bluuebunny/crossref_metadata_2025 huggingface dataset:
MANAGEMENT OF HERPES SIMPLEX KERATITIS: PROBLEMS ASSOCIATED WITH EPITHELIAL DISEASE
Authors: M. O'day DENIS
Published: November 2007

The management of active viral replication in the corneal epithelium is not always straightforward despite the availability of effective topical antiviral agents The list of lesions that may mimic epithelial infection with herpes simplex virus is long and now includes Acanthamoeba infection Problems with antiviral agent toxicity and corticosteroid administration may also at times obscure the diagnosis while at the same time making management difficult
SURVIVAL OF CORNEAL ENDOTHELIUM IN McCAREY‐KAUFMAN (M‐K) MEDIUM SUBJECTED TO AGITATION
Authors: F. Robertson IAN , Carroll NANETTE , M. V. Brooks ANNE
Published: November 2007

Studies were made comparing the corneal endothelium of bisected human corneas; one half of each was mechanically agitated In McCarey‐Kaufman (M‐K) medium, while the other half remained static in M‐K medium for an equal period of time. Scanning electron microscopic (SEM) analysis of the corneal endothelium suggested that the endothelium of the corneas undergoing agitation does not show deterioration in morphology when compared with the non‐agitated group. This finding is significant as donor corneas are now being transported in greater numbers.
SQUAMOUS CELL CARCINOMA OF THE CONJUNCTIVA: CASE PRESENTATION AND TREATMENT
Authors: Coop HAROLD V.
Published: November 2007

A case of the rare condition of invasive squamous cell carcinoma of the conjunctiva is presented The plan for surgical excision of the area involved, determined by resultsof frozen section biopsies, is outlined The methods of treatment of other authors are briefly reviewed, including the method (from Fraunfelder) of combined excision and cryotherapy.
OFFICE‐BASED INTRAOCULAR SURGERY IN AUSTRALIA
Authors: R. Elder JOHN
Published: November 2007

Office‐based intraocular surgery has been carried out for three years and over 1400 procedures have been performed There have been no systemic complications or infections

The establishment of an office‐based facility is a complex venture Apart from medicolegal, ethical and financial considerations there are regulations relating to structural requirements, steritisation of instruments, air‐conditioning, electrical hazards and other technical matters

Office‐based surgery is convenient for both the patient and the surgeon The patient remains calm and relaxed from the time of initial counselling to the end of postoperative convalescence

We have borrowed systems used in the United States for management of ambulatory surgical patients, in particular the counselling techniques This. in our opinion, has been a significant factor for calm relaxed surgery

Patient acceptance and preference for ambulatory surgery will ensure that it is here to stay A case can be made out for an economic and ethical obligation for this form of surgery to be implemented on a more widespread basis It is not, however, the universal solution to ocular surgery There are still specific indications and contraindications, in terms of both the doctor and the patient

At a time when government involvement is being felt more and more in the practice of medicine, any proven alternative method of health care delivery, provided entirely by the private sector, must be worthy of serious consideration.
COMPUTER‐AIDED AREA MEASUREMENT OF OCULAR IMAGES
Authors: Gosbell ANDREW D. , R. Barry WILLIAM , Favilla IAN , J. Turner IAN
Published: November 2007

Using a combination of computer‐aided measurement techniques and fundus camera images, the area of regions of interest on the fundus can be measured If these area measurements are corrected for the magnification effects of the patient's visual system, and the fundus camera optics, an estimate of the true anatomical size of the measured object can be determined in physical units While the results of measuring models indicate a maximum error of 6%for the system, the results of clinical trials demonstrate an average error of 10% for well‐defined areas of interest, with increasing error of up to 30% for poorly defined areas of interest.
COMPUTER‐AIDED VOLUME MEASUREMENT OF CHOROIDAL MELANOMAS
Authors: Gosbell ANDREW D. , R. Barry WILLIAM , Favilla IAN
Published: November 2007

Using a combination of conventional 8‐scan ultrasonography, standard video techniques, computer image digitisation and area analysis, it is possible to measure the volume of choroidal melanomas by area calculation of successive ultrasound image slices, allowing the monitoring of such tumours

The design of a combined water‐bath and linear tracking 8‐scan transducer is presented, together with a description of the instrumentation and computer software required The results of volume measurements performed upon eye models demonstrated that melanomas of volume greater than 100 mm3 could be measured with an average error of 6%.

The problems associated with linear calibration of the system from scan‐head to analysed image, resolution of the digitised image, reproducibility of the measurements, sources of error and assumptions made in formulating the measurement procedure are discussed.
BOOK REVIEWS
Authors: Banks C. Neville , Horowitz G. , Wechsler A. W. , Goldberg Ivan , Playfair T. Justin , Cher Ivan , Evans Kit , Mcgree Mark D.
Published: November 2007

Book reviewed in this article:

EYE DISEASES IN HOT CLIMATES John Sandford‐Smith. Bristol: John Wright & Sons, 1986. ISBN 0 7236 0749 4. Also available in paperback.

PERIPHERAL IRIDECTOMY. SURGICAL: ARGON: YAG Arthur Lim Siew Ming. Singapore: PG Publishing, 1987, pp. 86, 100 colour illustrations, £54.00. ISBN 9971 973 86 3.

RADIAL KERATOTOMY: SURGICAL TECHNIQUE R. F. Hofmann, R. L. Lindstrom, A. C. Neumann, J. J. Salz, G. W. Tate, S. P. Thornton. Thorofare, New Jersey: Slack, 1986, pp. 137, £67.75.

