bluuebunny/crossref_metadata_2025 huggingface dataset:
Problems of deep foveas
Authors: Locket N A
Published: November 2007

Deep or convexiclivate foveas occur in some birds, including raptors, some lizards and certain deep‐sea fishes. Theories on their function are reviewed. Common to raptor and deep‐sea fish foveas is a radial fibre lining, dark staining so probably optically dense, adjacent to the less refractile vitreous. The foveal curvatures and size are remarkably similar in a wide taxonomic and size range of birds and fishes.

Ray plotting through traced foveal outlines suggests that sharp images will be formed beneath the centre and shoulders, with the centre image enlarged enough to account for the high acuity of raptors. Deep foveas will also exaggerate eccentricity of off‐centre images of a point source, such as deep‐sea fishes may meet.

Despite similarities in foveal shape, the receptors differ widely between species. Raptors, and notosudid fishes, have short cones. Searsid fishes have long single rods. Howella and Bajacalifornia have multiple bank rods, more in the fovea than the periphery. Those of Howella are shown to be multiple inner‐outer segment complexes rather than interrupted single rods. Implications of foveal and receptor features are discussed.
Paediatric dacryocystorhinostomy
Authors: Elder Mark J
Published: November 2007

The results of 95 dacryocystorhinostomy procedures in 78 paediatric patients are reviewed. The success rate was 77%. Factors influencing success and failure are discussed.
Phenotypic similarities between Stargardt's flavimaculatus and pattern dystrophies
Authors: Lopez Pedro F. , Aaberg Thomas M.
Published: November 2007

Some heredomacular diseases share ophthalmoscopic and morphologic similarities despite being nosologically distinct. In part, this may arise from pathologic reaction patterns such as lipopigment accumulation and drusen deposition which are common to a variety of disorders of the photoreceptor—retinal pigment epithelium—Bruch's membrane complex. Two of these disorders, Stargardt's flavimaculatus and the pattern dystrophies of the retinal pigment epithelium may be especially difficult to differentiate clinically since they are characterised by both a similar ophthalmoscopic appearance and considerable inter and intrafamilial variation in their expression. Stargardt's flavimaculatus may, however, be distinguished from the retinal pigment epithelial pattern dystrophies by certain clinical and morphological features that are outlined below.
An abbreviated assessment of ocular exposure to ultraviolet radiation
Authors: Taylor Hugh R , Muñoz Beatriz , Rosenthal Frank S , West Sheila
Published: November 2007

Individual behaviour has a very large effect on determining the exposure of the eye to solar radiation. To be able to examine the relationship between ocular exposure to ambient ultraviolet radiation and ocular disease, a model was developed previously that assessed cumulative ocular exposure from individual information on work and leisure activities. In this paper, we present a simplified version of the model that uses data on exposure during the middle of the day (9 a.m. to 3 p.m. solar time) during the northern ‘summer’ months (April to September). The ocular exposure determined by the simplified model is highly correlated with the full model (r=0.98) and the simplified model predicts 62% of the total ocular exposure. This model should be useful for future epidemiologic studies of sun exposure and eye disease.
Limbal nodules in Sweet's syndrome
Authors: Davies Rodger
Published: November 2007

Sweet's syndrome is acute febrile neutrophilic dermatosis. Conjunctivitis and episceritis have been described with it before. A case of Sweet's syndrome, described here, was found to have limbal nodules with histology similar to the skin lesions. This is the first report of this association.
Laser photocoagulation treatment of choroidal melanoma
Authors: Qiang Zhao , Cairns James D.
Published: November 2007

Ten cases of choroidal melanoma were treated with Argon and/or Krypton laser photocoagulation in this retrospective study. Each patient received an average of 9.6 laser treatment sessions. Three female and seven male patients were treated and followed for an average of 69.9 months. Clinical regression was observed in seven cases (70%).

Tumour size in these successfully treated cases ranged from 4.5 times 5.0 times 1.5 mm to 7.0 times 7.0 times 3.5 mm. Continued growth occurred in one case (10%), tumour recurrence which failed to respond to additional laser treatment in another (10%), and although a recurrence appeared to respond to additional laser in a third case (the largest tumour in the series 11.0 times 9.0 times 2.5 mm) extraocular extension was found at enucleation (10%).

Complications of laser treatment included cystoid macular oedema (Case 5), branch retinal vein occlusion (Cases 3 and 6), vitreous haemorrhage from neovascularisation at the edge of the scar, optic atrophy and thrombotic glaucoma (Case 8), and macular involvement by laser (Cases 4, 7 and 10). All patients remain alive without any clinical evidence of metastatic disease at the end of the follow‐up period.

