bluuebunny/crossref_metadata_2025 huggingface dataset:
Bronchopulmonary atypical carcinoid tumour metastatic to the orbit
Authors: Aburn Neil S. , Whitehead Kevin , Sullivan Timothy J.
Published: November 2007

Background: Bronchopulmonary carcinoid tumours metastatic to the orbit are rare. A case is presented demonstrating presentation, histopathology and treatment.

Methods: A 64‐year‐old man with a history of bronchopulmonary atypical carcinoid presented with an orbital mass. The nature of this metastasis was confirmed with histology and it was surgically excised and, in addition, loeal radiotherapy and chemotherapy were administered.

Results: There was a good response to the treatment for the orbital mass but other metastases developed, causing death.

Conclusions: In this case of atypical carcioid, orbital metastasis was the first sign of disease progression. Histological confirmation of the diagnosis was important in this case to allow planning of oncological therapy and for appropriate patient counselling. A good local response was obtained with a combination of surgical excision, local radiotherapy and chemotherapy. The systemic prognosis remains poor in cases of metastatic bronchopulmonary atypical carcinoid tumour, in contrast to typical carcinoid.
A preliminary report on a DNA‐based screening method for retinitis pigmentosa: A trial on a West Australian population
Authors: Rakoczy P , Di Grandi S , Kelloway L , Chelva E
Published: November 2007

Purpose and background: Recent reports have linked numerous point mutations in the human genome to retinitis pigmentosa (RP), suggesting that in the near future molecular biology based genetic counselling for patients with RP might become a reality. In this paper we assess the viability of a DNA‐based screening method for RP. Specifically, we screened rhodopsin and the beta‐subunit of phosphodiesterase (6‐PDE) genes for the presence of abnormalities in West Australian RP patients.

Methods: Blood was collected from 27 patients. Leukocyte DNA was extracted from patients and 50 randomly selected controls. Exons 1–19 and 21 of B‐PDE and exons 1, 3 and 5 of rhodopsin were analysed using single‐strand conformational polymorphism (SSCP) following DNA amplification. The nature of anomalies detected by SSCP was classified with DNA sequencing.

Results: In RP patient samples, we found anomalous bands in exons 5, 9,10,15 and 16 and 17 of B‐PDE and in exons 1 and 3 of rhodopsin genes. In 6‐PDE none of the anomalous bands represented mutations. Some of the anomalous bands in the rhodopsin gene, however, corresponded to silent mutations at nucleotide positions 269 and 3982 in four patients.

Conclusions: In this study we have demonstrated that SSCP in combination with DNA sequencing is a powerful tool to identify new mutations and to provide information for a ‘mutational panel’ for future screening.
Comparison of growth rates of bovine retinal and brain microvascular pericytes in different oxygen concentrations in vitro
Authors: Wong HC , Thompson S , Yu DY , Cringle SJ , Alder VA , Taylor SJ
Published: November 2007

Background: The hyperoxic injury of the microcirculation in the central nervous system appears to be specific to the retina in premature mammals. Oxygen tensions in normal adult mammalian retina and brain vary between nearly 0 and 90 mmHg. This study sought to compare the in vitro replication of retinal and brain microvascular pericytes in normal glucose medium and in 1 %, 5% and 20% oxygen (equivalent to 15 mmHg, 35 mmHg and 150 mmHg, respectively).

Methods: A preliminary study, using oxygen micro‐electrodes, confirmed that the pericellular oxygen tension of pericytes, cultured in medium under air, was within 13 mmHg of the tension of the gas phase above the media.

Pericytes were highly enriched by magnetic antibody cell sorting with the anti‐pericyte monoclonal antibody (3G5) to 95% to 99% purity, to remove cell contaminants which may have invalidated the mitogenic assay.

Results: Mitogenic assays showed that brain pericytes replicated faster than their counterparts from retina (f< 0.0001, averaged for data from all culture conditions using three‐way ANOVA). Reduction of oxygen tension from 150 to 15 mmHg led to significantly increased replication of retinal pericytes (P=0.01), but an insignificant increase for brain pericytes.

Conclusions: We have found that pericytes from the brain and retina cultured conventionally in fetal calf serum consume a relatively low amount of oxygen. Decreasing the oxygen tension to 1% (15 to 20 mmHg) increased the replication of retinal pericytes but not brain pericytes in normal glucose concentrations and in fetal calf serum. That retinal pericyte replication is sensitive to variation in oxygen tensions, indicates that the retinal microvascular cells have a unique biological response. This growth sensitivity to oxygen may be important in the pathogenesis of retinopathy of prematurity.
Multiple endocrine neoplasia type two B A case report with light and electron microscopic and immunohistochemical correlation
Authors: Koh Lee K. , Francis Ian C. , Kappagoda Medduma B. , Hooper Michael J. , Filipic Marijan
Published: November 2007

Purpose: To describe a case of multiple endocrine neoplasia type two B (MEN IIB) where ocular and systemic clinicopathological findings are correlated, in association with light and electron microscopic and immunohistochemical findings.

Methods: A 23‐year‐old man presented with mucosal neuromas of the lips, tongue and eyelids, a Marfanoid habitus and prominent corneal nerves. These findings led to the diagnosis of multiple endocrine neoplasia type two B. The patient subsequently developed phaeochromocytoma and metastatic medullary thyroid carcinoma (MTC) which led to his demise. Correlation of light and electron microscopic and immunohistochemical findings with the systemic and ocular findings is presented to emphasise the aggressiveness of MTC in MEN IIB. Clinicopathological correlation was obtained by examining the eyes post mortem.