TEXTBOOK OF GLAUCOMA M. Bruce Shields. Baltimore: Williams and Wilkins, 1987, pp. 549,£240.00. ISBN 0 683 07694 9.

GLAUCOMA Edited by J. A. McAllister FRCS and Richard P. Wilson MD. London: Butterworths, 1986, pp. 278, £190.00. ISBN 0 407 02343 7.

NEURO‐OPHTHALMOLOGY REVIEW MANUAL Frank J. Bajandas, Lanning B. Kline. Second Edition Thorofare, New Jersey: Slack 1987, pp. 176, £A44.95. ISBN 0 943432 96 0.

OPHTHALMIC NURSING Rosalind Stollery. Southampton: Blackwell Scientific, 1987, pp, 261, £A38.95. ISBN 0 632 01S15 2.

ADLER'S PHYSIOLOGY OF THE EYE: CLINICAL APPLICATION Edited by Robert A. Moses and William Hart, Jr. Eighth edition. St Louis, CV. Mosby, 1987, pp, 709.
THE IDENTIFICATION OF DIFFERENT VASCULAR CELLS ON THE CORNEAL ENDOTHELIUM BY SPECULAR MICROSCOPY II. WHITE BLOOD CELLS ON THE CORNEAL ENDOTHELIUM IN KERATITIS
Authors: BROOKS ANNE M. V. , GRANT GLENYS , W. E. GILLIES FRACO, AIAP, FRACS, FRCS(Ed)
Published: November 2007

Examination of the corneal mosaic by the direct mode of specular microscopy and of its posterior surface by the relief mode in three cases of localized keratitis with adjacent clear cornea has enabled us to identify small round white cells. Comparison with the morphology of red blood cells seen in hyphaema indicates that these small round cells are probably lymphocytes since they are fairly uniform in size, spherical but not flattened spheroids and about the same size as or a little larger than red blood cells. These cells are present on the posterior surface of the corneal endothelium but could not be seen infiltrating beneath or between the endothelial cells. They were quite distinct from larger, numerous rounded blebs two to four endothelial cells in diameter tying beneath the endothelium which have previously been described.
ASSESSMENT OF THE DUTCH ORGAN‐CULTURE SYSTEM OF CORNEAL PRESERVATION WITHIN THE EYE BANK OF SOUTH AUSTRALIA
Authors: WILLIAMS K. A. , NOACK L. M. , ALIFRICH S. J. , DANZ R. , ERICKSON S. A. , COSTER D. J.
Published: November 2007

Thirteen per cent of all corneas harvested by the Eye Bank of South Australia during 1986 were discarded because storage time in McCarey‐Kaufman medium exceeded four days. We have therefore examined the suitability of the Dutch method of long‐term corneal storage for our purposes. Twenty‐two human corneas that had been discarded from the Eye Bank were assessed using the trypan blue‐sucrose staining technique, and then placed into long‐term storage for 15 to 17 days. They were then reassessed by vital dye staining before permanent flat‐mounts were prepared for silver staining of the endothelium. A good correlation (albeit subjective) was found between the non‐destructive and destructive techniques of endothelial cell assessment. Those corneas that failed to survive organ culture storage were easily detected. The Dutch system of corneal preservation and post‐storage assessment seems well‐suited to Australian eye‐banking.
THE WAIT OF THE WORLD
Authors: GRAHAM P. J.
Published: November 2007

In our modem world, avoidable blindness is as unacceptable as starvation. Frameworks exist for both preventative and curative ophthalmology, but these are under‐staffed. In developing countries, the emphasis must shift to the people themselves to take responsibility for their own eye health, an aim which may be achieved by simple teaching at grassroots level.
METHYLCELLULOSE FOR ENDOTHELIAL CELL PROTECTION
Authors: STEELE ARTHUR D. McG. , ANDREWS V.
Published: November 2007

A randomised trial of three types of endothelial cell protection for patients undergoing posterior chamber intraocular lens implant is described. The results confirm the superiority of a viscoelastic fluid over air as a form of endothelial cell protection. No statistically significant difference was found between sodium hyaluronate and hydroxypropylmethykellulose (HPMC). As the cost of sodium haluronate is prohibitive, a manufacturing technique for HPMC is given.
SURGICAL MANAGEMENT OF THE LACRIMAL DRAINAGE SYSTEM
Authors: BENGER ROSS
Published: November 2007

The physiology of normal tear drainage has been better defined in recent years. Some of the refined techniques developed in the fields of anaesthesia and surgery have been applied to the lacrimal drainage system. The combination of these advances has resumed in more rational and successful treatment of lacrimal drainage abnormalities. A review of these advances is presented with a discussion on the treatment of lacrimal drainage abnormalities.
CONGENITAL APONEUROTIC PTOSIS
Authors: MARTIN PETER A. , ROGERS PETER A.
Published: November 2007

Congenital aponeurotic ptosis is the result of a failure of the distal end of the aponeurosis to attach in the usual position. There is a ptosis of varying degree disproportionate to the amount of levator function. Unlike dystrophic congenital ptosis, the amount of levator function is good, usually exceeding 9 to 10 mm. Corrective surgery was performed in 12 cases of congenital aponeurotic ptosis, including identical twins with unilateral symmetrical ptosis, supporting the concept of a developmental mesodermal anomaly.
PEDICLE FLAPS FOR CICATRICIAL ECTROPION
Authors: KEILLOR R. B. , PEART D. A. , MOLTENO A. C. B.
Published: November 2007

