Methods: The experiment was conducted using New Zealand rabbits. The rabbits were randomly divided into three experimental groups. Twenty eyes received injections of 0.2 ml of one of the two anaesthetic preparations and ten control eyes received injections of 0.2 ml of balanced salt solution. Corneal thickness and clarity were measured before and 3 and 6 hours after surgery. Anterior chamber reaction was evaluated 1, 3, and 6 hours after the surgery. In corneal and lens tissues, malondialdehyde (MDA) and total thiol (SH) levels were measured with spectrophotometric methods.

Results: Levobupivacaine 0.5% caused corneal thickening, oedema, and anterior chamber reaction (p < 0.001). There were no biochemical changes in the levobupivacaine group (p > 0.05). We observed no change in the corneal thickness, oedema, and anterior chamber reactions while the level of MDA significantly increased in corneal and lens tissues (p < 0.001, p = 0.015, respectively), and the level of SH significantly decreased in the lens tissue in the lidocaine 2% group (p < 0.001).

Conclusions: The results of this study suggest that levobupivacaine 0.5% is shown to have an immediate toxicity on corneal endothelium. Lidocaine 2% causes oxidative damage on corneal and lens tissues. Surgeons should not prefer repetitive and high doses of intracameral lidocaine and use it in the presence of corneal pathology during cataract surgery.

Methods: A polymerase chain reaction (PCR)-amplified cDNA library was constructed using the RNAs isolated from FVMs obtained during vitrectomy. The sequence from the 5' end was obtained for randomly selected clones and used to generate expressed sequence tags (ESTs). Functional annotation was retrieved from Ensemble database and analyzed by FatiGo. The web-based VisANT software was used to identify the molecular networks within the FVMs.

Results: A total of 2816 ESTs were assembled in 625 nonredundant clusters. Among these, 515 matched the human cDNA database. The 515 clusters were subdivided by functional subsets of genes related to ribosomal activity, oxidative phosphorylation, focal adhesion, cell adhesion, and other functions. Querying against VisANT database yielded 3175 possible physical relationships to other genes/proteins which included an additional 2480 genes that were not detected in the FVM library.

Conclusions: The cDNA library constructed from human FVMs will be a valuable source of information that should facilitate a wide range of studies that can establish the molecular mechanisms underlying the development of FVMs.

Methods: Serum from 9 VKH patients and 9 controls with age-related or congenital cataract, was collected before and 1, 7, 30, and 90 days after surgery, and aqueous humor (AqH) at commencement of surgery. Protein levels of IL-23, IL-27, IL-17 and IFN- in serum and AqH were measured by ELISA. Laser flare-cell photometer was used to quantify intraocular inflammation.

Results: Serum IL-23 levels were significantly increased in VKH vs. control patients and peaked at 1 day postoperative, decreased rapidly in the first week, then attenuated gradully. In VKH patients, serum levels of IFN- were elevated in the first week after surgery and IL-27 was upregulated in the first month. Importantly, serum IL-23 levels were strongly correlated with aqueous flare value (r = 0.689; P = 0.007) and cell counts (r = 0.671; P = 0.01) in VKH vs. control patients.

Conclusions: Our data indicate that serum IL-23 levels are significantly elevated in VKH vs. control patients and strongly associated with postoperative intraocular inflammation.

Methods: A Pubmed review of the literature was performed for trabeculectomy, glaucoma drainage device procedures (Ahmed, Baerveldt and Molteno implants) and non-penetrating glaucoma surgery (deep sclerectomy and viscocanalostomy) for reports of postoperative infection, including blebitis, endophthalmitis, keratitis and orbital cellulitis. In addition, case series of non-penetrating glaucoma surgery with follow-up of at least 2 years were also reviewed.

Results: Sixty four articles on infections after glaucoma surgery were identified. Forty eight publications were related to infections following trabeculectomy, fifteen for glaucoma drainage devices, and only three for non-penetrating glaucoma surgery. There have not been any publications describing postoperative infective endophthalmitis associated with non-penetrating glaucoma surgery.

Conclusions: The literature on infections related to non-penetrating glaucoma surgery is sparse, in contrast to that for trabeculectomy and glaucoma drainage device procedures. Thus far, no case of endophthalmitis has been reported following non-penetrating glaucoma surgery, even with the use of intraoperative antimetabolites. However, there is currently insufficient evidence to conclusively demonstrate that NPGS is associated with significantly less risk of endophthalmitis and infection when compared to trabeculectomy and glaucoma drainage device implantation.

Methods: Cluster random surveys were undertaken to evaluate SAFE following three years of interventions. Children aged 1-9 years were examined for trachoma signs using the WHO simplified grading system and structured questionnaires used to assess uptake of A,F, and E. Active trachoma signs (trachomatous inflammation-follicular [TF] and trachomatous inflammation-intense [TI]) were used to derive an ordinal severity score where TI was considered more severe than TF. Associations between active trachoma and potential factors were investigated using ordinal logistic multilevel regression models.

Results: A total of 1,813 children aged 1-9 years were included in the analysis. Factors independently associated with reduced odds of active trachoma signs were: number of times treated with azithromycin (p-trend=0.026); months since last mass azithromycin distribution (p-trend<0.001); clean face (OR=0.6; 95% CI 0.5–0.8); and household pit latrine (OR=0.8; 95% CI 0.7–0.9).