These results suggest that laser photocoagulation treatment is a useful option in the management of small choroidal melanomas. It avoids the psychological trauma of enucleation, and maintains some vision, without compromising life expectancy.
Suppurative corneal ulceration in Bangladesh
Authors: Dunlop AAS , Wright ED , Howlader SA , Nazrul I , Husain R , McClellan K , Billson FA
Published: November 2007

Suppurative keratitis is an important preventable cause of blindness, particularly in the developing world. This study analyses 142 cases of suppurative keratitis referred to Chittagong Eye Infirmary, Bangladesh. Some 53.5% of cases were bacterial and 35.9% were fungal. The five most common pathogens were: Pseudomonas sp. 24%, Streptococcus pneumoniae 17%, Aspergillus sp. 13%, Fusarium sp. 7% and Curvularia sp. 6%. Gram stain and culture results were consistent in 62.6% of cases. Previous antibiotic treatment was a significant factor for failure of culture isolation and less so for Gram stain failure. On Gram stain, 55.9% of pseudomonal cases were missed, but only 2% of fungal cases were missed. Over all, Gram stain had a sensitivity of 62% and positive predictive value of 84% for bacterial cases, and 98% and 94% for fungal cases, respectively. Fungal ulcers were typically filamentous, but an antecedent history of trauma was not common. The most frequent injury was due to rice grains, but the inoculum appeared to be introduced during eye washing with contaminated water. Pseudomonal ulcers occurred most frequently in the monsoon season, and Fusarium cases were seen only in the hot, dry season.
Uveal effusion syndrome
Authors: Stelmach Maryla Z , O'Day Justin , Ryan Hugh
Published: November 2007

The history and clinical findings are presented of a patient who suffered from the uveal effusion syndrome over a 10‐year period from 1956. The funduscopic appearance is illustrated both at the time of initial presentation and 36 years later. This condition typically affects healthy middle‐aged men and causes recurrent, spontaneous, serous retinal and ciliochoroidal detachments, often resulting in significant visual impairment. Two separate hypotheses have been postulated to explain the pathogenesis of the uveal effusion syndrome, one relating to abnormally thickened sclera, the other to chronic bulbar hypotony. Both are discussed, as is the rationale behind the current management of this unusual condition.
Automated extraction and quantification of macular drusen from fundal photographs
Authors: Morgan William H , Cooper Richard L , Constable Ian J , Eikelboom Robert H
Published: November 2007

The objective quantification of drusen (and other macular lesions) should have applications epidemi‐ologically, in the study of the natural history of drusen, and with such instruments as the scanning laser ophthalmoscope. The automated extraction of drusen from photographs is technically difficult because of uneven macular reflectance, and the confusing pattern of darker vessels. We have developed a method using an IBM personal computer, an image digitising board and specially written software. Once the image is digitised, no further input from the operator is necessary. We present the results of manual counting versus automated counting on a small series of patients with drusen. The automated technique is highly reproducible, and will calculate the retinal area occupied by drusen. The area and numbers of drusen can be compared over time, giving an index of progression. Hard drusen are fairly well detected, but the detection of soft drusen with their lower contrast remains a problem. The technique cannot distinguish between drusen and other pale lesions (e.g., atrophic retinal changes).
Congenital lower eyelid deformity with trichiasis (epiblepharon and entropion)
Authors: O'Donnell Brett A , Collin J Richard O
Published: November 2007

A series of 43 patients with congenital lower eyelid malposition and trichiasis (epiblepharon and entropion) is presented with clinical findings, family history, approach to management and results of treatment. The average age of patients was 9.3 years. A family history was present in 21 %, and 30% had at least one parent of Oriental extraction. Thirty‐nine patients underwent surgery for persistent symptoms due to chronic eyelash‐globe contact. The surgical procedures performed were a modified Hotz procedure, Quickert sutures, and Jones‐type retractor plication. Surgery was effective in at least 90% of all procedures.
Retrobulbar botulinum toxin for treatment of oscillopsia
Authors: Ruben Simon , Dunlop Iain S , Elston John
Published: November 2007

Two cases are presented in which multiple episodic retrobulbar botulinum toxin injections have diminished incapacitating acquired oscillopsia and nystagmus and improved visual acuity. One transient ptosis occurred in six procedures. Improvement duration averaged approximately three months. This is a simple, safe and effective therapy where alternative treatments are typically unsatisfactory.
Isolated bulbar conjunctival Kaposi's sarcoma
Authors: Murray Neil , McCluskey Peter , Wakefield Denis , Beaumont Paul
Published: November 2007

We present a case of an isolated bulbar conjunctival Kaposi's sarcoma in a man with HIV infection. This is an unusual site for the initial presentation of Kaposi's sarcoma and in this site can be confused with a caroticocavernous fistula, cavernous haeman‐gioma or chronic subconjunctival haemorrhage. Biopsy is required to confirm the diagnosis in isolated disease. Local radiotherapy is the preferred treatment for isolated Kaposi's sarcoma.
Adult Coats' disease in branch retinal vein occlusion
Authors: Luckie Alan P , Hamilton AM Peter
Published: November 2007

We report a case of adult Coats disease secondary to a branch retinal vein occlusion. Angiograms show the relationship of the peripheral telangiectasis, aneurysm formation and vascular incompetence to the peripheral retinal ischaemia. The possible role of vascular remodelling in the pathogenesis of this uncommon complication of a common condition is discussed.
Ganglion cell death in glaucoma: pathology recapitulates ontogeny
Authors: Quigley Harry A.
Published: November 2007

I review some improvements in our knowledge about the death of retinal ganglion cells in glaucoma during the last 20 years. These include the realisation that glaucoma damage precedes its detection by perimetry, the fact that the lamina cribrosa is a major site of axonal injury to ganglion cells, and the association between regional structure of optic nerve head connective tissue and the pattern of glaucoma damage. The selective susceptibility of larger retinal ganglion cells and its functional significance are described.

