Visual evoked potential and pupillary signs. A comparison in optic nerve disease.

We measured the pupil cycle time, the relative afferent pupillary defect, and the pattern-reversal visual evoked potential (VEP) in 41 patients with unilateral anterior ischemic optic neuropathy (AION) and 24 patients with unilateral optic neuritis. We speculated that the relative afferent pupillary defect would match the VEP amplitude and that the pupil cycle time would correspond to the VEP latency. We found a correlation between the relative afferent pupillary defect and VEP amplitude in patients with AION, but not in patients with optic neuritis.

Ocular neovascularization with retinal vascular occlusion. II. Occurrence in central and branch retinal artery occlusion.

Sixty-one patients (64 eyes) with central retinal artery occlusion (CRAO) and 41 patients (44 eyes) with branch retinal artery occlusion (BRAO) were studied in detail clinically to find out the pathogenesis of their ocular neovascularization (NV). Ocular NV was seen in 12 eyes (11 patients) with CRAO: iris NV was seen in all 12 eyes, angle NV was seen with neovascular glaucoma (NVG) in ten of them, and no NV was seen in BRAO. Nine of ten patients with CRAO associated with NVG were old, having severe carotid artery disease (CAD) and severe generalized atherosclerotic arterial disease; in the remaining patient, NVG was caused by diabetes mellitus.

Occlusion of the posterior ciliary artery. V. Protective influence of simultaneous vortex vein occlusion.

In 28 eyes of rhesus monkeys, occlusion of all the posterior ciliary arteries (PCAs) was either performed alone (in seven eyes) or accompanied simultaneously by occlusion of one vortex vein (VV) (in 11 eyes) or two VVs (in ten eyes). In addition, in four eyes lateral PCA occlusion was combined with occlusion of two VVs. All the eyes were investigated for acute ischemic lesions in the fundus, ie, outer retinal infarcts and anterior ischemic optic neuropathy (AION).

Ocular neovascularization with retinal vascular occlusion. I. Association with experimental retinal vein occlusion.

Experimental occlusion of both major temporal retinal veins simultaneously (in six eyes of cynomolgus monkeys) and of the central retinal vein (in one rhesus monkey) produced a fall in intraocular pressure (hypotensive effect) and neovascularization (NV) of the iris and, less frequently, of the optic disc (vasogenic effect). The retinal changes (severity and extent of retinopathy, retinal capillary leakage, and onset and extent of retinal capillary obliteration) were correlated with the pattern of ocular NV and hypotony. No direct correlation was seen between the retinal capillary obliteration and the hypotensive or vasogenic effect.

Unilateral optic nerve head and choroidal metastases from a bronchial carcinoma.

A 61-year-old man presented with uniocular gradually progressive visual loss, pain in the eye, visual activity of 6/60, markedly constricted visual fields, optic disc edema, retinal pigment epithelial disturbance at the posterior pole, and markedly delayed filling of the choroid on angiography, with a normal fellow eye. He had suffered from recurrent seizures for 15 years, with some evidence of cortical demyelination. Erythrocyte sedimentation rate was elevated.

Anterior ischemic optic neuropathy.

Though anterior ischemic optic neuropathy (AION) has been widely reported, it is not fully appreciated as one of the commonest causes of impaired vision in persons past middle age. These patients are not infrequently suspected of having an intracranial tumor. This article reviews the clinical features of AION and discusses its pathogenesis and treatment.

Experimental allergic encephalomyelitis. I. Optic nerve and central nervous system manifestations.

Experimental allergic encephalomyelitis (EAE) was produced in six adult rhesus monkeys. The animals were evaluated serially by ocular, ophthalmoscopic, fluorescein fundus angiographic, pupillary, visual evoked potential, neurologic, cerebrospinal fluid (CSF), and hematologic examinations and by postmortem detailed histopathologic examination. All the animals developed acute EAE.

Experimental allergic encephalomyelitis. II. Retinal and other ocular manifestations.

Experimental allergic encephalomyelitis (EAE) was produced in 6 adult rhesus monkeys. All the animals developed acute EAE. Optic neuritis developed in all eyes.

Anterior ischemic optic neuropathy. V. Optic disc edema an early sign.

Four unusual patients had bilateral anterior ischemic optic neuropathy (AION). In all four cases, AION developed in the first eye with the classic presentation. The fellow eye had symptomless optic disc edema (ODE) with no subjective or objective visual loss initially, but the classic AION clinical picture developed later on.

Posterior ischemic optic neuropathy.

