; two of these patients had an IOP of 0 mmHg. Other complications of therapy were minimal, and patients had little pain. There was no significant change in visual acuity. Early results of this newly available therapy are encouraging.

Although toxoplasmosis is the most common infectious cause of posterior intraocular inflammation, it is rarely described in association with scleritis. The authors present five cases of toxoplasmosis with scleritis. Two of the five cases were diagnosed clinically and serologically as having toxoplasmosis. Their retinochoroiditis and scleritis responded well to medical therapy. Retinochroiditis and scleritis that was refractory to treatment developed in the other three patients, two of whom had been receiving immunosuppressive therapy for systemic diseases. Their therapeutic regimens did not include treatment for toxoplasmosis. All three eyes became blind and were enucleated. Results of pathologic examination of all three enucleated eyes showed Toxoplasma gondii in the retina. There was severe inflammation of the retina, choroid, and sclera. Toxoplasmosis should be considered in the clinical differential diagnosis of scleritis associated with retinochoroiditis, particularly in immunosuppressed patients.