Apoptosis is the mode of cell death in at least some ganglion cells in experimental glaucoma. This supports a theory that retrograde axonal transport failure leads to loss of trophic factor influence on ganglion cells, causing them to initiate their own suicide. As a consequence of this theory, two therapeutic avenues are suggested for prevention of glaucoma injury and cell death: delivery of trophic factors and manipulation of ganglion cell genetic expression of controlling influences over programmed cell death.
Patterns of visual loss associated with pituitary macroadenomas
Authors: Poon Alexander , McNeill Peter , Harper Alex , O'Day Justin
Published: November 2007

Purpose: To describe the patterns of visual loss associated with pituitary macroadenomas compressing the anterior visual pathway.

Method: A prospective survey of 29 patients with pituitary macroadenomas who presented to the neurosurgical unit at St Vincent's Hospital, Melbourne. Selected patients had histologically verified pituitary macroadenomas, and visual defects (acuity, colour and/or field loss) consistent with anterior visual pathway compression.

Results: All patients had visual field defects detected on perimetry, and the majority were asymmetrical. Bitemporal defects were most common but field defects ranged from monocular defects to generalised constriction. Four patients (13.8%) did not report visual symptoms, and of those who had symptoms, blurred vision was the most common complaint. Ninety‐six per cent of eyes had field loss, 56% had decreased colour vision, 46% had decreased acuity, 31% had optic disc pallor, and 2% had an ophthalmoplegia.

Conclusions: Patients with visual pathway compression by pituitary macroadenomas may be asymptomatic despite having field defects. Perimetry is the most sensitive method of identifying compression, followed by colour vision, visual acuity, then the presence of optic atrophy. Automated static threshold perimetry appears to show early field defects better than manual kinetic perimetry. All patients with pituitary macroadenomas should have thorough ophthalmological examinations, including perimetry to document visual deficits secondary to compression.
Hydroxyapatite orbital implants Experience with 100 cases
Authors: McNab Alan
Published: November 2007

Background: The hydroxyapatite (HA) intraorbital implant is a relatively new implant made from the porous skeleton of a coral species which allows fibrovascular ingrowth and therefore tissue integration. After fibrovascular ingrowth, a hole can be drilled in the implant and a motility peg inserted to increase movements of the prosthesis by coupling the implant to the prosthesis.

Method: The records of the first 100 cases of HA intraorbital implants inserted by the one surgeon were analysed for complications, pain and nausea postoperatively, length of hospital stay, and further surgical procedures required. A series of acrylic implants inserted by the same surgeon was used for comparison.

Results: Twenty‐five primary and 75 secondary HA implants were performed in patients ranging from six to 74 years of age. All were covered in donor sclera. Follow‐up was three to 34 months (mean 16.9, median 17.0). Complications occurred in 15 patients and included too large an implant (seven cases) requiring surgical reduction, scleral exposure in three (repair required in one), an early small exposure of the coral in one case, late thinning of the conjunctiva and later exposure of the implant in one, and shallowing of the inferior fornix requiring mucous membrane grafting in three. No implants migrated, extruded or became infected. Of 80 patients beyond six months follow‐up, 28 (35%) had insertion of motility pegs, and six (7.5%) of these suffered minor complications related to the peg. Compared to patients having acrylic implants, the postoperative analgesic requirements and length of hospital stay were significantly greater for the HA patients.

Conclusions: Hydroxyapatite intraorbital implants represent a significant advance over other implants and offer a more stable, safe alternative. They also offer the possibility of improved prosthesis motility. The additional cost of the implant, prolonged hospital stay and postoperative pain, should be considered in recommending such implants to patients either as primary or secondary implants.
Primary extramedullary plasmacytoma of the orbit
Authors: Aboud Niall , Sullivan Timothy , Whitehead Kevin
Published: November 2007

Background: We report a case of extramedullary plasmacytoma of the orbit. This is a rare tumour which has uncommonly presented in the orbit.

Case report: A 58‐year‐old woman presented with painless proptosis, upper lid swelling and ptosis. Incisional biopsy was performed. Clinical findings and investigations were correlated to establish the diagnosis. Treatment consisted of 35 Gy external beam radiotherapy.

Conclusions: This condition is considered to be of low grade malignancy and as such can be regarded as a separate entity to multiple myeloma involving the orbit or solitary myeloma of bone in terms of treatment and prognosis.
Aspergillus sphenoid sinusitis‐induced orbital apex syndrome in HIV infection
Authors: Lee Lawrence R. , Sullivan Timothy J.
Published: November 2007

Background: Orbital apex syndrome due to aspergillus sphenoid sinusitis is a rare condition. Human immunodeficiency virus (HIV) infection has recently been reported in aspergillus orbital abscess. To the authors' knowledge this is the first reported association of HIV with the orbital apex syndrome.

Methods: A 37‐year‐old HIV‐infected man presented with headache, reduced vision and progressive ophthalmoplegia in the right eye. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed sphenoid sinusitis. Sphenoid sinus biopsy was performed.

Results: Light microscopy revealed infiltrative branching septate fungal hyphae. Fungal culture isolated Aspergillus fumigatus.

Conclusion: Atypical fungal infection such as Aspergillus fumigatus sphenoid sinusitis should be suspected in HIV‐infected patients with orbital apex syndrome.
Malignant glaucoma following laser iridotomy
Authors: Small Keith M. , Maslin Keith F.
Published: November 2007

Background: A 69‐year‐old man presented with malignant glaucoma 10 days after an iridotomy for acute angle‐closure glaucoma.

