bluuebunny/crossref_metadata_2025 huggingface dataset:
Preparation and Orientation of Canine Retinal Vasculature A Modified Trypsin Digestion Technique
Authors: Fischer Mary W. , Slatter Douglas H.
Published: November 2007

Abstract

An existing technique was modified in order to demonstrate the oriented vasculature of the entire canine retina, and described for use by persons unfamiliar with this exacting technique. The or a ciliaris retinae of the canine retina is irregular in outline and the insertion of the optic nerve, is eccentric. When the eye is sectioned into quadrants, their retinal radii and included areas are of differing dimensions. Prominent retinal veins are visible through the dissecting microscope at various stages of the dissection and trypsin digestion procedure. These distinctive vascular patterns and varying radial lengths are recorded diagrammatically to permit the identification of the vitreal aspect of each retinal quadrant. The retinal vasculature is presented in its correct orientation in completed slide preparations. Orientation of retinal vasculature permits correlation with previous clinical and photographic studies, and enhances an evaluation of normal and abnormal histology and cytological parameters.
SURVEY OF EYE CASUALTY PATIENTS, 1976–7, PRINCESS ALEXANDRA HOSPITAL, BRISBANE
Authors: Boyle Rhonda
Published: November 2007

A medical audit was carried out on 10831 patients, presenting to an Eye Casualty Department in one year. 57% were treated (or refractive errors, 7.7% for ocular foreign bodies and 6.5% for conjunctivitis. One fifth of ocular foreign bodies were caused by grinding accidents. Defects in such a medical audit, arising from errors of input and from choice of diagnostic criteria, are discussed.
INTERRUPTED 10/0 NYLON SUTURES IN PENETRATING KERATOPLASTY
Authors: Robertson Ian R.
Published: November 2007

Slow insecure wound healing is a feature of continuous 10/0 monofilament nylon sutures in penetrating corneal grafts. Interrupted sutures of the same type promote more rapid healing but more corneal vascularization occurs; however, if interrupted 10/0 monofilament nylon sutures are removed before blood vessels enter the graft then steroid eye drops can be stopped sooner.

No graft displacement or rejection occurred when interrupted monofilament nylon sutures were used in 9 eyes exhibiting a variety of severe corneal diseases.
SECONDARY OCULAR INFECTIONS
Authors: Leopold Irving H.
Published: November 2007

Intraocular infection can follow endogenous or exogenous routes. Those of endogenous origin have increased due Jo increased use of immunosuppressive agents, hyperalimentation, long standing indwelling catheters, and prolonged use of antibiotics in supportive therapy. New surgical procedures such as intraocular lens implantations and vitrectomies, along with routine cataract extractions, retinal detachment repairs, glaucoma surgery, corneal grafts and strabismus surgery have all contributed to the endophthalmitis incidence. The organisms likely to produce intraocular infection may be varied, opportunistic, virulent or even of low pathogenicity Control of such infections requires an awareness of the many antibiotics, their toxicities and dosage, aids to selection, as a guide to therapy, role of pre and post‐operative cultures, the value and types of prophylaxis, the routes of administration, and the place of nonspecific anti‐inflammatory therapy and other adjuvant approaches.
PTERYGIUM LEADING TO BLINDNESS: A CASE REPORT
Authors: Taylor H.R. , Hollows F.C
Published: November 2007

A case report is presented of an aboriginal woman with a pterygium that covered the entire cornea, resulting in blindness. This case illustrates the fact that pterygia do not necessarily regress in eyes with deterioration of visual acuity.
THE INTRA OCULAR CUTTER
Authors: CROCK GERARD W. , PERICIC LJUBOMIR , NEWMAN RICHARD G. , KEIZER ANTHONY T. De
Published: November 2007

Inappropriate infusion, either suprachoroidal or subretinal massive intraocular haemorrhage and inadvertent tearing or nibbling ofthe retina, are problems which maybe inducediatrogenically during vitrectomy.

Familiarity with the mechanical principles of each type of vitrectomy instrument will serve to minimise such hazards.

This paper presents the special features of our newest generation Intra Ocular Cutter (I.O.C.) in its two modes: (1) the fully integrated, electronically controlled, automatic unit with surgical stand and tray; (2) the Standby I.O.C, which is battery operated with simple hand suction. Particular stress is laid on the economy of ocular perfusion which may be achieved with informed use of these instruments.
AN OPERATION FOR ENTROPION AND TRICHIASIS:A COMPOSITE OF METHODS FOR LID MARGIN ROTATION
Authors: GRAHAM P. J.
Published: November 2007

Abstract

An operation for entropion/trichiasis is presented which is applicable to both upper and lower lids, and for grades of distortion from mild to severe. It is suitable for gross trachomatous lid disease in Aboriginal patients, and also for the discomfort of chronic cicatricial trichiasis in aged Caucasians.

