Contact lens wear and IOL power calculation before cataract surgery: a cautionary tale.

Purpose: To present a case of erroneous corneal measurements, which led to inaccurate predicted intraocular lens (IOL) power.

Methods: A 60-year-old woman underwent preoperative assessment for cataract surgery. The predicted IOL power was 19.

Is visual outcome compromised when next day review is omitted after phacoemulsification surgery? A randomised control trial.

Aims: To examine the safety implications of omitting first day clinical review following phacoemulsification cataract surgery.

Methods: 362 patients were randomly assigned to "same day discharge" (SDD) or "next day review" (NDR). All patients were reviewed approximately 2 weeks after surgery.

A 10 year retrospective survey of cataract surgery and endophthalmitis in a single eye unit: injectable lenses lower the incidence of endophthalmitis.

Aim: To study the incidence of endophthalmitis following cataract surgery over a 10 year period, and to examine ways in which this may be related to changes in surgical technique.

Methods: All cases of endophthalmitis occurring over a 10 year period within a single ophthalmic unit in the United Kingdom were reviewed, and possible risk factors identified.

Results: During the study period, as the technique of extracapsular cataract surgery was replaced by phacoemulsification, there was a commensurate reduction in the incidence of endophthalmitis.

Combined congenital dacryocoele and anterior orbital hydrencephalocoele.

The differential diagnosis of a medial canthal cystic mass in the new-born child includes dacryocoele, dermoid and, much more rarely, encephalocoele. We present a child with coexistent bilateral dacryocoeles and bifrontal anterior orbital hydrencephalocoeles.

Paediatric dacryocystorhinostomy.

Of 258 cases of dacryocystorhinostomy performed on children in the period September 1981 to September 1991, 130 were for simple, unresolved congenital nasolacrimal duct obstruction. Other indications for surgery included punctal agenesis, lacrimal fistula, post-traumatic and post-inflammatory canalicular obstruction. Of 177 children without canalicular pathology, 171 (96%) were relieved of symptoms with one operation, without canalicular intubation.

Spontaneous hemorrhage within the rectus muscle.

Purpose: To describe, in three patients, the rare condition of spontaneous hemorrhage within the rectus muscle.

Methods: The records of three patients with a diagnosis of spontaneous hemorrhage within a rectus muscle were reviewed.

Results: Three adults had sudden unilateral painful proptosis with clinical and computed tomographic findings consistent with hemorrhage within a rectus muscle; in two patients, the presence of recent hemorrhage was confirmed on magnetic resonance imaging.

Primary vitrectomy for rhegmatogenous retinal detachment.

One hundred and twenty-four eyes with a rhegmatogenous retinal detachment, considered to be at high risk of failure if treated conventionally, underwent vitrectomy and internal tamponade, with or without scleral buckling, as the primary procedure. The retina was reattached in 64.5% of eyes after one operation, 75.

Management of the subluxed crystalline lens.

There has been a traditional reluctance to remove a subluxed (ectopic) lens because of the high surgical risk. The use of closed intraocular microsurgical techniques, however, now allows greater intraoperative control with few complications. The authors present the results of subluxed lens extraction, by limbal or pars plana lensectomy, in 44 eyes of 24 patients, in which the indication for surgery was lens subluxation causing a reduction in visual acuity or uncorrectable refractive error.

Sympathetic ophthalmia: visual results with modern immunosuppressive therapy.

Sympathetic ophthalmia is a rare bilateral panuveitis that follows penetrating injury to one eye. The use of systemic corticosteroids has transformed the prognosis, and good acuity in the sympathizing eye can now be achieved. The use of immunosuppressive drugs, such as cyclosporin and azathioprine, in combination with the steroids, allows control of the intraocular inflammation at a much lower steroid dose, with concomitant reduction in the systemic side effects that accompany the use of systemic steroids.

Use of cyclosporin in the management of steroid dependent non-necrotising scleritis.

Many patients with non-necrotising scleritis can be treated adequately with non-steroidal anti-inflammatory drugs or steroids. But, as many of them are young, treatment may present problems if they require high doses of steroids to control the scleral inflammation and then relapse when the dosage is reduced. Five such patients were treated with a combination of steroids and low-dose cyclosporin therapy, and in all cases the scleritis remained under control on a much lower dose of steroids than when steroids were used alone.

Use of orbital floor steroids in the management of patients with uniocular non-necrotising scleritis.

Most cases of non-necrotising scleritis can be successfully treated with non-steroidal anti-inflammatory drugs. If these are ineffective, then high-dose systemic corticosteroids, with all their attendant side-effects, are usually required. We have used orbital floor injections of depot steroid in the management of nine patients with non-necrotising scleritis in an attempt to avoid the use of systemic steroids, or to allow the dose of steroids to be reduced while maintaining disease control.

Binocular diplopia in unilateral aphakia: the role of botulinum toxin.

We have treated 12 unilaterally aphakic patients, with a manifest squint and binocular diplopia, with botulinum toxin injection to the appropriate horizontal rectus muscle, in an attempt to reduce the angle of squint and thereby resolve the diplopia. In all cases a short-term reduction in the angle of squint was achieved. In nine patients, whose aphakia was corrected with a contact lens, and eight of whom had had their lenses removed because of trauma, this reduction was only temporary.

Hemifacial atrophy: an unusual cause of enophthalmos.

We report on two cases of enophthalmos, caused by maxillary atrophy, a rarely reported monostotic forme fruste of hemifacial atrophy.

Topical flurbiprofen: an effective treatment for episcleritis?

Topical flurbiprofen was compared with placebo and prednisolone 0.3% in the treatment of episcleritis by a randomised double-blind trial. Seventy-seven eyes were included in the trial.

Sporadic diffuse corneal endotheliitis.

We studied two patients with acute diffuse corneal endotheliitis who had no family history of the disease. Endothelial specular photographs taken during and after an attack of endotheliitis demonstrate the deposition of inflammatory material on edematous endothelial cells, with areas of focal endothelial cell loss that resolved with treatment. These cases are distinctly different than the previously described "idiopathic" primary endotheliitis entities, which have included focal or sectoral areas of corneal edema, corneal edema in association with a migrating rejection line, or diffuse edema occurring as a dominantly inherited condition.

Anterior tucking of the iris caused by posterior chamber lenses with polypropylene loops.

One hundred ten eyes that had extracapsular cataract extraction with posterior chamber lens implantation were examined gonioscopically to ascertain the frequency of anteriorly displaced polypropylene loops "tucking" into the posterior iris surface. The association with iris transillumination defects and the development of postoperative uveitis, hyphema, and raised intraocular pressure were also recorded. Sixty-six eyes (60%) had one or two anteriorly tucked loops; 28 of them (25%) had some associated iris transillumination defect related to the implant.