bluuebunny/crossref_metadata_2025 huggingface dataset:
Computer‐assisted analysis of the electro‐oculogram
Authors: Gosbell Andrew D. , Barry William R. , Favilla Ian , Burkitt Guy
Published: November 2007

A method of acquiring and analysing electrooculogram signals was developed using computeraided techniques. The repetitive nature, characteristic shape and spectral properties of the electro‐oculogram are used in the automated analysis, enabling the retinal resting potential to be investigated. Online computer‐aided automatic analysis of the electro‐oculogram is efficient, reliable and accurate. Automated analysis produced results that have a highly significant degree of correlation (P < 0.001) with the results obtained manually from strip chart recording of the electro‐oculogram signals. The increased accuracy of the automatic analysis system demonstrates a significantly reduced (McNemar's Test) false positive rate in classifying abnormal results on the basis of Arden ratio. The computer‐aided analysis system offers a useful clinical means of measuring the electrooculogram for diagnostic and research purposes.
Creeping angle‐closure glaucoma: The influence of iridotomy and iridectomy
Authors: West R H
Published: November 2007

In 16 patients (30 eyes) with creeping angle‐closure glaucoma YAG laser iridotomy or surgical iridectomy was performed as part of treatment.

The initial characteristics of the affected eyes (refractive state, intraocular pressure, anterior chamber depth, iris contour, gonioscopic features, extent and severity of synechia formation and result of dark‐room testing in six eyes) are recorded, and also the influence on these features of iridotomy or iridectomy. lntraocular pressure was reduced on average by 2.46 mmHg (1.72 mmHg in nontrabeculectomised eyes) (P<0.02), and anterior chambers deepened on average by 0.05 mm (P<0.05). Extension of peripheral anterior synechiae was recorded in nine eyes.
Eyelid and fornix reconstruction in bilateral abortive cryptophthalmos (Fraser syndrome)
Authors: Sullivan Timothy J , Clarke Michael P , Rootman David S , Pashby Robert C
Published: November 2007

Cryptophthalmos refers to a group of uncommon congenital anomalies of eyelid formation that can occur alone or in combination with multiple congenital anomalies as part of the Fraser syndrome. We present a case of bilateral abortive cryptophthalmos in a child with Fraser syndrome and discuss the problems of surgical management. A brief discussion of isolated and syndromic cryptophthalmos, including normal eyelid development, the pathogenesis of cryptophthalmos, and the management options follows.
Pterygium treatment with triethylene thiophosphoramide
Authors: Chapman‐Smith JS
Published: November 2007

In this study 146 pterygia were excised from 116 patients. The eyes were treated with Thiotepa eyedrops over four weeks to discourage regrowth. All treatment was carried out by the one surgeon on consecutive patients. The relationship between pinguecula and pterygium is explored, and the pathogenesis of pterygium growth discussed.
Successful outcome following anastomosis of a severed trochlear nerve in the middle fossa
Authors: Ferrier Ross , Padmanabhan Vish , Hunn Andrew , Wilkinson Robin
Published: November 2007

Complete return of function has been obtained following neurosurgical repair of a trochlear nerve inadvertently divided during the clipping of a basilar tip aneurysm. To date this is the second case reported in the literature. The technique of repair and the method of recording the return of function is discussed.
Preservation of residual field after surgical lowering of intraocular pressure
Authors: Brooks Anne M V , Mack Heather , Gillies W E
Published: November 2007

A 52‐year‐old Caucasian woman with pigmentary glaucoma underwent a left cyclodiathermy procedure for raised intraocular pressure (IOP) in 1962 and right sclerectomy the following year. Over 25 years later a low IOP was still maintained though pilocarpine was needed in the left eye. After a left cataract extraction with insertion of a posterior chamber lens, field loss had not progressed very much in either eye though the visual acuity was reduced in the more affected eye. Both drainage operation and a cyclodestructive procedure controlled IOP over a long period of time in this patient and were associated with only a very gradual progression of field loss.
Leber hereditary optic neuropathy in Australia
Authors: Mackey David A. , Buttery Robert G.
Published: November 2007

Leber hereditary optic neuropathy (LHON) presents with sudden onset of visual loss mainly in young adult males. LHON is not uncommon in Australia, accounting for 2% of invalid blind pensions. We have identified 20 unrelated families carrying mitochondrial DNA mutations associated with LHON and 135 of 291 individuals with documented LHON are currently alive in Australia. The mean age of onset of visual loss for males was 26 years and for females 27 years, with a range from six to 65 years. The mean risk of visual loss was 20% for males and 4% for females. There are over 1750 male and female carriers living in Australia who have not yet lost vision; 600 carriers are under 24 years of age. The expected number of new cases of blindness from LHON is three to four per year.
Familial congenital corneal anaesthesia
Authors: Clarke Michael P , Sullivan Timothy J , Kobayashi Jeffrey , Rootman David S , Cherry Paul M H
Published: November 2007

Congenital corneal anaesthesia is a cause of severe corneal ulceration and scarring in childhood. Although uncommon, it may be underdiagnosed when present as an isolated entity. Measures such as the use of elbow splints and tarsorrhaphy may be necessary to prevent visual loss.

