Complication of Argon laser peripheral iridoplasty
Urrets‐Zavalia described a syndrome of a fixed dilated pupil (iris atrophy) and secondary glaucoma following penetrating keratoplasty in patients with keratoconus. He associated these cases with post operative mydriatic treatment. Uribe, however, reported a similar post operative mydriasis following corneal transplantation for keratoconus in which no mydriatic agents were used post operatively. Ritch and coworkers report eight patients who developed mydriatic pupils following argon laser keratoplasty for the treatment of narrow anterior chamber angles. Slow recovery of papillary function was observed in these patients.
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Can optometrists identify and manage patients in the emergency department?
In many countries a shortage of ophthalmologists creates a man power issue in delivering quality eye care. Partnership with optometry seems a logical way to solve this problem. Hau and coworkers describe a study performed in an emergency department of a busy eye hospital. In this study there was good agreement in both the diagnosis and management plan between optometrists and ophthalmologists in this setting. The authors conclude that optometrists can potentially work safely in an emergency department of an eye hospital.
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Value of retinal vein pulsation in predicting increased optic disc excavation
Retinal vein pulsation is frequently absent in glaucoma patients. However, it can be induced by applying a graded ophthalmodynamometric force (ODF) to the eye. Balaratnasingam and coworkers studied 75 glaucoma patients and suspects. They found that ODF at the initial visit was strongly predictive of increasing optic disc excavation. The authors conclude that ODF measurements may have predictive value in assessing the likelihood of glaucoma progression.
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Pre‐treatment of diabetic macular oedema with posterior subtenons triamcinolone
Macular oedema continues to be the most common cause of visual loss in diabetic patients. Various treatments for macular oedema in diabetes have been suggested. Currently both laser grid photocoagulation and subtenons triamcinolone injections have been used. Shimura and coworkers studied a group of diabetic patients who were treated with subtenons injection of trimacinolone prior to laser grid photocoagulation. They suggest that pre‐treatment with triamcinolone allows the patient to be treated with a lower intensity of laser spots and also prevents the decrease in central visual field sensitivity.
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Treating bacterial conjunctivitis
A number of different antibiotics are available for treating bacterial conjunctivitis. Cochereau and coworkers performed a multi‐center randomised investigator‐masked study of over 1000 children and adults with purulent bacteria conjunctivitis. They compared the efficacy of a azithromycin 1.5% twice daily for 3 days vs tobramycin 0.3% one drop every 2 hours for 2 days then four times daily for 5 days. They conclude from their study that azithromycin was as effective and safe as tobramycin. Moreover, they concluded that more patients in the azithromycin group had an early clinical cure than the tobramycin group. Because of azithromycin's bid dosing regiment for just three days the authors suggest that this has a distinct advantage over the more frequent dosing and longer duration of dose delivery required with tobramycin.
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Complications of local anesthesia for cataract surgery
In recent years anaesthesia for cataract surgery has changed dramatically. Eke and Thompson performed a prospective observational study of routine practice in the UK from 2002–2003 to study the complications of anaesthesia in cataract surgery. In their study the authors found a lower rate of serious complications with subtenons, topical and topical‐intracameral anaesthesia as compared to retrobulbar and peribulbar techniques.
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Visual field representation in human albinism
The optic nerve chiasmal anomaly in albinism is well documented. It consists of excessive crossing of fibres and decreased numbers of uncrossed fibres. The anomalous projection of temporal retina should produce visual field deficits. In some animal models of albinism this is the case. Nevertheless, Hoffman and coworkers studied 15 patients with albinism both electrophysiologically and with perimetry. They found no indication of a selective visual field defect induced by the projection anomaly in the chiasm. Some mechanism of cortical self organisation apparently compensates for the abnormal representation provided the anomalous chiasmal crossing.
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