bluuebunny/crossref_metadata_2025 huggingface dataset:
A FAMILY OF SQUINTS: THE DIFFERING EFFECTS OF HYPERMETROPIA ON FOUR SIBLINGS
Authors: HILTON ALAN F.
Published: November 2007

Four siblings in a famil of five were found to be affected with hypermetropia in differing degrees and with differing effects. dese were (i) unilateral hypermetropia, producing amblyopia; (ii) hypermetropia inducing an accommodative esotropia with minimal amblyopia and fully controlled with glasses; (iii) hypermetropia producing an accommodative esotropia with a high AC/A ratio, fully controlled with bifocals; and (iv) hypermetropia producing esotropia which was only partially corrected with glasses, therefore partially accommodative, with a residual squint which required surgery.

This family of four nicely demonstrates all the permutations and combinations possible in accommodative‐type esotropia and the piifalls therein.
OBJECTIVE TECHNIQUES OF VISUAL ACUITY ASSESSMENT IN INFANCY
Authors: HOYT CRElG S.
Published: November 2007

Three primary techniques for objective assessment of visual acuity m the preverbal infant are variations of optokinetic nystagmus, forced preferential looking and visual evoked potentials. Although these tests are useful, the clinician must be aware of their shortcomings.

Failure to evoke optokinetic nystagmus may reflect the infant's lack of interest in the stimulus, an inherently uninteresting stimulus, or a defect in the motor system generating the nystagmus, other than failure to see the stimulus.

Forced choice preferential looking has provided useful information about visual development in perverbal infants. The need for more complex stimuli to yield more precise estimates of acuity than the standard grating stimuli, especially in cases of amblyopia, is discussed.

Visual evoked potentials, like forced preferential looking, may grossly overestimate the acuity of the amblyopic patient. Of the techniques discussed, it holds the most promise.
EVALUATION OF SODIUM CROMOGLYCATE AND MEDRYSONE IN THE MANAGEMENT OF ATOPIC KERATOCONJUNCTIVITIS: A DOUBLE MASKED CLINICAL STUDY
Authors: VAJPAYEE R. B. , GUPTA S. K. , UPPAL R. K.
Published: November 2007

The efficacy of topical sodium cromolycate and medrysone was evaluated in 38 patients suffering from atopic keratoconjunctivitis. It was found that medrysone (1%) signifmntly improved the symptoms of itching, watering. photophobia and hyperaemia, while sodium cromoglycate (2%) was found to be ineffective. Tear prostaglandin E2 and histamine levels did not decrease significantly after sodium cromoglycate therapy. The findings of the present study reveal that sodium cromoglycate has no significant role in the management of atopic keratoconjunctivitis.
PHOTOKERATOSCOPY: SOME THEORETICAL AND PRACTICAL CONSIDERATIONS OF THE TECHNIQUE
Authors: WISE GORDON M. , OSBORN JONATHAN E. , ZWART PETER R.
Published: November 2007

Some theoretical limitations of photokeratoscopy associated with the quantification of keratograms are discussed.

Representative keratograms of normal and abnormal corneas are presented to illustrate the practical limitations of any mire imaging technique.
A HOSPITAL RENTAL SYSTEM FOR LOW VISION AIDS
Authors: SANDERSON G. F. , CUMMlNG A. E. , POLKINGHORNE P. J.
Published: November 2007

Costly low vision aids are rented to patients by the Otago Hospital Board Occupational therapists see the patients in the Low Vision Clinic and then as necessary in their homes As a consequence accurate follow‐up and analysis of the help provided by these aids is available Patients with senile macular degeneration use telescopic reading aids for an average of 27 months after they are prescribed
EFFICACY OF MICONAZOLE IN EXPERIMENTAL KERATOMYCOSIS
Authors: GUPTA S. K.
Published: November 2007

For the first time comparative efficacy of 1 % miconazole in ointment base and drops has been evaluated against Candida, Aspergillus and Fusarium organisms In experimental heratomycosis. The findings of the present study reveal that miconazole in ointment drug delivery system has the advantage of being more effective in healing the fungal ulcers and associated lesions. It requires much less frequent application than drops, a parameter of great importance in improving patient compliance. Miconazole ointment was well tolerated by the rabbit eye and produced no ocular or systemic toxicity. The present study confirms that miconazole is a broad‐spectrum antifungal agent and it could be a better alternative to presently available drugs to treat human heratomycosis.
MOLTENO TUBE IMPLANTS: LONG‐TERM RESULTS
Authors: WARD W. J. , COOPER R. L.
Published: November 2007

The Molteno implant is a well recognised method of treating end‐stage secondary glaucoma Several variations of the technique have been described in the literature, but few reports of long‐term studies have been published This paper reports the results of a series of patients followed for two to six years. Indications for the procedure and results are put forward
PREVENTING A HIGH RISE IN INTRAOCULAR PRESSURE AFTER LASER TRABECULOPLASTY
Authors: BROOKS ANNE M. V. , ELDER JAMES , MCNAB ALAN A. , McCOMBE MARK F. , MADHOK PRADEEP , GILLIES W. E.
Published: November 2007