In rare instances, the condition may be inherited. A family is presented with autosomal dominant isolated congenital corneal anaesthesia, and the systemic associations and treatment of the condition are reviewed.
Atypical mycobacterium keratitis
Authors: Grigg John , Hirst Lawrence W , Whitby Michael , Stallard Ken , Gnanaharan Padmini
Published: November 2007

We present two cases of Mycobacterium chelonae keratitis, both of which followed minor corneal trauma. One case initially showed improvement with medical therapy alone but eventually required penetrating keratoplasty. The second case required surgical intervention to provide tectonic support, but the infection resolved with antibiotic therapy.
Computer hardware and software to assist the visually impaired and blind
Authors: Boulton Lesley M.
Published: November 2007

Modern developments in computer hardware and software for the business world have been adapted to allow the partially sighted and blind to participate successfully in computer usage in education, employment and recreation. Adaptations such as the enlargement of the whole screen display, production of enlarged print and voice output of screen contents can assist the partially sighted. Conversion of computer screen information into speech or braille can be used in conjunction with sound boards and touch pads to allow the totally blind access to the exact spatial layout of screen contents

Optical character recognition devices whereby the printed page can be accessed by computer, and recent voice recognition techniques which allow a computer to interpret voiced commands, can also be used to assist the totally blind. Developments in these areas are discussed together with specific examples of equipment now available which make use of the various methods described
Characteristics of early onset esotropia
Authors: Page Gary , Ryan Hugh , Prior Chris , O'Day Justin
Published: November 2007

Some 115 patients with a reported onset of esotropia within the first six months of life were studied retrospectively to assess ocular findings and the evolution of any changes with time. All patients had been treated by one ophthalmologist and one orthoptist since 1972.

Of the 115 patients, 27% had an accommodative element associated with the esotropia. Patients with an accommodative esotropia had higher levels of hypermetropia when compared to the non‐accommodative group, but there were no other distinguishing characteristics.

The groups exhibited a large variation in angle size, ranging from four to 45 degrees at the initial visit. The presence of fusion, amblyopia and the degree of hypermetropia had no significant effect on the course of the squint. Amblyopia was noted in 67% of cases and appeared to stabilise at a later‐than‐expected age, with 66% of patients with ambylopia stabilising between eight and 11 years. Surgical intervention had no effect on the incidence of amblyopia at the initial or final visits.
Fusidic acid prophylaxis before cataract surgery: patient self‐administration
Authors: Gray T B. , Keenan J I. , Clemett R S. , Allardyce R A.
Published: November 2007

In a placebo‐controlled, randomised, double‐blind clinical trial, the authors evaluated the efficacy of patient‐administered 1% fusidic acid viscous eye drops in clearing the commonest organisms causing pseudophakic endophthalmitis (Staphylococcus epidermidis and aureus) from the lids and conjunctivae of 79 patients before cataract surgery. The treatment group self‐administered fusidic acid viscous eye drops four times daily for seven days before surgery; the placebo group received inert ophthalmic drops. Fellow eyes of both groups remained untreated as a natural control. Lower fornix and lid margin cultures were taken from both eyes before and after treatment. Before treatment, there was no statistical difference in organism counts between the groups. After treatment, eyes receiving fusidic acid were more likely to be free of clinically relevant Staphylococcus spp. than all pre‐treatment eyes (for lids, P≤ 0.001; conjunctivae, P= 0.02). A highly significant (P<0.001) number of lid margins were rendered ‘clinically clean’ (i.e., 0–49 organisms/swab) by fusidic acid when compared with untreated eyes. Treatment also effectively (P<0.05) reduced the numbers of bacteria isolated from conjunctivae. This study indicates that there is a highly significant reduction of Staphylococcus spp. (P≤0.001), non‐Staphylococcus spp. (P≤ 0.001) and attainment of sterile eyes (P≤0.001) at operation gained by patient self‐administration of 1 % fusidic acid four times daily for seven days before surgery.
Primary tubulointerstitial nephritis and uveitis syndrome
Authors: Murray N. , Wakefield D.
Published: November 2007

Primary acute tubulointerstitial nephritis and uveitis is an uncommon syndrome involving the kidney and eye. Although rare, to date 28 cases having been reported, it is important to recognise this entity to facilitate appropriate investigation and treatment. We report an unusual case of this syndrome in which the patient suffered a relapse of her nephritis concurrently with the onset of the first episode of uveitis. Both responded to treatment, although the uveitis subsequently recurred.
Midbrain angioma with disconjugate vertical gaze palsy
Authors: Saad N. , Sanders MD
Published: November 2007

Loss of depression in one eye with contralateral loss of elevation is rare. It has been attributed to a subnuclear lesion of the oculomotor nerve nuclear complex. We present a patient with these signs who has an arteriovenous malformation occupying his rostral midbrain. We argue that attributing these findings to a subnuclear lesion of the oculomotor nerve complex does not take into consideration the secondary, vertical action of the obliques.
Cryotherapy to close a corneal subepithelial aqueous track after trabeculectomy
Authors: Graham Stuart L. , Goldberg Ivan
Published: November 2007

