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1.
AIMS—To assess the clinical pictures, possible pathogenesis, management, and therapy of patients with infectious scleritis associated with multifocal scleral abscesses following pterygium excision.
METHODS—The records of patients with infectious scleritis after pterygium excision who developed multifocal scleral abscesses presenting from 1988 to the end of 1995 were reviewed. Early culture of abscesses was performed, and topical, systemic antimicrobials, or both were given to all patients. Fourteen eyes were operated on in addition to antimicrobial treatment.
RESULTS—The initial culture reports of scleral ulcers identified Pseudomonas species in 12 of these 18 patients, Aspergillus in one, Mycobacterium fortuitum in one, and mixed organisms in four. Subsequent abscess cultures were taken from 15 of the infected eyes, and revealed the same organism as the initial culture in 12. Associated complications included four serous retinal detachments, three choroidal detachments, two double detachments, five complicated cataracts, and four recurrences of the initial infection. Four eyes required eventual enucleation and 11 eyes regained useful vision.
CONCLUSIONS—With subsequent abscess cultures proving to be the same organism as found in the initial ulcer, the abscess formation appears to represent intrascleral dissemination. Early diagnosis and appropriate, prolonged topical plus systemic antimicrobial treatment are essential to halt the progression of such severe infections.

Keywords: infectious scleritis; scleral abscess; pterygium excision  相似文献   

2.
AIMS—Intractable glaucoma is glaucoma resistant to medical therapy and conventional surgical procedures. In this study, a planned surgical technique is discussed for controlling the increased intraocular pressure in selected cases with intractable glaucoma.
METHODS—Total pars plana vitrectomy with pars plana tube implantation was performed in 17 eyes of 17 cases with intractable glaucoma. Patients with neovascular glaucoma were not included in this study. The mean age of these patients (seven men, 10 women) was 44.6 (SD 22.1) years and mean follow up period was 30.3 (15.5) months (range 4-71). Drainage implants with a disc were used in 16 cases, whereas, a tube with scleral buckle (Schocket surgery) was preferred in one case. An intraocular pressure below or equal to 20 mm Hg without any adjunctive medication or with only one type of antiglaucomatous drop was considered as an adequate operative outcome.
RESULTS—16 out of 17 eyes maintained adequate pressure control. Only three out of these 16 eyes required prophylactic antiglaucomatous medications. One patient underwent reoperation for pressure control. The most severe complications observed postoperatively were intravitreal haemorrhage (one case), choroidal detachment (one case), implant failure (one case), total retinal detachment (two cases), and corneal endothelial decompensation (five cases).
CONCLUSION—Pars plana placement of drainage tube following pars plana vitrectomy should be considered as an alternative method for controlling increased intraocular pressures in selected patients with intractable glaucoma.

Keywords: glaucoma; pars plana vitrectomy; pars plana tube implantation  相似文献   

3.
AIM—To evaluate histomorphometrically the optic nerve head in highly myopic eyes with absolute secondary angle closure glaucoma.
METHODS—Optic disc sections of 16 highly myopic eyes with an axial length of more than 26 mm and of 19 eyes with an axial length of less than 26 mm were histomorphometrically evaluated. All eyes had been enucleated due to painful absolute secondary angle closure glaucoma.
RESULTS—In the highly myopic eyes compared with the non-highly myopic eyes, mean optic disc diameter was significantly larger (mean 2.33 (SD 0.55) mm versus 1.77 (0.50) mm; p=0.01), and the optic cup was significantly shallower (optic cup depth 0.34 (0.29) mm versus 0.63 (0.23) mm; p=0.03). The peripapillary scleral ring was significantly broader (0.58 (0.65) mm versus 0.08 (0.06) mm; p=0.001), and the β zone (0.83 (0.74) mm versus 0.28 (0.25) mm; p=0.006) of the parapapillary chorioretinal atrophy was significantly larger in the highly myopic eyes.
CONCLUSIONS—The results of the present study agree with biomorphometric data of the optic nerve head in highly myopic eyes with glaucoma. In the highly myopic group, a markedly enlarged peripapillary scleral ring characterised by absence of Bruch's membrane and choriocapillaris contributes in addition to α and β zone to the parapapillary atrophy.