Methods: The case notes are reviewed, describing his presentation and treatment, including the technique of extracapsular cataract extraction with anterior vitrectomy.

Results: An excellent visual outcome was achieved with no recurrence of the malignant glaucoma.

Conclusions: This case illustrates the recently established link between laser iridotomy and malignant glaucoma. Miotics and other possible causes are excluded, a surgical option is described and the importance of assessing central anterior chamber depth in cases of angle closure is emphasised.
The role of free radicals in disease*
Authors: Florence T M
Published: November 2007

Evidence is accumulating that most of the degenerative diseases that afflict humanity have their origin in deleterious free radical reactions. These diseases include atherosclerosis, cancer, inflammatory joint disease, asthma, diabetes, senile dementia and degenerative eye disease. The process of biological ageing might also have a free radical basis. Most free radical damage to cells involves oxygen free radicals or, more generally, activated oxygen species (AOS) which include non‐radical species such as singlet oxygen and hydrogen peroxide as well as free radicals. The AOS can damage genetic material, cause lipid peroxidation in cell membranes, and inactivate membrane‐bound enzymes. Humans are well endowed with antioxidant defences against AOS; these antioxidants, or free radical scavengers, include ascorbic acid (vitamin C), α‐tocopherol (vitamin E), beta‐carotene, coenzyme Q10, enzymes such as catalase and superoxide dismutase, and trace elements including selenium and zinc. The eye is an organ with intense AOS activity, and it requires high levels of antioxidants to protect its unsaturated fatty acids. The human species is not genetically adapted to survive past middle age, and it appears that antioxidant supplementation of our diet is needed to ensure a more healthy elderly population.
Molteno implant surgery for advanced glaucoma
Authors: Thomas Ravi , Gieser Stephen C. , FRACO Frank Billson
Published: November 2007

Purpose:
The use of adjunctive antimitotics with conventional filtering surgery appears to have decreased the need for Molteno implants in glaucomas with a poor prognosis. We review the current status, results and complications of Molteno implants.

Methods:
Review of the literature and practical experience from two university departments of ophthalmology.

Results:
Improvements in the design and surgical techniques for Molteno implants have decreased the incidence of over filtration, but this and other complications continue to pose problems. Increased success rates may be possible if antimitotics are used with Molteno implants.

Conclusion:
Molteno implants continue to be an option when conventional filtration with or without antimitotics has failed: they continue to be regarded as a last resort for filtration. The use of antimitotics to increase the success rate of Molteno implants is not proven, but merits further investigation.
Betaxolol eye drops: A clinical trial of safety and efficacy
Authors: BS Ivan Goldberg MB , BS Hazel Goldberg MB
Published: November 2007

Objective:
To study the cardiopulmonary safety and ocular hypotensive efficacy of topical betaxolol hydrochloride 0.5% (a selective beta‐1 blocker) in patients with unacceptably elevated intraocular pressure (IOP) and respiratory dysfunction.

Methods:
Thirty‐one patients with poor control of elevated IOP were selected on the basis of coexistent respiratory disease which could be exacerbated by beta‐antagonist administration and/or who had past adverse reactions to topical timolol. Using an open‐label design, the ophthalmic, cardiovascular and pulmonary parameters of these patients were measured before betaxolol therapy, for four hours immediately after the first administration of the drug, and after one, four and 12 weeks of therapy. The screening and 12‐week examinations included a bronchial challenge with methacholine, a non‐specific bronchoconstricting agent.

Results:
IOP reduction was significant at all time points measured after first instillation of betaxolol, with a mean maximum fall of 8.4 (SD, 3.2) mmHg (95% Cl ‐9.545 to ‐7.261) from a baseline mean IOP of 23.9 (SD, 3.8) mmHg. Over 12 weeks of therapy, the mean reduction from baseline in IOP was 3.9 (SD, 2.6) mmHg (95% Cl ‐4.908 to ‐2.988). After first instillation of betaxolol, mean arterial pressure (MAP) fell transiently to a mean maximum fall of 3.9 (SD, 9.3) mmHg (95% Cl ‐7.159 to ‐0.582), from a mean baseline MAP of 107.7 (SD, 9.4) mmHg. Heart rate did not change. There were no changes in any of the respiratory parameters measured: forced expiratory volume in one second, forced vital capacity and peak expiratory flow rate. Over 12 weeks of betaxolol therapy, there were no changes in any of the above systemic parameters and no change in mean bronchial reactivity as measured by methacholine challenge. Of the 31 patients, who included 13 patients with previous intolerance to timolol (a non‐selective beta‐antagonist), only one showed intolerance to betaxolol.

Conclusions:
Betaxolol appears to be an effective and well tolerated ocular hypotensive agent in a typical glaucoma population, which includes many patients with cardiopulmonary disease. Individual intolerance to betaxolol will continue to occur and care is always required when patients with cardiac or respiratory dysfunction are exposed to any beta‐antagonist.
Sporadic Leber hereditary optic neuropathy in Australia and New Zealand
Authors: Chan Christopher , Mackey David A. , Byme Edward
Published: November 2007

Background:Leber hereditary optic neuropathy (LHON) is one of the more common forms of hereditary optic neuropathy and one of the few mitochondrial neuropathies. Prior to the advent of molecular DNA testing, the diagnosis depended on the recognition of typical fundal changes, as well as a family history of maternal transmission. Sporadic cases were therefore diagnosed with a level of uncertainty. The aim of this study is to identify the proportion of patients with idiopathic bilateral optic neuropathy/atrophy who are suffering from LHON.