Conclusion: These findings are important since they make the case for continued implementing the A,F,E interventions simultaneously, and suggest appropriate timing of SAFE evaluations within 6-12 months after the last mass azithromycin distribution.

Methods: Twenty one specimen including 12 normal human corneas from 7 deceased patients, two eye bank corneo-scleral buttons, two eye bank corneo-scleral rims and 5 post-surgical specimens from 3 patients with keratoconus were studied. Corneal whole mounts were stained for cholinesterase enzyme using the Karnovsky & Roots direct coloring thiocholine modification of Acetylcholinestrase (AchE) technique.

Results: Approximately 44 thick nerve bundles were found to enter the human cornea in a relatively equal distribution round the limbus and move randomly toward the central cornea. At the mid-peripheral zone, anterior stromal nerves showed a characteristic budding and branching pattern. After passing through Bowman's zone they were noted to terminate into bulb like thickenings from which multiple sub-basal nerves arose. The perforation sites were predominantly located in the mid-peripheral cornea. The orientation of sub-basal nerves was mainly vertical at their origin from the perforation sites. Nerves from all directions converged toward the infero-central cornea to form a characteristic clockwise whorl pattern.

Conclusions: This study provides a comprehensive account of the architecture and distribution of nerves in the human cornea. It reconciles some of the existing information obtained from other modalities of investigation and identifies some novel features which provide a more complete picture of corneal innervation.

Methods: Eighty-eight eyes of 44 patients with moderate myopia were randomized to PRK with 0.002% MMC for one minute in one eye and LASIK in the fellow eye. One year follow-up was evaluated.

Results: There were no differences between LASIK and MMC-PRK eyes preoperatively. Forty-two patients completed one year follow-up. MMC-PRK eyes achieved better UCVA (p=0.03) and better BSCVA (p<0.001) one year after surgery. SE did not differ in the two groups during follow-up (p=0.12). Clinical significant haze was not found in surface ablation eyes. LASIK eyes presented greater HOA (p=0.01) and lower contrast sensitivity (p<0.05) than MMC-PRK eyes postoperatively. Excellent vision was reported in 64% of LASIK and 74% of MMC-PRK eyes one year after surgery. Corneal resistance factor and corneal hysteresis (ORA, Reichert Inc.) were higher in LASIK than in MMC-PRK eyes (p<0.01) at last follow-up.

Conclusions: Wavefront-guided PRK with 0.002% MMC was more effective than wavefront-guided LASIK for correction of moderate myopia. Further research is necessary to determine the optimal concentration, exposure time and the long-term corneal side effect of MMC.

To study the long-term visual and anatomic outcomes of anti-vascular endothelial growth factor (VEGF) monotherapy for the treatment of patients with retinal angiomatous proliferation (RAP).

To describe a novel technique for the preparation and transplantation of posterior corneal lamellae consisting of endothelium and bare Descemet’s membrane with a stromal supporting rim.

To establish the prevalence of heterophoria and its association with refractive error and ethnicity in a population-based study of Australian school children.

The MacuScope^TM uses a psychophysical technique known as heterochromatic flicker photometry to measure macular pigment optical density (MPOD). Our aim was to determine the measurement variability (noise) of the MacuScope^TM.

To review the evidence for the presence of lower levels of psychosocial well-being in working age adults with visual impairment, and for interventions to improve such levels of psychosocial well-being.

This study aimed to answer if Mycobacterium tuberculosis can be detected in corneas of donors who have active tuberculosis (TB) disease using polymerase chain reaction (PCR) or culture.

We aimed to develop and assess a zonal classification of the retina to facilitate description of the location of retinal haemorrhages in children.

Central retinal vein pulsation is affected by intracranial pressure (ICP), glaucoma and venous pathology. Its genesis is poorly understood with most models suggesting that intraocular pressure (IOP) fluctuation dominates the rhythm of venous pulsation, however this has not been explored experimentally. We planned to measure the timing of central retinal vein pulsation with respect to intraocular pressure pulse.

Type 2 (perifoveal) telangiectasia often is refractory to treatment, because focal targets such as aneurysms are not detected by fluorescein angiography (FA) in these eyes. We evaluated the efficacy of indocyanine green angiography (IA)-guided laser photocoagulation and sub-Tenon’s capsule injection of triamcinolone acetonide (STTA) for idiopathic macular telangiectasia.

To describe air regurgitation as a complication in patients on continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) following dacryocystorhinostomy (DCR) surgery with or without Lester Jones tube (LJT) insertion.

To assess the choroidal thickness and choroidal circulatory changes in eyes with myopic choroidal neovascularization (mCNV).

To provide a systematic review on ocular firework trauma with emphasis on incidence and patient demographics, the extent of ocular trauma and visual function loss, and firework regulation effects on injury rates.

ETo investigate the influence of 0.5% timolol gel-forming solution on ocular wavefront aberrations.

To compare 24-hour IOP control of morning and evening administered bimatoprost/timolol fixed combination (BTFC) and evening administered bimatoprost in exfoliative glaucoma (XFG).

