740
December, 1991
AMERICAN JOURNAL OF OPHTHALMOLOGY
3. Imes, R. K., Reifschneider,]. S., and O'Connor, L. E.: Systemic sarcoidosis presenting initially with bilateral orbital and upper lid masses. Ann. Ophthalmol. 20:466, 1988.
Correspondence Correspondence concerning recent articles or other material published in THE JOURNAL should be submitted within six weeks of publication. Correspondence must be typed double-spaced, on 81;', x l l-inch bond paper with Ph-inch margins on all four sides and should be no more than two typewritten pages in length. Every effort will be made to resolve controversies between the correspondents and the authors of the article before publication.
Echographic Diagnosis of Dural-Carotid Cavernous Sinus Fistulas EDITOR:
I read with interest the article, "Echographic diagnosis of dural carotid-cavernous sinus fistulas" by R. H. Spector (Am. J. Ophthalmol. 111:77, January 1991). It is always refreshing to read articles supporting the use of standardized echography in the evaluation of orbital disorders, including carotid-cavernous and indirect (dural) arteriovenous fistulas. I take issue, however, with the presentation of A-scan values for normal extraocular muscles on page 78 of the article. These unreferenced values originated from the Bascom Palmer Eye Institute Echography Department. Furthermore, the author did not obtain permission to use these data, derived from an incomplete study of 26 normal subjects. The study has now been completed, 38 subjects having been measured. This current study is an update of work published by McNutt, Kaefring (Frazier Byrne) and Ossoinig' in 1977. Since that time, several studies have been published that describe the combined use of B- and standardized A-scan for extraocular muscle evaluation.i" Our present study utilized these combined techniques with improved instrumentation for better resolution and more precise electronic measurements. SANDRA FRAZIER BYRNE
Miami, Florida
References 1. McNutt, L. c., Kaefring S. L., and Ossoinig, K. C.: Echographic measurement of extraocular muscles. In White, D., and Brown, R. E. (eds.): Ultrasound in Medicine, vol. 3A. Basel, Karger, 1977, pp. 927-932. 2. Ossoinig, K. c.. Standardized echography. Basic principles, clinical applications and results. Int. Ophthalmol. Clin. 19:165, 1979. 3. Byrne, S. F.: Standardized echography of the eye and orbit. Neuroradiology 28:618,1986. 4. Byrne, S. F., and Glaser, ]. S.: Orbital tissue differentiation with standardized echography. Ophthalmology 90:1071, 1983.
_ _ _ _ _ _ _ Reply
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EDITOR:
The A-scan values for normal extraocular muscles that appeared in my article were given to me in 1987 by the Director of Echography at Bascom Palmer Eye Institute. The values were also pinned to the bulletin boards of each examination room in Bascom Palmer Eye Institute's Department of Echography. I assumed the values to be time-tested, accurate, and statistically sound for two reasons: not a single amendment had made to them over a threeyear period, from 1987 to 1990, when I visited the echography department; and each of the Bascom Palmer Eye Institute echographers routinely referred to these values in their day-today echographic examinations of patients with suspected enlargement of the extraocular muscles. Throughout the performance of my study and the preparation of my manuscript I used the extraocular muscle measurements in the same way I saw them used at Bascom Palmer Eye Institute. There was no intent to take credit for the investigative work that went into ascertaining these data. They were accumulated by the members of the department of echography at Bascom Palmer Eye Institute, and I commend them for their final results. ROBERT H. SPECTOR, M.D.
Atlanta, Georgia
December, 1991
AMERICAN JOURNAL OF OPHTHALMOLOGY
3. Imes, R. K., Reifschneider,]. S., and O'Connor, L. E.: Systemic sarcoidosis presenting initially with bilateral orbital and upper lid masses. Ann. Ophthalmol. 20:466, 1988.
Correspondence Correspondence concerning recent articles or other material published in THE JOURNAL should be submitted within six weeks of publication. Correspondence must be typed double-spaced, on 81;', x l l-inch bond paper with Ph-inch margins on all four sides and should be no more than two typewritten pages in length. Every effort will be made to resolve controversies between the correspondents and the authors of the article before publication.
Echographic Diagnosis of Dural-Carotid Cavernous Sinus Fistulas EDITOR:
I read with interest the article, "Echographic diagnosis of dural carotid-cavernous sinus fistulas" by R. H. Spector (Am. J. Ophthalmol. 111:77, January 1991). It is always refreshing to read articles supporting the use of standardized echography in the evaluation of orbital disorders, including carotid-cavernous and indirect (dural) arteriovenous fistulas. I take issue, however, with the presentation of A-scan values for normal extraocular muscles on page 78 of the article. These unreferenced values originated from the Bascom Palmer Eye Institute Echography Department. Furthermore, the author did not obtain permission to use these data, derived from an incomplete study of 26 normal subjects. The study has now been completed, 38 subjects having been measured. This current study is an update of work published by McNutt, Kaefring (Frazier Byrne) and Ossoinig' in 1977. Since that time, several studies have been published that describe the combined use of B- and standardized A-scan for extraocular muscle evaluation.i" Our present study utilized these combined techniques with improved instrumentation for better resolution and more precise electronic measurements. SANDRA FRAZIER BYRNE
Miami, Florida
References 1. McNutt, L. c., Kaefring S. L., and Ossoinig, K. C.: Echographic measurement of extraocular muscles. In White, D., and Brown, R. E. (eds.): Ultrasound in Medicine, vol. 3A. Basel, Karger, 1977, pp. 927-932. 2. Ossoinig, K. c.. Standardized echography. Basic principles, clinical applications and results. Int. Ophthalmol. Clin. 19:165, 1979. 3. Byrne, S. F.: Standardized echography of the eye and orbit. Neuroradiology 28:618,1986. 4. Byrne, S. F., and Glaser, ]. S.: Orbital tissue differentiation with standardized echography. Ophthalmology 90:1071, 1983.
_ _ _ _ _ _ _ Reply
_
EDITOR:
The A-scan values for normal extraocular muscles that appeared in my article were given to me in 1987 by the Director of Echography at Bascom Palmer Eye Institute. The values were also pinned to the bulletin boards of each examination room in Bascom Palmer Eye Institute's Department of Echography. I assumed the values to be time-tested, accurate, and statistically sound for two reasons: not a single amendment had made to them over a threeyear period, from 1987 to 1990, when I visited the echography department; and each of the Bascom Palmer Eye Institute echographers routinely referred to these values in their day-today echographic examinations of patients with suspected enlargement of the extraocular muscles. Throughout the performance of my study and the preparation of my manuscript I used the extraocular muscle measurements in the same way I saw them used at Bascom Palmer Eye Institute. There was no intent to take credit for the investigative work that went into ascertaining these data. They were accumulated by the members of the department of echography at Bascom Palmer Eye Institute, and I commend them for their final results. ROBERT H. SPECTOR, M.D.
Atlanta, Georgia