Keywords: optic disc; histomorphometry; myopia; angle closure glaucoma  相似文献   

4.
Retinal detachment following excimer laser   总被引:3,自引:0,他引:3       下载免费PDF全文
AIMS—To report the clinical presentation, surgical management, and outcome of retinal detachment following excimer laser.
METHODS—Retrospective analysis of retinal detachments observed in 11 eyes of 10 myopic patients who had previously undergone photorefractive keratectomy (PRK) or phototherapeutic keratectomy (PTK) by excimer laser.
RESULTS—Symptoms of visual loss in two eyes were initially attributed to corneal haze. In 10 of 11 eyes visualisation of the retinal detachment and causative break was possible despite mild corneal haze and optical aberrations caused by the refractive laser procedure. Retinal reattachment was achieved in all 11 eyes though one eye required four surgical interventions.
CONCLUSION—This is the first published report to describe an association between retinal detachment and previous excimer laser treatment. The association would appear to reflect the predisposition of myopes to retinal detachment. Clinicians should be aware of potential retinal pathology in patients undergoing PRK.

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5.
AIMS—The effect of transpupillary thermotherapy (TTT) on human choroidal melanomas was investigated by means of histopathology.
METHODS—Before enucleation TTT was performed in 11 eyes with a xenon arc photocoagulator with a red filter or a diode laser at 810 nm. The exposure time was 1 minute; the estimated temperature at the top of the tumour was about 65°C.
RESULTS—Seven of 11 tumours developed necrosis to a maximum depth of 3.9 mm with a sharp demarcation between the necrotic and the viable part of the tumour. The depth correlated with penetration of heat into the tumour. Scattered small haemorrhages in the transitional zone between the necrotic and the viable part of the tumour were observed in three eyes but large haemorrhages were absent. Ocular media were not affected owing to the low rate of absorption of radiation at 810 nm. TTT did not cause significant scleral damage. Intrascleral tumour cells with a viable appearance were observed in one eye, where the tumour was almost totally necrotic.
CONCLUSION—Results show that TTT has potential as a conservative therapeutic treatment for choroidal melanomas.

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6.
AIMS/BACKGROUND—To determine the epidemiological characteristics and risk factors predisposing to corneal ulceration in Madurai, south India, and to identify the specific pathogenic organisms responsible for infection.
METHODS—All patients with suspected infectious central corneal ulceration presenting to the ocular microbiology and cornea service at Aravind Eye Hospital, Madurai, from 1 January to 31 March 1994 were evaluated. Sociodemographic data and information pertaining to risk factors were recorded, all patients were examined, and corneal cultures and scrapings were performed.
RESULTS—In the 3 month period 434 patients with central corneal ulceration were evaluated. A history of previous corneal injury was present in 284 patients (65.4%). Cornea cultures were positive in 297 patients (68.4%). Of those individuals with positive cultures 140 (47.1%) had pure bacterial infections, 139 (46.8%) had pure fungal infections, 15 (5.1%) had mixed bacteria and fungi, and three (1.0%) grew pure cultures of Acanthamoeba. The most common bacterial pathogen isolated was Streptococcus pneumoniae, representing 44.3% of all positive bacterial cultures, followed by Pseudomonas spp (14.4%). The most common fungal pathogen isolated was Fusarium spp, representing 47.1% of all positive fungal cultures, followed by Aspergillus spp (16.1%).
CONCLUSIONS—Central corneal ulceration is a common problem in south India and most often occurs after a superficial corneal injury with organic material. Bacterial and fungal infections occur in equal numbers with Streptococcus pneumoniae accounting for the majority of bacterial ulcers and Fusarium spp responsible for most of the fungal infections. These findings have important public health implications for the treatment and prevention of corneal ulceration in the developing world.

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7.
AIMS—Visual outcome of 66 eyes in 37 patients who had undergone treatment with either cryotherapy or diode laser for threshold retinopathy of prematurity was assessed.
METHODS—17 patients, representing 30 eyes treated with cryotherapy, were examined at between 56 and 98 months corrected age (median 68 months). 20 patients representing 36 eyes treated with diode laser, were examined at between 30 and 66 months corrected age (median 51 months). Structural outcome was categorised as: optimal—flat posterior pole; suboptimal—macular ectopia, optic nerve hypoplasia, retinal fold involving the macula, and retinal detachment involving the macula.
RESULTS—Optimal structural outcome was, in the absence of amblyopia, associated with optimal visual acuity (of 6/12 or better) in all cases, with most eyes achieving a visual acuity of 6/9 or 6/6. Suboptimal structural outcome was invariably associated with suboptimal visual acuity. Amblyopia was present in eight out of 20 cryotherapy treated eyes and in five out of 26 laser treated eyes with an optimal structural outcome. Refractive errors were significantly less in laser treated eyes as was the incidence of anisometropic amblyopia.
CONCLUSION—Eyes treated with either cryotherapy or diode laser for threshold retinopathy of prematurity with optimal structural outcome are associated with development of optimal visual acuity—that is, 6/12 or better. Treatment with either cryotherapy or laser does not in itself reduce the visual potential of these eyes.