Methods:Requests were sent to all ophthalmologists and neurologist in Australia and New Zealand for blood or hair follicle samples of patients with diagnosis of bilateral optic neuropathy/atrophy of uncertain aetiology for DNA testing by restriction endonuclease analysis.

Results:One hundred and fourty‐four samples were received, of which 96 were sporadic cases of idiopathic optic atrophy. Eleven of these sporadic patients were found to harbour pathogenetic mitochondrial point mutations associated with LHON.

Conclusions:Our results indicated that 11% of patients with bilateral optic neuropathy/atrophy of uncertain aetiology are suffering from LHON. Comparing this data with all the known familial cases of LHON, we report that at least 8% of all LHON cases in Australia are sporadic. We concluded that mtDNA testing for LHON in patients with idiopathic optic atrophy should be included in the initial laboratory work‐up.
AIDS and the eye A 10‐year experience
Authors: Maclean Hector , Hall Anthony JH , McCombe Mark F. , Sandland A Murray
Published: November 2007

Background:The AIDS database at Fairfield Hospital, Melbourne, maintains information on eye pathology as identified by the three visiting ophthalmologists. Patients underwent an eye consultation: if they had ocular symptoms; if signs were seen on direct ophthalmoscopy by physicians; or when their CD4+ve cell count fell below 50/μL. The first AIDS‐associated eye signs were identified in mid‐1984. In the subsequent decade, 3257 patients in Victoria tested positive for HIV, and 845 of the 1123 who developed AIDS were treated at Fairfield Hospital.

Methods:We undertook a retrospective review of the Fairfield Hospital database to identify the AIDS‐associated ocular problems seen.

Results:Some 723 patients had an eye consultation. In the earliest stage of HIV infection, minor non‐specific ophthalmic involvement may occur. As the disease progresses, microvasculopathy (cottonwool spots and haemorrhages) appears. External disease also occurs such as molluscum contagiosum and Kaposi's sarcoma of the conjunctiva. With more suppression of the immune system, opportunistic infections become common, and have a considerable visual morbidity. Cerebral toxoplasmosis (117 patients) is only rarely associated with ocular involvement (three patients), but cytomegalovirus (CMV) commonly causes retinitis [204 patients (24%)]. It has been the AIDS‐defining illness in 26 patients. A majority had the disease confined to one eye. Mean CD4 cell count at onset is 15±5 μL and it has been associated with a viraemia in all but two patients. Late complications of CMV retinitis include relapse in 41 (20%), spread to the other eye in 24 (12%), and retinal detachment in 30 (15%). Visual impairment follows from retinal destruction, optic nerve involvement, and retinal detachment.

Conclusion:The ophthalmic workload from late ocular complications of AIDS is increasing. Newer and more effective methods of treatment are being developed. Ophthalmologists are becoming more aware of the need for universal precautions to avoid risks from this and other blood‐borne infections.
Oedipism
Authors: Aung Tin , Yap EngYiat , Fam Han Bur , Law Ngai Mun
Published: November 2007

Background: Oedipism or self‐enucleation is a rare form of self‐mutilation, and most often described in acutely psychotic patients, who have religious or sexual delusions.

Clinical record: A 47‐year‐old Chinese man with a history of chronic schizophrenia enucleated his own left eye and mutilated his right eye. The reason for his behaviour was unknown. The history and legends surrounding autoenucleation and the medical literature are reviewed.

Results: The patient was managed jointly with the psychiatrist. He suffered extensive injury to his right eye, resulting in loss of vision.

Conclusion: The management of Oedipism requires close cooperation between ophthalmologists and psychiatrists. Precautions must be taken to prevent repeated attempts or other self‐mutilatory behaviour.
Molecular genetics of central retinal dystrophies
Authors: Moore Anthony T. , FRCOphth Kevin Evans MD
Published: November 2007

A range of chorioretinal dystrophies that principally affect the central retina have recently been associated with either specific genetic mutations or mapped to refined genomic loci. Mutations of two genes, peripherin/RDS (chromosome 6p) and TIMP3 (chromosome 22q) have been shown to be of particular importance to this group of disorders. Other conditions such as Stargardt's disease, Best's disease, pattern dystrophy, cone dystrophy and cone‐rod dystrophy have been mapped to different regions of the genome, however the underlying genetic mutations await identification. Molecular genetic diagnostic techniques are now available for a number of central choroidoretinal dystrophies allowing for earlier, accurate diagnosis and laying the groundwork for future studies of potential therapeutic protocols.
Perimetric and angiographic effects of retinotomy
Authors: Bourke Robert D. , Dowler JGF , Milliken AB , Cooling RJ
Published: November 2007

Aim: We sought to characterise the morphological and functional effects of drainage retinotomy on the vascular, neural, subretinal and epiretinal components of the affected retina.

