Australian journal of ophthalmology最新文献

Ultrastructural examination was performed on 30 eyes selected on the basis of a light microscopic classification as representing all stages of macular degeneration. The eyes belonged to 29 patients aged 40 to 91 years at death and all patients with the exception of the 40-year-old had been examined during life. The results indicate that monocytes, lymphocytes, fibroblasts and mast cells may play a role in the formation of breaks in Bruch's membrane at early and late stages of macular degeneration. The implications of these observations are discussed in the context of their possible role in choroidal neovascularization.

Successful implantation of prosthetic devices depends upon their freedom from postoperative inflammation and infection. Techniques and lessons learned in orthopaedic and other implant surgery should be applied to intraocular lens implantation. The avoidance of contamination by particles and micro-organisms is one essential principle of the surgical procedure. Practical steps are described to reduce both types of contamination. These measures taken together are recommended for adoption as a standard of environmental safety for lens implantation.

We report the case of a 72-year-old woman who presented with vitreous opacities of unknown cause. A pars plana vitrectomy yielded material in which there were atypical lymphoid cells consistent with malignant lymphoma. Five months after the vitrectomy, the patient re-presented with cerebral lymphoma. Our report emphasizes the value of cytological examination of the vitreous in selected cases. We also review the features of malignant lymphoma of the retina and stress the cerebroretinal axis of involvement in this disease.

Clinical studies of intraocular lenses (IOLs) as investigational devices have been regulated in the United States by the Food and Drug Administration (FDA) since 9 February 1978. As of August 1982, data have been collected on more than one million IOLs implanted. During the last 12 months of the study, 409 000 IOLs were implanted. Visual acuity of 20/40 or better at one year after surgery was present in 85% of over 45 000 cases reviewed. Increasing patient age, surgical problems, postoperative complications, and adverse reactions were factors that reduced the visual acuity. The current trend in the USA is for implantation of posterior chamber and anterior chamber IOLs.

A clinical, biochemical and ocular study was carried out on 17 children with type I diabetes mellitus. Eight had no clinical or angiographic evidence of retinopathy (Stage 0), seven had stage 1, one had stage 2 background retinopathy (Malone's classification) and one had intraretinal microvascular abnormalities. The vitreous fluorescein concentration 3 to 5 mm in front of the macula in those without retinopathy varied from low to abnormally high, while the concentrations in those with retinopathy were above normal. There was no correlation between haemoglobin A1 estimations taken at the time of the study and the vitreous fluorophotometry readings. This variation in fluorophotometry values obtained in diabetics with stage 0 disease differs from the findings in previous reports and may be of prognostic value in determining those patients at risk of developing retinopathy, and may be an indication for improving diabetic control.

The most important late complication of a longitudinal study of iris-supported lens was bullous keratopathy. Endothelial cell loss after using the closed chamber technique for lens insertion was more than halved. The cell loss rate after intracapsular extraction with a Federov I lens was compared with that after extracapsular extraction with an iridocapsular lens. The intermediate results did not show any significant difference between groups and there were eyes in both groups with a large initial loss which appeared to lose cells at a faster rate.

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.

Phacoemulsification is widely used in the USA for cataract extraction. The surgeon's ability has been enhanced by improved instrumentation and evolution of techniques which make the surgery less challenging. Such a technique is bimanual phacoemulsification, which is described in this paper.

Thirty cataract operations were performed in 28 patients using the disposable modified fornix flap technique described by Quinn and Ewald. Vision was 6/12 or better in 26 of 30 eyes with a mean follow-up period of seven months. Vision was corrected in 11 patients with intraocular lens implants, in 10 patients with aphakic spectacles and in seven patients with contact lenses. Four of the seven contact lens wearers had ocular irritation related to contact lens wear. The technique appears to work satisfactorily for intracapsular or extracapsular cataract surgery and for intraocular lens implantation.