The high rise in pressure which sometimes follows laser trabeculoplasty is a serious and sight‐threatening complication in patients with advanced glaucoma. In a previous study we found that patients undergoing laser trabeculoplasty were very unlikely to have a high rise in pressure if the initial pressure was less than 20 mmHg. In the present study a series of patients was given acetazolamide 500 mg immediately before laser trabeculoplasty if their pressures were greater than 20 mmHg. All patients were then monitored to see if this regime was effective in preventing a serious rise in intraocular pressure. Some of the patients with an initial pressure less than 20 mmHg still sustained a high rise in pressure after laser trabeculoplasty. A further series of patients was then given acetazolamide preoperatively and the postoperative rise in pressure was monitored two and 24 hours after trabeculoplasty. The acetazolamide prevented a high rise in pressure after laser trabeculoplasty in the majority of patients.
BETAXOLOL EYE DROPS AS A SAFE MEDICATION TO LOWER INTRAOCULAR PRESSURE
Authors: BROOKS ANNE M. V. , GILLIES W. E. , WEST ROBERT H.
Published: November 2007

Betaxolol, a cardioselective beta,‐adrenergic antagonist, was used in a clinical trial in nine patients with glaucoma and chronic obstructive airways disease to assess its patient acceptance, and its effect on intraocular pressure, respiratory function, corneal and tear function. Betaxolol was well tolerated by all patients with no adverse symptoms. It significantly lowered intraocular pressure (p = 0.03) with no significant change in respiratory function (forced expiratory volume in one second (FEV1), mean mid expiratory flow rate (MMEFR) and vital capacity). Although there was a tendency to decreased wetting with Schirmer 1, decreased breakup time and increased corneal staining with Rose Bengal, this was not statistically significant in this small series.

We confirmed the previously reported efficacy and safety of betaxolol in patients with glaucoma and airways disease with satisfactory patient acceptance.
BOOK REVIEWS
Authors: Hertzberg Reuben , Martin Frank J.
Published: November 2007

Book reviewed in this article:

POCKET ATLAS OF OPHTHALMOLOGY Fritz Hollwich..

DIAGNOSIS AND MANAGEMENT OF OCULAR MOTILITY DISORDERS Joyce Main and Brian Harcourt.
OCULOMOTOR NERVE PALSY IN CHILDHOOD
Authors: KEITH C. GREGORY
Published: November 2007

Oculomotor nerve palsy was found in 28 children. Trauma was the cause in seven, infection in six. while tumour, poison and migraine were each responsible for one case. Twelve cases were cryptogenic: eight of these were present at birth (but three were probably due to birth trauma), and four cases appeared in infancy, but with no cause found even on full neuroradiological investigation. Among these 12 cases the pupil was large in only three, normal in four and small in five. Cyclic spasms were not seen in this series. Among the five congenital cases associated abnormalities including spina bifida, Goldenhar's syndrome and developmental delay were found in four. Acquired palsy does not seem to have a sinister significance.
EFFICACY AND SAFETY OF HYPROMELLOSE IN OCULAR IMPLANT SURGERY
Authors: ROSEN P. A. , BROOKS A. M. V. , RAMSAY R. J. , GULLIFER K. P. , WOLFE R. J. B. , GILLIES W. E.
Published: November 2007

In order to assess the efficacy of hypromellose as a viscoelastic substance in cataract surgery with posterior chamber intraocular lens implantation, we studied a series of 88 cases who underwent surgery with either alternate use of a viscoelastic substance (hypromellose, 39 patients, or sodium hyaluronate, 5 patients) or air (44 patients) in the anterior chamber. Endothelial cell loss was least in the group in which air was used (18 ± 3% cell loss, mean ± SEM), compared with hypromellose (26 ± 3%) and sodium hyaluronate (28 ± 6%), but the difference in percentage cell loss between the groups did not reach statistical significance. Some operative difficulties were encountered in both groups. In both the air and hypromellose groups there were two patients with an early postoperative rise in intraocular pressure, but this was easily controlled, and in both groups there were two patients with postoperative corneal oedema which soon cleared. Viscoelastic substances used in this study were not shown to be superior to air in protecting the corneal endothelium. For this reason use of hypromellose should be confined to situations where its use is likely to confer some special advantage, as in the presence of a bound‐down pupil in patient's with chronic glaucoma or perhaps to facilitate “in the bag” implantation.
QUALITY CONTROL ISSUES IN MODERN CATARACT SURGERY
Authors: O'DAY DENIS M.
Published: November 2007

Modern extracapsular cataract surgery is considerably more complex than the previous intracapsular procedure Intraocular manipulations are required, and solutions and products must be introduced into the eye Due to the shift to ambulatory surgery, modern cataract surgery is also being performed in a difficult and more dangerous environment In these circumstances, sterility and product quality may be compromised when a lack of appropriate surveillance techniques leads to the use of defective products in surgery The modern cataract surgeon must, therefore, become knowledgeable about infect/on and quality control procedures In the operating room, and also about details of manufacture and industrial standards applicable to the products used in eye surgery
LAMININ‐LIKE IMMUNOREACTIVITY IN INDUCED NEW VESSELS IN KITTEN AND MOUSE EYES
Authors: GOLE GLEN A. , BELFORD DAVID A. , RUSH ROBERT A.
Published: November 2007

Laminin is a basement membrane glycoprotein, widely distributed in body tissues. It has been found on capillary basement membranes in both developing and adult retinal vessels. Oxygen‐induced retinopathy was produced in kittens and mice by exposing them to a high oxygen environment during the newborn period. When the animals developed a proliferative retinopathy after a period of survival in room air, they were sacrificed and the eyes enucleated and embedded in paraffin wax. Cross‐sections were cut and de‐waxed. After preliminary digestion with pepsin, we used a fluorescein isothiocyanate (FlTC)‐ labelled double antibody technique to identify laminin‐like immunoreactivity (LLlR). LLIR was found on both intravitreal and intraretinal new vessels in the kitten and mouse, indicating that it is probably secreted by endothelial cells during the formation of pathological new vessels.
ABNORMAL CORNEAS MEASURED BY A NEW PHOTOGRAMMETRIC TECHNIQUE
Authors: M. Wise GORDON , E. Osborn JONATHAN , R. Zwart PETER
Published: November 2007

