Surgical decision in glaucoma simplex.

The indications for 220 trabeculectomies performed by six surgeons at three different centres were studied. 82% of the decisions to operate were based on a non-progressive but high risk situation. The 18% of cases showing preoperative deterioration were characterised by early presentation and low preoperative residual pressures. There was a distinct similarity in the incidence of individual indications at the different centres.

Symptoms without signs in outpatients attending ophthalmology clinics.

Ophthalmic outpatients without physical signs have been shown, as a group, to be significantly more anxious and depressed than a control group. They also have a higher incidence of somatic complaints of a kind commonly made by patients with psychiatric 'disorder'. There was a higher incidence of past psychiatric history in the proband group, and they also gave a greater subjective assessment of recent conscious life stress.

Aetiology of keratoconus.

Keratoconus has a common association with atopic conditions. Most keratoconus patients rub their eyes excessively. Eye-rubbing is considered the dominant aetiological factor in two-thirds of patients with keratoconus who progress to contact lens wear. A classification of keratoconus based on the dominant aetiological factors is proposed. No significant psychoneurotic factor was found in the keratoconus patients compared with patients in the control group.

Intraocular surgery in advanced glaucoma.

Loss of visual field subserving macular function has been found to be rare after intraocular surgery in advanced glaucoma. Abrupt changes in refractive error, lens opacity, and suppression must be carefully excluded before macular fixation is deemed lost. Out of 69 intraocular procedures (46 drainage operations, 13 cataract extractons) two patients lost central visual field subserving macular fixation possibly as a result of surgery. There is an increased incidence of postoperative maculopathy in late glaucoma. Three drainage operations out of 46 and four cataract extractions out of 13 had this complication. Altogether 30% of drainage procedures induced deterioration of visual acuity of lenticular origin to a level normally requiring cataract extraction. Trabeculectomy was found to be less likely to cause this sequela than the Scheie procedure at the 6 month postoperative stage. However, 77% of patients with advanced glaucoma and cataract obtained a satisfactory improvement in visual status after cataract extraction.

Eyes in arhinencephalic syndromes.

The ocular features of eight cases of arhinencephaly have been described. Prediction of the degree of brain involvement from the eye defects could not be made, but eye abnormalities were present in all cases. The relationship of these syndromes to chromosomal abnormalities is emphasized. In the less severe cases treatable endocrine dysgenesis must be excluded.