To compare the quality of vision of patients with customized-aspheric intraocular lenses (IOL) versus patients implanted with zero-aberration IOL after a 1.8 mm micro-incision cataract surgery (MICS).

To compare two different techniques for preparation of precut lamellar corneal tissue for Descemet Stripping Automated Keratoplasty (DSAEK).

To assess the test-retest variability of intraocular pressure (IOP) and ocular pulse amplitude (OPA) measurements utilizing Dynamic Contour Tonometry (DCT) and to evaluate possible influential factors.

Adherent silicone oil on intraocular lenses (IOLs) following retinal detachment surgery induces large and irregular refractive errors, multiple images and gives rise to glare, distorted and often poor vision. Its removal remains challenging often requiring mechanical wiping or explantation. F4H5 is a new semifluorinated alkane into which silicone oil is readily soluble. We aim to establish the effectiveness of F4H5 in removing silicone oil from three different types of IOL in vitro.

The essential roles of basophils as an initiator of chronic allergic reaction has been elucidated in mouse models. The aim of this present study was to analyze the in situ immunolocalization of basophils and other relevant inflammatory cells in chronic allergic keratoconjunctivitis.

To report on a 23-gauge cannula with a microvitreoretinal (MVR) blade trocar which improved wound closure after vitrectomy and reduced the incidence of postoperative hypotony.

To investigate the incidence of Nd:YAG-laser treatment for posterior capsular opacification (PCO) over a period of five years from phacoemulsification in an unselected population, comparing outcomes for three acrylic intraocular lenses (IOLs).

We estimated the association between corneal biomechanical properties and axial length in myopic children and verified the relationship between axial length and intraocular pressure (IOP).

To examine the age- and gender- specific prevalent and 5-year incident risk of developing exfoliation syndrome (XFS).

To evaluate the invivo confocal microscopic corneal features seen in patients that underwent Descemet’s Stripping with Endothelial Keratoplasty (DSEK) and to correlate these findings with the postoperative best spectacle corrected visual acuity (BSCVA) obtained at the time of confocal microscopy.

The study involved eyes affected by pigment dispersion syndrome (PDS) or pigmentary glaucoma (PG) investigated by ultrasound biomicroscopy (UBM). Different iridocorneal parameters were assessed and compared to those from healthy controls. The aim was to investigate the capacity of the UBM in differentiating the cases and, potentially, in confirming the pathogenic mechanisms.

Congenital anophthalmos and microphthalmos do occur in 1-20/ 100,000 newborns. The conditions may be characterised by associated pathology in the fellow eye when unilateral disease is present and/or by complex systemic anomalies.

Congenital superior oblique palsy is usually associated with a structural abnormality of the superior oblique tendon. There have been many reports of familial congenital superior oblique palsy. However, there has been no magnetic resonance imaging (MRI) documentation of familial superior oblique hypoplasia.

To determine the risk of growth of presumed choroidal nevi in the adult Chinese population in Greater Beijing.

To investigate the change that occurs in intraocular pressure (IOP) and ocular pulse amplitude (OPA) with accommodation in young adult myopes and emmetropes.

To evaluate episcleral plaque radiotherapy with high dose I-125 for the treatment of circumscribed choroidal hemangioma (CCH).

To describe the fluorescein angiographic, fundus autofluorescence, and optical coherence tomography (OCT) findings in patients with a unique unilateral lesion of the temporal macula previously named torpedo maculopathy.

Rarebit testing implies probing for gaps in the neuro-retinal receptive field matrix, using bright micro dots on a dark background. Previous reports have found rarebit testing useful for the detection of macular lesions. In its original implementation the test requires darkroom facilities and a long test distance (2 m).

To compare detection rates of drusen and subretinal fluid by Fourier domain optical coherence tomography (FD OCT) and orange pigment by fundus autofluorescence (FAF) with ophthalmoscopy in indeterminate choroidal melanocytic lesions.

To evaluate the ultrastructural changes in the macula after successful repair of rhegmatogenous retinal detachment (RRD) using simultaneous spectral domain optical coherence tomography (sdOCT) and fundus autofluorescence (FAF) imaging and to perform functional correlations with microperimetry.

Diagnosis of rejection in the mouse model of corneal transplantation is based on subjective judgement of loss of graft transparency. The aims of this study were to (i) evaluate a pachymetry technique to measure changes in mouse corneal thickness, and (ii) to correlate increases in transplant thickness with clinical and histological correlates of rejection.

Retinoblastoma is one of the most common malignant tumors of childhood in Africa. However, very few studies on this disease have been published, particularly in French speaking countries in Africa.

To examine ethnic differences in optic nerve head and retinal nerve fibre layer (RNFL) parameters between European Caucasian and East Asian children aged 6 and 12 years.

Central visual loss caused by conditions such as age related macular degeneration is the commonest cause of blindness in the United Kingdom. Eccentric viewing training aims to teach the patients how to utilise the functioning areas of macula. This technique has yet to gain acceptance in U.K despite evidence of success.

To compare the optical coherence tomography (OCT) features of acute central serous chorioretinopathy (CSC) versus exudative age-related macular degeneration (AMD), and to determine if OCT features can distinguish between these two entities.