After filtering surgery for primary open‐angle glaucoma in a 64‐year‐old man, a persistent wound leak was encountered from the fornix‐based conjunctival flap. Cyanoacrylate adhesive was applied but was unsuccessful in sealing the leak. The limbal margin was sutured with 10/0 nylon. One week later a corneal subepithelial fistulous track developed from the edge of the bleb and extended across the cornea towards the inferonasal limbus. The inferior end of the track leaked aqueous. Further surgery was performed to refashion the conjunctival bleb, ablate the fistula at its origin and re‐form the anterior chamber. The track recurred 16 days later. The upper cornea was then treated with cryotherapy, which successfully closed the track with maintenance of a functional bleb (ocular pressure 6 mmHg). A faint asymptomatic subepithelial scar persisted.
An anatomical study of retinal arteriovenous crossings and their role in the pathogenesis of retinal branch vein occlusions
Authors: Jefferies Peter , Clemett Richard , Day Tony
Published: November 2007

To elucidate the anatomical features which predispose artery over vein (AV) crossings to be the preferential sites for retinal branch vein occlusions (RBVO), 11 AV and six vein over artery (VA) crossings in 12 eyes from non‐hypertensive donors who were aged 35 to 82 years, were studied by light and electron microscopy. At AV crossings the veins were often observed to abruptly alter direction to pass under the artery. Here focal stratification of the vein basement membrane opposite the point of contact with the artery was seen. A focal reduction in the vein lumen occurred at three of 11 AV crossings. In contrast, deviation of the vein, focal basement membrane stratification or focal narrowing was not seen at VA crossings. Both types of crossings had a common adventitial sheath when each vessel was of large calibre. This study demonstrated anatomical features which predispose AV crossings to be the preferential site for venous occlusion.
Reliability of the Otago photoscreener A study of a thousand cases
Authors: Molteno ACB , Hoare‐Nairne J. , Sanderson GF , Peart DA , Hodgkinson IJ
Published: November 2007

The Otago photoscreener is a 35 mm single lens reflex camera in which the flash light comes from a narrow ring around the outer margin of its lens. The margin is also the limiting aperture of the optic system and in the centre of the lens is a flickering fixation light. In a colour photograph taken at a distance of 66 cm from the face of the subject who is accurately focusing on and fixing the camera fixation light with both eyes, the fundus reflex in each pupil is very dark red and the corneal light reflexes are symmetrical. If either or both eyes are not appropriately focused or fixing, the fundus reflex is brighter and yellow or white. This article describes a prospective trial of the performance of the Otago photoscreener in a series of 1000 infants with actual or suspected amblyopia, refractive error or strabismus. In this study photoscreening showed a sensitivity of 94% and a specificity of 79%. Photoscreening also identified some cases of esotropia and of refractive error which were missed on clinical examination. In this series photoscreening passed as normal three children with mild to moderately severe amblyopia. This represents les than 1 % of the clinically abnormal children.
Desmoplastic malignant melanoma presenting with orbital involvement
Authors: Ellis Mark , Drewe Ross , O'Day Justin
Published: November 2007

Desmoplastic malignant melanoma (DMM) is a rare variant of spindle cell melanoma. We report a case of DMM of the forehead secondarily involving the orbit. The diagnosis was based on light microscopic features, including prominent peripheral cell nest formation and spindle cell fascicles in densely collagenous stroma. Immunohistochemical studies showed strong uniform staining for S100 antigen throughout the tumour. It was negative for HMB 45, smooth muscle actin, desmin, cytokeratins and Type IV collagen. Electron microscopy showed neither melanosomes nor myelin figures. The clinical and histological characteristics of desmoplastic malignant melanoma, and its differential diagnosis of malignant schwannoma, are discussed. DMM has a poor prognosis, since it tends to invade deeply, recur locally and metastasise readily.
Arthrogryposis multiplex congenita: a report of two cases
Authors: Brooks James G , Coster Douglas J
Published: November 2007

Arthrogryposis multiplex congenita refers to a group of birth defects characterised by multiple joint contractures. The syndrome is caused by neuropathic disease, myopathic disease, or any other cause of decreased fetal joint mobility. Multiple and usually symmetric joint abnormalities with associated muscular and soft tissue hypoplasia are noted at birth. A variety of associated congenital anomalies affecting many organ systems are frequently found. Ocular and orbital findings have been described in patients with arthrogryposis but corneal disease has only rarely been reported. We present corneal findings in two patients with arthrogryposis and discuss the implications for disease pathogenesis. Previous ophthalmologic reports are also reviewed.
Paediatric dacryocystorhinostomy
Authors: Hakin KN , Sullivan TJ , Sharma A , Welham RAN
Published: November 2007

Of 258 cases of dacryocystorhinostomy performed on children in the period September 1981 to September 1991, 130 were for simple, unresolved congenital nasolacrimal duct obstruction. Other indications for surgery included punctal agenesis, lacrimal fistula, post‐traumatic and post‐inflammatory canalicular obstruction. Of 177 children without canalicular pathology, 171 (96%) were relieved of symptoms with one operation, without canalicular intubation. Of 81 cases with canalicular disease, 55 of 70 (79%) who underwent DCR plus canalicular intubation, and 10 of 11 who underwent DCR plus Lester‐Jones tube, were substantially improved with one operation. No child required peroperative or postoperative blood transfusion. Dacryocystorhinostomy in childhood, in experienced surgical hands, is a safe procedure, achieving relief of symptoms in most cases, particularly in the absence of canalicular disease.
The long‐term results of fistulising trabeculotomy in chronic open‐angle glaucoma
Authors: Gillies WE , Brooks AMY
Published: November 2007

Background
: Fistulising trabeculotomy has been used for nearly 20 years to combine the minimally invasive surgery of trabeculotomy with production of a subconjunctival fistula.

