Background: To measure the ease of use and performance of the OptyseTM Lens Free Ophthalmoscope compared to the standard Keeler Pocket Ophthalmoscope, and to assess its suitability as an inexpensive ophthalmoscope for medical students.Design: Randomised cross-over study.Participants: Twenty second year medical students, ten as ophthalmoscopists (‘observers’) and ten as ‘patients’.Methods: Medical students used both ophthalmoscopes to examine the optic disc in each eye of ten ‘patients’. They were randomised as to the order in which they were used. A single Consultant Ophthalmologist was used as the gold standard.Main Outcome Measures: Accuracy in estimating vertical cup:disc ratio (VCDR), ease of use (EOU) for each examination, and overall ease of use (OEOU).Results: Of 400 attempted eye examinations, sufficient visualization was achieved in 220 cases to allow a VCDR estimation; 107/200 VCDR estimates with the OptyseTM and 113/200 with the Keeler. Accuracy of VCDR estimates was better with the OptyseTM by the equivalent of 0.05 VCDR (p = 0.002). There was no significant difference in EOU or OEOU between the two ophthalmoscopes. EOU for 400 examinations: median (IQR) of 6 (3-8) for OptyseTM vs. 6 (3-8) for Keeler (P = 0.648). OEOU for 20 scores: median (IQR) of 6.5 (2-9) for OptyseTM vs 5.5 (3-8) for Keeler (p = 0.21).Conclusion: Medical students found the OptyseTM and Keeler Pocket Ophthalmoscopes to be of similar ease of use, and performed slightly better with the OptyseTM when estimating VCDR. The lens free OptyseTM ophthalmoscope is a reasonable alternative to the standard Keeler Pocket ophthalmoscope.

Background: To study the compatibility of cephalosporins with intraocular irrigating solutions and intracameral medications commonly used in cataract surgery.Design: The was an in vitro experiment conducted in the Research Laboratory of the Department of Microbiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.Samples: Three cephalosporins – cefazolin, cefuroxime and ceftazidime – were separately diluted and mixed with irrigating solutions and intracameral medications to form 192 samples and 12 control solutions.Methods: The cephalosporins were dissolved in normal saline and further diluted to the concentration of 1 mg in 0.1 ml with normal saline (NS), Ringer's solution, balanced salt solution (BSS) and fortified balanced salt solutions (fBSS). These were mixed with BSS or fBSS, with adrenaline, acetylcholine, or carbachol and kept at 37°C for 2 hours. The concentrations of free cephalosporins were measured with rapid high-performance liquid chromatography (HPLC) at baseline (0 hour) and at 2 hour.Main Outcome Measures: Free concentrations of cephalosporins at 2 hour were compared to mean baseline (0 hour) value. A difference of 3 standard deviations or more was considered statistically significant.Results: At 2 hour there was a significant drop in the cefuroxime concentration in preparations in which cefuroxime was diluted with NS (p

Background: To evaluate the ophthalmic manifestations and risk factors for mortality in HIV patients in the post-highly active anti-retrovirus therapy (HAART) era.Design: Retrospective study at a tertiary eye hospital in Hong Kong.Samples: 151 patients with HIV infection.Methods: Review of all HIV patients who have attended the Hong Kong Eye Hospital between 2000 and 2007.Main Outcome Measures: Ocular findings especially opportunistic infections and systemic medical information including mortality during follow-up.Results: At presentation, 139 (92.1%) patients were already diagnosed with HIV and 58 (41.7%) had an AIDS indicator condition. Fifty-one (33.8%) patients had HIV-related eye disease on presentation and the leading manifestations were cytomegalovirus (CMV) retinitis and HIV microangiopathy. Low baseline CD4 cell count

Background: To evaluate the efficacy of wide-field digital retinal imaging (WFDRI) for retinopathy of prematurity (ROP) screening.Design: Retrospective study in a quaternary public neonatal intensive care unit.Participants: 108 premature infants screened for ROP.Methods: Retrospective chart and photo review were performed on participants screened by both serial WFDRI and concurrent binocular indirect ophthalmoscopy (BIO). Review of captured digital photos was performed independently by a masked reader. Using the BIO findings as the gold standard, the efficacy of WFDRI in detecting treatment-requiring ROP, defined as type 1 prethreshold disease, was determined.Main Outcome Measures: Sensitivity and specificity of WFDRI in detecting treatment-requiring ROP.Results: Treatment-requiring ROP was detected in 11 infants by both BIO examination and telemedicine images taken at the same visit. WFDRI has a sensitivity of 100% (95% CI: 76.2 to 100%) and a specificity of 97.9% (95% CI: 93.4 to 99.7%) in detecting infants with treatment-requiring ROP. Positive and negative predictive values of WFDRI were 84.6% (95% CI: 57.8 to 97.3%) and 100% (95% CI: 96.9 to 100%) respectively.Conclusions: Wide-field digital retinal imaging is accurate, reliable and efficient in detecting treatment-requiring ROP. Incorporating WFDRI with telemedicine in standard ROP management can potentially improve delivery, accessibility, quality and cost of ROP care.

Background: This study aims to assess the optic disc characteristics in healthy adult Malays and to correlate them with age, gender and refractive errors.Design: Cross sectional study.Participants: 200 voluntary participants (106 women and 94 men) among Malay students aged 20 to 37 years at Health Campus, Universiti Sains Malaysia.Methods: The relationship between HRT parameters with age, gender and refractive error were analyzed with correlation tests and multiple linear regression analyses.Main Outcome Measures: Twelve parameters i.e. disc area, rim area, cup area, cup to disc area, cup volume, rim volume, height variation contour, cup shape measure, mean cup depth, maximum cup depth, mean retinal nerve fibre layer (RNFL) thickness and RNFL cross-sectional area.Results: Disc area, rim area and cup-to-disc area ratio averaged 2.24 ± 0.52 mm2 (mean ± standard deviation), 1.64 ± 0.32 mm2 and 0.25 ± 0.12, respectively. Five parameters (disc area, cup area, cup volume, cup-to-disc area ratio and mean RNFL thickness) showed statistically significant difference between males and females. Age was negatively and significantly correlated with rim area with co-efficient r = -0.21, p = 0.003. All optic disc parameters were significantly correlated (p

Background: The incidence of new infection with syphilis is increasing, particularly in men who have sex with men, with HIV co-infection common. There has been a corresponding increase in ophthalmic manifestations which can be varied in presentation.Methods: 13 consecutive patients with syphilitic uveitis presenting to two ophthalmic departments in Sydney are described.Results: 12 patients were male, of whom 10 were homosexual and 6 HIV positive. Peripheral retinitis with panuveitis was the commonest ophthalmic presentation (n = 7, 54%), and 6 cases were initially treated with vitreous tap and intravitreal foscarnet as a precaution in case of viral retinitis. Retinitis was present in 6 of 6 (100%) HIV positive and only 1 of 7 (14%) HIV negative patients (χ2 10.6, p

Background: To demonstrate the morphological characteristics of vernal keratoconjunctivitis (VKC) by using in vivo laser scanning confocal microscope (LSCM).Design: Descriptive analysis of VKC under in vivo LSCM performed in Eye & ENT Hospital of Fudan University.Participants: 26 patients diagnosed as VKC and 26 age-matched healthy controls were enrolled in the study.Methods: The HRTII/RCM was used to examine bulbar conjunctiva, tarsal conjunctiva, superior limbus and inferior limbus. The images were recorded automatically by the equipment.Main Outcome Measures: The density of Langerhans cells and inflammatory cells in tarsal and bulbar conjunctiva were calculated by the software. The morphology of Vogt Palisades was analyzed and normal rate of Vogt Palisades at superior and inferior limbus was calculated respectively.Results: Infiltration of Langerhans cells and inflammatory cells could be identified in both bulbar conjunctiva and tarsal conjunctiva, with higher cellular densities than those in normal subjects. Furthermore, the density of Langerhans cells in tarsal conjunctiva was significantly higher in tarsal form and mix form than that in bulbar form (P = 0.048). Normal Vogt Palisades were visible only in 15 and 23 eyes at superior and inferior limbus respectively. In those with abnormal limbal morphology, Vogt Palisades were characterized by atrophy or absence of stromal papillae and disappearance of bright basal cells, accompanied with the infiltration of a larger number of Langerhans cells than normal control. At superior limbal area, bulbar form had the highest abnormal rate, followed by mix form, both of which were significantly higher than tarsal form (P = 0.005).Conclusions: The in vivo morphological characteristics of conjunctiva and limbus in VKC patients included the infiltration of Langerhans cells and inflammatory cells in epithelium and stroma, and the destruction of Vogt Palisades.

