Australian journal of ophthalmology最新文献

Three cases of neovascular glaucoma associated with ocular hypoperfusion secondary to carotid artery disease are reported. In two cases, anastomosis of the internal and external carotid artery systems via a superficial temporal artery to the middle cerebral artery (Yasargil procedure) resulted in resolution of the rubeosis, relief of the ocular pain and improvement of the circulation of the globe. The third case, which did not have this procedure, resulted in a blind eye with severe rubeotic glaucoma.

The modalities used to diagnose choroidal melanoma are described. The use of these procedures has reduced the misdiagnosis rate from 20% in the 1960s to less than 5% today. Observation and reinvestigation of small tumours is recommended. Surgery may cause dissemination of tumour emboli, which may be prevented by gentle handling of tissue, use of intravenous mannitol and hypotensive anaesthesia. Measures other than enucleation are available to treat choroidal melanoma, but few tumours meet the criteria for their use.

Two hundred and four cases of malignant eyelid tumours, managed at the Concord Hospital, were reviewed. These cases spanned a ten-year period between 1973 and 1982 and all were treated surgically. The nature of each tumour was confirmed by histopathological examination. Included in this review were the site of the tumour, the tumour pathology, the surgical management, the type of surgeon involved, the ocular complications, the management of recurrences and any mortality. The importance of preventing recurrences by adequate initial surgery with frozen section control is emphasized.

One hundred and thirty-three eyes with raised intraocular pressure treated by argon laser trabeculoplasty were studied to determine the factors predicting a fall in pressure with treatment. The two main predictive factors were: (i) initial pressure--a higher initial pressure was associated with a greater fall in pressure (p less than 0.001); and (ii) diagnosis (type of glaucoma)--pseudoexfoliative glaucoma (PXFG) and chronic open-angle glaucoma (COAG) had the greatest fall (p less than 0.05). Aphakic glaucoma was associated with the worst results. Of the other factors studied, only the degree of pigmentation of the angle was a significant predictor: the greatest fall in pressure occurred in eyes with moderately pigmented angles (p = 0.05). Complications of treatment were pigment scatter in the angle with depigmentation (41% of eyes), peripheral anterior synechiae (7.5%), immediate postoperative rise in pressure of 10 mmHg or more (7%), moderately severe iritis (3%) and hyphaema (2%). Medication was able to be ceased in only five patients after laser trabeculoplasty; even if a small fall in pressure is achieved, a large fall to the bottom of the normal range is unlikely.

A simplified cryotherapy technique for the treatment of trichiasis and distichiasis is described. The success rate of aberrant lash ablation with one treatment was 82%; this was increased to 95% with a repeat treatment. There have been minimal long-term side effects. This paper shows that a simplified time-based technique without the use of a thermocouple has produced results similar to other series using thermocouple control. A nitrous oxide cryo unit was used in a double freeze-thaw cycle to treat the area of aberrant lash growth. The times in the double freeze-thaw cycle found to be effective were 45 seconds freezing with a four-minute thaw in the first cycle and a repeat freezing cycle of 45 seconds' duration.

Two cases of serous detachment of the retina associated with congenital pits of the optic nerve were successfully treated with photocoagulation, vitrectomy and gas tamponade. The rationale of management and the results are discussed. It is suggested that this treatment deserves further study to see if early intervention will favourably affect the return of macular function, particularly in cases of optic nerve pits where the serous detachment is of short duration and fixed structural changes at the macula have not occurred.

This study investigates the effectiveness of combining vitrectomy, scleral buckling, intraocular microsurgery and liquid silicone injection for the treatment of retinal detachment complicated by proliferative vitreoretinopathy: 48 eyes were treated using these techniques combined. Complete attachment was achieved in 16 eyes (33%), partial attachment in 20 eyes (42%), and 12 eyes (25%) remained detached. Vision was improved in 17 eyes (35%), unchanged in 17 eyes (35%), and worse in 14 eyes (30%). Complications included emulsification of the silicone, glaucoma, cataract, band degeneration of the cornea, reproliferation of membranes and passage of silicone into the subretinal space. Significant preservation of mobility vision was achieved. A larger series of patients with longer follow-up will ultimately determine the place of this technique in the management of this complicated problem.

The Bardet-Biedl syndrome is characterized by five main features: obesity, polydactyly, pigmentary retinopathy, mental deficiency and hypogonadism; recently a sixth feature, renal disease, has been described. It was formerly known as the Laurence-Moon-Biedl syndrome, but Laurence and Moon described a different entity in which the main feature was paraplegia. Fourteen cases have been seen: all had pigmentary retinopathy which, in most cases, was severe and tended to affect central vision early in life. All had subnormal intelligence, twelve were obese, ten had polydactyly, eight hypogonadism, and two had renal disease. The condition was thought to be rare, but this may have been due to the failure to diagnose incomplete or partial cases. It is suggested that the prevalence is 1:160 000 of the population.

The National Registry of Drug-induced Ocular Side Effects is an international information centre for ocular toxicology. The Registry collects case reports of drug-induced ocular side effects from physicians and other national registries, and surveys the world literature for drug-related ocular events. Possible adverse drug associations can be identified in this system, and cause-and-effect relationships may on occasion be proven. Functions of this Registry include increasing ophthalmic awareness of human ocular toxicology, and promoting continuation of contributions to decrease the delay between recognition of a possible adverse drug reaction and the actual reporting of it in the literature.