bluuebunny/crossref_metadata_2025 huggingface dataset:
THE LEGAL ASPECTS OF MEDICAL DEFENCE
Authors: BOURKE D. J.
Published: November 2007

Defence organisations provide many varied “services” to members. Litigation involving doctors includes giving reports, giving evidence in court for or against the plaintiff or defendant, appearing as a witness at inquiries, e.g. coronial inquiries, and actions against doctors, generally alleging negligence. Patients do not seek treatment with the intent of eventually commencing proceedings. What are the catalysts for a patient commencing legal action or seeking legal advice? What should the doctor do to assist his/her defence? These questions are addressed in the article.
THE EFFECT OF THE NEW ZEALAND ACCIDENT COMPENSATION LEGISLATION ON MEDICAL MALPRACTICE
Authors: POWELL G. G.
Published: November 2007

The New Zealand Accident Compensation Act 1972 and its amending Act of 1982 have substantially altered the attitudes of the law, the medical profession and the public, to personal injury by accident. The element of fault is removed and the uncertainty of the outcome of a claim under adversarial court action no longer exists. Rehabilitation assistance on recovery from injury as well as accident prevention measures are cited in the Act as statutory responsibilities of the New Zealand Accident Compensation Corporation. Mechanisms of dealing with medical malpractice, with illustrative examples from ophthalmic practice, are described. Most such incidents are described as medical misadventure.
Disorders of calcium and bone metabolism
Authors: Evans Richard A.
Published: November 2007

Calcium levels in blood are maintained within narrow limits by parathyroid hormone, acting on kidney, bone and gut. Our understanding of the mechanisms of these actions has increased greatly in recent years, for example by identification of new hormones (eg 1,25 dihydroxy vitamin D) and by the study of isolated bone cells. Though most clinical disorders of calcium metabolism are now readily diagnosed and many are effectively treated, some serious problems still remain. Foremost amongst these are the early diagnosis of osteoporosis and the treatment of osteoporosis after fractures have occurred. Most disorders of calcium metabolism have ophthalmologic manifestations, sometimes troublesome to the patient, and sometimes diagnostically helpful.
Surgical technique for ptosis repair
Authors: Wobig John L.
Published: November 2007

There are many choices of operation for ptosis repair, but proper classification, diagnosis and an understanding of eyelid anatomy are essential. The anterior levator resection is recommended for ptosis repair with levator function, and fascia lata suspension is described for ptosis repair when no levator function is present.
Alport's syndrome and the eye
Authors: McCartney P. J. , McGuinness R.
Published: November 2007

Alport's syndrome comprises hereditary deafness, nephritis and ocular abnormalities. The features of Alport's syndrome are illustrated by a family with Alport's syndrome and hereditary oesophageal leiomyomatosis. The evidence that Alport's syndrome is due to a widespread basement membrane disorder is noted. Treatment of anterior lenticonus, the principal ocular abnormality, by lensectomy and intraocular lens insertion is recommended.
Blindness in leprosy—a forgotten complication
Authors: Ffytche Timothy
Published: November 2007

Leprosy remains one of the world's major blinding diseases and yet few ophthalmologists are aware of the spectrum of ocular complications. Cross‐sectional studies of the eye changes in leprosy patients, made under standardised conditions, have been carried out in 24 different leprosy centres throughout the world and the preliminary results are presented. They show that up to 20% of leprosy patients develop sight‐threatening lesions and between 5% and 7% are blind (depending on the definition of blindness). Visual impairment in leprosy needs special consideration by leprologists and ophthalmologists, not only because much of it is preventable, but also because it is a severe burden to be added to the problems of mobility and social stigma that characterise this ancient disease.
Pseudophakic retinal detachment after YAG laser capsulotomy
Authors: Tasman William
Published: November 2007

Eighteen eyes that developed pseudophakic retinal detachment after YAG laser capsulotomy were reviewed. There did not appear to be any relationship to the energy used, or the size of the capsulotomy. The majority of eyes had only one retinal break and these were located superior‐temporally two‐thirds of the time. High‐risk characteristics for post‐YAG retinal detachment included high myopia, lattice degeneration, and retinal detachment in the fellow eye.
Management of human keratomycosis with miconazole
Authors: Mohan Madan , Panda A. , Gupta S. K.
Published: November 2007

A prospective clinical study was undertaken to evaluate the efficacy of 1 % miconazole in 85 cases of smear‐positive fungal corneal ulcers. Miconazole therapy healed 44 ulcers, thereby achieving a success rate of 64.7%. The most common organism encountered was Aspergillus followed by Fusarium, Philophora and Candida. The average healing time was found to be 22 days. The drug was well tolerated by the eye and no symptoms of ocular toxicity were observed. The findings of this study suggest that miconazole is an effective agent for the management of human keratomycosis.
Public hospital day‐case surgery in a dedicated facility
Authors: Collie Donald M. , Rait Julian L. , Galbraith James E. K.
Published: November 2007

Abstract

The first dedicated, public hospital day‐case eye surgery unit opened in Melbourne in June 1987. This report details the mode of operation of this unit, and analyses the 218 procedures performed in the first 15 months of operation, and includes an assessment of the level of patient acceptance.
Microbial investigations in keratitis at the Sydney Eye Hospital
Authors: McClellan K. A. , Bernard P.J. , Billson F.A.
Published: November 2007

Abstract

We investigated 107 cases of presumed microbial keratitis amongst patients presenting to the Sydney Eye Hospital between October 1986 and August 1988 to determine the frequency of infection, the common causative organisms and those factors that predispose to corneal infection.