Methods
: The canal of Schlemm was unroofed 2mm on one side of a 3mm half‐thickness scleral flap. A trabeculotomy probe was passed about 30° along the canal on the opposite side and rotated into the anterior chamber.

Results
: Of 99 eyes of 74 patients, 35 eyes of 25 patients were available for follow‐up at 10 or more years. The mean IOP was 14 ± 4 mmHg (range 7 to 23 mmHg) from a preoperative IOP of 29 ± 8 mmHg (17 to 60 mmHg). Results in 44 similar patients undergoing trabeculectomy and 44 undergoing fistulising trabeculotomy were very similar at five‐year follow‐up.

Conclusion
: Fistulising trabeculotomy was effective for lowering intraocular pressure with a low complication rate and a large area of subconjunctival fistulisation.
Albipunctatus retinopathy in inherited interstitial nephritis
Authors: Colville Deb , Savige Judy
Published: November 2007

We describe here a patient with familial interstitial nephritis and albipunctatus retinopathy. Albipunctatus is often seen in patients with Alport syndrome, which is an X‐linked disorder characterised in affected males by renal failure by the age of 25, high‐tone sensorineural deafness, anterior lenti‐conus and albipunctatus. The diagnosis of Alport syndrome depends on the electron microscopic appearance of a trabeculated glomerular basement membrane (GBM); and mutations have been demonstrated in the gene for the alpha 5 chain of type IV collagen. In the familial interstitial nephritis described here, the inheritance was autosomal dominant, renal failure developed in middle age, and there was no associated hearing loss or anterior lenticonus.

The finding of albipunctatus retinopathy in this patient suggests that the genetic mutation responsible involves a protein common to both retinal and interstitial basement membranes. In addition, we conclude that the demonstration of albipunctatus in an individual with familial nephritis does not necessarily indicate that the underlying disease is Alport syndrome.
Treatment of orbital capillary haemangioma with interferon
Authors: Teske Scott , Ohlrich Stephen J , Gole Glen , Spiro Paul , Miller Malcolm , Sullivan Timothy J
Published: November 2007

Background: Capillary haemangiomas are vascular tumours of childhood characterised by proliferative and involutional phases and affecting 1% to 2% of newborns. Recently, recombinant interferons have been used in the treatment of life and sight threatening complications of these tumours.

Methods: The history, results of examination, investigations, management and outcome of two patients with sight‐threatening orbital capillary haemangiomas treated with recombinant interferon alpha‐2a and 2b respectively were reviewed.

Results: Orbital and systemic lesions displayed good response to interferons. Side effects noted were transient pyrexia and elevated serum aminotransferase levels. Disturbed liver function test results occurred in one case and normalised with temporary cessation of therapy.

Conclusions: The interferons are a useful alternative treatment of orbital capillary haemangioma in selected cases.
Necrotising anterior scleritis after pterygium surgery
Authors: Galanopoulos A , Snibson G , O'Day J
Published: November 2007

Necrotising anterior scleritis is a rare sequela of ocular surgery. Typically an intnse scleral inflammation develops at or adjacent to the site of the previous surgery. Necrosis supervenes and may then progress circumferentially to involve much of the anterior sclera. Surgically induced necrotising scleritis (SINS) has been previously described after cataract extraction, trabeculectomy, retinal detachment and strabismus surgery. We report three cases of SINS following pterygium excision. In each case the disease was prolonged, progressive and required protracted immunosuppressive therapy.
Community photoscreening of six to nine month old infants for amblyopiogenic risk factors
Authors: Hope Carolyn , Roulston Joanne , Hoey Caroline , Wong Andrew , Clover Gillian
Published: November 2007

Photorefraction (PR) is gaining acceptance as potentially the most effective objective screening technique for amblyopia risk factors in the preverbal child. This study determined the validity and feasibility of using the Auckland eccentric photorefractor in the detection of amblyopiogenic factors in six to nine month old infants in an established community‐based vision screening program. Photographs were analysed and compared to results of clinical examination including cycloplegic refraction.

Amblyopia risk factors were present in 7.2% of the infants clinically examined. Analysis only of readable photographs in children who were also clinically examined, gave sensitivities ranging from 71% to 79%, and specificities ranging from 81% to 86%. Inclusion in the analysis of photo‐failures lowered sensitivity figures to 56% to 61%, and specificity to 63% to 70%. Photofailures were predominantly due to poor operator technique. Calculation of kappa scores indicated fair observer reliability.

In conclusion, PR could provide a feasible and sufficiently reliable screening technique in the infant, but requires adequate training and auditing of screening personnel performance for optimum effectiveness.
Scedosporiutn prolificans sclerokeratitis
Authors: Sullivan Laurence J , Snibson Grant , Joseph Catherine , Taylor Hugh R
Published: November 2007

Background
: The fungus Scedosporium prolificans was first described as a human pathogen in 1984, and has been associated with metastatic endophthalmitis and one previously reported case of sclerokeratitis.

Methods
: We report a case of S. prolificans sclerokeratitis in the setting of late scleral necrosis complicating pterygium surgery with adjunctive (3‐irradiation.