Patients and methods: Following successful retinal reattachment surgery involving drainage retinotomy in 15 cases (retinotomy group) and no retinotomy in 14 cases (control group), the existence, nature and quadrantic area of visual field loss to a white III4e target was determined using kinetic Goldmann perimetry. Vascular alterations were characterised using fluorescein angiography with peripheral sequences.

Results: Visual field defects within 30° of fixation were present in 12 of 14 (86%) of the retinotomy group (including all eyes in which the retinotomy was sited within five disc diameters of fixation) and none of the control group (Fisher exact test, P=0.00005). Following superonasal retinotomy, inferotemporal field area (median area 82 units, range 44 to 128) was approximately half that following superotemporal retinotomy (median area 167 units, range 119 to 192) (Wilcoxon's ranksum P=0.003). No vascular abnormalities distal to the retinotomy were identified, although subretinal neovascularisation (two eyes) and epiretinal membrane formation (one eye) occurred at the retinotomy site.

Conclusion: We recommend that where possible subretinal fluid be drained via existing breaks, and if retinotomy is necessary, that it should be sited more than five disc diameters from fixation in the superotemporal quadrant to minimise visual field loss.
Weill‐Marchesani syndrome complicated by secondary glaucoma: Case management with surgical lens extraction
Authors: Taylor J Norton
Published: November 2007

Background: A case of the rare Weill‐Marchesani syndrome is presented with characteristic spherophakia, lenticular myopia and secondary glaucoma. The difficulties of management are described.

Methods and results: Following failure of conservative medical treatmen't with timoptol, pilocarpine drops and diamox; laser iridotomies temporarily improved but did not halt progress of the glaucoma. Ultimate removal of the lens was required adequately to control the tensions, although this surgical procedure proved hazardous.

Conclusions: The difficulties of management in the Weill‐Marchesani syndrome as reported in the literature, are confirmed in this case. Surgical removal of the lens to control the glaucoma may ultimately be the only option, but this procedure can be hazardous with vitreous loss and other complications to be expected.
Surgery for refractory glaucoma
Authors: Kitazawa Yoshiaki , Yamamoto Tetsuya , Sawada Akira , Hagiwara Yoko
Published: November 2007

Purpose:To determine the surgical outcome of mitomycin trabeculectomy in patients with refractory glaucoma.

Methods:Sixty‐six eyes of 52 patients with refractory glaucoma underwent mitomycin trabeculectomy. Mitomycin was applied for five minutes only once during trabeculectomy. The follow‐up period was six to 61 months.

Results:Cumulative success probability was calculated using Kaplan‐Meier life‐table analysis assuming the cut‐off postoperative IOP to be 20 mmHg or IOP reduction by at least 20% in eyes with preoperative IOP 24mmHg. At the end of 61‐month follow‐up the success probability was 80%± 6% without postoperative ocular hypotensive medication (complete success) and was 95%± 3% regardless of postoperative antiglaucoma medication (overall success), respectively.

Conclusion:The data suggest that mitomycin trabeculectomy is efficacious in reducing IOP in patients with refractory glaucoma.
Retinal detachment caused by retinal dialysis
Authors: Kennedy CJ , Parker CE , McAllister IL
Published: November 2007

Purpose:

To determine the characteristics of patients developing retinal detachment secondary to retinal dialysis in Western Australia and to confirm the clinical impression that these patients had a low rate of proliferative vitreoretinopathy (PVR).

Methods: A retrospective analysis of the records of 1601 consecutive patients with rhegmatogenous retinal detachment identified 71 patients in whom the retinal detachment was caused by a retinal dialysis.

Results: The majority of these patients were young adults (mean age of 30 years) and the male to female ratio was 1.3: 1. Seventy percent of patients provided a history of significant trauma to the affected eye. Sporting injuries, assault, and motor vehicle injuries together accounted for 72% of identifiable trauma. Examination revealed a dialysis of the inferotemporal quadrant in 75% of cases and despite obvious signs of chronicity of the associated retinal detachment (such as intraretinal macrocysts and demarcation lines) in approximately one‐third of the eyes, only 5.6% developed grade C1 PVR either pre‐ or postoperatively.

Conclusion: The present study supports the view that it is the low rate of PVR that explains the good prognosis and high surgical success rate for retinal detachments caused by retinal dialysis. It is postulated that a major reason for the low rate of PVR is that the vitreous base attachment to the posterior margin of a retinal dialysis acts as a significant barrier to the migration of potentially proliferative retinal pigment epithelial cells. This may lead to containment of the responsible proliferative cells within the loculated subretinal space.
Botulinum toxin in fourth nerve palsies
Authors: Garnham L , Lawson JM , O'Neill D , Lee JP
Published: November 2007

Background: Botulinum toxin A (BTXA) has not been used routinely in the management of fourth nerve (IV N) palsy. However, it is known that the results of surgery can be unpredictable with a risk of over‐ or undercorrection.

Methods: The results were reviewed of 20 patients, aged 19–70 years, with unilateral and bilateral IV N palsies who received BTXA injections to the inferior oblique or inferior rectus muscles. The aetiology was congenital in 12 (60%), traumatic in six (30%), due to myasthenia in one (5%), and unclear in one (5%). Fifty per cent of patients had had previous strabismus surgery to a maximum of four procedures. The mean pre‐injection vertical deviation was 11 prism dioptres. All but two patients had a single injection. Average follow‐up was 19 months.