The limitations of keratometry and photokeratoscopy are briefly discussed. A new photogrammetric technique of measuring corneal topography is described. Contours and cross‐sections of abnormal corneas are presented to illustrate the scope and application of the new technique.
REVERSIBLE CORNEAL ENDOTHELIAL CELL CHANGES IN DISEASES OF THE ANTERIOR SEGMENT
Authors: M. v. Brooks ANNE , Grant GLENYS , Gillies W. E.
Published: November 2007

We have demonstrated the reversibility of corneal endothelial changes which accompany superficial keratopathy (superficial punctate keratitis, exposure keratopathy, chemical keratopathy and keratocon‐juncitivits sicca). stromal keratitis and anterior uveitis (predominantly iridocyclitis). These changes include small subendothelial dark areas equal to or less than one cell in diameter and larger subendothelial dark areas up to two to four cells in diameter. These dark areas are similar but form two groups. The smaller ones may be due to oedema, some developing into larger dark areas, but it is also possible that smaller dark areas represent inflammatory cells or even local destruction of endothelial cells. The larger dark areas elevate the overlying endothelium. Either may be very numerous. They may be present together or separately. They become much less numerous and disappear with resolution or suppression of the acute keratitis or uveitis.

The relief mode of corneal specular microscopy was used to distinguish these dark areas from other inflammatory and degenerative changes (such as fine inflammatory deposits. larger keratic precipitates, pigment deposits and guttatae at the level of the corneal endothelium).
FIRST REPORT OF THE AUSTRALIAN CORNEAL GRAFT REGISTRY
Authors: Williams K. A. , Sawyer M. , Alfrich S. J. , Joseph L. , White M. , Coster D. J. , Mahmood M.
Published: November 2007

In the Australian Corneal Graft Registry's first 18 months of operation, May 1985 to November 1986, data supplied by 53 surgeons relating to 322 graft recipients have been entered and analysed with respect to: the most common presenting diseases (primarily keratoconus, bullous keratopathy and corneal opacities), risk factors (especially prior sensitisation to HLA antigens, corneal vascularisation, past or present anterior segment inflammation and history of raised intraocular pressure [IOP]), donor and recipient sex, cause of donor death, storage procedures for donor eyes, operative procedures accompanying the grafts themselves, and preliminary indications of overall graft survival by actuarial analysis.

It is hoped that the establishment of this Registry will not only reinforce the use of actuarial graft survival analysis as the method of choice for transplantation surgeons wishing to monitor the survival of their patients and grafts, but will also provide a useful service for the Australian ophthalmic community in general.
IDENTIFICATION OF FACTORS LIMITING THE ACTION OF THE HORIZONTAL RECTI MUSCLES A GUIDE TO THE AVOIDANCE OF GROSS LIMITATION OF ADDUCTION OR ABDUCTION AFTER SQUINT SURGERY
Authors: Glllles W.E. , Strang N. , Brooks A. M. v.
Published: November 2007

Limitation of the action of the medial rectus muscle will cause limitation of adduction of the eye just as limitation of the lateral rectus will cause limitation of abduction. factors limiting the action of the medial rectus are: (i) loss of ability of the muscle to contract beyond a certain proportion of its length; (ii) limitation of relaxation of the antagonist lateral rectus and fascia/ connections; (iii) innervational factors seen most obviously m Duane's syndrome, but also possibly active with various vertical anomalies; and (iv) loss of mechanical advantage or torque as the eye rotates inward. Using A scan the last factor may be assessed for a particular eye. There will be no loss of torque until the muscle passes a tangential point where its line of action is tangential to the globe, but torque will then be lost progressively until it becomes negligible as the null point is approached. At the null point the muscle has no torque, being perpendicular to the globe, and it marks the point where the oculomotor axis joining the centre of rotation of the eye and the apex of the orbit intersects the globe. The first three factors may be assessed clinically by measuring the adduction of the eye in degrees, and for 50 normal patients (100 eyes) the mean was 44°, standard deviation 3°. The tangential point for an average eye lies 54° behind the medial rectus muscle so for normal adduction there is no loss of torque in full adduction. The loss of torque for small recessions of the medial rectus is negligible, but for very large recessions it will be about 50% in full adduction and this is accompanied by a loss of gearing as the amount of contraction of the muscle to produce a similar rotation becomes less. Similar factors affect the action of the lateral rectus muscle, but underaction is less common probably due to the greater wrap‐around effect, stressing the importance of these geometric factors.
THE HUMAN PINEAL GLAND: A REVIEW OF THE “THIRD EYE”AND THE EFFECT OF LIGHT
Authors: M. Booth FRANCES
Published: November 2007

The human pineal gland is an extremely active neuroendocrine transducer Environmental light acts through the retina and entrains the pineal gland's circadian rhythms by way of the hypothalamus and sympathetic nervous system Light depresses pinealocyte activity