A surgical procedure is described for the correction of cicatricial ectropion secondary to actinic skin damage. This involves the rotation of an upper lid skin and muscle flap to the lower lid, thereby reversing the cicatrising process. The procedure, its advantages and disadvantages, are outlined. The procedure was successful in 44 of the 48 lids reviewed.
THE PREOPERATIVE ASSESSMENT OF THE CORNEAL ENDOTHELIUM
Authors: BROOKS ANNE M. V. , GRANT GLENYS , GILLIES W. E.
Published: November 2007

The ability of the cornea to maintain its transparency after surgery depends primarily upon the integrity of the corneal endothelium and in corneal grafting this is important for both donor and recipient eyes. The corneal endothelium may be significantly affected in various conditions of the anterior segment, especially if these exist over a considerable period of time. These conditions include superficial keratopathy, long‐term contact lens wear, cornea guttata and low‐grade anterior uveitis, especially chronic cyclitis which may be almost imperceptible clinically. The suitability of such corneas for use as donor material as well as the response of the eyes to anterior segment surgery can be assessed by specular microscopy and this may become even more important in the future as long‐term contact lens wearers become more numerous in the community.
SCLERAL REINFORCEMENT IN THE TREATMENT OF PATHOLOGIC MYOPIA
Authors: CORONEO M. T. , BEAUMONT J. T. L. , HOLLOWS F. C.
Published: November 2007

Pathologic myopia is a relatively common blinding condition for which current treatment is limited and controversial. Macular changes and vision loss proceed from the development of a posterior staphyloma. A scleral reinforcement technique has been used in seven eyes of six patients. The procedure is technically uncomplicated and safe.
LISTERIA MONOCYTOGENES ENDOPHTHALMITIS: A CASE REPORT
Authors: BRIAN G. R. , TREPLIN M. C. W.
Published: November 2007

Listeria monocytogenes endophthalmitis is characterised by a progressively darkening indolent hypopyon. Gentamicin and amoxycillin, as used in this, the first reported Australian case, is the currently recommended treatment.
BOTULINUM TOXIN — THE RATIONALE OF ITS USE
Authors: DUNLOP C.
Published: November 2007

Treatment with Oculinum, (Botulinum toxin, Type A), may induce three possible effects. These are a pharmacologic inhibitory effect, a mechanical effect and a sensory effect.
CARRIER DETECTION IN X‐PIGMENTARY RETINAL DYSTROPHY (X‐LINKED RETINITIS PIGMENTOSA) BY DNA RESTRICTION FRAGMENT LENGTH POLYMORPHISM STUDIES
Authors: CHEN J. D. , HALLIDAY F. B. , DENTON M. J.
Published: November 2007

As part of a patient care and DNA research programme commenced in 1985, a number of DNA markers on the short arm of the X chromosome have been used to demonstrate restriction fragment length polymorphisms (RFLPs) segregating with the X‐pigmentary retinal dystrophy (X‐linked retinitis pigmentosa) gene. The analysis of the segregation of the RFLPs in 3 kindreds enables carrier detection, to a high degree of probability, in females at risk who are not manifesting symptoms and signs.
THE LOSS OF FUSION IN ADULTS WITH INTRACTABLE DIPLOPIA (CENTRAL FUSION DISRUPTION)
Authors: PRATT‐JOHNSON J. A. , TILLSON G.
Published: November 2007

People over the age of 10 years can lose their fusion ability. This acquired disruption of fusion gives rise to intractable diplopia without suppression. An involuntary vertical bobbing movement of the non‐fixing eye, present only with both eyes open, occurs at or near the angle of superimposition. This appears to be a unique and characteristic sign of acquired disruption of fusion and was present in all cases. Other causes of diplopia are mentioned and differentiated. Acquired central fusion disruption usually results from serious head injury. Partial recovery may occur but is unlikely. Sensory deprivation of at least 31/2 years' duration due to poor vision in one eye resulting from a traumatic cataract and sometimes subsequent uncorrected unilateral aphakia caused loss of fusion in 15 patients. The practical implications with regard to intraocular lenses and unilateral aphakia is discussed. Less commonly, vascular, neoplastic and presumed inflammatory lesions in the mid‐brain area cause central fusion disruption.
EARLY EXPERIENCES WITH SOFT INTRAOCULAR IMPLANTS
Authors: STEELE ARTHUR O. McG.
Published: November 2007

The author recounts his early experience with implants for the posterior chamber made of silicone. While the numbers are small the visual results appear to be satisfactory. The results, however, are marred by an as yet unacceptable rate of post‐operative complications.
WHO REMEMBERS THE FIRST PROFESSOR OF OPHTHALMOLOGY?
Authors: LITTLEWOOD ROSS
Published: November 2007

The cradle of modern ophthalmology was the Joseph's Academy which still stands in Vienna's ninth district. History records some famous names from the academic lineage which flourished there in the nineteenth century, but few people have heard of Joseph Barth, who became the first professor of ophthalmology in 1773. A biography of Joseph Barth is presented.
Visual acuity development: A study of preterm and full‐term infants
Authors: Searle Cathie M. , Horne Susan M. , Bourne Katrina M.
Published: November 2007

Visual acuity was measured in both preterm and full‐term infants by means of forced‐choice preferential looking. The ages of infants tested ranged from one month to 12 months. The results of both groups were considered and compared in terms of natal and conceptional age. The data suggested that preterm infants show visual responses equivalent to their full‐term counterparts by nine months of age. Trends indicate that visual acuity development in healthy preterm infants appears to be accelerated when compared with full‐term infants of the same post‐conceptional age.
Keratoconus: diagnosis and management
Authors: FeRACO Michael Lawless , Douglas J , Phil Anthony J. Phillips M. , FRACO Mark Loane
Published: November 2007

Keratoconus is a common condition whose clinical features represent a common effect on the cornea of a number of diverse processes. This review deals with the clinical signs and accompanying histological and biochemical changes within the cornea, evaluates the significance of associated ocular and systemic conditions and assesses the incidence and prevalence of the disorder.