Results: Ten patients (group 1) received BTXA as a primary therapy. Following inferior oblique injection, six patients received little benefit and went on to surgery (83%) or continued with prisms (17%). Five patients from group 1 who had inferior rectus toxin were discharged symptomfree. Group 2 (10 patients) received BTXA for residual deviations postoperatively; in this group all except one patient with no fusion achieved long‐term benefit following inferior rectus BTXA. In those who had inferior oblique injections, BTXA was useful in one patient (25%). Inferior rectus injection produced a greater chance of temporary reversal of the deviation.

Conclusions: BTXA is of greatest benefit in patients with residual deviations particularly when the inferior rectus is injected, but is of limited value as a primary therapy in chronic IV N palsy.
Penetrating eye injuries in rural New South Wales
Authors: Thompson CG , Griffits RKS , Nardi W , Tester MP , Noble MJ , Cottee L , Weir P
Published: November 2007

Purpose: To determine the epidemiology and outcomes of penetrating eye injuries in a rural Australian setting.

Methods: A retrospective study of an 11 year period to identify 77 cases of penetrating eye injury in Lismore, New South Wales.

Results: The commonest cause of penetrating eye injury was fencing wire followed by hammering metal. The average age was 32.6 years, and males were involved in 88% of cases. A final visual acuity of 6/12 or better was achieved in 61% of cases. Enucleation was performed in 14%. Visual outcome was best for wounds involving the cornea only.

Conclusions: Penetrating eye injuries are potentially devastating to vision, but with modern surgical techniques patients are likely to achieve reasonable vision. Prevention requires education to ensure adequate protective measures are taken in potentially hazardous settings.
Intracapsular cataract extraction: Experience of a general surgeon in Niger, West Africa
Authors: Chew A
Published: November 2007

Background:

Cataract is the major cause of blindness in the world and affects an estimated 20 million persons globally. In Africa, there is an incidence of half a million new cases of cataract blindness annually, with a backlog of 3 million persons requiring sight‐restoring surgery. The burden of this form of curable blindness resides mainly in less developed nations, which typically have limited numbers of ophthalmologists and medical resources. The experience and results of a general surgeon working in rural West Africa, without prior ophthalmic skills but with limited training in the field, are reported.

Methods: Data on all consecutive planned intracapsular cataract extractions performed between January 1994 and July 1995 inclusive were collected prospectively and the visual outcome as well as surgical complications were analysed.

Results: A total of 243 planned intracapsular cataract extractions were performed. Data were incomplete or missing in five cases leaving 238 for analysis. All the patients were blind pre‐operatively, with visual acuities of 3/60 or less. Functional vision (6/60 or better) was restored in 95% of all cases.

Conclusions: General surgeons can be satisfactorily trained in the art of intracapsular cataract extractions, with good visual outcomes. This is very useful in the setting of undeveloped countries where there are severe limitations of resources, and the recruitment of trained general surgeons will help reduce the burden of curable blindness in these regions.
Changing indications for penetrating keratoplasty: A newly developed country's experience
Authors: Wong TY , Chan C , Lim L , Lim T , Tan DTH
Published: November 2007

Purpose: To study the changing indications for penetrating keratoplasty in Singapore and compare local indications with developed countries with established corneal graft programs.

Methods: A descriptive study of all penetrating keratoplasty cases performed in the Singapore National Eye Center over a 5 year period, from 1 January 1991 to 31 December 1995 using records of the Singapore Eye Bank registry.

Results: A total of 327 penetrating keratoplasties were performed. Bullous keratopathy was the indication in more than a quarter of all cases (26.3%). Aphakic bullous keratopathy (11.6%) and pseudophakic bullous keratopathy (11.3%) accounted for the majority of the bullous keratopathy cases. The other leading indications were: regrafts (11.9%), corneal dystrophies (10.4%), traumatic scarring (10.1%) and keratoconus (9.8%). A higher proportion of aphakic and pseudophakic bullous keratopathy as well as regrafts was noted in this series, compared to a previous report on corneal transplantation in the 1980s. A rising indication rate of pseudophakic bullous keratopathy, in conjunction with a declining indication rate of herpetic keratitis was observed over the 5 year study period.

Conclusions: The indications for penetrating keratoplasty in Singapore appear to follow the trend seen in developed Western countries over the past few decades.
Profile of ocular trauma in Papua New Guinea
Authors: Verma Nitin , Verma Anu , Jacob George , Demok Steven
Published: November 2007

Background: Ocular trauma is a significant cause of blindness in Papua New Guinea (PNG). This study was done to determine the pattem and rates of ocular and adnexal injuries so as to determine the size and extent of the problem.

Methods: A retrospective study of 4157 cases presenting with ocular trauma in three regions of PNG was carried out. The data were analysed with respect to the age, sex, province, type and cause of injury, time interval between injury and presentation to the hospital and the final visual outcome after treatment.

Results: Ocular trauma rates in PNG were alarmingly high (39.1 per 100 000). The commonest cause of injury in the younger age group was due to lime. Alcohol‐related violence and fights resulted in injuries in the adult age group. Most of the injuries were grievous and 60.7% of patients were left with a visual acuity of less than 6/60 in the injured eye. In addition, 78.7% of the patients were under 30 years of age.

