bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of diabetic retinopathy by Australian ophthalmologists
Authors: McCarty Cathy A , McKay Rob , Keeffe Jill E ,   the Working Group on Evaluation of the NHMRC Retinopathy Guideline Distribution
Published: March 2003

ABSTRACT Objective: To describe current management practices of diabetic retinopathy used by Australian ophthalmologists. Setting: Two‐page self‐administered questionnaire mailed to 622 ophthalmologists listed with the Royal Australian College of Ophthalmologists. Methods: The survey included questions about practice details such as size and location; specialty; current practice with regard to management of patients with diabetes; confidence in screening for diabetic retinopathy; and a number of patient scenarios related to screening, follow‐up and treatment of diabetic retinopathy. Results: Of the 577 eligible ophthalmologists, 475 (82%) completed the questionnaire. They had been practicing ophthalmology between 1 and 50 years (median 16 years) and 89 (19%) indicated that they had a subspecialty interest either in vitreo‐retinal surgery or in medical retina. For 145 (30.5%) of the ophthalmologists, at least one of their practices was located in a country area. The estimated percentage of patients with diabetes ranged from 0.1 to 60% (mean = 9.9%). Retinal specialists perform between 0 and 750 macular focal photocoagulation procedures per year (mean = 94) compared with a range of 0–350 for non‐retinal specialists (mean = 10.3) (t = 6.1, P < 0.001). The ophthalmologists were presented with a hypothetical patient with cataract requiring surgery and clinically significant macular oedema that would be difficult to treat (but not impossible) because of the cataract. Seventy‐seven ophthalmologists (16%) said they would delay the macular laser therapy until after the cataract surgery had been performed. In multivariate logistic regression models, non‐retinal specialists were 4.44 times as likely to perform the cataract surgery first (95%CL = 1.57, 12.6) and ophthalmologists who had been in practice more than 15 years were 2.50 times as likely to perform cataract surgery first (95%CL = 1.47, 4.26). There were other examples of practice that differed from the National Health and Medical Research Council (NHMRC) guidelines in patient scenarios. The majority of ophthalmologists (60%) expressed a moderate or strong need to learn more about the management of diabetic retinopathy. Discussion: The variability in the management of diabetic retinopathy by Australian ophthalmologists and the desire of ophthalmologists to learn more about diabetic retinopathy provide evidence to support the need for the NHMRC Guidelines for Diabetic Retinopathy. These data will be used to evaluate changes in practice as a result of the implementation of the guidelines.
Operated and unoperated cataract in Australia
Authors: McCarty Catherine A , Nanjan Mukesh B , Taylor Hugh R 
Published: March 2003

ABSTRACT Purpose: To quantify the prevalence of cataract, the outcomes of cataract surgery and the factors related to unoperated cataract in Australia. Methods: Participants were recruited from the Visual Impairment Project: a cluster, stratified sample of more than 5000 Victorians aged 40 years and over. At examination sites interviews, clinical examinations and lens photography were performed. Cataract was defined in participants who had: had previous cataract surgery, cortical cataract greater than 4/16, nuclear greater than Wilmer standard 2, or posterior subcapsular greater than 1 mm
2. Results: The participant group comprised 3271 Melbourne residents, 403 Melbourne nursing home residents and 1473 rural residents. The weighted rate of any cataract in Victoria was 21.5%. The overall weighted rate of prior cataract surgery was 3.79%. Two hundred and forty‐nine eyes had had prior cataract surgery. Of these 249 procedures, 49 (20%) were aphakic, 6 (2.4%) had anterior chamber intraocular lenses and 194 (78%) had posterior chamber intraocular lenses. Two hundred and eleven of these operated eyes (85%) had best‐corrected visual acuity of 6/12 or better, the legal requirement for a driver’s license. Twenty‐seven (11%) had visual acuity of less than 6/18 (moderate vision impairment). Complications of cataract surgery caused reduced vision in four of the 27 eyes (15%), or 1.9% of operated eyes. Three of these four eyes had undergone intracapsular cataract extraction and the fourth eye had an opaque posterior capsule. No one had bilateral vision impairment as a result of cataract surgery. Surprisingly, no particular demographic factors (such as age, gender, rural residence, occupation, employment status, health insurance status, ethnicity) were related to the presence of unoperated cataract. Conclusions: Although the overall prevalence of cataract is quite high, no particular subgroup is systematically under‐serviced in terms of cataract surgery. Overall, the results of cataract surgery are very good, with the majority of eyes achieving driving vision following cataract extraction.
Modulation of tear film protein secretion with phosphodiesterase inhibitors
Authors: Evans Victoria , Willcox Mark D P , Millar Thomas J 
Published: March 2003

