bluuebunny/crossref_metadata_2025 huggingface dataset:
A CASE OF CONGENITAL ECTROPION IN DOWN'S SYNDROME
Authors: MILLER ROSS , MARTIN FRANK , ALLEN HUGH
Published: November 2007

A rare case of primary congenital ectropion of all 4 eyelids in a child with Down's syndrome is reported to emphasise the problems of surgical management and to distinguish the condition from congenital eversion of the eyelids. Congenital ectropion is associated with other eyelid abnormalities and usually requires surgical measures to protect the cornea in contrast to congenital eversion which is characterised by the protrusion of oedematous conjunctiva from everted eyelids. This usually resolves spontaneously with simple supportive measures and no structural or functional eyelid abnormality remains.
Betaxolol
Authors: FRACO Ivan Goldberg
Published: November 2007

Drugs classified as beta‐blockers have proved to be valuable in the treatment of patients with glaucoma. Timolol has become the most widely used ocular hypotensive agent. Actual and potential side effects associated with its non‐selective beta‐blockade have prevented its use in patients with reactive airways disease, and to a lesser extent, with various cardiovascular conditions. Betaxolol is a relatively selective beta‐1 blocker which in most patients is almost as effective as timolol in lowering intraocular pressure, and may be partly additive with dipivefrin. It is probably safer in patients unable to tolerate non‐selective beta‐blockers. However, it needs to be used with caution in these patients, who are unpredictably susceptible to systemic side effects.
Bilateral internuclear ophthalmoplegia—an unusual initial presenting sign of giant cell arteritis
Authors: Crompton John L. , Burrow Donald J. , Iyer Prema V.
Published: November 2007

A 63‐year‐old man presented six days after the sudden onset of horizontal double vision. His left eye became divergent two days later. On initial examination he had bilateral internuclear ophthalmoplegia with weakness of adduction and abducting nystagmus. Convergence was weak but there were no other neuro‐ophthalmic signs. Constitutional signs included confusion and unsteadiness on his feet. A provisional diagnosis of arteritis was made. His ESR was 92 mm/h and a superficial temporal artery biopsy confirmed the diagnosis of giant cell arteritis. After two weeks or oral prednisolone his eye movements returned to normal. There have been no further relapses.

This would appear to be a unique presentation of giant cell arteritis. The causes of internuclear ophthalmoplegia are discussed along with a review of the ocular and neuro‐ophthalmic signs of giant cell arteritis.
Tinted lenses and dyslexics—a controlled study
Authors: SPELD S.A.
Published: November 2007

We have carried out a randomised prospective controlled trial of the effect of tinted lenses on the reading ability of 24 non‐asthmatic dyslexic children aged between nine and twelve years. Reading ability was assessed using the Neale Analysis of Reading. After one school term, there was no significant difference in the change in reading age between treatment and control groups. After two school terms (approximately six months), only 11 children (44%) were still wearing the glasses. Of 381 suitable subjects for entry into the study, 208 were excluded because of a diagnosis of asthma (to avoid effects of medication on cerebral function). As a result, we may have excluded subjects who would have responded favourably to tinted lenses.
A new panfunduscopic lens: a + 9OD‐GOLDMANN fundus lens combination
Authors: Leung Kam W.
Published: November 2007

A new panfunduscopic lens is made by combining a +90 D lens and Goldmann contact fundus lens. The optics involved is explained.
Posterior chamber intraocular lens dislocations and malpositions
Authors: Obstbaum Stephen A. , To King
Published: November 2007

Decentration and malposition of posterior chamber intraocular lenses (PC IOL) accounts for one of the remaining and unresolved conditions associated with the implantation of these lenses. This condition assumes importance Since in approximately 50% of cases where a PC IOL is removed there is an aspect of improper positioning. The common types of malpositions are: pupil capture; sunset syndrome; sunrise syndrome; horizontal decentration; and the windshield wiper syndrome. This paper will explore the causes and management of these conditions and discuss the virtues of capsular bag implantation.
Topical antibiotic prophylaxis for cataract surgery: a controlled trial of fusidic acid and chloramphenicol
Authors: MB I. W. Dallison , Simpson A. J. , ANZIMLT J. I. Keenan , Clemett R. S. , Allardyce R. A.
Published: November 2007

The effectiveness of topical fusidic acid 1%, in a viscous drop base, to reduce or eliminate ocular microflora in patients undergoing cataract surgery has been studied. Forty‐two patients received fusidic acid on a double‐blind basis and for comparison 21 patients were similarly assessed with topical chloramphenicol. A further 17 patients received no treatment other than subconjunctival cephazolin administered to all operated eyes at the time of surgery. Quantitative bacterial counts from the conjunctivae and lash lines of each patient were made 24 hours before surgery, on the morning of operation and again 48 hours after surgery. With a regimen of five administrations on the day prior to surgery, neither topical fusidic acid 1.0% nor chloramphenicol 0.5% produced clinically or statistically significant reductions of the ocular microflora. In contrast perioperative subconjunctival cephazolin effectively reduced or eliminated lid and conjunctival microflora following surgery. This study indicates that the effectiveness of a topical antibiotic preparation for overt ocular infection cannot be directly extrapolated to the effect on resident ocular microflora, at least with short‐term use for presurgical prophylaxis.
The significance of reactions to betaxolol reported by patients
Authors: Brooks Anne M. V. , Burdon J. G. W. , Gillies W. E.
Published: November 2007

