Australian and New Zealand journal of ophthalmology最新文献

Purpose: Unoperated cataract is the leading cause of blindness in the developing world. Many developing countries now use extracapsular cataract extraction (ECCE) with intra-ocular lens insertion (IOL) in their cataract blindness-prevention programmes. To date, little research has been directed at visual outcomes and complication rates of ECCE/IOL surgery in developing countries.

Methods: We conducted a follow-up study of 155 eyes approximately 12 months after ECCE/IOL surgery by eight local eye surgeons in Central Vietnam. We report the findings for the 144 eyes (93%) successfully reviewed. All subjects underwent manual ECCE with insertion of a three-piece posterior chamber IOL. All eyes were also assessed for the presence and severity of posterior capsule opacification (PCO) using a newly developed grading system.

Results: Overall, 110 eyes (75%) had uncorrected visual acuities > or = 6/24 and 107 eyes (74%) had best spherically corrected visual acuities > or = 6/18. Some degree of PCO was found in 40% of eyes, but was graded as visually significant in only 4% of eyes. No major sight-threatening complications were noted. A portable neodymium:yttrium aluminium garnet (Nd:YAG) laser was used to perform capsulotomies on all eyes with visually significant PCO. There were no laser complications noted.

Conclusions: At approximately 1 year after ECCE/IOL, the visual outcomes for subjects in this cohort were favourable and complication rates were low. Posterior chamber opacification was not a major cause of vision impairment in this cohort. Portable Nd:YAG lasers may provide an effective solution to the problem of visually significant PCO occurring in developing countries as a late complication of extracapsular surgery. These findings support an increasing role for ECCE/PCIOL surgery by trained local eye surgeons in developing countries.

Unlabelled: BACKGROUND METHODS: Fifty patients who had undergone combined extracapsular cataract extraction (ECCE), intra-ocular lens (IOL) placement and trabeculectomy (ECCE-trab) and 50 who had undergone combined cataract phaco-emulsification, IOL placement and trabeculectomy (phaco-trab) were reviewed over a period of 12 months.

Results: Postoperatively, intra-ocular pressure (IOP) in both eyes fell significantly (P < 0.005). Initially, IOP fell to roughly equal degrees (mean IOP being 14 mmHg at 3 months; P = 0.84). At 12 months, IOP in the phacotrab group was slightly lower than that in the ECCE-trab group (13.4+/-4.3 vs 15.4+/-4.4 mmHg, respectively; P = 0.0312). The number of pre-operative medications did not appear to affect outcome (P = 0.124). Visual recovery was approximately 3 months faster in the phaco-trab group. By 12 months there was little difference in visual acuity, with an average improvement of two Snellen lines (P = 0.68). The mean change in astigmatism was significantly less in the phaco-trab group (0.61+/-1.25 vs 1.39+/-1.46 D, respectively, P = 0.0063). Transient hypotony (IOP < 5 mmHg) was more frequent in the phaco-trab group (66 vs 32%, respectively; P < 0.002). The frequency of other complications was not significantly different between the two groups.

Conclusion: Both ECCE-trab and phaco-trab procedures are safe and effective. However, the phaco-trab procedure may have slightly improved IOP control, earlier visual recovery and less astigmatism.

Purpose: To evaluate the management and possible aetiology of the snapped inferior rectus muscle in strabismus surgery.

Methods: Three patients are described whose inferior rectus muscle broke across its width some 8-10mm behind the insertion while being held on a squint hook without excessive force during strabismus surgery. The proximal part of the muscle was not found. The distal part of the snapped muscle was excised for pathological examination. Transposition of the inferior halves of the adjacent horizontal muscles to the insertion of the inferior rectus (a modified inverse-Knapp procedure) was performed in all cases.

Results: After the transposition surgery, one patient was orthotropic in the primary position, one patient required a prism correction to produce a range of single vision and the third patient was orthotropic after a further operation. There was good depression in one case and the other two had a limitation of depression. In all cases, horizontal movements remained intact and there were no signs of anterior segment ischaemia.