We found that 95% of culture‐proven cases were caused by bacteria and that Staphylococcus epidermidis and Corynebacterium sp, accounted for 42.5% of these cases. All bacteria (except Staphylococcus epidermidis and Mycobacrerium chelonae) were sensitive to gentamicin.

In 62.6% of cases, cultures for bacteria and fungi were negative. Retrospective review of the clinical records of these patients showed that herpes simplex virus, contact lens wear, staphylococcal marginal keratitis and recurrent erosion were important causes of keratitis in this group.
Two cases of hereditary keratoderma with congenital glaucoma
Authors: Slade Michael P. , Brooks Anne M. V. , Gillies W. E.
Published: November 2007

Abstract

Two cases are reported: a father and son with a new syndrome consisting of a severe congenital glaucoma associated with a form of palmoplantar keratoderma showing features of mutilating palmoplantar keratoderma. Both the glaucoma and keratoderma may be attributed to an autosomal dominantly inherited genetic mutation of a single chromosome affecting two tissues of neural crest origin, the ectodermal tissues of the hands and feet and the cranial mesenchyme from which the tissues of the chamber angle develop. Elucidation of the precise chromosomal abnormality causing these defects may help in understanding the inheritance and aetiology of glaucoma.
The Wisconsin epidemiologic study of diabetic retinopathy: An update
Authors: Klein Ronald , Klein Barbara E. K. , Moss Scot E.
Published: November 2007

Population‐based epidemiologic data on the incidence and progression of diabetic retinopathy are important in developing approaches to preventing diabetic retinopathy, in medical counselling and rehabilitative services. The objectives of the Wisconsin Epidemiological Study of Diabetic Retinopathy were as follows: (1) to describe the prevalence, incidence, and progression of diabetic retinopathy and its component lesions, and to determine the incidence of visual impairment in a large population‐based cohort; and (2) to determine the relationships between incidence and progression of diabetic retinopathy and risk factors in this cohort. Grading of stereoscopic fundus photographs was performed at the University of Wisconsin Fundus Photograph Reading Centre for photographs from both the baseline examination in 1980–1982 and follow‐up examination four years later. Insulin‐taking persons diagnosed to have diabetes before 30 years of age had the highest prevalence (71%), four‐year incidence (59%) and progression to proliferative diabetic retinopathy (11%) while older‐onset persons diagnosed to have diabetes at or after 30 years of age and not using insulin had the lowest prevalence (39%), incidence (344%) and progression to proliferative diabetic retinopathy (3%). These incidence data indicate that a substantial proportion of older onset diabetic people, a group previously thought to be protected from retinopathy, developed it during the four‐year interval and underscores the need for careful ophthalmologic examination.
Interaction of retinal pericytes, capillary endothelial cells and pigment epithelial cells in vasoproliferative retinopathies
Authors: Wong H. C.
Published: November 2007

Degeneration of intramural pericytes is the first histopathological lesion seen in diabetic retinopathy. Since pericytes from the optic nerve and brain are spared, such degeneration appears to be specific to the retinal circulation. Recent studies have shown that when retinal pericytes and microvascular endothelial cells are co‐cultured in vitro, direct contact between the two types of cells leads to the inhibition of proliferation of endothelial cells. Previously it was shown that when pericytes are cultured in the absence of microvascular endothelial cells, the cultured medium conditioned by the pericytes is actively mitogenic for retinal capillary endothelial cells. Furthermore, conditioned medium from human retinal pigment epithelial cells is also mitogenic for retinal capillary endothelial cells and pericytes. On the basis of these results, a new working hypothesis is proposed for the mechanism of action of photocoagulation used in vasoproliferative retinopathies.
Ocular cicatricial pemphigoid
Authors: Francis Ian C. , McCluskey Peter J. , Walls Ronald S. , Wakefield Denis , Brewer Janice M.
Published: November 2007

A series of 17 patients with ocular cicatricial pemphigoid (OCP) is described retrospectively. The importance of early recognition, especially of disease involving the medial canthus and caruncular region, diagnosis by biopsy, and adequate immunosuppressive and surgical therapy, are emphasised.

A detailed grading scheme has been developed and this has enabled the authors to determine the success or failure of the therapy during the active treatment period. A combined ophthalmological and immunological approach to treatment can result in a successful visual outcome of this potentially blinding disease.
An unusual case of crystalline keratopathy
Authors: BS P. Pararajasegaram MB , FRCS C. W. Barras , FRACO D. J. Coster , BS G. Mower MB
Published: November 2007

A 48‐year‐old woman developed a crystalline stromal lesion four years after a penetrating corneal graft, with few signs of ocular inflammation. An initial diagnosis of fungal keratitis was made because of the appearance of the lesion. An excisional biopsy revealed the presence of Gram‐positive cocci lying between the stromal lamellae in the posterior third of the cornea. Large numbers of Gram‐positive cocci were observed on light and transmission electron microscopy but no organism could be cultured from the biopsy. The replacement graft has remained clear over the subsequent two years.
An unusual intracerebral foreign body asSociated with eye trauma
Authors: MBBS D. Lawson , FRACO J. Glastonbury , FRACS P. Oatey
Published: November 2007