Background: To identify the concerns of experienced artificial eye wearers and investigate whether these had changed since they lost their eye.Design: A retrospective study of private practice patients.Participants: Sixty-three experienced artificial eye wearers.Methods: An anonymous questionnaire was posted to participants. Paired Wilcoxon tests were used to investigate changes to concern levels over time. Ordinal logistic regression was used to investigate associations of demographic variables with concern levels.Main Outcome Measures: Changes in level of concern over time.Results: At the time of initial eye loss, participants were mainly concerned about the health of their remaining eye, coping with monocularity and receiving good advice. Between initial eye loss and the present, reductions in concern occurred with judging distance, peripheral vision, appearance, receiving good advice, comfort, retention, colour and movement of the artificial eye, fullness of orbit, loss of balance and post operative pain. Patients whose jobs involved the public were more concerned about appearance and reduced visual range than those in other occupations. Participants’ chief present day concerns were health of the remaining eye and watering, crusting and discharge. Statistical indices p

Ocular lymphoid tumours represent a spectrum of lymphoproliferative disease, and can be subdivided into benign or reactive lymphoid hyperplasia, indeterminate or atypical lymphoid proliferations and malignant lymphoma. Treatment options include a wait and watch approach, systemic steroids, local radiotherapy, or systemic chemotherapy. We describe a case of bilateral atypical lymphoid hyperplasia treated successfully with combination immunotherapy and radiotherapy. A 60 year old lady presented with proptosis and left supra-orbital mass, and was diagnosed to have bilateral atypical lymphoid hyperplasia. She had extensive extra-ocular facial infiltrates but no other sites of involvement on staging investigations. She was treated with eight doses of Rituximab 375 mg/m2 at weekly intervals with a good partial response, followed by consolidative radiotherapy. Rituximab may be an effective treatment adjunct/ alternative for patients with atypical lymphoid hyperplasia of the orbit, particularly where widespread lesions preclude the use of initial radiotherapy.

Backround: The study of the clinical and electrophysiological effects of eye muscle surgery on patients with infantile nystagmus has broadened our knowledge of the disease and its interventions.Design: Prospective, comparative, interventional case series.Participants: 24 patients with a vertical head posture due to electrophysiologically diagnosed INS. The ages ranged from 2.5-38 yrs and follow up averaged 14.0 months.Methods: Thirteen patients with a chin-down posture had a bilateral superior rectus recession, inferior oblique myectomy and a horizontal rectus recession or tenotomy. Those 11 with a chin-up posture had a bilateral superior oblique tenectomy, inferior rectus recession and a horizontal rectus recession or tenotomy.Main Outcome Measures: Outcome measures included: demography, eye/systemic conditions and pre- and post-operative; binocular, best optically corrected, null zone acuity, head posture, null zone foveation time and nystagmus waveform changes.Results: Associated conditions were strabismus in 66%, ametropia in 96%, amblyopia in 46% and optic nerve, foveal dysplasia or albinism in 54%. Null zone acuity increased at least .1 LogMar in 20 patients (p

Background: To determine the effect on macular function of removal of the internal limiting membrane (ILM) during epiretinal membrane surgery.Design: Prospective, interventional study.Participants: Twenty-two eyes of 22 patients with idiopathic epiretinal membranes undergoing surgery with removal of the ILM.Methods: Histologic analysis of the ILM specimens were classified based on amount of retinal tissue fragments attached to the removed ILM. The ophthalmic examinations were assessed prospectively.Main Outcome Measures: The best-corrected visual acuity, optical coherence tomography, and multifocal electroretinography at baseline, 1 and 3 months after surgery.Results: The visual acuity at baseline, 1 and 3 months after surgery were not different between the small and large retinal debris groups. On multifocal electroretinography, there was no significant difference in response of the N1 amplitude, N1 latency, and P1 amplitude between the small and large retinal debris groups at baseline, and 1 and 3 months after surgery. However, compared to the small debris group, the P1 latencies in the foveal areas were delayed in the large debris group at 1 and 3 months (p = 0.020, p = 0.047, respectively). The central retinal thickness was significantly reduced in the large debris group, while the status of the photoreceptor line was not different based on optical coherence tomography between the small and large debris groups 3 months after surgery(p = 0.047).Conclusion: Large amounts of retinal debris attached to the removed ILM did not affect visual acuity. However, the ultrastructural findings of Muller cell damage might be related to subtle macular dysfunction on multifocal electroretinography after surgery.

Background: We evaluate the Visian Implantable Collamer Lens (ICL, Staar, Monrovia, CA) phakic intraocular lens for treating post keratoplasty anisometropia.Methods: Case series of three eyes (2 phakic and 1 pseudophakic).Results: The mean age was 47.3 years (range, 30 – 73years), with a minimum of 3 months follow up. The mean preoperative SE was -8.75 ± 5.17 D (- 4.00 to -14.25 D) improving to -0.29 ± 1.21 D postoperatively (range 0.75 D to -1.625). Mean logMAR UCVA improved from 1.66 ± 0.60 (20 / 800) preoperatively to 0.41 ± 0.52 (20 / 50-2). Mean logMAR BSCVA improved from 0.32 ± 0.15 (20 / 40) preoperatively to 0.10 ± 0.11 (20 / 25). Anisometropia improved from a difference of 6.37 +/- 2.59D preoperatively to 2.09 +/- 1.37D postoperatively, and there were no complications.Conclusions: Our technique for this clinical indication shows that the Visian ICL is a safe and effective alternative for treating post keratoplasty anisometropia.

Purpose:  To examine the rates of intermediate-term intraocular pressure (IOP) control after trabeculectomy with adjunctive mitomycin C (MMC) and assess for associated complications.Methods:  Medical records of patients undergoing primary trabeculectomy with MMC at Concord Repatriation Hospital, Sydney between January 1997 and December 2005 were reviewed. All eyes with a minimum of 2-year follow up were included. Follow-up data were collected in a standardized form on postoperative IOP, bleb-related and other complications. Success was measured as IOP ≤ 18 mmHg and ≥6 mmHg (criteria 1) with (qualified success) or without (absolute success) the use of glaucoma medications. A secondary outcome measure was an IOP reduction of greater than 20% from baseline (criteria 2). Eyes with preoperative IOP of 18 mmHg or less were included, but also analysed separately to those eyes with preoperative IOP above 18 mmHg.Results:  Sixty eyes from 42 patients were included in the study, with 3-year follow up on 48 eyes. Mean preoperative IOP was 25.3 mmHg (range 8–45) and mean postoperative IOP was 14.0 mmHg at 1- and 2-year follow up, and 14.7 mmHg at 3 years (ranges: 3–31, 4–30 and 8–45 mmHg respectively). Cumulative success for criteria 1 was 85.0% at 2 years and 83.3% at 3 years, and for criteria 2 it was 80.0% and 79.2%, respectively. The number of eyes on glaucoma medications was reduced from 51 preoperatively to 30 at 3 years. Complications were infrequent. There was one eye with a shallow anterior chamber beyond the immediate postoperative period. One eye required cataract surgery at 1-year follow up. Subgroup analysis was performed using the first operated eye only, and results did not differ significantly from overall results.Conclusion:  MMC-augmented trabeculectomy can significantly reduce IOP in the short and intermediate term, with a favourable safety profile.