The wider ophthalmic community shares in the treatment of keratoconus, so the general principles of contact lens fitting associated with this difficult condition are examined and the specific protocol used at the Flinders Medical Centre is presented. When contact lenses are not tolerated or an adequate improvement in visual acuity is not achieved, surgery is the next option, so a full assessment is made of the risks and benefits of penetrating keratoplasty. Older techniques, such as thermokeratoplasty and lamellar keratoplasty, are examined and the new technique of epikeratophakia is evaluated.
Conal anaesthesia: a new approach to retrobulbar anaesthesia
Authors: Buttery Robert , Wise Gordon
Published: November 2007

We have set out critically to assess the current percutaneous technique of retrobulbar anaesthesia. Access to the confined space within the muscle cone is limited by the globe itself and the medially directed lateral orbital wall. By approaching the retrobulbar muscle space with a curved needle through the inferior conjunctival sac these anatomical constraints are overcome. This technique is referred to as conal anaesthesia. A quantitative comparison of the two techniques demonstrates that the conal approach produces more reliable and effective muscle block with faster onset of action than conventional percutaneous anaesthesia. The conal approach is safe and offers advantages with its ease of application, excellent anaesthesia and akinesis and through its rapid and consistent results.
Experimental compounds to lower intraocular pressure
Authors: Podos Steven M. , Camras Carl B. , Serle Janet B.
Published: November 2007

A need exists for new ocular hypotensive agents that are more efficacious and that have fewer side effects than those now clinically used. Laser‐induced glaucoma in monkeys is an excellent model to test potential new drugs that lower intraocular pressure (IOP). A variety of agents that act through secondary messenger systems or via enzymes to lower IOP are being investigated in primates. Several alpha‐adrenergic agonists and antagonists are effective ocular hypotensive agents in monkeys and humans. Para‐aminoclonidine, an alpha, agonist, inhibits the transient post‐laser rise of IOP in humans. Prostaglandin F2α‐1‐isopropyl ester significantly reduces IOP when tested in multiple dose fashion in glaucomatous monkey eyes and glaucoma patients. Modified carbonic anhydrase inhibitors, designed to enhance intraocular penetration, reduce IOP in the monkey model and in ocular hypertensive patients in single‐dose studies when given topically. Studies show that forskolin and vanadate are less promising agents for glaucoma therapy.
Cyclitic glaucoma
Authors: Brooks Anne M. V. , Glenys Grant AAIPP, MOPS, RBI  , Young T. , Newton A. , Gillies W. E.
Published: November 2007

A series of patients is presented showing the widely variable clinical behaviour of different groups of patients who share the common features of cyclitic glaucoma. These cyclitic glaucomas may be classified:

1. Glaucomatocyclitic crises: unilateral or bilateral. This condition presents acutely, almost always in males with a strong tendency to spontaneous resolution but a liability to subsequent recurrence. Some cases are slow to resolve and may recur frequently.

2. Heterochromic cyclitis: glaucoma infrequently complicates heterochromic cyclitis and then with only a mild rise in intraocular pressure (IOP).

3. Chronic cyclitis: unilateral or bilateral. This is more common in females often presenting with a high rise in IOP which may be difficult to control medically.

An insidious form of chronic cyclitis occurs in middle‐aged, blue‐eyed females, often with sarcoid, and is likely to progress to profound visual loss if unrecognised.
A comparison of the efficacy of betaxolol and timolol in ocular hypertension with or without adrenaline
Authors: Clark J. B. , Brooks A. M. V. , Harper C. A. , Mantzioros N. , Gillies W. E.
Published: November 2007

Betaxolol hydrochloride, a selective beta:‐adrenergic blocker, is claimed to be less likely to aggravate chronic obstructive airways disease than timolol maleate, a nonselective beta‐blocker. It is not clear which drug is more effective in lowering intraocular pressure (IOP) and how each acts in combination with topical adrenaline. To assess this we conducted a randomised clinical trial on ocular hypertensive patients. Both betaxolol and timolol produced a significant fall in IOP though not in all patients. No significant difference was found between betaxolol and timolol. The addition of dipivefrin gave an additional fall in some eyes only. No significant difference was found between the addition of dipivefrin and adrenaline. Some fellow eyes had a fall in IOP when dipivefrin was added to timolol. It is important to assess the response carefully in each individual eye when using betaxolol or timolol or when adding additional medication.
Mycobacterium chelonae keratitis
Authors: Richardson Peter , Crawford Geoffrey J. , Smith David W. , Xanthis Colin P.
Published: November 2007

A case of Mycobacterium chelonae keratitis is described. As with any infective keratitis, appropriate treatment depends upon rapid and accurate microbiological assessment of corneal scraping. Acid‐fast stains such as Ziehl‐Nielson should be performed, particularly in chronic corneal ulcers, as only these stains will distinguish mycobacteria from the more common diphtheroid organisms. The mycobacterium chelonae organism was sensitive only to tetracyclines.
Expulsive choroidal haemorrhage—A clinical and pathological review
Authors: Whitehouse Geoffrey M. , Filipic Marijan , Francis Ian C
Published: November 2007