A case report is presented of penetrating orbital trauma in the driver of a motor vehicle which collided with a kangaroo. A tooth fragment from the kangaroo traversed the orbit, lodging intracranially. Management of the case is described and appropriate choice of antibiotic regime discussed.
A Review of the use of Irlen (tinted) Lenses
Authors: Cotton M. M. , Evans K. M.
Published: November 2007

Helen lrlen identified a syndrome defined as ‘scotopic sensitivity’ which it was claimed could be responsible for the inability of some people to read fluently and the symptoms of which could be ameliorated by the wearing of prescribed coloured lenses. The literature to date presents a confused and inconsistent picture concerning the use of the lenses. The literature (much of which is unpublished and difficult to obtain) is critically reviewed. Recent experimental evaluations of the lenses do not support the use of the lenses as a useful intervention for children with reading disabilities.
Photoscreening to detect potential amblyopia
Authors: Mash Keith , Hope Carolyn
Published: November 2007

Photoscreening to detect amblyopiogenic conditions is particularly applicable for the child under three years of age because conventional testing is difficult. We have designed an eccentric photoscreener that is inexpensive, easily used and requires only one diagnostic photograph. Some 231 infants and children were refracted and photoscreened and results compared in a blind study. Compliance was good and all cases of strabismus, amblyopia, and amblyopiogenic conditions were diagnosed.
Bullous keratopathy due to nonguttate corneal endothelial dystrophy
Authors: Brooks Anne M. V. , Grant Glenys B. , Gillies W. E.
Published: November 2007

Corneal oedema and bullous keratopathy may occur following intraocular surgery or arise spontaneously in nonguttate eyes. In some patients the fellow eye shows a relatively normal endothelial cell count with abnormal pleomorphism and polymegathism of the endothelial cells, while in others it shows a markedly lowered endothelial cell count with no evidence of corneal guttae. A survey of 17 such patients suggested the following classification.

1. Nonguttate corneal endothelial dystrophy with irregular endothelial cell morphology but a relatively normal endothelial cell count occurring following surgery (eight patients) or spontaneously (four patients).

2. Nonguttate corneal endothelial dystrophy with grossly reduced endothelial cell count occurring spontaneously (two patients).

Three additional post‐surgical patients showed a relatively normal endothelial cell count and only mild changes in the morphology of the corneal endothelium.

These findings support the presence of a nonguttate corneal endothelial dystrophy in both the spontaneous and some of the post‐surgical cases.
The effect of age and initial visual acuity on the systemic and visual prognosis of central retinal vein occlusion
Authors: D'Amato Robert J. , Miller Neil R. , Fine Stuart L. , Enger Cheryl , Quinlan Patricia , Elman Michael J.
Published: November 2007

Papillophlebitis is the term that is often used to describe a central retinal vein occlusion with preserved visual acuity in a young, healthy patient. Among 194 patients with a diagnosis of central retinal vein occlusion (CRVO), 19 patients were identified who were under 50 years of age and who had visual acuity of 6/12 or better in the affected eye. These patients retained good vision in the affected eye during the course of the disorder with 17 eyes returning to 6/6. All of these patients remained healthy over a mean follow‐up period of about four years. This group of patients was compared to a second group of 28 patients who also were under 50 years of age, but who had initial visual acuity in the affected eye less than 6/12. These patients had a variable visual outcome. In addition, they had a higher prevalence of systemic hypertension over the follow‐up period than did a group of age‐matched control subjects. An additional comparison was made to a group of 26 patients with visual acuity of 6/12 or better in the affected eye but who were over 50 years of age. Forty‐six per cent of these patients had final visual acuity less than 6/12, and they had a higher prevalence of systemic vascular disease than did a group of age‐matched control subjects.
Bone implants after enucleation
Authors: Molteno A.C.B. , ChB M.J. Elder MR
Published: November 2007

A method of preparing antigen‐free cancellous bone for use as an orbital implant is described together with the surgical technique for its use in enucleation. The results of 52 patients with follow‐up spanning 10 years is reported. In the first four years, five implants had to be removed, all due to infection following breakdown of Tenon's capsule in the early postoperative period. However, with more careful closure of Tenon's capsule, there have been no extrusions during the last six years.
Papillitis, retinal neovascularisation and recurrent retinal vein occlusion in Toxoplasma retinochoroiditis: A case report with uncommon clinical signs
Authors: MRCP Geoffrey E. Rose
Published: November 2007

A clinical case report, illustrative of three uncommon features of ocular toxoplasmosis, is presented. The unusual signs were recurrent retinal vein occlusion, papillitis and florid disc neovascularisation.
Pterygium recurrence rate at the Princess Alexandra Hospital
Authors: Sebban Allan , Hirst Lawrence W.
Published: November 2007

Over two separate time periods, 136 consecutive pterygium operations in 103 patients were performed at the Princess Alexandra Hospital. These patients were evaluated for recurrence of their pterygia in a retrospective study by chart review and re‐examination. In 136 eyes there was an overall recurrence rate of 46% using a number of therapies. This study highlights the relatively unsatisfactory result of pterygium removal in a day surgery and eye outpatient department surgical setting by a number of trainee ophthalmologists, and stresses the need for a reassessment of pterygium and its treatment.
Kingella kingae endophthalmitis in an infant
Authors: Carden S. M. , Colville D. J. , Gonis G. , Gilbert G. L.
Published: November 2007

