bluuebunny/crossref_metadata_2025 huggingface dataset:
The expression of adhesion molecules in the human retina and choroid
Authors: Duguid I. G. M. , Boyd A. W. , Mandel T. E.
Published: November 2007

This study examines the expression of some selected adhesion molecules likely to be important in the migration of leucocytes across the blood‐retinal and blood‐aqueous barriers in samples of normal human retina and choroid by immunoperoxidase staining. ICAM‐1, LFA‐3 and ELAM‐1 were expressed on retinal endothelium and ICAM‐1, ELAM‐1 and CD44 in the region of the external limiting membrane. VLA‐2 was found around the retinal ganglion cells and in the inner and outer fibre layers and is likely to be important in maintaining the structural integrity of the retina. The endothelium on the choriocapillaris showed moderate staining of ICAM‐1, and slight staining of LFA‐3 and ELAM‐1. These molecules may have an important functional role in the pathogenesis of many immunological ocular conditions, including uveoretinitis and cornea! allograft rejection.
Moving muscles with microchips, mathematics and models: an update on the ‘reverse’ model
Authors: Stark Denis , Kault David , Horsburgh Bradley
Published: November 2007

This paper reviews the current status of our computer model for the management of strabismus and its future direction. Vector analysis was first used in the 1950s for the assessment of strabismus. Robinson's model' was the first computer simulation of ocular motility. Using physiological principles and anatomical approximations, Robinson's model sought to predict the strabismic pattern to be expected from a given injury. The Kault/Stark 'reverse' model works in the opposite direction, to first simulate the given strabismic pattern and then advise the surgery required to restore orthophoria. The surgeon is able to 'trial' various operations and compare the expected postoperative results. An automated system is currently being developed to ease the difficulty in measuring the position of the eyes in all nine positions of gaze. This paper includes three illustrative case reports.
Submandibular gland transfer in the correction of dry eye
Authors: MacLeod A M , Robbins S P
Published: November 2007

Following rabbit experiments which showed that microvascular submandibular gland transfer could ameliorate the deleterious effects of lacrimal gland ablation, a clinical transfer of the submandibular salivary gland to the temple region was performed. The beneficial results from this initial operation have led to the procedure being used in a total of eight patients with 12 transfers. The procedure has led to increased moisture in the eye and decreased symptoms but the assessment of change in corneal function and pathology is difficult.
Management of congenital dacryocystocoele
Authors: Sullivan Timothy J , Clarke Michael P , Morin J Donald , Pashby Robert C
Published: November 2007

Congenital dacryocystocoele occurs when the nasolacrimal drainage apparatus in the newborn has concommitant blocks at the level of the junction of the common canaliculus with the lacrimal sac and at the distal end of the nasolacrimal duct. This results in a typical pink or blue swelling in the region of the medial canthus. Spontaneous resolution is common, although dacryocystitis may supervene. Treatment should be conservative unless dacryocystitis occurs, or intranasal extension coexists. A series of seven consecutive cases is presented and a management plan for the neonate with congenital dacryocystocoele is proposed.
The surgical management of congenital lacrimal fistulae
Authors: Sullivan Timothy J , Clarke Michael P , Morin J Donald , Pashby Robert C
Published: November 2007

Congenital lacrimal fistulae are developmental anomalies of the lacrimal apparatus that are usually symptomatic, frequently causing epiphora and occasionally causing fistulitis or dacryocystitis. They may be associated with other abnormalities of the lacrimal system or with systemic anomalies. Complete excision alone, or in combination with nasolacrimal intubation and/or dacryocystorhinostomy is recommended for treatment.
A retinitis pigmentosa register for Western Australia
Authors: Chelva E , McLaren T L , Kay SMS , Collins D W K , Black J L , Candy D R
Published: November 2007

This paper describes the main elements of the Western Australian retinitis pigmentosa register including details of the data stored on the register, aspects of the coding systems used and some description of the tests employed in diagnosis of retinitis pigmentosa. The register is family based and contains data on affected individuals and on their unaffected relatives. As at November 1991, the register contained data for 391 individuals from 207 separate families. Of the 391 individuals, 240 had definite or probable retinitis pigmentosa and 26 were possibly affected. The remainder were unaffected family members. In many cases, both affected and unaffected family members are being studied serially and the register is designed to store and easily retrieve serial data to allow study of disease progression for individuals and within families.
The objective assessment of abnormal eye movements in infants and young children
Authors: Jacobs Mark , Harris Christopher , Shawkat Fatima , Taylor David
Published: November 2007

Recordings of eye movements from infants and young children can be of clinical value in patients with certain neuro‐ophthalmological problems. This requires that the characteristics of normal eye movements in this same age‐group are known. Using an electro‐oculographic technique in a specially developed laboratory we have been able to assess the saccades, binocular and monocular smooth pursuit, binocular and monocular optokinetic nystagmus (OKN), and sustained vestibular rotation in infants and young children; these recordings were performed in one session lasting approximately 35 minutes. The recordings from four children with abnormal eye movements (delayed visual maturation, hemicerebral cyst, congenital ocular motor apraxia, and gaze‐paretic nystagmus) are briefly reported and compared to normal eye movements of age‐related children. The limitations of this procedure are discussed.
The aetiology of ocular toxoplasmosis in Melbourne
Authors: Hall Anthony JH , Renehan Mark J. , Harper C Alex
Published: November 2007

The biological mothers of 23 patients presenting with acute chorioretinal toxoplasmosis had sera screened for the presence of antibodies to Toxoplasma gondii. Twenty‐two of the mothers (96%) had positive serology and one (4%) had negative serology. This is consistent with the hypothesis that most cases of ocular toxoplasmosis are congenital in origin, but indicates that some cases are due to acquired toxoplasmosis.
Screening for congenital colour vision defects
Authors: Littlewood R , Hyde F
Published: November 2007

A prospective comparison between the Ohkuma1 and Ishihara2 pseudoisochromatic (PIC) plates was carried out in a group of 400 patients attending a general ophthalmology practice. The sensitivity of the Ohkuma test was compared to the Ishihara test, and the specificity of both was determined by reference to anomaloscopy as a gold standard.

