Accommodative Esotropia

Galin, Kwitko and Restrepo, Proceedings of the International Strabismological Association (1969),746 found PHT useful in the treatment of accommodative esotropia. A study with thirty-five children was completed. Their ages ranged from two-and-a-half to fourteen years. Children less than six years of age were given 30 mg PHT twice daily, then increased to three times daily if after two days it was well tolerated. Standard orthoptic studies were performed before and after PHT. Of twenty-five patients with abnormal near-point accommodation, twenty improved with a decrease of three diopters and ten of these had a concomitant decrease in esotropia. Because they were too young, the near point of accommodation was not obtained in ten patients. Nine out of twenty-one patients responded to PHT in the combined accommodative groups (including thirteen accommodative and eight partial accommodative). Accommodative convergence/accommodation (AC/A) ratios were most favorably influenced by PHT in those patients having high ratios. PHT had little effect on normals. Phospholine iodide, which had greater effect on AC/A ratios than PHT, was not selective and had an effect on normals as well as abnormals.

746. Galin, M. A., Kwitko, M., and Restrepo, N., The use of diphenyihydantoin in the treatment of accommodative esotropia, Proc. Int. Strabismological Assn., In Proc. Int. Ophthalmological Congress, Mexico, 1969.

Glaucomatous Field Loss

Becker and Podos, Symposium on Ocular Therapy (1973),812 in earlier studies had found that PHT partly protected the optic nerve in vitro when subjected to anoxia, cyanide or ouabain. They decided to explore the possibility that PHT might reverse some of the effects of ischemia on the optic nerve in humans. The authors instituted a study to examine the effects of PHT in glaucomatous field loss. This study involved fifty patients who were given 100 mg PHT t.i.d. for two to five months. The effects on visual fields were quantitatively recorded. When treated with PHT, only one of the fifty patients had a worsening of visual fields, twenty-nine showed no worsening, and twenty patients showed improvement in visual fields. This salutary effect in visual fields occurred despite the fact that intraocular pressures, which previously had been deleterious, persisted. In seven of the patients that showed improvement, PHT was discontinued and worsening of visual fields occurred. The authors found of considerable interest the fact that when PHT was reinstituted in five of these seven patients, improvement in visual fields again occurred. The authors conclude that this pilot study suggests that where the blood supply is decreased, PHT may be able to protect optic nerve function.

812. Becker, B. and Podos, S. M., Diphenyihydantoin and its use in opticnerve disease, Symposium an Ocular Therapy, Vol. VI, I. H. Leopold, Ed., C. V. Mosby Co., St. Louis, 1973.