An 11‐month‐old girl presented with metastatic endophthalmitis. The causative organism was the Gram‐negative coccobacillus Kingella kingae. This is an uncommon organism first recognised in 1967. It has never been previously reported to cause endophthalmitis, but is associated with at least four other infective syndromes in children. Endophthalmitis is a potentially lethal and sight‐threatening disease. Kingella kingae is primarily a paediatric pathogen which fortunately responds well to antibiotics. A case study, details of the bacteriology and a table of other clinical syndromes associated with this organism seen at our institution constitute this article. (12 references)
The presence of the parasite Demodex folliculorum on the skin surface of the eyelid
Authors: English Frank P. , Zhang Guang Wen , McManus Don P. , Home Felicity A.
Published: November 2007

It is well established that Demodectic mites can infest the meibomian glands, eyelash and hair follicles of the eyelid. In this study, scanning electron microscopy revealed Demodex folliculorum occurring freely on the skin surface of the eyelid. This indicates some mobility and implies further vector potential. Exoskeletons from these parasites also occur on the eyelid.
The incidence and progression of lens opacities
Authors: Taylor Hugh R. , Muñoz Beatriz
Published: November 2007

Selected clinic patients were entered into a prospective longitudinal study to assess the incidence and rate of progression of lens opacities. Ninety‐seven patients aged 15 to 88 years (median 63 years) were followed for two to 35 months (median 16 months). Lenses were photographed on a photo slit lamp and retroillumination cataract camera. Photographs were graded independently and then assessed in a side‐by‐side comparison. The incidence rate of cortical opacity was found to be 4% and for nuclear cataract between 11% and 20%. The rates of progression were 18% to 21% for cortical opacity, 14% to 16% for nuclear opacity, and 39% to 40% for posterior subcapsular opacities. These data suggest that these simple photographic means are sufficiently sensitive to detect changes in lens clarity.
The clinical features and associations of retinal emboli
Authors: O'Donnell Brett A , Mitchell Paul
Published: November 2007

A series of 207 patients with retinal emboli is presented with the ocular findings andsystemic associations examined. Emboli were most frequently single, unilateral, crystalline and involved the left eye. Emboli were most frequently observed at the major retinal vascular temporal arcades and posterior pole arterioles, with 40% seen at a bifurcation and 10% at an arteriovenous crossing. Non‐crystalline emboli were more likelyto be associated with retinal pathology, such as retinal artery or vein occlusion. Carotid ultrasound was performed in 74 patients: 18% of asymptomatic subjects had internal or common carotid stenosis < 75%; 21% of symptomatic patients had stenosis >75%. In 70%, the stenosis was worse on the side of the embolus. In symptomatic patients, significant stenosis is more likely to be unilateral.
Five‐year follow‐up of clear cornea trabeculectomy
Authors: Elder M J , Molteno A C B
Published: November 2007

A five‐year follow‐up of a prospective trial of 21 eyes with clear cornea trabeculectorny is reported. The procedure had a 56% success rate at five years.
Partly reversible visual failure with methanol toxicity
Authors: Stelmach Maryla Z , O'Day Justin
Published: November 2007

Methanol is a highly toxic substance which is used as an industrial solvent and in automotive antifreeze. If accidentally ingested blindness or death may result. The case of a young woman who developed sudden onset of visual failure following ingestion of a methanol‐fortified beverage is presented. Although she failed to seek immediate medical help visual function improved. Acute changes of bilateral optic disc hyperaemia and venous engorgement were present at initial examination. She subsequently developed optic disc atrophy together with glaucomatous‐like cupping of the optic discs. The aetiology of visual failure in methanol poisoning is discussed, as are the current therapeutic guidelines in the management of acute cases.
A clinicopathological study of loop recession in strabismus
Authors: Elder MJ , Dempster AG , Molteno ACB
Published: November 2007

This communication reports the histological structure of loop recessions of extraocular muscles from seven patients. In all cases the loops formed pseudotendons in which the typical histological structure was well established by four months. Subsequently, moulding of these pseudotendons occurred with improved alignment of collagen and decrease in vascularity. By three and a half years after the operation the pseudotendon had acquired a very close resemblance to true tendon.
Ophthalmology in the undergraduate curriculum: A review in Queensland
Authors: Stark Denis , Beinssen Andrew , Morrey Chris
Published: November 2007

Three hundred and sixty‐nine postal questionnaires related to the content and teaching of the undergraduate medical course were sent to Queensland city and provincial ophthalmologists, general practitioners, physicians and surgeons. The return rate was 53%. The views of the four groups were similar in most respects. The majority of respondents thought that ophthalmology should be taught as a separate course. They stated visits to operating theatre and eye casualty unit should be included in the course. Ophthalmologists and general practitioners stated the course should be longer, physicians thought it should remain the same length and surgeons felt less time should be dedicated to the teaching of ophthalmology. Topic areas regarded as essential were the acute care areas: trauma; glaucoma; infection; use of an ophthalmoscope; acute visual loss; and red eye. Squint was also regarded as an essential area by ophthalmologists.
The effect of topical corticosteroids on laser‐induced peripheral anterior synechiae
Authors: West R H
Published: November 2007

Purpose: To assess the influence of different topical steroid agents and a non‐corticosteroid medication after Argon laser trabeculoplasty (ALT) on the development of peripheral anterior synechiae (PAS) and the reduction of intraocular pressure (IOP).