Background:  To evaluate by anterior segment optical coherence tomography (AS-OCT) the changes in the anterior chamber structures in Caucasian eyes after laser peripheral iridotomy (PI).Methods:  Retrospective study of consecutive Caucasian primary angle closure suspect (PACS), primary angle closure (PAC) or primary angle closure glaucoma (PACG) patients who underwent laser PI over a 25-month period at a specialist glaucoma practice. The AS-OCT images of the temporal and nasal angles (in light and dark) before and after laser PI were analysed. The parameters studied were trabecular-iris angle (TIA), angle opening distance (AOD), trabecular-iris space area (TISA), trabecular-iris contact length (TICL), iris thickness (IT) and maximum iris bow height (MIBH).Results:  Images of 71 eyes of 71 patients were assessed. The mean age at laser PI was 60.3 ± 10.0 years. Forty (56.3%) were women, and 14 (19.7%) had PACG. The mean time from laser PI to the follow-up AS-OCT scan was 5.92 ± 3.22 weeks. The IT did not alter significantly after laser PI, but there were significant increases in the TIA, AOD and TISA, as well as a significant decrease in MIBH, in both light and dark. There was no difference in the magnitude of change seen between the temporal and nasal angles, or between PACS/PAC and PACG eyes.Conclusion:  In Caucasian eyes, laser PI resulted in significant angle widening (increased TIA, AOD and TISA) and iris profile flattening (decreased MIBH) at the temporal and nasal angles based on AS-OCT imaging in both light and dark.

Background:  To study the effect of size of the posterior polar opacity on surgical and visual outcome of phacoemulsification in posterior polar cataract.Setting:  Post Graduate Institute of Medical Education and Research, Chandigarh, India.Methods:  Consecutive patients with posterior polar cataract who underwent phacoemulsification were analysed for intraoperative complications and postoperative outcome. The continuous curvilinear capsulorhexis size was kept approximately 5.5 mm, and hydrodelineation was done instead of hydrodissection.Results:  There were 58 eyes of 51 patients who underwent phacoemulsification for posterior polar cataract. The mean follow-up time was 15.4 months (range 12–40 months). Twenty-three eyes had size of polar opacities 4 mm or more in diameter whereas 35 eyes had less than 4 mm. Posterior capsule rupture occurred in nine eyes (15.51%). In eyes with polar opacities 4 mm or more, seven (30.43%) had posterior capsule rupture whereas in eyes with less than 4 mm size, only two (5.71%) had posterior capsule rupture. Capsular bag placement of intraocular lens (IOL) was achieved in 50 eyes and sulcus-sulcus in eight eyes. Three-piece hydrophobic acrylic IOL was implanted in 47 eyes and all polymethylmethacrylate IOL in 11 eyes. Postoperatively best-corrected visual acuity of 6/12 or better was achieved in 55 eyes (94.8%) and three eyes achieved 6/24 or less.Conclusion:  Phacoemulsification in eyes with larger size of polar opacity has significant risk of posterior capsule rupture.

Background:  To evaluate long-term contrast sensitivity (CS) and visual acuity following implantation of monofocal, accommodating, refractive and diffractive multifocal intraocular lenses (IOLs) in patients with unilateral cataractMethods:  In this prospective non-randomized clinical trial, 87 patients with unilateral cataract were enrolled in four groups for phacoemulsification and IOL implantation in Ophthalmology Department of Goztepe Training and Research Hospital. Twenty-four patients had monofocal (Alcon Acrysof; group 1), 21 patients accommodating (Human Optics 1CU; group 2), 22 patients diffractive multifocal (Tecnis ZM900; group 3) and 20 patients refractive multifocal (AMO Rezoom; group 4) IOL implantations. Ages of patients were between 40 and 70. Parameters analysed at the 18th postoperative month were subjective refractions, monocular and binocular distance and near photopic CSs, visual acuities.Results:  Near visual acuities were statistically better in group 3 than the other groups (P 

Background:  To compare corneal hysteresis (CH) and corneal resistance factor (CRF) in eyes 1 year following penetrating keratoplasty (PK) with that of normal eyes using the Ocular Response Analyser.Methods:  Prospective case comparison of 166 normal right eyes and 34 unilateral post-PK eyes presenting to a teaching hospital in Birmingham, UK. The CH, CRF and Goldmann-correlated intraocular pressure, of each eye was measured using the Ocular Response Analyser. The central corneal thickness (CCT) was measured using an ultrasonic pachymeter.Results:  The mean CH was 10.6 ±2.0 mmHg, standard deviation (SD) and CRF was 10.2 ± 2.0 mmHg (SD) in normal eyes and 8.9 ± 3.3 mmHg and 8.1 ± 3.3 mmHg in post-PK eyes, respectively. The mean CCT was 541.8 ± 36.1 µm in normal eyes and 556.0 ±69.2 µm in post-PK eyes. The Goldmann-correlated intraocular pressure was 16.1 ± 3.1 mmHg and 12.4 ± 2.9 mmHg in normal eyes and post-PK eyes, respectively. The CCT was found to be higher in post-PK eyes compared with normal eyes but the difference was not statistically significant (P > 0.5).Conclusion:  Reduced biomechanical measures were found in post-PK eyes despite a higher mean CCT. This may be due to the altered corneal structure following PK.

Background:  To determine the presence, severity and context of diabetic retinopathy among diabetic adults using hospital eye clinic services in Honiara, Solomon Islands.Methods:  Fifty consecutive known diabetic patients aged ≥20 years were interviewed and underwent Snellen distance vision testing and complete ocular examination, including dilated 90 D funduscopy. Diabetic retinopathy was graded according to the International Clinical Diabetic Retinopathy and Macular Oedema Disease Severity Scales.Results:  Participants were predominantly Melanesian (94%). Mean age was 53.6 ± 10.7 years; 42% were female; and 34% were rural dwellers. Diabetes had been diagnosed 10 years ago for 42%, 34% and 24% of participants. However, 54% denied ever having had a dilated fundus examination. Proliferative retinopathy, severe non-proliferative changes and maculopathy were present in 5, 12 and 26 eyes, respectively. For the 32 eyes with pinhole acuity ≤6/12, diabetic eye disease was the cause for 20, with all but one due to maculopathy. Diabetes reduced the pinhole vision of five eyes to ≤6/60. Twenty-four per cent of participants had diabetes-related pinhole vision ≤6/12 in at least one eye. Those diagnosed with diabetes 5–10 and >10 years were 17.5 and 58.8 times more likely to have such an eye compared with those recently (

Purpose:  To evaluate visual outcome and factors affecting visual outcome in herpes zoster ophthalmicus (HZO).Methods:  A prospective, longitudinal, observational study was undertaken in 64 consecutive patients with HZO presenting within 72 h of rash onset. Patients underwent detailed ophthalmological and dermatological examinations at presentation, with follow up at first, second and fourth weeks and third and sixth months. All patients received both systemic and topical acyclovir. The main outcome measure was best-corrected visual acuity at 6 months' follow up. Local and systemic factors were correlated with visual outcome using univariate and multivariate analyses.Results:  Overall visual outcome was good, with 36/64 (56.3%) patients having a visual acuity of 6/6 or better. Mild visual loss occurred in 22/64 (34.3%), moderate loss in 3/64 (4.7%) and severe loss in 3/64 (4.7%); moderate to severe visual loss was due to severe uveitis (2), neurotrophic keratitis (1) and cataract (3). Increasing age (P = 0.04), positive Hutchinson sign (P = 0.001), absent corneal sensation (P = 0.01), corneal epithelial lesions (P = 0.03) and uveitis (P 

Background:  To characterize diabetic eye disease and its management among adults aged ≥40 years with self-reported diabetes in Fiji.Methods:  During a population-based cross-sectional survey using multistage cluster random sampling, participants reported health information, including whether a doctor had diagnosed diabetes. HbA1c and visual acuity were measured. Diabetic eye disease was assessed using 90-dioptre lens dilated funduscopy.Results:  Of those enumerated, 1381 (73.0%) participated, with 222 reporting diabetes. Twenty fundi were not examined (19 due to cataract). Of the remaining 424 eyes, 75.5% had no diabetic disease, 1.2% had proliferative retinopathy, 7.5% had active significant maculopathy and 0.7% had burnt-out/treated disease. By person, 27.2% had retinopathy and/or maculopathy in at least one eye. Mean HbA1c (9.9 ± 2.3%) for this group was significantly higher (P = 0.004) than for those without eye disease. Vision-threat occurred in at least one eye of 11.5%. Diabetes (predominantly maculopathy) caused pinhole acuity 10 years ago was predictive of any (odds ratio [OR] 8.13; 95% confidence interval [CI] 3.28–20.21; P 

