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PRIMARY LENS EXTRACTION IN ACUTE PRIMARY ANGLE CLOSURE

Although peripheral iridotomy is the current standard therapy for acute primary angle closure many Asian eyes with angle closure develop uncontrolled intraocular pressure even after this treatment. Tan and co-workers describe the results of a prospective observational case series of 135 consecutive angle closure patients who underwent primary lens extraction. They document good visual acuity and a low complication rate for this procedure. See p 14

OUTCOMES OF VITRECTOMY FOR DIABETIC MACULAR OEDEMA

Vitrectomy for diabetic macular oedema is a well established therapy. However, whether there are subgroups of patients with diabetic macular oedema who are more appropriate for this therapy has not yet been established. Shah and co-workers describe a prospective interventional case series of 33 patients who underwent vitrectomy for diabetic macular oedema. In this study the visual benefit for diabetic macular oedema was limited to patients who exhibited signs of macular traction either clinically and/or on optical coherence tomography. See p 33

MAKING TRABECULECTOMY SAFER

The classic trabeculectomy technique has at least three weaknesses—the amount of filtration is variable, peroperative flat chamber and hypotony are a serious complication, and debris that remains at the surgical site can induce an inflammatory response that leads to fibrosis of the wound. Stalmans and co-workers describe a technique of trabeculectomy using a fornix based conjunctival flap, an anterior chamber maintainer, and a standardised punch technique combined with an adjustable and releasable suture. This procedure offers the possibility to tailor the intraocular pressure postoperatively with a minimum of postoperative complications. See p 44

AGE RELATED MACULAR DEGENERATION AND THROMBOSPONDIN-1

The pathogenesis of age related macular degeneration is only incompletely understood. It has, however, been suggested that an increase of pro-angiogenic factors may contribute to the choroidal neovascularisation associated with this disorder. Uno and co-workers investigated the expression and localisation of thrombospondin-1. In this study thrombospondin-1 was found in Bruch’s membrane and choroidal vessels during development of age related macular degeneration. See p 48

AGE RELATED MACULAR DEGENERATION, SUN EXPOSURE, AND SMOKING

Excessive sun exposure has been suggested to be a risk factor for the development of age related macular degeneration. However, Khan and co-workers describe 446 cases with end stage age related macular degeneration who were compared to 283 spouse controls. In this study there was no association between age related macular degeneration and sun exposure nor change in iris or hair colour. Recent studies have suggested that smoking may be a significant risk factor in the development of age related macular degeneration. The same group of workers describe their findings in the same study group of 435 cases of age related macular degeneration. In this study the risk of developing age related macular degeneration was significantly linked to smoking and the amount smoked. Stopping smoking was associated with reduced odds of developing age related macular degeneration. The authors demonstrate a very strong association between the risks of geographic atrophy and choroidal neovascularisation and the past years of cigarette smoking. Stopping smoking appears to be an effective way to reduce the risk of developing age related macular degeneration. See pp 29 and 75

STEREOACUITY IN THE ADULT POPULATION

Stereoacuity is frequently measured in the paediatric ophthalmic population because of its usefulness in the detection and evaluation of amblyopia and strabismus. It is less commonly measured in the adult population. Garnham and Sloper studied stereoacuity in 60 normal adult subjects. They found that there was a decline in stereoacuity with age no matter which stereoacuity tests were used. The authors suggest that cortical stereoacuity found using random dot stereo tests alone should be interpreted with some caution, particularly in relation to everyday visual function in older patients. See p 91

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