Ptosis evaluation and management in the 21st century

Determining the etiology and appropriate management of ptosis requires a directed evaluation seeking specific signs and symptoms. The clinical significance of such concomitant findings as motility deficits, pupillary abnormalities, levator function abnormalities, ocular manifestations, and associated systemic symptoms are discussed. Management options for correction of specific types of ptosis are reviewed. The clinical application of new technologies, such as the CO2 laser, or molecular biology, such as muscle cell transplantation or gene mapping, open exciting possibilities for future novel therapeutic alternatives. With an emphasis on newer and better, the fundamental question of indications and outcomes will remain relevant.     

Imaging in the 21st century

Methods which are likely to become increasingly common in the next century for producing images of the eye and related structures are briefly reviewed. Although techniques based on reflected visible light will continue to be of importance, improved versions of methods based on other physical principles will come into increasingly widespread use. Digital image recording will probably play a dominant role and it is concluded that a key feature that will be common to almost all the methods will be their capacity to provide quantitative data on the state of the eye.     

Childhood glaucoma surgery in the 21st Century

Most children with glaucoma will require surgery in their lifetime, often in their childhood years. The surgical management of childhood glaucoma is however challenging, largely because of its greater potential for failure and complications as compared with surgery in adults. The available surgical repertoire for childhood glaucoma has remained relatively unchanged for many years with most progress owing to modifications to existing surgery. Although the surgical approach to childhood glaucoma varies around the world, angle surgery remains the preferred initial surgery for primary congenital glaucoma and a major advance has been the concept of incising the whole of the angle (circumferential trabeculotomy). Simple modifications to the trabeculectomy technique have been shown to considerably minimise complications. Glaucoma drainage devices maintain a vital role for certain types of glaucoma including those refractory to other surgery. Cyclodestruction continues to have a role mainly for patients following failed drainage/filtering surgery. Although the prognosis for childhood glaucoma has improved significantly since the introduction of angle surgery, there is still considerable progress to be made to ensure a sighted lifetime for children with glaucoma all over the world. Collaborative approaches to researching and delivering this care are required, and this paper highlights the need for more high-quality prospective surgical trials in the management of the childhood glaucoma.     

Cataract treatment in the beginning of the 21st century

PURPOSE: To describe the principles upon which present day cataract treatment success resides. DESIGN: Literature review and collective experience of the authors. RESULTS: Surgical removal remains the standard treatment for cataract now and in the foreseeable future. Ultrasound cataract removal with a foldable "in-the-bag" intraocular lens with a truncated edge treated for dysphotopsia best correlates with core treatment principles, as we now understand them. Improving refractive results is an important trend. The worldwide burden of this problem is immense. CONCLUSIONS: While results for treatment of cataracts are excellent today, improvements in safety and refraction precision are needed. Other approaches are desperately needed to stem the worldwide tide of cataract related ocular dysfunction.