Results and conclusions: Three new findings in MEN IIB have been established by this study. The enlarged corneal nerves can now be regarded as ganglioneuromas. Medullary thyroid carcinoma metastases were found in the choroid. Light and electron microscopic examination of the eye showed ganglioneuromas of the nerves in the limbus, trabecular meshwork, uveal tract and posterior ciliary nerves; this finding may account for the glaucoma occasionally seen in patients with MEN IIB.
Silicone oil insertion: A review of 127 consecutive cases
Authors: Fisk M J , Cairns J D
Published: November 2007

Silicone oil was used in combination with vitrectomy to treat 127 cases of complicated retinal detachments. An initial anatomic success in 120 cases (94%) was reduced to 68 (54%) after an average follow‐up of 32 months and was attributable to ongoing proliferative vitreo‐retinopathy (PVR). The indications for the use of silicone oil were:

1. Retinal detachment complicated by PVR (107 cases), 20 of which required multiple operations. Anatomic success was achieved in 59 (55%) and of these 23 (40%) had visual acuity of 6/60.

2. Giant retinal tears (GRT) (7 cases). Four (57%) of these remained attached, three (75%) having final vision of 6/36.

3. GRTs complicated by PVR (8 cases). Four (50%) were anatomically successful and two had final vision of 6/60.

4. Proliferative diabetic retinopathy (5 cases). Two (40%) remained attached and one of these (50%) had hand movements vision.

The silicone oil was removed electively in 23 eyes, 16 (70%) of these being anatomically successful. Oil was removed in 43 eyes because of complications, and in 20 (46%) of these, the retina remained attached at the end of follow‐up. Complications included cataract in all 14 phakic eyes; rubeosis in 19 eyes (15%); corneal opacification in 52 eyes (41%), there being no clear cut difference between those eyes with an inferior iridectomy (35 of 85 eyes — 41%) and those without (12 of 29 eyes — 41%); and raised intraocular pressure in 55 eyes (43%). We conclude that although far from being ideal, silicone oil appears to have played some part in achieving the successful results reported in this study.
Retinopathy of prematurity in a South Australian neonatal intensive care unit
Authors: Smith Justine , Spurrier Nicola , Goggin Michael
Published: November 2007

Purpose:
To establish the incidence and severity of retinopathy of prematurity (ROP) in an Australian population of premature infants, and define risk factors for this population.

Methods:
A survey of neonates born weighing less than 1501 g and/or with gestational age below 33 weeks, was undertaken at a neonatal intensive care unit in South Australia.

Results:
ROP was diagnosed in 16.0% of the 94 neonates who were screened until retinal vascularisation was complete. Threshold disease occurred in 4.2%. Logistic regression identified three significant risk factors for the development of ROP: days of mechanical ventilation, multiple birth and female sex.

Conclusions:
The incidence of ROP was relatively low when compared with figures recently published for two large populations studied in the United States and England. This difference was due to a lower incidence of mild forms of the disease. Days of mechanical ventilation, multiple birth and female sex were independently predictive of the occurrence of ROP. As small numbers of infants with ROP are managed at individual Australian centres each year, a national ROP register is recommended to facilitate the study of the disease in this country.
Steroid‐induced ocular hypertension in the presence of a functioning Molteno seton
Authors: Muecke James , Brian Garry
Published: November 2007

Background:
Steroid‐induced ocular hypertension is generally attributed to alterations in the trabecular meshwork, reducing aqueous outflow.

Method and Results:
A case with several episodes of steroid‐induced ocular hypertension is presented. Later, with unremitting intraocular pressures above 50 mmHg, despite maximal hypotensive medication, there is evidence of extensive failure of aqueous egress. A successful Molteno seton bypasses the failed trabecular meshwork to lower the pressure into the teens. The eye is then challenged with topical steroid on two occasions. The pressure rises, only to fall again with steroid withdrawal.

Conclusion:
Here is a case where the trabecular meshwork has been bypassed, but ocular hypertension was still induced with the application of topical steroid.
Prophylactic perifoveal laser treatment of soft drusen
Authors: Sarks Shirley H. , Arnold Jennifer J. , Sarks John P. , Gillies Mark C. , Walter Clement J.
Published: November 2007

Purpose:To assess the efficacy and safety of perifoveal laser to cause drusen to resorb, and establish a treatment protocol.

Methods:Treatment technique was determined by the outcome in one patient with 15‐year follow‐up. In an uncontrolled series a perifoveal ring of gentle laser was applied to 30 eyes of 28 patients, 18 with bilateral drusen and 10 with exudative disease in the fellow eye. Comparison was made between treated and untreated eyes in 14 patients with bilateral drusen. Mean follow‐up was 16.8 months (range, three to 42 months).

Results:Soft drusen resorbed in all treated eyes in the vicinity of laser and within the fovea. Large soft confluent drusen (>500 μm) responded most rapidly. Visual acuity improved one or more lines in 12 (40%) treated eyes, was unchanged in 16 (53%) and deteriorated in two (7%). In 14 patients with bilateral drusen in whom only one eye was treated, VA remained unchanged in 10 eyes and improved in four treated eyes while none of the untreated eyes improved (P= 0.03, χ2) and decreased in four eyes. Atrophic expansion of laser burns was minimal. CNV developed in two of 30 eyes (7%).