No new procedure is proposed. The method combines features of several well tried operations to free the inturned lid margin and resuture it in proper apposition.
BIELSCHOWSKY'S SIGN. ITS GENESIS ANDOTHER OBSERVATIONS BY BIELSCHOWSKY
Authors: Hertzberg R.
Published: November 2007

Abstract

Reference is made to the life of Bielschowsky and his influence on the clinical assessment of strabismus. His approach to the study of ocular movement was founded on the work of Hering whom he referred to as “the master of physiology of space sense and movements of the eyes” and Sherrington who formulated the law of reciprocal innervation.
AMBLYOPIA IN THE FOUR TO NINE YEAR AGE GROUP. A FOUR‐YEAR SURVEY
Authors: FRACO MARY H. BREMNER , DBO MEGAN LEWIS
Published: November 2007

A guide to the ophthalmologist in the choice of the older child with amblyopia most likely to respond to active intensive visual stimulation in short bursts is presented. A series of 99 children treated on a CAM vision‐stimulator is described. Visual improvement of at least two rows of letters on the Snellen chart was maintained for at least three years after treatment in 62% of these patients aged between five and nine years with visual fixation within 3° of the fovea. Amblyopia following minor trauma or minor pathology also responded well. Children maintaining the visual improvement were those with esophoria up to 13°. those with hypermetropia up to 11.0 D and those with astigmatism of 1.5 D. Also responding well were children with anisometropia with up to 3.0 D of either hypermetropia or astigmatism
RETINOBLASTOMA IN THE ANTERIOR CHAMBER OF THE EYE
Authors: FRACO M. H. BREMNER
Published: November 2007

An uncommon presentation of retinoblastoma in an eleven‐year‐old boy is discussed. There was no family history of retinoblastoma and the child had never complained of a sore eye. He was not aware that he could not see out of his right eye.
LASER TRABECULOTOMY OR TRABECULOPLASTY: EARLY EXPERIENCE WITH A NEW NON‐INVASIVE SURGICAL TECHNIQUE FOR GLAUCOMA
Authors: GILLIES W. E. , WEST R. H. , CEBON L.
Published: November 2007

A series of 38 laser trabeculoplasty operations in 32 eyes of 29 patients is described. An average fall of 5.32 mmHg intraocular pressure was obtained; if secondary glaucomas were excluded the average fall was 7.39 mmHg. If a fall of 10 mmHg or more is considered a good result then eight eyes obtained a good result, five of these eyes having pseudoexfoliative glaucoma. A fall of 3–9 mmHg was considered a moderate result and 12 eyes obtained this, 11 of them having chronic simple open‐angle glaucoma, the other being the only other case of pseudoexfoliative glaucoma in the series. Five eyes with chronic simple open‐angle glaucoma and seven eyes with secondary glaucoma all obtained no significant fall. It is stressed that in chronic simple open‐angle glaucoma there was often only a small fall or no fall at all, so that it seems unwise to temporise if there is a high uncontrolled pressure in this condition. Great care is also needed in advanced chronic simple open‐angle glaucoma because of the occasional occurrence of a high rise of pressure soon after operation. The procedure works well in pseudoexfoliative glaucoma.
THE INTERMUSCULAR SEPTUM OF THE INFERIOR OBLIQUE MUSCLE: REVISED CONCEPTS
Authors: FRACO IAN ROBERTSON
Published: November 2007

The classical anatomical descriptions of the inferior oblique muscle give little or no account of its intermuscular fascial septum.

Operative and cadaver dissections show that a definite and constant fascial septum exists between the sheaths of the inferior oblique and the lateral and inferior recti.

The clinical significance of this fascia is realised when it is pulled laterally, as its inner surface provides a guide to the inferior oblique sheath; also, when a muscle hook is placed under the lateral rectus muscle it may snag the septum and kink the inferior oblique and cause its overaction. The fascia forms a sling for the inferior oblique sheath and helps to maintain its line of action.

For these reasons the intermuscular septum of the inferior oblique should be included in anatomical accounts of the ocular fascia and should be remembered during operations on the inferior oblique or lateral rectus muscles.
BELL'S PHENOMENON: A STUDY OF 508 PATIENTS
Authors: FRACO IAN C. FRANCIS , DOBA JULIE A. LOUGHHEAD
Published: November 2007

Bell's phenomenon is an important physical sign in clinical medicine. An assessment of Bell's phenomenon may help to explain or localize the cause of ocular disease and lead to the diagnosis of systemic disease. We report in this paper our findings in 508 patients who presented consecutively to a general ophthalmic practice, and who were examined for their Bell's phenomenon and for lagophthalmos. The study demonstrated a good deal of variability not only in the amount but also in the type of Bell's phenomenon response in normal patients. It also demonstrated the usefulness of Bell's phenomenon in specific clinical situations. The literature on the usefulness of Bell's phenomenon is reviewed.
CLINICAL FEATURES OF HLA‐B27 ANTERIOR UVEITIS
Authors: WAKEFIELD DENIS , EASTER JOAN , PENNY RONALD
Published: November 2007

The association of anterior Uveitis (AU) with the HLA‐B27 histocompatibility antigen is now well established; however, the clinical features of this subgroup of AU patients have not been extensively studied. We investigated 81 consecutive patients with AU over a 12‐month period.

Fifty‐one percent of the patients were HLA‐B27‐positive as were all patients with ankylosing spondylitis and Reiter's syndrome. This group of AU patients, when compared to HLA‐B‐27‐negative patients, had more frequent attacks of shorter duration and rarely developed chronic AU.