Background:  To determine the effect of adipose-derived adult stem cells (ADASCs) and optimal concentration of fibrin on fibrovascular ingrowth into porous polyethylene orbital implants (Medpor).Methods:  Medpor sheet treated with O.25% fibrin only and ADASCs in mixtures containing fibrin (0.25%, 0.5% or 1.25%) were applied to a Medpor sheet and implanted in the back of each of 20 athymic nude mice. After 10 days, implants were removed and observed for fibrovascularization and stability. Haemoglobin, collagen and cellular DNA content were determined in quantitative assays.Results:  Haemoglobin, collagen and cellular DNA levels were significantly higher in ADASC group than in the cell-free implant (0.25% fibrin only) group (P 

Background:  Botulinum toxin (BTX) is the first-line treatment in managing benign essential blepharospasm (BEB) and hemifacial spasm (HFS). We wished to assess the difference in duration of effect and the number of BTX treatments required to treat patients with BEB and HFS.Methods:  A prospective study of patients attending the BTX clinic in Manchester Royal Eye Hospital over 6 months. All treatments were administered by a single experienced ophthalmologist. A questionnaire was completed for each patient. In patients with BEB where the BTX was injected bilaterally, one side was randomized to compare with HFS patients. Patient demographics, cumulative dose of BTX, duration of BTX effect with patient satisfaction and the number of previous BTX injections were recorded.Results:  Sixty-four patients were included in the study. The mean age was 60.8 years. Among them, 30 patients had BEB and 34 had HFS. Patients with HFS received a lower mean dose of BTX than patients with BEB (12.23 units vs. 16.2 units). The patients with HFS had a longer duration of effect than patients with BEB, with fewer BTX treatments. Of all patients, 90% with HFS and BEB were satisfied with the effect of their last BTX injection. Three unsatisfied patients in the BEB group were referred on for surgical management of their disorder.Conclusions:  We have shown that patients with BEB have a shorter duration of effect with BTX and require more frequent BTX treatments than patients with HFS, highlighting that facial dystonias in patients with BEB is more challenging to manage.

Purpose:  To describe the self-reported vision, history of eye disease and general health of indigenous Australian participants in the National Indigenous Eye Health Survey.Methods:  Using a multistage cluster sampling methodology, 30 geographic areas, stratified by remoteness, were selected to provide a representative population of indigenous Australians aged 5–15 years and 40 years and over. Before an eye examination, participants completed a questionnaire about their eye health and eye care facilities consulted, satisfaction with their vision and general health.Results:  A total of 1694 indigenous children (49.2% female, mean age 9.5 ± 2.9 years) and 1189 adults (61.0% female, mean age 53.1 ± 9.7 years) participated. Three-quarters of adults (259/342) and 88.4% of children (129/146) wore the right distance glasses. Adults from remote areas were less likely to have refractive error (P = 0.002) as well as males versus females (P = 0.02). Similar results were found for children. Adults wearing appropriate distance glasses were as satisfied with their vision as people with normal vision who did not need glasses (P = 0.6). Both groups were more satisfied with their distance vision than people with poor presenting vision (P = 0.007). Self-report of cataract, diabetic retinopathy, glaucoma and age-related macular degeneration did not match with clinical findings (P 

Purpose:  To investigate the efficacy of intravitreal bevacizumab for the treatment of neovascular age-related macular degeneration (AMD) using an as required dosing regimen.Methods:  A retrospective study of 210 patients (231 eyes) with choroidal neovascularization resulting from neovasacular AMD. Patients were treated with 1.25 mg intravitreal bevacizumab at a vitreoretinal practice in Adelaide, South Australia. Patients were followed up at 2–4 weeks and then at 1-month intervals; repeat injections were offered in the event of recurrence. Recurrence was defined as either a decrease of best-corrected visual acuity or an increase in macular oedema, subretinal fluid or intraretinal fluid on optical coherence tomography, after complete or partial resolution in previous follow-up visits. Patient data were collected for 12 months of follow up or until the patient's treatment was changed to ranibizumab.Results:  Significant improvement in visual acuity and central retinal thickness was demonstrated at 1 month with an improvement of vision from logMAR equivalent 0.76 to 0.68 (P 

Background:  To characterize the infrared (IR) and fundus autofluorescence (FAF) images of eyes with optic disc pit maculopathy.Methods:  A retrospective non-comparative study of three patients with optic disc pit maculopathy who were followed by optical coherence tomography (OCT) and retinal angiography (Heidelberg retina angiograph 2) before and after vitreous surgery without laser photocoagulation.Results:  The areas of serous retinal detachment and inner retinal schisis were dark in the IR and FAF images preoperatively; and they changed to brighter areas following reattachment of the retina. There was an increase in the granular hyperfluorescence in the FAF images accompanied by an increase in the number of subretinal precipitates. OCT showed a thickening of the photoreceptor outer segments. The outer retinal layer defect initially appeared bright in the IR images and hypofluorescent or hyperfluorescent in the FAF images. The outer retinal layer defect became larger with a reduction of the outer retinal schisis and increased retinal detachment, but then became smaller with the resolution of the retinal detachment. All cases had a resolution or reduction of the retinal detachment and retinal schisis after the vitrectomy.Conclusion:  The IR and FAF images in eyes with optic disc pit maculopathy reflect the changes in the inner and outer retinal layers corresponding with the stage of recovery of the disease.

Background:  To compare the efficacy and tolerance of three prostaglandin analogues, bimatoprost, latanoprost and travoprost in patients with previously untreated open-angle glaucoma and ocular hypertension.Methods:  Prospective randomized single (investigator) masked comparative clinical trial at the Taunton and Somerset NHS Hospital, Taunton, UK. Newly diagnosed, treatment naïve glaucoma/ocular hypertension patients were recruited. Patients were randomized into three groups to receive one of the three prostaglandin analogues. Intraocular pressure (IOP) was measured before starting treatment and after 2 and 6 months of treatment. The IOP reduction and the tolerance profile of each drug were compared. The data were analysed on the basis of intention to treat, using analysis of covariance comparing IOP in the three groups at 2 and 6 months, adjusting for baseline IOP. Tolerance levels were compared using Kruskal–Wallis test.Results:  Of the 122 patients, 40 patients were given bimatoprost, 42 received latanoprost and 40 had travoprost. At 2 months, there was a significant difference between the three treatment groups (P = 0.013) with bimatoprost achieving a greater reduction in IOP than the other two drops. However, at 6 months, the difference was not statistically significant (P = 0.13). There was no significant difference in the tolerance profile.Conclusion:  All the three topical prostaglandin analogues are effective at lowering IOP, but bimatoprost was found to be most effective in the initial phase of the trial, and there was no statistically significant difference in the efficacy, among the three prostaglandin analogue eye drops after 6 months of treatment.

Background:  Toric intraocular lenses (IOLs) are advocated as an effective treatment for both regular corneal-based astigmatism and cataract in both non-penetrating keratoplasty and penetrating keratoplasty (PK) patients. The aim of this analysis is to compare postoperative outcomes for both PK and non-PK patients to determine whether or not the past PK is relevant when calculating the appropriate IOL and predicting the postoperative results.Methods:  A retrospective analysis was performed on 14 non-PK and eight PK patients who underwent cataract surgery and astigmatism correction with a Rayner toric IOL. Preoperatively, best spectacle-corrected visual acuity, biometry and refractive data were recorded. Postoperative analysis at 1 month looked at best-uncorrected visual acuity (BUVA), refractive data and IOL axis. Statistical analysis was undertaken to test for differences in outcomes between the PK and non-PK groups.Results:  Preoperatively, a significant difference was seen between cylinder and astigmatism and not between sphere, axial length or anterior chamber depth. Analysis of preoperative best spectacle-corrected visual acuity, IOL error predictability, IOL rotational stability and refractive outcomes revealed no difference between PK and non-PK groups, but a significant difference was seen postoperatively with PK patients having worse BUVA.Conclusion:  Toric IOLs are an effective means for treating both regular corneal-based astigmatism and cataract in both PK and non-PK patient groups. Analysis of results revealed similar trends for both groups in all areas except postoperative BUVA. Further studies are planned to better understand why PK patient's BUVA did not fit the trend of the other results.