Conclusion:Perifoveal laser treatment appears to expedite the regression of soft drusen within the fovea. The risks of complications may be reduced by treating eyes early, before pigment changes develop and by applying a minimum number of burns at a distance greater than 750 μm from the foveal centre. Treatment should currently be administered only in the context of a prospective clinical trial, which is required to assess whether this treatment results in lowered risk of visual loss from CNV or geographic atrophy.
Corneal topographic lagoons: a potential new marker for post‐traumatic recurrent corneal erosion syndrome
Authors: McGhee Charles NJ , Bryce Iain G. , Anastas Constantine N. , Webber Suzanne K. , Burvill Malcolm , Murray AidanT
Published: November 2007

Background:Post‐traumatic recurrent corneal erosion syndrome is a common clinical problem in which a definitive diagnosis is not always possible based solely upon biomicroscopic corneal signs. Indeed, in some cases archetypical symptoms or a preceding history of epithelial trauma cannot always be elucidated.

Methods:Four groups of patients underwent corneal analysis using computer videokeratography. Group 1 (n=11), subjects who presented with simple corneal epithelial trauma approximately three months before the study. Group 2 (n=11), prospective analysis of subjects presenting with simple corneal epithelial trauma. Group 3 (n=12), prospective analysis of subjects with an established diagnosis of post‐traumatic recurrent erosion syndrome. Group 4 (n=135), prospective analysis of healthy control subjects.

Results:Small, well delineated areas (1.0 to 1.5 mm in diameter) of markedly reduced corneal dioptric power (greater than 2 dioptres), which we have termed ‘corneal topographic lagoons’, were identified more commonly in eyes with recurrent corneal erosion syndrome and in eyes that had recently sustained corneal epithelial trauma; being found in 18.2% of Group 1, 9.1 % of Group 2, 58.3 % of Group 3 but only 1.5% of Group 4 (control).

Conclusions:The identification of areas of focal abnormality in the corneas of patients with post‐traumatic recurrent corneal erosion syndrome remains a significant clinical problem. Corneal topographic analysis has demonstrated a focal abnormality, the ‘corneal topographic lagoon’, which is much more prevalent in cases of recent corneal trauma and recurrent corneal erosion syndrome than in the ‘normal’ population. Computerised videokeratography therefore adds a new tool to the armamentarium of the clinician seeking to identify and locate abnormalities in these difficult cases.
Trabeculectomy and manual clot evacuation in traumatic hyphaema with corneal blood staining
Authors: Verma Nitin
Published: November 2007

Background:The management of traumatic hyphaema with raised intraocular pressure and corneal blood staining is difficult. Residual blood clots after anterior chamber washout are responsible for sustained postoperative elevation of intraocular pressure, even after trabeculectomy and clot evacuation.

Methods:Thirty‐five patients with traumatic hyphaema, elevated intraocular pressure and varying degrees of corneal blood staining underwent a combined trabeculectomy with manual clot evacuation from the anterior chamber in a general hospital.

Results:The postoperative control of intraocular pressure was found to be adequate in all patients at the end of two months. Examination of the posterior segment was made possible earlier. Although the procedure is more complex, no significant complications were encountered.

Conclusion:In patients presenting with traumatic hyphaema, secondary glaucoma and corneal blood staining, trabeculectomy with manual extraction of the clot through a large incision appears to be a safe and reliable procedure where medical therapy fails to control the intraocular pressure.
A controlled clinical trial of Dorzolamide: a single‐centre subset of a multicentre study
Authors: Simpson Allan J. , Gray Trevor B. , Ballantyne Claire
Published: November 2007

Purpose:To assess the safety and intraocular pressure (IOP)‐lowering activity of 2% dorzolamide (topical carbonic anhydrase inhibitor), compared to 0.5% timolol and 0.5% betaxolol eyedrops.

Methods:A parallel, masked, randomised one‐year clinical trial was conducted in 16 patients with open‐angle glaucoma or ocular hypertension, being a subset of a multicentre study which enrolled 523 subjects. Patients had IOP > 22 mmHg in one eye at baseline following washout of ocular hypotensive medications and were then randomised in a 3:l:l ratio to receive 2% dorzolamide thrice daily, 0.5% timolol twice daily or 0.5% betaxolol twice daily respectively. IOP was measured at Hour 2 (morning peak), Hour 5 and Hour 8 (afternoon trough for dorzolamide) at baseline, Weeks 2 and 4 and Months 2, 3, 6, 9 and 12.

Results:Topical dorzolamide 2% solution was well tolerated and safe. Mean IOP for dorzolamide at Hour 2 was 29.1 mmHg at baseline and 20.8 mmHg on treatment at one year, a 28.5% change. Mean IOP for dorzolamide at Hour 8 was 24.5 mmHg at baseline and 20.2 mmHg on treatment at one year, a 17.6% change. Comparable percent changes for timolol and betaxolol were 43.2/25.7 mmHg at Hour 2 and 21.9/13.5 mmHg at Hour 8 respectively.