Abstract

Some patients may experience respiratory side effects on betaxolol in spite of the greater safety which is claimed for this ocular hypotensive drug compared with timolol. Six of 29 patients using betaxolol complained of wheeze or respiratory distress and five of these patients were rechallenged with betaxolol and a placebo in a double‐masked clinical study, respiratory function being measured before and after each medication according to the American Thoracic Society guidelines. No patient showed any change in respiratory function either with betaxolol or the placebo. The findings further support the safety of betaxolol even in patients with respiratory disease, though some caution should be observed.
Metastatic breast carcinoma of the orbit
Authors: Jacobs Mark , Benger Ross
Published: November 2007

Abstract

Two Caucasian females in whom an orbital mass was the first sign of metastasis from a breast carcinoma are described. Each subject had undergone a radical mastectomy to treat a primary breast carcinoma, one six years and the other eight years previously. Each presented with ipsilateral proptosis, and restricted upper eyelid action; one had altered ocular motility. In each subject an open biopsy of the orbital mass via an eyelid crease incision revealed metastatic scirrhous adenocarcinoma of the breast. The clinical features, investigations, and treatment of orbital metastases from breast carcinoma are discussed.
Outpatient penetrating keratoplasty
Authors: Collie Donald M.
Published: November 2007

Abstract

Elective penetrating keratoplasty has been performed on an outpatient basis on 37 patients since July 1987. The commonest indications have been herpetic keratitis, keratoconus, and pseudophakic or aphakic corneal oedema. Local anaesthesia, with little or no sedation, was used in most cases, and only three patients had a general anaesthetic. Accompanying procedures have included anterior vitrectomy, extracapsular cataract extraction with posterior chamber lens implantation and IOL exchange. The results demonstrate that outpatient keratoplasty is a safe, effective alternative to hospitalisation, and has a very high level of patient acceptance.
High‐dose intravitreal gancyclovir for cytomegaloviral (CMV) retinitis
Authors: Heery Steve , Hollows Fred
Published: November 2007

Abstract

A patient with acquired immune deficiency syndrome (AIDS) with bilateral cytomegaloviral (CMV) retinitis who had become neutropaenic from intravenous gancyclovir, was treated with a total of 16 intravitreal 2 mg/0.l ml doses of gancyclovir in each eye under topical anaesthesia. The injections were well tolerated with no evidence of retinal toxicity. A moderate vitreous haze which did not affect vision was the only complication. The patient retained useful vision until the time of his death, three months later.
Advances in the management of diabetes mellitus
Authors: White Christopher P. , Hooper Michael J.
Published: November 2007

This article shall highlight several areas where recent developments have made, and may make in the future, practical advances to diabetes care. These advances have been in the areas of insulin therapy, glucose monitoring, identifying pre‐diabetics and using immunosuppressive agents in pre‐diabetes and early diabetes, pancreatic transplantation, and managing acute and chronic complications of diabetes.
Sunglasses: are they necessary in Christchurch?
Authors: Borthwick J. H. , Clemett R. S.
Published: November 2007

Concern over potential eye injury from sunlight prompted this study to see if the levels of sunlight in Christchurch posed a particular risk to our population's eyes, whether the populace was aware of any risk and whether effective sunglasses were freely available to the public. While there has been a 4% to 9% increase in UV radiation since 1969 due to global ozone depletion, no firm evidence was found that focal ozone depletion was a particular problem in New Zealand. Christchurch residents were poorly informed about the ocular hazards of sunlight. A questionnaire completed by 200 adults disclosed 32% were unaware of the particular danger of UV light and only 3% knew that snow blindness, eclipse burns and cataracts could all be caused by sunlight. Fifty‐four sunglasses were analysed for labelling and for transmission characteristics of their lenses. The standard of labelling of the sunglasses was poor with only 53% making reference to UV transmission characteristics and only three pairs stating that they adhered to the New Zealand Sunglass Standard. Attention is drawn to the need to improve public awareness of the potential for eye injury from sunlight and to improve the standard of labelling of sunglasses.
Behset's syndrome: ocular features in an Australian population
Authors: Wakefield D. , McCluskey P.
Published: November 2007

Inflammatory eye disease (IED) is often the most severe manifestation of Behçet's syndrome (BS). This disease is a common cause of uveitis in Mediterranean countries, the Middle East and Japan. In order to ascertain the prevalence of this disease in Australia, we reviewed the aetiology of patients attending our uveitis clinic over a five‐year period. Twelve of 426 patients with inflammatory eye disease had definite Behcet's syndrome. Four patients had anterior uveitis, four had posterior uveitis, four had retinal vasculitis and one also had optic neuritis. Although inflammatory eye disease was the initial clinical feature of Behcet's syndrome in only three of our patients, it was the feature that led to a definite diagnosis in all but one patient. The inflammatory eye disease of Behçet's syndrome was characteristically recurrent and severe with significantly decreased vision in 10 eyes, cataracts in six eyes, macula oedema in four eyes and glaucoma in two eyes.

