Gerasimos M. Voros

Clinical outcome of endonasal KTP laser assisted dacryocystorhinostomy

BackgroundTo evaluate the clinical outcome of primary endonasal laser assisted dacryocystorhinostomy (ENL-DCR) using the potassium-titanyl-phosphate laser.MethodsWe retrospectively reviewed all primary ENL-DCRs performed within a period of twelve months by the same combined Ophthalmology and Otorhinolaringology team in Freeman Hospital, Newcastle upon Tyne, UK. The main outcome measure for success was resolution or significant improvement of epiphora. Details of surgery, intraoperative and postoperative complications, as well as pathology associated with failure were also studied. Patients were followed up for at least 12 months.ResultsA total of 41 consecutive ENL-DCRs on 29 patients (22 females, 7 males, mean age 75 years) were analysed. All patients had bicanalicular silicone intubation for at least 4 months. The success rate at 12 months postoperatively was 78.1%. Pathology associated with failure included: intranasal pathology (12.2%), mucocele (7.3%), and systemic sarcoidosis (2.4%). No significant intra-operative complications were recorded.ConclusionThe ENL-DCR with potassium-titanyl-phosphate laser can be considered as a safe and efficient primary procedure for the treatment of nasolacrimal duct obstruction.

Interventions for unilateral refractive amblyopia

BACKGROUNDnUnilateral refractive amblyopia is a common cause of reduced visual acuity in childhood, but optimal treatment is not well defined. This review examined the treatment effect from spectacles and conventional occlusion.nnnOBJECTIVESnEvaluation of the evidence of the effectiveness of spectacles and or occlusion in the treatment of unilateral refractive amblyopia.nnnSEARCH STRATEGYnWe searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS. Relevant conference proceedings were manually searched. There were no date or language restrictions. The searches were last run on 7 July 2008.nnnSELECTION CRITERIAnRandomised controlled trials of treatment for unilateral refractive amblyopia by spectacles, with or without occlusion were eligible. We included studies with participants of any age.nnnDATA COLLECTION AND ANALYSISnTwo authors independently assessed abstracts identified by the searches. We obtained full text copies and contacted study authors where necessary. Eight trials were eligible for inclusion. Data were extracted from seven. No meta-analysis was performed.nnnMAIN RESULTSnFor all studies mean acuity (standard deviation (SD)) in the amblyopic eye post treatment is reported.Comparison: Spectacles only versus no treatment (Clarke 2003). Mean (SD) visual acuity: spectacles group 0.31 (0.17); no treatment group 0.42 (0.19). Mean difference (MD) between groups -0.11 (borderline statistical significance: 95% confidence interval (CI) -0.22 to 0.00).Comparison: Spectacles plus occlusion versus no treatment (Clarke 2003). Mean (SD) visual acuity: full treatment 0.22 (0.13); no treatment 0.42 (0.19). Mean difference between the groups -0.20 (statistically significant: 95% CI -0.30 to -0.10).Comparison: Spectacles plus occlusion versus spectacles only: Clarke 2003 MD -0.09 (borderline statistical significance 95% CI, -0.18 to 0.00); PEDIG 2005b; MD -0.15 (not statistically significant 95% CI -0.32 to 0.02); PEDIG 2006a; MD 0.01 (not statistically significant 95% CI -0.08 to 0.10).Comparison: Occlusion regimes. PEDIG 2003a: 2 hours versus 6 hours for moderate amblyopia: MD 0.01 (not statistically significant: 95% CI -0.06 to 0.08); PEDIG 2003b: 6 hours versus full-time for severe amblyopia: MD 0.03 (not statistically significant: 95% CI -0.08 to 0.14). Stewart 2007a: 6 hours versus full-time occlusion: MD -0.12 (not statistically significant: 95% CI -0.27 to 0.03)nnnAUTHORS CONCLUSIONSnIn some cases of unilateral refractive amblyopia it appears that there is a treatment benefit from refractive correction alone. Where amblyopia persists there is some evidence that adding occlusion further improves vision. It remains unclear which treatment regimes are optimal for individual patients. The nature of any dose/response effect from occlusion still needs to be clarified.

Acute optic neuropathy in patients with Behçet's disease. Report of two cases.

Although acute optic neuropathy has been rarely reported in patients with Behçet’s disease, a detailed description of its clinical course is lacking. We report in detail the course of acute optic neuropathy in two patients with Behçet’s disease. Our experience suggests that it can be bilateral, can affect both eyes simultaneously, and can be recurrent. The severity of the visual loss and its recovery can be very variable even in the same patient. Early recognition of this entity and treatment with high-dose systemic corticosteroids may limit the degree of permanent visual loss. However, the optimal treatment has not been established.

Interventions for refractive amblyopia

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: n nBy reviewing the available evidence we want to establish the role of occlusion therapy in the treatment of anisometropic and unilateral meridional amblyopia. In particular this review aims to: n n(1) examine the impact of occlusion therapy on the outcome of the treatment of anisometropic and unilateral meridional amblyopia; n(2) analyse the role of the types of occlusion available (excluding pharmacological penalization) for the treatment of anisometropic and unilateral meridional amblyopia; n(3) establish the effectiveness of different occlusion regimes, in particular: n(a) dose/response effect; n(b) duration of treatment.

Scleral perforation after trans-scleral cyclodiode laser for intraocular pressure reduction

Herein a case is reported of a full‐thickness scleral burn in the left eye of a 61‐year‐old man, following contact trans‐scleral cyclodiode laser treatment for traumatic aphakic glaucoma, unresponsive to maximal medical treatment. The defect was successfully repaired by scleral suturing under local anaesthetic.