Penetrating keratoplasty in the mentally retarded.

Penetrating keratoplasty is infrequently performed in the mentally retarded due to the high risk of serious post-operative complications, in particular wound rupture and severe inflammation of the graft. Graft survival is hindered by the patient's tendency for eye rubbing and possibly self-inflicted injury. Adequate nursing support is essential to ensure strict compliance with post-operative treatment. A retrospective study of corneal graft outcomes in mentally retarded patients was undertaken to assess graft survival, visual rehabilitation, post-operative complications and the influence on social behaviour. Six cases of penetrating keratoplasty performed in mentally retarded patients by one surgeon are presented. A continuous 10-0 nylon suture was employed in all cases. In 2 cases surgery was undertaken following perforation of the globe in patients with Down's syndrome. The grafts were retained in all cases and 2 patients achieved reasonably good acuity, although formal visual acuity assessment in these patients is limited. Penetrating keratoplasty in mentally retarded patients is a potentially hazardous procedure and patients require close supervision and good support care. This series demonstrates that relatively successful outcomes can be obtained in some mentally retarded patients.

Congenital ptosis: a good cosmetic result with redefinition and suturing of the orbital septum.

A surgical technique employing orbital septum sutures during ptosis surgery in children is described. A retrospective study of 16 children (age range 6 months to 14 years) undergoing surgery for congenital ptosis over a 6 year period was undertaken with regard to cosmetic outcome. All surgery was performed by one consultant ophthalmic surgeon with the patient under general anaesthesia. A standard levator resection was undertaken, following which the orbital septum was redefined and sutured with interrupted 5-0 catgut. This resulted in a well-defined lid crease post-operatively, with a good cosmetic outcome. The only significant post-operative complication was the occurrence of a suture-related granuloma in one patient. All achieved a good cosmetic result. A mild residual ptosis occurred in 3 cases, requiring a further procedure. Special attention to suturing of orbital septum as a separate tissue layer during levator resection for congenital ptosis gives good lid crease definition which may enhance the overall cosmetic outcome.

Photorefractive keratectomy for myopia: 6-month results in 95 eyes.

Ninety-five eyes of 91 patients with myopia from -1.00 to -6.00 D (mean -3.40 D, +/- 1.2) were treated with an ExciMed UV2OOLA 193-nanometer excimer laser (Summit Technology, Inc, Waltham, Mass) (with version 5.5 software) with a 5-millimeter ablation zone. At 6 months, 67 eyes (70%) were within +/- 0.50 D, 84 eyes (88%) were within +/- 1.00 D, and 94 eyes (99%) were within +/- 2.00 D. There was an average overcorrection of +0.25 D which had decreased to +0.18 D by 9 months. Best spectacle corrected visual acuity was 6/6 or better in 88 eyes (94%) and six eyes (6%) had a corrected visual acuity of 6/9. Fifty percent of eyes had slight astigmatism (mean 0.68 D, range 0.25 to 2.00 D) and this reduced to 0.33D (0.02 > p > 0.01) at 6 months.

Ocular complications of systemic steroid after renal transplantation and their association with HLA.

The eyes of 62 patients who had received allogenic renal transplants were examined for eye disease. Thirty-six patients were found to have steroid induced cataract. Six patients had ocular hypertension. Twelve patients showed arteriosclerotic changes in their fundi relating to their previous hypertensin. There was no significant difference in HLA type in patients who developed cataract and those who did not. 83.3% of the 6 patients with ocular hypertension had HLA B12 in common. None of the patients had cytomegalic retinitis.

Ocular manifestations of Turner's syndrome.

In a series of 24 patients with Turner's syndrome, amblyopia was found to be present in ten (41.6 per cent), strabismus in nine (37.5 per cent), hypermetropia in ten (41.6 per cent), ptosis in seven (29.1 per cent), and bilateral epicanthus in eleven (45.8 per cent) cases. Turner (1938) described a syndrome of infantilism, congenital webbed neck, and cubitus valgus, which has come to be known as Turner's syndrome. Since then many cases have been reported and multiple other associated features have also been recognized. Isolated ocular features have been mentioned in some sporadic case reports (Cunningham and Harley, 1951; Laurent, Royer, and Noel, 1961; Lessell and Forbes, 1966; Khodadoust and Paton, 1967; Szymanska and Szymanski, 1976; Troupe and Troupe, 1981). So far no significant series of cases has been studied to assess the ocular defects. This report of a series of 24 patients presents classified ophthalmic features.

Prognosis of perforating eye injury.

The assessment of visual function in a series of 130 consecutive patients of perforating eye injuries, revealed that visual acuity of 6/12 or better was regained in 63 per cent, between 6/60 and 6/18 in 9-2 per cent, less than 6/60 in 15-3 per cent, and enucleation was necessary in 9-2 per cent. In 3 per cent, the eyes were retained as blind, symptomfree, and cosmetically satisfactory organs. Two eyes were found to develop complete traumatic aniridia. None in the series was found to have sympathetic ophthalmitis.