We conclude that Behçet's syndrome is a rare cause of inflammatory eye disease in Australia and is unlikely to be recognised as a distinct clinical entity prior to the onset of ocular involvement. The visual prognosis of ocular inflammation in Behçet's syndrome remains guarded despite the use of a variety of immunosuppressive agents.
Cyclosporin therapy in Vogt Koyanagi Harada disease
Authors: Wakefield Denis , McCluskey Peter , Reece Graeme
Published: November 2007

Vogt Koyanagi Harada Disease (VKHD) is a rare cause of uveitis and has not been previously reported in the Australian literature. The natural history of this severe inflammatory eye disease may be modified by the early use of high‐dose immunosuppressive therapy, especially oral corticosteroids. We report three cases of VKHD who either failed to respond to high‐dose corticosteroid (oral and intravenous) therapy alone or developed significant side effects, one of whom subsequently showed a beneficial response and another a transient beneficial response to cyclosporin therapy. Disease relapse or exacerbation of uveitis was the major problem encountered on attempted cyclosporin withdrawal. Further research is needed to define the optimum timing and indications for cyclosporin therapy in patients with VKHD.
Clinical features and surgical management of dermolipomas
Authors: McNab Alan A. , Wright John E , Caswell Anthony G.
Published: November 2007

Dermolipomas are solid choristomas which present as a lateral canthal mass. A series of 35 cases is reported, 27 of whom were female. Six patients had features of Goldenhar's syndrome. Proximity of the dermolipoma to the lacrimal ductules, the lateral rectus and upper lid structures makes extensive surgical excision dangerous. A microsurgical technique of partial excision of the lesion is described and was used successfully in 13 cases without significant complications.
Ophthalmic manifestations of perineural spread of facial skin malignancy
Authors: Smith Jeremy B. , Bishop Virginia L. M. , Francis Ian C. , Kos Sue , Kneale Ken A.
Published: November 2007

Facial skin malignancy, when complicated by perineural spread (PNS), can lead to devastating orbital, intracranial and paranasal sinus involvement, the management of which requires a multidiscipli‐nary approach and which itself may be devastating. Adequate surgical excision with frozen section control, and specific inspection of histological specimens for perineural invasion, are essential to avoid this problem. This report presents four patients who manifested such involvement, and emphasises the importance of recognition of such ominous symptoms as facial pain, paraesthesiae and weakness. Thorough neuro‐ophthalmic examination is mandatory to detect signs of nerve involvement which may indicate perineural spread both at the initial assessment of primary tumour and at suspected recurrence. In this series, the most common sensory and motor nerves affected were, respectively, single, small branches of the ophthalmic and facial nerves.
Monoclonal antibody to ICAM‐1 prolongs murine heterotopic corneal allograft survival
Authors: BS Robyn H. Guymer MB , BS T. E. Mandel MB
Published: November 2007

Graft rejection requires an initial interaction between donor antigen presenting cells (ARC) and recipient T cells; an interaction known to involve a variety of cell surface molecules. We have been investigating an interaction involving two of these molecules: lymphocyte function associated antigen‐1 (LFA‐1) on the T cell and its ligand, intercellular adhesion molecule‐1 (ICAM‐1) on the APC, in an effort to assess the effect its interruption would have on the ability of the recipient to reject an allograft. A monoclonal antibody (MAb) against ICAM‐1 was given peritransplant to mice with heterotopically grafted corneas. Mice were killed at various time points and the grafts taken for histological assessment of rejection. Mice treated with Mab have a delayed influx of cells into the graft site and marginally better graft viability to day 50 after transplantation compared to controls. These results suggest that it is possible to decrease rejection even with brief peritransplant treatment. This provides encouragement for further experiments using more extensive therapy.
Septic cavernous sinus thrombosis — A case report
Authors: Mackintosh Heather T.
Published: November 2007

This paper reports a case of septic cavernous sinus thrombosis following a chronic ear infection and paranasal sinusitis. The diagnosis and management of this condition are discussed.
Reducing corneal toxicity of 5‐fluorouracil in the early postoperative period following glaucoma filtering surgery
Authors: Loane Mark E. , Weinreb Robert N.
Published: November 2007

To gain a better understanding of the relationship between postoperative 5‐fluorouracil administration and corneal complications associated with its use, we analysed 43 consecutive filtering procedures in which it had been employed. Nine of the 43 eyes had corneal complications during that period. At the end of the three‐month period, these corneal complications had all resolved. There was no correlation between postoperative intraocular pressure lowering and incidence of corneal complications. A low dose of 5‐flourouracil, and early recognition and treatment of corneal toxicity associated with its use may reduce corneal complications while maintaining filtration in eyes with poor surgical prognosis.
Enlisting the eccentric photoscreener in a public hospital eye department
Authors: ChB James Stewart MB , Gross Keith , Hare Fiona , Murphy Chris
Published: November 2007

We analysed retrospectively non‐acute new referrals of children to Waikato Hospital over one year. It was found that children were required to wait unacceptably long to be seen. Almost half the children with established amblyopia were not seen until after the age of five years (42% were not referred until after that age). On the other hand, half the children seen had no significant pathology, and the high level of non‐attendance also wasted clinic time.