It is possible to do without the pineal, but this tiny gland is considered to be the “regulator of regulators” and important In general homeostasis. A direct retino‐hypothalamic pathway is probably involved, and a system of synchronising potentially independent oscillators is postulated
ACUTE MACULAR NEURORETINOPATHY
Authors: L. Ralt JULIAN , O'day JUSTIN
Published: November 2007

The presentation of bilateral incongruous paracentral scotomata in an otherwise well 27 year old woman was found to correspond to dark red‐brown, wedge‐shaped lesions surrounding the macula Like previously described cases of acute macular neuroretinopathy, these lesions seemed to be located in the superficial retina and appeared to be associated with oral contraceptive use and a recent history of viral illness

At follow‐up 8 months after presentation the scotomata were persistent and unchanged No treatment is known
MELANIN: BLACKGUARD OR RED HERRING? ANOTHER LOOK AT CHLOROQUINE RETINOPATHY
Authors: Banks C. NEVILLE
Published: November 2007

Of old when folk lay sick and sorely tried The doctors gave them physic, and they died. But here's a happier age: for now we know Both how to make men sick and keep them so.
SOLAR RETINOPATHY: ITS SIGNIFICANCE FOR THE AGEING EYE AND THE YOUNGER PSEUDOPHAKIC PATIENT
Authors: Hunyor A. B. L.
Published: November 2007

The sun is the main source of ultraviolet (UV). visible and infrared radiation reaching our atmosphere. The short wavelength components of the sun's spectrum have been shown to have deleterious effects on the retinal photoreceptors. These effects are photochemical and mostly not thermal in nature. Except in early life, most of the ultraviolet (300.400 nm) is effectively filtered out by the lens which in later life also filters out considerable proportions of shorter visible wavelengths to 450 nm.

The photochemical effects are mediated by the production of free radicals from the interaction of oxygen, photons and receptor molecules. These radicals attack, among others, polyunsaturated fatty acid components of cell membranes which may eventually degenerate.

Protective mechanisms within the receptors and the adjacent pigment epithelium may be overwhelmed in the presence of high retinal irradiances over prolonged periods of time–as may occur in aphakic and pseudophakic eyes. The cone system, with a much slower replacement rate of light‐sensitive membranes. is more likely to suffer permanent damage than the rod system, with predictable consequences.

The above considerations have special relevance in old patients because of their age‐compromised retinas, and in the younger patient who may be rendered aphakic or pseudophakic and faces a prolonged period of exposure to excessive UV irradiation as a consequence.

Protection for the retina, whether by sunglasses or UV‐absorbing intraocular lenses, as appropriate, is recommended.
VITRECTOMY TECHNIQUES IN THE TREATMENT OF GIANT RETINAL TEARS: A FLEXIBLE APPROACH
Authors: CAIRNS JAMES D. , FRACO WILLIAM G. CAMPBELL
Published: November 2007

We describe a flexible approach employing vitrectomy, scleral buckling and intraocular tamponading agents in the treatment of giant retinal tears. Intraocular gas without a buckle was used in the 10 least complicated cases. In five eyes we considered a scleral buckle to be necessary in addition to gas tamponade. Silicone oil was selected as the primary tamponading agent in the six most complex cases with PVR and in five re‐operations. The overall anatomical success rate was 71 % of which 73% had a final visual acuity of at least 6/60 and 60% achieved 6/18 or better.
A COMPARISON OF CORNEAL ENDOTHELIAL MORPHOLOGY IN CORNEA GUTTATA, FUCHS‘ DYSTROPHY AND BULLOUS KERATOPATHY
Authors: BROOKS ANNE M. V. , GRANT GLENYS , GILLIES W. E.
Published: November 2007

Changes on corneal endothelial specular microscopy were compared in 14 patients with cornea guttata, 4 patients with Fuchs' corneal dystrophy and 19 patients with various forms of bullous keratopathy. The patients with cornea guttata showed well marked guttae 1 to 6 endothelial cells in diameter in the endothelial mosaic and in the relief mode while the endothelial mosaic was usually otherwise within normal limits. In 2 patients with Fuchs' dystrophy the endothelium could be examined, showing gross guttae but a few areas of relatively normal endothelial cells. The unaffected eye of 3 other patients snowed findings similar to cornea guttata, but with some reduction in endothelial cell count in 2 patients. The patients with bullous keratopathy fell into 2 groups, one with gross reduction in cell count in a markedly abnormal endothelial cell mosaic, the other a mixed group with moderate reduction in cell count and numerous guttae. Some miscellaneous cases included one of aphakic peripheral bullous keratopathy, one associated with cyclitis and aphakia and 2 with idiopathic non‐surgical bullous keratopathy. We believe the corneal endothelium is not grossly abnormal away from the guttae in Fuchs' dystrophy, but the gross guttata formation determines the endothelial dysfunction.
THE PRESENTATION OF ACUTE GLAUCOMA IN PSEUDOEXFOLIATION OF THE LENS CAPSULE
Authors: GILLIES W. E. , BROOKS ANNE M. V.
Published: November 2007