ABSTRACTA double‐blind randomized clinical study was conducted to determine whether nicardipine hydrochloride was a useful treatment for dry eye. We examined its effect on the tear film, ocular surface and ocular comfort. Nicardipine hydrochloride, 3‐isobutyl‐1‐methylxanthine and pilocarpine hydrochloride were dissolved in an artificial tear vehicle and applied topically to one eye of 12 subjects on separate days. Ocular physiology, ocular comfort and tear volume were assessed. The trial was repeated with nicardipine in an aqueous gel vehicle. Tears were collected and assessed for protein concentration and protein profile, using electrophoresis and mass spectrometry. Nicardipine induced conjunctival redness and symptoms of dryness and irritation. There was no change in total tear protein concentration or volume. An increase in a 68 kDa protein was observed, this was probably due to conjunctival vessel dilation and leakage of albumin. The adverse symptomatology and increased conjunctival redness experienced with nicardipine make it an undesirable treatment for dry eye.
Survey of dry eye symptoms in Australian pilots
Authors: McCarty Daniel J , McCarty Catherine A 
Published: March 2003

ABSTRACTIn 1996, a questionnaire was distributed to 4000 Australian commercial pilots for the quantification of symptoms of dry eye. The 1246 respondents ranged in age from 18–71 years (mean age 40.4 years), and 98.2% were men. Symptoms of dry eye during flight were reported by 901 (72.3%, 95% CI = 69.7–74.8) while only 67 (5.4%, 95% CI = 4.2–6.8) reported dry eye independent of flight. In univariate analyses, the following factors were associated with dry eye in flight: age, use of distance glasses, smoking, average weekly number of flight hours, type of aircraft usually flown, and normal cruising altitude. In a multiple logistic regression model, only the class of aeroplane (large jets vs propeller‐driven planes) (OR = 1.75, 95% CI = 1.34–2.28) and estimated number of flight hours per week (OR = 1.58, 95% CI = 1.34–1.86) were related to dry eye symptoms. In conclusion, self‐reported symptoms of dry eye are common in Australian pilots and are associated with aeroplane class and flying time.
Projected number of Australians with glaucoma in 2000 and 2030
Authors: Rochtchina Elena , Mitchell Paul 
Published: March 2003

ABSTRACTAccurate Australian glaucoma prevalence has been provided by two population‐based studies: the Blue Mountains Eye Study (BMES) and the Melbourne Visual Impairment Project (MVIP). Both studies defined glaucoma as the presence of matching optic disc cupping with rim thinning and glaucomatous field defects demonstrated on automated perimetry. Combining ‘definite’ and ‘probable’ rates, the glaucoma prevalence in persons aged 50 and over, age‐standardized for the 2000 projected Australian population, was 2.70% (BMES) and 3.13% (MVIP), including rates for ‘definite’ glaucoma of 2.12% (BMES) and 2.50% (MVIP). The number of Australians aged 50 and over in the year 2000 with glaucoma could be estimated as from 144 000 persons (BMES) to 167 000 persons (MVIP). Assuming similar age‐specific rates, the number of Australians aged 50 and over in the year 2030 with glaucoma could be estimated as from 307 000 persons (BMES) to 337 000 persons (MVIP). Ocular hypertension (OH) was defined as present in subjects without glaucoma with intraocular pressure (IOP) of more than 21 mmHg, including treated subjects with ‘normal’ examination IOP. The age‐standardized OH prevalence was 5.15% (BMES), which projects to 275 000 Australians with OH in 2000, increasing to 513 000 in 2030.
An innovation in developing world cataract surgery: sutureless extracapsular cataract extraction with intraocular lens implantation
Authors: Ruit S , Paudyal G , Gurung R , Tabin G , Moran D , Brian G 
Published: March 2003