An attempt was made to address these problems by holding regular screening clinics using a photoscreener, assessing all children within three weeks of referral so that children with pathology could be examined and treated promptly. Preliminary investigations into mass community photoscreening produced an average recall rate of 11 % (54% of whom fell into our definition of pathological). We feel that enlisting the photoscreener has provided a much more efficient paediatric service, which it is hoped will lead to a reduction in visual loss due to amblyopia.
Cytokines, fibrosis and the failure of glaucoma filtration surgery
Authors: Gillies Mark C.
Published: November 2007

Current therapies for the prevention of fibrosis after glaucoma filtering surgery can be effective but often produce unwanted side effects. An understanding of the cellular basis of the fibrotic reaction may lead to better treatments. Wound repair revolves around angiogenesis and the activation of fibroblasts by cytokines. These peptides, a number of which have been described, act together in intricately complicated networks to encourage fibroblast chemotaxis, proliferation and contractility, as well as to stimulate the production of glycosaminoglycans and collagen. Since interferons seem to inhibit many of these responses, they deserve further evaluation in the treatment of ocular fibrosis.
Diode laser trabeculoplasty
Authors: Vicary Diane L.
Published: November 2007

Diode laser is a solid state Gallium Aluminium Arsenide (Ga AIAs) laser with a wavelength of approximately 800 nm (near infrared radiation). It has a similar penetration to, and absorption within the ocular tissues as, Krypton red. Diode laser trabeculoplasty (DLT) was carried out on 20 glaucomatous eyes resulting in a mean fall in intraocular pressure of 6.35 mmHg at one month and 6.45 mmHg at three months. Over this early period DLT has an effect similar to argon laser trabeculoplasty (ALT) in the management of open‐angle glaucoma.
Visual disability and major causes of blindness in NSW: A study of people aged 50 and over attending the Royal Blind Society 1984 to 1989
Authors: Chan Charles W. C. , Billson Frank A.
Published: November 2007

Visual disability in individuals aged 50 years and over seeking services of the Royal Blind Society in the years 1984 to 1989, was studied with respect to changes in frequency of major causes together with age and sex of those affected.

The results mirror statistics in the UK. Age‐related macular degeneration (AMD) accounts for an increasing proportion of visual disability (34% in 1984 to 43% in 1989). Of particular interest was the frequency of disability attributed to cataract. While decreasing (24% in 1984 to 19% in 1989), cataract still represents a significant cause of potentially treatable disability.

The authors conclude that there is a changing prevalence of visual disability caused mainly by an increase in AMD and a subgroup of patients attending for services who appear to have a potentially remediable disability. These conclusions affirm the need for close liaison between ophthalmological practitioners and agencies for the blind.
Steroid sensitive Acanthamoeba keratitis
Authors: Horsburgh Bradley , Hirst Lawrence W. , Carey Terence , Whitby R. Michael , Nimmo Graeme , Stallard Ken
Published: November 2007

A 44‐year‐old woman with proven Acanthamoeba keratitis was successfully treated medically with resultant 6/9 vision. During the treatment, repeated attempts to titrate the patient off topical corticosteroids resulted in recurrent flare‐up of inflammatory keratitis from which Acanthamoeba could not be recultured. It is suggested that steroid administration during the course of Acanthamoeba keratitis may need to be withdrawn extremely slowly to avoid the recurrence of what appears to be an immunological corneal reaction.
Micrographically controlled excision (Mohs' surgery) of basal cell carcinoma around the eye: Combined dermatological surgical clearance and oculoplastic surgical repair
Authors: Irvine C , Walker N P J , Ramnaraint N D , Downes R N , Collin J R O
Published: November 2007

Periorbital infiltrative basal cell carcinomas are notoriously difficult to treat, particularly those around the medial canthus. Micrographically controlled excision with horizontal frozen sections (Mohs' surgery) allows for clearance of the tumour with minimal loss of normal tissue. Once the tumour has been completely removed, the defect can be repaired by the oculoplastic surgeon for the best functional and cosmetic result. This is the ideal treatment for tumours with a contiguous growth pattern that are liable to be seriously over or under treated by other modalities.

The technique requires special training for both the operator and the Medical Laboratory Scientific Officer (MLSO). It is costly in time and manpower but in selected cases, where recurrent tumour is most dangerous and where tissue conservation is paramount, it may be invaluable. Close collaboration between dermatological and oculoplastic surgeons in such cases probably offers the patient the best treatment and outcome.
Present challenges in the global prevention of blindness
Authors: Thylefors B
Published: November 2007

Cataract is responsible for 50% of world blindness, with at present an estimated backlog of 13.5 million cases in need of surgery. Low‐cost cataract surgery must be made more available in developing countries, making use of alternative approaches for outpatient surgery and optimal management of available resources. Trachoma control needs to be targeted at the worst affected areas in endemic countries, with more emphasis on behavioural, educational and community aspects of the disease. Vitamin A deficiency and xerophthalmia control are becoming matters of maternal and child health care, with early intervention during infancy in view of the mortality issue. There are good prospects for the prevention of blindness from onchocerciasis, through the availability of ivermectin, but large‐scale distribution schemes are still needed in most of the African countries concerned.

