Michael Austin

Pigment dispersion with elevated intraocular pressure after acrysof intraocular lens implantation in the ciliary sulcus

A 45-year-old white woman had phacoemulsification with intraocular lens (IOL) implantation. The surgery was routine except for a linear tear in the posterior capsule; there was no disruption of the anterior vitreous face. After residual soft lens matter was removed, an AcrySof IOL was placed in the ciliary sulcus. One month postoperatively, the patient presented with an intraocular pressure (IOP) of 30 mm Hg and signs of pigment dispersion with 360 degrees of heavy pigmentation of the trabecular meshwork and iris transillumination defects. Intraocular pressure was controlled with a topical beta-blocker. The optic disc appearance and visual field remained normal, but the uniocular hyperpigmentation of the trabecular meshwork was still present. We hypothesize that the sharp square edge of the AcrySof IOL increases the risk of a chafing effect on the posterior iris pigment and advocate that this IOL be placed in the capsular bag and ideally have 360 degrees of protective overlapping of the anterior capsule over the edge of the optic.

The treatment of acute dacryocystitis using laser assisted endonasal dacryocystorhinostomy

Aims: To determine whether acute dacryocystitis complicated by abscess formation can be successfully treated using laser assisted endonasal dacryocystorhinostomy. Methods: A protocol was adopted for the management of acute dacryocystitis presenting to an ophthalmology department. All patients were assessed jointly by an ophthalmologist and otolaryngologist for their suitability for primary internal drainage via a nasal endoscopic approach. All suitable patients during the study period August 1999 to November 2000 were managed by intravenous antibiotics and holmium:YAG laser dacryocystorhinostomy. Results: Nine patients were studied (mean age 72 years (range 38–82 years), three men, six women). A history of chronic epiphora was found in 78% of patients, and recurrent nasolacrimal infections in the same 78%. Resolution of symptoms and signs of acute dacryocystitis occurred in all nine patients. No recurrence of acute dacryocystitis occurred during the median follow up period of 11 months (range 6–31 months). Ostium patency defined as the absence of epiphora and the observation of irrigated lacrimal fluorescein at the ostium was achieved in 67% of patients. Epiphora recurred in 33% of cases. Conclusion: Laser assisted endonasal dacryocystorhinostomy is an effective primary treatment in cases of acute dacryocystitis complicated by abscess formation. In addition, pre-existing symptoms of epiphora and recurrent nasolacrimal infections are relieved in the majority of patients.

Transscleral Cyclodiode Laser Photocoagulation in the Treatment of Aqueous Misdirection Syndrome

PURPOSE To describe the outcome of using transscleral cyclodiode laser ciliary body ablation as a novel treatment for aqueous misdirection syndrome. DESIGN Retrospective case series review. PARTICIPANTS Five patients diagnosed with aqueous misdirection syndrome. INTERVENTION Patients successfully managed using transscleral cyclodiode laser. MAIN OUTCOME MEASURES To evaluate demographic information, risk factors, visual acuity, medical treatment, intraocular pressure (IOP) control, and complications. RESULTS The patients were aged 27 to 78 years and 3 were female. All were hyperopic, with narrow iridocorneal angles and patent peripheral iridotomies (PI). Four developed aqueous misdirection syndrome after intraocular surgery and 1 developed it spontaneously in the presence of a patent PI after losing vision in the fellow eye to the same condition 8 years earlier. All 5 patients responded to transscleral cyclodiode laser photocoagulation with rapid deepening of the anterior chamber; 1 patient required a second treatment 1 year later. All patients had good long-term vision and IOP control. CONCLUSIONS The outcome of transscleral cyclodiode ciliary body ablation in these patients supports the use of this technique in cases of aqueous misdirection syndrome where medical treatment has not been sufficient to control the IOP.

Incorporation of a virtual assessment into a care pathway for initial glaucoma management: feasibility study.

Purpose:  To investigate the feasibility of a glaucoma triage assessment based on the consideration of clinical data in a virtual clinic environment.

Conjunctival leiomyosarcoma: Letters to the Editor

as a laser in situ keratomileusis’s (LASIK)-related complication and traumatic surgeries. It generally occurs in the early times after the procedure, the longest reported interval being 20 months. This case illustrates the possibility to have an epithelial ingrowth following other surgeries than LASIK and trauma, even in the absence of risk factors. Another peculiarity of our case is that the abnormal growth of epithelial cells created an over 300-mm-thick opacity, which expanded to the centre of the cornea, differently from the typical post-LASIK ingrowth. We suggest that a possible risk factor is the construction and the size of the tunnel. A wide and irregular incision may create a breach for epithelial cells, leading to the ingrowth. Even if epithelial ingrowth is an uncommon complication after cataract surgery, it must be promptly recognized and treated to avoid serious consequences.

Initial management of ocular hypertension and primary open-angle glaucoma: an evaluation of the royal college of ophthalmologists' guidelines

AbstractPurpose The purpose of this study was to identify any consensus of opinion among consultant ophthalmologists in Wales with respect to the initial management of glaucoma referrals based on the published guidelines of the Royal College of Ophthalmologists (RCO) and to compare consultant opinion with the practice in a typical hospital.Method The RCO guidelines document was studied to identify clear statements, which could be adopted as standards for audit purposes. A questionnaire was designed and sent to all consultant ophthalmologists in Wales (n=37) to obtain their opinions. An audit was performed of 100 consecutive patients referred to our unit as glaucoma suspects with regard to initial management. Descriptive statistical analysis was performed.Results A good response rate for a postal questionnaire was obtained (81%) with 79.1% of responders finding the guidelines of at least some help. Levels of agreement with the definitions of ocular hypertension (OH) and primary open-angle glaucoma (POAG) were 76.7 and 86.7%, respectively. There was consensus of consultant opinion regarding many of the elements of the baseline clinical assessment with the significant exceptions of the necessity for dilated fundoscopy, gonioscopy, retinal nerve fibre layer assessment, and drawing of optic discs. The various ‘clinical scenarios’ for management of the RCO document were not all endorsed. The clinical audit results of the initial management of glaucoma referrals accurately reflected the consensus of the consultant opinion.Discussion The RCO guidelines document represents a useful contribution to the management of patients with OH and POAG. Nevertheless, considerable variation in opinion exists concerning even the most basic areas. With the advent of clinical governance, bridging the gap between the conclusions of College working parties and realities of everyday practice will assume greater importance.

Virtual assessment and glaucoma shared care.

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA Department of Ecology, Evolution and Organismal Biology, The Ohio State University, Columbus, OH, USA E-mail: etu@uic.edu