Method: In two separate prospective, randomised, group‐controlled studies, topical fluorometholone 0.1% (FML Liquifilm) was compared with dexamethasone 0.1% (Maxidex) (Study A), or naphazoline hydrochloride 0.1% (Albalon) (Study 6) after ALT for chronic open‐angle glaucoma, with particular reference to the formation of PAS and the IOP response.

Results: In Study A (N=109) eyes treated with Maxidex had a significantly higher incidence of PAS than those treated with FML—45% compared with 22%, P<0.05 (normal deviate test).

In Study B (N=75) the incidence of PAS was equal in eyes treated with FML or Albalon (23%).

In the two studies combined (N=184), the development of PAS was associated with a significantly lower mean response of IOP to ALT—1.47 mmHg compared with 3.22 mmHg, 0.01<P <0.05 (Student t‐test).

Conclusion: The incidence of PAS after ALT is significantly higher with the post‐laser use of Maxidex than with FML, and is the same for Albalon as for FML. The therapeutic benefit of ALT is significantly reduced if PAS develop.
Optic neuritis in children with poor recovery of vision
Authors: Good William V , Muci‐Mendoza Rafael , Berg Bruce O , Frederick Douglas R , Hoyt Creig S
Published: November 2007

We reviewed the records of 10 children with optic neuritis in whom recovery of vision was poor or incomplete. Our cases were otherwise similar to those described in previous studies in that they were always bilateral, often accompanied by a viral prodrome (seven of 10), and usually associated with disc oedema (seven of 10).

Seven of twenty eyes had a final visual acuity of 6/60 or worse and only one patient regained 6/6 vision in either eye. In three patients the best vision in either eye was 6/60 or worse. Recovery of vision was often slow, taking up to six years. Five of 10 patients have developed multiple sclerosis (MS), and one child had acute disseminated encephalomyelitis (ADEM) with optic neuritis.

Optic neuritis in children does not always carry a good prognosis for recovery of vision; however, the failure of vision recovery in a short period of time does not necessarily indicate a poor outcome. Some children with optic neuritis develop MS, which can develop even when optic neuritis follows a viral illness.
Treatment of subfoveal choroidal neovascular membranes with systemic interferonl α 2a
Authors: Loughnan Michael S. , Heriot Wilson J. , O'Day Justin
Published: November 2007

Systemic interferon‐α has recently been reported to be useful in the treatment of choroidal neovascular membranes (CNVM) in age‐related macular degeneration. To further investigate its effect we treated eight patients with subfoveal choroidal neovascular membranes of various aetiologies including idiopathic, age‐related macular degeneration and myopic chorioretinal degeneration. Only one of the eight patients responded with an angiographically demonstrated decrease in the size of the CNVM; this was in a patient from the idiopathic group. Considerable side‐effects were reported with marked lethargy and malaise limiting compliance with some patients. Although this is an initial report with limited patient numbers and follow‐up, it does suggest a role for interferon‐α in patients with idiopathic neovascular membranes where the retina is otherwise normal, but raises some doubt as to its efficacy in the treatment of age‐related macular degeneration.
A clinical and cytological study of vitamin A deficiency in Kiribati
Authors: Danks J. , Kaufman D. , Rait J.
Published: November 2007

Vitamin A status was assessed clinically and by conjunctival impression cytology in a selected group under seven years of age in the Republic of Kiribati. A total of 230 children were studied. Of 185 with readable histology, 14.6% were clinically and histo‐logically abnormal; 19.5% were clinically abnormal but histologically normal; and 15.7% were clinically normal and histologically abnormal. The remainder (50.3%) were clinically and histologically normal. There was a significant correlation between clinical disease and histology (P<0.001). The prevalence of the disease in males was 45.8% and 26.3% in females. The risk of deficiency appeared to increase with advancing age. There was no significant difference between the two villages studied.
The effect of cataract extraction with implant in glaucomatous eyes
Authors: MD Anne MV Brooks , FRACO WE Gillies
Published: November 2007

The effect of cataract surgery in patients with glaucoma controlled by either topical medication or surgery was assessed in 64 patients. At one year there was a small significant fall in intraocular pressure (IOP) for eyes without previous surgery (preoperative IOP 18.9 ±4.7, range 12 to 35 mmHg; postoperative IOP 16.3 ±3.4, range 10 to 26 mmHg; P<0.01) and also for those with previous surgery (preoperative IOP 15.0 ±4.3, range 3 to 22 mmHg; postoperative IOP 14.2 ±3.7, range 6 to 22 mmHg, P<0.05). There was a significantly greater incidence of high rise in IOP to 30 mmHg or more immediately after operation in patients without (32%) than those with previous surgery (13%) (x2 = 3.9; P<0.05). Complications were minimal in each group. lridotomy to deliver the nucleus was necessary in nine eyes without and 21 with previous surgery. Cataract extraction usually causes only a small fall in IOP in glaucomatous patients. If a separate corneal section is used there is no loss of function of the filtering bleb in patients with previous glaucoma surgery.
The long‐term results of surgical correction of childhood esotropia
Authors: Infeld David , Prior Chris , Ryan Hugh , O'Day Justin
Published: November 2007

The results of surgical management by one ophthalmologist of 102 patients with congenital esotropia and 74 patients with acquired esotropia in childhood were analysed. The majority of patients had undergone a monocular recession‐resection procedure, with 91% and 93% of patients showing a reduction in the angle, of more than five degrees, following surgery for congenital and acquired esotropia respectively. Unexpectedly, varying the amount of lateral rectus resection from 3 to 6 mm, when combined with a constant 5 mm medial rectus recession, did not produce significantly different amounts of change in the ocular alignment after surgery.

