VOL. 64, NO. 2 NOTES, CASES, INSTRUMENTS 319

The aspheric lens, either a +20D or a +30D, is of plastic. The holder is aluminum, thus in­suring little interference with the balance of the forceps. The lens diameter of about one inch allows the surgeon a binocular field of view. The lens is attached to the holder by a malleable wire so that it can be positioned for sharpest focus. Experience has shown that the lens must be positioned in such a way that its surface faces the surgeon but does not reflect the rays of the overhead operating light into the eyes of the surgeon.

243 Charles Street (02114)

PIGMENTARY GLAUCOMA

REPORT OF A CASE OF STEROID RESPONSIVENESS

ALVIN H. BRACKUP, M.D.

AND S A M S O N W E I N G E I S T , M.D. Long Island City, New York

Becker and Podos1 proposed that pigmen­tary glaucoma is a variant of primary open-angle glaucoma. Their work was based on responsiveness to steroid testing in patients with established Krukenberg spindles. In support of this we wish to report the re­sponse of a patient to the topical adminis­tration of prednisolone 0.25% prior to the development of a Krukenberg spindle.

CASE REPORT

A 22-year-old white woman, a nurse, was seen February 9, 1965, because of redness of each eye

with a mucous discharge. Her visual acuity was 20/20 in each eye with a correction of : R.E., —S.OD sph and L.E., —4.25D sph. A marked follicular conjunctivitis was found in each lower fomix which improved after two days of therapy with Isopto-cetapred drops and Metimyd ointment at bedtime.

The intraocular pressure was 22 mm Hg in each eye (applanation) and the discs were normal. After five days of this therapy, the conjunctivitis was almost cured but the intraocular pressure had increased to 30 mm Hg in each eye. No abnormal intraocular pigmentation was noted at this time. The steroids were stopped and one week later the intraocular pressure was: R.E., 20 mm Hg and L.E., 18 mm Hg. A water-drinking test at this time was negative. There was no family history of glaucoma.

The patient was next seen March 10, 1966, at which time a Krukenberg spindle was noted in the left eye and the angles in both eyes were noted on gonioscopy to have marked pigment de­position on the trabecular meshwork, more how­ever in the left eye. The intraocular pressure was 10 mm Hg in each eye. The discs and visual fields were normal. Water-provocative tonography at this time showed facility of outflow of 0.13 in each eye and a Po/c of 130 and 169. The patient was placed on pilocarpine 1% three times daily in each eye and after one week the facility of outflow had improved to 0.23 in each eye and Po/c to 65 and 73 at which level it has remained until November 22, 1966.

SUMMARY

This is believed to be the first case report of positive steroid responsiveness prior to the development of a Krukenberg spindle and increased trabecular pigmentation.

30-74 36th Street (11103)

REFERENCE

1. Becker, B., and Podos, S. M. : Krukenberg's spindles and primary open-angle glaucoma. Arch. Ophth. 76:635, 1966.