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Br J Ophthalmol. 2007 October; 91(10): 1257.
PMCID: PMC2000987

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Monitoring Editor: Harminder S Dua and Arun D Singh, Editors‐in‐Chief

Multiple intravitreal triamcinolone injections for refractory diabetic macular oedema

The safety and efficacy of repeated intravitreal triamcinolone injections (IVTA) for diabetic macular oedema is unclear. In a prospective, observational case series of 27 eyes receiving IVTA for diabetic macular oedema, LogMAR visual acuity (VA) and central macular thickness (CMT) were measured at baseline and at regular intervals. Correlation was made with the number of IVTA injections. Although VA improved in all patients, neither the final VA nor the improvement in CMT correlated with the number of injections. This study suggests that repeat injections of IVTA continue to be as effective as the first injection over a 2‐year period, but the probability of cataract surgery increases with number of injections.

See page 1323

“Small bubble technique” for success of “big bubble”

Lamellar keratoplasty has heralded a new era in corneal transplant surgery. Deep anterior lamellar keratoplasty attempts to remove as much of the stroma as possible leaving the recipient's normal endothelium behind. Of the various techniques employed to achieve this, the “big bubble” technique is the one that ensures the deepest dissection, right up to Descemet's membrane. If the corneal stroma becomes opaque during the injection of air, it becomes difficult to assess whether a big bubble has been achieved or not. The authors describe a simple technique that helps in this regard.

See page 1369

Incidence of retinal detachment after macular surgery

Retinal detachment (RD) remains the most common serious complication of macular surgery. In an attempt to evaluate the rate of retinal detachment after macular surgery, a retrospective study of 634 macular surgery procedures was undertaken. The rate of RD occurring after idiopathic macular hole (IMH) surgery was higher than epiretinal membrane surgery (6.6% vs 2.5%, p  =  0.02). The rate of RD was higher in patients presenting with stage 2 and 3 IMH than with stage 4 IMH. Careful examination of the peripheral retina is a key issue in preventing retinal detachment occurring after macular surgery.

See page 1327

Early detection of glaucoma by means of a novel 3D computer‐automated visual field test

A sensitive, reliable, widely available, and quick screening method for detection of early glaucoma is needed. A recently devised 3D computer‐based threshold Amsler grid test was compared with standard automated perimetry (achromatic standard or SITA standard 30‐2 or 24‐2) in its ability to identify early and distinctive defects in glaucoma suspects (66 eyes). In addition, 23 eyes with no risk factors were tested as controls. In a 5‐min test, patients repeatedly outlined scotomas on a computer touch screen with varying contrast while maintaining their gaze on a central fixation marker. In this pilot study 79% of the eyes tested in the glaucoma‐suspect group consistently demonstrated visual field loss with the 3D perimetry whereas no visual field changes were detected by the Humphrey visual field test. Although promising, additional longitudinal follow‐up studies are necessary to establish 3D computer‐automated threshold Amsler grid test as a screening tool for primary open angle glaucoma.

See page 1331

Comitant horizontal strabismus: an Asian perspective

In this study children with comitant horizontal strabismus in Singapore were profiled. The type and size of the strabismus, visual acuity, refractive error and stereopsis were noted at the initial presentation in 682 children aged <16 years presenting with strabismus. 72% were exotropic, the majority (92%) of whom had intermittent exotropia. The divergence excess type was most common (59.5%) followed by basic (29.0%) and convergence weakness (11.5%). Esotropia was present in 28% children. Children with infantile esotropia were younger, had larger squint size and were less hyperopic. Although exotropia was twice as frequent esotropia, the distribution and characteristics of various strabismus subtypes were similar to those described in the Western countries.

See page 1337

The Pakistan National Blindness and Visual Impairment Survey

Cataract remains the leading cause of blindness worldwide, accounting for nearly half of all blindness. With the population estimated at 160 million, Pakistan is the sixth most populous country in the world. A national blindness and visual impairment survey was undertaken to estimate the prevalence of visual impairment due to cataract, the prevalence of aphakia/pseudophakia, the cataract surgical coverage, and to identify barriers to the uptake of cataract services among adult population of Pakistan. Based on examination of 16 507 adults, the crude prevalence rate of blindness (<3/60 in the better eye) due to bilateral cataract was 1.75%. More than 3.5 million eyes were visually impaired (<6/60) due to cataract. Variation in surgical coverage was noted in relation to gender, place of residence and level of education. Cost of surgery was the main barrier to surgery.

See page 1269

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