The early detection and management of open‐angle glaucoma still poses a major problem in developing countries, and further development of appropriate technology is needed in this field. Another area where more efforts are needed is ocular trauma, which is commonly the cause of unilateral loss of vision. General preventive measures must be enforced and better training provided to health personnel to deal competently with such cases, in order to prevent late complications. Diabetes, finally, is on the increase in many developing countries, giving rise to problems in dealing effectively with the ensuing retinopathy. Given the general constraints of resources and technology, more emphasis must be placed on general measures for optimal disease regulation and surveillance.

Major efforts for the mobilisation of needed support for blindness prevention must be undertaken rapidly, in order to allow for proper eye care services in the developing countries and to counter a further increase in the number of the world's blind.
The role of botulinurn toxin in third nerve palsy
Authors: Saad Nick , Lee John
Published: November 2007

Isolated third nerve paresis is a rare diagnosis among patients presenting to the Botulinum Toxin Clinic at Moorfields Eye Hospital. Ten patients with this diagnosis are reviewed in this study. Head trauma is a common cause of third nerve palsy and is often severe enough to cause damage to fusion potential. If fusion is present and there is adequate adduction of the divergent eye, then botulinum toxin injection of the lateral rectus may induce long‐term control of the ocular deviation. Three of the four patients who experienced tong‐term control of their ocular deviation following toxin injection shared these features. Toxin injected into the lateral rectus did not, however, reliably assess medial rectus function and therefore predict the outcome of horizontal squint surgery. Reasons for this are discussed.
Third nerve palsy due to cerebral artery aneurysm in a child
Authors: Branley Michael G , Wright Kenneth W , Borchert Mark S
Published: November 2007

We report a case of cerebral aneurysm in a seven‐year‐old girl who presented with subacutely progressive third nerve palsy. To our knowledge this is the youngest reported patient with this condition. Confusion with myasthenia gravis occurred because of improvement in the patient's ptosis after intravenous edrophonium chloride. Cerebral CT revealed a hyperdense mass that was characterised on cerebral angiography as an aneurysm of the posterior communicating artery. Another occult aneurysm of the posterior cerebral artery was found at surgery. This case demonstrates that third nerve palsy due to cerebral aneurysm may affect patients at a younger age than has previously been recognised. Therefore we suggest that even young children should have aneurysm excluded by cerebral CT and angiography if they present with acquired third nerve palsy involving the pupil. In addition this case highlights the false‐positive results that may occur with the edrophonium chloride test for myasthenia gravis.
Superior sagittal sinus thrombosis—an unexnected cause of papilloedema
Authors: Macken Peter , Arora Anil , Hipwell Geoffrey , Hunyor Alexander
Published: November 2007

Two patients with superior sagittal sinus thrombosis are reported. Papilloedema was an important diagnostic sign in both cases. Magnetic resonance imaging (MRI) provided the diagnosis in each case and proved to be the investigation of choice. Superior sagittal sinus thrombosis should be considered in the differential diagnosis of papilloedema as it is both potentially fatal and probably underdiagnosed.
Development of experimental chronic intraocular hypertension in the rabbit
Authors: Zhu Mei Dong , Cai Feng Ying
Published: November 2007

There are many unanswered questions about chronic glaucoma which cannot be investigated in the available animal models. The present experiments were designed to develop a rabbit model of chronic intraocular hypertension with characteristics similar to human chronic glaucoma by ligating vortex veins or by making single or multiple intraocular injections of 0.5% or 1%α‐chymotrypsin, 20% chondroitin sulphate, 2% hydroxypropyl methylcellulose, 2% sodium carboxymethylcellulose or 1% or 2% methylcellulose. Evaluation was based on the clinical findings, intraocular pressure and the retrograde axoplasmic transport function of the optic nerve using a horseradish peroxidase histochemical technique. Most methods either failed to produce moderate chronic intraocular hypertension or were associated with other complications. However, a reliable and relatively long period (eight weeks) of intraocular hypertension was developed by a series of four intra‐anteriar chamber injections of 1% or 2% methylcellulose. This model has been proved suitable for the study of structural and functional damage to the retina and optic nerve caused by chronic glaucoma.
Day‐surgery external dacryocystorhinostomy
Authors: Benger Ross
Published: November 2007

A retrospective study of patients undergoing day‐surgery external dacryocystorhinostomy (DCR) over five years is presented. The patients were medically fit for day‐surgery, preferred outpatient to inpatient care, and had appropriate domiciliary support. There was a high success rate with minimal morbidity, similar to findings in an inpatient setting. Patient satisfaction was uniformly high. The author believes that external DCR can be performed on a day‐surgery basis safely and successfully.
Pseudallescheria boydii keratitis
Authors: FRACO Richard Mills , FRACO Graham Garrett
Published: November 2007

We treated a case of post‐traumatic keratitis caused by the soil saprophyte, Pseudallescheria boydii. The injury was caused by a wood splinter which produced a perforating corneal laceration that was primarily repaired. Signs of corneal infection were not evident until the fourth postoperative week. The organism was eradicated by topical miconazole and natamycin. Subsequent penetrating keratoplasty combined with cataract extraction and intraocular lens implantation has achieved a good visual outcome.
Congenital hypertrophy of the retinal pigment epithelium and familial adenomatous polyposis
Authors: McKay David L.
Published: November 2007

