Prophylactic perifoveal laser treatment of soft drusen

Purpose: To assess the efficacy and safety of perifoveal laser to cause drusen to resorb, and establish a treatment protocol.
Methods: Treatment technique was determined by the outcome in one patient with 15-year follow-up. In an uncontrolled series a perifoveal ring of gentle laser was applied to 30 eyes of 28 patients, 18 with bilateral drusen and 10 with exudative disease in the fellow eye. Comparison was made between treated and untreated eyes in 14 patients with bilateral drusen. Mean follow-up was 16.8 months (range, three to 42 months).
Results: Soft drusen resorbed in all treated eyes in the vicinity of laser and within the fovea. Large soft confluent drusen (>500 μm) responded most rapidly. Visual acuity improved one or more lines in 12 (40%) treated eyes, was unchanged in 16 (53%) and deteriorated in two (7%). In 14 patients with bilateral drusen in whom only one eye was treated, VA remained unchanged in 10 eyes and improved in four treated eyes while none of the untreated eyes improved (P= 0.03, χ²) and decreased in four eyes. Atrophic expansion of laser burns was minimal. CNV developed in two of 30 eyes (7%).
Conclusion: Perifoveal laser treatment appears to expedite the regression of soft drusen within the fovea. The risks of complications may be reduced by treating eyes early, before pigment changes develop and by applying a minimum number of burns at a distance greater than 750 μ m from the foveal centre. Treatment should currently be administered only in the context of a prospective clinical trial, which is required to assess whether this treatment results in lowered risk of visual loss from CNV or geographic atrophy.     

Fusidic acid prophylaxis before cataract surgery: patient self-administration

In a placebo-controlled, randomised, double-blind clinical trial, the authors evaluated the efficacy of patient-administered 1% fusidic acid viscous eye drops in clearing the commonest organisms causing pseudophakic endophthalmitis ( Staphylococcus epidermidis and aureus ) from the lids and conjunctivae of 79 patients before cataract surgery. The treatment group self-administered fusidic acid viscous eye drops four times daily for seven days before surgery; the placebo group received inert ophthalmic drops. Fellow eyes of both groups remained untreated as a natural control. Lower fornix and lid margin cultures were taken from both eyes before and after treatment. Before treatment, there was no statistical difference in organism counts between the groups. After treatment, eyes receiving fusidic acid were more likely to be free of clinically relevant Staphylococcus spp. than all pre-treatment eyes (for lids, P ≤ 0.001; conjunctivae, P = 0.02). A highly significant ( P <0.001) number of lid margins were rendered 'clinically clean' (i.e., 0–49 organisms/swab) by fusidic acid when compared with untreated eyes. Treatment also effectively ( P <0.05) reduced the numbers of bacteria isolated from conjunctivae. This study indicates that there is a highly significant reduction of Staphylococcus spp. (P≤0.001), non- Staphylococcus spp. (P≤ 0.001) and attainment of sterile eyes ( P≤ 0.001) at operation gained by patient self-administration of 1 % fusidic acid four times daily for seven days before surgery.     

Albipunctatus retinopathy in inherited interstitial nephritis

We describe here a patient with familial interstitial nephritis and albipunctatus retinopathy. Albipunctatus is often seen in patients with Alport syndrome, which is an X-linked disorder characterised in affected males by renal failure by the age of 25, high-tone sensorineural deafness, anterior lenti-conus and albipunctatus. The diagnosis of Alport syndrome depends on the electron microscopic appearance of a trabeculated glomerular basement membrane (GBM); and mutations have been demonstrated in the gene for the alpha 5 chain of type IV collagen. In the familial interstitial nephritis described here, the inheritance was autosomal dominant, renal failure developed in middle age, and there was no associated hearing loss or anterior lenticonus.
The finding of albipunctatus retinopathy in this patient suggests that the genetic mutation responsible involves a protein common to both retinal and interstitial basement membranes. In addition, we conclude that the demonstration of albipunctatus in an individual with familial nephritis does not necessarily indicate that the underlying disease is Alport syndrome.     

Thirty years of retinoblastoma (1960–89): changing patterns of incidence

Summary. This study of a 30-year population-based dataset investigates further an earlier observation that the incidence of sporadic bilateral retinoblastoma appeared to be increasing in recent years in the West Midlands Health Authority Region (WMHAR).
Stringent measures were applied to ensure complete ascertainment of all cases of retinoblastoma in children in the region, resulting in a total of 117 cases diagnosed during the period 1960–89 in the WMHAR. Hospital case notes were abstracted and follow-up data obtained. Incidence rates were calculated.
The overall incidence remained constant over the 30-year period, but that of sporadic bilateral tumours increased, with a corresponding decline in familial cases. There was a statistically significant excess seen in Asian children.     

