SOCIETY PROCEEDINGS EDITED BY DR. ]

WASHINGTON, D.C., OPHTHAL-MOLOGICAL SOCIETY

February 2, 1942

DR. E. LEONARD GOODMAN, presiding

OPHTHALMIC SURGICAL ANATOMY

DR. A. B. REESE (by invitation) pre-sented a paper on this subject. He gave the average measurements for locating the ciliary zone, the ora serrata, and the vortex veins. He also discussed the dif-ferent types of limbus, the horizontal and the vertical, in which it is overlapped by the conjunctiva, with the suggestion that the limbus be studied before a trephining is done. He cautioned that Descemet's membrane may be detached if the trephine is dull, but pointed out that a separation of Descemet's mem-brane which occurs in cyclodialysis is usually not serious. This membrane is elastic, and since elastic tissue tends to dis-appear with old age, there may be changes in later years. Wrinkling of Descemet's membrane occurs (1) when intraocular pressure has been high and has been reduced by treatment or operation, (2) when corneal edema has been present and subsides, and (3) following operative manipulations with buckling of the cor-nea.

Dr. Reese said the sclera also loses elasticity in old age and there may be calcium deposits. Such deposits, if in the form of plaques, may interfere with a cataract section. A loss of volume in the eye in the young is made up by elasticity of the sclera. In older people, it is made up by (1) collapse of the cornea, (2) sucking of air into the anterior chamber, (3) detachment of the retina, and (4)

^LPH H. MILLER

collapse of the sclera. In a cyclodialysis operation, the an-

terior emissary artery is usually injured. For that reason some operators have the patient placed in a sitting position, so that if there is bleeding into the anterior chamber it will go to the lower part and away from the site of operation. Such bleeding in aphakic eyes may cause harm by infiltrating into the vitreous. These ar-teries may be dilated in glaucoma. They are also dilated in the sector overlying a tumor of the ciliary body. A long ciliary nerve may make a loop just beneath the conjunctiva and resemble a small tumor. The most posterior of the zonular fibers supporting the lens are attached to the ora serrata. This explains retinal separa-tions following traumatic cataract and the needling of tough membranes.

The iris pigment seen at the pupillary margin tends to disappear with age. In diabetes it may become edematous. In older people, just behind the sphincter of the iris, fibrous tissue interposes itself. This tends to contract and is responsible for the miosis seen in the aged, Dr. Reese stated. The iris is thinnest and most easily torn at its attachment to the ciliary body. Some of the ciliary processes may be on the posterior surface of the iris.

The ciliary body is largest in hyperopia and smallest in myopia. The hypertrophy of the ciliary body in hyperopic patients may help to account for embarrassment of the angle and the resulting increased intraocular pressure.

ANGIOMATOSIS OF THE RETINA

DR. G. VICTOR SIMPSON presented a patient with angiomatosis of the retina and reported the history of the case.

746 SOCIETY PROCEEDINGS

ANGIOID STREAKS WITH BILATERAL RET-INAL LESIONS

DR. STERLING BOCKOVEN presented a case report on this subject.

PARENCHYMATOUS KERATITIS FOLLOWING MUMPS

DR. EVERETT CALDEMEYER reported on a case of this nature.

HYPERPHORIA

DR. ERNEST SIIEPPARD showed col-ored motion pictures illustrating the hy-perphorias.

Sterling Bockoven, Secretary.

COLLEGE O F PHYSICIANS O F PHILADELPHIA

SECTION ON OPHTHALMOLOGY

February 19, 1942

ALFRED COWAN, M.D., chairman

FURTHER STUDIES OF THE PENETRATION OF SULFATHIAZOLE INTO THE EYE

DR. H. G. SCHEIE reported on experi-ments which showed that microcrystal-line sulfathiazole penetrated into the aqueous humor of normal eyes to about the same percentage of the blood level as does regular sulfathiazole, about 24 percent. In other groups of animals with infected eyes, all work being on cats, sul-fathiazole was seen to enter the aqueous in much greater amounts. In casesj of severe vitreous abscesses the aqueous level was 91 percent that of the blood. Vasodilators also increased the penetra-tion of sulfathiazole. It was concluded that the use of sulfathiazole, at least in severe intraocular infections, was justi-fied.

Discussion. Dr. F. H. Adler remarked that the results of these experiments were clear and convincing. They had a value

which was beyond their immediate re-sults, because they pointed out factors that must be taken into account when evaluating the effect of drugs in the eyes. They showed an effect that one can-not always deduce; namely, the action of a drug in a diseased condition as com-pared with its effect in a normal eye. As Dr. Scheie pointed out, in ocular infec-tions the blood-aqueous barrier is altered and is much more permeable than in the normal eye. As a result of this, certain drugs which fail to pass through the nor-mal barrier are found in the inflamed eye.

As to the microcrystalline form of sulfa drugs, Dr. Scheie said, last year Dr. Souders, in their department, was in-terested in obtaining some of the sulfa drugs which could be injected by hypo-dermic needle. The ordinary sulfa crys-tals are too large to go through the bore of a hypodermic needle. The biochemists in the Johnson Foundation succeeded in obtaining the sulfa drugs in microcrystal-line form. The importance of this was im-mediately realized by other departments in the hospital and, as a result, extensive research was begun under a grant from the Smith, Kline, and French Company, under the direction of Dr. Joseph Stokes, Professor of Pediatrics. The microcrys-talline form of these drugs was now be-ing investigated by various members of their department.

As a result of these experiments of Dr. Scheie and Dr. Leopold, they know that the ordinary form of these drugs may be used by injecting them into the blood stream. If it was advisable to inject the drug directly into the vitreous or aque-ous, the microcrystalline form may be used.

TEMPORARY ABDUCENS PARALYSIS NOT ASSOCIATED WITH OTHER GENERAL OR NEUROLOGIC ABNORMALITIES

DR. W. I. LILLIE reported eight cases