Both tests correctly identified the same group of 24 patients as having a red/green confusion axis, and the Ohkuma test was equally as sensitive as the Ishihara. The grading plates in both tests are unreliable, but the Ohkuma test is quicker, easier to administer, gives less ambiguous responses and has a clearer cut‐off score for abnormality. On the basis of this experience the Ohkuma test is recommended as more appropriate for routine colour vision screening than either the 24 or 38 plate Ishihara tests.
Radiation hazards during cobalt 60 plaque therapy for choroidal melanoma
Authors: Jefferies Peter , Clemett Richard S. , Turner John R.
Published: November 2007

Pompted by the concerns of the staff and patients, radiation hazards from Cobalt 60 (Co 60) plaque therapy for choroidal melanoma were recently assessed when two patients were concurrently treated at Christchurch Hospital. The risks from radiation to the attending medical staff, nursing personnel from the operating theatre and ward, and the patients' visitors were investigated.

The radiation dose for all staff and visitors involved with the two patients was found to be well below the recommended weekly limits set by the International Commission on Radiological Protection. Our department code of practice to minimise radiation hazard during plaque therapy has been revised.
Demographic characteristics of ophthalmic outpatients at the Royal Victorian Eye and Ear Hospital
Authors: Guest Charles S. , Lee Sharon E. , Ferguson Malcolm P. , Urquhart Nicole L. , Taylor Hugh R.
Published: November 2007

To investigate demographic aspects of the access to services at the Royal Victorian Eye and Ear Hospital (RVEEH), routine registration records on outpatients were linked to the population of state health regions, the distribution of ophthalmologists and projected population growth. In the six‐month period September 1990 to March 1991, 19 339 persons came to the hospital (Emergency Department or Outpatients) at least once with an eye problem. Most (93%) lived in the Melbourne metropolitan area. The largest group (40%) came from Health Region 6, the Western Metropolitan region, which also has the lowest density of ophthalmologists in Victoria (1.6 per 100 000 total population, excluding ophthalmologists in the central business district of Melbourne).

In the sample, 7243 patients (37%) were aged 65 years or older. Of these older patients, 75% had multiple visits to the hospital for a given illness, compared with 30% in younger patients (P<0.01).

By application of projected age‐group growth rates in the Victorian population to the current profile of RVEEH outpatients, we forecast a 32% increase in the number of outpatients attending the hospital over the 15 years to 2006,10% more than the projected population growth of 22% over this period.
Retractor plication for lower lid entropion in ocular cicatricial pemphigoid
Authors: Rosser Paul M. , Collin JRO
Published: November 2007

The surgical treatment of lower lid entropion in ocular cicatricial pemphigoid has previously met with limited success and conventional techniques have in some cases caused disease progression. We have treated lower lid entropion in this condition with retractor plication, avoiding surgery to the conjunctiva in five patients (seven eyelids) over the past five years with successful correction of the condition and symptomatic improvement in all patients. It has not led to an acute exacerbation of the condition in any patient and we recommend it as the procedure of choice in the surgical management of entropion in this disorder.
Carrier detection in X‐linked retinitis pigmentosa
Authors: Gurvitz A , Leigh DA , Halliday FB , Lai LYC , McDonald BL
Published: November 2007

X‐linked retinitis pigmentosa (XLRP) is manifested in affected males in their first decade and results in blindness by the third or fourth decade. Carrier detection is difficult since most carrier females show no or only equivocal signs well into or beyond their reproductive years. The genes, or the mutations causing RP have not been identified but at least two have been localised to the short arm of the X chromosome provisionally named RP2 and RP3. Identifying inheritance of one or other of these genes must be done by linkage in families using close, informative DNA markers. Here we report the localisation of a highly informative polymerase chain reaction (PCR) detectable microsatellite marker DXS538 using a previously studied family with X‐linked RP3 in which recombination had occurred in the region of importance. The DXS538 dinucleotide repeat locus was previously localised to Xp21.1‐p11.21 to study RP3 in one XLRP family. Using published RFLP data we narrowed the localisation of DXS538 to the region Xp21.1 ‐ p11.23. Thus DXS538 is now a convenient diagnostic tool, aiding carrier detection of XLRP in females, as shown in the family presented here.
Retinopathy of prematurity in infants less than 29 weeks' gestation at birth
Authors: Todd David A , Kennedy John , Roberts Sharyn , Watts Jane , Psaila Kim , John Elizabeth
Published: November 2007

