The treatment of pterygium

The treatment of pterygium is still quite controversial, with various treatments being advocated in the scientific literature. Unfortunately, there are very few well-conducted controlled clinical trials of treatments. However, years of anecdotal and noncontrolled studies have confirmed that some methods, such as bare scleral closure, are no longer acceptable in the treatment of pterygium and that other methods are likely to be more useful. In the future it will be important to develop a grading system, and surgeons will need to be conservative in the treatment of pterygium until such time as a single treatment provides a lower recurrence rate and complication rate.

Comparison of the Retinomax autorefractor with hand-held retinoscopy in 1-year-old infants

This study aimed to determine the accuracy (and usability) of the Retinomax, a hand-held autorefractor, compared to measurements taken from hand-held retinoscopy (HHR) in a sample of normal 1-year-old children. The study was a method comparison set at four Community Child Health Clinics. Infants (n = 2079) of approximately 1 year of age were identified from birth/immunization records and their caregivers were contacted by mail. A total of 327 infants ranging in age from 46 weeks to 81 weeks (mean 61 weeks) participated in the study. The children underwent a full ophthalmic examination. Under cycloplegia, refraction was measured in each eye by streak retinoscopy (HHR) and then re-measured using the Retinomax autorefractor. Sphere, cylinder, axis of cylinder and spherical equivalent measurements were recorded for HHR and Retinomax instruments, and compared. Across the range of refractive errors measured, there was generally close agreement between the two examination methods, although the Retinomax consistently read around 0.3 D less hyperopic than HHR. Significantly more girls (72 infants, 47.7%), struggled during examination with the Retinomax than boys (52 infants, 29.5%) (P < 0.001). Agreement deteriorated between the two instruments if the patient struggled during the examination (P < 0.001). In general, the Retinomax would appear to be a useful screening instrument in early childhood. However, patient cooperation affects the accuracy of results and is an important con-sideration in determining whether this screening instrument should be adopted for measuring refractive errors in early infancy.

Spreading and synchronization of intrinsic signals in visual cortex of macaque monkey evoked by a localized visual stimulus

Spatio-temporal maps of the occipital cortex of macaque monkeys were analyzed using optical imaging of intrinsic signals. The images obtained during localized visual stimulation (IS) were compared with the images obtained on presentation of a blank screen (IB). We first investigated spontaneous variations of the intrinsic signals by analyzing the 100 IBs for each of the three cortical areas. Slow periodical activation was observed in alternation over the cortical areas. Cross-correlation analysis indicated that synchronization of spontaneous activation only took place within each cortical area, but not between them. When a small, drifting grating (2degreesX2degrees) was presented on the fovea. a dark spot appeared in the optical image at the cortical representation of this retinal location. It spread bilaterally along the border between V1 and V2, continuing as a number of parallel dark bands covering a large area of the lateral surface of V1. Cross-correlation analysis showed that during visual stimulation the intrinsic signals over all of the three cortical areas were synchronized, with in-phase activation of V1 and V2 and anti-phase activation of V4 and V1/V2. The significance of these extensive synergistic and antagonistic interactions between different cortical areas is discussed. (C) 2003 Elsevier B.V. All rights reserved.

Controlled trial of hyperbaric oxygen treatment for alkali corneal burn in the rabbit

Purpose: To evaluate the efficacy of hyperbaric oxygen therapy in the treatment of alkali-induced corneal burns in an animal model. Methods: Twenty-four rabbits were randomized into a control group (n = 12) and hyperbaric oxygen treatment group (n = 12). After induction of anaesthesia, the alkali burn model was established by application of 1 N sodium hydroxide to one eye of each rabbit. The hyperbaric oxygen treatment group was treated each day for 21 days with hyperbaric oxygen at 2.4 Atmospheres Absolute (ATA) for 1 h. The eyes of the animals were examined daily for 2 weeks and then weekly until the end of the trial. The principal endpoint was that of perforation of the cornea at which time the animals were killed with a lethal dose of either intravenous or intraperitoneal barbiturate and the eyes immediately enucleated and fixed in 10% neutral buffered formalin. All animals in which complete healing took placed were also killed, the eyes removed, fixed and examined histologically. Photographs were taken of the rabbit's eyes at weekly intervals and the area of vascularization and epithelial defects in the hyperbaric and control groups were compared. Results: Equal numbers (seven) of the control and hyperbaric oxygen treated groups had perforated corneas and there was no statistical difference in the mean time to perforation (control 30.1 days; treated 30 days). There was also no statistical difference between the two groups with respect to epithelial defect size. Conclusion: Treatment with hyperbaric oxygen for 1 h daily for 21 days had no beneficial effect on alkali-induced corneal burns.