Background:  The aim of this study was to evaluate the efficacy, safety and complications of orbital steroid injection versus oral steroid therapy in the management of thyroid-related ophthalmopathy.Methods:  A total of 29 patients suffering from thyroid ophthalmopathy were included in this study. Patients were randomized into two groups: group I included 15 patients treated with oral prednisolone and group II included 14 patients treated with peribulbar triamcinolone orbital injection. Only 12 patients in both groups (16 female and 8 male) completed the study.Results:  Both groups showed improvement in symptoms and in clinical evidence of inflammation with improvement of eye movement and proptosis in most cases. Mean exophthalmometry value before treatment was 22.6 ± 1.98 mm that decreased to 18.6 ± 0.996 mm in group I, compared with 23 ± 1.86 mm that decreased to 19.08 ± 1.16 mm in group II. Mean initial clinical activity score was 4.75 ± 1.2 and 5 ± 1.3 for group I and group II before treatment, respectively, which dropped to 0.83 ± 1.2 and 0.83 ± 1.02, 6 months after treatment, respectively. There was no change in the best-corrected visual acuity in both groups. There was an increase in body weight, blood sugar, blood pressure and gastritis in group I in 66.7%, 33.3%, 50% and 75%, respectively, compared with 0%, 0%, 8.3% and 8.3% in group II. No adverse local side effects were observed in group II.Conclusion:  Orbital steroid injection for thyroid-related ophthalmopathy is effective and safe. It eliminates the adverse reactions associated with oral corticosteroid use.

Purpose:  The aim of the study was to evaluate long-term results of autologous serum treatment for recurrent corneal erosions.Methods:  In this prospective single-centre study, 33 eyes of 33 patients (21 male and 12 female) were treated with autologous serum eye drops for recurrent corneal erosions. Mean age of the patients was 49.3 ± 9.8 standard deviation (range 24–73) years. All subjects had failed to respond to other treatments. Autologous serum drops were administered for a 6-month period: six times daily for the first 3 months and four times daily for the remaining 3 months. Detailed informed consent was obtained from the entire patient group before the study.Results:  The mean follow-up period was 30 ± 6.3 standard deviation (range 12–48) months. None of the patients experienced a recurrence while under treatment. Twenty-eight patients (85%) had complete healing of erosions with no relapses of the disease over the whole follow-up period. Five patients (15%) presented a single recurrence 3–12 months after the end of the treatment. No sight-threatening complications were reported over the follow up. There was no statistically significant difference in the best spectacle-corrected visual acuity values (tstat = 2.1, F = 0.096, degree of freedom = 40 166, P 

We present the case of a 48-year-old woman with a clinically and histopathologically confirmed Kearns–Sayre syndrome who developed a maculopathy resembling an adult-onset vitelliform macular dystrophy in her right eye. DNA analysis identified the presence of multiple deletions in the mtDNA of the muscle sample, with the common deletion of 4977 bp the most abundant. To the best of our knowledge, there have been no previous reports of such macular lesion occurring in association with Kearns–Sayre syndrome.

Inflammatory myofibroblastic tumour (IMT) is a rare distinctive neoplasm of intermediate biological potential with a predilection for the abdominopelvic region and lung of children and young adults. It is histologically composed of spindle cells (myofibroblasts) in a myxoid to collagenous stroma with a prominent inflammatory infiltrate composed primarily of plasma cells and lymphocytes. Its pathogenesis is controversial. Arising most commonly in the lungs, only two cases of histopathologically confirmed IMT originating from the infratemporal and pterygopalatine fossae have been documented in the literature. Neither had orbital involvement. We now report the first case of IMT originating from the infratemporal fossa with orbital extension in a previously well 31-year-old woman. The patient presented with a 5-month history of intermittent right-sided headaches, progressive trismus and right lower lid swelling. She then developed right proptosis, diplopia and paraesthesia in the ophthalmic and maxillary divisions of her trigeminal nerve. Magnetic resonance imaging showed a soft tissue mass occupying most of the right infratemporal fossa with extension into pterygopalatine fossa and orbit. Provisional diagnosis from an open biopsy was nodular fasciitis. She underwent surgical debulking of the infratemporal fossa and lateral orbit through a coronal and trans-oral approach with trans-zygomatic access via total zygomatic osteotomy. Review of intraoperative specimens revised the diagnosis to IMT. Further management included systemic corticosteroids and adjuvant radiotherapy.

Background:  A 12-month Diploma of Eye Care course for mid-level eye care workers was initiated in 2007 as part of Timor-Leste's National Eye Health Strategy. This paper reports the development and implementation of this course, examines its initial results and makes suggestions for improvements to the training and deployment of these workers.Methods:  Course curriculum development and delivery, trainee selection and candidate assessment were examined. Graduate clinical knowledge retention at 6 months after course completion was investigated using clinical vignettes to determine diagnosis, management and patient counselling knowledge for common primary eye health conditions. Graduate workplace environments and activities were appraised.Results:  Development of the course curriculum and its delivery were in response to local circumstance, and according to education best practice teaching and learning strategies. Four rural nurses successfully completed the inaugural course. Although all remained in rural eye care services at 6 months after graduation, there was considerable variation in activity. Substantial depletion of clinical competency was revealed across the cohort.Conclusions:  Adherence to current best practice in the design and delivery of the curriculum and course was insufficient to ensure productive graduates of ongoing clinical competency, positioned to make an impact on eye health. Attention needs to be directed to postgraduation integration into the workplace, and continuing support once there. The efficacy of this mid-level cadre and its impact on eye health requires further evaluation.

Purpose:  We study the vitreous interface of the optic disc to delimit the passages for the flow of fluids through the prelaminar tissue of porcine eyes.Methods:  Wet scanning electron microscope (SEM), conventional SEM and transmission electron microscope (TEM) were used to explore the surface of the optic nerve of the pig. The vitreous cavity was perfused with a fluorescent marker and colloidal gold at controlled pressure. Samples of perfused optic nerve head were cryosectioned and observed with the confocal laser microscope (lectin) or resin embedded and observed under TEM (gold).Results:  Fenestrations were present under the SEM in all three regions of the vitreous interface. SEM results were confirmed at the TEM level and under the wet-SEM. Perfusion experiments traced the flow of a fluorescent molecule delineating routes of preferential flow with origin in the fenestrations. Colloidal gold marked the site of entrance in the prelaminar tissue identifying major fenestrations in the basal membrane.Conclusions:  Interchange of fluid between the optic nerve and the vitreous cavity in the pig is facilitated by fenestrations of varied sizes in the basal membrane and preferential flow routes through the prelaminar tissue. Preferential flow routes exist in the extracellular spaces of Elschnig and Kuhn’ astrocytes and give a sharply distinct image when compared with flow through zones in which astrocytes envelope axons. Escape routes may be instrumental in preventing oedemas of the optic nerve head, but they could also serve as entrance doors for fluids from the vitreous and aqueous and play a pathogenic role in ageing and glaucoma.