Methods. Prospective multicentre population based observational study. Data was collected on all patients with primary retinal detachment presenting in Scotland between 1 November 2007 and 31 October 2008. Every patient was allocated a validated deprivation ranking according to their postcodes based on the Scottish Index of Multiple Deprivation (SIMD), which takes into account income, employment, health, education, housing, geographic accessibility and crime in 6505 postcode based datazones. The patients were divided into four quartiles according to their SIMD ranking.

Results. 572 patients were included. The annual incidence of detachment declined from 15.4/100,000 in the most affluent quartile to 13.6/100,000 in the second, 9.3/100,000 in the third and 6.9/100,000 in the most deprived (x² for trend = 50.2, p<0.0001). The trend was more marked for men than women, but was present in both sexes. There were no differences in the rate of macula-off detachments, nor the number of quadrants detached. Rates of pseudophakic and myopic detachment were evenly distributed across all quartiles.

Conclusions. Retinal detachment appears to be associated with affluence. This has not been previously reported and may be partly responsible for the variation in estimates of the incidence of retinal detachment. It may also have implications for service planning. The reason for this association is unknown.

Methods: In 22 molecularly proven PXE patients and 25 obligate carriers, PXE retinopathy was evaluated using funduscopy, white light, red-free, infrared and autofluorescence imaging.

Results: At least one characteristic of PXE retinopathy was evident on fundoscopy of all eyes. Angioid streaks could be subdivided in those with (brick red) or without (feathered) adjacent RPE alterations. Infrared imaging showed the brick red coloured streaks as well-demarcated dark fissures, even when these passed unnoticed on funduscopy. Feathered types were detected as triangular areas of hypo-autofluorescence. The peau d’orange was much better visible and much more widespread on infrared imaging, with extension from the posterior pole towards the whole midperiphery. Comets and comet tails were best seen with red-free imaging.

Conclusions: Infrared, red-free and autofluorescence imaging are more sensitive than white light funduscopy and imaging in visualizing early retinal signs of PXE. In addition, this specialised imaging allows better appreciation of the extent of lesions. Hence, such imaging increases the chances of making a correct diagnosis early, and aids in the accurate evaluation of evolution of disease in the ophthalmic follow-up of PXE patients.

Method: The database contains retrospective data from 1981, and prospective data from 1999. Analyses have been carried out using specially written queries to generate reports relating to prescription trends and reasons for treatment discontinuation.

Results: Numbers of patients: POAG: 580, OHT: 242, NTG: 134. Of 2928 treatment change episodes recorded, failure to reach or maintain a target IOP accounted for 51.9%, while adverse effects accounted for 22.1%. Latanoprost use increased sharply since 1996, and brimonidine, betaxolol and dorzolamide, use has declined significantly. Bimatoprost had a higher rate of discontinuation due to adverse effects (25%) than travoprost (16.3%), or latanoprost (12.4%), but this was only statistically significant between latanoprost and bimatoprost (p=0.0038). In 2000 the database informed the introduction of a new treatment protocol that resulted in a fall in discontinuations due to adverse effects by almost two thirds.

Conclusion: A large and unique treatment database has been established at the Glaucoma Clinic of Glasgow Royal Infirmary. Containing data spanning a 26 year period, it promises to be an invaluable resource for audit and research and has already demonstrated its worth by informing changes in prescribing practice that have resulted in direct patient benefit.

Methods: Prospective, open-label trial of monthly intravitreal ranibizumab (0.5 mg) injections for PCV in 12 eyes of 12 patients. Primary outcome measures were stabilization of vision (loss <15 ETDRS letters). Secondary outcome measures included incidence of ocular and systemic adverse events, and changes in subretinal hemorrhage, central foveal thickness (CFT), and polypoidal complexes on ICG angiography at 6 months.

Results: Baseline findings included 8 eyes with subretinal fluid, 6 eyes with subretinal hemorrhage, and 5 eyes with macular edema (CFT > 275 um). No patient lost > 15 letters in visual acuity at 6 months. Subretinal fluid decreased in 5/8 eyes (63%). Subretinal hemorrhage resolved in 6/6 eyes (100%). Macular edema improved in 4/5 eyes (80%). Polypoidal complexes decreased in 4/12 (33%) eyes. There were no ocular or systemic adverse events.

Conclusions: Continuous monthly intravitreal ranibizumab is safe and well tolerated in eyes with PCV. Preliminary results show stabilization of vision, resolution of subretinal hemorrhage, and decrease in macular edema. Polypoidal lesions decreased in 4/12 (33%) eyes, but branching choroidal vessels persisted.

Methods: A commercially available SD-OCT system, configured with a standard source as well as an external broadband light source was used to acquire 4mm horizontal line scans of the right eye of 10 normal subjects. Scans were averaged to reduce speckling and multiple retinal layers were analyzed in the resulting images.

Results: For all layers a significant improvement in the mean local contrast was found, (average improvement by a factor of 1.66) when using the broadband light source. Intersession variability is shown not to be a major contributing factor to the observed improvement in image quality obtained with the broadband light source. We report the first observation of sub-lamination within the inner plexiform layer (IPL) visible with SD-OCT.