Males with AU, when compared with females, had a higher incidence of HLA‐B27 (31/41; p<0.005) and were more likely to have an associated rheumatic disease such as anky losing spondylitis, Reiter's syndrome or another seronegative arthritis. In contrast, HLA‐B27‐positive AU patients without associated rheumatic disease occurred with equal frequency in males and females. Females in this group had a comparatively later age of onset of AU (47 vs 40 years); had more attacks, each being of longer duration; and had a higher attack rate per year. This study defines the nature, severity and prognosis of AU with respect to the sex, associated rheumatic disease and HLA‐B27 status of patients.
METHYLPREDNISOLONE PULSE THERAPY IN SEVERE ANTERIOR UVEITIS
Authors: WAKEFIELD DENIS
Published: November 2007

Six patients with severe, refractory anterbr uveitis (AU) were treated with intermittent, intravenous pulses of methylprednisolone (MP). Five patients had bilateral AU and all had decreased visual acuities. AU was idiopathic in four subjects, one male had ankylosing spondylitis (HLA‐B27+) and one female had juvenile polyarthritis. All patients were initially treated with 1 gofMP intravenously (IV) on alternate days during the first week. Subsequently, patients received weekly injections of MP on a reducing dosage regime to a maintenance dose of 125 mg IV weekly. This therapy produced a rapid resolution of the signs of uveal inflammation and improved visual acuity. Two patients have been maintained on this treatment regime for over 12 months without evidence of disease relapse or serious drug side effects. Pulse MP is effective in the treatment of severe anterior uveitis and may be a useful adjunct in the management of patients with uveitis.
A TRANSCONJUNCTIVAL CRYOSURGICAL APPROACH FOR INTRAORBITAL TUMOURS
Authors: LAZAR MOSHE , ROSEN NACHUM , GEYER ORNA , GODEL VICTOR
Published: November 2007

A transconjunctival cryotechnique for the management of retrobulbar tumours is described. Fourteen retrobulbar tumours, evaluated by CTscan, were treated by this simple and minimally invasive operation. Patient's recovery is prompt and uneventful.
RETINOPATHY OF PREMATURITY: REVIEW OF A FIVE‐YEAR PERIOD, EXAMINATION TECHNIQUES AND RECOMMENDATIONS FOR SCREENING
Authors: CLEMETT R. S. , DARLOW B. A. , HIDAJAT R. R. , TARR K. H.
Published: November 2007

The reported resurgence of retinoathy of prematurity prompted analysis of the prevalence of retinopathy among premature infants born at Christchurch Women's Hospital over a five‐year period. Of the 129 surviving very‐low‐birth weight infants, 65 (50.4%) underwent ocular screening during the review period. Retinopathy was detected in 17.1% (22/129) of surviving infants, or 34% (22/65) of selected infants referred by paediatricians for ocular screening. Five infants had severe or blinding retinopathy and these premature infants were of significantly lower birthweight and born after shorter gestation periods than those found to have no retinopathy. Examination techniques for eyes of premature infants are discussed, and recommendations for screening for retinopathy of prematurity made.
CHANGES IN THE IRIS VASCULATURE AND CORNEAL ENDOTHELIUM IN CHRONIC CYCLITIS
Authors: BROOKS ANNE M. V. , AIAP GLENYS GRANT , FRACO WILLIAM E. GlLLlES
Published: November 2007

Fluorescein angiography of the iris vasculature and specular microscopy of the corneal endothelium were used to examine two important anterior chamber tissues in cases of heterochromic cyclitis, classical chronic cyclitis and some cases of iridocyclitis. The 13 cases of heterochromic cyclitis and eight cases of classical chronic cyclitis all showed vascular hypoperfusion of the iris, except for two young females with heterochromia. In these cyclitis eyes there was pupillary leakage of dye and all but one young female with heterochromia showed evidence of microneovascularization of the iris. Most patients showed evidence of abnormalities of the corneal endothelium, but this was most marked in elderly patients with heterochromic cychtis, probably due to the long duration of the condition. Six of the patients with chronic cyclitis had bilateral disease and five of these were elderly women with glaucoma and grey irides, the group being distinct enough to form a discrete clinical entity. Seventeen of the patients with chronic cyclitis were females with grey irides suggesting that this type of patient is more susceptible to cyclitis. Patients with acute iridocyclitis showed little abnormality on fluorescein angiography, while those with recurrent or chronic disease showed vascular hypoperfusion and microneovascularization suggesting that these changes in the iris contribute to the chronicity of the condition. It is suggested that hypoperfusion and microneovascularization of the iris and abnormal permeability are important factors in the production of chronic cyclitis, and that the integrity of the corneal endothelium is affected by these changes if they operate over a long period of time.
ORBITAL CELLULITE AND PRESEPTAL CELLULITE IN CHILDHOOD
Authors: LAWLESS MICHAEL , MARTIN FRANK
Published: November 2007

A study was made of 112 children with preseptal cellulitis, orbital cellulitis, subperiosteal abscess, and orbital abscess. These were consecutive admissions to the Royal Alexandra Hospital for Children, Sydney, during the period June 1976 to August 1985. The average age was 3 years 6 months. The clinical and radiological signs for each group were defined.

Of the 112 children, 43.8% (with an average age of 3 years 3 months) had a clinical history of an upper respiratory tract infection. Trauma was a factor in 13.4% of patients.

Haemophilus influenzae was recovered from blood culture in two patients and from conjunctival culture in seven patients. The average age of this group was 3 years 7 months.

Plain radiographs taken of 53 patients revealed evidence of paranasal sinus disease in 29 (54.7%). Computerized tomography was performed in 14 patients.