Purpose:  This study was designed to evaluate the effect of sorafenib administration on laser-induced experimental choroidal neovascularization (CNV) in rats.Methods:  A total of 36 rats were divided into three groups. Sorafenib, an oral, multitargeted receptor tyrosine kinase inhibitor, was administered at a dose of 10 mg/kg per day (n = 12) or 30 mg/kg per day (n = 12) for 1 day before the laser induction of CNV. Rats continued to receive the drug for 14 days. Fluorescein angiograms were analysed for CNV dye leakage and the thickness of CNV was assessed by histology. The levels of vascular endothelial growth factor, platelet-derived growth factor, monocyte chemoattractant protein-1 and intercellular adhesion molecule-1 mRNA were measured by the use of real-time quantitative reverse-transcription polymerase chain reaction.Results:  Sorafenib-treated rats had significantly less fluorescence leakage as compared with vehicle-treated rats (P 

Background:  To determine whether repair of a monocanalicular laceration using a Mini-Monoka stent provides a functioning system.Methods:  This prospective study included patients who underwent repair of a monocanalicular laceration with placement of a Mini-Monoka stent. Silicone punctal plugs were placed in the unaffected punctum on the side that had sustained the injury and in the same punctum on the fellow eye. The plug was left in place for between 7 and 17 days. The patient was questioned after placement regarding symptoms of epiphora.Results:  Eight patients were included in the study; five injuries involved the lower canaliculus, two the upper, and one the upper and lower but only the lower was repaired. Of injuries, 50% were as a result of assault. Seven out of eight patients had no epiphora from the repaired eye during plug placement. One patient complained of significant epiphora from the repaired eye during the time the plugs were placed; this patient had a partial nasolacrimal duct obstruction and no canalicular stenosis. Of patients, 88% had an anatomically patent canaliculus and 100% were tearing-free when no plug was placed.Conclusions:  In this study, a repaired monocanalicular injury provided a functioning system in 88% of cases. In previous studies, it has been shown that many patients are symptom-free with just one functioning canaliculus. However, a fully functioning canalicular system may help to prevent tearing under stress conditions, and will provide a viable system if the other canaliculus is irreparably damaged in the future. Therefore, repair is recommended.

Background:  To determine the prevalence of vision loss due to cataract in indigenous Australians.Methods:  A national, stratified, random cluster sample was selected in 30 communities across Australia. Data collection was undertaken in 2008. Adults 40 years and older were examined using a standardized protocol that included a questionnaire. The presence of visually significant cataract was assessed.Results:  Response rates were good and 1189 indigenous adults were examined and overall recruitment was 72%. Low vision (

Purpose:  To evaluate the safety and efficacy of double peel using triamcinolone acetonide (TA) and trypan blue (TB) in removing epiretinal tissues in vitrectomy for myopic macular hole with retinal detachment (MHRD).Methods:  Prospective interventional case control study. Patients with myopic MHRD underwent vitrectomy with TA-assisted adherent cortical vitreous (ACV) removal followed by TB-assisted internal-limiting membrane (ILM) peeling and gas tamponade. The results were compared with historical control group without the use of any vital dye or TA.Results:  Ten eyes of 10 study cases were compared with nine eyes of nine control cases. Mean axial length was 28.3 ± 1.4 mm and 29.6 ± 2.4 mm and mean follow-up period was 15 months and 42 months for the study group and the control group, respectively. Reattachment rate was 70% in the study group and 44% in the control group. Mean logMAR visual acuity improvement was 0.02 at 6 months and 0.01 at 12 months for the study group (P

Background:  To examine the relationships between optic disc area and parameters measured at the cornea; central corneal thickness (CCT), corneal hysteresis (CH) and ocular pulse amplitude (OPA) in glaucoma subjects and controls.Methods:  In this prospective experimental study, patients underwent measurement of CCT, OPA, CH and optic disc imaging with the Heidelberg Retina Tomograph II (HRT-II). Pearson's correlation coefficient was calculated to assess the associations between optic disc area and CCT, OPA and CH.Results:  A total of 100 patients, 38 with glaucoma and 62 controls were examined. In a univariate analysis of this group, CCT and CH were significantly lower in glaucoma patients (P = 0.01). CCT was inversely correlated with optic disc surface area (Pearson's correlation coefficient r = −0.200; P = 0.05). This inverse correlation did not achieve statistical significance when glaucoma patients and controls were analysed separately. There was no statistically significant association between optic disc area and OPA or CH.Conclusions:  There was an inverse relationship between CCT and optic disc area in this study group. No association was found between optic disc area and OPA or CH.

An 80-year-old man presented with an 8-week history of painless swelling in the right lacrimal gland region with infero-medial dystopia of the globe. The lesion was excised and histology confirmed an orbital plasmacytoma. Multiple myeloma screening was negative and a solitary extramedullary plasmacytoma arising from the lacrimal gland was diagnosed. The patient was subsequently treated with radiotherapy.

Treatments for angle closure include eye drops, laser procedures, trabeculectomy and other drainage procedures, and now lens extraction. A 2006 Cochrane review of the role of lens extraction in angle closure disease concluded that there was no published evidence supporting the efficacy of lens extraction in chronic primary angle closure glaucoma. More recent randomized controlled trials have suggested greater promise. We wish to address the rationale, evidence base and philosophy for lens extraction – especially clear lens extraction – in preventing vision loss from glaucoma in angle closure disease.

Purpose:  To evaluate the efficacy of intravitreal injection of bevacizumab as a preventive intervention of vascular endothelial cell proliferation in the retina of diabetic rats.Methods:  Fifty-four streptozotocin-induced diabetic Wistar rats were injected intravitreally with 3 µL (25 mg/mL) of bevacizumab into left eyes and 3 µL of saline into the right eyes. Immunohistochemistry and enzyme-linked immunosorbent assays for CD34 and VEGF were used to assess retinal angiogenesis, and transmission electron microscopy was used to evaluate the ultrastructure of retinal capillaries.Results:  Retinal expression of VEGF was inhibited 1 week and 1 month after injection (P  0.05, Dunnett's t-test). The amount of VEGF expression was higher 2 months after injection than 1 week or 1 month after injection, and also higher 1 week after injection compared with 1 month after injection (P 

Background:  This study was to investigate the association of two single nucleotide polymorphisms (SNPs) in LOC387715 and HTRA1 with exudative age-related macular degeneration (AMD) in a Korean population and the gene–gene and gene–environment interactions in the development of AMD.Methods:  We genotyped two SNPs that are located in the LOC387715 locus (rs10490924) and HTRA1 (rs11200638) in 137 cases of exudative AMD and 187 controls.Results:  Both two SNPs were significantly associated with AMD (P = 0.0001). Homozygotes for the risk allele at LOC387715 and HTRA1 had a 3.80-fold and a 4.03-fold increased risk of exudative AMD, respectively, compared with homozygotes for the wild-type allele (P = 0.0001). The joint effects for complement factor H (CFH) Y402H and 10q26 variants indicated an increased risk of exudative AMD. The odds ratios (ORs) of AMD for individuals carrying one-, two- and three-copy risk alleles of CFH Y402H and LOC387715 were 1.08, 3.49 and 3.64, respectively. Also, the combination effect of the CFH Y402H risk alleles with HTRA1 risk alleles was dose-dependent. The interaction analysis between gene and environmental factors showed that among several factors, smoking synergistically increased the susceptibility of AMD for variants of LOC387715 and HTRA1, with OR 8.33 (3.05–22.74) and OR 8.50 (3.07–23.51), respectively.Conclusion:  This study demonstrated the significant association of the 10q26 SNPs (HTRA1 and LOC387715) in an AMD cohort from Korea and was consistent with previous studies from other populations. Also, a statistically significant interaction between genetic and environmental factors was found.

Medulloepithelioma is an uncommon tumour. These tumours most commonly arise in the brain and spinal cord; however, they also may arise from the optic nerve. We, herein, report a rare case of malignant non-teratoid medulloepithelioma of the optic nerve with intraocular extension.

Background:  Infantile haemangiomas are the commonest tumours of the orbit in children. Treatment is usually expectant, unless they are visually threatening. Although steroids, other pharmacological and surgical treatment modalities have their place, there are risks involved. A previous case series reported the successful use of propranolol for infantile haemangioma. The safety and efficacy of propranolol in the treatment of periorbital haemangioma was reviewed in a serious of our patients.Methods:  We performed a retrospective review of patients seen by two ophthalmologists (TJS and GAG), collecting data on colour, size of lesion, duration of treatment and side-effects of treatment. Our main outcome measures were colour and size of infantile haemangioma before and after treatment, the change in astigmatism of our patients and the incidence of complications from propranolol.Results:  We reviewed 10 patients with infantile haemangioma. They were treated with propranolol oral syrup 2 mg/kg/day in divided doses for a mean duration of 32.8 (range 12–42) weeks. All our patients had a reduction in colour and size of the lesions. The mean lesion size decreased from 756.7 to 543.2 mm2 after treatment (P = 0.075). Five patients had significant astigmatism and 60% had successful reduction of astigmatism after treatment. None of our patients suffered significant side-effects of propranolol.Conclusion:  Propranolol appears to be a safe and effective treatment in the management of infantile haemangioma.