Conclusions:Dozolamide 2% given thrice daily was well tolerated and safe, with a clinically significant effect on IOP comparable to betaxolol 0.5% twice daily, but not as great as timolol 0.5% twice daily.
Precipitous visual loss secondary to optic nerve toxoplasmosis as an unusual presentation of AIDS
Authors: Wei Marc E. , Campbell Stephen H. , Taylor Chris
Published: November 2007

Life‐threatening conditions requiring urgent medical treatment rarely present to the ophthalmolgist. This case report describes a patient with precipitious visual loss as the primary complaint and which subsequently led to the diagnosis of Toxoplasmic papillitis and life‐threatening cerebral involvement as an initial manifestation of AIDS.
The revolution in molecular genetics and its impact on ophthalmology
Authors: Della Neil G.
Published: November 2007

Rapid advances in molecular technology have led to the identification of many genes responsible for inherited disease in ophthalmology. These discoveries also portend an understanding of the pathogenesis of more common ophthalmic disorders which have a genetic component, such as open‐angle glaucoma and age‐related macular degeneration. This review comprises a summary of these advances in molecular genetics, particularly the contribution of the Human Genome Project; a tabulation of the genes recently proven to be mutated in hereditary ocular conditions; and a discussion of the implications for the practising ophthalmologist.
Excirner phototherapeutic keratectomy for recurrent granular dystrophy
Authors: Maclean Hunter , Robinson Lyon P. , Wechsler Alfred W. , Goh Alvin
Published: November 2007

Purpose: Corneal grafting is a standard treatment for visually disabling granular dystrophy. The visual results of this procedure are generally good, but can be marred by recurrences of granular deposits some years later. We report the results of phototherapeutic keratectomy (PTK) for recurrent granular dystrophy in three eyes from two patients and discuss the possibilities of treating de novo granular dystrophy with excimer laser.

Methods: The records of two patients (three eyes) treated with excimer PTK for recurrent granular deposits on the donor cornea were reviewed.

Results: In all cases visual acuity was improved and repeat corneal grafting avoided. No significant complications occurred although one eye had further recurrence of granular deposits which was also successfully retreated with excimer PTK. Follow‐up on these cases varies between five months and three years.

Conclusions: We believe that excimer PTK offers a simple, safe and repeatable way of restoring visual acuity to most cases of recurrent granular dystrophy. Visual recovery is fast and all the incumbent problems of repeat grafting are avoided.
Evaluation of topical 0.03% flurbiprofen drops in the treatment of herpetic stromal keratitis
Authors: Vajpayee Rasik B. , Dhakal Bhim P. , Gupta Suresh K. , Sachdev Mahipal S. , Satpathy Geeta , Honavar Santosh G. , Panda Anita
Published: November 2007

Purpose: The management protocol for herpetic stromal keratitis (HSK) is still controversial. We have attempted to compare the relative efficacy of topical dexamethasone 0.01 % and flurbiprofen 0.03% in combination with topical acyclovir 3% in HSK.

Methods: In this institutional, prospective, randomized, controlled, double‐blind study, 45 clinically diagnosed cases of HSK were randomly distributed into three coded treatment groups — topical placebo, dexamethasone 0.01 %, and flurbiprofen 0.03% each in tapering frequency and in combination with acyclovir 3% ointment five times per day for four weeks. Therapeutic response was assessed every third day for four weeks. Decoding of the treatment groups was done at the conclusion of the study and data analysed.

Results: Four‐week success rate was 93.3% (14 of 15) in the dexamethasone‐acyclovir treatment group, 66.7% (10 of 15) in the flurbiprofen‐acyclovir treatment group and 20% (3 of 15) in the placeboacyclovir treatment group.

Conclusion: While dexamethasone in combination with acyclovir gives the best results in HSK with minimal side‐effects, the role of topical flurbiprofen seems promising.
Disturbance of central vision after carbonmonoxide poisoning
Authors: Fine Ronald D. , Parker Geoffrey D.
Published: November 2007

Background: Cerebral achromatopsia is a disturbance of colour perception which may be complete or partial.

Clinical record: A 28‐year‐old male patient presented five months after carbon monoxide poisoning with achromatopsia. The achromatopsia was unaccompanied by an inability to recognise faces (prosopagnosia) nor was there any disorder of form or depth perception.

Results: Magnetic resonance imaging showed bilateral sharply defied areas of haemorrhagic infarction in the globus pallidus with extensive infarction involving temporal and occipital lobes and with apparent partial sparing of the visual cortex, presumably due to arterial insufficiency. The disturbance of central colour vision resolved spontaneously after a further period of 6 months.

Conclusion: The symptom of achromatopsia is analysed with particular reference to the recent work of Professor Zeki on disturbance of central colour vision following CO poisoning and the unusual MRI findings.
Macula toxicity after intravitreal amikacin
Authors: Seawright Ashley A. , Bourke Robert D. , Cooling Robert J.
Published: November 2007

Background: Although intravitreal aminoglycosides have substantially improved visual prognosis in endophthalmitis, macular infarction may impair full visual recovery.

Methods: We present a case of presumed amikacin retinal toxicity following treatment with amikacin and vancomycin for alpha‐haemolytic streptococcal endophthalmitis.

Results: Endophthalmitis resolved with improvement in visual acuity to 6/24 at three months. Fundus fluorescein angiography confirmed macular capillary closure and telangiectasis.

Conclusions: CurrentIy accepted intravitreal antibiotic regimens may cause retinal toxicity and macular ischaemia. Treatment strategies aimed at avoiding retinal toxicity are discussed.
The venous closing pressure in central retinal vein obstruction
Authors: Luckie Alan P. , Wroblewski John J. , Bird Alan C. , Hamilton AM Peter , Sanders Michael D. , Green William , Slater Nicolas G.
Published: November 2007

Objective: To assess the rate of change in the central retinal venous closing pressure in central retinal vein obstruction over time, and its relationship to visual acuity improvement and the development of rubeosis iridis.

