Orbital giant cell myositis is an unusual and potentially lethal cause of bilateral ophthalmoplegia - A case report and literature review.

We present a case of orbital giant cell myositis (OGCM), presenting with bilateral subacute progressive ophthalmoplegia and optic nerve dysfunction. An early extraocular muscle biopsy confirmed the diagnosis and guided appropriate management. Comprehensive investigation excluded any underlying systemic disease, including myocarditis. Twenty two months after presentation, the patient remains well on azathioprine with complete resolution of orbital signs.

Ptosis, ophthalmoplegia and corneal endothelial disease - ocular manifestations of mitochondrial disease.

PURPOSE: To describe two patients with bilateral ptosis, ophthalmoplegia, cataracts and corneal endothelial disease requiring corneal transplantation. OBSERVATIONS: Histopathological analysis of muscle biopsy samples from both patients identified features consistent with a mitochondrial cytopathy. A single multigenic mitochondrial deoxyribonucleic acid (DNA) deletion was detected in the first patient. Pathogenic mutations in the POLG gene which codes for mitochondrial DNA polymerase, tasked with replicating the mitochondrial genome were identified in the second patient. CONCLUSION: The collection of clinical features present in both cases described can be explained by a diagnosis of mitochondrial disease. IMPORTANCE: Corneal endothelial disease, in addition to ptosis, ophthalmoplegia, cataract, pigmentary retinopathy and optic atrophy should be recognised as a feature of mitochondrial disease.

The fourth New Zealand cataract and refractive surgery survey: 2007.

BACKGROUND: To examine the current practice and changing trends for cataract and refractive surgery in New Zealand (NZ) between 1997 and 2007. METHODS: A self-administered confidential postal questionnaire was sent to all consultant ophthalmologists practising in NZ in 2007, eliciting surgical volumes and technique, anaesthetic, preferred equipment and patient management. Results were compared with previous NZ surveys and international surveys of surgeons in Northern America, Europe and the UK. RESULTS: From the 113 ophthalmologists surveyed 88% responded, comprising 86 cataract surgeons and 20 refractive surgeons. Key findings for cataract surgeons were: 65% routinely used sub-Tenon's anaesthetic, 20% topical anaesthetic, 24% favoured intracameral antibiotics, 88% operated via clear corneal or anterior limbal incisions and 61% used temporal incisions. Acrylic foldable intraocular lenses (IOLs) were preferred, 27% of surgeons routinely used aspheric IOLs, 31% used presbyopia-correcting IOLs and 63% expressed high interest in toric IOLs. Of the refractive surgeons, 83% would perform bilateral LASIK at the same surgical event; phakic IOL was the treatment of choice for 30-year-old -12D myopes, and clear lens exchange for 45-year-old +5D hyperopes. CONCLUSIONS: The majority of NZ cataract surgical practice remains comparable with results from international surveys. A notable exception, as in previous comparisons, is a lower use of topical anaesthetic in NZ with a higher use of sub-Tenon's anaesthetic instead. Refractive surgery practice in NZ is generally comparable with that of American Society of Cataract and Refractive Surgery members.

The New Zealand ophthalmology workforce 2008.

BACKGROUND: The ongoing supply of quality ophthalmic care to the New Zealand (NZ) population depends on a sustainable ophthalmology workforce. The NZ population is growing and aging rapidly, placing increasing demands on ophthalmic services. Predicting future supply of NZ ophthalmologists requires an accurate description of the current workforce. METHODS: A confidential postal workforce survey, the fourth since 1997, was sent to all NZ consultant ophthalmologists in October 2007. A second survey conducted in January 2008 by email and direct telephone contact gained a complete dataset of NZ ophthalmologists. Results were compared with NZ population data, and the Australian Ophthalmology Workforce Model 2006 was used to estimate future demands on NZ ophthalmic services. RESULTS: There are currently 16-24 vacancies for consultant ophthalmologists in NZ, with another eight positions planned to be created by 2010, bringing the shortfall to 24-32. Retirement rates average to three per year, although 28 consultants are planning to retire by 2013. Retention of new NZ Fellows stands at around 71%. Increasing demands of an aging population are likely to increase the shortfall of ophthalmologists to 40-50 by 2015, and 46-69 by 2025. CONCLUSIONS: This report identifies a growing gap between supply of NZ ophthalmologists and demand for their services. We highlight the need for a comprehensive model with a detailed analysis of the many factors influencing supply and demand, enabling planning for an appropriate supply of ophthalmologists meeting the needs of the future NZ population.