VOL. 92, NO. 5 MEETINGS, CONFERENCES, SYMPOSIA 741

hamster melanoma was implanted in the anterior chamber of rabbits. After in­travenous administration of hematopor-phyrin derivative, 10 mg/kg of body weight, maximal fluorescence in the tumor occurred between 24 and 48 hours, when lens pseudofluorescence was also observed. Histopathologic findings confirmed that the fluorescence corre­sponded to the malignant melanoma cells in the anterior chamber. No ocular toxici-ty was demonstrable histologically one week and eight weeks after hematopor-phyrin derivative administration. With intravenous doses sufficient to detect flu­orescence in tumor, no ocular toxicity was observed. Hematoporphyrin deriva­tive fluorescence photography may be useful in the diagnosis of ocular melano­ma.

D O U B L E - B L I N D R A N D O M I Z E D C L I N I C A L T R I A L COMPARING H I G H

D O S E SYSTEMIC STEROIDS VS P L A C E B O ON T H E C O U R S E AND COMPLICATIONS

O F H E R P E S Z O S T E R O P H T H A L M I C U S W I T H PARTICULAR R E F E R E N C E T O

P O S T - H E R P E T I C N E U R A L G I A

We conducted a double-masked ran­domized clinical trial to determine the effect of high-dose systemic corticoste-roids on the ocular complications of her­pes zoster ophthalmicus with particular reference to post-herpetic neuralgia. Corticosteroid therapy did not affecf'the course of the pain. All patients who had pain at the end of the trial were pain-free several days after starting treatment with Elavil and Trilafon.

T H E IMPORTANCE O F F L U O R E S C E I N IN APPLANATION T O N O M E T R Y

T. Rosenstock and C. W. Breslin The purpose of this study was to com­

pare ocular tension measured by means of Goldmann applanation tonometry using white light without fluorescein, blue light without fluorescein, and blue light with fluorescein. These were also compared to

values obtained by the EMT 20 tonome­ter. A total of 80 eyes underwent repeat­ed tension measurements. All underwent one white light without fluorescein test and one blue light with fluorescein test plus one other method. Fifty-two eyes were evaluated by all four methods. Re­sults indicated that the white light with­out fluorescein gives lower tensions than the blue light without fluorescein, which in turn gives a lower reading than blue light with fluorescein. These differences are significant when compared by t-test analysis. Furthermore, a strong correla­tion exists between values obtained by blue light with fluorescein and EMT 20 tonometry. We conclude that in order to measure tension accurately with the Goldmann applanation tonometer, fluo­rescein and blue light must be used.

PERIPAPILLARY H E M O R R H A G E S L. Schonberger and D. J. Morin

Thirty-three patients with fresh myo-cardial infarcts were examined for possi­ble visual field defects and peripapillary changes. These patients were examined just before being discharged from the hospital for their recent infarcts. The group contained more men than women and ranged in age from 37 to 80 years. There was a 12% incidence of peripap­illary hemorrhage in patients with normal intraocular pressures. One of the patients with a peripapillary hemorrhage also had an arcuate visual field defect. The pa­tients with peripapillary hemorrhages tended to be more than 60 years old and all had an additional medical problem such as diabetes, hypertension, anemia, or previous coronary bypass surgery.

INTRALAMELLAR RE FRA CT IV E KERATOPLASTY IN RABBITS

J. Η. Sher and W. S. Dixon A previous study had demonstrated

that intracorneal insertion of silicone but­tons increased the curvature of rabbit corneas and induced myopia, although

742 AMERICAN JOURNAL OF OPHTHALMOLOGY NOVEMBER, 1981

corneal melting occurred within several weeks in all cases. Our aim was to deter­mine the suitability of hydrophilic soft contact lenses of varying water content and donor corneal material as intralamel-lar corneal inserts, and to determine the corneal curvature and refractive changes induced by them. Rabbits were examined preoperatively for keratometric readings and refractive error. They were then anesthetized and underwent intracorneal lamellar separation, followed by insertion of trephined buttons of Bausch & Lomb Soflens (polymacon), Cooper Permalens (perfilcon A), or donor corneal material sectioned on a histologie cryostat and frozen until use. Excluding eyes in which infection occurred and the eyes of rabbits who died or were killed for unrelated reasons, there were five Soflens, seven Permalens, and four corneal inserts in 12 rabbits. Perforation and sloughing oc­curred in all the Soflens inserts. Six of seven Permalens inserts and all four cor­neal inserts were clear after three months. Steepening of the corneal curva­ture and induced myopia were demon­strated. We believe the intrastromal insertion of highly hydrophilic soft contact lenses or microlathed donor corneal buttons has potential for cor­rection of aphakia.

ESSENTIAL BLEPHAROSPASM. A R E V I E W O F M E D I C A L M A N A G E M E N T

AND A T H E R A P E U T I C T R I A L O F C H O L I N E C H L O R I D E

J. B. S k a r f a n d J . A. Sharpe

Essential blepharospasm is a chronic, variably progressive disorder in which bilateral, almost symmetrical eyelid clo­sure occurs involuntarily. We reviewed

the therapeutic approaches that have been tried in this condition as well as the records of 14 patients followed at the neuro-ophthalmology unit of the Toronto Western Hospital in the last nine years. Numerous medications have been used to suppress the eyelid spasm but, in gener­al, the response to treatment has been variable, unpredictable, and often tran­sient. Essential blepharospasm resem­bles other hyperkinetic movement disor­ders clinically and like them may result from a relative deficiency of acetylcholine in the brain. Hence, we believed that choline, a natural precursor of acetylcho­line, might be beneficial in patients with uncontrolled blepharospasm since brain levels of this neurotransmitter are in­creased in animals and in man when choline is taken orally. Seven patients with chronic intractable blepharospasm were treated with orally administered choline chloride. An initial daily dose of 2.1 gm was progressively increased by multiples until adequate control of the blepharospasm was achieved or until the side effects of the choline (principally nausea and diarrhea) became intolerable. Three of these patients reported substan­tial improvement of their symptoms with doses of 4.2 to 8.4 gm/day and a compari­son of films made before and during their treatment showed markedly decreased frequency and intensity of eyelid spasm. The remaining four patients had no sig­nificant change in their symptoms. Thus, there appears to be a subgroup of patients with essential blepharospasm who re­spond favorably to treatment with choline chloride. A trial with the preparation is suggested before therapy with sedatives or other psychoactive drugs is initiated.

P. K. BASU