Australian and New Zealand journal of ophthalmology最新文献

A patient presented with a history of chronic corneal ulceration and corneal hypoaesthesia. This proved to be an unusual presentation of breast carcinoma metastatic to the sphenoidal wing. This was an unexpected diagnosis in view of the long duration of ocular signs without other evidence of metastatic disease.

In this series of one surgeon's first 100 cases of endocapsular phacoemulsification cataract surgery (EPECS), believed to be the first truly prospective study of its kind, 86% of patients achieved corrected vision of 6/6 to 6/4; 96% achieved vision of 6/12 or better; and excluding those with pre-existing pathology, 99% achieved 6/12. Posterior capsular rupture occurred in 11 cases, with vitrectomy being required in eight cases. Detailed analysis of the 100 cases is provided.

We describe a case of topical exposure to a commercial solution of paraquat. Chronic, severe ocular surface destruction resulted, probably due to absorption of the herbicide into the surface tissues, facilitated by a surfactant present in the preparation, and to intracellular redox cycling of the paraquat cation. Ocular paraquat toxicity is described and explained in the context of the toxicity of systemic absorption.

It is important to compare the pressure-lowering effect of the recently introduced diode laser with that of the argon laser currently used for trabeculoplasty, since there is a considerable difference in their wavelengths. In 50 consecutive eyes of 50 patients argon laser trabeculoplasty (ALT) produced a fall from 23 to 18 mmHg at three months compared with a fall from 23 to 19 mmHg at three months with diode laser trabeculoplasty (DLT). This difference was not statistically significant. Comparing the magnitude of the fall in intraocular pressure (IOP) in these two groups of 50 eyes, 28 patients achieved a fall of 5 mmHg or more with ALT and 17 with DLT and this difference was significant (chi 2 1df = 4.04, P < 0.05). Comparing 23 paired fellow eyes which both needed laser trabeculoplasty, those treated with ALT achieved a fall from 22 to 17 mmHg compared with a fall from 22 to 19 mmHg with DLT and this difference was statistically significant (T = 53.5, P < 0.02, Wilcoxon matched-pairs signed rank test). These results suggest that the pressure lowering effect of DLT is comparable to that of ALT, but ALT is somewhat more effective as shown by a greater fall in IOP after ALT than DLT in fellow eyes of the same patient. In the unpaired eyes the number of falls of 5 mmHg or more was significantly greater with ALT than DLT, although the mean fall was not statistically different between the two groups.

A presumptive clinical diagnosis of cytomegalovirus (CMV) retinitis was made in two patients presenting with atypical ophthalmologic findings. The diagnosis was confirmed by finding specific CMV DNA sequences in sampled vitreous fluid using a polymerase chain reaction (PCR) based assay. Neither of these patients yielded CMV on culture or PCR of peripheral blood leucocytes, nor was CMV present in tears or urine of either patient. Serum antibody titres were stable and did not help in establishing the diagnosis. This report suggests that CMV retinitis can occur in the absence of disseminated CMV disease.

We present a patient with chronic myeloid leukemia (CML) who had marked bilateral disc swelling as part of his initial presentation. This occurred in the setting of raised intracranial pressure (ICP), with normal cerebrospinal fluid (CSF) composition and cell content, and normal neuroimaging. We discuss the possible mechanisms which could lead to disc swelling in CML and conclude that the raised ICP and subsequent papilloedema in our patient were the result of poor absorption of CSF into the dural venous sinuses. We propose that the very high white cell count (WCC) led to a hyperviscosity state which resulted in poor absorption of CSF and in so doing, created a clinical picture of benign intracranial hypertension (BIH).

Severe epistaxis after combined nasolacrimal duct probing and cardiac catheterisation in a one-year-old child is reported. The epistaxis followed streptokinase infusion given as treatment for femoral artery thrombosis secondary to cardiac catheterisation and necessitated nasal packing and blood transfusion. The authors recommend that probing not be undertaken in conjunction with another procedure if anticoagulant and/or thrombolytic agents are likely to be required.

Ophthalmic lasers are used as diagnostic as well as therapeutic modalities in patients with retinal diseases. Recent advances in laser technology have allowed more convenient selection of wavelength and a wide variety of delivery systems is available to deliver the laser energy to the retina. In addition, newer lasers that disrupt and cut tissue will become available for use in patients with retinal diseases. The use of imaging lasers and lasers in combination with dyes selectively to enhance their effects have become useful in diagnosis and understanding of pathophysiology of diseases. These lasers will also be therapeutically useful. This manuscript delineates the new types of diagnostic and therapeutic lasers, new imaging dyes and techniques as they apply to retinal diseases as well as the principles of laser-tissue interaction as applied to the retina. This should allow the ophthalmologist who treats patients with retinal diseases to make more intelligent decisions regarding the use and acquisition of laser systems.

NADPH-diaphorase histochemistry was used to identify and analyse the topography of cones in adult human retinae (in the age range 44 to 68 years). Retinae were treated for NADPH-diaphorase reactivity, present in vascular walls, amacrine cells and cone and rod outer segments; a subpopulation of less intensely reactive profiles, morphologically resembling cones, possibly represents the blue cone population. Regularly spaced pairs of cones (one intensely labelled and one weakly labelled cone) were also apparent throughout the retina, and were most common along the horizontal meridian, particularly towards the periphery. The diameters and distributions of labelled cone outer segments were assessed using image analysis. Cone density in the adult retina ranged from 2000 per mm2 in the temporal periphery, to 82,000 to 120,000 per mm2 at the fovea centralis. Distribution patterns confirmed the presence of a cone streak, extending from the foveal region into nasal retina, but no evidence of superior-inferior asymmetry was detected.