Of seven patients requiring surgical drainage of orbital or subperiosteal abscess (average age 7 years 2 months), five had clinical upper respiratory tract infection.
TRIGEMINO‐ABDUCENS SYNKINESIS: AN UNUSUAL CASE OF ABERRANT REGENERATION
Authors: McGOVERN STEPHEN T. , CROMPTON JOHN L. , INGHAM PETER N.
Published: November 2007

An unusual case of major head trauma is described involving injury to the right third, fifth, sixth and seventh cranial nerves in a basal skull fracture in a young woman, Two years later there persisted a total voluntary abducens nerve palsy, right facial hemianaesthesia and right temporalis and masseter palsy. However, involuntary abduction of the involved eye occurred on eating or chewing. Electromyography of the lateral rectus muscle documented aberrant reinnervation to support the clinical findings. Extraocular muscle surgery improved the compensatory head posture and minimized the chewing‐induced abduction.

The mechanisms for acquired synkinesis and the anatomy of the involved nerves are reviewed. It is postulated that regenerating motor fibres of the trigeminal nerve were misdirected along proprioceptive channels to the lateral rectus in the case reported here.
CONGENITAL UPPER lid COLOBOMA
Authors: COLLIN J. R. O.
Published: November 2007

Twenty‐two patients with congenital upper lid colobomas were assessed Strabismus occurred in 13 cases and was associated with bands of fibrous tissue or adhesions, high refractive errors and opacities in the ocular media A traction test is strongly recommended early in all children with congenital upper lid colobomas A lateral cantholysis and direct closure was the commonest type of surgery, but unless the coloboma closed easily a lower lid rotation flap gave the best results.
TRACHOMA: 1985 UPDATE IN WESTERN AUSTRALIA
Authors: COOPER R. L. , COlD D. , CONSTABLE I. J.
Published: November 2007

Aboriginal preschool and school children were surveyed in the Eastern Goldfields Region and the Eastern Kimberley Region of Western Australia between 1979 and 1985. Statistics from these surveys show that there has been an apparent change in pattern of follicular trachoma since the National Trachoma and Eye Health Programme ln some of the communities. The prevalence of follicular trachoma in the 0 to 9 year old age groups had declined from 26.4%/n 1977 to 8.8% in 1984/1985 in the Eastern Goldfields and Red Centre combined (0.10 > p > 0.05). The prevalence reduction occurred in areas where there have been improvements in school hygiene and housing. The prevalence of cicatricial trachoma has also apparently declined from 65% in 1977 to 39% in 1985 in the Red Centre, from 39% in 1977 in the Eastern Goldfields to 21.7% in 1985, and from 58% in 1977 to 24.9% in 1985 in the Eastern Kimberley. Communities at risk were identified and recommendations made for frequency of continued screening, depending on age, distribution and location.
SINGLE‐EYED INFANTILE ESOTROPIA‐ABDUCTIONAL NYSTAGMUS SYNDROME (UNILATERAL CONVERGENT SQUINT FOLLOWING ENUCLEATION)
Authors: DUBEY ARVIND KUMAR , YADAV SAVITA
Published: November 2007

Three infants underwent enucleation of one eye for different indications. This was followed by the development of esotropia of varying degree within one to four months in all the three cases, and was associated with a coarse nystagmus present in abduction, but absent in the primary and adducted positions of gaze. There was a face turn to the side of remaining eye. This appears to be a separate clinical entity and not early onset esotropia. Possible mechanisms and medicolegal implications are discussed.
POST‐CATARACT ASTIGMATISM: ITS CONTROL AND CORRECTION
Authors: BARTHOLOMEW R. S.
Published: November 2007

The factors responsible for postoperative astigmatism — wound compression and wound gape — are discussed and illustrated for a number of suture incision combinations. Variability is pronounced. Midlimbal incisions sutured with 8‐0 virgin silk had a range of 8D at four days, 8.5D at four weeks and 9D at three months. Nylon 9‐0 double continuous, tied normally, had 8D at four days, 7D at four weeks and 7.5 D at three months. The same suture tied tightly gave a range of 5D at four days, 7.5D at four weeks and 6D at three months. Methods of control and Correction are discussed and illustrated with case histories.
CLINICAL TYPES OF PRIMARY ANGLE CLOSURE GLAUCOMA
Authors: LOWE RONALD F.
Published: November 2007

There is no internationally adopted terminology for the clinical types of primary angle‐closure glaucoma. Descriptions of three clinical types: 1. intermittent angle closure; 2. acute and subacute angle closure; and 3. creeping angle closure are presented with reasons for the division into and naming of these types. Chronic angle closure is not a distinct form but a late derivation from various types of angle closure.
RETINAL DETACHMENT FOLLOWING Nd: YAG CAPSULOTOMY
Authors: AMBLER JOHN S. , CONSTABLE IAN J.
Published: November 2007

In a retrospective study of 862 patients undergoing Nd: YAG capsulotomy for secondary posterior capsule opacification after extracapsular cataract surgery, the prevalence of retinal detachment was found to be 1.4% with minimum follow‐up of six months. Thirty‐eight per cent of these detachments occurred within the first two months and 69% occurred within the first six months following capsulotomy. The increase in the prevalence of retinal detachment following Nd: YAG capsulotomy is most likely due to changes in the vitreous which occur when the posterior capsule is no longer intact.
COMPLICATED STRABISMUS AND ADJUSTABLE SUTURES
Authors: PRATT‐JOHNSON J. A.
Published: November 2007

