BOTULINUM TOXIN IN OPHTHALMOLOGY

Alan B. Scott selected, researched and developed Type A Botulinum toxin for clinical use in ophthalmology. This unique drug has proved invaluable for treatment of a number of conditions which are difficult to treat in ophthalmology and in a variety of other disciplines. The indications, methods and problems of its use are described and the results of treatment of 133 patients are discussed. Up to December 1986 over 13 000 patients have been treated in a multicentre international trial without significant complications.     

Primary tubulointerstitial nephritis and uveitis syndrome

Primary acute tubulointerstitial nephritis and uveitis is an uncommon syndrome involving the kidney and eye. Although rare, to date 28 cases having been reported, it is important to recognise this entity to facilitate appropriate investigation and treatment. We report an unusual case of this syndrome in which the patient suffered a relapse of her nephritis concurrently with the onset of the first episode of uveitis. Both responded to treatment, although the uveitis subsequently recurred.     

Screening for congenital colour vision defects

A prospective comparison between the Ohkuma¹ and Ishihara² pseudoisochromatic (PIC) plates was carried out in a group of 400 patients attending a general ophthalmology practice. The sensitivity of the Ohkuma test was compared to the Ishihara test, and the specificity of both was determined by reference to anomaloscopy as a gold standard.
Both tests correctly identified the same group of 24 patients as having a red/green confusion axis, and the Ohkuma test was equally as sensitive as the Ishihara. The grading plates in both tests are unreliable, but the Ohkuma test is quicker, easier to administer, gives less ambiguous responses and has a clearer cut-off score for abnormality. On the basis of this experience the Ohkuma test is recommended as more appropriate for routine colour vision screening than either the 24 or 38 plate Ishihara tests.     

THE GRANULOMATOUS REACTION IN HERPETIC STROMAL KERATITIS: IMMUNOHISTOLOGICAL AND ULTRASTRUCTURAL FINDINGS

A granulomatous reaction was identified in six corneal buttons obtained from patients with herpetic stromal keratitis. The inflammation, characterized by lymphocytes, plasma cells, macrophages and multinucleate giant cells, was associated with Descemet's membrane in five cases and with a break in Bowman's membrane in one case. The ultrastructural changes were documented by scanning electron microscopy in all cases. Transmission electron microscopy, performed in four cases, failed to disclose the presence of viral inclusions. Immunoperoxidase stains utilizing antibodies to the herpes simplex virus were done on all cases. Positivity (the presence of herpes simplex virus antigen or herpes simplex-like antigen) was detected within epithelium (three cases), within stroma (three cases), and within some inflammatory cells of the granulomatous reaction at Bowman's membrane. Positive staining was not detected in cells of the granulomatous reaction at Descemet's membrane. These results suggest that the reaction at Descemet's membrane, which has been found in a variety of corneal conditions, may be due to a poorly understood alteration in the antigenicity of Descemet's membrane.     

AMBLYOPIA IN THE FOUR TO NINE YEAR AGE GROUP. A FOUR-YEAR SURVEY

A guide to the ophthalmologist in the choice of the older child with amblyopia most likely to respond to active intensive visual stimulation in short bursts is presented. A series of 99 children treated on a CAM vision-stimulator is described. Visual improvement of at least two rows of letters on the Snellen chart was maintained for at least three years after treatment in 62% of these patients aged between five and nine years with visual fixation within 3^° of the fovea. Amblyopia following minor trauma or minor pathology also responded well. Children maintaining the visual improvement were those with esophoria up to 13^°. those with hypermetropia up to 11.0 D and those with astigmatism of 1.5 D. Also responding well were children with anisometropia with up to 3.0 D of either hypermetropia or astigmatism     

DRAINING PUS FROM THE CORNEA

Thirteen patients with varying grades of suppurative keratitis were studied with regard to their response to keratoplasty. In all patients there was a rapid improvement in symptoms and signs. In eight of the 13 there was restoration at least of previous function: one patient lost all vision due to secondary closed-angle glaucoma, because he refused further surgery. Corneal graft opacification occurred in three eyes; one other became partially opaque; whilst in a fourth, the lamellar graft remained clear while the original autograft failed. At last follow-up, all eyes were normotensive and free of symptoms. Keratoplasty should assume an important part of the management of suppurative keratitis, from both theoretical and practical considerations.     

OUTLINE FOR A COMPREHENSIVE CLASSIFICATION OF RETINAL DYSTROPHY AND ITS CONSEQUENCES

Classification of all relevant factors is a prerequisite to the formulation of specific objectives to attain goals of prevention of retinal dystrophy (RD) and effective provision of services. National and international agreement on a classification is sought. This outline stresses the importance of a sound conceptual basis. The root meaning of dystrophy (difficult nourishment), and the concepts given in the World Organization's International Classification of Impairments, Disabilities and Handicaps are emphasized. The proposed classification is designed to be statistical as well as assisting diagnosis and case management. The scheme for RD entities takes into account special features, in contrast to most treatable eye diseases. Genetics is stressed because of the importance of genetic counselling and rapid research advances.
Three appendices illustrate portions of a comprehensive classification already in operation at the Retinal Dystrophy Service of NSW.     

A REVIEW OF LEISKE STYLE SEMI-FLEXIBLE INTRAOCULAR LENSES 1981–1984

A consecutive series of 205 patients had 237 intracapsular cataract extractions performed with the insertion of a semi-flexible intraocular lens in the period 1981–1983. The average follow-up period was 17.8 months; 87.0% of cases obtained a visual acuity of 6/12 or better after operation, compared with 80.6% of cases whose preoperative visual acuity was 6/36 or worse. Twenty-six eyes (11 %) had clinical cystoid macular oedema at some stage after operation, and seven eyes (3%) had persistent cystoid macular oedema at final follow-up. Only one eye had a postoperative retinal detachment. Thirty eyes (14.1%) required treatment for elevated intraocular pressure at some time after operation.