Up to 25% of patients with pseudoexfoliation of the tens capsule (PXF) and glaucoma may present with an acute rise in intraocular pressure (IOP) but the majority of these are not due to angle closure glaucoma. A series of 139 cases with acute presentation of PXF is described; this comprised 86 cases of acute open angle PXF glaucoma (9 bilateral), 18 cases of acute angle closure glaucoma with PXF, 21 cases of neovascular glaucoma with PXF and 14 cases of absolute PXF glaucoma. Males suffered acute open‐angle PXF glaucoma and absolute PXF glaucoma significantly more frequently than females. The anterior chamber depth was 2.2 mm or less in all eyes having acute angle closure glaucoma with PXF but few cases with acute open‐angle PXF glaucoma had a shallow anterior chamber, this difference being highly statistically significant (P < 0.001). The response to medical treatment was poor in most cases, while surgical treatment was successful in lowering IOP in the majority of cases. Argon laser trabeculoplasty was less successful with a risk of late high rise in IOP.
PRIMARY EYELID MALIGNANT MELANOMA ASSOCIATED WITH PRIMARY CONJUNCTIVAL MALIGNANT MELANOMA
Authors: GIBLIN M. E. , SHIELDS C. L. , SHIELDS J. A. , EAGLE R. C.
Published: November 2007

Two patients presented with the unusual occurrence of isolated foci of malignant melanoma of the upper eyelid and ipsilateral inferior conjunctiva. Neither patient had clinical evidence of primary acquired conjunctival melanosis, but in one case there was histopathologic evidence of this condition. The clinical features, histopathologic findings, and possible significance of this unusual occurrence are discussed.
Supranuclear disorders of eye movement
Authors: Milder D. G. , Billson F. A.
Published: November 2007

Eye movements are the result of activity in discrete systems. Saccades and smooth pursuit movements respond to target position and target velocity respectively. Compensatory responses to movements that alter the position of the eyes in space depend upon the vestibular and optokinetic systems. Vergence movements allow fusion and binocular vision.

Eye movement abnormalities of supranuclear origin may be divided into nystagmus, other ocular oscillations, saccadic dysfunction, smooth pursuit dysfunction, gaze palsy, tonic deviation, and vergence disability.

An algorithm for the analysis of supranuclear eye movement disorders is presented.
Surgical management of oculomotor nerve palsy with lateral rectus transplantation to the medial side of globe.
Authors: FRACO J. Norton Taylor
Published: November 2007

An operation for complete third nerve paralysis involving lateral rectus muscle transplantation to the medial side of the globe as a basic procedure is described. An inferior rectus muscle recession plus resection of an apparent completely paralysed medial rectus was subsequently performed at a second stage operation. The results appeared to be an improvement on previous surgery, particularly in terms of ocular motility, with almost full adduction of the operated eye being achieved. This adduction movement occurred as part of a normal conjugate movement of the two eyes, and the question arises as to the responsible muscles, with some evidence to suggest that relearned action of the transplanted lateral rectus muscle may be implicated. Finally, a Fasanella‐Servat procedure as a third stage operation appeared to be adequate to correct the ptosis.
Spontaneous resolution of primary congenital glaucoma
Authors: FRACO Patrick Lockie , FRACO James Elder
Published: November 2007

We report a further four cases of spontaneously resolved primary congenital glaucoma, including one case seen bath prior and subsequent to the resolution. This condition is detected usually in eyes with megalocornea, which are later found to have breaks in Descemets membrane. Two other patients also had this diagnosis made, but later developed active glaucoma, requiring surgical treatment, indicating the need for continued observation of apparently abortive forms of congenital glaucoma.
The clinical grading of lens opacities
Authors: Taylor Hugh R. , West Sheila K.
Published: November 2007

A simple system has been developed for the clinical grading of the presence and severity of lens opacities. The densities of nuclear opacities as seen on clinical slit‐lamp examination are graded in comparison with a set of standard photographs. The extent of cortical opacities seen on retroillumination is estimated in terms of segments involved. The dimensions of posterior subcapsular opacities are measured using the slit beam. Inter‐and intra‐observer trials were conducted with three observers. Twenty subjects were selected to provide a range of lens opacities. Weighted Kappa statistics for intraobserver agreement for these three types of opacities range between 0.58 and 1.00 and for intraobserver agreement between 0.41 and 0.71. This clinical grading system shows good reproducibility and compares well with the grading of lens opacities in photographs. It should prove to be of considerable use in clinical and epidemiological studies of cataract.
A clinical evaluation of equipment which allows the partially sighted and blind to access computer–based information
Authors: Boulton Lesley M.
Published: November 2007

Twenty‐five visually handicapped people, including two who were completely blind, were trialled on recently developed equipment which enables such severely visually impaired people access to the modern computerised world. Twenty‐one of the people found that such equipment would enhance their study, work and recreational capabilities and allow them to utilise computerised technology alongside their normally sighted peers. Two already had equipment sufficient for their needs, and two children were too young to require it at this stage.
Atypical mycobacterial keratitis
Authors: McClellan Kathleen A. , Bernard Penelope J. , Robinson Lyon P. , Meades Kerrie V. , Aylward G. William , Billson Frank A.
Published: November 2007

A case of marginal corneal abscess and hypopyon due to Mycobacterium chelonae is presented. Its therapy is described, followed by a brief discussion of atypical mycobacterial keratitis.
Sjögren's syndrome beyond the eye
Authors: Preston Sally J. L. , Arnold Mark H. , Buchanan W. Watson
Published: November 2007

Sjögren's syndrome is a common systemic disease with major clinical manifestations in the eye, mouth and musculoskeletal system. The major clinical presentations of Sjögren's syndrome are reviewed with emphasis on diagnostic criteria, laboratory features, complications and treatment.
Early and late botulinum toxin treatment of acute sixth nerve palsy
Authors: Murray A. D. N.
Published: November 2007

Ten patients with sixth nerve palsy were treated with botulinum toxin injection to the antagonist nonparetic medial rectus. All patients were followed for a minimum of 14 months after the last injection. Six patients were treated within eight weeks of the onset of the palsy. Within a few days five of the six gained fusion, without the necessity of a marked head turn and none complained of confusing reversal of diplopia. The same five recovered full function. Four patients with no medial rectus contracture on forced duction testing were treated six months or longer after the onset of the palsy and none recovered full function. One of the four patients was permanently over‐corrected despite persistent weakness of the lateral rectus.