Clinical experience in performing over 500 adjustable strabismus operations is mentioned in this paper particularly as it relates to complicated strabismus. A maximum hang‐loose recession of a rectus muscle has a limited effect, which is tabulated and the implications discussed. Aids in finding the lost medial rectus muscle are mentioned. Adjustable sutures are then exploited in managing the found “lost” medial rectus. Adjustable recession of both vertical recti in the affected eye were used in some cases of blow‐out fracture to manage limitations of upward and downward gaze. Adjustable recession of both yoke medial recti are used in some unilateral superior oblique palsies where the main sequela is hypertropia in downward gaze only. A previously paralysed lateral rectus muscle, which has completely recovered function but has left the patient with a concomitant esotropia with full ductions and normal versions, responds excessively to resection. This should be taken into consideration when planning adjustable strabismus surgery in such a case.
PROFESSIONAL NEGLIGENCE
Authors: MOORE MAX C.
Published: November 2007

In the last 5 years there has been an extraordinary increase in negligence actions against South Australian ophthalmologists. This paper considers the reasons, in particular those changes in the interpretation of the law which have made doctors vulnerable. Medical practice needs to be modified if doctors, especially surgeons, are to protect themselves, but the appropriate changes may not be in patients' best interests. The law of negligence is said to be on the brink of collapse and the Australian situation offers an interesting contrast to New Zealand's no‐fault accident insurance scheme.
Postural drainage in the management of postoperative hyphaema
Authors: Thomas Ravi , Painter Geoffrey , Billson Frank A.
Published: November 2007

We describe the technique of postural drainage of hyphaemas following trabeculectomy alone or when combined with lens extraction and intraocular lens implantation. This technique helps avoid surgical intervention and seems to have no short‐term deleterious effect on bleb function.
Episcleral plaque radiotherapy for uveal melanoma
Authors: Giblin Michael E. , Shields Jerry A. , Augsburger James J. , Brady Luther W.
Published: November 2007

The use of radioactive Iodine, Ruthenium, Iridium and Cobalt plaques of varying dimensions to treat choroidal and ciliochoroidal melanomas is discussed and placed in perspective with other treatment modalities. The regression pattern following plaque treatment appears to be more rapid for tumours that are more poorly differentiated. The visual results following plaque brachytherapy compare very favourably with those following local resection and external beam radiation. Ocular complications are significantly greater for tumours whose initial thickness exceeds 8 mm. The survival rater after plaque treatment is compared with that for patients who have had primary enucleation for equivalent‐sized tumours.
Transcleral ciliary sulcus fixation of posterior chamber intraocular lens implants
Authors: Agapitos Peter J. , Lindstrom Richard L.
Published: November 2007

We present our results of transcleral ciliary sulcus fixation of posterior chamber intraocular lens implants (IOL) in IOL exchange cases, secondary implants, and complicated cataract extractions. Follow‐up data are presented on a total of 19 patients. The technique is facilitated by using a long needle attaching 10–0 prolene suture to both haptics of an all polymethylmethacrylate (PMMA) posterior chamber intraocular lens implant (PCL). Our early results show that the procedure is safe and predictable.
Neodymium: YAG laser vitreolysis for treatment and prophylaxis of cystoid macular oedema
Authors: Tchah Hungwon , Rosenberg Mike , Larson Rhondi S. , Lindstrom Richard L.
Published: November 2007

Eighteen eyes with vitreous strands adherent to the corneoscleral wound of previous cataract surgery were treated with neodymium: YAG laser to achieve vitreolysis. Twelve eyes were treated for management of cystoid macular oedema (CMO group) and six eyes were treated for prophylaxis of possible CMO (prophylactic group). In the CMO group, visual acuity improved two or more Snellen lines in 10 eyes (83.3%) and seven eyes had a post–laser visual acuity of 20/40 or better (one eye had a pre–treatment visual acuity of 20/40 or better). In the prophylactic group, visual acuity was either maintained at the pre–treatment level or improved in five eyes (83.3%) eighteen months after laser treatment. This procedure was complicated by retinal detachment in one case and elevation of intraocular pressure over 10 mmHg in another case.
The place of trabeculectomy in the management of primary open‐angle glaucoma and factors favouring success
Authors: Thomas Ravi , Billson Frank
Published: November 2007

Medical treatment has always been the mainstay in the management of primary open‐angle glaucoma (POAG). Surgical intervention has been reserved for cases with intraocular pressures uncontrolled on medical therapy and/or progression of visual field loss. Following the introduction of trabeculectomy, there was a move toward earlier surgery in POAG with some advocating it as a primary procedure. However, others have emphasised the cornplications and unpredictability of trabeculectomy and use it only as a last resort. In this article the literature is reviewed and the factors that prevent complications and help ensure a successful result in trabeculectomy are considered. While the role of trabeculectomy as a primary procedure in POAG is debatable, the authors favour earlier surgical intervention rather than using surgery as a last resort.
Paediatric aphakic epikeratoplasty: early Australian experience
Authors: Collie Donald M.
Published: November 2007

Epikeratoplasty has been performed on eight eyes of seven patients by one surgeon in Melbourne since March 1988. All cases were contact lens or spectacle intolerant. Standard surgical techniques utilising donor lenticules imported from the United States and including an annular keratectomy were employed for the procedure. An eight‐month followup is availabe for the first two cases, aged two and 10 years. The elder of these children has achieved corrected acuity of 6/9 in each eye. Refractive and early visual acuity results are presented for the five other cases which have at least two months of followup. The results indicate that in appropriately selected patients, epikeratoplasty offers a safe, effective modality for visual restoration and development in otherwise untreatable aphakic children.
Glaucoma and its relationship to intraocular lens implantation
Authors: Obstbaum Stephen A. , Orlando Fred
Published: November 2007