ABSTRACT Purpose: The benefits of sutureless cataract surgery have not been available to the majority of developing world patients. This report describes a surgical technique developed to gain the benefits of self‐sealing sutureless techniques, without the need for costly, complex instrumentation, expensive consumables, or difficult nucleus fragmentation manoeuvres in the anterior chamber. Method: A detailed description of a sutureless technique that uses only standard manual extracapsular cataract extraction instrumentation is presented. The clinical records of 362 consecutive completed sutureless surgeries were reviewed, and preliminary indicative data of visual outcome for those having follow up between postoperative weeks 3 and 8 are also presented. Results: Hospital and eye camp experience confirms this operation offers speed, routinely 5 min or less with mature cataracts, reduced cost because no suture, viscoelastic or anterior chamber maintainer is needed, wound security and stability, and rapid effective visual rehabilitation. Uncorrected distance visual acuity during the third to eighth postoperative week was available for 266 of the 362 patients (73%): 10, 145, 101, and 10 had acuities of better than 6/9, 6/9–6/18, 6/24–6/60, and worse than 6/60, respectively. Ninety‐seven, 165, 12, and two of the 276 (76%) patients with recorded corrected distance acuity were in the same groups. Comparing postoperative with preoperative corneal astigmatism for each patient with postoperative information available (208), without regard to axis, the amplitude of astigmatism worsened by a mean of 0.94 dioptres (± 0.17, 95% confidence; ± 1.23 standard deviation; 7.5D maximum worsening; 2.5D maximum improvement). No attempt has been made to analyse complication type or frequency in this preliminary report. Conclusion: The authors believe this sutureless cataract extraction technique to be an innovation with widespread application in the developing world. Further and more exhaustive critical appraisal is warranted.
Diode laser cyclophotocoagulation: longer term follow up of a standardized treatment protocol
Authors: Walland Mark J 
Published: March 2003

ABSTRACT Background: Diode laser cyclophotocoagulation (cyclodiode) is gaining acceptance as a therapy for refractory or end‐stage glaucoma. The aim of the study was to establish whether a reproducible dose–effect relationship exists following a single standardized cyclodiode treatment to lower intraocular pressure (IOP). Methods: This paper reports results from a longer‐term follow up of a trial involving the study of 30 patients with uncontrolled IOP and advanced glaucoma who were treated with a single episode of either a half or a full standardized dose of laser depending on clinical risk of phthisis and monitored for IOP control, visual acuity, postoperative inflammation and phthisis. Results: A lowering of IOP at the final follow up was achieved in 83% of patients, with a mean follow‐up time of 21 months. For patients receiving a full standardized laser dose, preoperative IOP was 49.4 ± 11.2 mmHg (mean ± SD) and postoperative IOP was 28.5 ± 20.0 mmHg (42% reduction); 45% of patients achieved IOP < 22 mmHg and 68% gained an IOP reduction > 30%. For the half treatment cases, the preoperative IOP was 29.4 ± 4.3 mmHg (mean ± SD) and the postoperative IOP was 18.3 ± 10.0 mmHg (38% reduction); 63% of patients achieved IOP < 22 mmHg and 50% gained an IOP reduction of > 30%. Of 22 sighted eyes, nine (41%) recorded no change in vision; and nine (41%) lost and four (18%) gained vision. Hypotony was seen in 4/22 (18%) of full standardized laser dose cases. Conclusion: Longer follow‐up times confirm that diode laser cyclophotocoagulation is a convenient and useful therapy in the control of IOP in end‐stage glaucoma. Response of IOP to the laser therapy is highly variable, particularly in the neovascular glaucoma group, and it does not appear to be possible to predict an IOP outcome for an individual eye. Circumferential treatments in neovascular eyes should be avoided. Prospects for long‐term vision retention in end‐stage eyes are poor, perhaps due to progression of the underlying disease.
Contrast sensitivity following focal laser photocoagulation in clinically significant macular oedema due to diabetic retinopathy
Authors: Talwar Dinesh , Sharma Namrata , Pai Anant , Azad Raj Vardhan , Kohli Anupama , Virdi Prem S 
Published: March 2003