Methods: Fifty patients presenting with central retinal vein obstruction of less than three months' duration, between the ages of 40 and 80 years, were reviewed prospectively. The central retinal venous closing pressure was measured by digital ocular compression. Patients were discharged from the study after the six‐month visit.

Results: All patients had elevated venous closing pressure at presentation, whereas at six months only 24 patients had persistent elevation. Of 16 patients with lowering of the venous closing pressure within four months of onset of central retinal vein obstruction, 11 (69%) had two or more lines of visual acuity improvement. Only two of 10 patients (20%) developing lowering of the venous closing pressure thereafter had visual improvement. No patient developed rubeosis iridis after the venous closing pressure lowered.

Conclusion: The central retinal venous closing pressure is raised in central retinal vein obstruction to about central retinal arterial diastolic pressure, and is its pathognomonic sign. This sign is easily elicited via digital pressure on the eyelid, and has prognostic significance for visual acuity improvement and the development of rubeosis iridis.
Prevalence of blindness and visual impairment in an elderly urban population
Authors: Casson Robert , Giles Lynne , Newland Henry S.
Published: November 2007

Background: Accurate data on the prevalence of blindness in urban populations is not readily available. The Australian Longitudinal Study of Ageing is a prospective multidimensional study examining a broad range of age‐related health issues, including visual function.

Methods: A population‐based sample of 1466 persons, 70 years of age and over, from the Adelaide metropolitan area underwent visual acuity measurements.

Results: Approximately 1% were legally blind by Australian definitions.

Conclusions: This percentage is low by world standards, however projections indicate that the absolute number of blind elderly people is rapidly increasing. Data such as this are crucial for the planning of adequate ophthalmic care.
Mobile retinal photography: A means of screening for diabetic retinopathy in Aboriginal communities
Authors: Karagiannis Arthur , Newland Henry
Published: November 2007

Background:Mobile fundus photography undertaken by Aboriginal health workers has been suggested as a practical and effective method of screening for diabetic retinopathy among Aboriginal and Torres Strait Islander communities.

Methods:A pilot study was undertaken to demonstrate that interpretable colour slides of the retina could be produced by Aboriginal health workers trained over a two‐week period.

Results:Of 47 subjects, 36 (76.6%) had interpretable retinal photographs.

Conclusions:These findings warrant further evaluation as to the benefits and cost effectiveness of mobile retinal photography.
A simple snare for transscleral fixation of dislocated intraocular lenses
Authors: Poon Alex , Clark J Ben , Grey Rodney HB , Markham Richard HC
Published: November 2007

Purpose:The construction and use of a surgical snare in retrieving and securing posterior chamber intraocular lenses is described.

Methods:The snare consists of a 10‐0 polypropylene suture threaded into a 25‐gauge ret‐robulbar needle. This is used after a pars plana vitrectomy to retrieve the dislocated intraocular lens. The needle attached to the polypropylene suture is used to secure the lens haptic 1.5 mm behind the limbus. Two snares are used to secure the two lens haptics.

Conclusions:The snare is easy to make with readily available materials. The use of this snare involves less intraocular and extraocular manipulations than other described methods.
The cellular mechanism underlying neuronal degeneration in glaucoma: Parallels with Alzheimer's disease
Authors: Vickers JC
Published: November 2007

Evidence is presented that the characteristic pattern of neuronal degeneration associated with glaucoma is due to a combination of the persistent physical damage to axons at the level of the lamina cribrosa and the associated neuronal reaction to this kind of trauma. The class of neuronal cytoskeletal proteins known as the neurofilament triplet are crucially involved in the reaction to physical damage and the selective localization of these proteins to larger retinal ganglion cells may underlie their susceptibility to eventual degeneration. The appearance of glaucoma‐like neuronal pathology in Alzheimer's disease may follow the reaction of neurofilament‐containing retinal ganglion neurons to persistent damage to their axons by β‐amyloid plaque formation in subcortical visual centres.
Extended wear disposable soft contact lenses as an alternative to photorefractive keratectomy: Report of 4 years experience
Authors: Buckley CA , Buckley CJ , Griffiths J
Published: November 2007

Purpose: To establish whether; in a well‐informed population, the use of extended wear disposable soft contact lenses (EWDSCL) poses an unacceptable risk to vision and corneal health due to complications associated with their use.

Methods: A 4 year retrospective review of EWDSCL, involving 371 patients in Melbourne from a single general ophthalmology practice. The important aspects of this group were that all patients were given written instructions about the methods of ensuring initial and ongoing cleanliness of lenses, no lenses were cleaned and reinserted, and no solutions other than the saline in the original packaging, and comfort drops, were used. Two types of EWDSCL were used, in powers from ‐ 9.0 to + 6.0 D, and with an initial aim of 4 weeks uninterrupted extended wear. Follow‐up was from 2 to 52 months, with an average of 24 months.

Results: Of the 354 patients followed up, 236 (66%) regularly wore them on an extended overnight basis, and of these 180 (76%) wore them for the suggested 4 week period before renewal of lenses. In the 471 eyes of 236 patients, adverse reactions occurred at the following rates: marginal infiltrates (12 cases, 2.5%); corneal oedema (10 cases, 2%); peripheral corneal vascularization (2 cases, 0.4%); and presumed infective keratitis (1 case, 0.2%). No eyes lost one or more lines of Snellen acuity.