From January 1986 to December 1991 we examined the eyes of 206 infants born at Westmead Hospital, Neonatal Intensive Care Unit who were less than 29 weeks' gestation at birth to determine the incidence of retinopathy of prematurity. Eighty‐five infants (41.3%) had no retinopathy of prematurity (ROP) in either eye, 82 infants had stages 1 or 2 ROP (39.8%), 29 had stage 3 ROP (14.1%) and 11 had stage 4 ROP (5.3%). Of these, cryotherapy was performed in 18; six now have bilateral retinal detachment and are blind

The more severe stages of ROP were significantly associated with an increase in the number of days of oxygen supplementation, an increase in the number of days of mechanical ventilation and the presence of patent ductus arteriosus. Infants receiving steroids for mechanical ventilator dependence had a significantly greater chance of requiring cryotherapy (11 or 22 receiving steroids versus seven of 43 without steroids; P < 0.01).
Safety goggles should be worn by Australian workers
Authors: de la Hunty David , Sprivulis Peter
Published: November 2007

Eye injuries in the workplace are a major cause of morbidity and disability, despite well publicised standards for industrial eye protection. A prospective survey of 51 patients presenting to a metropolitan emergency department with a work‐related eye injury revealed that 32 injuries (63%), occurred to workers wearing some form of protective eye wear. However only seven (14%) were wearing eye protection that complied with the Australian Standard AS 1336 for occupational eye protection. Thirty‐six patients (71 %) had suffered previous eye injuries at work. Most injuries were'caused by medium velocity particles generated by power tools, generally causing superficial corneal injury. We conclude that education to reduce the widespread misuse of safety glasses by tradespeople and trades assistants during tasks for which goggles are recommended could considerably reduce the incidence of occupational eye injuries.
The role of eye protection in work‐related eye injuries
Authors: Fong Lye Pheng , Taouk Yamna
Published: November 2007

Purpose/Background: A recent survey of general hospitals by the Victorian Injury Surveillance System found that ocular trauma represented 15% of work‐related injuries. As circumstances surrounding occupational eye injuries have been poorly documented previously, their associations to occupation, industry and work‐safety practices, including safety eyewear use, need to be identified to develop appropriate preventive strategies for high‐risk groups.

Design and Setting: From a prospective cross‐sectional survey of all eye injuries treated at the Royal Victorian Eye and Ear Hospital, work‐related cases were analysed for demographic, occupational and safety eye‐wear information. Hospital‐based data were supplemented by information from Workcover Authorities and Labour Force statistics to derive incidence and cost estimates.

Results: There were 9390 eye injuries during the 18‐month survey period: 42% (n= 3923) of total and 29% (n=52) of penetrating ocular injuries occurred at work. The most frequently injured were metal, automotive and building trades workers grinding and drilling (41% of outpatients) and hammering (53% of penetrating eye injuries). Automotive workers had the highest frequency for penetrating injuries, and most were exposed to hammering and were also the least likely to wear safety eye‐wear.

Conclusion: Eye injuries are frequent (10% of work‐related injuries) and highly preventable by the correct use of safety eye‐wear, a cost‐effective intervention that may result in cost savings of £59 million for work‐type activities in the occupational and domestic settings in Australia each year.
Clinical detection of unilateral keratoconus
Authors: Lee Lawrence R. , Hirst Lawrence W. , Readshaw Grahame
Published: November 2007

Purpose: To determine the incidence of true unilateral keratoconus on the basis of computerised corneal topography in a group with clinically diagnosed unilateral keratoconus.

Methods: Retrospective review of 295 patients with keratoconus identified 51 patients with a provisional diagnosis of unilateral keratoconus. Thirty‐one of these patients were re‐examined clinically and 21 patients met the criteria for a clinical diagnosis of unilateral keratoconus. Computerised corneal topographic analysis (Tomey TMS) was then performed.

Results: In a group of 21 patients with clinically diagnosed unilateral keratoconus, computerised corneal topographic analysis identified 14 (67%) patients with bilateral keratoconus and seven (33%) patients with true unilateral keratoconus. Contact lens wear had no significant influence (P= 0.76) on the topographical diagnosis of keratoconus in the clinically unaffected fellow eye. The estimated incidence of true unilateral keratoconus in the cohort of 295 patients was 4%.

Conclusion: Computerised corneal topography improves sensitivity in detection of true unilateral keratoconus.
Perfluorocarbon heavy liquids
Authors: Bourke Robert D. , Cooling Robert J.
Published: November 2007

Perfluorocarbon heavy liquids (PFCL) facilitate the transfer of intraocular fluids and other surgical manoeuvres in the posterior segment. The indications for their use have extended since first described in the management of giant retinal tears and proliferative vitreoretinopathy. We reviewed our personal experience and experimental evidence, including adverse effects, in order to identify the current role of PFCL in vitreoretinal surgery. High‐density perfluorocarbon liquids represent a major advance in vitreoretinal surgery. Clinical experience and the results of experimental investigations have demonstrated their efficacy and safety as an intraoperative device.
Screening for glaucoma in a Brisbane general practice — the role of tonometry
Authors: Jackson C , Bullock J , Pitt M , Keogh J , Glasson W , Hirst L
Published: November 2007

Objectives: (1) To pilot, and evaluate, a tonometry training intervention for general practitioners; (2) to evaluate the efficacy of three types of tonometer (Perkins, Schiotz and Tonopen) in the hands of these general practitioners; (3) to evaluate the predictive value of tonometry in screening for glaucoma in a general practice population; and (4) to evaluate the acceptability of tonometry to general practice patients.

