Australian and New Zealand journal of ophthalmology最新文献

An endonasal approach was used to restore lacrimal drainage in both primary and secondary obstructions. Patients in the primary group had a history of keloid scar formation, or wished to avoid a scar and declined to have surgery performed via an external approach. Patients in the secondary group had undergone one or more previous unsuccessful lacrimal drainage repairs. A fibreoptic endonasal telescope, linked to a video monitor, and appropriate nasal and lacrimal instruments, were used. The approach proved highly successful, in both anatomical and functional terms, in each group. In the secondary group, the endonasal approach allowed direct visualisation and repair of both nasal and lacrimal causes of failure; this approach is our preference in this group. In the primary group, endonasal instrumentation had no advantage over a conventional external operation, other than avoiding a scar. The application of laser technology may make the endonasal approach a realistic option in primary DCRs as well.

The technique of endocapsular cataract extraction and intraocular lens implantation surgery provides optimal surgical conditions and more reliable intraocular lens positioning in the capsular bag. Several capsulectomy techniques are in use to remove anterior capsule from the central zone. The Koch endocapsular punch provides a new technique for creating a continuous anterior capsulectomy. In this study the Koch punch was used in 96 eyes consecutively undergoing intended endocapsular cataract extraction and intraocular lens implantation. Ninety-five eyes had appropriate lens centration at six months. There were no cases of vitreous loss. Ninety-nine per cent of cases had visual acuity of 6/6 or better at six months. This data demonstrates the Koch endocapsular punch to be an effective and safe means for anterior capsulectomy.

A 28-year-old man, after subtotal resection of a Grade I-II frontal lobe astrocytoma, received 5600 cGy of radiotherapy in 200 cGy fractions to residual intracranial tumour. One year later he presented with severe bilateral retinopathy which, in appearance was consistent with retinopathy from irradiation. Total irradiation received by the retina of each eye (< 50 to 1500 cGy) was far less than the dose which commonly produces radiation retinopathy. Also, the pattern of retinopathy did not reflect the distribution of radiation received by the eye. Alternative causes for the retinopathy were sought but not found. Proliferative retinopathy occurred in each eye and one eye developed a dense vitreous haemorrhage. Argon laser pan-retinal photocoagulation controlled the neovascularisation in the other eye. This patient has developed severe retinal ischaemia after a low dose of retinal irradiation.

The aims of the Australian Corneal Graft Registry are to collect and collate statistical information on the practice of corneal transplantation around Australia, to identify risk factors for corneal graft failure, and to provide information on graft and visual outcome. The current report encompasses analyses performed on 3608 corneal grafts (96% penetrating and 4% lamellar) entered into the Registry between May 1985 and July 1991. Sixty-four per cent of grafts have undergone one or more rounds of follow-up by the 189 contributing surgeons and 110 additional referring practitioners: five-year Kaplan-Meier graft survival for penetrating and lamellar grafts is 72% and 84%, respectively. The main indications for penetrating keratoplasty were keratoconus (31%), bullous keratopathy (25%), history of failed previous graft (14%), corneal scars and opacities (11%), and corneal dystrophies (7%). The most common reasons listed for failure of penetrating grafts were rejection (33%), glaucoma (11%), non-viral infections (10%), endothelial cell failure (8%) and herpetic infection (7%). In 19% of cases, the reason for graft failure was unclear. The main indications for lamellar keratoplasty were pterygium (32%), thinning, necrosis or ulceration from old beta-radiation therapy for pterygium (17%), and scleral ulcers, necrosis, ectasia, perforations or melts (29%). The most common reasons for the failure of lamellar grafts were corneal melting (43%) and sloughing of the graft (29%). Among the factors that influenced the survival of penetrating corneal grafts to a significant extent (P < 0.05) in univariate analysis were: the centre effect, indication for graft, graft number, a history of pregnancy or blood transfusion, inflammation before or at the time of graft, corneal vascularisation at the time of graft, a history of raised intraocular pressure, the donor cornea procurement source, the death to donor cornea enucleation time, graft size and large degrees of oversizing, lens status and the type of intraocular lens in situ. In the postoperative period, risk factors for failure included early removal of graft sutures, neovascularisation of the graft, herpetic recurrences in the graft and the occurrence of rejection episodes. The variables that best predicted penetrating corneal graft failure in Cox proportional hazards regression analysis were aphakia or the presence of an anterior chamber of iris-clip intraocular lens, very small or very large grafts, a history of previous ipsilateral graft, an indication for graft that was neither keratoconus nor any of the corneal dystrophies, inflammation at the time of graft, and a postoperative rise in intraocular pressure.(ABSTRACT TRUNCATED AT 400 WORDS)