Australian journal of ophthalmology最新文献

The first ophthalmologists came to Australia from Great Britain in the early 1860s and founded charitable eye hospitals on the British pattern. For many years, during which Australian States remained colonies of Great Britain, all specialist medical training was obtained overseas. World War II greatly accelerated Australian independence and stimulated Australian technology, science, education, culture and economics. Australian ophthalmologists met the challenge with tight organization, home-based training, academic responsibilities and research.

The clinical findings, investigations, and course of three patients who ingested quinine sulphate or bisulphate tablets and suffered severe visual loss are described. Methods and control of treatment for these patients are discussed, and the assessment of the effectiveness of treatment, and its relationship to the visual outcome are considered.

Thirteen patients with varying grades of suppurative keratitis were studied with regard to their response to keratoplasty. In all patients there was a rapid improvement in symptoms and signs. In eight of the 13 there was restoration at least of previous function: one patient lost all vision due to secondary closed-angle glaucoma, because he refused further surgery. Corneal graft opacification occurred in three eyes; one other became partially opaque; whilst in a fourth, the lamellar graft remained clear while the original autograft failed. At last follow-up, all eyes were normotensive and free of symptoms. Keratoplasty should assume an important part of the management of suppurative keratitis, from both theoretical and practical considerations.

Ten cases of the basal cell naevus syndrome (BCNS) are reported. The study is based on clinical findings with no investigations beyond two skull radiographs. The diagnosis is made on some or all of the following findings: family history, jaw cysts, progressive development of basal cell carcinomas (BCCs), pitting of the palms and soles, frontal bossing, abnormality of the skeletal system and ectopic calcification. Eight of the cases are in one family covering three generations. With the exception of a one-year-old child in the third generation (not included) all of this group have the syndrome. The dominant trait is demonstrated, as is the high degree of expressivity and penetrance. Genetic counselling is essential where applicable. Sympathetic regular clinical examination over a lifetime is recommended to avoid disastrous complications.

Australian legal blindness is defined as bilateral corrected visual acuity less than 6/60; if visual acuity is better than this, collateral visual impairments may be included. Persons thus affected qualify for the Invalid Pension (Blindness). From October 1975 to June 1982, I studied clinical data of 311 persons assessed as legally blind, and recorded diagnoses. I personally examined 259 of these persons and a medical colleague examined 52. Examinees were resident in Brisbane (or environs), Australia. Eleven persons had asymmetrical conditions (analysed separately), and 300 had symmetrical conditions. Causes of the latter were genetically transmissible (20.3%), adult maculopathy (18%), congenital (12.7%), vascular (non-diabetic) (8.7%), adult glaucoma (8.3%), diabetes (7.3%), trauma (6%), and others (18.7%). Of 61 symmetrical genetic cases causes were retinitis pigmentosa (34.4%), congenital cataracts (16.4%), retinal dystrophy and maculopathy (13.1%), Leber's optic atrophy (9.8%), and others (26.3%). These results suggest that more attention should be directed to genetic counselling.

The fundi of 114 patients were evaluated one to 14 years following contusional eye injury. Most injuries to children occurred at sport and play. Domestic and civil assaults, sporting injuries and industrial accidents were common. Males in the second and third decades of life were predominantly affected. Iris tears, pupillary abnormalities and angle recession were typically associated with the fundal lesions. Contusional injuries of the retina and choroid were found in 92 patients and were graded according to their location, extent and severity. Twenty-six patients (grade 1) had focal or diffuse disturbances of the inner or outer retina. In 15 patients the lesions predominantly affected the receptor-retinal pigment epithelial layers and in six patients there were associated breaks in Bruch's membrane. Five further patients had atrophic inner retinal alterations and lamellar holes at the macula. Most patients in this group retained good visual function. Thirty-six patients (grade 2) had single or multiple choroidal tears. In 21 instances the outer retina was primarily involved; however, in 15 cases there was associated inner retinal damage. Only three patients developed subretinal neovascularisation. Sixteen patients (grade 3) had extensive areas of chorioretinal atrophy associated with retinal pigment epithelial atrophy, proliferation, plaque and membrane formation. Fourteen patients (grade 4) developed retinal holes or tears and 10 proceeded to retinal detachment two weeks to 14 years following injury. Contusional retinal and choroidal lesions have an unfavourable visual prognosis, only 38.6% of patients regaining a visual acuity of 6/12 or better.

The classical anatomical descriptions of the inferior oblique muscle give little or no account of its intermuscular fascial septum. Operative and cadaver dissections show that a definite and constant fascial septum exists between the sheaths of the inferior oblique and the lateral and inferior recti. The clinical significance of this fascia is realised when it is pulled laterally, as its inner surface provides a guide to the inferior oblique sheath; also, when a muscle hook is placed under the lateral rectus muscle it may snag the septum and kink the inferior oblique and cause its overaction. The fascia forms a sling for the inferior oblique sheath and helps to maintain its line of action. For these reasons the intermuscular septum of the inferior oblique should be included in anatomical accounts of the ocular fascia and should be remembered during operations on the inferior oblique or lateral rectus muscles.

A basic problem encountered in all forms of lamellar refractive surgery has been the predictability of the optical corrections. Corneal tissue used in refractive surgery behaves in a variable fashion because its shape is determined in vivo by the process of healing and graft repopulation. Therefore no preoperative measure of the ultimate power of the lathed corneal lens can be made. Another drawback is the limited supply of donor corneal tissue. In an effort to overcome these problems, we have used alloplastic materials in conjunction with lamellar refractive surgery to improve the predictability of the result. The use of this material would also allow accurate preoperative determination of lens power. Intralamellar implants appeared to heal quite rapidly after surgery. Their optical clarity was excellent and the corneal surface appeared stable. Further research into long-term stability and predictability are currently underway.