Background:  Propranolol is a novel therapeutic agent in the treatment of cutaneous infantile haemangiomas. We assessed the effect of propranolol therapy in infantile haemangiomas of the orbit.Methods:  A case series of four patients with orbital infantile haemangiomas were referred for management in our tertiary referral hospitals. Two of the patients had inadequate responses to prior corticosteroid therapy. One of the patients was commenced on propranolol at 2.5 years of age when the lesion was not in the proliferative phase. This represented the first case report of propranolol treatment for infantile haemangioma outside infancy. The other three children were in their infancy when propranolol was commenced. The patients were treated with oral propranolol.Results:  All patients had significant improvement in their physical appearance, ocular examination findings and size of their lesions on radiological evaluation. No side-effects of propranolol treatment were observed.Conclusions:  Propranolol is a promising treatment against infantile haemangiomas in the orbit, not only in infants but also in an older child with a stable lesion.

Purpose:  To investigate the levels of erythropoietin (EPO) and soluble CD44 (sCD44) in the aqueous and plasma of human eyes with primary open-angle glaucoma (POAG), and to correlate their concentration with severity of glaucoma.Methods:  A total of 30 patients with POAG and 25 patients with senile cataract (control group) of matched age and gender were included in the study prospectively. Aqueous samples were obtained by paracentesis from glaucoma and cataract patients who were undergoing elective surgery. Aqueous and corresponding plasma samples were analysed for EPO and sCD44 concentrations by enzyme-linked immunosorbent assay.Results:  The EPO and sCD44 levels were significantly higher in aqueous of POAG patients with respect to the comparative group of cataract patients (P 

Background:  The public health concern represented by eye injury in Victoria, Australia has been known for a period now approaching 20 years. However, there has been no improvement observed in this public health concern since it was first identified in the 1990s. This study further investigates the epidemiology of eye injury in Victoria, specifically hospital-admitted eye injury.Methods:  The Victorian Admitted Episodes Dataset was surveyed for eye injury coded by the International Classification of Diseases 10th revision during the period spanning 2001–2005, retrieving all cases of hospital-admitted eye injury in Victoria during the surveyed period.Results:  During the period surveyed, the average incidence of eye injury requiring hospital admission in Victoria was 53.6 per 100 000 person-years. Sixty-four per cent of patients were male and 36% were female (P 

Purpose:  To determine the concentration of alpha-lipoic acid in the aqueous and investigate if its topical instillation can increase quantities.Methods:  A total of 70 patients selected to undergo cataract surgery were randomly divided into two groups. Group 1 was used as a control group; for the patients in Group 2, a single instillation of alpha-lipoic acid eye drops (1%) was administered. Immediately before surgery, an aliquot of 40–120 µL of aqueous was aspirated. The individual aspirations were combined to constitute pools representing time intervals with respect to administration. The levels of alpha-lipoic acid in the aqueous were measured using gas chromatography/mass spectrometry.Results:  Pool 0 was created by combining the samples of aqueous obtained from the patients in Group 1, the control group; and the level of alpha-lipoic acid was 27.5 + 2.6 ng/mL. In the other pools, the time interval between the administration of the eye drops and sampling was, respectively, 23 min, 53 min, 72 min, 93 min and 114 min; and the level of alpha-lipoic acid was 33.0 + 10.8 ng/mL, 52.0 + 2.5 ng/mL, 86.7 + 2.5 ng/mL, 91.2 + 2.5 ng/mL and 80.3 + 2.5 ng/mL.Conclusion:  Our study demonstrates the presence of alpha-lipoic acid in the aqueous and indicates that its concentration increases after it is administered in the form of eye drops, reaching maximum values after around 93 min. The concentrations that are achieved in the anterior chamber allow us to theorize the possibility of exploiting the antioxidant properties of alpha-lipoic acid.

Purpose:  To assess the relationship of retinal vessel diameter and diabetic retinopathy (DR) in a subgroup of participants recruited through the Darwin Region Urban Indigenous Diabetes study.Methods:  Participants were examined as part of the Darwin Region Urban Indigenous Diabetes study. All participants with gradable fundus photographs were included in the current analysis. Assessment of retinal vascular diameter, including arteriolar diameter (central retinal arteriolar equivalent) and venular diameter (central retinal venular equivalent), was undertaken using a semi-automated retinal vascular imaging program. DR was graded according to the modified Early Treatment DR Study scale.Results:  A total of 110 participants, 25 men and 85 women, with a mean age of 50.8 years were included in the analysis. The odds ratio for having DR for each standard deviation increase in central retinal venular equivalent was as high as 1.62 (95% confidence intervals 0.94, 2.80); however, this did not reach statistical significance (P = 0.08). Moreover, individuals with severe non-proliferative DR and proliferative DR were found to have narrower arteriolar diameters compared with those with no DR, but this was not statistically significant (−8.1 µm, 95% confidence intervals, −39.3 µm, 23.1 µm; P = 0.612).Conclusion:  Our data indicate a trend for narrower arteriole diameter and wider venular diameter with DR in this high-risk ethnic group, which concurs with overall trends seen in non-indigenous populations.

Purpose:  Retinal vein occlusion (RVO) is an increasing problem leading to visual impairment in Nepal. Our study investigates the demographic characteristics, patterns and risk factors for RVO in this developing Asian country.Methods:  This is a hospital-based case–control study conducted at the Tilganga Institute of Ophthalmology of Nepal during the period of January 2007 to January 2008. All consecutive new cases of RVO diagnosed at the Institute were included. Cases with intraocular inflammation or a prior history of intraocular injections, laser therapy or vitrectomy for RVO were excluded from the study. Age, sex and geographically matched subjects were recruited as a control group from patients who presented for regular eye examinations at the same hospital during the study period.Results:  A total of 218 patients with RVO presented during the study period. The mean age of the patients was 61.1 ± 12.3 years with more men (58.3%) than women. The mean age for control groups was 61.3 ± 13.0 years. Seventy per cent of subjects had branch retinal vein occlusion, whereas central retinal vein occlusion was present in 26.6%. 63.9% of branch retinal vein occlusion was found in the superotemporal branch. Hypermetropia, primary open angle glaucoma, hypertension, mixed diabetes and hypertension, and heart disease were significantly higher in RVO cases as compared with the control group.Conclusion:  The demographic characteristics, patterns and risk factors of RVO in Nepal can help guide interventions against these blinding diseases in similar developing countries.

Background:  Previous reports have emphasized the self-limited nature of idiopathic neuroretinitis. There is less information about a subgroup of patients who suffer recurrent episodes with worse visual outcome. We sought to better characterize the clinical features of recurrent idiopathic neuroretinitis including the effects of immunosuppressive treatment.Methods:  Retrospective chart review of neuroretinitis patients from a single institution from 1983 to 2008. Inclusion criteria included two or more episodes of acute visual loss with disc oedema and macular exudates in a star pattern. Cases due to a specific infectious or inflammatory aetiology were excluded.Results:  Forty-one patients were included with an average follow up of 67 months. Median age at the time of the first episode was 28 years (range 10–54 years). Attacks were bilateral sequential in 34 patients (83%). We documented a total of 147 episodes in 75 eyes with an average of 3.6 attacks per patient. The average interval between attacks was 3 years. Visual field loss had a nerve fibre bundle pattern in most cases. Only 36% of eyes retained 6/12 or better visual acuity and greater than two-thirds of their visual field. Long-term immunosuppressive treatment in 13 patients decreased the attack rate by 72%.Conclusions:  Recurrent idiopathic neuroretinitis typically affects young adults, with no gender preference. Recovery is limited and visual loss is cumulative with repeated attacks, often resulting in severe permanent visual loss. Immunosuppressive treatment appears to lessen the attack frequency.

