Australian journal of ophthalmology最新文献

H. D. McLaurin, the first ophthalmic surgeon to St Vincent's Hospital, Sydney, was appointed in 1872 and in 1874 he also became physician to the Hospital. The clinic passed to a line of talented, well trained, dedicated but highly individualistic ophthalmologists, but with its division into two and later four, a large ophthalmological department evolved with competitive individualism giving way to cooperative team work. The golden years were probably ten years before and after World War II. Ophthalmology advanced with increasing medical science and technological development, while control slipped from the Sisters of Charity and an Honorary Medical Staff to a salaried service and a ponderous secular bureaucracy. An amazing level of therapeutic and surgical efficiency was reached, but at a cost of reduced spiritual and human values.

Most epidemiological studies of diabetic retinopathy have been based on clinic populations. This produces a bias for the more severe cases and later stages of the disease. To avoid this bias, 1567 Micronesian adults of Nauru (82% of total adult population) were examined. Diabetic retinopathy was classified by both the World Health Organization (WHO) criteria and the Airlie House reference photographs. Results were subject to multiple logistic regression model analysis. Diabetic retinopathy was present in 7% of the general population and in 24% of diabetics. Of the signs, microaneurysms and microhaemorrhages were the most important, being present alone in 19.5%; and in 68.1% when associated with exudates. Proliferative retinopathy was present in 4.5% of cases. Exudates alone were found in two cases (2.2%). Duration of diabetes was the strongest predictor variable and increasing two-hour plasma glucose levels significantly increased the risk of developing retinopathy.

A small personal series of patients with chronic open-angle glaucoma who underwent combined trabeculectomy and cataract extraction is analysed with regard to the effect of the operation on the control of intraocular pressure. The results support the regular use of the operation as an effective means of reducing intraocular pressure.

Fifty-nine patients with a superior oblique palsy had a superior oblique tuck as part of their surgical treatment. The average size of the tuck was 12.0 mm. All cases had a decrease in the hyperdeviation in the primary position and some decrease in elevation in adduction in the operated eye (Brown's syndrome). Seventeen per cent of the patients required take-down of the tuck three to 24 months after surgery (average time for reoperation, 9.1 months). Symptoms forming indications for take down of the tuck were head tilt, vertical diplopia, torsional diplopia, and a tight feeling on elevation in adduction. No patient who had a tuck alone required take-down. Brown's syndrome was more likely to occur in cases with weakening of the antagonist inferior oblique and when a bilateral tuck of the superior oblique had been done. Taking down of the tucked tendon relieved the symptoms of Brown's syndrome in seven of 10 patients, without a recurrence of superior oblique underaction. After superior oblique tuck in all patients, a residual vertical deviation could be measured and in nearly every case a Brown's syndrome could be found.

Posterior polymorphous endothelial dystrophy and iridocorneal endothelial syndrome share common specular microscopic findings, clinical course, and some histopathological features. Despite differences in inherited trait and severity of disease a common pathogenetic mechanism for the two diseases is suggested. This consists of congenital epithelialisation of the posterior corneal surface during embryogenesis with migration of these cells around the anterior segment uninhibited by surrounding normal endothelium.