The management of glaucoma and cataract is a complex subject that has remained controversial until recently. Extracapsular cataract surgery with posterior chamber lens implantation has made the procedure safe to perform in most eyes with glaucoma controlled medically, by laser trabeculoplasty or after filtering surgery. This paper will review the literature to establish rational guidelines for this particular group of patients.
A modified combined indirect ophthalmoscope and illuminated magnifying loupes
Authors: Leung Kam W.
Published: November 2007

A modified combined indirect ophthalmoscope and magnifying loupes with illumination was made by mounting a pair of Zeiss loupes below the SOLA indirect ophthalmoscope eye‐piece. A beam‐splitter, which was made of a piece of ordinary microscopic glass slide, splits a secondary light beam off from the original light source of the indirect ophthalmoscope at an angle of ˜15° to provide additional illumination for the magnifying loupes. The optics involved was discussed.
Intralenticular abscess
Authors: Moore David C.
Published: November 2007

lntralenticular abscess is an uncommon complication of surgery or trauma. A case of intralenticular abscess following penetrating trauma is presented. In this case, the offending organism was identified as Propionibacterium acnes. This organism is considered to be a cause of slowly progressing endophthalmitis and has been implicated as a cause of the so‐called toxic lens syndrome.
Cavernous haemangiomas of the orbit
Authors: McNab Alan A , Wright John E
Published: November 2007

Abstract

Cavernous haemangiomas are well circumscribed vascular masses which commonly occur in middle‐aged women. The majority occur within the muscle cone lateral to the optic nerve and produce a slowly progressive and painless proptosis. Predilection for sites lateral to the optic nerve may be related to origin from arterial rather than venous elements. Complete excision is usually possible and surgical morbidity is low. A series of 85 consecutive cases is reported.
Eccentric photorefraction: improving the predictive value and yield in detection of refractive errors
Authors: Dortmans Renus J , McKenny Brian S. , Gole Glen A
Published: November 2007

Abstract

Eccentric photorefraction (EPR) is a simple photographic technique for detecting amblyopiogenic conditions. Previous EPR studies to detect refractive errors (RE) have demonstrated high sensitivity but poor predictive value. We have established new criteria for detecting RE involving quantifying retinoscopic reflex crescent widths, thereby achieving 67% predictive value with 100% sensitivity for detecting RE ≥+ 3.5 D in a clinical study of 69 children.

Optical analysis of EPR shows that anticrescent width (light crescent‐free portion of the pupil) is independent of pupil diameter. Quantifying anti‐crescent widths in the above clinical trial increased the predictive value to 85%.

Schematic eye and human eye EPR studies verify the theoretical prediction that similar ability to detect refractive errors is maintained when the working distance and eccentricity (distance of light source from lens edge) are reduced.

These improvements in EPR reduce its cost and improve its yield; both are essential for its introduction as an acceptable community screening tool.
Ivermectin treatment of onchocerciasis
Authors: Taylor Hugh R.
Published: November 2007

Abstract

Ivermectin is a recently developed macrocyclic lactone that has. widespread antiparasitic activity. A series of clinical trials has shown that ivermectin is safe and effective in the treatment of human infection with Onchocerca volvulus. Although it is rapidly microfilaricidal, it does not cause a severe reaction as is seen with diethylcarbamazine treatment. The drug also temporarily interrupts production of micrdfilaria but has no known long‐lasting effects on the adult worms. In patients with onchocerciasis, a single oral dose of ivermectin (150 μg/kg) repeated once a year leads to a marked reduction in skin microfilaria counts and ocular involvement. At this dose, ivermectin causes minimal side effects and appears to be sufficiently free of severe adverse reactions to be used on a mass scale. Its use promises to revolutionise the treatment of onchocerciasis.
Small‐incision cataract surgery using the Perrin intraocular cataract scissors and forceps
Authors: Perrin Russell
Published: November 2007

An original operative technique for performing extracapsular cataract extraction through a small incision is described. The technique is both inexpensive and simple to perform. Intraocular cataract scissors are used to bisect the nucleus of the cataractous lens, and each of the halves of the bisected nucleus is removed with intraocular cataract forceps. Both the scissors and the forceps have been specifically designed for this task. The incision size of 7.5 mm allows insertion of currently available intraocular lenses. During the procedure viscoelastic is used to protect intraocular structures, in particular the corneal endothelium and the posterior capsule.
Donor cornea procurement: six‐year review of the role of the eye bank in South Australia
Authors: PhD K. A. Williams , BSc(Hons) M. A. White , BSc(Hons) P. R. Badenoch , SRN T. R. Wedding , SRN S. J. Alfrich , Sawyer M. A. , Noack L. M. , BSc(Hons) E. W. Johnstone , Zilm G. , FRACO D. J. Coster
Published: November 2007

The Lions Eye Bank of South Australia was established six years ago and has collected corneas from 790 donors. The consent rate is currently 82% of requests made. Two‐thirds of donors have been male, with mean donor age/year varying from 54 to 64 years (range two to 93 years). Cardiovascular and respiratory diseases, trauma and haemorrhage account for 80% of all donor deaths. Mean death to enucleation time is five hours. Corneas assessed as being of excellent or very good quality are released preferentially from the bank; those with central endothelial cell counts of less than 1500 cells/mm2 are discarded. Fewer than 1% of donors have returned a positive result for HIV or hepatitis B. Of the 1580 corneas collected by the bank, 863 (55%) have been used for transplantation with a primary non‐function rate of 0.46%. The evolving policies, logistics of operation and methodologies employed by the bank are described in detail.
Basic ophthalmic assessment and care workshops for rural health workers
Authors: Brian Garry , Dalzell Joseph , Nangala Stanley , Hollows Fred
Published: November 2007