This paper describes two cases of expulsive choroidal haemorrhage (ECH) where the final corrected visual acuity was 6/5. The management of one case consisted simply of vitrectomy; and the other of suprachoroidal drainage of blood followed by vitrectomy. The pathological findings in a series of eyes enucleated following ECH are also described. The literature is reviewed with regard to the aetiology, pathology and management of ECH.
A survey of hereditary aspects of pigmentary retinal dystrophies
Authors: Dickinson Pamela , Mulhall Lin
Published: November 2007

A study of 707 cases of retinitis pigmentosa and choroideraemia presenting over 12 years were classified according to their modes of inheritance‐439 autosomal recessive (62%), 193 autosomal dominant (27%), 75 X‐linked (10.7%). The patients with autosomal recessive transmission included 58 Usher syndrome, 12 Laurence‐Moon‐Bardet‐Biedl syndrome and 33 Leber's congenital amaurosis. Another 37 had an early onset with macular degeneration and 31 were of late onset with pericentral dystrophy. Forty two were offspring of consanguineous parents. Of 193 individuals (78 families) with autosomal dominant inheritance, 20% had night blindness from early childhood. With X‐linked transmission, 33 males and 31 female carriers comprised the retinitis pigmentosa group and eight males and three carrier females, choroideraemia. Almost all this X‐linked group were of British ancestry. Of patients originating from the Mediterranean area, 94% had autosomal recessive disease.
Subretinal new vessel recurrence in age‐related macular degeneration
Authors: Constable Ian J. , Walker Louise N. , McAllister Ian L.
Published: November 2007

Laser photocoagulation with argon or krypton is currently used to treat selected patients with age‐related macular degeneration and sudden visual loss from subretinal new vessel formation. In 102 consecutive cases, treated over two years, closure of the vessels was achieved without additional major visual loss in 79% when assessed at two months. Early failure occurred in 21% and was due either to selection of cases with central location or failure to close the new vessel. Later failures due to recurrent subretinal new vessel formation or progression of other macular degenerative changes has occurred in a further 28% so far. Although controlled clinical trials show a significant benefit of treatment, the overall impact of these few successes on the population with macular degeneration is small. Further understanding of the mechanism of subretinal new vessel formation is urgently required. Areas under investigation include the response of injured retinal pigment epithelium, choroid and retina and cellular production of facilitatory factors including proteases and fibronectin.
Detection and recognition of visual field defects resulting from lesions involving the visual pathways
Authors: FRACO P. C. Wellings
Published: November 2007

Abstract

A prospective study of visual field defects associated with lesions of the visual pathway was carried out using kinetic and suprathreshold static stimuli with a view to establishing the most effective screening method for these field defects. The 215 abnormal fields so obtained showed that all field defects due to lesions of the visual pathways are detectable within 30 degrees of fixation and that not only is central field testing mandatory in excluding such a field defect, but more peripheral field testing alone is ineffecve. This study also revealed that when kinetic fields are charted, it is probably not worthwhile searching for scotomata other than within the most central part of the field. Furthermore, where outer and inner isopter depression is not coextensive, inner isopters are always depressed more than outer isopters when the field defect is due to a lesion of the visual pathway.
The scotopic threshold response in diabetic retinopathy—a preliminary report
Authors: Aylward G. W. , Billson F. A.
Published: November 2007

Abstract

The scotopic threshold response (STR) and the scotopic b‐wave of the electroretinogram were recorded in a group of 30 patients with insulin‐dependent diabetes mellitus. Retinopathy was assessed using colour stereo fundus photography and an adaptation of the Airlie House classification scheme. Wide‐angle fundus fluorescein angio‐graphy was also performed and angiograms were graded for the presence of leakage and capillary non‐perfusion. The STR was reduced in those eyes with retinopathy of grade 3 or above compared with eyes with retinopathy of grade 2 or below. There was a significant correlation between the amplitude of the STR and: (1) the grade of retinopathy; and (2) fluorescein leakage. There was no correlation between the b‐wave amplitude and the severity of retinopathy. The STR may have a role as a screening test for diabetic retinopathy.
The role of penetrating keratoplasty and epikeratoplasty in the surgical management of keratoconus
Authors: FRACO Michael A. Lawless , MD Richard C. Troutman
Published: November 2007

Abstract

A series of 86 penetrating keratoplasties for kerataconus was analysed. The surgery, using an 8.2 mm donor cornea into an 8.0 mm recipient opening, was performed between January 1983 and January 1986. The donor cornea was secured by two opposing continuous sutures, placed at full corneal thickness under surgical keratometry control. Both sutures were removed on average 30 weeks after surgery. The mean postoperative sutures out astigmatism was 5.4 dioptres (range 0 to 19.0), and following astigmatism surgery in 17 eyes, the mean astigmatism was 4.3 dioptres (range 0 to 10.5). Graft reaction occurred in 11.6% but was cleared medically in all cases and no corneas were lost. One month after suture removal, with spectacle correction, 45.5% of the primary group achieved vision of 6/6, 90.7% were 6/9 or better, and 97.7% were 6/12 or better. Comparing these results with recently published data on epikeratoplasty, for the treatment of keratoconus, it is evident that penetrating keratoplasty offers the best means whereby the eye can obtain its full visual potential.
Acute non‐haemorrhagic conjunctivitis due to coxsackievirus A24
Authors: MD Anne M. V. Brooks , MB Percy H. Cowen , PhD John A. Marshall , Msc Wendy A. Leong , BSc Vicki Bitsianis , ARMIT Maurice Evered , BSc Margery L. Kennett
Published: November 2007