Results
: A poor clinical response to topical natamycin and amphotericin B, and systemic itraconazole and ketoconazole was encountered. Enucleation was required, with subsequent microbiological cure. Pathological correlation is described.

Conclusions
: S. prolificans infections often respond poorly to medical therapy. Early surgical intervention is indicated in culture‐proven scleritis due to Scedosporium prolificans.
Brisbane GPs' perceptions of screening for primary open‐angle glaucoma
Authors: Jackson C , Hirst L
Published: November 2007

Background: Primary open‐angle glaucoma (POAG) is one of the three leading causes of blindness in Australia, often causing considerable visual field loss before the patient becomes symptomatic. Recent years have seen a quickening of public health interest in primary open‐angle glaucoma. Our study evaluates the attitudes and skills of Brisbane GPs with regard to screening for POAG.

Objectives: To evaluate general practitioners' current use of possible screening modalities for POAG. To evaluate general practitioners' attitudes to screening for POAG. To evaluate general practitioner's levels of satisfaction with their knowledge and skills in the diagnosis of common ophthalmological conditions.

Method: A questionnaire was distributed to 130 randomly selected GPs in the Brisbane metropolitan area. Response rate was 94%.

Results: Tonometry and funduscopy were infrequently used in Brisbane general practice. Only 15% of the sample were satisfied with their current knowledge and skills concerning the detection of POAG. 88% felt that patients >50 years should be screened for POAG and nominated a variety of sources — 75% advocating ophthalmology screeners, 65% GP screeners, and 41% optometrist screeners. Ninety‐nine per cent believed ophthalmologists should be treating glaucoma patients, and 57% believed GPs should have a role in management. Only 1 % supported a therapeutic role for optometrists. Major perceived barriers to glaucoma screening in the elderly were the inaccuracy of current general practice screening tools (65%) and paucity of information concerning the desirability of screening (32%).

Conclusion: Brisbane general practitioners believe patients >50 years old should be screened for POAG. They advocated a role for screening by ophthalmologists, GPs and optometrists. Major perceived barriers to current screening in general practice are the inaccuracy of current general practice tools (65%) and paucity of information on the subject (32%). The majority (85%) requested further information and provision of skills in this area.
Scanning laser ophthalmoscopy of choroidal neovascularisation using indocyanine green
Authors: Chan Tang Kong , Liu Henry A.
Published: November 2007

Background: Choroidal neovascularisation is an important cause of visual loss in age‐related macular degeneration. Visualisation of these choroidal abnormalities with fluorescein angiography may be difficult, particularly if there is haemorrhage, excessive pigment, or excessive fluorescence. We report on our experience with indocyanine green (ICG) angiography in demonstrating choroidal neovascularisation.

Method: Patients with suspected choroidal neovascularisation were assessed with indocyanine green angiography using the Rodenstock Scanning Laser Ophthalmoscope and results recorded on a videotape. Fluorescein angiograms were also obtained in a similar fashion. The angiograms were then compared.

Results: In some instances ICG angiography was able to demonstrate the margins and structure of choroidal neovascular membranes more clearly than fluorescein, particularly in the presence of haemorrphage, excessive fluorescence and blocked fluorescence. However, there were instances where it was difficult to interpret the choroidal abnormalities found. Some illustrative cases are discussed.

Conclusion: We conclude that ICG angiography is a useful adjunct to fluorescein angiography in detection and delineation of choroidal neovascularisation, but that further study is needed.
Amyloidosis of the conjunctiva
Authors: O'Donnell Brett , Wuebbolt Gordon , Collin Richard
Published: November 2007

Background: Amyloid of the eyelid conjunctiva is an extremely rare condition which may result in chronic discomfort and multiple surgeries.

Methods: A retrospective study of four patients from Moorfields Eye Hospital is presented to assess the clinical features and results of surgical treatment.

Results: Three patients had persistent ocular irritation and required multiple surgical procedures for recurrent amyloid. However, one patient has been followed for nearly 30 years with relatively few symptoms, and has required only infrequent surgical intervention. All patients underwent debulking and ptosis surgery at least once. The more severe clinical course was not related to the type of amyloid protein present. Shave excision of recurrent tarsal conjunctival arnyloid with split‐thickness mucous membrane grafting was successfully tried in one patient in order to minimise postoperative cicatrisation of the posterior lamella.

Conclusion: The clinical course of patients with eyelid amyloid may vary greatly. Management should be conservative when possible, but surgery is an integral part of management since debulking of amyloid deposits and ptosis surgery was required in all patients in this series.
Acute glaucoma ‐1941
Authors: Lowe Ronald F.
Published: November 2007

Purpose: To describe the treatment of acute glaucoma before the technological and pharmacological advances that followed World War 2.

Method: A narrative of personal experience is presented.

Conclusions: In 1941, acute congestive glaucoma received heroic treatment ‐ strong miotics, bloodletting by leeches, purging with mercury. If satisfactory response did not occur within four hours, a broad iridectomy was performed on the hard, congested eye. Affected eyes commonly remained blind or with severely reduced vision.
Reversible ophthalmoplegia in CPEO
Authors: Dunlop Iain S. , Dunlop Patricia
Published: November 2007

Purpose: To present a case of improvement of ocular motility in a patient with chronic progressive external ophthalmoplegia (CPEO) with Coenzyme Q10.