The inequitable distribution of medical services in Australia means that many rural dwellers do not have easy access to ophthalmic care. In regions with no medical personnel, appropriately trained rural health workers may provide ophthalmic assessment, primary treatment, and, in some circumstances, definitive care. In areas with overburdened services, these rural health workers may augment facilities already established. In an attempt to improve the accessibility and quality of ophthalmic services available to presently disadvantaged rural inhabitants, the aims, curriculum, and structure of a ‘Basic Ophthalmic Assessment and Care Workshop’, for the transfer of knowledge and skills to such rural health workers, is presented.
Exclusion of the autosomal dominant retinitis pigmentosa gene from a substantial region of chromosome 1: Study of a large Australian family
Authors: Chand A. , Olsson J. E. , Adams L. , Denton M. J.
Published: November 2007

In an attempt to map the gene(s) responsible for autosomal dominant retinitis pigmentosa (ADRP), the technique of reverse genetics was used on a large multigenerational Australian pedigree. The family demonstrated a form of the disease which appears to be less severe than that observed in the Irish pedigree. It was typed for 10 restriction fragment length polymorphism (RFLP) markers on chromosome 1. The data from the linkage study was analysed using the programs LIPED 3; six markers gave informative results. The ADRP gene was excluded from this family from 102 cM using previously prepared chromosome 1 maps. This accounts for 36% of chromosome 1 which is estimated to be the longest human chromosome.
Random dot stereogram E in vision screening of children
Authors: Hope Carolyn , Maslin Keith
Published: November 2007

The random dot stereogram E (RDE) has been shown to be a simple and effective test for the detection of binocular abnormalities and defective visual acuity in children. We determined the validity of the RDE as a screening test for reduced visual acuity, amblyopia and strabismus in two separate populations of children.

A nonselective group of 100 school children (aged 5 to 15 years) who presented consecutively to the ophthalmology department at Auckland Public Hospital were tested with the RDE. All cases of amblyopia and strabismus were detected by the RDE. Similar screening with the RDE test of 168 preschool children (aged three to four years) in the community resulted in an unacceptably high over‐referral rate. The test was unreliable in the preschool age group because of difficulty in distinguishing between test failure and non‐cooperation with the test. The low positive predictive value of the test in the younger age group suggests the test to be unsuitable for preschool vision screening.
Trial of a disc lens for intercapsular cataract extraction
Authors: Kent David G. , Gross Keith A.
Published: November 2007

The preliminary results are presented of a prospective trial of a new ‘disc’ intraocular lens. (Pharmacia Model CD801 A). Forty‐four lenses were implanted into the capsular bag using an intercapsular cataract extraction technique.

The lens is a one‐piece all‐polymethylmeth‐acrylate (PMMA) lens with a 6 mm biconvex optic. The optic sits within a 9 mm diameter flexible PMMA ring. Two haptic stalks link this flexible haptic ring to the optic.

The lens was assessed for its ease of insertion, its rate of decentration, the incidence of posterior capsular opacity and its effects on pupillary function.

Results of the trial at three months follow‐up are presented. They show that the lens is easy to insert into the capsular bag even through small pupils. It is very easy to dial, placing no stress on the bag when doing so. The incidence of decentration of 1 mm or greater was 5%, and the incidence of posterior capsular fibrosis at three months was 2%. As predicted, the lens sits well back in the eye, clear of the pupil.
The management of intraocular foreign bodies
Authors: Hadden Osmond Bruce , Wilson John L.
Published: November 2007

This study of 69 cases of retained intraocular foreign body confirms that eyes with anterior segment foreign bodies fare better than those with posterior segment foreign bodies, that eyes with smaller foreign bodies fare better than those with larger, and that the magnet is the safest method of removal. There is no evidence to support primary vitrectomy in every case of posterior segment foreign body. Computerised tomography is the best method of localisation, but a foreign body can be missed on computerised tomography, and a plain x‐ray is still the best method of detection.
Visual parameters in patients with pituitary adenoma before and after transsphenoidal surgery
Authors: Marcus Mira , Vitale Susan , Calvert Preston C. , Miller Neil R.
Published: November 2007

Eighty‐two patients with pituitary adenoma who underwent transsphenoidal surgery were examined before and after surgery. Nineteen patients had a normal preoperative neuro‐ophthalmological examination. All of these patients maintained normal visual parameters postoperatively. The remaining 63 patients had tumour‐related loss of visual acuity, visual field, or both. These patients ranged in age from 18 to 78 years. Duration of symptoms ranged from one day to ten years, with a median of six months. Preoperative visual acuity was 6/12 or better in 72% of eyes, with 90% of patients having 6/12 or better in their better eye. Only 7% of eyes had a normal preoperative visual field. Both visual acuity and visual field improved postoperatively in the majority of eyes. In eyes that were examined within one week after surgery and subsequently, substantial improvement occurred within the first postoperative week, but further improvement continued over weeks to months postoperatively, with visual field taking longer to stabilise than visual acuity. Visual acuity at last examination was 6/12 or better in 87% of eyes, and visual field at last examination was normal in 50% of eyes. A total of 92% of patients had visual acuity of 6/12 or better in their better eye, and 62% of patients had a normal visual field in their better eye. Visual acuity at last examination was correlated with both age and preoperative visual acuity. Last visual field also was correlated with both age and preoperative visual field. Patients with preoperative optic atrophy had a poorer visual prognosis than did patients with normal fundi.
Corneal hazards in use of Simmons shell
Authors: Rajeev Buddi , Thomas Ravi
Published: November 2007