Congenital hypertrophy of the retinal pigment epithelium is a common eye sign in patients with familial adenomatous polyposis (FAP). FAP has autosomal dominant inheritance with virtually 100% risk of colonic malignancy in adult life. There may be other associated systemic abnormalities including extracolonic malignancy. Early detection of disease is desirable, but has in the past been reliant on regular endoscopic examination. The nature of congenital hypertrophy of the retinal pigment epithelium and its usefulness as a predictive marker of the disease are discussed
Anaerobic orbital abscess secondary to intraorbital wood
Authors: Sullivan Timothy J. , Patel Bhupendra C. , Aylward G William , Wright John E.
Published: November 2007

A case of anaerobic orbital cellulitis secondary to intraorbital wood and an approach to management are presented. Retained foreign bodies should be suspected in all penetrating orbital injuries involving wood. Computed tomography (CT) should be performed to delineate the location and size of any foreign body and to determine damage to adjacent structures. Magnetic resonance imaging (MRI) is useful in certain circumstances. Orbital infection should be anticipated and broad‐spectrum antibiotic cover (including anaerobes) provided. Surgical intervention should be undertaken to remove any retained foreign bodies to prevent vision‐threatening complications.
Internal ophthalmoplegia – a complication of ocular varicella
Authors: Hodgkins Peter R. , Luff Andrew J. , Absolon Michael J.
Published: November 2007

We report a case of unilateral internal ophthalmoplegia associated with varicella zoster in a five‐year‐old boy. Pupillary dilatation and accommodative paralysis persist after three years. A brisk reaction to topical pilocarpine suggests a denervation. Bifocal spectacle correction has restored the visual acuity
Retinal disease associated with AIDS*
Authors: Freeman William R.
Published: November 2007

In recent years an enormous amount of new information in the area of retinitis and retinal disease in immunosuppressed patients has been acquired. There have been exciting new developments in our understanding of the pathogenesis of retinal disease in AIDS patients as well as important advances in the diagnosis and therapy of infectious retinitis. This article will summarise the recent advances in this area and outline the direction of future research as it applies to the clinical management of patients with retinal manifestations of AIDS. Diagnostic and therapeutic difficulties will be addressed including the appropriate selection of antiviral drugs and other therapeutic modalities in patients with sight‐threatening retinitis.
Long‐term intraocular pressure control by trabeculectomy: a ten‐year life table
Authors: Robinson DIM , Lertsumitkul S. , Billson FA , Robinson LP
Published: November 2007

A retrospective study of 179 eyes in 127 patients who underwent trabeculectomy at Sydney Eye Hospital under the supervision of two surgeons between 1977 and 1982 was carried out. Survival analysis by life table method shows cumulative two, five, and 10 year success rates to be 78%, 70%, and 67% respectively, with mean duration of intraocular pressure control (IOP<21 mmHg) being 88 months. Anti‐glaucoma medication improved the long‐term survival significantly (Hazard Ratio of 0.49 and P = 0.01) so that when the definition for failure is taken as IOP >20 mmHg while using medication, the two, five and 10 year success rates were 89%, 87% and 86% respectively. A rise in average intraocular pressure is seen between two weeks and three months after trabeculectomy. The improvement in long‐term success rate with use of topical steroids was suggestive (Hazard Ratio of 0.69) but not conclusive (P = 0.21). No difference was found in survival comparing fornix versus limbal based flap technique.
Open evaluation of a new non‐preserved artificial tear
Authors: Smith George TH , Lee Sharon , Taylor Hugh R.
Published: November 2007

In an open, one‐eye controlled study the efficacy of a new, non‐preserved artificial tear (sodium chloride 0.34% W/W, hydroxyethylcellulose 0.44% W/W), stored in single‐use disposable units (Minims, Smith and Nephew) was compared to a variety of other tear substitutes in 30 patients who were currently applying artificial tears to both eyes. It was found that the new drop was tolerated well by the majority of patients with 19 subjects (63%) preferring them to their existing medication. There was a significant reduction in the overall rose bengal staining pattern and also in the stain uptake of the medial conjunctiva between the first and second visits in the Minims treated eyes, but not in the eyes treated with the other drops (P < 0.05). There was also a significant improvement in the patients' subjective feelings of dryness and grittiness in the Minims treated eyes, but not in the other eyes (P < 0.05).
Non‐ulcerative fungal keratitis diagnosed by posterior lamellar biopsy*
Authors: Brooks James G. , Coster Douglas J.
Published: November 2007

We report a case of Fusarium solani keratitis which highlights the difficulties often associated with management of fungal corneal infections. This case demonstrates several unusual and interesting features: the occurrence of deep fungal pathology after superficial injury, the difficulties encountered in attempting to isolate and identify the causative organism, and the protracted course taken by an organism often noted to be rapidly destructive. These features necessitated an individual approach to therapy, employing unconventional medical and surgical techniques to achieve a satisfactory outcome
Endophthalmitis in Auckland 1983–1991
Authors: Kent David G
Published: November 2007