Methods: Coenzyme Q10 300 mg daily was given for three years with a three‐day trial period of 200 mg daily after one year. Ocular ductions were measured by synoptophore.

Results: Ocular ductions improved with treatment with Coenzyme Q10.

Conclusion: Coenzyme Q10, is effective in limiting the severity of ophthalmoplegia in this case.
Prospective study of 210 consecutive cases of endocapsular phacoemulsification using the AM0 SI‐30NB 3‐piece foldable lens
Authors: Irvine Simon , Francis Ian C. , Kappagoda Medduma B. , Haylen Margaret J. , Alexander Stella , Schumacher R Steve , Boytell Keny A.
Published: November 2007

Purpose: To assess the acceptability of clinical outcome achieved with use of the SI‐30NB lens, as well as the incidence of any lens related complications.

Methods: This prospective study evaluated 210 consecutive eyes undergoing endocapsular phacoemulsification cataract surgery (EPECS), with implantation of the AM0 SI‐30NB foldable three‐piece lens, commencing with the first patient in our practice receiving this implant. There was 99% follow‐up for at least three months, with a mean of nine months, and a range of three to 14 months. Incisions were a maximum of 3.2 mm in size, and this allowed minimisation of astigmatism, and maximisation of early visual rehabilitation.

Results: The final visual acuity results were excellent, with 95% of cases achieving corrected vision of 6/12 or better. All cases without pre‐existing ocular pathology achieved corrected vision of 6Y6, apart from a single case which achieved 6/9, but the patient died before follow‐up. The lens‐related complication rate was less than 1% (two patients). No decentration of any other implant ocurred, and no patient complained of edge glare. There were no cases of iris chafing or pigment dispersion. Only three patients (1.4%) required Yag posterior capsulotomy in the first 14 months of the study. Central bag‐bag fixation was achieved in 206 of the 210 cases in the study (98%).

Conclusion The results achieved using the SI‐30NB lens with a small incision phaco procedure were excellent. Lens‐related complications occurred in only two cases and very few cases have had problems with posterior capsular opacification.
Trichotillomania: ophthalmic presentation
Authors: BS Justine R Smith MB
Published: November 2007

Purpose:
A case of trichotillomania, or compulsive hair‐pulling, involving the eyelids is presented to alert ophthalmologists to this common, but frequently overlooked cause of eyelash and eyebrow alopecia.

Methods and results:
Clinical records of a 33‐year‐old woman suffering from trichotillomania were reviewed. Compulsive hair‐pulling began in childhood and had become chronic. Psychiatric intervention was unsuccessful.

Conclusions:
The diagnosis of trichotillomania is made on history and slit‐lamp examination findings. A skin biopsy may be necessary to exclude alopecia areata. Adults should be referred to a psychiatrist. Although childhood disease is usually benign, often reflecting a disturbed parent‐child relationship, in adults hair‐pulling is generally chronic and associated with psychiatric illness.
Vision testing in atrophic macular degeneration
Authors: Littlewood Ross , Johnson Gary , House Phillip
Published: November 2007

Purpose:To determine the correlation between a group of vision tests in atrophic macular degeneration (AMD) in an office setting.

Methods:Patients with documented vision loss from atrophic macular degeneration in one eye were invited to attend an eye clinic every three months for a series of six vision tests for their good eye followed by fundus photography. Modified contrast sensitivity, blue/yellow anomaloscopy, flicker fusion frequency, Amsler grid, and photo‐stress recovery time were correlated with Snellen acuity using the Pearson correlation coefficient. The regression of the Snellen acuity result on sex, age and the presence of disciform macular degeneration in the other eye was obtained using a general linear model.

Results:The correlation with Snellen acuity result was low for all tests. It was highest for Amsler grid abnormality (r= ‐0.33345) and blue/yellow anomaloscopy matching range (r= ‐0.20742), where r denotes the correlation coefficient. Patient age was strongly correlated with Snellen results (P= 0.0001), but it was not significantly related to sex (P= 0.1187) or the presence of disciform macular degeneration in the other eye (P= 0.9989). The photostress recovery time showed enormous inter‐visit variations and poor correlation with Snellen acuity (P= 0.0526).

Conclusions:The course of AMD is routinely assessed by Snellen acuity and any of several additional tests. When employing a test battery in an office setting, a clinician needs to know the relative utility and correlation between the tests at his disposal. Of the tests used in this study, the Amsler grid was the most useful addition to the Snellen acuity at all stages of atrophic macular degeneration, and blue/yellow anomaloscopy was useful only in mild macular degeneration where Snellen acuity was 6/12 or better.
A clinical trial of MK‐507, Trusopt, for raised intraocular pressure ‐ The Australian Experience
Authors: Gillies W E. , Brooks Anne MV
Published: November 2007

Background: Since the introduction of carbonic anhydrase inhibitors, a topical preparation has been sought to avoid the complications of systemic medication while retaining the effect of lowering intraocular pressure. Recently, a topical carbonic anhydrase inhibitor, MK‐507, has been found superior to others and introduced for multicentre clinical trial.

Patients and methods: As part of an international rnulticentre trial, we compared MK‐507 with beta blockers for one year in 20 patients with raised intraocular pressure, both as monotherapy and in combination.