Background:  To determine whether a significant correlation exists among the changes in the size of the abnormal parafoveal autofluorescence ring, the length of the photoreceptor inner and outer segment (IS/OS) junction, and the visual function in patients with retinitis pigmentosa.Methods:  Retrospective observational case series. A total of 50 eyes of 26 patients with typical retinitis pigmentosa and an autofluorescence ring were examined by optical coherence tomography and microperimetry. During the follow-up period of >2 years, the changes in the diameter and area of the autofluorescence ring, the length of the IS/OS line, the best-corrected visual acuity and mean retinal sensitivity in the central 10° were determined.Results:  The diameter and area of the autofluorescence ring, and the length of the IS/OS line decreased significantly during the follow-up period (all, P 

Purpose:  To describe the 3-year risk of cataract after intravitreal triamcinolone (IVTA) injections for diabetic macular oedema and the outcomes of cataract surgery.Methods:  Prospective data from a randomized clinical trial were analysed. At baseline, 27 phakic eyes with diabetic macular oedema were randomized to receive IVTA and 25 to receive sham injection. After 2 years, initial sham-treated eyes were eligible to receive IVTA as the study became open label for the third year. The cumulative incidence of cataract surgery was the primary outcome of the study. Other outcomes assessed included progression of cataract, best-corrected logarithm of the minimal angle of resolution visual acuity before and after surgery and central macular thickness.Results:  Over the 3 years of the study, 15/27 (56%) phakic eyes in the IVTA treated group underwent cataract surgery as compared with 2/25 (8%) initial sham-treated eyes (P 15 letters. In the IVTA-treated group, 10/15 (67%) eyes that had three or more injections had progression of posterior subcapsular cataract by ≥2 grades as compared with only 2/12 (17%) eyes that had fewer than three injections (P = 0.009).Conclusions:  Over half of the eyes receiving IVTA injections for diabetic macular oedema required cataract surgery within 3 years. In eyes with three or more IVTA injections, two-thirds had progression of posterior subcapsular cataract. Visual outcomes after cataract surgery were generally good, although a small proportion of eyes lost greater than 15 letters over the course of the study.

Background:  To compare the self-reported management of diabetic retinopathy by Australian ophthalmologists with the 1997 National Health and Medical Research Council (NHMRC) guidelines.Methods:  Self-reported cross-sectional survey of patterns of practice. Questionnaires were sent to all Australian ophthalmologists, comprising questions regarding professional details, diabetic retinopathy screening attitudes/practices and specific hypothetical management scenarios. Data were analysed using Chi-squared and adjusted logistic regression.Result:  480 of the 751 (64%) eligible Australian ophthalmologists participated. The majority (80%, n = 376) reported they consistently reviewed patient's glycaemic control, but only 55% and 41% regularly reviewed blood pressure and serum cholesterol control, respectively. Ophthalmologists generally adhered to NHMRC-recommended screening intervals, although only 38% agreed with the guidelines relating to screening of pre-pubertal diabetic patients. Fluorescein angiogram was used more than recommended, especially for mild non-proliferative diabetic retinopathy where 45% of respondents used this investigation. Practice duration >15 years was associated with more regular fluorescein angiogram use (OR = 3.74; 95% CI: 2.53–5.53, P 26% referred to retinal subspecialists for management; 85% of the remaining ophthalmologists performed macular laser first. Respondents with practice duration >15 years were 7.8 times (P = 0.001) more likely to perform cataract surgery first.Conclusion:  Diabetic retinopathy management guidelines were generally well followed by Australian ophthalmologists. However, areas of practice variation existed including frequent use of fluorescein angiogram. Significant proportion of practitioners referred diabetic patients to retinal subspecialists, who were more likely to adhere to guideline recommendations. Ophthalmologists with greater experience (>15 years) were more likely to employ practices differing from NHMRC recommendations.

Background:  Transforming growth factor β (TGF-β) plays an important role in diabetic retinopathy. βIG-H3 is a downstream target molecule of TGF-β that may participate in the pathogenesis of diabetic retinopathy and in particular in the loss of pericytes during early pathological changes.Methods:  We observed bovine retinal pericytes apoptosis and the increased expression of TGF-β and βIG-H3 induced by high concentrations of glucose in the cell culture media. An anti-TGF-β antibody was used to block glucose-induced retinal pericytes apoptosis. Retinal pericytes were also transfected with cDNA encodings either wild-type or mutant βIG-H3 lacking Arg-Gly-Asp (RGD) sequences in order to validate the effects of βIG-H3 and RGD signalling on retinal pericytes apoptosis.Results:  A cell death-detecting enzyme-linked immunosorbent assay revealed that 25 mM glucose significantly increased cell death compared with 5.5 mM glucose after 5 or 7 days of exposure (P 

Objectives:  This study aims to compare retinal vessel anatomy of normal rhesus monkeys and humans and to provide a basis from a structural perspective for the use of rhesus monkey as an experimental model in future studies of retinal vessels.Methods:  The retinas of six normal rhesus monkey eyes and eight human eyecups following corneal transplantation were obtained and stained using adenosine diphosphatase methods. The distributions, orders, layers of the retinal vessels and the perifoveal vascular ring were compared.Results:  With adenosine diphosphatase staining, distinct retinal vessels were fully discernable from the first order surrounding the optic disc to the fifth order. There were no statistically significant differences between rhesus monkeys and humans in the percentages of vessels surrounding the optic disc at the equator and the peripheral region. Vascular networks in both species were arranged in several layers around the optic disc, two anastomotic layers at the equator and one sparse layer peripherally. Capillaries at the macular area were quite dense and an intact perifoveal vascular ring was observed. No differences were observed between rhesus monkeys and humans in the percentage area of the vessels and the area, perimeter and diameter of the perifoveal vascular ring.Conclusions:  The distributions, orders, layers and the perifoveal vascular ring of the retinal vessels of rhesus monkey are quite similar to those of humans. The data suggest that from an anatomical perspective, the rhesus monkey is a good animal model for the study of human retinal vessels, particularly the macular capillaries.

Purpose:  To elucidate the insertion of the levator aponeurosis and Müller's muscle on the upper eyelid of Caucasians through cadaveric study.Methods:  Sagittal full thickness sections of 11 cadaveric upper eyelids in Caucasian (7 right and 4 left; age range, 78–101 years old at death; age average, 87.7 years old) were prepared and stained with Masson's trichrome. The specimens were examined microscopically to discern the configuration of the levator aponeurosis, Müller's muscle and tarsus. Main outcome measures were the position of insertion of the levator aponeurosis and Müller's muscle onto tarsus.Results:  In all 11 specimens, the levator aponeurosis inserted onto the distal tarsal plate, reaching the level of the marginal arterial arcade. The extension of Müller's muscle in 4/11 specimens (36.4%) surpassed the superior margin of the tarsal plates, but did not reach any further down the tarsus than its upper third; in the remaining seven specimens (63.6%), Müller's muscle attached to the superior aspect of the tarsal plate.Conclusions:  This study from Caucasian cadavers suggests that fibres from the levator apponeurosis extends down to the distal portion of upper eyelid tarsus, with majority of Müller's muscle insertion being onto the superior aspect of the tarsal plate.

Conservative management of retinoblastoma has evolved from external beam radiotherapy to systemic chemotherapy by intravenous route and now to localized chemotherapy by intra-arterial route in some cases. With 16-year experience, systemic chemotherapy has been found effective for minimal to moderately advanced retinoblastoma with tumour control of 90% or better, few side effects and even hope for return of some vision. Localized intra-arterial chemotherapy with delivery under fluoroscopy and catheterization of the ophthalmic artery is now undergoing evaluation and appears to provide striking control for retinoblastoma, particularly recurrent tumour seeds following other therapies. The limitations and complications of this approach have yet to be defined. Toxicity of the chemotherapy to the delicate retinal vessels is unknown. Despite its allure, intra-arterial chemotherapy should be used with caution, as in other fields of paediatric oncology it has been found to provide no advantage over intravenous chemotherapy. Time will tell.