This Issue of Acta (2003)

Several contributions in this issue deal with treatment of age-related macular degeneration with transpupillary thermotherapy (TTT). Macular degeneration has defied intensive therapeutic efforts for a long time, and it may be motivated to consider TTT as great a promise for patients with macular degeneration as photodynamic therapy (PDT). TTT can also be administered at a fraction of the cost as compared to PDT. The results reported by Algvere and coworkers in a safety and efficacy study are commented on in the Guest Editorial by Ciulla, who concludes that the results of the large prospective material in Algvere's paper ‘corroborate and amplifies the previous studies that suggest a role for TTT in the treatment of occult CNVM, lesions with minimal or no benefit from PDT’. These results are very important, and we must agree with Ciulla that we are now at the stage when we must look forward to the results of a randomised, prospective TTT trial. Everything has a downside, however. Salinas-Alamán and coworkers describe a case of over-treatment with TTT in a letter to the editor. The review article in the current issue is on a highly modern subject: telemedicine in ophthalmology, authored by Lamminen and coworkers. Telemedicine holds great promise making specialty care available everywhere. Studies have shown that the concept works, but cost efficiency has not been conclusively proven. The potential value of telemedicine is particularly large in the Nordic countries, where distances are often great. The technological solutions are available, and we are waiting for a situation when also the organisational aspects have been addressed and solved. The Clinical Questions and Answers section discusses the management of a patient with an inadvertent filtration bleb after phacoemulsification with suture-less wound closure. The patients had disturbing symptoms, and treatment was not without problems. Primary papillary pigment epithelial iris cysts are rare. In the Diagnosis and Therapy in Ophthalmology section Sallo and coworkers show beautiful pictures pre and post surgery in two patients with this condition. Original articles in this issue cover a broad spectrum of ophthalmology. In an unusual, prospective study Tranos and coworkers have compared the subjective visual experience of patients during phacoemulsification and IOL implanation with regional versus topical anesthesia. A study by Splunder and coworkers involving 900 Dutch adults with profound intellectual disabilities found that many had nonoptimal spectacle correction and that more than half of those needing reading glasses did not have them. The results are similar to those reported by Warburg in this journal (Warburg 2001), and suggest that visual function screening is motivated in persons with intellectual disabilities. Fahnehjelm and colleagues describe four cholestatic infants with optic nerve hypoplasia; three of them were blind or had low vision. Early assessment by paediatric ophthalmologists is important in children with neonatal cholestasis. Uretmen and coworkers have studied psychosocial implications of strabismus– reactions of school teachers to digitally altered photographs of children with and without strabismus, and showed that the children were rated more negatively when strabismic. Fledelius and coworkers report findings of orbital ultrasound sonography in a large series of patients with thyroid-associated orbitopathy. Most patients had increased muscle thickness, and the examination techniques could not discern between inflammatory and fibrotic changes. Two studies deal with glaucoma. Naruse et al. describes a new technique to remove the inner wall of Schlemm's canal during nonpenetrating surgery using cyanoacrylate. Inan and coworkers found increased blood flow velocities in retro-bulbar vessels both in eyes treated with latanoprost and with brimonidine. Akyol et al. found that levels of serum trace elements were considerably lower in chronic heavy smokers than in controls, and were associated with reductions in contrast sensitivity functions. Trace element alterations may play a causative role in the smoking induced retinal toxicity. Conjunctival papillomas may be very difficult to treat. Keizer and de Wolff-Rouendaal describe two cases with conjunctival papillomas that were successfully treated with alpha-2-interferon eye drops, after previous unsuccessful management with a variety of treatment modalities. There are many basic science papers in this issue. Söderberg et al. have developed a new method to estimate a threshold UV radiation dose for cataract. Wiencke and coworkers found that not only ‘good looks’ (histologically!), but also DNA profiles should be taken into account when retinal pigment epithelium is cultured for transplantation purposes. Two articles have studied Vitamin E. Bilgihan et al. investigated the effects of this vitamin administered topically in conjunction with photorefractive keratectomy. Yargicoglu found that vitamin E had a protective effect against stress-induced VEP changes in a rat model. And do not forget to read some interesting letters in this issue!