Effect of applanation tonometry on mean corneal curvature.

PURPOSE: To evaluate whether applanation tonometry affects corneal curvature and if so, the implications for intraocular lens power calculation. SETTING: Birmingham and Midland Eye Hospital, Birmingham, England. METHODS: Twenty-two patients attending the preoperative assessment clinic were enrolled in the study. Keratometry was performed immediately before, 1 minute after, and 10 minutes after standard Goldmann tonometry. Main outcome measures were mean corneal refractive power and its reproducibility (coefficient of repeatability). RESULTS: No clinically significant difference was noted between preapplanation and postapplanation readings (P = .6), and reproducibility was not significantly affected. CONCLUSION: The results indicate that corneal applanation before keratometry does not compromise the prediction of postoperative refraction.

Day-case trabeculectomies: safety and efficacy.

A comparison of 90 day-case and 102 in-patient trabeculectomies is presented. There was no statistically significant difference in the incidence of post-operative hyphaema (Chi-squared test p = 0.84), shallow anterior chamber (p = 0.46), flat bleb (p = 0.84) or hypotony (p = 0.87) between the two groups. Casualty attendances, readmissions and further surgery in the postoperative period were seen with similar frequency in each group. Intraocular pressure control three months following surgery was not compromised by undergoing the procedure as a day-case (p = 0.29). This study demonstrates the safety and efficacy of ambulatory filtration surgery.

A novel conjunctival incision for horizontal strabismus surgery.

We present a randomised, controlled study of a new approach to conjunctival incision in horizontal strabismus surgery. A peritomy is performed from 2 to 10 o'clock inferiorly allowing free access to the horizontal recti from below. No limbal stay sutures are required and the conjunctiva is left unsutured on completion of surgery. Results of 13 patients are presented. Each patient is paired with a control on whom conventional surgery was performed. The pairs were matched for age and surgeon. Results show a decrease in the time taken for the procedure and decreased discomfort in the post-operative period. The external appearance of the operated eye and the incidence of complications over a 6 week period were the same for both techniques.

Bilateral metastatic endophthalmitis as a complication of major burns.

Metastatic infection of the eye is a rare complication of burns. The following report describes a patient with endophthalmitis occurring as a complication of major burns. The diagnostic difficulties that arose are discussed and the recommended treatment outlined.

Removal of scleral explant elements: a 10-year retrospective study.

There are several studies in the American literature on the incidence and causes of retinal redetachment following removal of explants. This is, to our knowledge, the first such study from Britain and differs in its findings from the American experience. The reason for removal of explants, the time of removal after initial detachment surgery and the consequences of removal were reviewed for the 10-year period from 1980 to 1990. During this period 1898 retinal detachment operations were performed at this centre, with an explant removal rate of 3.2% (61 eyes). Extrusion of the element was the cause in 74%. Of these 8% subsequently suffered a redetachment. In two eyes no retinal break was identified at initial surgery. Both of these suffered a redetachment following removal of the explant. Contrary to previous reports, redetachment was not related to short periods of explant or to infection of the explant. This study suggests that explant removal is a safe procedure. However, there is a significant risk of redetachment after explant removal if no breaks are identified at the time of initial surgery.

Cyclic esotropia in a patient with unilateral traumatic aphakia: case report.

Cyclic esotropia is a rare and poorly understood condition normally treated by correcting the deviation measured on the squinting day. Control in some patients with this condition can be gained by correcting their refractive errors, thereby improving acuity. We report on an adult patient who developed cyclic esotropia after unilateral traumatic aphakia with failed contact lens wear whose squint was corrected by secondary intraocular lens implantation. This may be explained by the reduction in the degree of aneisokonia which subsequently improved steropsis.

Intraocular foreign bodies. Indications for lensectomy and vitrectomy.

This review of the outcome of the conventional management of magnetic foreign bodies shows that, with the exception of the severe open-eye injuries associated with large foriegn bodies, where immediate lensectomy and vitrectomy is required, conventional magnetic extraction should be performed as close to the foreign body as is feasible. It is important to assess posterior segment damage both before and after extraction of the foreign body, as the subsequent management will depend on the presence of vitreous haemorrhage and retinal damage.

Peripheral retinal cryotherapy as a treatment for neovascular glaucoma.

This treatment does have a place in the management of the established conditions because, when it is successful, some guiding vision is maintained; this is potentially important, as a central retinal vein thrombosis may affect the second eye. Restoring a normotensive eye has other long-term advantages; it is cosmetically better, and is unlikely to lead to a degenerate cornea, which would otherwise occur, and might lead to late endophalmitis.

Interaction of prostaglandin E 1 and calcium in the guinea-pig myometrium.

1. Prostaglandin E(1) (PGE(1)) increased the responses of guinea-pig myometrium in a low calcium medium to added Ca(2+), acetylcholine, vasopressin, Ba(2+) and Sr(2+). The concentration of PGE(1) used (50 pg/ml) was clearly below the threshold for direct spasmogenesis. In the presence of PGE(1) the doses necessary for half-maximal contractions were decreased by factors of 2.6 for Ca(2+), 2.4 for acetylcholine, and 3.7 for vasopressin. The responses to Ba(2+) or Sr(2+), though studied less extensively, were found to be affected in much the same manner.2. The K(+) depolarized myometrium in a low Ca(2+) medium contracts in response to added Ca(2+). These responses also were increased by low concentrations of PGE(1), but the effective concentration of PGE(1) was indistinguishable from that for direct spasmogenesis.3. Possible mechanisms for the interaction of PGE(1) and Ca(2+) in the myometrium are discussed. It is tentatively suggested that these findings may be relevant to the physiological control of human myometrium.