Patients with congenital esotropia generally developed a stable postoperative angle later than patients with acquired esotropia. The degree of improvement of ocular alignment with surgery was independent of hypermetropia, presence of preoperative amblyopia or fusion.
An improved method of densitometry of red‐free retinal nerve fibre layer photographs
Authors: Eikelboom RH , Cooper RL , Barry CJ
Published: November 2007

The red‐free negatives of 53 right eyes (30 normal eyes and 23 glaucomatous eyes) and 51 left eyes (32 normal eyes and 19 glaucomatous eyes) were analysed using two different image densitometry techniques. The first technique measured the density from rectangular sample areas, while the second measured density from sector‐shaped sample areas which more closely follow the course of the nerve fibres in the retina.

Indices which measured the deviation of the data from a clinically determined normal ‘gold standard’ were calculated, and were used to determine the optimum sensitivity and specificity in separating normal from glaucomatous eyes.

There is a significant difference between the data from the normal and glaucomatous groups of eyes, when measured from the sector sample areas. The relative efficacy of this technique is also shown by the improved values of sensitivity (from 42%‐70% to 70%‐91%), although specificity remained fairly constant (from 66%‐83% to 62%‐88%).
Acanthamoeba keratitis: A masquerade of presentation in six cases
Authors: Tay‐Kearney Mei‐Ling , McGhee Charles NJ , Crawford Geoffrey J , Trown Kevin
Published: November 2007

Acanthamoeba keratitis is an uncommon but devastating complication of contact lens wear causing significant ocular morbidity. Six consecutive cases occurring in Western Australia in an 18‐month period are reported. In all cases either poor contact lens hygiene or an association with swimming pools and contact lens use is a feature.

There is invariably a delay in making the diagnosis, with the appearance frequently mistaken for herpes simplex keratitis. In all cases corneal biopsy was required to confirm the diagnosis. Of the six patients, four responded to medical therapy alone, one required a corneal graft and one required enucleation.

We suggest that earlier rather than later corneal biopsy is important in unresponsive cases of culture‐negative keratitis, especially in contact lens wearers. We would agree that the treatment of choice is intensive topical propamidine and neosporin. Prevention by strict adherence to contact lens care and hygiene is urged.
Comparison between Fastpac and conventional Humphrey perimetry
Authors: Young Ivan M , Rait Julian L , Guest Charles S , Carson Cathy A , Taylor Hugh R
Published: November 2007

As part of the Melbourne Visual Impairment Project, a substudy was performed to determine the efficacy of the newly released Fastpac program for the Humphrey Field Analyser. A comparison was performed of the Fastpac and conventional full threshold 24–2 fields obtained in 39 eyes of 36 participants. Also a comparison study was performed of the standard and non‐standard 80‐point screening tests to the standard 24–2 full threshold test in 23 eyes of 23 participants.

In the full threshold comparison there was 100% agreement between the two with Fastpac being 32% to 39% faster than standard. In the 80‐point screening test comparison, non‐standard was no faster than standard. Sensitivities were 17/17 (1.0) for non‐standard and 15/18 (0.83) for standard, as compared with the standard 24–2 full threshold test.

Fastpac software offers accurate screening and threshold testing in less time than the standard algorithm.
Peripapillary disciform lesions in the elderly
Authors: Davis Garry J , Wong HC
Published: November 2007

We present seven consecutive cases of peripapillary disciform lesions (PPDL) managed over a period of four and a half years. All patients were elderly, with a median age of 74 years. A protocol was used for the management of these patients. Four underwent ablative laser treatment when the lesion demonstrated growth and was sight threatening. The final visual acuity in this treated group improved by one line in one patient, was reduced by one line in two and was unchanged in the other. No recurrent lesions were seen beyond three months after treatment. The lesions in the remaining three patients were non‐progressive and required no treatment. Of these, the final visual acuity remained unchanged in two patients and was reduced by one line in the other.
Refractive keratoplasty for post‐graft astigmatism
Authors: Whitehouse Geoffrey , Sutton Gerard , Lawless Michael A , Rogers Christopher
Published: November 2007

Refractive keratoplasty using modified relaxing incisions with compression sutures was performed on 33 patients with high post‐keratoplasty astigmatism. The mean reduction in keratometric astigmatism was 8.38 dioptres from a preoperative mean of 12.21 dioptres (SD, 3.59) to 3.93 dioptres (SD, 2.13). All patients noted a marked functional improvement. Two patients required reoperation. One patient required resuturing. Our modification of undercutting the relaxing incisions greatly increases the range of astigmatism that can be treated with this technique.
Ophthalmodynamometry and corticosteroids in central retinal vein occlusion
Authors: Beaumont Paul E , Kang H Kwon
Published: November 2007

Purpose
: This is the first report of the monitoring of the clinical progress of a central retinal vein occlusion by measuring the retinal venous collapse pressure using ophthalmodynamometry.