ABSTRACT Purpose: To evaluate the influence of focal laser photocoagulation on contrast sensitivity in diabetic patients with clinically significant macular oedema (CSMO). Methods: A prospective non‐comparative interventional study was performed on a group of patients with CSMO at Dr Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, a tertiary eye care centre. Thirteen diabetic patients (14 eyes) with CSMO and no history of prior photocoagulation were recruited for this study. Direct focal photocoagulation of all leaking microaneurysms was performed using an argon green laser (514 nm). A contact lens was used as a slit lamp delivery system. Evaluation of the best corrected Snellen visual acuity, contrast sensitivity, slit lamp biomicroscopy, macular status on direct ophthalmoscopy and fluorescein angiography was carried out 1 month and 3 months after laser photocoagulation. Results: Following direct focal laser photocoagulation, focal CSMO resolved completely in all but one eye, 4–8 weeks later, as seen on slit lamp biomicroscopy and/or fluorescein angiography. Post‐treatment, visual acuity remained stationary in eight eyes, improved by one line in three eyes, by two lines in two eyes and by three lines in one eye. The mean ± SD pretreatment and post‐treatment decimal visual acuities were 0.49 ± 0.30 and 0.59 ± 0.28, respectively. The mean ± SD pre‐laser contrast sensitivity score was 121.3 ± 83.6, which increased significantly to a mean ± SD of 151.6 ± 80.5 following direct focal photocoagulation. Conclusion: Focal argon laser photocoagulation in CSMO in diabetics helps in improving the contrast sensitivity and stabilizes the visual acuity. The changes in contrast sensitivity and visual acuity are independent of each other.
Transforming growth factor‐β1 induces α‐smooth muscle actin expression and fibronectin synthesis in cultured human retinal pigment epithelial cells
Authors: Stocks Shelli Z , Taylor Steve M , Shiels Ian A 
Published: March 2003

ABSTRACT Background: Proliferative vitreoretinopathy is a serious complication of retinal detachment, yet its pathogenesis is not fully understood. Retinal pigment epithelial cells and glial cells are found in the fibrous membranes in proliferative vitreoretinopathy. Many cytokines are involved in the pathology. Transforming growth factor (TGF)‐β1, a cytokine found in serum, has been shown to be an important factor regulating the synthesis of fibrous extracellular matrix in proliferative vitreoretinopathy. Methods: Cultured human retinal pigment epithelial cells were used in the experiments. The effects of TGF‐β1 on phenotype and function in retinal pigment epithelial cells were recorded as changes in the expression of α‐smooth muscle actin and fibronectin synthesis using immunohistochemistry and enzyme‐linked immunosorbent assay, respectively. Results: TGF‐β1 induced the expression of α‐smooth muscle actin (P < 0.0001, n = 3), and significantly increased the synthesis of fibronectin by cultured human retinal pigment epithelial cells (P < 0.01, n = 4). Conclusions: Elevated levels of TGF‐β1 in proliferative vitreoretinopathy may contribute to phenotype changes in retinal pigment epithelial cells leading to matrix deposition and contraction. Since the elevated levels of TGF‐β1 may emanate from a number of diverse sources in proliferative vitreoretinopathy, developing an antagonist to TGF‐β1 may offer an approach to the treatment of proliferative vitreoretinopathy.
The increasing prevalence of myopia: implications for Australia
Authors: Rose Kathryn , Smith Wayne , Morgan Ian , Mitchell Paul 
Published: March 2003

ABSTRACTMyopia is often regarded as a minor priority in public health research, yet the public health costs of myopia are considerable, both due to the costs of optical correction and from the costs imposed by the morbidity resulting from myopia in terms of associated eye disease (glaucoma, posterior subcapsular cataract), and the visual impairment and blindness that can result from myopia due to myopic retinal degeneration and retinal detachment. There is clear evidence for a high and increasing prevalence of myopia in East Asia, apparently driven by increasing educational pressures and urbanization. Data from the USA, Europe and Australia are consistent with the data from Asia in terms of the role of these risk factors. However, the evidence for an increasing prevalence of myopia is more problematic, due to the lack of adequate longitudinal studies, and the confounding effects of age‐related hypermetropization. It is concluded that the prevalence of myopia is probably increasing in Australia, although the changes are of much lower magnitude than in East Asia. Longitudinal studies are, therefore, clearly required to quantify changes in the prevalence of myopia in Australia, for accurate assessment of the public health impacts and to assist with the development of preventive approaches.
Production of N‐acyl homoserine lactones by Gram‐negative bacteria isolated from contact lens wearers
Authors: Zhu Hua , Thuruthyil Sophy J , Willcox Mark DP 
Published: March 2003

ABSTRACTThe purpose of this study was to investigate the production of N‐acyl‐homoserine lactone (AHL) signal molecules in ocular Gram‐negative bacteria. A total of 91 ocular strains isolated from contact lens adverse response patients and asymptomatic subjects were used in the study. These included Acinetobacter, Aeromonas hydrophila, Escherichia coli, Haemophilus influenzae, Klebsiella oxytoca, Pseudomonas aeruginosa, Serratia liquefaciens, Serratia marcescens, and Stenotrophomonas maltophilia. The biosensor strains Chromobacterium violaceum mutant CV026 and Agrobacterium tumefaciens A136 were used for detection of AHL signal molecules. The majority of A. hydrophila, P. aeruginosa, and S. liquefaciens strains produced more than one AHL molecule. Serratia marcescens strains were AHL positive only under detection of A136. The rest of the test species did not show any AHL production under the current detection system. These findings indicate that AHL‐ mediated quorum‐sensing systems are present in some of the ocular bacteria, and the different signal molecules may be involved with the quorum‐sensing pathway in the other bacterial species.
Posterior subtenon injection of corticosteroids using polytetrafluoroethylene (PTFE) intravenous cannula
Authors: Venkatesh Pradeep , Garg Satpal P , Verma Lalit , Lakshmaiah Nevratti C , Tewari Hem K 
Published: March 2003

