Current diagnosis and treatment of corneal ulcers.

Successful treatment for a corneal ulcer requires proper diagnosis and antibiotic selection. The management should be guided by the severity of the clinical presentation, the ophthalmologist's confidence in making the proper diagnosis of bacterial keratitis, and the level of trust in the antibiotic agents chosen for the causative organisms. Universal standards include pretreatment cultures and dual broad-spectrum fortified antibiotics. Recent changes in practice suggest that empirical monotherapy treatment with a fluoroquinolone antibiotic may be appropriate for certain cases of bacterial keratitis. This article reviews the various diagnostic methods and treatment options currently practiced in the ophthalmic community.     

门诊眼科治疗中严重眼心反射的预防救治探讨

目的探究眼科治疗中严重眼心反射的发生原因，从而进行有效的预防，降低眼科门诊的护理风险；方法对眼科治疗中发生的两例严重眼心反射致心脏骤停患者的救治过程进行回顾性的分析和探讨；结果在治疗中眼局部疼痛和压力的刺激下，患者产生对眼科治疗的紧张和恐惧、坐位治疗的情况下发生了严重的眼心反射；结论为了防止治疗中严重眼心反射的发生，眼科治疗护士治疗前应该做好患者的心理护理，治疗时操作轻柔，尽可能减少对眼的刺激，平卧位治疗以增加患者的心脑供血并执行严密的病情观察，及早发现严重眼心反射的先兆症状，及时有效救治。     

Proper and improper stigmatic optical systems.

Stigmatic optical systems are of two classes: proper and improper stigmatic systems. The purpose of the article is to explore the nature of the two classes. The image may be rotated in the case of proper stigmatic systems and is reflected in a line in the image plane in improper stigmatic systems. Chirality is preserved through proper stigmatic systems but reversed in improper systems. The image also undergoes magnification that is the same in all meridians and, in the case of decentered systems, a transverse translation. Negative magnification implies inversion in a point. The magnification depends on the distance of the object plane from the system, whereas the rotation and reflection do not. The article shows how to identify a system as astigmatic or proper or improper stigmatic from the transference and how to construct the transference of a system that will achieve a particular magnification and rotation or reflection.     

Improving awareness of peripheral visual field using sectorial prism

BACKGROUND: The authors wish to alert optometrists that an increased awareness of peripheral visual field is possible in selected patients with complete homonymous hemianopsia through the use of ground-in sectorial prisms. METHOD: A case series of nine patients prospectively completed activities of daily living (ADL) questionnaires before and after the use of sectorial prism spectacles for the treatment of complete homonymous hemianopsias. RESULTS: Of the nine enrolled patients, seven reported subjective quantitative improvement in ADL scores on questionnaire responses and two patients did not report improvement. CONCLUSION: Patients with homonymous hemianopic visual-field loss may improve their functional vision and activities of daily living through the use of hemianopic prism spectacles. These sectorial prisms--along with proper training--may enhance peripheral awareness through more efficient visual scanning skills.     

眼心反射的再认识

眼心反射（OCR）在眼科手术中的发生率高达90％,而大多数临床医师认为OCR的表现仅仅是心动过缓、心律失常,却忽略了其他系统的表现,如：“眼肺反射”（ORR）、“眼胃反射”,也有人称之为“眼一呕吐反射（OER）”等。OCR并非仅仅为眼科手术的并发症,其在窦房结内镜手术过程中和治疗进行性三叉神经痛的过程中也可发生,但对此现象的描述以临床表现报道居多。目前的研究有助于提高临床医师对OCR的认识,对OCR的眼胚胎、解剖、生理、电生理、发生机制等研究进展进行综述,提出应重新认识OCR的本质特征,认为其名称为眼迷走神经反射（OVR）更为合理。     

Ocular kinematics,vergence, and orbital mechanics

Important aspects of ocular kinematics relate to the geometric configuration of extraocular muscles (EOMs). The orbital layer of each rectus EOM inserts on a connective tissue ring called a pulley that deflects the EOM path. Global layer fibers of each EOM pass through the pulley to insert on the sclera. The orbital layer thus controls linear translation of the pulley, regulating the EOM’s pulling direction, while the global layer rotates the eye. The active pulley hypothesis (APH) states that pulleys are actively positioned to regulate ocular kinematics. The coordinated control postulate of the APH proposes that during conjugate visually guided eye movements, rectus pulleys move the same anteroposterior distance as their insertions, but the inferior oblique pulley moves with vertical gaze by half the amount as the inferior rectus insertion. These motions, observable by magnetic resonance imaging (MRI), shift the pulling directions of these EOMs by half the ocular angle, mechanically implementing a ‘linear oculomotor plant’ appearing mathematically commutative to the brain and consistent with Listing’s Law of ocular torsion. In the non-converged state with the head upright and stationary, rectus pulleys move little transverse to the EOM axes. During convergence and during the static torsional vestibulo-ocular reflex, MRI shows that the rectus pulley array rotates around the line of sight. Oblique EOM orbital layers may implement this shift.     

