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INHIBITING WOUND HEALING IN TENON’S CAPSULE
The postoperative healing response that occurs in the subconjunctival tissue following filtration surgery for the treatment of glaucoma is an essential process in determining the success of such surgery. Treatments that modulate the subconjunctival healing response, especially 5-fluorouracil (5-FU) and mitomycin C (MMC), have been extremely effective in preventing bleb failure. Constable and coworkers describe the effect of a single dose of β radiation on the wound healing behaviour of human Tenon capsule fibroblasts. They demonstrate that unlike the effects of 5-FU and MMC the growth arresting dose of β radiation does not alter the ability of human Tenon’s fibroblast to migrate or contract. β Radiation appears to act as an effective antiproliferative treatment but not as a global inhibitor or on fibroblast wound healing. See p 169
INTRAOCULAR LENS CHOICE AND POSTERIOR CAPSULE OPACIFICATION
Many different kinds of folding intraocular lenses composed of various different optical materials have been developed. In choosing a specific lens one of the important questions is whether or not it is associated with significant posterior capsule opacification. Hayashi and coworkers describe 95 patients who underwent a hydrogel intraocular implant in one eye and an acrylic intraocular lens implant in the opposite eye. In this study posterior capsule opacification in eyes with a hydrophilic hydrogel intraocular lens is significantly more extensive than in eyes with a hydrophobic acrylic lens. See p 182
β ANTAGONISTS AND RESPIRATORY SIDE EFFECTS
Topical β antagonists are prescribed for glaucoma in approximately 500 000 people in the United Kingdom. They are associated with an excess incidence of airway obstruction. Kirwan and coworkers studied whether selective topical β antagonists are associated with excess airway obstruction. In this study, 12 of 1324 patients treated with selective topical β antagonists developed airway obstruction. This was considerably higher than in a control group. The authors conclude that even selective β antagonists have a significant risk of obstructive respiratory side effects. See p 196
PHOTODYNAMIC THERAPY: IS IT WORTH IT?
Although two published trials have clearly shown that photodynamic therapy with verteporfin is more effective than placebo in slowing the rate of visual loss in patients with age related macular degeneration the cost associated with this therapy is considerable. Concern has been raised therefore that this is not a cost effective therapy for age related macular degeneration. Meads and Hyde undertook a systematic review of the clinical effectiveness of PDT compared with current practice. They conclude that the true size of the effect of this therapy is particularly important in assessing cost effectiveness. If the whole trial estimate is used, relatively pessimistic results are obtained. In contrast, subgroup analysis results in cost effectiveness being demonstrated in some of the subgroups in comparison with the results of a whole trial estimate. See p 212
CONGENITAL FOURTH NERVE PALSIES—ARE THEY REALLY?
So called congenital fourth nerve palsies are commonly seen in clinical practice. Recent observations have suggested that these vertical deviations may not come about as the result of injury to the fourth nerve directly but because of congenital anatomical anomalies of the superior oblique tendon, trochlear position, and/or orbital configuration. The well recognised orbital asymmetry seen in congenital fourth nerve palsies has raised the question of whether the pathophysiology of these deviations is due to a minor orbital asymmetry. Jiang and coworkers challenged this notion by suggesting that mutations of the ARIX, a homeobox-containing gene, that is found in families with congenital fibrosis of the extraocular muscles (type 2) may be seen in patients with congenital superior oblique muscle palsy as well. In this study nucleotide changes were identified in five patients. Whether these nucleotide polymorphisms are important in the pathophysiology of congenital superior oblique muscle palsy remains to be determined. See p 263