A Simmons tamponade shell was used in 10 cases of post‐trabeculectomy overfiltration leading to shallow (iridocorneal touch) or flat anterior chamber. The Simmons shell was an unqualified success in only three cases. Corneal abscess (one case) and corneal abrasion/epithelial loss (four cases) necessitated premature removal of the shell. Three of the patients with corneal abrasions had a formed anterior chamber at the time of shell removal but this shallowed again within 12 hours. Two of these required surgical reformation of the anterior chamber and one reformed spontaneously. Air entrapment causing corneal dessication was probably responsible for the abrasion/epithelial loss. The patient who developed a corneal abscess was grossly malnourished. Use of the Simmons shell needs close monitoring and it should be removed at the first sign of corneal toxicity (abrasionfepithelial loss). Extreme care is necessary in malnourished cases.
The use of YAG cyclophotocoagulation to lower pressure in advanced glaucoma
Authors: Brooks Anne M. V. , Gillies W. E.
Published: November 2007

YAG cyclophotocoagulation is a non‐invasive cyclodestructive procedure which may be used in a graduated dosage as an outpatient procedure in cases of refractory glaucoma. In a group of 60 patients treated there were 37 patients with absolute glaucoma and 23 patients with advanced glaucoma in most of whom drainage operation had failed to control the intraocular pressure (IOP). Following treatment IOP fell in all but one case with absolute glaucoma. In 21 cases with absolute glaucoma it fell to 22 mmHg or less, while in 21 cases with advanced glaucoma it was 22 mmHg or less. Treatment was graduated as mild, moderate or maximal. Reactions were more severe with maximal treatment. In advanced glaucoma mild treatment only was used and this was repeated if necessary. Hypotony only occurred with maximal therapy.
Corneal ulceration due to Nocardia asteroides
Authors: Douglas R. M. , Grove D. I. , Elliott J. , Looke D. F. M. , Jordan A. S.
Published: November 2007

A case of corneal ulceration due to infection with Nocardia asteroides is described. Microbiological examination of corneal scrapings permitted accurate diagnosis and suggested appropriate therapy. Nineteen other cases that have been described in the world literature are reviewed.
Management of eyelid trauma
Authors: Nelson Christine C.
Published: November 2007

The management of eyelid trauma presents some frustrating challenges to the general ophthalmologist. Because each case is unique, adaptation of general principles is essential for optimal ophthalmic treatment. This review includes the essentials of approaches to the evaluation and treatment of eyelid margin and canalicular lacerations. Specific attention is directed towards avoidance of complications.
Increased numbers of higher left intraocular pressures in 428 patients referred to the glaucoma clinic
Authors: Booth F M
Published: November 2007

Seventy‐four per cent of 428 patients referred to the glaucoma clinic at Concord Hospital exhibited intraocular pressure (IOP) asymmetry. There was a preponderance of left eyes, in that two‐thirds of the patients with asymmetrical pressures had the higher IOP in the left eye. As the degree of asymmetry increased, this trend became more pronounced. In addition, the statistically significant difference between right and left mean IOP among the glaucoma patients was not found among normal controls, even when the order of testing the eyes was reversed.
Ophthalmic manifestations of head injury
Authors: Kowal L
Published: November 2007

Head injuries are frequently associated with ophthalmic problems. The commonest problems seen in this series of 161 patients with head injury were problems with poor accommodation (16% of patients; 58% of these persisted), convergence (14% of patients; 35% of these persisted), pseudomyopia (19%; 55% persisted) and optic atrophy (26% of the patients; 78% of these were mild and easily missed on routine testing, and 22% were severe).

Motility disorders were common, especially cranial nerve palsies. Other less frequent motility disturbances included apparent inferior oblique palsy, comitant esotropia, and exotropia which was often of the convergence insufficiency type.
Modern management of sixth nerve palsy
Authors: Lee John
Published: November 2007

Between November 1982 and September 1991, 179 patients with unilateral or bilateral sixth nerve palsy were treated in the Botulinum Toxin Strabismus Clinic at Moorfields Eye Hospital. Indications for treatment included prophylaxis (as part of a prospective treatment trial), maintenance therapy, diagnosis and adjunct to surgical therapy. A management plan for established sixth nerve palsy based on the rational use of toxin and surgery is suggested.
Epidemiological patterns of ocular trauma
Authors: Thylefors B
Published: November 2007

Ocular trauma is the cause of blindness in approximately half a million people worldwide, and many more have suffered partial loss of sight. Trauma is often the most important cause of unilateral loss of vision, particularly in developing countries. There is a cumulative risk of ocular trauma and visual loss during life, but the true incidence of accidents involving the eyes is not known. Males tend to have more eye trauma than females, and this is already apparent from childhood; lower socioeconomic classes are also more associated with ocular trauma. The setting for the occurrence of trauma is most commonly the workplace and, increasingly, road accidents. On the other hand, domestic accidents are probably under‐reported. Of particular importance in some developing countries is the occurrence of superficial corneal trauma in agricultural work, often leading to rapidly progressing corneal ulceration and visual loss.

The impact of ocular trauma, in terms of need for medical care, loss of income and cost of rehabilitation services when indicated, clearly makes the strengthening of preventive measures very worthwhile.