Low vision management of retinitis pigmentosa.

The low vision treatment of patients with retinitis pigmentosa (RP) has evolved through an understanding of the needs of the patient with extreme peripheral field constriction. Patient care involves four main areas: 1) best refraction and simple magnification, including the possibility of electronic type magnification for reading; 2) control of glare and determination of the proper illumination for reading and mobility; 3) use of field enhancement procedures for sighting and for mobility, including the understanding of cane travel and scanning techniques; 4) additional counseling and ancillary care. Through the methods described, patients who might have been poor prospects for low vision care 15 or 20 years ago, may now be able to function at much higher levels.     

The Heredity and Treatment of Angle-closure Glaucoma Secondary to Iris and Ciliary Body Cysts

Three families with peripheral iris and ciliary body cysts are described. The cysts were multiple in 10 of the 11 affected patients, and they were bilateral in 8 of the 11. Angle closure glaucoma secondary to the cysts was present in 4 of the 11 cases. The management of this glaucoma requires a high index of suspicion, careful gonioscopic evaluation and proper medical and/or surgical treatment. Laser therapy for the angle closure caused by pigmented cysts may be curative. Nonpigmented ciliary body cysts are refractory to argon laser treatment and carry a poor prognosis. The cases described suggest an autosomal dominant hereditary pattern. The importance of examination and follow up of healthy relatives of patients with iris and ciliary body cysts is stressed, as early detection and treatment by laser cystotomy may prevent or cure angle closure glaucoma if the disease is diagnosed prior to the establishment of synechial closure.     

An ophthalmoscope is not a retinoscope. The difference is in the red reflex

Both the retinoscope and the ophthalmoscope allow observation of the fundus and of the "red reflex." Retinoscopy, however, requires an effective light source that may be quickly moved off the visual axis. The ophthalmoscope is unable to provide this type of illumination. On the other hand, the retinoscope is unable to provide sufficient illumination of the retina to make it useful for ophthalmoscopy . Ophthalmoscopy requires the examiner's retina to be conjugate to the retina being examined, whereas the examiner's retina becomes conjugate to the peephole of the retinoscope in retinoscopy. The "red reflex" seen with either the retinoscope or the ophthalmoscope may be clear or blurred. The clear red reflex is more useful for ophthalmoscopy , while the blurred red reflex is primarily used for retinoscopy.     

Eye-position dependence of torsional velocity during interaural translation, horizontal pursuit, and yaw-axis rotation in humans

The translational vestibulo-ocular reflex (tVOR) stabilizes an image on the fovea during linear movements of the head. It has been suggested that the tVOR may share pathways with the pursuit system. We asked whether the tVOR and pursuit would be similar in their behavior relative to Listing's Law. We compared torsional eye velocity as a function of vertical orbital position during interaural translation, pursuit, and yaw-axis rotation. We found that the eye-position-dependence of torsion was similar during translation and pursuit, which differed from that during yaw-axis rotation. These findings further support a close relationship between the mechanisms that generate pursuit and the tVOR.     

Current treatment approaches in diabetic macular edema

PURPOSE: To review current treatment approaches in diabetic macular edema (DME). METHODS: The underlying pathopathology, classifications and diagnostic examination techniques including fluorescein angiography, optical coherence tomography and stereoscopic biomicroscopy. Treatment modalities with focal or grid argon laser photocoagulation, pars plana vitrectomy with and without peeling of the inner limiting membrane (ILM), as well as intravitreal injections using triamcinolone acetonide or novel vascular endothelial growth factor (VEGF) inhibitors are described. RESULTS: DME results from a series of biochemical and cellular changes, causing progressive leakage and exudation. Focal and grid photocoagulation remains the standard care for diabetic maculopathy. However, the availability of new agents raises the possibility of improvements if significant benefits can be validated in randomized clinical trials. Posterior vitreous attachments play a critical role through several mechanical or physiological mechanisms. Vitrectomy without ILM removal seems to be effective in reducing the retinal thickness and improving visual acuity. CONCLUSION: A proper evaluation of the vitreous and retina is fundamental to select the most appropriate treatment approach in DME. While small microaneurysms with focal DME may be treated by conventional focal photocoagulation, diffuse DME which do not respond to grid photocoagulation may benefit from intravitreal injections using triamcinolone acetonide or novel VEGF inhibitors. Eyes with DME and additional vitreous traction may benefit from pars plana vitrectomy without ILM peeling. A combination of laser, pharmacological and surgical treatment modalities may be necessary to maintain central vision in eyes with DME.     