A review was made of 58 cases of suspected endophthalmitis presenting to Auckland Public Hospital between January 1983 and July 1991 (103 months). Thirty culture positive cases were found comprising 13 early onset postoperative, six delayed onset postoperative, five bleb‐associated, four post‐traumatic and two endogenous cases. The most frequent organism grown in postoperative endophthalmitis was Staphylococcus epidermidis. No conclusion could be reached as to the effectiveness of early versus delayed vitrectomy. Endophthalmitis due to S. epidermidis usually had a good prognosis while streptococcal endophthalmitis had a poor prognosis. Delayed‐onset postoperative endophthalmitis most often had a good prognosis while bleb‐associated endophthalmitis had a uniformly poor visual outcome. Two isolates responsible for cases of delayed‐onset postoperative endophthalmitis, Propionibacterium acnes and Rhodococcus species, did not grow on agar plates until the seventh day of culture. Significant bacterial resistance to cephazolin was identified with 33% of Gram‐positive and 75% of Gram‐negative isolates resistant. Prevention of postoperative endophthalmitis is discussed.
Phototherapeutic keratectomy for Reis Bucklers' corneal dystrophy
Authors: Rogers Christopher , Cohen Peter , Lawless Michael
Published: November 2007

Superficial keratectomy, penetrating and lamellar keratoplasty have all been advocated when intervention in Reis Bucklers' corneal dystrophy is necessary because of diminished visual acuity. In this study, 11 eyes were treated by phototherapeutic keratectomy with an excimer laser. Two eyes had previously been treated by penetrating keratoplasty. The visual acuity improved in all eyes, from an average of 6/60 to 6/9 with complete cessation of recurrent erosions. The technique was modified, with experience, to minimise the hyperopic shift that occurs with this procedure. Phototherapeutic keratectomy has significant advantages over other procedures and is now the procedure of choice once surgery is required in Reis Bucklers' dystrophy.
Effective corneal retrieval in a general hospital The Royal Melbourne Hospital Eye Bank
Authors: Chopra GK , Vincentis F De , Kaufman D. , Collie D.
Published: November 2007

An active program of corneal transplantation depends upon a constant supply of high quality donor tissue. We describe an effective and inexpensive system of corneal donor retrieval in a major teaching hospital, and present an analysis of its donor population. During the five‐month period studied in detail (May to October 1991), 365 deaths occurred in the hospital. The relatives of the deceased were contacted and consent for donation was requested after 323 (88.5%) of these deaths. Consent was given in 212 cases (65.5% of requests), with a mean age of the donor population of 69 years. After screening donor tissue for quality, 110 pairs of corneal buttons and 10 globes of sclera were despatched for surgery during the study period, giving an overall procurement rate of over 30%. Further, the efficient notification and ‘on‐call’ retrieval system led to very rapid corneal retrieval, resulting in an average death to storage medium time of less than two hours.
The application of a computerised diagnostic index for ophthalmic practice
Authors: Simpson A J
Published: November 2007

All 2792 patients seen in my private practice between July 1989 and September 1992 and receiving a diagnosis were coded according to the International Classification of Diseases‐9 (Clinical Modification), 1979. Any procedures performed were coded according to the American Medical Association Current Procedural Terminology. Patient details and codes were filed by computer using a customised database in Foxpro 2.0 software. Those with minor refractive error or presbyopia alone and those who had no abnormality were excluded from the database. The set‐up and maintenance of this diagnostic index is described and the database structure is specified. A modification of the glaucoma section of ICD‐9, which better suited my needs, is presented. Examples of the potential information available from such a database is described, including some analysis of this general ophthalmic practice.
MRI in the heavy eye phenomenon
Authors: Kowal L , Troski M , Gilford E
Published: November 2007

The heavy eye phenomenon presents as progressive esotropia and hypotropia in high myopia. It appears to be due to compression of the lateral rectus muscle against the lateral orbital wall by the enlarged myopic globe. We present the first published magnetic resonance imaging (MRI) scans of this condition and a summary of the literature.
Langerhans' cell histiocytosis of the frontal bone
Authors: Moshegov Con , Martin Peter , Myers Philip , Filipic Marijan
Published: November 2007

Two cases of Langerhans' cell histiocytosis of the frontal bone are presented. This condition was previously known as eosinophilic granuloma and rarely involves the orbit but may be associated with widespread and life‐threatening disease. Clinical, radiological and histopathological features are presented. A discussion of the light and electron microscopic appearances, investigation and management follows.
A fifty‐year follow‐up of ocular defects in congenital rubella: late ocular manifestations
Authors: Arnold Jennifer J , Mcintosh E David G , Martin Frank J , Menser Margaret A
Published: November 2007

Fifty patients born with congenital rubella in 1939–1945 were reviewed in 1967. In 1991 this cohort was again studied and their ophthalmic features are presented here. The presence of two new cataracts and one case of possible choroidal neovascularisation are again noted; apart from these three eyes, the group showed no evidence of other delayed manifestations of the congenital rubella syndrome. A review is given of the ocular complications of the congenital rubella syndrome, with particular emphasis on the late complications.
Long‐term results with argon laser trabeculoplasty
Authors: Gillies WE , Dallison IW , Brooks AMV
Published: November 2007