3 patients (5 eyes) with posterior ischemic optic neuropathy (PION) are presented. PION is a distinct clinical entity, caused by ischemia of the posterior part of the optic nerve. These eyes presented with a visual acuity varying from normal to no light perception, optic nerve-related visual field defects, and no fundus abnormality (on ophthalmoscopy or fluorescein fundus angiography) at the onset of the disease and for about a month thereafter, but after about 5-6 weeks the optic disc developed atrophic changes.

Anterior ischemic optic neuropathy. VI. In juvenile diabetics.

3 cases of acute optic neuropathy in juvenile diabetics are reported. The neuropathy included initially optic disc edema (ODE), usually with prominent, dilated and frequently telangiectatic vessels over the disc, and later, generally, development of optic disc-related visual field defects. On resolution of the neuropathy, the disc was normal in all eyes except for a mild pallor in one, and the visual acuity and fields recovered to normal.

Experimental occlusion of the central artery of the retina. I. Ophthalmoscopic and fluorescein fundus angiographic studies.

Transient experimental occlusion of the central artery of the retina (OCAR), lasting from 15 to 270 minutes, was produced by clamping the artery in the orbit in 63 eyes of rhesus monkeys. Ophthalmoscopic and fluorescein angiographic studies were performed before and during clamping of the artery, as well as periodically after unclamping, for periods of up to 22 weeks. The effects of transient retinal ischaemia on the retina, optic disc, and retinal vascular bed were studied.

Experimental occlusion of the central artery of the retina. IV: Retinal tolerance time to acute ischaemia.

Ophthalmoscopic, fluorescein angiographic, electrophysiological, and morphological studies on 63 eyes of rhesus monkeys with acute transient experimental occlusion of the central artery of the retina (OCAR) showed that the retina suffered irreparable damage after ischaemia of 105 minutes but recovered well after ischaemia of 97-98 minutes. The tolerance time of the brain to acute transient ischaemia is many times shorter than that of the retina. The metabolism of ischaemic neurones (in the retina and brain) is discussed with a view to explaining this difference, and also the various factors possibly responsible for the retina's longer tolerance to ischaemia, as compared to the brain.

Hemi-central retinal vein occulsion. Pathogenesis, clinical features, and natural history.

A two-trunked central retinal vein (CRV) in the anterior part of the optic nerve may persist as a congenital abnormality in a certain proportion of humans. One of the two trunks, like the CRV, may get occulded in the optic nerve to produce hemi-CRV occulsion (hemi-CRVO). It is shown that hemi-CRVO is a distinct entity, clincially and pathogenetically closely related to CRVO, and unrelated to branch retinal vein occlusion because of fundamental differences between the two.

Acute choroidal ischaemia.

Some of the factors influencing the site, extent, and appearance of acute choroidal ischaemic lesions are considered. Retrograde flow of venous blood (with its high oxygen content) into the area with choroidal artery occlusion seems to exercise a certain protective influence against ischaemic insults to the choroid.

Anterior ischemic optic neuropathy. IV. Occurrence after cataract extraction.

Findings are described from 13 eyes in which post-cataract-extraction anterior ischemic optic neuropathy (PCE-AION) developed immediately after an uncomplicated cataract extraction. During the early stages of the disease, the disc is edematous, with optic disc-related visual-field defects, but after about two months, the disc is pale. The almost invariable high rise of intraocular pressure during the immediate postoperative period plays a critical role in production of PCE-AION in eyes with vulnerable optic nerve head circulation.

Interim FDA report on intraocular lenses.

Intraocular lenses have been regulated by the Food and Drug Administration since February 9, 1978. Data reported through August 9, 1979 reveal 177,503 lenses of four different classes have been implanted. The anterior chamber intraocular lens appears to have a higher incidence of certain postoperative complications compared with both control operations and implantation of lenses in the other three classes.

Central retinal artery occlusion and retinal tolerance time.

Transient central retinal artery occlusion (CRAO) was produced in 63 eyes of rhesus monkeys by lateral orbitotomy and temporary clamping of the central retinal artery (CRA) for between 15 and 270 minutes. Thirty-three eyes were examined at regular intervals for 12 to 22 weeks. Color fundus photography, fluorescein fundus angiography, electroretinography (ERG) and visual evoked response (VER) were performed before and during clamping of the CRA as well as periodically after unclamping.

Quantification of visual fields for statistical analysis.

The importance of visual fields in the study of ocular vascular disorders prompted the development of a method to convert visual fields plotted on a Goldmann perimeter into a digital form so that the data could be analyzed and stored by a computer. An instrument called a scotometer was designed to measure the visual fields and the various scotomata, and a data coding form was developed to facilitate the entry of the data into the computer. After extensive testing, this method is now being used in several clinical trials.