Results: Twelve patients with a mean peak pressure of 31.9 ± 6.8 mmHg (range, 22 to 49 mmHg) off all medication received MK‐507. After two weeks, mean peak pressure was 24.7 ± 6.1 mmHg (range, 14 to 41 mmHg) — a 22.6% fall in pressure. Six of these patients had a mean peak pressure of 27.8 ± 6.4 mmHg (range, 21 to 41 mmHg), a fall of 19.2% from day one and were given timolol as add‐on therapy. This resulted in a fall to 19.1 ± 2.8 (range, 15 to 24 mmHg) at year one, a fall of 31.3% after add‐on. Four patients on timolol and four on betaxolol gave similar falls in pressure with an additional fall when MK‐507 was used as add‐on therapy.

Conclusions: MK‐507 demonstrated its effectiveness as an ocular hypotensive agent in this trial of patients with an unusually high rise in pressure. It showed a hypotensive effect roughly equivalent to beta blockers. It is likely that either a topical carbonic anhydrase inhibitor or a cardioselective beta blocker will be the medication of first choice in newly diagnosed glaucoma.
The effectiveness of sub‐Tenon's infiltration of local anaesthesia for cataract surgery
Authors: Verghese Indira , Sivaraj R. , Lai YK
Published: November 2007

Purpose: To determine if adequate anaesthesia and akinesia could be obtained using an inferonasal quadrant sub‐Tenons anaesthesia for cataract surgery.

Methods: The sub‐Tenons method of local anaesthesia was used in 50 patients undergoing extracapsular cataract extraction and lens implantation. The technique followed was that described by JD Stevens in his study of 50 patients. Posterior sub‐Tenons space was approached through a conjunctival incision in the inferonasal quadrant and the anaesthetic solution delivered by an irrigating cannula. The patients were assessed for residual ocular movements just before surgery. Effectiveness of anaesthesia was assessed during surgery using a verbal pain rating score. Scoring was based on the concept of a visual analogue pain score chart.

Results: Total akinesia was obtained in 20% patients and total anaesthesia in 24% patients. The remainder of the patients had adequate akinesia and anaesthesia to proceed with and complete the surgery.

Conclusion: This method provides satisfactory anaesthesia for cataract surgery.
Referral to low vision services by ophthalmologists
Authors: Keeffe J E. , Lovie‐Kitchin J E. , Taylor H R.
Published: November 2007

Purpose: People in need of low vision rehabilitation services often experience delays in referral to services. This study investigated referral criteria of Australian ophthalmologists, the frequency of referral of their patients with low vision and their perceptions of low vision services.

Methods: A survey was sent to a representative, random sample of 200 ophthalmologists. They were asked about criteria used for the referral of their patients with low vision. The survey included questions on the frequency with which they prescribed low vision devices (LVD) and referral of their patients to low vision and rehabilitation services and peer support groups. Perceptions of the quality and availability of low vision services were also investigated.

Results: The response rate was 82%. Approximately 11% of ophthalmologists' patients have low vision. It is uncommon for ophthalmologists to prescribe LVD but 67% refer most of their patients with low vision. It is less common for them to refer to rehabilitation services (29%) or peer support services (18%). The perceived local availability of services influences the rate of referral. Ophthalmologists who used the criteria of moderate low vision (<6/21 to <6/60) are more likely to refer more of their patients than those who use the criteria of severe low vision.

Conclusions: Australian ophthalmologists refer most of their visually impaired patients to low vision services, but infrequently to rehabilitation services or peer support groups. Differences in perceived need for low vision services indicated by the criteria used for referral, and the perceived availability, influence the rate at which ophthalmologists refer their patients for services. Ophthalmologists are encouraged to refer patients with permanent visual loss to low vision services earlier.
Relation of hormone and menopausal status to outcomes following excimer laser photorefractive keratectomy in women
Authors: McCarty Cathy A. , Ng Irene , Waldron Ben , Garrett Sinead KM , Downie Julie A. , Aldred Geoff F. , Wolfe Rick JB , Taylor Hugh R.
Published: November 2007

Purpose: To examine the effect of hormone use, pregnancy and menopausal status on clinical outcomes following excimer laser surgery for myopia and myopic astigmatism.

Methods: Participants comprised all female patients of the Melbourne Excimer Laser Group (MELG). A standardised surgical protocol was followed by the 27 MELG members, using the VisX 20/20 excimer laser and included the prospective collection of the following information preoperatively and one, three, six and 12 months after the procedure: uncorrected and best corrected visual acuity with a LogMAR chart; best manifest refraction: and subjective assessment of corneal clarity. A survey that elicited information about oral contraceptive (OC) use, pregnancy history, surgical and natural menopause, and use of hormone replacement therapy (HRT) was mailed to all the women.

Results: A 77% response to the mailed survey was achieved. Two women were pregnant at the time of surgery, one became pregnant during the first month after surgery, and all three women were excluded from further analyses, although a review of two of the case histories revealed suboptimal clinical outcomes. Women taking OC were included in the control group after OC use was shown not to be associated with outcome. Women were grouped accordingly: control, n=225; pre‐menopausal on HRT, n=7; post‐menopausal not on HRT, n=34; and post‐menopausal on HRT, n=21. The groups differed significantly with regard to age and preoperative spherical equivalent. After controlling for age and preoperative spherical equivalent, the mean number of uncorrected LogMAR letters read one year after surgery was significantly lower for the post‐menopausal women on HRT in comparison with the control group. Best corrected acuity and corneal clarity were not significantly different among the groups.

