British Journal of Ophthalmology

Brown, N A; Sparrow, J M

doi: 10.1136/bjo.72.7.487pmid: 3046654

A study is reported on cataract surgery, with intraocular lens implant, with measurement of the preoperative astigmatism and of the postoperative astigmatism over 28 weeks. Nine interrupted 10/0 nylon sutures are used to close a limbal section. Preoperative astigmatism is compensated for in the method of suturing by the placement of additional sutures. Postoperatively sutures are cut in line with the plus cylinder axis in eyes showing excessive astigmatism with the rule. Final postoperative astigmatism is controlled within 2.25 D cyl. 68% of cases lie within 1.0 D cyl with the rule to 1.0 D cyl against the rule. The average case in which sutures are not cut is one having 1.51 D cyl with the rule at one week postoperatively, declining to zero at approximately 12 weeks, and having a final value of 0.17 D cyl against the rule. No significant change in cylinder is seen after 10 weeks. The final postoperative astigmatism is only weakly correlated with the preoperative astigmatism, showing that the surgical method is effective. The spherical equivalent error is shown to shift in the direction of myopia in the postoperative period.

Adams, K S; Abramson, D H; Ellsworth, R M; Haik, B G; Bedford, M; Packer, S; Seddon, J; Albert, D; Polivogianis, L

doi: 10.1136/bjo.72.7.494pmid: 3415941

Two hundred and twenty-three patients treated by cobalt plaque for uveal melanoma were compared with 416 patients treated by enucleation for uveal melanoma in terms of patient survival. The median follow-up time for the patients treated by cobalt plaque was 4.3 years. Kaplan-Meier survival curves were calculated up to five years following treatment based on time to tumour-related deaths. Cox's proportional hazards multivariate analysis was performed to determine which variables were related to melanoma-related deaths while controlling for age, size, and location of the tumours. Statistically significant predictive factors were location of tumour and largest tumour dimension. There was not a statistically significant difference in survival between patients treated by cobalt plaque and those treated by enucleation.

Hitchins, C A; Grierson, I

doi: 10.1136/bjo.72.7.498pmid: 3415942

The intravitreal injection of autologous cultured fibroblasts has been used by many groups to study proliferative vitreoretinopathy. Ninety-five New Zealand white rabbits were used to study the pathological effects on the ocular tissues following such an injection over various time periods up to six months. The ocular tissues were studied by light microscopy, electron microscopy, immunohistochemistry, and autoradiography. The cells which contributed to the inflammatory response (initially neutrophils, then later macrophages and lymphocytes) were found to gain entry into the vitreous via the pars plana, pars plicata, and the vessels associated with the optic nerve head. In the experimental eyes the detached retinae had a reduced ability to incorporate 3H proline. Both epiretinal and subretinal membranes were found on the retinal surfaces. The majority of the glial cells within the membranes were identified as Müller cells. The retinal pigment epithelium beneath the detached retinae incorporated 3H thymidine and detached into the subretinal space. Clear evidence was obtained of both epithelial cell migration through the retina and involvement within epiretinal membranes.

Cole, M D; Smerdon, D

doi: 10.1136/bjo.72.7.511pmid: 3261991

We have reviewed 19 patients with dart-induced perforating eye injuries. Fourteen of the injuries were in childhood. A poor visual outcome was common, not only from the injury directly but also from irreversible amblyopia or endophthalmitis. Preventive measures are considered.

Martyn, C N; Kean, D

doi: 10.1136/bjo.72.7.515pmid: 3415943

Nuclear magnetic resonance (NMR) imaging has been used to visualise a localised area of demyelination in the dorsal pons of a patient who presented with an unusual disorder of eye movements, namely, the one-and-a-half syndrome. Judged clinically the patient made a nearly complete recovery, but little change was apparent in the NMR image six months later.

Lepage, P; Bogaerts, J; Kestelyn, P; Meheus, A

doi: 10.1136/bjo.72.7.518pmid: 3415944

Nine neonates with culture proved gonococcal ophthalmia neonatorum were treated with a single intramuscular injection of 100 mg/kg of cefotaxime without topical antibiotic therapy. Five of the nine strains were penicillinase-producing Neisseria gonorrhoeae. All nine cases were clinically and microbiologically cured, and no side effects were observed.

Daikos, G L; Pulido, J; Kathpalia, S B; Jackson, G G

doi: 10.1136/bjo.72.7.521pmid: 2843218

The efficacy and toxicity of ganciclovir given by intravenous or intravenous plus intravitreal injection were studied in nine patients with cytomegalovirus (CMV) retinitis; seven with AIDS and two with drug induced immunodeficiency. Five patients had retinitis with macular involvement in six sighted eyes; six patients had only peripheral retinitis in seven eyes. In two patients (two eyes) with macular involvement intravenous plus intravitreal injection of ganciclovir preserved sight; intravenous infusion alone did not in four eyes of three other patients. In seven eyes (six patients) with peripheral retinitis vision was retained regardless of the route of ganciclovir treatment. Following intravenous ganciclovir drug levels in the vitreous fluid were 1.4-2.2 mmol/l, that is, 44 and 65% of the concomitant serum concentration. Clinically and at necropsy three eyes showed no evidence of toxicity from intravitreal injection of ganciclovir. All of five patients with AIDS who received intravenous ganciclovir for more than one week developed leucopenia. CMV retinitis of the macula may be benefited with minimal drug toxicity by intravitreal injection of ganciclovir. Treatment of peripheral CMV retinitis in patients with AIDS may be optional.

Orellana, J; Teich, S A; Winterkorn, J S; Mathur-Wagh, U; Handwerger, S; Schlamm, H; Malamud, S C; Yancovitz, S R; Cederberg, D M; Mildvan, D S

doi: 10.1136/bjo.72.7.525pmid: 2843219

Claoué, C M; Ménage, M J; Easty, D L

doi: 10.1136/bjo.72.7.530pmid: 3046655

We report a prevalence study of the best visual acuity in the affected eye of 100 selected patients with herpetic keratitis seen during a two-year period. Sixty-two patients retained an acuity of 6/9 or better without requiring penetrating keratoplasty (PK). The prevalence of reduced visual acuity severe enough to warrant PK was 33%. Patients requiring PK for whom full clinical records were available suffered a mean of 6.8 episodes of keratitis. In this group of patients the vision of 18 fell from 6/6 to 6/60 over a mean period of 8.5 years. Once visual acuity was permanently reduced to 6/12, 78% of patients proceeded to lose vision to 6/60. Unilateral visual impairment occurs in at least a third of patients with severe herpetic keratitis. Once vision falls permanently to 6/12, the long-term prognosis for vision appears to be poor.

Mitchell, K W; Wood, C M; Howe, J W

doi: 10.1136/bjo.72.7.534pmid: 3415945

Pattern reversal visual evoked potentials (VEPs) have been elicited in 16 female hyperthyroid patients before and after treatment and compared with those from a similar group of age and sex matched control subjects. No effect on latency was seen, and although larger amplitude values were noted in the thyrotoxic group these too were not significant. We would conclude that hyperthyroidism per se has little effect on the pattern reversal VEP, and any observed effect on these potentials is probably due to other factors.