Partial Jensen's procedure for the treatment of myopic strabismus fixus

Myopic strabismus fixus (MSF) is a rare strabismus entity of uncertain etiology. The most recent explanation of etiology was provided by Yokoyama et al,(1) who noted that the enlarged globe in high myopia herniates superotemporally and retroequatorially through the muscle cone. In a typical case, the eye is fixed in depression and adduction. We report the use of a partial Jensen's procedure (superior arm only) for the treatment of MSF.

Telepaediatrics and diabetic retinopathy screening of young people with diabetes in Queensland

We have examined the feasibility of a telemedicine-enabled screening service for children and adolescents with diabetes in Queensland. There are approximately 1400 young people with diabetes in Queensland and only about two-thirds of them are screened in accordance with international guidelines. A regional retinal screening service was established using a non-mydriatic digital retinal camera. Seven centres volunteered to participate in the study. During a five-month pilot trial, 83 of the young people with diabetes who attend these centres underwent digital retinal screening (3.7%). Retinal images were sent via email to a paediatric ophthalmologist for review and results were returned via email. A copy of each participant's results was forwarded by mail to the referring diabetes doctor and the participant and family. The majority of the image files (96%) were rated as excellent or good. Only one participant was identified as having an abnormal result. Participants and their families expressed satisfaction with the digital retinal screening process.

Diode laser treatment of pre-threshold and threshold retinopathy of prematurity

Purpose: Retinopathy of prematurity (ROP) is a sight-threatening condition of premature infants. This study aimed to investigate the efficacy of diode laser photocoagulation in the treatment of pre-threshold and threshold ROP. Methods: A retrospective review was conducted of patients who underwent diode laser treatment for ROP by one author (GAG) from 1992 to 2000. During this time, 2137 babies

Primary trabeculodysgenesis in association with neonatal Marfan syndrome

We present the clinical and ophthalmological findings in two infants with neonatal Marfan syndrome (nMFS) and primary trabeculodysgenesis (PT). Fibrillin 1 (FBN1) mutations were confirmed in both cases. Numerous eye anomalies have been recognized in infants with nMFS, but PT has not been reported previously. Our report expands the phenotype of nMFS, and highlights the importance of early and careful ophthalmological assessment of these infants. (C) 2004 Wiley-Liss, Inc.

Panoptic versus conventional ophthalmoscope

Background: The 'ease of use' andaccuracy in measurement of the vertical optic cup/discratio (VCDR) was compared between the conventional direct ophthalmoscope(CO) and Panoptic direct ophthalmoscope (PO) in a group of 'naive' firstyear medical students to determine which would be more suitablefor non-ophthalmologists. Methods: In this quasi-randomized method comparison study,eight students received an introductory session on ophthalmoscopythen examined 18 eyes (9 left, 9 right) with each ophthalmoscopein a private practice. The subjects were the eight students themselvesplus two other subjects. Each subject (n = 10)had one eye dilated. Students determined a VCDR and a subjectivescore of 'ease of use' on a scale of 1 (difficult)to 10 (easy). A consultant ophthalmologist (GAG) determined thebenchmark VCDR for each eye with each ophthalmoscope. Results: Of 288 eye examinations, there were 111 measure-ments of VCDR using the CO (47 undilated, 64dilated), and 140 measurements using the PO (75 undilated, 65 dilated).Differences in the students' estimated VCDR and the benchmarkwere similar for the CO and PO (P = 0.67). 'Easeof use' was scored in 288 eyes and the median score washigher in the PO overall (CO: median 8, IQR 6-9; PO median9, IQR 8-10; P < 0.0001), andwithin each session (P < 0.0001 foreach session). Conclusions: Medical students found the PO mucheasier to use, with accuracy of rating the VCDR similar to the CO. Thiscomparison would support the wider use of the PO amongst medicalstudents, general practitioners and other primary care providers.

Psilocybin impairs high-level but not low-level motion perception

The hallucinogenic serotonin(IA&2A) agonist psilocybin is known for its ability to induce illusions of motion in otherwise stationary objects or textured surfaces. This study investigated the effect of psilocybin on local and global motion processing in nine human volunteers. Using a forced choice direction of motion discrimination task we show that psilocybin selectively impairs coherence sensitivity for random dot patterns, likely mediated by high-level global motion detectors, but not contrast sensitivity for drifting gratings, believed to be mediated by low-level detectors. These results are in line with those observed within schizophrenic populations and are discussed in respect to the proposition that psilocybin may provide a model to investigate clinical psychosis and the pharmacological underpinnings of visual perception in normal populations.