Abstract

Two cases of acute non‐haemorrhagic conjunctivitis due to coxsackievirus A24 (CA24) are described. These are the first Australian isolates. The presentation was as a severe conjunctivitis in otherwise healthy adults who had not travelled outside Australia. The course was of short duration and self‐limiting, with no long‐term sequelae. The isolates could not be neutralised by antiserum prepared against prototype CA24 but were identified by immune electron microscopy and complement fixation.
Update and implications from the Newcastle diabetic retinopathy study
Authors: Mitchell Paul , MBBS Paul Moffitt
Published: November 2007

Over 11 years from 1977 a large study of diabetic retinopathy has been conducted in Newcastle and in 1988, 5519 diabetic subjects had been assessed. Where possible, all had retinal photography. Prevalence rates for any retinopathy, proliferative retinopathy and maculopathy were assessed in relation to the known duration of diabetes for subjects diagnosed before or after age 30 years. These data indicate a peak of retinopathy prevalence in the second or third decade of diabetes with slightly lower rates in longer survivors. Treatment with insulin was associated with a higher retinopathy prevalence. Incidence rates for the new development of background retinopathy in previously unaffected subjects show a peak late in the first decade of diabetes in young‐onset cases, while in the older‐onset group, the peak occurs in the second decade of diabetes. Over all, 8% of diabetics without retinopathy developed it per year. The implications of this data for the routine management of diabetic patients is discussed and the current recommendations for retinal screening by the Australian Diabetes Society are outlined.
The prevention of diabetic retinal and renal basement membrane thickening in mice by islet cell allografts
Authors: Gillies M. C. , Mandel T. E.
Published: November 2007

The effect of fetal islet cell allografts on retinal capillary (RCBMT) and glomerular (GBMT) basement membrane thickening in diabetic mice was studied, as well as the effect of diabetes on the anterior lens capsule and the inner lamina of Descemet's membrane. CBA mice rendered diabetic with streptozotocin received fetal pancreatic islet cell grafts from C3H and BALB/c donors four weeks after induction of diabetes with an additional late transplant group receiving C3H grafts after six months of diabetes. After 12 months animals with successful grafts were examined for RCBMT along with untreated diabetics (UD, n % 4) and normals (N, n % 9). Untreated diabetics had significantly increased RCBMT (167.1 ± 12.1 vs 129.2 ± 24.3 nm, p% 0.05) and GBMT (278 ±11 vs 248 ± 6 nm, p% 0.004) compared to normals. All graft recipients had RCBMT similar to normal and significantly less than untreated diabetics: BALB/c (n % 7), 123.8 ± 21.0, p% 0.02; C3h early (n % 5), 126.6 ± 21.7, p% 0.05; C3H late (n % 4), 134.4 ±16.9, p % 0.03. The same was true for GBMT; 250 ± 10 nm, p % 0.02 for BALB/c recipients, 250 ± 8 nm, p% 0.04 for early and 255 ± 9 nm, p% 0.02 for late C3H recipients. GMBT in six month biopsies of normals and prospective late graft recipients were well below these levels. The anterior lens capsule and inner lamina of Descemet's membrane were not thickened in diabetic mice compared to normals, suggesting that factors associated with proximity to the circulation, apart from hyperglycaemia, may also be important in the generation of basement membrane thickening. This study supports the notion that islet cell allografts should prevent the long‐term retinal and renal complications of diabetes if performed early in the disease.
Aspects of growth hormone control in diabetes
Authors: Hyer S. L. , Kohner E. M.
Published: November 2007

Growth Hormone (GH) has been implicated in the development of retinal new vessels that characterise diabetic proliferative retinopathy. Formerly, pituitary ablation was successful in causing such new vessels to regress but this approach has been largely superseded by panretinal photocoagulation. A clearer understanding of the GH abnormalities in diabetes might not only shed light on the process of retinal new vessel formation but could also provide a means for pharmacological suppression of GH in those patients not fully responding to laser photocoagulation. In this review, GH control in diabetes is considered with particular reference to studies in patients with diabetic retinopathy.
Retinopathy of prematurity: approaches to surgical therapy
Authors: Machemer Robert , DeJuan Eugene
Published: November 2007

Retinopathy of prematurity (ROP) is a vaso‐proliferative disease with infiltration of the vitreous gel. Contraction of the infiltrate results in traction detachment with typical peripheral trough formation. Cryotherapy inhibits proliferation in the active stages of the disease (Stage 3, ‘plus’). With development of traction detachment involving the macula (Stage 48) encircling buckling procedures should first be tried. Closed vitrectomy is considered when high retinal detachment and opacification by vitreous strands occur. The surgical technique is described. Anatomical (64%) and functional (43%) successes are reasonably high for Stage 4 cases, but disappointing (anatomical 40%, functional 16%) for Stage 5 ROP. Open funnels of detached retina fare better than closed ones. It is probably best to perform surgery not before the cicatricial stage, i.e. six months after birth.
Infectious crystalline keratopathy
Authors: Sutton Gerard L. , Miller Ross C. , Robinson Lyon P.
Published: November 2007

