Graham A. Lee

Ocular surface squamous neoplasia

Ocular surface squamous neoplasia presents as a spectrum from simple dysplasia to carcinoma in situ to invasive squamous cell carcinoma involving the conjunctiva as well as the cornea. It is a distinct clinical entity, although it has been known by a variety of different names throughout the literature. Most commonly it arises in the limbal region, occurring particularly in elderly males who have lived in geographic areas exposed to high levels of ultraviolet-B radiation. Symptoms range from none to severe pain and visual loss. The development of preoperative diagnostic techniques, such as impression cytology, are of value in clinical decision making and follow-up management. Simple excision with adequate margins is currently the best established form of treatment despite trials of other modalities. The course of this disease may be evanescent, but is more frequently slowly progressive and may require exenteration and occasionally may lead to death.

Risk Factors in the Development of Ocular Surface Epithelial Dysplasia

BACKGROUND Ocular surface epithelial dysplasia involves a spectrum of diseases ranging from only minor eye irritation to blindness and potentially death. METHODS A case-control study involving 60 patients with ocular surface epithelial dysplasia treated between 1972 and 1991 and 60 age- and sex-matched individuals was conducted to compare relative ultraviolet light exposures over their lifetimes. A standardized self-administered ultraviolet exposure questionnaire was used for assessment. RESULTS Risk factors identified include phenotypic features such as fair skin (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.1, 25.6), pale iris (OR, 1.8; 95%; CI, 0.9, 3.8), and propensity to sunburn (OR, 3.8; 95% CI, 0.7, 19.7), history of previous skin cancers removed (OR, 15; 95% CI, 2.0, 113.6), and being outdoors more than 50% of time in the first 6 years of life while living 30 degrees or less from the equator (OR, 7.5; 95% CI, 1.8, 30.6). CONCLUSION These risk factors suggest that ocular surface epithelial dysplasia is an ultraviolet light-related disease.

Prognostic indicators for open globe injury

Background:  The purpose of the study is to identify factors predictive of outcome after open globe injury in 273 patients admitted to the Royal Brisbane Hospital, Queensland, Australia between 1992 and 2003.

The corneal thickness and intraocular pressure story: where are we now?

A review of the current literature was conducted regarding the effect of corneal thickness on the diagnosis of glaucoma, and the influence of excimer laser refractive surgery on intraocular pressure (IOP) measurement with Goldmann applanation tonometry. In general, normals and primary open angle glaucoma patients have a similar distribution of corneal thickness; however, there is a wide variation, ranging from 427 to 716 µm. Normal tension glaucoma patients have a tendency towards thinner corneas than normals; however, there is an overlap of thickness measurements of more than two‐thirds in 95% of patients. There is a trend for ocular hypertensives to have thicker corneas than normals, but again there is an overlap of about one‐third in 95% of patients. The general trend after excimer laser refractive surgery is for a decrease in IOP, with a mean fall in IOP measured of 0.63 mmHg per dioptre correction. There is, however, a large scatter of values with some patients having the same or lower IOP post‐laser, but with other patients measuring higher pressures. Corneal thickness can influence IOP measurement by Goldmann applanation tonometry; however, the magnitude of the effect is subject to much individual variation.

Autologous serum in the management of recalcitrant dry eye syndrome

Purpose:  To evaluate the efficacy and safety of long‐term application of autologous serum eye drops treating recalcitrant dry eye syndrome.

Self-tonometry in Glaucoma Management—Past, Present and Future

Glaucoma is the leading cause of irreversible blindness in the world. Diagnosis and management of glaucoma is significantly associated with intraocular pressure, but contemporary office-based measurements are not sufficient to discover diurnal changes and spikes, nor do they demonstrate the effect of medication and compliance. Patient-directed self-tonometry can be taken throughout the day and is therefore the subject of much discussion and research. In this article we review the history of self-tonometry devices and present technologies for the future.

Comparison of intraocular pressure measurement between rebound, non-contact and Goldmann applanation tonometry in treated glaucoma patients

Background:  To compare the intraocular pressure readings obtained with the iCare rebound tonometer and the 7CR non‐contact tonometer with those measured by Goldmann applanation tonometry in treated glaucoma patients.

Pig eye trabeculectomy-a wet-lab teaching model.

PurposeA teaching model for trabeculectomy is described using pig eyes prepared in formalin.MethodThe model enables trainee surgeons to practice various aspects of tissue handling required for successful trabeculectomy including the construction of a fornix-based conjunctival flap, scleral flap with buried releasable sutures, and water-tight conjunctival closure.ResultsExposure to the necessary skills required to perform trabeculectomy surgery can be improved by the use of wet laboratory practice.ConclusionsTrabeculectomy surgery experience is becoming more limited as fewer procedures are being performed due to the efficacy of recent medications. Wet laboratories will become an increasingly important aspect of a comprehensive ophthalmology training programme.

Subretinal perfluorodecalin toxicity

BACKGROUND Subretinal injection of perfluorocarbon liquids (PFCL) can occur during vitreoretinal surgery. The long-term effects of this complication are not well established. METHODS A case report is presented of a patient with retained subretinal perfluorodecalin following retinal detachment repair for a giant retinal tear. RESULTS In the early postoperative period, the macular retinal pigment epithelium (RPE) became opalescent in appearance and by 2 months postoperatively the patient developed macular RPE atrophy with resulting poor central vision. CONCLUSIONS Toxicity of subretinal perfluorodecalin causing RPE atrophy is proposed. We recommend all traces of PFCL should be removed if possible.

OUTCOMES OF AUTOCONJUNCTIVAL GRAFTING FOR PRIMARY PTERYGIA WHEN PERFORMED BY CONSULTANT COMPARED WITH TRAINEE OPHTHALMOLOGISTS

Purpose:  To define rates of recurrence and surgical complications of primary pterygia excision with autoconjunctival grafting when the surgery is performed by consultant ophthalmologists compared with trainee ophthalmologists.