Conclusion: The practical improvement with the broadband light source was significant, though it remains to be seen what the utility will be for diagnosing pathology. The approach presented here can serve as a model for a more quantitative analysis of SD-OCT images, allowing for more meaningful comparisons between subjects, clinics, and SD-OCT systems.

Method: Twenty eyes of 19 pseudophakic patients with regeneratory posterior capsule opacification (PCO) that were scheduled for YAG-capsulotomy were included in this prospective study. High resolution digital retroillumination images were taken 2 weeks, 1 week and shortly before and immediately, 1 week and 2 weeks after Nd:YAG-capsulotomy. The series of images were analysed using a dedicated image analysing software (PearlTracer).

Results: In total 2431 Elschnig-pearls were observed over the time-course of 4 weeks in this study. Of these 535 pearls (30.6%) disappeared and 503 pearls (27.6%) survived on the remaining capsule peripheral to the capsulotomy-opening. The surviving pearls showed a significant decrease in size (20%) from immediately before to 10 minutes after capsulotomy. Within the first weeks after capsulotomy there was a high number of newly appearing pearls, with 26% of all pearls being new between 1 and 2 weeks indicating high pearl turn over.

Conclusion: Capsulotomy had immediate impact on the morphology of PCO outside the capsulotomy opening, probably due to the direct mechanical impact of the laser shockwave.

Methods: Case notes of 139 consecutive patients presenting with APAC at the Birmingham and Midland Eye Centre were examined. Deprivation was scored using the IMD 2004, and the Townsend scores. These score were compared to the West Midlands reference population.

Results: The level of deprivation in patients with APAC was graded according to the IMD quintiles in which quintile 1 represents the highest level of deprivation and quintile 5 represents the lowest level of deprivation. 66.1% of patients (n = 90) were from quintiles 1 or 2 (most deprived), whereas 9% of patients (n=12) came from quintile 5 (least deprived); compared to predicted frequencies of 40% and 20% respectively. Deprivation levels measured by frequency within each IMD quintile were significantly higher in the APAC group compared to the reference population (Chi-square; p< 0.001).

Conclusions: In this population patients presenting with APAC are more likely to come from areas with a high level of social deprivation.

Methods: A literature search was conducted to identify studies related to posturing duration following macular hole surgery. Where appropriate, studies were compared in a meta-analysis. The Mantel-Haenszel fixed effect method was used to calculate the summary statistics. The main outcome measures were macular hole closure rate and visual acuity improvement.

Results: 17 studies investigating the effect of face-down posturing time on the outcome of macular hole surgery were identified. 9 studies included a comparison group and were deemed suitable for inclusion in the meta-analysis. Studies were divided into two groups depending on the duration of face-down posturing investigated. The meta-analysis revealed a relative risk of anatomical failure of 1.34 (95% CI 0.66 – 2.72) with face-down posturing for 24 hours or less compared to face-down posturing for 5 to 10 days, however this was not statistically significant (p=0.42). Study design was too dissimilar to allow meaningful comparison of visual acuity outcomes.

Conclusions: Currently there is insufficient evidence to allow firm conclusions as to whether face down posturing following macular hole surgery influences hole closure rates. Meta-analyses are limited by the quality of included studies; a well conducted randomised control trial is needed.

Methods: A total of seven patients with CMV-associated iridocyclitis and four patients with CMV-associated corneal endotheliitis were enrolled. Presence of CMV, but not other human herpes viruses, was confirmed by multiplex polymerase chain reaction (PCR). Viral load was measured using real-time PCR. Clinical manifestation was examined using a slit-lamp microscope and ophthalmoscope, applanation tonometer, and specular microscope.

Results: All 11 patients had unilateral recurrent anterior uveitis with high intraocular pressure (IOP) and mutton fat keratic precipitates with pigmentation. Stromal edema of the cornea was found in CMV-associated endotheliitis, but not in CMV-associated iridocyclitis patients. A significant corneal endothelium cell loss was recorded in all 11 patients with CMV-associated endotheliitis and iridocyclitis patients. High viral loads of CMV were detected in the aqueous humor of all 11 patients. A significant association was found between the corneal endothelial cell loss intensity and CMV viral load in the aqueous humor.

Conclusion: There is a significant correlation between the CMV viral load and corneal endothelial cell loss in both CMV-associated iridocyclitis and corneal endotheliitis.

Methods: Sixty-nine eyes of 42 keratoconus patients were implanted with the Keraring (Mediphacos, Belo Horizonte, Brazil). All patients self-administered the NEI-RQL before and 41/2 to 8 months after surgery. We evaluated and analysed the results, along with best spectacle-corrected visual acuity, refraction, contrast sensitivity, corneal topography and aberrometry.

Results: There was a significant improvement in all NEI-RQL scales and the overall scale. The greatest improvements were noted in "Clarity of vision", "far vision", "near vision", "activity limitations", "appearance" and "satisfaction with correction", ranging from 25 to 50 preoperatively to 80 to 90 after surgery. BSCVA and binocular BSCVA improved significantly and there was a significant decrease in keratometric values, from 50.22D preoperatively to 46.27D postoperatively. Contrast sensitivity function improved postoperatively, especially at the frequency of 6 cpd. Low-order RMS improved after surgery, but high-order RMS did not.