The long‐term effectiveness of argon laser trabeculoplasty (ALT) is still questioned. In order to assess the long‐term effect of ALT in our hands we reviewed the results of 102 patients who underwent ALT nine to 11 years ago. Thirty eyes of 22 patients were still available for follow‐up at 9.5 years, having a fall in intraocular pressure (IOP) from 23 ± 7 mmHg (range, 15 to 44 mmHg) before treatment to 17 + 4 mmHg (10 to 30 mmHg) at 9.5 years. A mean field loss of 39%± 29% in 21 eyes with IOP controlled in a range of 15 mmHg or less progressed another 5%+ 4% additional loss. In eight eyes whose IOP could not be controlled below 20 mmHg a mean field loss of 10%± 24% sustained an additional 22%± 24% loss. Pressure control in the range of 16 to 20 mmHg gave intermediate results for progression of field loss. Argon laser trabeculoplasty with adjunctive medical therapy continues to lower IOP long term, but IOP control at 15 mmHg or less optimally slows field loss.
Tissue plasminogen activator in the surgical management of subretinal haemorrhage
Authors: Manning Leslie M , Conrad Diana K
Published: November 2007

We report three cases of the use of tissue plasminogen activator (TPA) to aid the surgical removal of subretinal haemorrhage. All patients had choroidal neovascular membranes secondary to age‐related macular degeneration. The technique involved infusing a sterile solution of TPA through a small retinotomy and irrigating out the dissolved clot. The visual acuity improved in the first patient from a preoperative 6/36 to 6/18 five weeks after surgery, but subsequently deteriorated to 6/60 after six months from a new choroidal neovascular membrane (CNVM), remaining 6/60 at nine months after surgery. The second patient's visual acuity improved from count fingers to 6/24 three weeks after surgery, but subsequently deteriorated to 6/60 after four months from a new CNVM, remaining 6/60 at nine months after surgery. The third patient's visual acuity improved from count fingers to 6/36 and remains stable at 6/36, eight months after surgery. Although long‐term prognosis remains guarded, these early results suggest that TPA may have a role in the management of subretinal haemorrhage.
Reflexes and the eye
Authors: Hunyor Alex Paul
Published: November 2007

Reflexes are an essential part of protective and homeostatic function, both in general terms and with specific reference to ocular structures. A wide range of stimuli and responses, with varying degrees of central processing, is involved in such reflexes.

The simplest reflexes are monosynaptic, such as the stretch or myotatic reflex. More complex polysynaptic reflexes are involved in many regulatory and protective functions ‐ these include autonomic as well as somatic reflexes. Ocular autonomic reflexes include the oculocardiac, pupillary, accommodative and lacrimatory reflexes. Ocular somatic reflexes include eyelid and extra‐ocular muscle reflexes (such as Bell's phenomenon, vestibulo‐ocular and optokinetic reflexes).

An account of the above reflexes is given in the format of an essay, modified from the FRACO Part I Examination in Physiology. The topic was ‘Discuss reflex activities with particular reference to the eye’. The content is based on several of the texts recommended for the Part I Examination, as listed under references.
The importance of epidemiology in understanding eye disease
Authors: Livingston Patricia M , Taylor Hugh R
Published: November 2007

Most leading causes of visual impairment are age related, so the health care implications of an increasing prevalence of eye disease in the elderly are significant. Epidemiological research provides the foundation to address immediate and long‐term needs associated with visual impairment and eye disease. It contributes to a community's knowledge of the presence, diagnosis, characteristics, and distribution of eye conditions affecting the elderly. Obtaining accurate epidemiological information on the extent of visual impairment and eye disease in the community is essential to determine and estimate the cost of primary and secondary eye health care needs.
Age‐related medial ectropion of the lower eyelid
Authors: O'Donnell Brett
Published: November 2007

Background
: A simplified procedure is proposed for the repair of medial lower eyelid age‐related ectropion.

Methods
: A posterior horizontal incision is made in the medial half of the lower eyelid at the inferior border of tarsus. The lower eyelid retractors are exposed and then plicated to the tarsus without excision of posterior lamellae or the use of everting sutures. The lid is then shortened horizontally with excision of a pentagonal section or lateral tarsal strip procedure.

Results
: The procedure was performed in six patients successfully without complication.

Conclusions
: This is an effective method for repair of lower lid medial age‐related ectropion.
Occlusion therapy for strabismic amblyopia
Authors: Elder Mark J
Published: November 2007

Objective
: To assess the outcome of occlusion therapy in strabismic amblyopia.

Methods
: The case notes of 369 children requiring strabismus surgery were reviewed.

Results
: Of 369 children requiring surgical correction for strabismus, 109 had strabismic amblyopia. All of these patients were treated with occlusion. Seventy‐eight per cent (85 of 109) had improvement of their visual acuity to within one Snellen line of the other eye. Another 11% (12 of 109) of patients genuinely failed to achieve equal acuity in both eyes despite occlusion and 11% (11 of 109) failed to improve due to poor compliance.

Conclusions
: Occlusion for six hours per day, every day, produced an effective and rapid response in most patients. There was no occlusion amblyopia. Admission to hospital for occlusion was effective in some refractory cases.
Macular holes: Pathogenesis, natural history and surgical outcomes
Authors: Luckie Alan , Heriot Wilson
Published: November 2007

Idiopathic full‐thickness macular holes (FTMH) are a common cause of usually uniocular reduced visual acuity. The accepted pathogenesis has macular hole formation proceeding in stages from an impending hole to a FTMH, with visual acuity deteriorating to less than 6/60 in 85% of cases. Recent surgical advances in the treatment of FTMH, with excellent anatomic and visual results, have changed the surgical indications for both impending and established full‐thickness macular holes.