Design: After being trained, three general practitioners recruited 73 of their patients over 50 years of age to attend for measurement of intraocular pressure by tonometry. Intraocular pressure was initially measured by an ophthalmologist using the Goldmann applanation tonometer, and then recorded in random order by GPs using three types of tonometer — the Perkins, Schiotz and Tonopen.

Setting: A group general practice in a middle‐class suburb in southern Brisbane.

Outcome measures: (1) Comparison of measurements on the Perkins, Schiotz and Tonopen tonometers with that of the ‘gold standard’, the Goldmann Applanation tonometer; (2) Prevalence of disc and perimetric abnormality suggestive of glaucoma among those patients with increased intraocular pressure; and (3) the acceptability of contact tonometry to general practice patients.

Results: There was considerable variability between intraocular values obtained across doctors and across instruments (6% to 95% of values within 4 mm of the ‘gold standard’). The Schiotz tonometer provided the most uniform assessment of intraocular pressure across the groups. Nineteen of the 73 patients (26%) had intraocular pressures ≥21 mmHg using the ‘gold standard’. Of these, 18 were followed up with funduscopy, gonioscopy, repeat measurement of intraocular pressure and visual field assessment. Five had persistent elevations of intraocular pressure ≥21 mmHg on subsequent assessment, and two had mild abnormalities of cup—disc ratio with normal fields on testing with Humphrey computerised perimetry.

Conclusion: No one hand‐held tonometer proved highly accurate in the hands of all three doctors. Even measured optimally, increased intraocular pressure alone was a poor predictor of glaucoma. Of the population screened, two patients (3%) showed evidence of mild cup‐disc abnormality requiring follow‐up.
Excimer laser lamellar keratoplasty
Authors: Cano David B. , Downie Nicholas A. , Young Ivan M. , Carroll Nanette , Pollock Graeme R. , Taylor Hugh R.
Published: November 2007

Purpose: To evaluate a procedure using the excimer laser to perform lamellar keratoplasty to treat deep corneal scars in the central optical zone. To determine if excimer laser can safely prepare a smooth surface for the host bed and the donor button, assess the interface opacity and evaluate the effects of the ablation on the recipient's endothelial surface with the deeper ablation.

Methods: Nineteen rabbits underwent an excimer laser lamellar keratoplasty in one eye. The rabbits were followed for 9 to 12 weeks until they were sacrificed.

Results: Little opacity developed at the graft‐host interface and scanning electron microscopy of the endothelial surface showed little difference between the treated and untreated areas or the endothelium of the untreated eyes.

Conclusions: Our results suggest that the use of the excimer laser to treat corneas with deep stromal scars and normal endothelium is feasible. However, we have not proved that this technique will give a better result than conventional lamellar dissection methods.
Ultrasound biomicroscopic features of spherophakia
Authors: Macken PL , Pavlin CJ , Tuli R , Trope GE
Published: November 2007

Background: Spherophakia is an uncommon diagnosis. This is the first case report of spherophakia evaluated by ultrasound biomicroscopy.

Methods: Ultrasound biomicroscopy is a new diagnostic technique developed by one of the authors and provides images with microscopic resolution of the anterior segment. A patient with spherophakia was evaluated by ultrasound biomicroscopy (Zeiss‐Humphrey, 50MHz) before and after YAG laser iridotomy.

Results: Ultrasound biomicroscopic assessment revealed a shallow anterior chamber, a very steep anterior lens curvature, iridolenticular contact, elongated zonules, and an increased distance between the lens equator and the ciliary processes. Angle closure glaucoma was due to a pupil block mechanism. The pupil block was relieved by YAG laser iridotomy.

Conclusions: Ultrasound biomicroscopy is a useful technique to confirm the diagnosis of spherophakia. The pupil block in spherophakia is relieved by YAG laser iridotomy.
Corneal tattooing revisited: excirner laser in the treatment of unsightly leucornata
Authors: Anastas Constantine N. , McGhee Charles NJ , Webber Suzanne K. , Bryce Iain G.
Published: November 2007

Background: Corneal tattooing, a procedure first used by Galen in the treatment of unsightly leucomata, has in recent times received relatively little attention due to major advances in intraocular and corneal surgery. Resurrection of the technique, however, may be reasonably considered in ‘high risk’ cases of leucomata or lexocoria where corneal transplantation would lead to rejection and failure, or, in eyes with no visual potential, where removal of cosmetically unacceptable dense, white cataracts carries an unreasonable risk of phthisis bulbi or sympathetic ophthalmitis

Methods: Corneal tattooing requires the accurate and limited removal of corneal epithelium to act as the tattoo bed and unfortunately, if removal of the epithelium exceeds, or goes beyond the circumference of, the chosen area, a ragged cosmetically less pleasing ‘pupil’ is created. The excimer laser appears to be an ideal tool to create a perfectly circular corneal bed to improve upon older techniques.

Conclusion: We report, for the first time, an updated, simple and improved technique for successful corneal tattooing using excirner laser technology.
Visual outcome of excimer laser photorefractive keratectomy for myopia: A comparison of three laser delivery systems in Australia
Authors: won Kang H K. , Beaumont Paul E. , Taylor Hugh R. , van Saarloos Paul P. , Constable Ian J.
Published: November 2007

Purpose: To compare the performance of the three excimer laser delivery systems in correcting myopia.