Conclusions: When disposable soft contact lenses do not come into contact with cleaning solutions, saline from bottles or aerosol cans, or storage cases, their use on an extended wear basis (up to 4 weeks continuous) appears to be associated with a low risk of minor or major complications. The results of this review indicate that controlled usage of EWDSCL is safer than previous reports have indicated.
Atypical choristomatous cysts of the orbit
Authors: West JA , Drewe RH , McNab AA
Published: November 2007

Background: The commonest choristomatous cysts of the orbit are dermoid and epidermoid cysts, which are lined by kerantinizing seuamous epithelium. They typically occur in the superior orbit, most commonly superotemporally. Other types, lined by different epithelia, and other orbital sites are much less common.

Methods: Five cases of atypical orbital cystic choristomas that presented over the past 6 years are reported. The clinical and radiological features, surgical approach and findings, and histology are described. Similar cases from the literature are reviewed, and possible aetiology discussed.

Results: Four of the cysts were lined by a non‐keratinizing epithelium resembling conjunctiva; two had adnexal structures in their walls. Compared with typical dermoid and epidermoid cysts, these ‘conjunctival dermoids’ and ‘conjunctival cysts’ of the orbit tended to present later in life, none were associated with bony defects, and three of the four occurred in the superomedial quadrant. One case occurred inferiorly, a rare site for orbital conjunctival dermoids and cysts, or typical dermoids and epidermoids. The fifth case, also inferior; is an example of a cyst within choristomatous lacrimal tissue.

Conclusion: Choristomatous cysts of the orbit may occur with non‐keratinizing epithelial linings, and such cysts tend to differ clinically from the commoner dermoids and epidermoids. They may also occur in atypical sites such as the inferior orbit.
Meningococcal conjunctivitis
Authors: Irani F , Ruddell T
Published: November 2007

Background: Primary meningococcal conjunctivitis is a rare condition that can have devastating ocular and systemic complications.

Methods: Review of the case records.

Conclusions: Appropriate Gram stain and cultures should be obtained in cases of hyperacute conjunctivitis, especially in young patients, and systemic antibiotics should be initiated promptly where Gram‐negative diplococci are found and prophylaxis for close contacts considered in Neisseria meningitidis conjunctivitis.
Scedosporium prolificans corneoscleritis: A successful outcome
Authors: Kumar B , Crawford GJ , Morlet GC
Published: November 2007

Background: A case of Scedosporium prolificans corneoscleritis is reported in a patient who had developed scleral necrosis following pterygium surgery, with adjunctive β‐irradiation. This fungus has been reported to be the causative organism in only two previous cases of corneoscleritis.

Methods: The patient presented with signs and symptoms typical of corneoscleritis. When the fungus was isolated from a biopsy specimen, aggressive scleral debridement was carried out and intensive antifungal therapy was instigated.

Results: After a prolonged course, the eye was rendered sterile.

Conclusion: Early conjunctival recession and aggressive scleral debridement combined with intensive instillation of antifungals are crucial to the successful management of fungal corneoscleritis.
Lack of association between localized cataract and visual field loss: The Blue Mountains Eye Study
Authors: Ivers Rebecca Q. , BOptom  , Mitchell Paul , Cumming Robert G.
Published: November 2007

Purpose: To examine whether localized cataract is related to localized field defects on suprathreshold visual field testing.

Methods: Suprathreshold screening visual fields (Humphrey 76‐point test) and lens photographs, graded using the Wisconsin System, were performed on participants attending the Blue Mountains Eye Study, which examined 3654 subjects residing in an area west of Sydney, NSW, Australia. The results for 2276 subjects were analysed in the present study.

Results: There were no significant relationships between total points missing in the visual field and the degree of cortical, posterior subcapsular (PSC) or nuclear cataract after adjusting for confounders (test for trend P=0.9, 0.7 and 0.9, respectively). Adjusted prevalence ratios and 95% confidence limits for the association between 10 or more points missing and the presence of cataract were 0.94 (0.77–1.25) for cortical, 1.26 (0.82–1.93) for PSC and 1.06 (0.86–1.30) for nuclear cataract. Similarly, there was no relationship between the presence of cortical or PSC cataract and sectoral visual field loss in any quadrant or hemifield.

Conclusions: Neither cortical, nuclear nor PSC cataracts increase the total points missing on the 76‐point suprathreshold field test. Similarly, neither cortical nor PSC cataracts cause sectoral visual field loss on this screening field test. In the presence of cataract, sectoral visual field loss on non‐thresholding visual field screeners must be attributed to other causes, such as glaucoma. The present study provides a clinical alert that localized field loss is unlikely to be related to cataract.
Use of a confocal laser scanning ophthalmoscope to detect glaucomatous cupping of the optic disc
Authors: Cucevic Viviene , Brooks Anne MV , Strang Nicole T. , Klein Anthony G. , Nugent Keith A.
Published: November 2007

Purpose: The aim of the present study was to test the hypothesis that the three‐dimensional (3‐D) topography of the optic disc contains sufficient information to diagnose glaucoma with a high degree of reliability.

Methods: The Zeiss ‘Confocal Laser Scanning Ophthalmoscope’ (CLSO) was used to obtain digitized samples of 3‐D images of optic nerve heads from the following three groups of patients: (i) 40 normals with normal optic discs, normal Humphrey 24–2 full threshold visual fields and an intraocular pressure (IOP) ≤ 21 mmHg; (ii) 20 established glaucoma patients with cupping, glaucomatous field loss and an IOP > 21 mmHg; and (iii) 20 early glaucoma patients with early cupping, field loss with a mean defect less than –10 dB and IOP > 21 mmHg. The cupping in these patients was paramaterized by spherical harmonics and was classified by multivariate statistical analysis.