Keywords: retinopathy of prematurity; cryotherapy; laser; visual acuity  相似文献   

8.
AIMS—To determine the efficacy of probing in the initial treatment of epiphora and the symptom free period in adults with blocked nasolacrimal ducts.
METHODS—The results of probing in 85 eyes with epiphora due to nasolacrimal duct obstruction were studied retrospectively after a mean follow up of 7.4 months (SD 11.6) by a questionnaire and interview survey of patients.
RESULTS—35% of the eyes had an outcome of no watering after probing, 17% mild watering, 35% moderate watering, and 11% severe watering. The patients' satisfaction (watering subjectively improved) after undergoing this procedure was 82%, which is higher than previously reported. The mean symptom free period in eyes with no watering was 11.25 months, in eyes with mild watering 8.20 months, in eyes with moderate watering 5.35 months, and in eyes with severe watering 0.95 months. There was a significant difference (p=0.001) in the symptom free period between the no watering and severe watering groups.
CONCLUSIONS—Probing in adults with confirmed nasolacrimal duct obstruction can be recommended as an initial treatment procedure because of its relatively good efficacy and high patient satisfaction without compromising subsequent surgical treatment if unsuccessful.

Keywords: epiphora; nasolacrimal ducts; probing  相似文献   

9.
Prevalence of blindness and cataract surgery in Nepal   总被引:17,自引:3,他引:14       下载免费PDF全文
BACKGROUND—A national eye care programme was launched in Nepal in the early 1980s. The impact of this programme on blindness and cataract surgery prevalence was evaluated in two geographic zones.
METHODS—People aged 45 years and older were sampled using a stratified cluster design. Within randomly selected clusters, door to door enumeration was followed by visual acuity measurement and eye examinations at conveniently located sites. The full survey was preceded by a pilot study where operational methods were refined and quality assurance measures carried out.
RESULTS—Of the 5112 enumerated individuals 90% were examined. Blindness, defined as presenting visual acuity less than 6/60 in both eyes, was found in 5.3% (95% CI 3.6, 6.8) of individuals examined, with cataract being the principal cause in at least one eye in 78% of cases. Considering both cataract operated and unoperated cataract blind cases, surgical coverage was approximately 42%.
CONCLUSION—The findings suggest that blindness prevalence may have decreased slightly from that estimated in a 1981 national survey, both overall and cataract related. Similarly, cataract surgical coverage may have increased somewhat. None of these changes, however, are at statistically significant levels. Accordingly, the blindness problem remains challengingly high.

Keywords: blindness prevalence, cataract blindness, aphakia/pseudophakia  相似文献   

10.
AIMS—To assess retrospectively the prognosis and complications of corneal grafting for congenital opacities.
METHODS—Fifty eight eyes of infants and young children with congenital corneal opacities were studied retrospectively. Preoperative diagnoses included sclerocornea (27 eyes), Peters' anomaly (17 eyes), partial sclerocornea (12 eyes), and congenital glaucoma (two eyes). Penetrating keratoplasty was performed between 5 days and 65 months of age with a mean follow up of 40 (SD 29) months.
RESULTS—The overall success (including regrafts) was 70% in eyes with sclerocornea, 83% for partial sclerocornea, and 100% for Peters' anomaly. However, 23 eyes had to be regrafted between 2 weeks and 110 months postoperatively. The probability of maintaining a clear graft, calculated by survival analysis, was 75% (SE 6%) at 1 year and 58% (7%) at 2 years for the entire group. Complications included cataract development (12 eyes), secondary glaucoma (14 eyes), epithelial defects (six eyes), band keratopathy (five eyes), retinal detachment (three eyes), wound leakage (two eyes), retrocorneal membrane (one eye), and microbial keratitis (two eyes).
CONCLUSIONS—It is concluded that corneal grafting for congenital opacities in infants has an excellent potential for long term survival and should be performed as early as possible for unilateral as well as bilateral involvement. The postoperative course is complex and often requires regrafting.

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