糖尿病患者白内障超声乳化人工晶状体植入术的临床观察

目的 :观察糖尿病患者白内障超声乳化吸出 (PHACO)联合人工晶状体植入术和现代囊外摘除术 (ECCE)联合人工晶状体植入术对术后视力和术后反应的影响。方法 :糖尿病患者白内障 85例 (10 1只眼 ) ,其中PHACO组 3 7例 45眼 (A组 ) ,ECCE组 48例 5 6眼 (B组 ) ,对两组的术后视力和术后反应进行比较分析。结果 :1 术后视力 :术后反应消失后 ,视力≥ 0 5者 ,A组 40眼 (88 89% ) ,B组 3 8眼 (67 86% ) ,差异有显著性意义 (P <0 0 5 )。 2 术后反应 :房闪 (+ + )以上、瞳孔区纤维素样渗出或晶状体表面弥漫色素沉着 ,A组 5眼 (12 5 0 % ) ,B组 17眼(3 0 3 6% ) ,差异有显著性意义 (P <0 0 5 )。结论 :糖尿病患者白内障行PHACO手术比ECCE手术视力恢复好、术后反应小。     

异体巩膜条睑板延长术治疗复发性瘢痕性睑内翻

目的：探讨异体巩膜条睑板延长术治疗复发性瘢痕性上睑内翻的手术疗效。方法：对27例(36只眼)复发性瘢痕性上睑内翻患者采用从睑板沟切断睑板的方法，在睑板铁损区嵌入异体巩膜条，延长睑板，松解瘢痕。结果：28只眼内翻矫正，8只眼复发，3只眼再次手术后矫正。结论：采用异体巩膜条睑板延长术治疗复发性瘢痕性眼睑内翻，手术方法简便，损伤小，可反复操作，疗效满意，异体巩膜易于获得及保存，是一种值得推广的手术方法。     

大鼠眼铁质沉着症早期光感受器的细胞凋亡

目的 验证光感受器的细胞凋亡是否为实验性大鼠眼铁质沉着症视网膜损伤的机制之一。方法 5mg的消毒纯铁（99．98％）颗粒经显微手术植入32只实验组大鼠眼的玻璃体腔，体积相近的普通光学玻璃颗粒植入10只对照组大鼠眼的玻璃体腔作对照。术后1到15d的不同时间摘除眼球。用凋亡原位染色法（TdT-mediated,dUTP-biotin nick-end labeling,TUNEL)观察受损视网膜神经元细胞核的改变；电泳观察视网膜细胞核DNA核小体间降解所产生的阶梯状条带。结果 实验组大鼠术后2d起在视网膜外颗粒层观察到TUNEL阳性细胞核，其数目随观察时间延长而增加，术后15d，外颗粒层仅有散在的正常细胞核残留；视网膜DNA琼脂凝胶电泳观察到典型的阶梯条带。对照组大鼠则未见上述改变。结论 光感受器细胞凋亡是实验性大鼠眼铁质沉着症早期视网膜损伤的机制之一。     

Pterygium: Intensity and Frequency of Activity

A review of the literature on prevalence studies, a specific study in 1965–1966 on veterans seen in Sydney, a review of clinical records dating back to 1939 and a follow-up study from 1962 to 1975 on the rate of pterygium removal operations performed in the Repatriation General Hospital, Sydney, against the background of the veteran population of N.S.W. showed that the highest incidence of pterygium was in early middle-age and the lowest incidence in late middle-age (excluding childhood when pterygium was rare). Pterygium activity has been classified according to its frequency and intensity. Frequency of activity is a new concept and means the percentage of eyes (not subjects) affected with active pterygia in a given population. This includes newly developed pterygia and pterygia which had developed in an earlier age group but which were still active. Frequency of activity was found to be low in youth, very high in early middle-age, very low in late middle-age and high in senility. Intensity of activity, on the other hand, was found to be high in youth and low in middle-age and thereafter.     

Parry-Romberg syndrome associated with Adie’s pupil and radiologic findings

We describe Adie’s pupil and radiologic changes related to Parry-Romberg syndrome in a child who presented with facial hemiatrophy with no neurologic deficit. We suggest that cerebral lesions in Parry-Romberg syndrome without neurologic symptoms must be carefully investigated.