Results: Of 40 glaucoma patients, 39 were correctly classified. Of 40 normal patients one was classified as glaucoma.

Conclusions: This study demonstrates that the CLSO, with the use of spherical harmonics, can differentiate glaucomatous from normal optic discs in this selected group of patients without the need for a skilled observer. This constitutes a promising technique to be tested on a large, unselected body of patients as a screening tool.
Differentiation of the maturity of cataractous human lens capsules according to changes in protein secondary structures determined by Fourier‐transformed infrared spectroscopy
Authors: Lee Shui‐Mei , Lin Shan‐Yang
Published: November 2007

Purpose: Cataract‐induced alterations in the protein secondary structure of human lens capsules in different maturity of cataractous patients was investigated.

Methods: Fourier‐transformed infrared (FT‐IR) spectroscopy with Fourier self‐deconvolution and curve‐fitting algorithms was used. Twenty‐seven immature and four mature cataractous patients (previously classified through observations of the depth of the shadow cast by the iris on oblique illumination) were investigated in the present study.

Results: Two groups with progressive cataract formation could be effectively redifferentiated and re‐arranged. In the first group, all the peak positions were the same and the peak at 1651 cm‐1 assigned to the α‐helix structure was predominant, but the structural compositions of the β‐sheet and β‐turn changed with progressive cataractogenesis. In the second group, in which cataract formation was more advanced, the peak at 1651 cm‐1 assigned to the α‐helix structure shifted to 1658 cm‐1 and a new peak appeared at 1647 cm‐1, due to random coil structure; the structural composition of triple helix significantly decreased but the compositions of the β‐sheet and β‐turn slightly increased. Amides II and III of the IR spectra seemed to be less changed in secondary structures.

Conclusions: These results suggest that FT‐IR spectroscopy with Fourier self‐deconvolution and curve‐fitting programs can be used as a diagnostic tool for the determination of the cataractous maturity of human lens capsules.
A review of 24 cases of Mohs surgery and ophthalmic plastic reconstruction
Authors: Kumar B , Roden D , Vinciullo C , Elliott T
Published: November 2007

Purpose: Mohs surgery (micrographically controlled excision) has been advocated as an effective method of dealing with infiltrative periorbital skin tumours. It has been shown to have high rates of tumour clearance with minimal loss of normal tissue, thus making oculoplastic reconstruction easier and functional preservation better: The aim of the present study was to confirm this. Guidelines for the selection of patients for Mohs surgery are discussed.

Methods: We retrospectively reviewed 24 cases of primary (n= 18) and recurrent (n=6) periorbital basal and squamous cell carcinomas managed by Mohs micrographic excision and plastic reconstruction who presented to the Royal Perth Hospital between 1992 and 1996.

Results: Our high rate of tumour clearance (100%) was similar to that of previous studies, although our follow‐up period was only 14.6 months. The fact that 50% of our patients with lid involvement had an intact posterior lamella after Mohs excision correlates with the high level of normal tissue preservation. The low rate of postoperative symptomatic problems suggests good maintenance of function. The infiltrative nature of these tumours was highlighted by the substantial proportion of cases (37.5%) that had a much larger excision defect than what was expected prior to excision.

Conclusions: Our analysis confirms that Mohs excision and subsequent oculoplastic reconstruction is an effective method to use when managing periorbital infiltrative skin tumours.
Cataract surgery reduces subjective visual disability
Authors: Pesudovs K , Coster DJ
Published: November 2007

Purpose:

The present study examines the impact of cataract on visual disability (VD) and how cataract surgery alters VD.

Methods:

Fifty‐six patients were assessed pre‐ and at 3 months post‐cataract surgery. Cataract severity was measured with the Lens Opacities Classification System ill (LOCS III). Visual disability was assessed by questionnaire. The relationship between LOCS III scores and total VD score was examined with linear regression. Repeated measures analysis of variance was used to determine whether the pre‐ and postoperative VD scores were different.

Results: The VD score was found to relate more closely to the LOCS III score in the least affected eye than in the most affected eye. The VD score is related to nuclear opacity (P=0.01), and posterior subcapsular cataract (PSC; P=0.0004), but not to cortical cataract (P=0.51) (r2= 0.43). The VD score is significantly greater before surgery (mean ±SD) 1.81 +0.67) than after (1.19 ± 0.21; P± 0.001).

Conclusions:

Nuclear and PSC cataracts cause more visual disability than cortical cataracts. Visual disability is significantly reduced by cataract surgery.
A computer‐generated test of acuity for multi‐handicapped children
Authors: Fitzmaurice K , Maclean H
Published: November 2007

Assessment of visual function in severely intellectually handicapped children is difficult but necessary for educational purposes. The difficulties encountered include: lack of literacy skills; lack of verbal and fine motor skills; and low interest level of the optotypes. A computer‐generated test has been developed that helps overcome these difficulties. This test presents pictures equivalent in line width to Snellen, which are manipulated on screen to provide movement and change of size to facilitate non‐verbal responses and to increase interest level. Evaluation trials were conducted with 96 cognitively normal children and 37 multi‐handicapped children. The computer test facilitated testing of significantly more of the multi‐handicapped children. Data from both trial groups indicated a good positive correlation between the computer test and a standard optotype test. Further refinement and evaluation of this computer test is continuing.
Gender, oestrogen, hormone replacement and age‐related macular degeneration: Results from the Blue Mountains Eye Study
Authors: Smith W , Mitchell P , Wang JJ
Published: November 2007

Purpose:

To determine whether females have a higher age‐specific age‐related maculopathy prevalence than males; whether there is an increased risk of age‐related macular degeneration (AMD) with early menopause; and whether there is a decreased risk of AMD with use of hormone replacement therapy (HRX).