Bilateral central retinal vein occlusion associated with blood hyperviscosity syndrome--case report

The authors report the case of a 16-year-old male patient who presented with blurred vision and bilateral optic disc edema, then developing bilateral central retinal vein occlusion. On laboratory work-up, he was found to have multiple myeloma IgA along with hyperviscosity syndrome, which led to the ophthalmological features. After proper treatment, the patient recovered visual acuity and normalized his eye fundus changes. Bilateral central retinal vein occlusion finding may yield the diagnosis of major systemic diseases. Fundoscopic features may serve as parameters on treatment evaluation.     

Challenges in the diagnosis of microbial keratitis: A detailed review with update and general guidelines

The incidence of microbial keratitis (MK) is variable worldwide with an estimated 1.5–2 million cases of corneal ulcers in developing countries. The complications of MK can be severe and vision threatening. Therefore, proper diagnosis of the causative organism is essential for early successful treatment. Accurate sampling of microbiological specimens in MK is an important step in identifying the infective organism. Corneal scrapping, tear samples and corneal biopsy are examples of specimens obtained for the investigative procedures in MK. Ophthalmologists especially in an emergency room setting should be aware of the proper sampling techniques based on their microbiology-related basic information for each category of MK. This review article briefly describes the clinical presentation and defines in details the best updated diagnostic methods used in different types of MK. It can be used as a guide for ophthalmology trainees and general ophthalmologists who may be handling such cases at initial presentation.     

Pseudomonas keratitis and folliculitis from whirlpool exposure

A local outbreak of pseudomonal folliculitis from whirlpool exposure occurred in 12 persons. A corneal ulcer developed in one patient within 48 hours of using the whirlpool. Treatment with fortified gentamicin resolved the corneal infiltrate and vision returned to normal. A second patient, who had not showered immediately after leaving the whirlpool, was left with areas of skin hyperpigmentation and scarring despite treatment with ultraviolet rays and tetracycline. Although the skin rash may be self-limited, the potential for visual loss from pseudomonal keratitis emphasizes the need for proper disinfection of swimming and whirlpool water.     

手术消毒致对侧眼表损害

目的探讨眼科手术消毒导致对侧眼表损害的原因和防治。方法对21例（21眼）眼科手术0．5％聚维酮碘与75％乙醇消毒致对侧眼表损害进行分析,并给予心理上的疏通和药物治疗。结果消毒液致对侧眼表损害是多因素造成的,经治疗后21例均痊愈。结论眼科手术消毒致对侧眼表损害若能及时发现并正确治疗,可获痊愈;若能采取有效的预防措施,可避免其发生。     

白内障超声乳化联合IOL植入术后角膜水肿的研究进展

角膜水肿是白内障超声乳化联合人工晶状体（IOL）植入术后常见的并发症,是由于各种原因造成的角膜内皮细胞损伤所引起,导致患者视物模糊、视力下降,长期不退可造成角膜失代偿甚至失明。因此,角膜水肿的预防与合理治疗十分重要。根据具体临床状况,可采用药物、接触镜、手术等方法进行治疗。本文就白内障超声乳化联合人工晶状体植入术后角膜水肿的发病机制、致病因素及其防治的研究进展作一综述。     

Fine-needle aspiration biopsy in the diagnosis of orbital tumours

Fine-needle aspiration biopsy was used for the diagnosis of 25 consecutive patients with orbital tumours. CT scan was used to locate the lesion accurately. In two cases of orbital sarcoma and three out of four cases of orbital meningeoma, pre-operative fine-needle biopsy provided the correct diagnosis for proper operative treatment. Post-operative histopathological examination of the tumours proved that the cytological diagnoses had been correct.Two cases were diagnosed as metastatic carcinomas, 4 as malignant lymphomas and 11 as chronic inflammatory lesions. Orbitotomies were performed in 3 cases only, and the cases were managed accordingly with radiation, chemotherapy or corticosteroids. With conservative treatment the results varied from arrest of the condition to total disappearance of the lesion.No complications were encountered as a result of orbital fine-needle biopsies. The procedure is simple, requiring only topical anaesthesia and if proper cytological service is available, invaluable diagnostic information is provided for proper clinical management. It can also be used if recurrence of orbital tumour is suspected and a new mass is seen by CT scan. The method may save the patient from unnecessary exploratory orbital surgery.     

Optometric management of Fuchs's endothelial dystrophy.

Fuchs's endothelial dystrophy interferes with removal of fluid from the cornea by the endothelium. It progresses through stages of corneal guttata, corneal edema, bullous keratopathy, vascularization, and scarring, and complications such as glaucoma or infection. The optometrist can detect this disorder and manage its early stages as well as provide counseling and proper referral. This paper includes a case study and a discussion of the course and treatment of this disease.     

The Radius of Curvature of the Human Foveal Pit

ABSTRACT: The human fovea forms images by reflection (the foveal reflex of ophthalmoscopy) which may be used to determine its curvature “in vivo”. In a population of young people radii of curvature lay between 1.04 and 1.7mm. These values are compatible with histological data on the assumption that the foveal shape approximates a section of a sphere.