Methods: The first generation ercimer laser systems produced by Summit, VEX and LEI were examined. The first 40 consecutive eyes with six‐month refractive results were selected from the LEI centre. Forty consecutive eyes, matched for age and attempted corrections, were then selected from each of the Summit and VEX centres, The postoperative visual results were examined retrospectively and compared among the three groups.

Results: At six‐month follow‐up, the mean and standard deviation of the spherical equivalent refraction were +0.27 (SD, 0.65) dioptre in the Summit group, ‐0.33 (SD, 0.83) dioptre in the VISX group and ‐0.62 (SD, 0.89) dioptre in the LEI group (P= 0.0001, ANOVA). Thirty‐five eyes (88%) in the Summit group, 33 eyes (83%) in the VISX group and 28 eyes (70%) in the LEI group achieved corrections within 1 dioptre of intended corrections (P = 0.131, χ2 test). Four eyes (10%) in the Summit group, two eyes (5%) in the VISX group and one eye (3%) in the LEI group were over‐corrected by more than 1 dioptre at six‐month follow‐up. Unaided visual acuity (Snellen equivalent) was 6/12 or better in 37 eyes (93%) in the Summit group, 34 eyes (85%) in the VISX group and 34 eyes (87%) in the LEI group (data missing in one eye). Loss of one or more lines of best corrected visual acuity (Snellen equivalent) was found in 6 of 39 eyes (15%) in the Summit group, 10 of 40 eyes (25%) in the VISX group and 4 of 36 eyes (11%) in the LEI group (P= 0.258, χ2 test). Regression between one and six month follow‐up differed significantly (P= 0.001, ANOVA) among the groups, with the mean of ‐1.25 (SD, 0.94) dioptres in the Summit group, ‐0.59 (SD, 1.01) dioptre in the VISX group and ‐0.40 (SD, 0.99) dioptre in the LEI group.

Conclusions: Statistically comparable results were found in the three groups in terms of refraction and visual acuity six months after myopic photorefractive keratectomy. No statistical differences were found between the groups in terms of significant overcorrection or loss of best corrected acuity. The group treated using the Summit system demonstrated significantly greater regression than the other groups, necessitating larger initial hyperopic shifts.
Exudative macular degeneration and intravitreal triamcinolone A pilot study
Authors: Penfold Philip L. , Gyory Joseph F. , Hunyor Alex B. , Billson Francis A.
Published: November 2007

Purpose: To study the efficacy of the anti‐inflammatory agent triamcinolone (Kenacort A‐40) in patients with exudative age‐related macular degeneration and subfoveal and juxtafoveal choroidal new vessels, considered unsuitable for laser photocoagulation.

Method: Thirty eyes of 28 patients were treated with intravitreal injection of triamcinolone. The subsequent visual acuity (VA) of treated eyes was compared with published VA outcomes of untreated eyes. Patients were classified into three types according to their responses to treatment.

Results: Within two weeks of receiving treatment, exudation decreased and vision improved in the majority of Types I and II patients (87%), the trend continuing in longer term follow‐up. The overall VA outcome for treated eyes was significantly better than published VA data for untreated exudative macular lesions.

Conclusions:The preliminary results are encouraging and no serious side effects of a single injection of triamcinolone have been detected in patients followed for up to 18 months. The treatment should, however, continue to be regarded as unproven and only administered in the context of a prospective, case‐controlled clinical trial.
Congenital ptosis: results of surgical management
Authors: Whitehouse Geoff M. , Grigg John RB , Martin Frank J.
Published: November 2007

Purpose: To determine the visual and cosmetic outcome following the surgical correction of isolated congenital ptosis.

Methods: A retrospective review of the outcome of isolated congenital ptosis corrected under the supervision of one surgeon at The Children's Hospital, Camperdown, between January 1983 and January 1993 was examined. Some 65 patients with 80 involved eyes were identified; 30 eyes underwent a levator resection procedure, 40 eyes underwent a brow suspension using donor stored fascia lata, and in 10 eyes a brow suspension was performed using mersilene mesh.

Results: In 78 eyes of 63 patients, a good cosmetic result was achieved. In two patients (two eyes) a poor cosmetic result was achieved. These two patients refused further surgery following an undercorrection of their initial ptosis. The recurrence rates for the primary procedures were 16.7% for levator resection procedures, 35% for brow suspension procedures using donor fascia lata, and 30% for brow suspension surgery using mersilene mesh. Some 35.3% of eyes following mersilene slings required further surgery for granulomas and exposed mersilene mesh compared with 6% having similar complications with stored fascia lata. Nine patients (11.25%) had reduced visual acuity (one line or more on the Snellen chart or its equivalent with the other tests used) on the operated side. Only one patient was found to have significant astigmatism.