Methods:

Pooled data from three study populations that have used similar AMD diagnostic criteria were used to answer the first hypothesis: the Beaver Dam Eye Study (BDES), the Rotterdam study of the elderly, and the Blue Mountains Eye Study (BMES). The BMES population was used to answer the second and third hypotheses. This population included residents aged 49 or older with 2072 women participating, of whom 1899 postmenopausal women answered questions about menopause, menarche and HRT AMD was diagnosed from graded retinal photographs using modified international criteria.

Results:

The overall pooled odds ratio (OR) for association between sex and AMD revealed a significant increase in AMD prevalence among females compared with males, adjusting for 10‐year age categories, OR = 1. 15 (1. 10‐1.21), with no significant heterogeneity between studies. A significant decrease in the odds of early AMD with increasing years from menarche to menopause was observed.

Conclusions:

The results suggest that females may have a higher risk of AMD. The significant decrease in early AMD with increasing years from menarche to menopause supports the concept that a shorter duration of oestrogen production may increase risk of AMD.
Effect of hydrogel lens wear on the major tear proteins during extended wear
Authors: Carney FP , Morris CA , Willcox MDP
Published: November 2007

Purpose:

The purpose of the present study was to determine whether contact lens wear disturbed the levels of tear proteins and to further determine whether this was a transient or continuous disruption.

Methods:

Lactoferrin, lysozyme and albumin were quanti‐tated from tears of neophyte patients and were compared with the levels of these proteins in contact lens wearers after one and six nights and 6 months of extended wear The quantitation of these tear proteins was performed by sandwich ELISA and turbidimetric assay.

Results:

Results showed that there were no statistically significant changes in the concentration of any of the proteins investigated.

Conclusions:

Extended wear of hydrogel lenses does not appear to alter the concentration of the major tear film proteins, indicating that the tear film is constantly replenished to maintain protein levels, which are depleted due to protein adsorption to the lens surface.
Adhesion and growth of Serratia marcescens on artificial closed eye tears soaked hydrogel contact lenses
Authors: Hume EBH , Willcox MDP
Published: November 2007

The adhesion to hydrogel contact lenses and growth of Serratia marcescens on artificial tear fluid (ATF) soaked lenses was investigated. Results indicated that a corneal ulcer isolate adhered more avidly to lenses; ATF increased adhesion for all strains tested. The contact lens induced acute red eye (CLARE) isolate adhered poorly; however; it grew to a larger extent on ATF‐coated lenses. The ability of the corneal ulcer isolate to adhere to lenses may be an important factor in its pathogenicity whereas the ability of the CLARE isolate to grow on the lens in the presence of antimicrobial tear proteins may be important in the development of inflammation.
A light‐driven rhythm in neurotensin‐like immunoreactivity in the chicken retina
Authors: Yang DS , Li ZK , Morgan IG
Published: November 2007

Purpose:

To determine if the pattern of release of neurotensin from the enkephalin‐, neurotensin‐ and somatostatin‐like immunoreactive amacrine cells in response to light and dark is the same as that of the enkephalins and somatostatin.

Methods/Results:

Both the enkephalins and somatostatin are released at high rates in the dark and at lower rates in the light, and these rate changes are reflected in increasing intracellular levels of the peptides in vivo in the light and decreasing levels in the dark The levels of neurotensin‐like immunoreactivity show a similar diurnal light‐driven and non‐circadian rhythm in vivo.

Conclusion:

This implies that the actual release rates of neurotensin follow the same patterns as those demonstrated in vitro for the enkephalins and somatostatin.
Barrier activity of fractionated human serum
Authors: Langford‐Smith J , Gillies M , Billson F
Published: November 2007

Purpose:

Breakdown of the blood‐retinal barrier is a major cause of visual loss in diseases such as diabetic retinopathy, age‐related macular degeneration and retinal vein occlusion.

Methods:

Human serum, fractionated by gel filtration, was screened for factors that enhance barrier activity by measuring electrical resistance across monolayers of human umbilical vein endothelial cells.

Results:

Two peaks of barrier‐enhancing activity were detected. The larger peak was broad, contained a preponderance of albumin and increased barrier activity to 183% of controls. The barrier‐enhancing properties of the larger peak, however, appeared to be associated with proteins in general and not just albumin. The fractions associated with elution of the larger peak induced maximal increase in resistance in under I h, relative to controls. The smaller peak was associated with molecular weights much smaller than those of proteins.
A multiple‐frequency, multiple‐region pattern electroretinogram investigation of non‐linear retinal signals
Authors: Maddess T , Bedford S , James AC , Rose KA
Published: November 2007

It has been proposed that the spatial frequency doubled (FD) illusion may originate from Y‐like non‐linear retinal ganglion cells. If the contrast of multi‐frequency stimuli is increased, Y cells show a phase advance in the self‐sum frequencies but not in other output frequencies. We looked for these effects with a multi‐region pattern electroretinogram (PER.G) displaying the sum of two temporal frequencies in each visual field location. Regional variation was found in the recorded sum and difference frequencies. The results indicate that PERG signals become dominated by responses from Y‐like cells when the FD illusion is seen.