Lindsay A. McGrath

Transscleral fixation of a supplementary toric intraocular lens to prevent rotation in a pseudophakic patient

A 61-year-old woman with a penetrating keratoplasty and a pseudophakic supplementary toric intraocular lens (IOL) (Sulcoflex toric 653T, ‒3.00 sphere and +5.50 cylinder) in the right eye presented to our practice multiple times for IOL realignment. The IOLs undulating haptics were designed for lens stability; however, lid forces and ovalization of the sulcus resulted in repeated anticlockwise rotation off the desired axis. The IOL was therefore sutured transsclerally to maintain axis orientation at 20 degrees. The postoperative refraction was +0.50 -1.00 × 76 with visual acuity of 20/25. Transscleral fixation of a supplementary IOL in an eye with a previous corneal graft is described. This procedure can result in stabilization of a pseudophakic supplementary toric IOL with good visual rehabilitation.

Irritant bullous contact dermatitis caused by a rove beetle: an illustrated clinical course.

A 26‐year‐old Australian female traveller in Sierra Leone presented with an irritant bullous contact dermatitis consistent with paederus dermatitis. The lesions were treated with a potent topical corticosteroid with good effect. The affected area resolved in 6 weeks and hyperpigmention persisted for months until complete resolution. This dermatitis occurs when beetles of the genus Paederus (rove beetles) are crushed on the skin, releasing pederin. The same dermatitis ensues with Australian Paederus species. Serial clinical photographs are presented which will aid Australian dermatologists in the diagnosis of this dermatitis, which presents in regional Australian patients and returned overseas travellers.

Techniques, indications and complications of corneal debridement

The cornea is the most exposed surface of the eye and, as such, is vulnerable to external trauma and the risk of infection. Many corneal diseases alter shape, surface, and transparency and thus result in reduced vision. The external position of the cornea, however, lends itself to diagnostic and therapeutic maneuvers that are commonly performed and readily done in the clinic. More sophisticated techniques require the use of complex equipment such as excimer and femtosecond laser. Complications that develop from poor healing and/or secondary infection are best avoided with appropriate technique, antisepsis, and modification of wound healing. We review corneal debridement in the management of corneal disease.

Corneal epithelial debridement for diagnosis and therapy of ocular surface disease.

There is a wide range of ocular surface conditions that can be diagnosed or treated with epithelial debridement. The purpose of this study is to analyse the indications, instrumentation and outcomes of corneal epithelial debridement for anterior segment pathology.Background There is a wide range of ocular surface conditions that can be diagnosed or treated with epithelial debridement. The purpose of this study is to analyse the indications, instrumentation and outcomes of corneal epithelial debridement for anterior segment pathology. Methods One hundred and thirty-three eyes of 129 patients with ocular surface disease were treated with epithelial debridement. Different methods were used, appropriate to the specific disease, aetiology and outcome measure. Results The mean patient age was 56 years and 81 (60.9 per cent) were male. Sixty-two eyes (46.6 per cent) were undertaken for diagnosis and 71 (53.4 per cent) for therapy. Common indications for diagnostic corneal debridement included infective keratitis 48 (36.1 per cent), neoplasia 14 (10.5 per cent), while those for therapeutic corneal debridement included recurrent erosion 30 (22.5 per cent) and band keratopathy 16 (12.0 per cent). The most common post-operative complication was pain, occurring in all patients to some extent. Band keratopathy was seen to recur in two (12.5 per cent) of the treated eyes and there was a single relapse of recurrent erosion during the follow-up period. Conclusion The techniques presented can be undertaken in the office rather than a day procedural unit, improving time and cost-effectiveness for the ophthalmologist and patient.

Topical ophthalmic use of cyclosporin A for Splendore-Hoeppli phenomenon

The Splendore-Hoeppli reaction is a rare phenomenon characterised by the formation of eosinophilic material around infectious or non-infectious agents. A 33-year-old patient with persistent Splendore-Hoeppli phenomenon was previously treated with topical steroids but this resulted in a rise in intraocular pressure. The patient was treated with topical cyclosporin A one per cent twice daily as an alternative immunosuppression. After three weeks of treatment the patient had complete resolution of her conjunctival granuloma. This case report introduces cyclosporin A as a treatment option for the Splendore-Hoeppli phenomenon. This is a safe drug for long-term topical use in this condition.The Splendore‐Hoeppli reaction is a rare phenomenon characterised by the formation of eosinophilic material around infectious or non‐infectious agents. A 33‐year‐old patient with persistent Splendore‐Hoeppli phenomenon was previously treated with topical steroids but this resulted in a rise in intraocular pressure. The patient was treated with topical cyclosporin A one per cent twice daily as an alternative immunosuppression. After three weeks of treatment the patient had complete resolution of her conjunctival granuloma. This case report introduces cyclosporin A as a treatment option for the Splendore‐Hoeppli phenomenon. This is a safe drug for long‐term topical use in this condition.

Comment on: Proposal for a new classification for ocular surface squamous neoplasia

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Transconjunctival approach to peribulbar block.

As increasing numbers of anesthetists perform eye block anesthesia, thorough understandings of peribulbar injection techniques are important for safe practice. There is uncertainty in the literature regarding the optimum needle length, entry point, volume of injectate, and use of single vs double-injection techniques. A modified technique of peribulbar block anesthesia is presented, which offers increased safety, simplicity, low cost, and little change to instrumentation.

Corneal Debridement Update: Adjuvant Therapies and Wound Healing.

AbstractCorneal debridement techniques have seen evolution in instrumentation and indication. Although the techniques themselves are simple and usually effective, there is often the need for adjuvant topical therapies to augment healing and/or prevent recurrence of disease. To better understand the requirement for adjuvant therapies, the current theories of corneal wound healing are reviewed.

Optic Nerve Haemangioblastoma: Signs of Chronicity

Optic nerve haemangioblastomas remain exceedingly rare extrinsic tumours of the optic nerve, often associated with von Hippel-Lindau disease. The authors report a 25-year-old female with a slowly progressive unilateral optic nerve lesion, causing reduced vision and bilateral optic tract oedema. A diagnosis of optic nerve haemangioblastoma with piloid gliosis was made histologically after surgical resection. This is the first reported case of such dual pathology occurring in the optic nerve. The patient has been monitored without further adjuvant treatment, and has not had a recurrence to date, at 6 years of follow-up.

A Case of a Cavitary Iris Melanoma with Aqueous Cytological Modulation

Malignant melanoma is the most common primary malignant tumour of the iris, but represents a small proportion of all uveal melanomas. The authors describe a 34-year-old male with a pigmented lesion of the iris. The lesion remained stable for 7 years, but the patient re-presented after this time with sudden enlargement of the mass and hyphaema. Excisional biopsy confirmed cavitary melanoma of the iris. This is the first reported case of cavitation in a primary iris melanoma. The patient has not had any further adjuvant treatment and remains metastasis free at 5 years of follow-up.