Conclusions: The unique relations of the inferior rectus to the surrounding tissues may be a factor in causing the breaking of this muscle. Two of the patients were elderly and this may be a factor also. Transposition surgery is the appropriate management when the proximal part of the snapped muscle cannot be located and has satisfactory but imperfect results.

Background: Recurrent immune-mediated scleritis after adequate treatment of leprosy is not well documented in the literature. We describe an Australian resident with unilateral intra-ocular lepromatous leprosy who had persistent non-infectious scleritis.

Methods: A man of Anglo-Indian ancestry initially presented with lepromatous leprosy and unilateral ocular involvement. The affected eye had an interstitial keratitis and a granulomatous anterior uveitis that responded to antileprotics and anti-inflammatory agents. Despite systemic cure with triple antileprotic therapy, he developed recurrent scleritis that required multiple scleral patch grafts for scleral thinning and, subsequently, an enucleation. Histology failed to demonstrate persistent infection, rather a chronic non-granulomatous scleritis, which was probably immune mediated.

Results/conclusions: This case demonstrates an ocular complication of leprosy that is infrequently reported. Patients with ocular involvement by leprosy are at risk of developing recurrent scleritis despite systemic cure with antileprotics.

Purpose: To evaluate the efficacy and safety of external argon laser choroidotomy for drainage of subretinal fluid (SRF) during scleral buckling procedures for the repair of rhegmatogenous retinal detachments.

Methods: Fifty eyes of 50 consecutive patients presenting to a hospital-based retinal outpatient clinic with rhegmatogenous detachments underwent choroidotomy with argon endolaser for SRF drainage. The laser parameters used were 0.5s duration and 0.8W power. The primary outcome measures were successful drainage of SRF and incidence of complications. The drainage was considered successful if it was sufficient to complete the planned scleral buckling procedure. The extent of subretinal haemorrhage was graded.

Results: The mean age of patients was 55 years (range 16-80 years). Successful drainage of SRF was obtained in 47 eyes (94%). The complications observed at the drainage site included subretinal haemorrhage of less than 1 disc diameter in six eyes (12%) and retinal perforation in one eye (2%).

Conclusion: External argon laser choroidotomy appears to be an effective method of draining SRF in rhegmatogenous retinal detachments.

Purpose: To highlight external rear vision mirrors as a cause of ocular injuries in motor vehicle accidents.

Methods: Three cases of perforating eye injuries due to shattered external rear vision mirrors in motor vehicle accidents are described. The relevant Australian design rules are reviewed.

Results/conclusion: External rear vision mirrors can be responsible for serious ocular injuries in motor vehicle accidents. Further investigation of the incidence of such injuries is required to determine whether vehicle manufacturing methods and the design rules covering their production warrant revision.

Purpose: Patients with any form of visual disturbance, no matter how unusual, often present first to their ophthalmologist. An example of the Charles Bonnet syndrome as a result of bilateral macular degeneration is presented. The significance of early diagnosis is highlighted as reassurance and explanation of the condition seems to be the cornerstone of management.

Methods/results: A chronological case history, results of investigations and management are presented.

Conclusions: The diagnosis of Charles Bonnet syndrome should be considered in elderly, cognitively intact patients who present with vivid, elaborate and complex visual hallucinations following ocular pathology. Although there is no universal definition of this entity and there is no specific pharmacotherapy, patients may be referred for counselling.

Background: Scarring may follow refractive surgery, causing irregular astigmatism and loss of visual acuity.

Methods: A case report of scarring and irregular astigmatism occurring in a corneal transplant following photorefractive keratectomy and arcuate incisions is presented.

Results: Following surgical excision of the scar, unaided visual acuity improved from 1/60 to 6/12. Histopathology of the excised scar was obtained.

Conclusions: Refractive surgery following corneal transplantation may produce scarring. The origin of the scar in the present case has not been established.