This Issue of Acta (2002)

In this issue of Acta we have two review articles. Baldwin and Marshall address a subject of high current interest: growth factors in corneal wound healing after refractive surgery. The first part of their review provides important basic definitions of growth factor terminology, and puts forward a model for understanding growth factors in a wound healing context. In the second part of the paper, the literature on growth factors in the cornea is reviewed, including changes associated with wound healing after refractive surgery in the epithelial, stromal and endothelial layers. The authors show that PRK may have short-term complications such as pain and haze, whereas LASIK may have longer-term adverse effects on corneal biomechanics. LASEK provides a different wound, which may be less susceptible to the inherent complications of PRK and LASIK. Results obtained from the Swedish national cataract register are reviewed by Lundström and co-workers. Their review covers data from a nine year-period and 400,000 cataract surgery procedures, the great majority of surgeries in Sweden between 1992 and 2000. Outcomes of surgery in terms of patient benefit and technical results have been studied continuously during the whole period. The rate of surgery has increased steadily, as has average preoperative visual acuity. The studies have demonstrated a positive impact of surgery in very old patients, and from second eye surgery. Another paper from the same study in this issue, by Montan and co-workers, showed a 0.1% incidence of endophthalmitis in 1998. Acrylic lenses were associated with an even lower risk. The problems of cataract surgery are different in developing countries. Senne and co-authors re-evaluated patients who had undergone cataract surgery in two rural areas in Brazil. In both areas more than half of the operated eyes had low vision usually caused by posterior capsule opacification and uncorrected refractive errors. Strategies are needed to resolve such problems. Wohlrab and collaborators report results from primary surgical decompression of traumatic optic neuropathy. CT findings underestimated the extent of bony optic canal injuries. Most cases who improved underwent decompression within 48 h of the injury. Two studies investigate cardiovascular effects of topical glaucoma drugs in young healthy adults. In one of the studies unoprostone, unlike timolol, did not reduce exercise-induced heart rate: In the other brimonidine and timolol, alone and in combination, were compared with placebo. All drugs influenced heart rate consistently with their pharmacology. Liu et al. report the influence of latanoprost on IOP spikes after laser iridotomy. IOP was reduced but the value of the treatment was limited because of the late onset of the drug effect. Long-term results after trabeculectomy are reported by Ehrnrooth and co-workers. The results are sobering; while IOP was ‘controlled’ in 82% of patients after one year, ‘success’ dropped to 52% after five years. Exfoliation glaucoma and postoperative IOP over 30 mmHg were associated with a higher risk of failure. There are two papers on diabetic retinopathy in this issue. A population-based study from Sweden reports outcomes eight years after implementation of a comprehensive screening programme. Among 374 patients with diabetes, only three had VA ≤ 0.1, all with type 2 diabetes and unsuccessful laser surgery for macular oedema. In a study from Sicily a large cohort of patients with insulin-dependent diabetes was followed from 10 years with fundus photography and ERG. The results showed that reduced electroretinogram oscillatory potentials are a risk indicator for subsequent diabetic retinopathy. Kauppinen-Mäkelin and co-workers report results from a randomised study comparing intravenous methylprednisolone therapy and oral prednisone on thyroid-associated ophthalmopathy. This is an important clinical problem, with little available data in the literature. Influence on grade of diplopia, proptosis and soft tissue involvement did not differ between treatment groups, but the IV treated group needed additional therapy less frequently than those who had received oral prednisone. A population-based prospective follow-up study of cognitive and visual function in children treated for retinoblastoma is presented by Ek and co-workers. No child was totally blind. Bilateral retinoblastoma was associated with superior cognitive capacities, but results suggest that radiation therapy during the first months of life may be associated with adverse cognitive and visual outcomes. Another epidemiological study concerns children with optic nerve hypoplasia. Young maternal age, first parity and smoking were risk factors. There are many interesting case reports in this issue. Havelius and Åsman report a series of 7 cases who presented with unilateral mydriasis because of accidental contact with Angel's trumpet, a nowadays commonly cultivated flower containing scopolamine. Recognition of this cause of sudden unilateral mydriasis could save unusual neurological and neuro-radiological work-up. The beautiful flower is shown on the cover of this issue. Christensen et al. describe the first case ever of an intramuscular haemangioma in the orbit. Three surgical procedures were required before a diagnoisis was established and the tumour removed. Söker Çakmak and co-workers show images of an unusual patient with alkaptonuria and ocular ochronosis. The editorial describes a new section in the journal: Diagnosis/Therapy in Ophthalmology. Anders Heijl Chief Editor