Conclusions: An acceptable cosmetic result was achieved with one operation in 75.3% of cases. In 20.8% of cases a second operation was required and in 3.9% of cases three or more operations were required. This series supports the view that where possible, levator resection is the preferred form of surgery to correct congenital ptosis. When the levator function is inadequate, brow suspension is performed. The use of donor fascia lata resulted in a good cosmetic appearance with a low occurrence of surgical side effects. Amblyopia, when strictly defined, occurred in 11.25% of eyes despite early surgery for severe cases and intensive amblyopia therapy. Management requires repeated follow up for early detection and introduction of occlusion therapy or surgical ptosis correction.
Clinical exophthalmometry: a comparative study of the Luedde and Hertel exophthalmometers
Authors: Chang Andrew A. , Bank Alan , Francis Ian C. , Kappagoda Medduma B.
Published: November 2007

Exophthalmometry, the quantitative assessment of the position of the globe in the orbit, is a clinically useful measurement. The purpose of this study was to examine the performance of a simple exophthal‐mometer that would lend itself to accurate and convenient use in clinical practice. In this study, two observers independently performed exophthalmometry on 100 eyes using the Hertel and Luedde instruments. The results were compared between instruments and between observers. There was no statistically or clinically significant difference between measurements taken with the Luedde as compared with the Hertel instrument. The Luedde exophthal‐mometer has a number of advantages over the Hertel exophthalmometer, and represents a simple, inexpensive and equally reliable means of evaluating clinically the anteroposterior position of the eye in the orbit.
Persisting epithelial herpes simplex keratitis while on cyclosporin‐A ointment
Authors: Field Andrew J. , Gottsch John D.
Published: November 2007

Background: This is the first report of cyclosporin‐A ointment (CsA) adversely affecting epithelial herpes simplex virus keratitis in a corneal graft.

Methods: The details of this case were obtained from the patient's record at The Wilmer Ophthalmological Institute.

Results: Ceasing CsA ointment resulted in resolution of the epithelial HSV keratitis.

Conclusion: Immunosuppression caused by CsA ointment resulted in persisting epithelial HSV keratitis despite adequate topical treatment.
The bilobed flap in medial canthal reconstruction
Authors: Sullivan Timothy J , Bray Lindsay C
Published: November 2007

Background:
Although several techniques for repair of medial canthal defects have been described, most have shortcomings which prevent satisfactory repair. We describe the use of a bilobed flap which allows for optimal reconstruction in this area.

Surgical Technique:
A bilobed flap was used to repair 36 medial canthal defects in 35 patients. The primary lobe is usually slightly smaller than the defect. The secondary lobe is smaller than the primary though of equal length, fashioned so that its axis lies within the relaxed skin tension lines of the face to allow direct closure with minimal tension. All patients achieved a satisfactory cosmetic and functional repair.

Conclusions:
We recommend this technique as an excellent means of repairing all types of medial canthal defect. The technique allows reconstruction to be performed in a single stage with rapid rehabilitation and minimal morbidity.
Assessment and management of manual traumatic enucleation
Authors: Aboud Niall D , Shah Peter , Sullivan Frank
Published: November 2007

Background:
Gouging injuries represent a rare, severe form of orbital trauma. We report a case of manual traumatic enucleation.

Method:
Records of the patient were reviewed.

Results:
The outcome of this case was loss of the globe with an uncomplicated recovery.

Conclusions:
Without attention to the particular principles of assessment and management outlined in this report, a satisfactory outcome is not assured.
Behçet's disease: corneal perforation as an ocular manifestation
Authors: ShyanWong Jun , Chee Caroline K L.
Published: November 2007

PurposeAlthough ocular manifestations are common among patients with Behçet's disease, corneal perforation has not been reported in the literature. We report an unusual case of Behçet's disease with corneal perforation as the main ocular involvement.

Methods/resultsAn elderly Chinese patient was referred for eye examination because of clinical suspicion of Behçet's disease. Eye examination showed evidence of long‐standing autoimmune disease of the eye, mild iritis and a corneal perforation in the left eye. Despite evidence of chronicity and corneal perforation, the patient was asymptomatic. The perforation was successfully treated with cyanoacrylate glue.

ConclusionsWhile anterior segment involvement is common in Behçet's disease, this case highlights an unusual and hitherto unreported ocular involvement.
The flashlight test and van Herick's test are poor predictors for occludable angles
Authors: Thomas Ravi , George Thomas , Braganza Andrew , Muliyil Jayaprakash
Published: November 2007

Objective: To determine the reliability and validity of the flashlight test and van Herick's test in detecting occludable anterior chamber angles.

Methods: The flashlight test, van Herick's test and gonioscopy were performed independently by two observers on 96 consecutive new patients in our outpatient clinic. lnterobserver agreement was determined using the weighted Kappa statistic. Using the glaucoma specialist's assessment of occludability of the angle (assessed by gonioscopy) as a gold standard, the sensitivities and specificities of the two tests were calculated.

Results: All three tests showed good agreement (Kappa more than 0.75). The sensitivity and specificity of the flashlight test were 45.5% and 82.7% respectively. For the van Herick's test they were 61.9% and 89.3%.

Conclusion: The flashlight test and van Herick's test are of limited use as screening tests for occludable angles.
Branch retinal artery occlusion in a child
Authors: Sebban Allan I. , Sullivan Timothy J. , Davison Malcolm B.
Published: November 2007

Background: Retinal artery occlusive events are unusual in the paediatric population. The average age of their occurence is 60 years and the aetiology most often related to cardiovascular disease.

Case Report: A healthy 11‐year‐old white girl developed permanent unilateral visual field loss as a result of a branch retinal artery occlusion. An extensive work‐up included transthoracic and transoesophageal echocardiograms, routine haematological and biochemical testing including serum lipids, screening for thrombophilia and thrombolysis, as well as autoantibodies, all of which proved to be within normal limits.

Conclusions: Recognition of the underlying aetiology is not always possible, but should be sought as prognosis for vision or survival may rest upon these findings.
Results of anterior transposition of the inferior oblique
Authors: Seawright Ashley A. , Gole Glen A.
Published: November 2007

Purpose:We present the results of anterior transposition of the inferior oblique in a series of patients with inferior oblique overaction and dissociated vertical deviation (DVD).

