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THE CONTINUING PROBLEM OF LEPROSY
Over 700 000 new cases of leprosy were registered in the year 2000. Leprosy is still considered a public health problem in 15 countries. Mpyet and Solomon report a study from eastern Nigeria of the causes of blindness and low vision in patients with leprosy. Only a third of the burden of ocular pathology in these patients was related directly to the effects of leprosy. Other major causes of visual disability included cataract and refractive error. See p 417
WHAT IS THE CAUSE OF THE DECREASE IN STRABISMUS SURGERY?
Several studies in the United Kingdom and in Canada have suggested that there is a dramatic decrease in surgical correction of strabismus in children, ranging from 42% to 59%. Arora and co-workers performed a retrospective analysis of strabismus surgery performed in England and Wales, and in Ontario, Canada. In this study there was a 41% decrease in strabismus procedures in England and Wales from 1989–99 and a 26% decrease in Ontario, Canada from 1994–2000. Two factors explain this decreas—better conservative strabismus management and improved quality of surgery with a reduction in the need for re-operation. See p 409
THE QUESTION OF INDOCYANINE GREEN TOXICITY
Idiopathic epiretinal membrane is seen in 2% of those under 60 years of age and 12% of those beyond the age of 70. It may be associated with macular dysfunction and require surgical removal. Indocyanine green has been introduced to enhance visualisation of the epiretinal membrane. Potential toxicity of the dye however has been a subject of great controversy. A study by Lee and co-workers of 37 patients suggests that trypan blue dye is less toxic than indocyanine green when used in dye assisted peeling of epiretinal membranes and macular hole repair. In contrast, Hillenkamp and co-workers studied 39 patients who underwent epiretinal membrane surgery with or without the assistance of indocyanine green. In this study no adverse effects attributed to indocyanine green were recognised. See pp 420 and 437, and editorial, p395
THE PROBLEM OF KERATITIS AND CONTACT LENS WEAR
Contact lens practice has changed dramatically over the past decade with the introduction of daily disposable lenses and silicone hydrogel materials. Nevertheless, complications of contact lens wear persist. Of particular interest is the problem of keratitis. Morgan and co-workers performed a prospective 12 month study of contact lens wearers and the problem of keratitis. In this study severe keratitis was significantly more of a problem in those contact lens wearers who slept in their contact lenses. The authors recommend that patients who choose to sleep in their contact lenses should wear silicone hydrogel lenses which are less likely to cause severe keratitis. See p 430
SURGICAL PROCEDURES AND CONGENITAL GLAUCOMA
Primary congenital glaucoma continues to be a difficult problem to treat. The choice of surgical procedure for this disorder is not clear. Al-Hazmi and co-workers report on 532 paediatric glaucoma patients operated on before 1 year of age. In this study dividing the cases into mild, moderate, and severe appeared to be important in deciding which surgical procedure to perform. The mild form had a high surgical success rate regardless of the procedure chosen. However, for moderate and severe cases, trabeculotomy-trabeculectomy with mitomycin C gave the best results. See p 449
REFRACTIVE ERRORS AND RETINAL DYSFUNCTION IN CHILDREN
Ametropia has been known for some time to be a common finding in many retinal disorders. Flitcroft and co-workers studied 123 consecutive patients referred for electrophysiological investigation of reduced vision. High ametropia and astigmatism in children was associated with a higher rate of retinal electrophysiological abnormalities than emmetropia. This finding suggests that the retina is involved in the process of emmetropisation. See p 484
THE FUTURE OF GLAUCOMA SURGERY?
Although antiproliferative drugs have been used successfully to prevent scarring after filtration surgery alternative techniques to enhance filtration bleb success rates are under investigation. A single application of β radiation leads to long term growth arrest and expression of p53 in Tenon’s capsule fibroblasts. Johnson and co-workers report the use of recombinant adenoviral vector containing transgenes encoding for human p53. Adenoviral p53 gene transfer led to significant growth inhibition of human Tenon capsule fibroblasts. The authors suggest that p53 may have the potential to replace mitomycin C and 5-fluorouracil in glaucoma surgery. See p 508