A 76‐year‐old patient was found to have a crystalline keratopathy with no evidence of acute inflammation in her right corneal graft. The patient had been on long‐term topical steroids. Subsequent microscopy of the graft demonstrated pockets of Gram‐positive cocci with a paucity of inflammatory cells. This is the tenth reported case of infectious crystalline keratopathy, first reported by Gorovoy in 1983.‘It does not always occur in corneal grafts, but the use of long‐term topical steroids, together with an epithelial defect, allows the microorganism, usually Streptococcus viridans, to invade the corneal strorna and replicate along the lamellar planes, unhindered by the usual inflammatory response. Retrospective analysis of this patient's history suggests that she has suffered the same keratopathy in previous corneal grafts. Treatment involves cessation of steroids, antibiotic cover and often a repeat penetrating keratoplasty. If this is required, the lowest possible dose of steroid cover should be used with prolonged use of topical antibiotics. To the best of our knowledge this is the first reported case of infectious crystalline keratopathy in Australia.
Adult vitelliform macular degeneration: a clinical spectrum
Authors: Greaves A. H. , Sarks J. P. , Sarks S. H.
Published: November 2007

Adult vitelliform macular degeneration (adult Best's disease) has a spectrum of clinical appearances which may include focal macular pigment clumps as well as the more typical small, yellow lesions. We surveyed 81 patients with this diagnosis retrospectively. Ages ranged from 36 to 87 years, with an average age of 67 years. Males and females were almost equally represented. Median visual acuity at presentation was 6/12 for eyes with yellow lesions, and 619 for eyes with pigment clumps. Of 17 cases followed for an average of 3.6 years, there was a decrease in visual acuity of two lines or more in five cases. A significant proportion of patients also had other manifestations of age‐related macular degeneration. Adult vitelliform macular degeneration probably falls within the spectrum of age‐related macular degeneration.
The development and management of neovascular glaucoma
Authors: Brook Anne M. V. , Gillies W. E.
Published: November 2007

Patients with neovascular glaucoma (NVG) often present with neovascularisation of the iris (NVI) already established and prompt energetic treatment of these patients is needed to reverse or stabilise the condition with possible retention of some visual function. In this series if the ocular media were still clear panretinal photocoagulation (PRP) caused regression of NVI in about 60% of cases and if a persistent rise in intraocular pressure (IOP) were still present this could be dealt with by drainage operation, Molteno implant or cyclophotocoagulation. If the media were already opaque or NVI did not regress then a Molteno implant or cyclophotocoagulation was used to reduce the IOP, preserving corneal endothelial function so that a comfortable eye could be obtained. Some regression of the NVI process was likely with time if the IOP were controlled by surgical treatment. Of 32 patients reviewed here, 20 patients developed NVG following a central retinal vein occlusion; in six patients NVG followed diabetic proliferative retinopathy, in five it followed arterial occlusion, and in one it followed an old traumatic retinal detachment. In those patients where NVG followed venous or arterial occlusion the common risk factors were always present. Patients were usually under treatment for their systemic condition but this treatment should be reviewed.
The management of metastases to eye and orbit from carcinoma of the breast
Authors: Burmeister B. H. , Benjamin C. S. , Childs W. J.
Published: November 2007

This report describes 11 patients who developed visual symptoms due to choroidal or orbital metastases from carcinoma of the breast. All patients were treated using palliative radiotherapy with regression of metastases in five of six patients (83%) having choroidal involvement and three of five patients (60%) having orbital metastases. There were no complications due to radiotherapy. All these patients had advanced metastatic breast cancer with poor survival following development of orbital or choroidal metastases.
A method for measuring neuroretinal rim area
Authors: Simpson A. J. , Lee S. , Hanna K. J. , Bron A. J.
Published: November 2007

A practical method for measuring the neuroretinal rim area (NRA) of the optic nervehead is described. Sequential stereo photographs are taken on 35 mm colour transparencies using a Zeiss fundus camera with Allen stereoseparator. While examining a stereo pair with a pocket viewer the disc and cup margins are traced against the stereo image with a Rotring pen (0.1 mm tip) on a clear transparency overlying one of the photographs. This tracing is digitised and analysed by an ‘edge detection’ algorithm which measures the area between the traced lines, i.e. NRA. The intraobserver intraphotograph coefficient of variation (standard deviation/mean) was calculated for measurements of disc area, cup area and NRA made on 10 stereo photographs of discs with various topographies. Coefficients for NRA ranged from 3.2% to 3.9% for discs with easily discernible cup margins and from 1.6% to 7.2% for discs with less obvious cups.
Intraocular lacrimal gland choristoma
Authors: O'Donnell Brett A. , Martin Frank J. , Kan Alex E. , Filipic Marijan
Published: November 2007

There have been nine previously reported cases of intraocular lacrimal gland choristoma. This case report is of an infant with an intraocular lacrimal gland choristoma which was managed conservatively for a 19‐month period until the onset of glaucoma. Tumour biopsy was initially performed because until this time the tumour's behaviour suggested it was not malignant. The latter was confirmed on biopsy, however hypotony resulted following the surgical intervention.
Lymphomatoid granulomatosis presenting as sudden blindness
Authors: FRACO David McKay , FRACO Roger Williams , FRACO Frank Taylor , FRACP Jonathan Ell
Published: November 2007

