Australian journal of ophthalmology最新文献

An outbreak of epidemic keratoconjunctivitis (EKC) in a rural area is described. It was characterised by its explosive outbreak, relatively short duration and high infectivity. The aetiology is discussed.

Observations of intraocular pressure (IOP) variations in response to CO2, adrenaline, speech and compression of the neck veins were documented by continual monitoring of IOP by radiotelemetry. Carbon dioxide increased IOP in the supine, but not in the erect, conscious subject. Adrenaline 2% caused a rapid short-lived painful increase in IOP, followed by a profound decrease. This was due to an increase in facility of outflow and was associated with paralysis of the sympathetic supply to the iris. Speech caused a small rise in IOP which was reversed by rest in silence. Compression of the neck veins caused a variable increase in IOP. These physiological variations in IOP may contribute to the errors of tonometry.

Twenty-five laser trabeculoplasty procedures were performed on 20 patients. All patients were treated as inpatients so that early changes in intraocular pressure could be monitored. The range of fall was recorded: in four cases there was a significant rise in intraocular pressure in the first four hours which, if sustained, could have lead to a further visual field loss in patients with advanced chronic simple open-angle glaucoma. Patients with a high initial intraocular pressure had the greatest fall in intraocular pressure. Those patients with a more pigmented trabecular meshwork with wide open angles were the easiest to treat and gave the best signs of effective laser endpoint reaction. Gonioplasty was performed in many patients with narrow angles, which gave much better access to the posterior trabecular meshwork.

An initial series of 500 eyes with cataract was managed with phacoemulsification and posterior chamber lens implantation, with operative capsulotomy. The operative technique, complications and visual results are presented. Complications reported with other lens implant techniques are discussed and reviewed. It was found that the complication rate associated with this technique was lower than that associated with routine intracapsular surgery, and that visual rehabilitation was far superior.

A 39-year-old Vietnamese refugee with upper eyelid swelling followed by vertical diplopia and mild proptosis was shown by computerised tomography to have a localised lesion in the region of the right superior oblique muscle. At operation, this was a cyst and histology confirmed the larval form of Taenia solium (cysticercosis).

The current indications for and method of application of tissue adhesive are described. A method for an expanded utilisation of tissue adhesive is discussed. To study the effect of the introduction of tissue adhesive to The Wilmer Institute in 1974, the records of 104 consecutive non-traumatic corneal perforations or descemetoceles admitted to The Wilmer Institute from 1960 to 1980 were assessed retrospectively with follow-up being obtained from records or from referral physicians for 87 of these perforations. Forty-nine percent of the cases were caused by bacterial corneal ulcers, 13% by exposure, 12% by chemical burns, 6% by fungal keratitis, 5% by herpes simplex keratitis, and 15% were undiagnosed. Since the introduction of tissue adhesive in 1974, there has been an apparent trend towards a lower enucleation rate (6%) in the tissue adhesive treated group compared with 19% in perforations treated by other therapies.

An uncommon presentation of retinoblastoma in an eleven-year-old boy is discussed. There was no family history of retinoblastoma and the child had never complained of a sore eye. He was not aware that he could not see out of his right eye.

Nine hundred and thirty-eight consecutive primary intraocular lens (IOL) implant cases performed at The Wilmer Institute during the past six years by two surgeons were reviewed. Progressive corneal endothelial cell loss and an increased rate of late-onset corneal oedema were detected in the group with the Morcher (European) four-loop iris-clip Binkhorst IOLs. A higher rate of clinically-significant cystoid macular oedema developed in eyes with the American-manufactured four-loop Binkhorst lens, presumably from chronic iritis caused by contaminants on the IOLs. Our short-term results with the American-manufactured Shearing-type IOLs implanted at the time of extracapsular cataract extraction are encouraging, with 96% of cases achieving 20/40 vision or better, excluding those with known macular degeneration or amblyopia. Analysis of data submitted to the United States Food and Drug Administration (FDA) indicates that most of the four classes of intraocular lenses (anterior chamber, pupillary-supported, iridocapsular, and posterior chamber) are safe and effective at one-year follow-up. During the past three years there has been a gradual shift of preference in the type of IOLs being implanted--away from pupillary-supported and iridocapsular IOLs and, in part, from anterior chamber IOLs, to posterior chamber IOLs. A continued conservative approach to IOL implantation is recommended.

Six cases of malignant choroidal melanoma were treated by microsurgical excision under hypotensive anaesthesia with follow-up periods varying from four months to four years. This paper presents the case for local excision of malignant choroidal melanoma in the light of the current controversy surrounding the management and natural history of choroidal melanoma. The indications for surgery, techniques, and results are described. Vision was preserved best in tumours with diameters of less than 10 mm. No deaths and no evidence of extraocular recurrence occurred.