Method
: A 38‐year‐old woman with a non‐ischaemic central retinal vein occlusion received systemic prednisone. The dose of prednisone was increased and decreased both abruptly and gradually. The response was monitored by weekly measurements of visual acuity, retinal appearance and retinal venous collapse pressure. The retinal appearance was assessed by comparison of repeated stereo colour photographs and fluorescein angiographs. Retinal venous collapse pressure was estimated by taking the mean of four or more ophthalmodynamometric measurements.

Results
: An inverse relationship between the ophthalmodynamometric retinal venous collapse pressure and systemic prednisone dosage was observed. The visual acuity and retinal appearance remained unchanged throughout the follow‐up.

Conclusions
: Ophthalmodynamometry in this case was a useful method of quantitatively monitoring the response of central retinal vein occlusion to systemic prednisone. The response would not have been detected if only visual acuity and retinal appearance were used to monitor the progress.
Ocular migraine in an eight‐year‐old girl
Authors: Narita Andrew S , Elder James E
Published: November 2007

Background
: A case of ocular migraine in an eight‐year‐old girl is presented. This is believed to be the youngest reported patient with ocular migraine.

Conclusion
: The choroid was noted to darken during an episode of visual loss, suggesting choroidal ischaemia as the cause of the visual loss.
Argon and diode laser treatment of benign eyelid lesions
Authors: Ghabrial Raf , Francis Ian C
Published: November 2007

This study reports the experience of 14 patients (15 lesions) treated with the argon or diode laser for small, benign eyelid conditions. The technique is suitable for use by ophthalmic surgeons because the lesions are localised, the surgery can be performed precisely to maintain adequate lid function and cosmesis, and both the argon and diode laser viewing systems and delivery systems provide excellent control for the surgery.

There were no complications from the laser surgery, and the surgical aims of lesion clearance, good cosmesis and function were fulfilled in all patients. The advantages in lid surgery of the diode and argon lasers over the carbon dioxide laser are highlighted.
Ocular complications in renal transplant patients
Authors: Matsunami C , Hilton AF , Dyer JA , Rumbach OW , Hardie IR
Published: November 2007

One hundred and seventy‐six patients who received a renal transplant between 1982 and 1988 were examined for ocular complications of steroid therapy. Posterior subcapsular cataracts (PSC) were present in 60 patients (34.1%). Patients were classified into three groups (HS, LS, NoS) depending on their maintenance immunosuppression therapy. The HS group received high doses of steroids after renal transplantation. LS had low steroid doses, and NoS had no steroids. The incidence of PSC was 21 of 38 in HS (55.3%), 33 of 117 in LS (28.2%), and 1 of 16 in NoS (6.2%). The difference between HS and LS was statistically significant (x2= 8.1, P < 0.01). Grading the severity of PSC (PSC 0, PSC +, PSC > ++) showed a significant correlation between the degree of PSC and the steroid therapy. In the HS group, five patients had PSC +, and 16 had PSC > ++ (76%), compared to 19 patients with PSC +,14 patients with PSC > ++ (42%) in the LS group (x2= 4.6; P < 0.05). There was no correlation between the incidence of PSC and use of steroids for more than three months before dialysis. Comparison with the results of our earlier series (1973 ‐1981)1 using high doses of steroids showed a similar incidence of PSC with HS (40.7% Series 1; 55.3% Series 2) but a lower incidence with LS and NoS.
Infectious crystalline keratopathy
Authors: Horsburgh Bradley , Hirst Lawrence W , Hoole Geoff A , Snr Kevin Vandeleur , Green W Richard , Whitby R Michael
Published: November 2007

Two cases of typically appearing crystalline keratopathy both grew an alpha haemolytic streptococcus and had many of the features common to other cases. In one case, the use of topical and systemic antibiotics alone resulted in resolution of the disease, while in the second case even after corneal transplantation, a recurrence occurred which required further long‐term antibiotics plus a repeat transplant.
Herpes zoster ophthalmicus and the orbital apex syndrome
Authors: Bourke Robert D , Pyle John
Published: November 2007

Herpes zoster ophthalmicus (HZO) commonly causes isolated ophthalmoplegic syndromes. Visual loss caused by optic neuritis secondary to HZO can be reversible or irreversible. HZO rarely presents as an orbital apex syndrome, when an association with meningo‐encephalitis has been reported. We report a case of orbital apex syndrome secondary to HZO treated with systemic steroids and acyclovir. Our patient suffered no systemic complications and displayed a rapid resolution of optic neuropathy. We discuss this case in the light of previous reports and explore the possible pathogenic mechanisms involved.
Sterile ocular inflammatory reactions to monofilament suture material
Authors: Sullivan Laurence J , Su Charles , Snibson Grant , Taylor Hugh R
Published: November 2007

Objective
: To report six cases of sterile inflammatory reactions to fine monofilament suture materials, which is exceedingly rare in ophthalmology.

Methods
: We report six patients (four underwent penetrating keratoplasty and two underwent cataract surgery) with unusually severe local inflammatory reactions to suture material.