Conclusion: ICRS implantation improves not only the quantitative metrics such as visual acuity and refraction, but also has a positive impact on patients’ quality of life.

Methods: The expression of keratin 3 (K3), keratin 12 (K12), keratin 19 (K19) and mucin 1 (MUC1) was analysed through immunofluorescence on both histological sections of conjunctiva, limbus and cornea and impression cytology specimens from six healthy normal subjects (12 eyes) and twelve patients diagnosed with chronic ocular surface disorders. Levels of fluorescence expression of the different markers were quantified through Quantitative Fluorescence ImmunoHistoChemistry (Q-FIHC).

Results: Impression cytology specimens from normal and diseased ocular surfaces showed distinct expression patterns for K12 and MUC1. Healthy corneas expressed only K12 (but not MUC1) while conjunctivalized corneas from patients with LSC were characterized by the presence of MUC1 and the disappearance of K12. Similar clear-cut results were not seen with the traditional pair of markers K3/K19, which showed lack of specificity and overlapping signals in cornea and conjunctiva impression cytology specimens.

Conclusions: The ability of K12 and of the antibody used to detect MUC1 to discriminate clearly between limbus/cornea and conjunctiva in impression cytology specimens could become a valuable diagnostic and clinical monitoring tool for ophthalmologists in order to evaluate alterations of the ocular surface and the grading of LSC deficiency.

Design: Observational, cross-sectional, interviewer-administered study.

Methods: 46 patients with unilateral BRVO were included in this study. Scores on the VFQ-25 were analyzed and converted to scaled scores per NEI VFQ-25 algorithms. Clinical data including age, gender, employment status, living arrangements, visual acuity, number of systemic diseases and duration of BRVO were also recorded. Subscale results were compared to previously published data and subgroup analyses were performed.

Results: Mean adjusted subscale responses amongst BRVO patients were higher (except for ocular pain) than known averages in patients with diabetic retinopathy, central retinal vein occlusion, age-related macular degeneration, and low vision, but lower than known averages in a reference group of people without ocular disease. Subscale responses correlated significantly with visual acuity in the involved eye. This observation held true in 8 of 12 subscales even in patients who maintained vision of 20/25 or better in the uninvolved eye. The General Health subscale and number of systemic diseases correlated significantly with both the General Vision and Peripheral Vision subscale scores. There was no correlation between subscale responses and age.

Conclusions: Branch retinal vein occlusion is a retinal vascular disease that is associated with a decrease in vision-related quality of life as determined by the VFQ-25. A decrease in VFQ-25 score is correlated with involved eye visual acuity, even when good visual acuity is maintained in the uninvolved eye.

Methods: A clinical and molecular genetic study was performed on eleven patients from six families with MCD. Clinical diagnosis was confirmed by slit lamp biomicroscopy and histopathological examination of corneal buttons following keratoplasty. The coding region of the carbohydrate sulfotransferase (CHST6) gene was amplified by polymerase chain reaction (PCR) in all affected subjects. This was followed by direct sequencing and restriction digest analyses. Enzyme-linked immunosorbent assay (ELISA) of antigenic keratan sulfate (KS) in patients’ serum was also performed.

Results: Six homozygous mutations of which three are novel were identified within the coding region of CHST6 in six unrelated MCD families. The barely detectable level of antigenic KS in the serum of the affected individuals indicated that they all have MCD type I, including the subtype IA.

Conclusions: This is the first report of molecular genetic analysis of MCD in the Egyptian population. Our data indicates the extensive allelic heterogeneity within CHST6 and further support its essential role in maintaining corneal transparency.

Methods: Skin AF was assessed in 73 consecutive patients with active and documented neovascular AMD without evidence for diabetic or hypertensive retinopathy and in 31 healthy age matched controls. Exclusion criteria were: known renal disease, current inflammatory or malignant disease, or skin type V or VI. Skin AF was measured on the forearm and was calculated as a ratio of mean intensities detected from the skin between 420-600 and 300-420 nm. Student’s t-test and chi-square test were used to compare differences between groups.

Results: Skin AF was increased in neovascular AMD compared with controls (2.57 ± 0.68 vs. 2.23 ± 0.63 * 10^-2 arbitrary units; p = 0.018). In patients without vascular risk factors or cardiovascular disease, skin AF was not significantly higher compared with controls. Skin AF correlated with age in both patients and controls.

Conclusion: Skin AF is increased in patients with neovascular AMD, suggesting that AMD is accompanied by enhanced systemic AGE accumulation, which may implicate a role in the pathophysiology of AMD.

Methods: An RTVue-100 FD-OCT (Optovue, Inc, Fremont, CA) was used to determine the size, depth, and location of deposits in six patients with homozygous or heterozygous GCDII.

Results: The RTVue-100 FD-OCT revealed the depth of the deposits quite precisely, allowing the determination of the appropriate depth of PTK and the appropriate selection of lamellar vs. penetrating keratoplasty as the procedure of choice. In each case, visually significant opacities were adequately removed or would be removed.

Conclusion: FD-OCT provides useful information for the selection and planning of surgical procedures to remove corneal opacities in patients with GCDII.