Lymphomatoid granulomatosis is an uncommon clinical problem and even more rarely presents to the ophthalmologist. A case is described in which a 60‐year‐old Fijian woman presented with sudden, sequential, complete visual loss in asSociation with signs of scleritis. Direct eyewall biopsy and nasal mucosal biopsy confirmed the diagnosis of lymphomatoid granulomatosis. Despite intensive high‐dose oral prednisone therapy her vision remained at no light perception and she developed recrudescence of disease necessitating the use of radiotherapy. All systemic investigations failed to show any other organ involvement by the disease process and she remains well. This is the first report of lymphomatoid granulomatosis presenting as sudden blindness.
Transient monocular blindness
Authors: Lord Reginald S.A.
Published: November 2007

Transient monocular blindness (TMB) or amaurosis fugax is diagnosed when visual disturbance or loss (blindness, dimming, fogging, blurring) affects one eye for seconds or minutes. TMB may occur alone or in combination with transient hemispheric ischaemia (TIA). The cause of TMB is usually an atheromatous plaque at the carotid bifurcation in the neck liberating emboli or causing a temporary reduction in carotid and retinal blood flow. In most patients no embolus or ischaemic change is visible in the fundus. TMB should be investigated and treated in the same way as neurologic TlAs with emphasis on rapid detection of extracranial arterial disease, cardiac abnormalities and haematological disorders.
Paired comparison of contrast sensitivity in diffractive multifocal IOLs and conventional monofocal IOLs
Authors: Lehmann R. P.
Published: November 2007

Multifocal intraocular lens (IOL) optics produce a retinal image of reduced contrast, which results from splitting incoming light between multiple focal points. This study sought to determine whether the reduced‐contrast image results in functional loss of contrast sensitivity. Contrast sensitivity was measured in patients in the US Food and Drug Administration (FDA) study of the 3M Diffractive IOL, using the Pelli‐Robson Letter Chart. Fifty‐eight of these patients, including six from our clinic, were ‘best‐case’ patients with no pathology, and also had paired multifocallmonofocal implants. Data from these ‘best‐case’ patients with paired eyes indicate no functional difference in contrast sensitivity. Additional data obtained on our six patients with the Regan Low Contrast Charts suggest small predictable differences may exist for some patients at very low contrast levels. Further study is needed to determine whether these differences have functional significance.
Retinochoroidal (optociliary) shunt veins, blindness and optic atrophy: A non‐specific sign of chronic optic nerve compression
Authors: Miller Neil R. , Solomon Stephen
Published: November 2007

Fifteen patients are described in whom the triad of blindness, optic disc swelling followed by optic atrophy, and optociliary shunt veins occurred. The causes of the syndrome included spheno‐orbital meningioma, optic nerve glioma, meningocele of the optic nerve, and chronic papilloedema. It is postulated that chronic compression of the intraorbital portion of the optic nerve produces gradual obstruction of the central retinal vein, thus preventing the normal passage of venous blood from the retina through the central retinal vein to the cavernous sinus. Optociliary veins are a pre‐existing shunt system that allows retinal venous blood to bypass the central retinal vein and exit from the orbit via the choroidal circulation and its anastomoses.
An effective method of anastomosis of the nasolacrimal canal
Authors: Guiying Fang
Published: November 2007

An effective method of anastomosis of the nasolacrimal canal is summed up in data derived from 150 cases seen over 20 years at the People's Hospital of Jiangsu Province. This paper describes briefly this experience and analyses the success of this procedure.
Corneal biopsy in microbial keratitis
Authors: Whitehouse G. , Reid K. , Hudson B. , Lennox V.A. , Lawless M.A.
Published: November 2007

Presumed microbial keratitis in the absence of a specific microbiological diagnosis is a particularly difficult clinical problem. Corneal biopsy may provide the diagnosis when corneal scrapings have been negative. We present two cases in which corneal biopsy was helpful and discuss the role of corneal biopsy in the management of chronic keratitis
The medical museum in Palmerston North and some medical history*
Authors: Warnock David C.
Published: November 2007

A brief history is given of the establishment of the N.C. Little Memorial Medical Museum in Palmerston North, New Zealand with an introduction into its functions and aims, together with a brief history of medicine with implications for the future.
Problems in the diagnosis and management of unilateral retinoblastoma
Authors: AO Francis A. Billson , Dunlop Iain S.
Published: November 2007

The improved prognosis for life in retinobiastoma challenges us to readdress the severe morbidity associated with late presentation and treatment, particularly in unilateral disease. Three cases of unilateral sporadic retinoblastoma are presented to illustrate the range of therapeutic options that need to be considered in management and to show that early recognition of the tumour and local treatment have the potential to minimise morbidity and to enable binocular vision to be retained.
Volume measurement of intraocular tumours by cross‐sectional ultrasonographic scans
Authors: Gosbell Andrew D. , Barry William R. , Favilla Ian , Burgess Fabian
Published: November 2007

The volume of intraocular tumours can be calculated from tumour height and cross‐sectional areas measured in maximal orthogonal B‐mode ultrasonograms, on the assumption that the tumour morphology is hemi‐ellipsoidal. Comparison of this method with an accurate but more complex computer‐aided B‐mode ultrasonic tomographic method demonstrated a highly linear relationship with a correlation coefficient of 0.93. Furthermore, the comparison of cross‐sectional areas measured from B‐scan images and histological cross‐sections in a small series of enucleated eyes demonstrated that tumour cross‐sectional area measured from ultrasound images provides an accurate representation of the true physical size of the tumour in the globe.

This method can be easily implemented with readily available B‐mode ultrasound equipment. Unlike previously reported volume measurement methods, customised hardware or software is not required. The method is rapid and easy to perform, and may offer a useful standard method of measuring and monitoring intraocular tumours.