AbstractInjection of corticosteroids into the posterior subtenon space is a well established and highly effective modality in the treatment of intermediate uveitis. The conventional technique of posterior subtenon injection involves the use of a sharp tipped 26‐gauge, 5/8 inch needle that must be inserted up to its hub to obtain adequate placement of the drug into the posterior subtenon space. With this technique the risk of perforation of the globe, although minimal, remains a potential complication. Herein is described a new technique for injection of corticosteroids into the posterior subtenon space using an intravenous cannula made of polytetrafluoroethylene (PFTE) that allows safer delivery of the drug into the pos­terior subtenon space.
Endophthalmitis
Authors: Elder Mark J , Morlet Nigel 
Published: March 2003

AbstractAustralia and New Zealand continue to be at the forefront of endophthalmitis research. In this Clinical Controversy, an ophthalmologist from each country presents different approaches to the management of a 72‐year‐old patient with routine endophthalmitis following cataract surgery. Mark Elder concludes that this case needs aqueous and vitreous aspirates for culture and the initial treatment of choice is intracameral vancomycin and amikacin. The evidence for intravitreal steroids is equivocal. Systemic antibiotics are indicated if there is a possibility of a bacterial biofilm present on the intraocular lens. Nigel Morlet concludes that timely intervention with appropriate antibiotics delivered in the right concentration to the vitreous cavity is the crux of successful management of endophthalmitis. Aggressive treatment of the inflammatory response is also required to further reduce the damage to the intraocular structures. Both ophthalmologists agree that vit­rec­tomy is not necessarily the most appropriate treatment option.
Orbital abscess following uncomplicated phacoemulsification cataract surgery
Authors: Irvine Fiona , McNab Alan A 
Published: March 2003

AbstractThe case is presented of an 80‐year‐old woman who developed an orbital abscess after undergoing routine phaco­emulsification cataract surgery to her right eye. She was treated by drainage via an anterior orbitotomy and a sensitive Staphylococcus aureus was cultured. The presenting signs and symptoms resolved and final visual acuity was 6/9 in the right eye. One possible aetiology was the introduction of skin flora to orbital tissues during the peribulbar administration of local anaesthetic for the cataract surgery. Alternatively, secondary haemorrhage with secondary infection may have occurred.
Randomized clinical trial of the efficacy and safety of tropicamide and phenylephrine in preoperative mydriasis for phacoemulsification
Authors: Lam Philip TH , Poon Betty TM , Wu Wai‐Kwan , Chi Stanley CC , Lam Dennis SC 
Published: March 2003

Abstract Purpose: To compare the mydriatic effect and safety between different concentrations of tropicamide and phenyle­phrine in preoperative mydriasis for phaco­emulsification. Methods: Two hundred and seventeen consecutive eyes in the same number of Chinese patients undergoing phaco­emulsification under local or topical anaesthesia in a university‐based eye hospital were analyzed. Patients were randomized into two groups by cluster randomization, each group receiving a different preoperative mydriatic regimen. Regimen A consisted of tropicamide 1.0% with phenylephrine 2.5%, and Regimen B consisted of tropicamide 0.5% with phenylephrine 0.5%. The main outcome measures were horizontal pupillary diameter, systolic, diastolic and pulse pressure and pulse rate. Results: The group who received Regimen A attained a mean horizontal pupillary diameter of 7.00 ± 1.06 mm. Their pupils were significantly larger than those receiving Regimen B (6.61 ± 1.03 mm, P = 0.007). No untoward cardiovascular effects were noted in either groups. Conclusion: Regimen A attained better preoperative mydriasis for phacoemulsification than Regimen B. Both regimens were safe with regard to their cardiovascular effects. The combination of tropicamide 1.0% and phenylephrine 2.5% is recommended as preoperative mydriatic for phacoemulsification in Chinese patients who have darkly pigmented irides.