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Angle closure glaucoma is recognised as a major cause of glaucoma blindness especially in Asians. Epidemiology studies from several Asian regions have documented the high prevalence of occludalble angles. Casson and coworkers report the findings of a study of a Burmese population. In this study, the prevalence of primary angle closure glaucoma suspects was 5.7% and the prevalence of primary angle closure was 1.5%. Suspected primary angle closure in glaucoma was more common in women than in men.
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The technique of trabeculectomy surgery has improved over the last 15 years with concomitant improvement in pressure management. However, many of the current techniques used for trabeculectomy surgery require significant post‐operative manipulation. In a study of 119 patients, King and coworkers reported that 49% of blebs underwent massage and a similar number required at least one suture removal. 31% required at least one anti‐metabolite injection. This obviously implies that intensive post‐operative follow‐up is mandatory for the management of trabeculectomy patients. Despite this the group that requires the most manipulation appears to be the one more likely to have uncontrolled intraocular pressure.
See page 873
Optic neuropathy has been reported to appear in 1–5% of patients treated with ethambutol. Ocular manifestations usually develop in the months following initiation of therapy, with a sub‐acute clinical coarse of painless loss of central vision. Fundoscopy examination is commonly reported to be normal. Foroozan and coworkers report a study of eight patients with ethambutol‐induced optic neuropathy studied with optical coherence tomography . In this study, there was a decrease in the retinal nerve fibre layer in all quadrants in patients with ethambutol‐induced optic neuropathy. The decrease was most pronounced in the temporal quadrant.
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Another clinical use of optical coherence tomography has been reported by Matsuo and coworkers. They studied 58 patients with retinitis pigmentosa with optical coherence tomography in order to obtain horizontal and vertical retinal cross‐section images of the center of the macula. They conclude from this study that optical coherence tomography can obtain information regarding retinal layer structure in patients with retinitis pigmentosa and may be a useful clinical test in assessing patients who are candidates for retinal prostheses in the future.
See page 888
Prevention of posterior capsule opacification is important in all surgically treated cataract patients. It is especially important in paediatric patients and in those patients receiving special modern IOL‐types, such as accommodative or multifocal lens implants. A number of techniques have been investigated to prevent posterior capsule opacification. Rabsilber and coworkers describe a technique of sealed capsule irrigation during cataract surgery to prevent posterior capsule opacification. In this study, they documented that the procedure was safe, however they did not document that the use of distilled water reduced posterior capsule opacification. They suggest that alternative substances should be evaluated.
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Over the past two decades visual outcomes in patients with congenital cataracts has improved dramatically. However, very few investigations have studied the quality of life of these children over the long‐term. Rahi and coworkers report the results of the British Congenital Cataract Study. The PEDS QL scores of children with congenital cataract were comparable to those reported for children with severe systemic diseases such as rheumatological disease and some cancers. The authors emphasise that specific vision related quality of life measures for children are urgently needed.
See page 922
Recurrent corneal erosion, although a benign condition, is painful and can often times affects a person's comfort and lifestyle. Most mild episodes can be managed with topical lubrication. More recalcitrant erosions offer a significant challenge. Dua and coworkers report the results of 20 patients with recurrent corneal erosions treated with alcohol delamination of the corneal epithelium. In this study alcohol delamination was safe and effective for treating patients with corneal erosions.
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Pulsed electron avalanche knife is a new pulse electrosurgical device which allows for a precise traction free tissue dissection. Triglinger and coworkers report the results of a study of the use of the pulse electron avalanche knife in the treatment of cataracts. They found that the pulsed electron avalanche knife was a helpful cutting device for complicated cases especially for mature and congenital cataracts. Posterior iris synechiae could be released and anterior capsule opacification was dissected without complications.
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Recent evidence suggests that the CFH gene region may be implicated in the pathophysiology of age related macular degeneration. Y402H has been demonstrated to predict an increased risk for age related macular degeneration in several populations. Lotery and coworkers utilised fine scale linkage disequilibrium mapping and found that there is at least one and more likely several other mutations in the CFH gene, which may play a role in disease manifestation in age related macular degeneration.
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