This preliminary report suggests that early botulinum toxin injection of patients with recent onset (acute) sixth nerve palsy is beneficial. Since some patients may recover spontaneously a randomised double‐blind study is necessary to more precisely determine the effectiveness of this form of therapy. Botulinum toxin does not appear to be effective in facilitating recovery in those cases with poor lateral rectus function six months or longer after the onset of the palsy, even when there is no contracture of the medial rectus.
Vertical offsets of horizontal recti muscles in the management of A and V pattern strabismus
Authors: Scott William E. , Drummond Garry T. , Keech Ronald V.
Published: November 2007

Vertical transposition of the horizontal rectus muscles is the preferred operation in cases of A and V pattern strabismus in which oblique muscle dysfunction is inadequate to merit oblique surgery. Fifty‐nine patients undergoing standard horizontal surgery with half tendon width vertical offsets and eight patients undergoing two‐thirds to full tendon width offsets were retrospectively studied. Technique for pattern measurement and surgery are discussed. Postoperative data were analysed on a short‐term (less than six weeks) and long‐term (greater than 12 months) basis. Standard horizontal surgery combined with half‐tendon width vertical transposition is shown to be an effective operation for collapsing all subgroups of A and V pattern strabismus when indications are appropriate. The initial correction to within ± 10 D of pattern was 96% over all with 78% remaining collapsed to within ± 10 D over an average 36‐month follow‐up:

Recess‐resect, bimedial and bilateral rectus recession operations with offsets are all approximately equally effective in pattern collapse. A graded pattern collapse response was found with greater collapse being related to greater initial pattern. The risk of conversion, from a more desirable pattern (AET, VXT) to a less desirable pattern (AXT, VET) is low (7.3%). For patterns >30 D, three quarters to full‐tendon width offsets were effective in collapsing pattern. For A and V patterns with significant oblique muscle dysfunction, oblique surgery is advocated.
External trabeculotomy in the surgical treatment of congenital glaucoma
Authors: Martin Bruce B.
Published: November 2007

Recent advances in ophthalmic microsurgical instrumentation and techniques make ab‐externo trabeculotomy a more attractive alternative to goniotomy in the treatment of congenital glaucoma than was the case in the past. A series of seven consecutive cases (14 eyes) treated by trabeculotomy is presented, with the results of follow‐up over a period of two to seven years.

This, and other series, suggests that control of developmental glaucoma may be achieved utilizing fewer procedures when trabeculotomy is employed rather than goniotomy.
Vogt‐Koyanagi‐Harada syndrome—isolation of cloned T cells with specificity for melanocytes and melanoma cells
Authors: McClellan K. A. , MacDonald M. , Hersey P. , Billson F. A.
Published: November 2007

Abstract

The pathogenesis of Vogt‐Koyanagi‐Harada syndrome is poorly understood. A unifying mechanism for its diverse clinical manifestations affecting central nervous system, eye, integument and auditory system has not been found, although many authors have suggested that the features of the disease are the result of autoimmune responses.

We performed immunological studies on two patients with Vogt‐Koyanagi‐Harada syndrome. In one case antibodies to melanoma cells in cytotoxic assay were detected, which it was thought may indicate the presence of antibodies to melanocytes. In the second patient three clones of interieukin‐2‐dependent T cells were isolated which appeared to have specificity in both cytotoxic and proliferative assays to cultured normal melanocytes and to three allogeneic melanoma cells.

These findings further support a role for autoimmunity to pigmented cells in the pathogenesis of Vogt‐Koyanagi‐Harada syndrome. However, the precise role of autoimmunity in this disease is yet to be established.
Inter‐observer comparisons of ophthalmoscopic assessment of diabetic retinopathy
Authors: FRCS R. T. Lienert
Published: November 2007

Abstract

Five hundred patients attending a general diabetic clinic were examined ophthalmoscopically both by a non‐ophthalmic practitioner (NOP) and by an ophthalmologist. The findings were recorded on separate data sheets and the staging of diabetic retinopathy (DR) and grading of diabetic maculopathy by the NOP is compared with that of the ophthalmologist.

Comparisons are made for NOPs collectively and for subgroups of NOPs of different levels of experience in ophthalmoscopic assessment of DR. A profile is presented of DR occurring in this diabetic clinic population. The comparison studies show significant variations in ability of different observer groups and also between observers of the same status. It is concluded that an ophthalmologist is a necessary member of a diabetic care team.
Assessment of the corneal endothelium following keratoplasty
Authors: MD Anne M. V. Brooks , AAIPP Glenys Grant , ERACO W. E. Gillies
Published: November 2007