Conclusions: Ocular injuries in PNG are an important cause of visual disability. Some specific injuries, such as those due to lime in children, can easily be prevented by health education.
Pythium insidiosum keratitis
Authors: Murdoch D , Parr D
Published: November 2007

A case of Pythium insidiosum keratitis is described. It is an unusual organism that is difficult to isolate. Cases in animals and humans have been reported from tropical and subtropical parts of the world but this is the first case from a temperate region and was acquired from a hot pool. Although resembling a fungus, it is insensitive to all antifungals and requires wide surgical excision for cure.
Human papillomavirus in corneal and conjunctival carcinoma
Authors: Tabrizi Sepehr N. , McCurrach Fiona E. , Drewe Ross H. , Borg Anthony J. , Garland Suzanne M. , Taylor Hugh R.
Published: November 2007

Purpose: To investigate the role of human papillomavirus (HPV) types 6, 11, 16 and 18 in corneal and conjunctival carcinoma, we examined 88 dysplastic corneal and conjunctival specimens and 66 controls that had been formalin‐fixed and paraffin‐embedded.

Methods: Sections were graded for histological abnormality by light microscopy and the presence of HPV DNA was determined by polymerase chain reaction using LI consensus primers.

Results: Human papillomavirus DNA was detected in 34 (39%) dysplasias and in five (7.5%) controls. Of dysplasias that were HPV‐positive, 20 (59%) contained either types 16 or 18, 13 (38%) contained only types 6/11, while combinations of HPV types were present in 11 (32%). A histological correlation was found with HPV positivity (all genotypes) and unusually large (‘epithelioid’) dysplastic cells.

Conclusion: The present study demonstrates a lower incidence of HPV in corneal and conjunctival carcinoma than previously reported, but shows an unexpectedly high incidence of HPV 6/11 in conjunctival carcinomas.
Spectrum of sarcoidosis involving the eye and brain
Authors: Ghabrial Raf , McCluskey Peter J. , Wakefield Denis
Published: November 2007

Purpose: To illustrate the spectrum of sarcoidosis involving the eye and brain and the difficulties of confirming its clinical diagnosis

Methods: The presentation of two unusual case reports of patients with ocular and cerebral involvement with sarcoidosis.

Results: Tissue biopsy, an essential component in the differential diagnosis, was required to confirm the diagnosis of sarcoidosis in each patient.

Conclusions: Sarcoidosis remains an enigmatic disease with protean manifestations and widely differing outcomes.
Delayed microbial keratitis following radial keratotomy
Authors: Lu Yi , Snibson GR
Published: November 2007

Background: We report on the case of a 46‐year‐old female who presented with delayed microbial keratitis 10 years after uncomplicated radial keratotomy.

Methods: The pre‐ and postoperative clinical record was reviewed following her presentation to the Corneal Clinic. Slit‐lamp examination revealed a stromal inflammatory infiltrate at the site of an earlier radial keratotomy incision. The lesion was scraped and a coagulase‐negative Staphylococcus aureus was cultured in enrichment broth.

Results: The keratitis was treated successfully with combination fortified topical antibiotics without loss of vision.

Conclusions: Although microbial keratitis is a well documented complication of incisional refractive procedures, it is rarely encountered as late as one decade after surgery. Patients should be warned of this possibility and the need for prompt treatment.
Intraocular lens materials and styles: A review
Authors: Chehade Mark , Elder Mark J
Published: November 2007

Biomaterial science has lead to the development of a variety of foldable intraocular lens (IOL) biomaterials. This literature review examines these lenses from both a basic science and a clinical perspective. By most parameters, hydrogel, soft acrylic and silicone IOL are better than polymethylmethacrylate (PMMA) lenses.

Plate haptic silicone IOL have the lowest incidence of cystoid macula oedema and posterior capsule opacification, but these lenses require an intact anterior capsularhexis and posterior capsule. Yttrium aluminium garnet (YAG) laser capsulotomy must be delayed at least 3 months to avoid posterior lens dislocation. Silicone has the lowest threshold for YAG laser damage of all IOL materials and also adheres irreversibly to silicone oil with subsequent optical impairment. Three piece silicone IOL with polypropylene haptics have a higher incidence of decentration, pigment adherence and capsule opacification compared with PMMA haptics. Hydrogel lenses are very biocompatible and resistant to YAG laser damage, but pigment adheres to the surface more readily than PMMA. Soft acrylic IOL unfold slowly, resulting in controlled insertion, but it is possible to crack the lens and some lenses develop glistenings due to water accumulation.

There are significant socioeconomic implications to the large differences in posterior capsule opacification rates between the various biomaterials and the lens styles.
Keratoprosthesis results in animals: An update
Authors: Hicks CR , Lou X , Platten S , Clayton AB , Vijayasekaran S , Fitton HJ , Chirila TV , Crawford GJ , Constable IJ
Published: November 2007

Background:

The report presented is an update on continuing development work on modified PHEMA core‐and‐shirt KPros in animals.

Methods:

Two variations (improved wet‐eye, and dry‐eye) of a prototype core‐and‐skirt Chirila KPro are described. The clinical success rate on implantation of these versions of the Chirila KPro was assessed.

Results:

It was found that a significant improvement in retention rate was shown in the improved model but that the dry‐eye model failed early in two of the three implanted.

Conclusions:

The significance of the improved strength and the reasons for disappointing results with the early dry‐eye KPros are discussed. Ongoing work is briefly outlined.