No abstract

The miotic pupil during sleep is a well-known phenomenon but the mechanism has so far been incompletely analysed. Information on the tonus of the parasympathetic ciliary muscle is on the whole lacking. The state of the ciliary muscle during sleep is of physiologic interest particularly with reference to effects on the outflow resistance.Some methodological factors have to be considered in a n investigation of this problem: A study of the tonus of the ciliary muscle restricts the material to primates. Induced sleep with general anesthetics is not acceptable since it may very possibly have central and local eye effects different from those in physiological sleep. In the present investigation the experimental material was selected from human subjects with a high arousal threshold (i. e. children) and who were examined during a defined period of sleep by retinoscopy. Physiology of sleep: Sleep is not a uniform condition. I n humans two principal types of physiological sleep are distinguished. At the onset of sleep slow ccrtical waves with big amplitude and sleep spindles appear on the EEG. The muscle tonus diminishes, the blood pressure, the pulse rate, the respiratory frequency and the temperature decrease. Sweat and gastric secretion increase, salivation decreases and peripheral vessels dilate. I n the pioneer work on sleep by Hess 9110 some of these physiological data were taken as evidence of a generally increased parasympathetic activity during sleep. This "synchronized" sleep is interrupted after 1-2 hours for a period of 10-15 minutes of "desynchronized" sleep. This period is characterized by the appearance of fast waves with small amplitude on the EEG. Fluctuations in blood pressure, pulse rate, and respira-

1573 examinations were performed on 397 eyes. hh was found in 55 eyes--thromboses included--at 91 examinations. Part of this material qualified for use in a comparative study with pilocarpine in 81 eyes and timolol in 82 eyes. The relative frequency of hh in the treated groups and in the pretreatment group was not significantly different from that of the whole material. No indication of pressure reduction with effect on the occurrence of hh could be detected. The average probability of hh at an examination chosen at random was 6 per cent in this material of ordinary simple and capsular glaucoma cases. The occurrence of haemorrhages in relation to age, sex, general hypertension and diabetes are discussed.

Intraocular fungus infections a r e often difficult to diagnose and despite new fungistatic drugs they often present great therapeutic problems. This communication reports 1 cases with metastatic spread of fungus infection to the eye; one case with Aspergillus fumigatus endophthalmitis and 3 cases with Candida albicans endophthalmitis. Case 1Clinical hirtory: A 38-year-old man with a severe insufficiency and stenosis of the aortic valve secondary to a rheumatic fever in childhood, was operated with excision of the aortic ostium and replacement with a Cutter prosthesis. Postoperative fever was treated with large doses of antibiotics (penicillin, ampicillin, cloxacillin and erythromycin) and terminally with amphotericin B intravenously. In spite of the therapy the patient died with signs of sepsis 2 months after the operation.Eye signs: The eyes were examined before operation and were normal. Six weeks after operation the patient complained of diminishing vision in the right eye (O.D.). The vision was slightly reduced and there were preretinal and retinal haemorrhages in the macular region. In the left eye (0. S) small haemorrhages lay near the papilla. Four days later vision in the 0. D. was reduced to light perception; there was fibrinous exudate in the anterior chamber and the vitreous was clouded. The 0. S. was unchanged.During the following week the vitreous body of the O.D. became less clouded and in the central part a yellow-white mass with rather distinct margins was seen. I n the temporal part a pear-shaped body protruded from the main lesions. These findings led to the suspicion of a fungal infection. In spite of treatment with amphotericin B intravenously and nystatin orally there was no improvement. The patient died 1 week later.

There have been reports of a few cases in which diabetic retinopathy has been aggravated during pregnancy. Some of the patients have improved after delivery, but in some the visual impairment has been lasting.In the present study 24 diabetics were followed during and after pregnancy, having frequent checks of the blood sugar and fundus. The treatment of the diabetes aimed at a blood sugar below 100 mg/100 ml. The fundus was examined in the ophthalmoscope and photographed. In some cases fluorescein angiography was performed. The patients ranged in age from 17 to 37 years, and the duration of their diabetes was from 0-24 years. Two had mild toxaemia of pregnancy. One had an early spontaneous abortion and one a stillbirth. In 16 of the 24 patients diabetic retinopathy was diagnosed, of the proliferative type in 3. Five exhibited unmistakable progression of the retinopathy during pregnancy. Two of them had mild toxaemia of pregnancy. Of the remaining 3 patients 2 developed proliferative retinopathy. In all 5 cases the changes regressed partially after delivery.Two of the 3 patients who got worse (without having toxaemia) exhibited considerably higher triglyceride values than the mean values for the entire series towards the termination of pregnancy. On the other hand, there was no difference in the cholesterol levels.