Methods: RNA was extracted from leukocytes and cDNA reverse transcribed and hybridized to Affymetrix Gene Chips. Principle component analysis (PCA) and the Rate monotonic algorithm (RMA) were performed and further analysis applied to genes with a 2-fold expression difference and p < 0.015 between patients and controls.

Results: The gene expression profile of patients with the 11778 mtDNA mutation was significantly different from controls. The most commonly up-regulated genes (n = 137) were found to be related to the cellular transport (13.8%; 19/137) and transcription (12.4%; 17/137). Similarly, the most commonly down-regulated genes (n = 152) were also related to the cellular transport (17.8%; 27/152) and transcription (18.4%; 28/152). None of the 13 mitochondrial coded genes and no structural mitochondrial nuclear-encoded genes were differentially expressed. Interestingly, OPA1 gene was down-regulated in all LHON patients and this may leads to fragmentation of the mitochondrial network, dissipation of the mitochondrial membrane potential, and disorganization of the cristae.

Conclusions: The presence of the 11778 mtDNA mutation resulted in a unique gene expression profile compared to controls. Down-regulation of OPA1 may contribute to the pathogenesis of LHON.

Methods: Prospective, randomised, investigator-masked, multicentre clinical trial. Patients on latanoprost 0.005% monotherapy requiring additional IOP lowering discontinued latanoprost and were randomised to bimatoprost 0.03% (n=131) or travoprost 0.004% (n=135). IOP was measured at latanoprost-treated baseline and after 1 and 3 months of replacement therapy.

Results: Baseline mean diurnal IOP on latanoprost was similar between groups. Mean diurnal IOP was significantly lower with bimatoprost than with travoprost at 1 (p=0.009) and 3 months (p=0.024). Overall, 22.0% of bimatoprost patients vs 12.1% of travoprost patients achieved a ≥15% reduction in diurnal IOP from latanoprost-treated baseline at both months 1 and 3 (p=0.033). At month 3, the additional mean diurnal IOP reduction from latanoprost-treated baseline was 2.1 (95% CI: 1.7, 2.5) mm Hg (11.0%) with bimatoprost and 1.4 (95% CI: 0.9, 1.8) mm Hg (7.4%) with travoprost (p=0.024). At 3 months, 11.5% of bimatoprost and 16.5% of travoprost patients demonstrated a ≥1-grade increase in physician-graded conjunctival hyperaemia (p=0.288). Hyperaemia was reported as a treatment-related adverse event in 3.1% of bimatoprost and 1.5% of travoprost patients (p=0.445).

Conclusion: Patients on latanoprost requiring lower IOP achieved greater additional short-term diurnal IOP reduction when latanoprost was replaced by bimatoprost compared with travoprost. Low rates of hyperaemia were observed in patients treated with bimatoprost or travoprost after switching from latanoprost.

Methods: Twenty-five microdissected RB samples were analyzed to investigate the LOH in 140 microsatellite markers. Expression of genes flanking D13S265 was investigated by real-time quantitative-PCR on available frozen samples. The promoter and entire coding region of GPC6 were examined for sequence changes in an extended batch of 29 RB samples.

Results: Allele losses were found in 92% (23/25) of the tumors. We identified a new LOH locus at 13q31 (D13S265) with high ocurrence rate (67%, 14/21) apart from the RB1 locus (68%, 17/25). Expression study detected the reduced expression of Glypican 6 (GPC6) transcript is significantly associated with the LOH at 13q31 (p=0.024). Furthermore, mutation screening revealed no remarkable sequence alteration in GPC6 that could affect its expression.

Conclusion: Our result document that reduction of GPC6 mRNA in retinoblastoma is associated with the non-random allelic loss at 13q31 that could contribute to RB development.

Results: The reversal of optic disc cupping was detected in 28 (15.2%) eyes. At baseline of the study, the degree of disc damage was significantly worse (P = 0.036, Mean Difference: -0.704, 95% Confidence Interval (CI): -1.362, -0.045) in the reversal group than in the non-reversal group. Both groups did not vary significantly in the time of total follow-up. Cox proportional hazard regression analysis demonstrated that reversal of optic disc cupping depended significantly on baseline disc damage (P = 0.022, Hazard Ratio (HR): 1.3, 95%CI: 1.1,1.6), but was independent of age, and the amount of intraocular pressure (IOP) difference between the first visit and the last visit in the same eye.

Conclusion: Baseline disc damage might be the predictive factor associated with the reversal of optic disc cupping in primary open-angle glaucoma.

Methods: Allogeneic keratoplasty was performed between Lewis and Fisher rats. The recipients’ ages were 10 and 3 weeks, respectively. All experiments were controlled syngeneically. Survival rates were calculated and cellular infiltrates analyzed histologically.

Results: Median graft survival times were 15 days in old recipients and 9 days in young recipients (p<0.01). We noted fewer infiltrating cells in the younger rats than in the older ones on the day of rejection. Despite the fact that T cells dominated we detected significantly more NK in young recipients at all time points after transplantation when compared to old recipients.

Conclusions: We established an animal model that shows similar rejection kinetics as in children, i.e. corneal graft failure occurs sooner in young rats. Already little infiltration was sufficient to reject a corneal allograft. The dominance of infiltrating NK cells and the vigorous rejection process suggest an involvement of the innate immune system in this process.