Patients and methods:We performed a retrospective study of 37 procedures on 21 patients who had unilateral or bilateral inferior oblique anterior transpositions. Before surgery, patients had +1 to +3 inferior oblique overaction and +1 (< 10 PD) or +2 (10 PD‐20 PD) degree of DVD. The inferior oblique insertion was transposed to between 2 mm posterior to and 2 mm anterior to the temporal border of the inferior rectus insertion. Mean follow‐up period was 27 months.

Results:Incidence of inferior oblique overaction of +2 or more was reduced from 84% before surgery to 16% at last postoperative assessments. Some 43% of eyes had no inferior oblique overaction and 86% had an improvement in the degree of inferior oblique overaction. At last assessments, 57% of eyes had no evidence of DVD and 68% of eyes had no evidence of DVD or an improvement in the degree of DVD. No patient who had unilateral anterior transposition developed hypotropia in primary position and there was no evidence of inferior oblique underaction in any patient at last assessment. Three patients requiring repeat inferior oblique surgery are discussed, including one patient who developed a large Y‐pattern exotropia after bilateral anterior transposition of the inferior obliques.

Conclusions:Inferior oblique anterior transposition has a place in the treatment of coexistent inferior oblique overaction and dissociated vertical deviation.
Association of keratoconus with granular corneal dystrophy
Authors: Vajpayee Rasik B. , Snibson Grant R. , Taylor Hugh R.
Published: November 2007

A 2‐year‐old woman presented with a history of reduced vision and foreign body sensation in both her eyes. Ocular examination revealed the simultaneous presence of bilateral keratoconus and granular corneal dystrophy. To our knowledge, bilateral concurrent occurrence of keratoconus and typical granular corneal dystrophy has not been reported previously. In such a case, penetrating keratoplasty performed for keratoconus may also carry the risk of recurrence of the granular dystrophy.
Embolization of carotid cavernous fistulas via the superior ophthalmic vein
Authors: Gioulekas J , Mitchell P , Tress B , McNab AA
Published: November 2007

Background: Carotid cavernous fistulae are treatable by various means, one of which is embolization via the superior ophthalmic vein (SOV). The use of this technique over the past 12 years at the Royal Melbourne Hospital, Victoria, Australia, is reviewed.

Methods: Five patients with carotid cavernous fistulas were treated with embolization of the fistula via the surgically isolated SOV.

Results: Each patient had successful endovascular closure of the fistula using embolization via the SOV approach.

Conclusions: Treatment of certain types of carotid cavernous fistulas that cannot be closed by the conventional endovascular (arterial and venous) approaches can be successfully closed by using a transvenous approach through the SOV
Orbital tuberculoma masquerading as an orbital malignancy
Authors: Chin PK , Jacobs MB , Hing SJ
Published: November 2007

Background: Orbital tuberculosis is exceedingly rare in areas where tuberculosis is non‐endemic. A case of childhood orbital tuberculosis is reported, which the authors believe to be the first reported case of orbital tuberculosis in the Australasian region.

Methods/Results: The patient, a 6‐year‐old boy, presented with proptosis and was initially mistaken to have an orbital malignancy. Treatment with antituberculous drugs resulted in resolution of the condition.

Conclusion: This case served as a timely reminder of the need to keep awareness of the extrapulmonary manifestations of tuberculosis alive even in developed countries. A high index of suspicion for this eminently treatable disease in the appropriate clinical situation is particularly important when migrant communities from high‐prevalence areas are involved.
Cracked acrylic intraocular lens requiring explantation
Authors: Lee GA , Pra ML Dal
Published: November 2007

Background: Intraoperative cracking of foldable acrylic posterior chamber intraocular lenses has previously been documented. However; most cracks have resulted in no significant visual impairment.

Methods: A case report of an acrylic posterior chamber intraocular lens that cracked during folding.

Results: The crack in the lens resulted in significant optical disturbance and required explantation and insertion of another lens.

Conclusions: Acrylic intraocular lenses must be folded carefully with the appropriate forceps to prevent cracking of the optic.
Orbital squamous cell carcinoma following retinal detachment surgery
Authors: Lee LR , Sullivan TJ , Vandeleur K
Published: November 2007

Background: Orbital squamous cell carcinoma following retinal detachment surgery is a rare condition. A proposed pathogenesis involves implantation of conjunctival squamous epithelium at the time of surgery, with subsequent malignant transformation.

Methods/Results: An 81 ‐year‐old Caucasian man presented with a six‐month history of a discharging painful red right eye. Ten years earlier a right scleral buckling with an encircling sponge exoplant had been performed. Examination revealed exposure of the sponge, and a large mass in the superomedial conjunctival fornix. Computed tomography revealed a mass invading around the globe in the region of the exoplant. Biopsy revealed squamous cell carcinoma. Orbital exenteration was performed.

Conclusion: Orbital squamous cell carcinoma may arise following retinal detachment surgery presumably due to iatrogenic conjunctival implantation deep in the orbit.
Intravitreal cilia in phakic penetrating eye injury
Authors: Seawright AA , Bourke RD , Gray PJ , Cooling RJ
Published: November 2007

Background: Intraocular cilia present clinical perplexity due to their radiolucency, the extremely variable ocular response to such cilia, and the inadvisability of using MRI in cases of suspected metallic intraocular foreign bodies (IOFB).