Abstract

The corneal endothelium was assessed following penetrating keratoplasty in a series of 50 patients and eight illustrative cases are described. Assessment disclosed a wide variation in the endothelial cell count and morphology following keratoplasty. In some patients the endothelial cell count was so low and the morphology so abnormal that long‐term survival of the graft was doubtful. In cases with such a low count it is very doubtful, whether the graft will survive a secondary procedure such as cataract extraction or, intraocular lens implantation. Some donor material may carry corneal guttae and the use of such material should be avoided. If the material is good it will withstand inflammatory episodes including graft rejection if treatment is prompt and appropriate. Satisfactory material may be obtained from elderly donors while a young donor does not guarantee suitable material. It is desirable to assess the corneal endothelium of donor material carefully before use.
‘Hot’ corneal grafts—a long‐term study
Authors: BS G. C. Lam MB , FRACO R. L. Cooper
Published: November 2007

Abstract

A six‐year follow‐up of nine of 13 eyes treated by therapeutic keratoplasty for suppurative keratitis is described. One of the thirteen cases died three years after surgery‐and three were lost to follow‐up. Two of the nine refused reoperation after early graft failure. Of the remaining seven, three had retained good functional visual acuity. Three of the penetrating keratoplasties required regrafting two to four years later, when conditions were less critical. Long‐term results indicate that therapeutic keratoplasty may be an alternative modality for the management of suppurative keratitis with satisfactory long‐term optical results.
Risk factors in progression beyond stage 2 retinopathy of prematurity
Authors: Todd David , Kennedy John , Roberts Victor , John Elizabeth
Published: November 2007

Of the 96 babies born at less than 30 weeks gestation at Westmead Hospital between January 1986 and December 1987,91 were studied. Of these 37 developed some form of retinopathy of prematurity (ROP), with eight babies having stage 3 or worse. We compared the clinical features of these eight babies to a control group of eight babies with stage 2 ROP, having matched for gestational age.

Factors of statistical significance in progression beyond stage 2 were male sex and number of days of assisted ventilation. The presence of a patent ductus arteriosus, although not statistically significant, is a factor which we consider to be clinically important. The development of Plus disease is associated with a poor prognosis.
The conservative management of choroidal melanoma
Authors: Billson Frank A. , Painter Geoffrey , Dunlop Iain , Thomas Ravi , Aylward G. William
Published: November 2007

The results of 32 choroidal melanomas managed by observation, Iodine‐125 scleral plaques and local surgical excision are presented. Initially, 12 patients were managed by observation, and of these three continued to be managed by observation alone. Fifteen patients were managed with Iodine‐125 scleral plaques and followed for an average of 15 months. The tumour regressed in 11, remained the same in three, and recurred in one case. The final visual acuity remained within two Snellen lines of that recorded preoperatively in 10 patients.

Fourteen patients underwent local excision with an average follow‐up of 31 months. These cases, in general, had larger tumours. The final visual acuity was within two Snellen lines of the pre‐operative vision in four patients. Five eyes required enucleation at a later date. Four of the five enucle‐ations occurred earlier in the series.

The management of choroidal melanoma remains controversial. Various methods of conservative treatment are described and the indications for conservative management by observation, scleral plaque and local èxcision are discussed.
Surgery for pre‐macular fibrosis
Authors: Muralidhar N. S. , Playfair T. J. , Gregory‐Roberts J. C.
Published: November 2007

We review 12 consecutive cases of pre‐macular fibrosis (PMF) treated by vitreous surgical techniques. The causes of PMF included retinal detachment surgery in four patients, idiopathic in three patients, laser treatment in three patients, pars planitis in one patient and diabetic retinopathy in one patient. The membrane was successfully removed in all the patients. One patient developed a retinal detachment that was repaired successfully. All patients had improved visual acuity (VA) of two Snellen lines or more and six patients achieved VA of 6/12 or better. Patients with PMF following retinal detachment had poorer final VA.
Removal of a dislocated hypermature lens from the posterior vitreous
Authors: Haymet B. T.
Published: November 2007

Sodium hyaluronate can be used to manipulate a hypermature dislocated cataract from the posterior pole of the eye and stabilise it in the retropupillary area prior to its removal, intact, through a lirnbal incision.
The use of spectacles in the treatment of congenital esotropia and amblyopia — a financial hazard
Authors: Bremner M. H.
Published: November 2007

Congenital esotropia and amblyopia are treated during the ‘sensitive period’ of brain‐eye development. Not all children require spectacles for treatment of these conditions but when refractive errors are present, correct and properly fitting spectacles play an important part.

This prospective survey shows that one‐third of the under three‐year‐old children wearing spectacles require surgery for esotropia, and that one‐third of all children under eight years of age wearing spectacles need amblyopia treatment.

It is uninterrupted treatment in these age groups that produce results. Approximately 50% of children wearing spectacles in the four‐year‐old and under group need a second or third pair of spectacles within a 12‐month period. If these spectacles become unsuitable because of dense scratches, changed refraction or poor fit because of increasing P D, then the treatment is interrupted and the visual acuity is likely to regress.

Many families cannot afford a second or third pair of spectacles within the 12‐month period and hospital benefit funds often will not help. The treatment is interrupted. This financial hazard must be overcome.
Subretinal fluid in the diagnosis of posterior scleritis
Authors: Tewari H. K. , Sihota R. , Azad R. V. , Gupta K. K. , Khosla P. K.
Published: November 2007

The etiology of subretinal mass lesions is very difficult to establish. A 28‐year‐old man presented to us with an area of choroiditis, which progressed, despite corticosteroid and antibiotic therapy, to an exudative retinal detachment, secondary glaucoma and a painful blind eye. To develop a means of identifying the cause of such lesions, we did a subretinal fluid tap prior to enucleation. Cytopathology showed only inflammatory cells and the final histopathological diagnosis was that of a granulomatous scleritis.
Treatment of pterygia in Queensland
Authors: Sebban Allan , Hirst Lawrence W.
Published: November 2007