Results
: Patients developed multiple focal inflammatory infiltrates and corneal oedema related to 10/0 monofilament nylon sutures. Four patients had evidence of either atopy or raised serum IgE and one had an autoimmune disorder (systemic lupus erythematosis). Onset was four to 11 days in five cases and six weeks in one. Allograft reaction occurred in two of the four corneal grafts, and three grafts failed. One of the cataract patients developed significant against‐the‐rule astigmatism. Microbial cultures of corneal scrapings, donor corneal rims, and suture material were generally negative. Polymorphonuclear leucocytes were noted on Gram stain in four cases, and cytology of corneal scrapings demonstrated eosinophils in one case.

Conclusions
: Sterile inflammatory reactions to monofilament suture material are an uncommon complication of ocular surgery which may lead to corneal graft failure, and which is more common in atopic individuals. Systemic steroid therapy may be required.
Interrater agreement in oculo‐kinetic perimetry ‐ a screening test for glaucoma
Authors: Westling Agneta K. , Newland Henry S.
Published: November 2007

In a study at the Flinders Medical Centre, South Australia, 24 glaucomatous eyes with known field defects were tested by three examiners of different backgrounds using oculo‐kinetic perimetry, a screening test for glaucoma. The interrater agreement was excellent; only in one case did results differ. Seventeen eyes had a defective result, but in six cases the test was normal. Both patients and untrained staff find this test easy to do, but the apparent high false‐negative rate is cause for concern and needs further evaluation. Oculo‐kinetic perimetry may well be better used as a complementary test by those opticians doing tonometry and by general practitioners who currently rarely screen for glaucoma.
The Albury‐Wodonga syndrome: A tale of two cities
Authors: Howsam Geoffrey
Published: November 2007

Purpose: An epidemic of acutely painful eyes having a seasonal restriction and an apparent response to topical indomethacin, is described.

Methods: From patients seen in a rural private practice, the clinical picture of this acute syndrome and the use of indomethacin drops is described.

Results: A favourable response to topical indomethacin in 21 patients is documented.

Conclusion: Topical indomethacin is worthy of further trial and investigation in the management of the Albury‐Wodonga syndrome, harvester's eye, Christmas eye or seasonal corneal ulcer.
Excimer laser surgery for myopia and myopic astigmatism
Authors: Hadden O Bruce , Morris Antony T. , Ring C Peter
Published: November 2007

Photorefractive keratectomy using the Summit Excimer Laser has been carried out on 1333 eyes with myopia or myopic astigmatism which have been followed up for six months or longer. Of those, 607 have been followed up for one year.

Of the eyes with myopia or myopic astigmatism of up to 3 dioptres spherical equivalent, at one year 85.6% had unaided vision of 6/6, 97.2% 6/9 or better, and 99.4% 6/12 or better. Of the eyes between ‐3.25 and ‐6.00 dioptres spherical equivalent, at one year 72.1% achieved 6/6 vision unaided, 88.8% 619 or better, and 94.2% 6112 or better. Of the eyes between ‐6.25 and ‐10.00 dioptres, at one year 49.6% achieved 616 vision unaided, 76.1% 619 or better and 88.0% 6/12 or better.

To achieve these figures, 28% of the patients had astigmatic keratotomy, either two or three weeks before photorefractive keratectomy, or at the same time as photorefractive keratectomy. Photorefractive keratectomy is as predictable as radial keratotomy in eyes of under 6 dioptres myopia, but is more predictable than radial keratotomy in higher myopia. Photorefractive keratectomy has the advantages of leaving an eye which is structurally sound, and without diurnal variation of focusing.
Comparison of stereo optic disc photographs from the Nidek 3‐Dx and Zeiss retinal cameras
Authors: Barry Chris J. , Eikelboom Robert H.
Published: November 2007

Objective: To compare the Zeiss retinal camera with the Nidek 3‐Dx camera for photographic quality and stereo separation.

Subjects: Eleven subjects (22 eyes) were selected from patients referred for optic disc photography.

Methods: The subjects were photographed using the Nidek 3‐Dx camera for simultaneous stereo photographs, and the 30° field and 15° field settings on the Zeiss retinal camera for sequential stereo photographs. Four ophthalmologists qualitatively scored the photographs on a five‐point scale for stereo separation and photographic resolution and sharpness. The results from the four observers were averaged and the Friedman two‐way analysis of variance used to analyse the results.

Conclusions: It was found that the stereo separation is significantly better using the Nidek camera when compared with both the 30° and 15° Zeiss results. There was no significant difference in photographic quality between the Nidek and Zeiss 30° photographs. It was also found that the Zeiss 30° images had a significantly higher quality than the Zeiss 15°, which contradicted previous results.
Acute irreversible cataracts in diabetes mellitus
Authors: Cornwell Mark , Lepre Frank
Published: November 2007

Aim: To report an unusual cause of blindness in a patient newly diagnosed with insulin‐dependent diabetes mellitis (IDDM).

Method: A 19‐year‐old man presented with classical symptoms of hyperglycaemia. On presentation his visual acuity and ophthalmic examination were normal. He was prescribed twice‐daily insulin therapy and six weeks later presented with visual loss. He had only light and dark perception and was noted to have bilateral, dense, mature cataracts.

Outcome: Right cataract extraction and intraocular lens implant was performed with restoration of vision. Despite good diabetic control the left cataract did not resolve. Seven months later the patient had left cataract extraction and intraocular lens implant, again with good result.

Conclusion: Mature dense cataracts rarely occur and appear not to resolve with control of hyperglycaemia, as in this case, and require surgical treatment.