Methods: Two cases of intravitreal cilia associated with phakic penetrating eye injury are described where preoperative CT scan revealed no retained IOFB.

Results: B‐scan ultrasonography detected intravitreal cilia in one patient and raised this suspicion in the other. One patient presented with endophthalmitis unresponsive to intravitreal antibiotics, the other with culture‐negative anterior uveitis. Both underwent vitrectomy and removal of cilia.

Conclusions: Intravitreal cilia should be considered in penetrating eye injuries even in phakic eyes with no radiological evidence of IOFB, especially if associated with endophthalmitis. B‐scan ultrasonography may aid detection of intravitreal cilia and thus alter clinical management.
Optic disc haemorrhages and vascular abnormalities in a glaucoma population
Authors: Barry CJ , Cooper RL , Eikelboom RH
Published: November 2007

Purpose: To retrospectively examine the optic disc photographs of a glaucoma population for optic disc haemorrhages, vascular occlusions and vascular abnormalities.

Methods: The optic disc photographs of 906 eyes of glaucoma and suspect glaucoma patients were examined. Optic disc photographs were taken annually, where possible, with the follow‐up period varying between 1 and 14 years duration (mean, 2.89). Glaucoma patients are regularly reviewed every 4–6 months and glaucoma suspects every 1–2 years, depending on the ophthalmologist. Low‐tension glaucoma patients were reviewed more frequently (mean, every 2.6 months). The results of the findings were compared to a control group of 39 subjects with a mean follow‐up period of 7 years, using Fisher's exact test.

Results: It was found that during the period under review, 7.4% (n= 67) of eyes had optic disc haemorrhages. The highest frequency of optic disc haemorrhages (37.5%) was found in the low tension glaucoma group (P= 0.0001) followed by 11.4% of primary open‐angle glaucoma eyes (P= 0.03). In the normal group there were three eyes with optic disc haemorrhages and one with a disc collateral, which constitutes 5.1% vascular changes in this sub‐group.

Of the study eyes 2.8% had central retinal vein occlusions, 1.3% branch vein occlusion, 1.2% disc vessel abnormalities (loops) and 1.1% disc collaterals. Discrete nerve fibre layer haemorrhages and microaneurysms were found in 0.8% and 1.8% of eyes, respectively.

Conclusions: A total of 16.8% of the eyes observed in this study had either disc haemorrhages or vascular changes. The underlying trend of vascular and haemorrhagic changes in glaucoma are demonstrated in this sample, which is in general agreement with previous studies. The high percentage of optic disc haemorrhages in low tension glaucoma is highlighted. The presence of microaneurysms and nerve fibre layer haemorrhages is interesting but of unknown significance.
Acute ocular methanol toxicity: Clinical and electrophysiological features
Authors: McKellar Malcolm J. , Hidajat Rudy R. , Elder Mark J.
Published: November 2007

Purpose: The present report describes previously undocumented changes in the electroretinogram (ERG) and visualevoked response (VER) following acute methanol ingestion and highlights the ocular effects of methanol poisoning.

Methods: Two cases of acute ocular damage following methanol ingestion are presented. One patient underwent extensive electrophysiological and psychophysical testing.

Results: Both patients reported transient visual disturbances. In each patient vision was 6/6 in both eyes at presentation but subsequently improved to 6/4. Colour vision (Ishihara plates) and pupiliary reactions were normal. The optic discs were hyperaemic and swollen and retinal oedema extended along the major vascular arcades. There was cystoid macular oedema and ‘pseudo cherry red spots’ were observed. Automated field analysis revealed a generalized depression of retinal sensitivity, an enlargement of one blind spot and paracentral scotomas. The scotopic ERG was subnormal with diminished a‐ and b‐waveforms and the cone response to flicker was reduced. The pattern VER P2 waveform was normal in latency but decreased in amplitude.

Conclusions: Acute methanol ingestion can cause characteristic ocular damage, together with widespread electrophysiological dysfunction. The data presented suggest that methanol affects the photoreceptors, Muller cells and the retrolaminar portion of the optic nerve.
Retrospective study of ocular surface squamous neoplasia
Authors: Lee Graham A , Hirst Lawrence W
Published: November 2007

Background: Ocular surface squamous neoplasia (OSSN) encompasses the conditions of simple dysplasia to carcinoma in situ to invasive squamous cell carcinoma. It has a high rate of recurrence after treatment and the potential to metastasize. The present retrospective study was aimed at further defining the characteristics and clinical course of OSSN.

Methods: With ethical approval, the records of all major pathology laboratories in Queensland were surveyed. Two hundred and eighty‐eight cases were identified: 155 dysplasia, 71 carcinomas in situ and 62 invasive squamous cell carcinoma. The records were analysed and an attempt was made to contact and re‐examine the patients.

Results: Ocular surface squamous neoplasia occurs mainly in males (78.5%) with a mean age of 60.1 years (range 20–88 years). They present as irritation (40.1%) and are located usually at the limbus (87.8%). The majority of OSSN are treated by simple excision (87.5%), after which there is a high rate of recurrence (23.3%). The main predictors for recurrence include histological grade of the lesion, corneal location and larger size (> 2 mm).

Conclusions: Management of OSSN requires adequate excision and careful follow up to monitor any recurrence. As with other ultraviolet light‐related conditions, preventative measures must remain the key to disease control.