All practising ophthalmologists in Queensland completed a written survey on their current methods of treatment of pterygia. The indications for surgical removal, in decreasing order of importance, were mainly size, symptomatic complaints, cosmetic appearance and activity. Most surgeons graded pterygia into a variety of classifications. The most common form of treatment for primary pterygia was simple excision plus mobilisation of conjunctiva and suturing conjunctival free edges together followed by bare sclera technique, and simple excision plus thiotepa drops. For recurrent pterygia simple excision plus beta‐irradiation was the most common form of treatment, followed by simple excision plus thiotepa drops and simple excision plus mobilisation of conjunctiva and suturing conjunctival free edges together. A third of the ophthalmologists electively avoid cautery use during pterygium surgery, while almost a quarter of the ophthalmologists attempt to polish the corneal and limbal region. When beta‐radiation or Thiotepa is used there is a general consensus on the dosage for each of these. Seventeen per cent of ophthalmologists said they had not encountered any complications after pterygium surgery with the remainder quoting corneoscleral necrosis from beta‐radiation and Tenon's granuloma as the most common complications. It would appear that there is no consensus on the best way to treat pterygia in Queensland, which probably reflects the lack of scientific proof for one method being superior to another.
Ocular surface and lacrimal disturbances in chronic graft‐versus‐host disease: the role of conjunctival biopsy
Authors: West Robert H. , Szer Jeffrey , Pedersen John S.
Published: November 2007

Forty‐four patients (21 male, 23 female) were studied following bone marrow transplantation (BMT): 40 after allogeneic, one after syngeneic and three after autologous transplantation. Diffuse punctate conjunctival and corneal epitheliopathy was seen in 27 (61%), reduced or disordered tear film in 26 (59%), acquired lacrimal outflow obstruction in three (7%) and posterior subcapsular lens opacities in five (12%) patients. Conjunctival histology showed abnormal features, including those of graft‐versus‐host disease (GVHD) in 41 patients. Of these, 28 (64%) had clinical and laboratory features of GVHD and six patients with no systemic evidence of GVHD had conjunctival histology specific for GVHD.

We conclude that after BMT, subclinical changes of GVHD are very common in the periocular tissues and may be universal in long‐term survivors following allogeneic BMT. Some minor conjunctival changes are more likely to be due to the primary disease or the transplant conditioning regimen. Conjunctival biopsy is useful in demonstrating low‐grade GVHD or GVHD confined to the ocular structures and may be diagnostic in some cases.
Prediction of response to treatment in patients with scleritis using a standardised scoring system
Authors: McCluskey Peter , Wakefield Denis
Published: November 2007

Scleritis is a severe chronic inflammation of the eye wall. High‐dose corticosteroids and other immunosuppressive drugs are often required to control the inflammatory process. With the development of new and potentially more effective treatment modalities for scleritis has emerged the need for an accurate and reproducible system for quantifying the severity of scleritis and evaluating the response of individual patients to treatment.

We have developed a quantitative scoring system, based on common clinical signs of scleritis, and evaluated it in 24 patients with scleritis. Our results indicate that this system is simple, rapid, reproducible and useful in grading the severity of scleritis and in predicting the response of patients to systemic immunosuppressive therapy.
Vitelliform dystrophy: long‐term observations on New Zealand pedigrees
Authors: Clemett Richard
Published: November 2007

Long‐term observations on 29 patients from four pedigrees with vitelliform dystrophy (Best's disease) are described. The majority of patients were examined at yearly intervals and had a mean follow‐up of 7.4 years. For analysis, eyes were staged according to Mohler and Fine's classification. Although vitelliform dystrophy exhibited considerable polymorphism in the study group 'recognisable stages', such as egg‐yolk cysts, scrambled cysts or pseudohypopyon, were present in 48% of eyes at the initial examination. Egg‐yolk cysts and pseudohypopyons were found to be the most evanescent of stages lasting on average 2.0 and 2.4 years respectively. Evolution of lesions did not necessarily follow a regular progression through the later stages of the vitelliform classification. Several unusual features such as recurrent pseudohypopyon, apparent regeneration of retinal pigment epithelium, exudative retinal detachments and development of stellate pigment figures were observed during the study. The majority of patients retained 6/12 or better visual acuity until the fourth decade when vision deteriorated. Correlations between changes in visual acuity and staging of the fundal lesions were made. Similarities between the group of patients reported, and a comparative group from overseas1 have been discussed.
Congenital rubella infection from reinfection of previously immunised mothers
Authors: Keith C. Gregory
Published: November 2007

Two children developed congenital rubella infection when their mothers had been proven to be satisfactorily immunised against rubella before the affected pregnancy. One child was severely affected with heart lesions, brain damage, severe deafness, physical retardation, cataracts and rubella retinopathy. The other child had moderately severe sensorineural deafness and a mild reduction in visual acuity due to rubella retinopathy.
A case of progressive hemifacial atrophy with uveitis and retinal vasculitis
Authors: Ong Keith , Billson F. A. , Pathirana D. S. J. , Clifton‐Bligh P.
Published: November 2007

Parry Romberg syndrome is a rare disorder characterised by progressive hemifacial atrophy that is usually unilateral, involving the skin, subcutaneous tissue, and subsequently the muscle, cartilage and bone. Previous cases with various ocular manifestations have been reported. A case of Parry Romberg syndrome with retinal vasculitis is reported.