Discussion: These preliminary results suggest that the interaction of menopausal and HRT status could decrease the effectiveness of PRK and PARK, but require confirmation with a further study in a prospective manner using objective measures of corneal epithelial healing and serum hormone levels.
A randomised prospective study of outpatient haemodilution for central retinal vein obstruction
Authors: Luckie Alan P. , Wroblewski John J. , Hamilton Peter , Bird Alan C. , Sanders Michael , Slater Nicolas , Green William
Published: November 2007

Purpose: Central retinal vein obstruction (CRVO) has significant visual morbidity. We prospectively evaluated an outpatient haemodilution (HD) regimen for CRVO.

Methods: We recruited 59 patients with CRVO of less than three months' duration and visual acuity (VA) worse than or equal to 6/9.5. Thirty patients underwent HD (packed cell volume of <0.35, 12 weeks); there were 29 controls and follow‐up was for six months.

Results: Incidence rates for VA improvement (P=0.708) and rubeosis iridis (P=0.619) between the two groups were not different. The incidence rate of VA deterioration was 5.315 times higher with HD (P=0.035, Cox Proportional analysis).

Conclusion: This data does not support the previous studies on haemodilution.
Experimental corneal neovascularisation using sucralfate and basic fibroblast growth factor
Authors: Loughnan Michael S. , Chatzistefanou Klio , Gonzalez Evelyn M. , Flynn Evelyn , Adarnis Anthony P. , Shing Yuen , D'Amato Robert J. , Folkman Judah
Published: November 2007

Purpose: To develop a non‐inflammatory model of both acute and chronic angiogenesis in the rabbit cornea using a known directly angiogenic cytokine.

Methods: Pellets made of the slow‐release polymer Hydron (polyhydroxyethylmethacrylate) and containing sucralfate and/or basic fibroblast growth factor (basic‐FGF) were implanted into rabbit corneas. The neovascular response to the implantation of pellets containing basic‐FGF alone, sucralfate alone or a titration of basic‐FGF in the presence of a constant amount of sucralfate was measured. The role of inflammation in the neovascular response was also investigated.

Results: The addition of sucralfate to the pellets led to the sustained release of basic‐FGF resulting in a predictable and aggressive neovascular response with a low dose of basic‐FGF that by itself was unable to elicit neovascularisation. At a dose of 500ng per pellet, approximately one‐third of the surface area of the cornea was vascularised within eight days of implantation. Minimal or no vascularisation occurred with the same dose of basic‐FGF without sucralfate. While this dose of basic‐FGF induced corneal oedema, only minimal inflammation was observed and the response was unaffected by ionising radiation. A less aggressive though still robust neovascular response with no or only minimal oedema was observed when the dose was lowered to 50ng of basic‐FGF per pellet. Some induced vessels persisted for more than three months.

Conclusion: This is an inexpensive in vivo model of angiogenesis with the advantages of the neovascularisation being aggressive, predictable, persistent, unassociated with an obvious inflammatory response and induced by the sustained release of an agent known to have a direct stimulatory action on endothelial cells.
Cataract surgery in Australia 1985–94
Authors: Keeffe Jill E. , Taylor Hugh R.
Published: November 2007

Background:Cataract surgery is the most common form of major ophthalmic surgery in Australia and a common surgical procedure among the elderly. The purpose of this report is to compile the numbers and rates of cataract extractions and implant of IOLs over the period 1985–94 for Australia.

Methods:Data were obtained for public and private cataract extractions and IOL implants from state and territory ministries of health and from the Health Insurance Commission. The data relating to cataract surgery were compared with the growth in the proportion of elderly people in the population.

Results:The number of cataract extractions has increased by 2.6 times over the ten‐year period to 67459 in 1994 and IOL implants have increased by 2.9 times over the same period to 70084. The increase in the elderly population for the period was 1.3 times so that there is a relative doubling in the rate of surgery. The proportion of public patients has risen from 19% to 28% from 1985 to 1994.

Conclusions:The numbers of cataract extractions and IOL implants was increased at double the rate expected from the growth in the elderly population. Advances in microsurgery and IOL technology have resulted in improved outcomes and have created a greater patient demand. The improved outcomes have also lead to ophthalmologists recommending cataract surgery at better visual acuity levels than previously.
Merkel cell turnour occurring simultaneously in the upper and lower eyelids
Authors: Marshmann Wendy E. , McNab Alan A.
Published: November 2007

Purpose:To highlight an unusual presentation of two Merkel cell turnours in the same patient.

ResultWe report a case of two Merkel cell turnours occurring simultaneously in the upper and lower eyelids of an elderly woman, a unique occurrence. Wide local resection and reconstruction resulted in microscopic clearance of the tumours. Lymphatic spread was detected, a common feature. She had previously undergone excision of a similar lesion from the lower eyelid.

Conclusion:Merkel cell tumour is a rare turnour of the elderly that often locally recurs and metastasises early. Treatment consists of wide local excision with or without adjuvant radiotherapy. Juxtaposing lesions on the eyelids have not been previously reported. We postulate that this patient showed local recurrence and a new tumour of the upper eyelid simultaneously.