Methods: One hundred and four healthy and 75 glaucomatous eyes from the Advanced Imaging in Glaucoma Study (AIGS) were imaged with GDx-VCC, HRT II, and StratusOCT. Quality score (QS≥8), pixel standard deviation (SD≤50), and signal strength (SS≥5) were used as quality parameter cutoffs, respectively. GDx nerve fiber indicator (NFI), and HRT Moorfields regression analysis (MRA) classifications and OCT mean retinal nerve fiber layer (RNFL) thickness were used as the discriminatory parameters. Logistic regression models were used to model the dichotomous clinical classification (healthy vs. glaucoma) as a function of image quality parameters and discriminatory parameters.

Results: Quality parameter covariates were statistically non-significant for GDx and HRT but had an inverse effect on OCT in predicting disease (higher SS had lower probability of glaucoma). Age was a significant covariate for GDx and HRT, but not OCT, while ethnicity and interaction between the image quality and the institute where scans were acquired were significant covariates in the OCT models.

Conclusion: Within scans considered to be acceptable based on the manufacturers’ recommended limits, scan quality does not affect the discriminating ability of global discriminatory parameters of GDx, HRT but have an effect on OCT measurements.

Methods: In OASS a score of between 0 (poor) and 14 (excellent) was devised measuring motor (ocular motility, levator and orbicularis function) and sensory functions (digital spear pressure at limbus and topical anaesthetic sting). 40 patients were studied prospectively to analyse inter-observer consistency in OASS. A further 100 patients were collected into four groups receiving either sub-Tenon's or peribulbar block with 150 or 300 units of hyaluronidase. Patient satisfaction was determined using Visual Analogue Pain Scale (VAPS) and Iowa Satisfaction with Anaesthesia Scale (ISAS).

Results: There was no significant difference in OASS scores between two independent observers (p=0.8910). The sub-Tenon's approach achieved significantly better OASS scores than the peribulbar approach (p<0.0004). 300 units of hyaluronidase gave significantly higher OASS scores in both sub-Tenon's (p<0.0001) and peribulbar groups (p<0.0001). Spearman rank correlation showed that OASS correlates significantly with VAPS (-0.82, p<0.0001) and ISAS (0.70, p<0.0001). The median satisfaction score was significant in order of magnitude: sub-Tenon’s with 300 units of hyaluronidase > sub-Tenon’s with 150 units of hyaluronidase > peribulbar with 300 units of hyaluronidase > peribulbar with 150 units of hyaluronidase.

Conclusion: OASS is a simple and robust system for assessing and comparing non-topical local anaesthetic techniques. Of the techniques evaluated a sub-Tenon’s block with 300 units of hyaluronidase gives best anaesthesia, analgesia and patient satisfaction results.

Methods: 69 eyes (42 patients) with one or more characteristic myopic fundal change were prospectively studied. The pattern of myopic changes were recorded by fundus photography. The deep/longest axis of the crescent and peripapillary atrophy (PPA) was determined and ascribed a value in degrees in a manner similar to the axis of astigmatism in refraction. Refraction was then carried out. The axis of PPA and that of the crescent was correlated with the axis of myopic astigmatism and the coefficient of correlation determined (Spearman’s rank correlation coefficient).

Results: A statistically significant correlation was found between the axis of compound myopic astigmatism and the long axis of myopic retinal degeneration (r=0.89 p<0.001) and with the deep axis of disc crescents (r=0.80 p-<0.001).

Conclusion: Astigmatism is likely to have an aetiopathogenic association with myopic fundal changes.

Methods: C57BL/6J mice were exposed to 75% oxygen from postnatal day 7 (p7) to 12. Immediately after transfer to room air at p12, mice received an intravitreal injection of 150µg/µl thalidomide or control solution. Preretinal neovascularization was quantified at p17. VEGF levels were assessed in whole retinal lysates at p13 and p17. Retinal toxicity was assessed by measuring retinal layer thickness and by analysing caspase-3 activity and apoptotic cell counts in retinal layers to examine retinal apoptosis.

Results: Intravitreal application of thalidomide significantly reduced preretinal neovascularization by 62% compared to control treated contralateral eyes (P=0.01). Interestingly, this effect was established without a change in retinal VEGF levels. Intravitreal thalidomide was not toxic as retinal layer thickness and neither retinal caspase-3 activity nor apoptotic cell counts were altered.

Conclusion: These data indicate that intravitreal application of thalidomide can be an effective and safe way to treat retinal neovascularization.

Methods: A campaign to treat the entire district population with azithromycin 1.5% eye drops was undertaken in February, 2008. To measure the effectiveness of treatment on the prevalence of active trachoma, two epidemiological studies were conducted on a representative sample of children aged between 1 and 10 years. The first study was performed just prior to the treatment campaign and the second study was performed one year later.

Results: The prevalence of active forms of trachoma (TF + TF/TI) dropped from 31.5% (95%CI 26.4-37.5) before treatment to 6.3% (95%CI 4.1-9.6) one year after treatment; a reduction of nearly 80%.

There were no reports of serious or systemic side effects. Tolerance was excellent. No treatment was interrupted.

Conclusion: Mass treatment with azithromycin 1.5% eye drops is therefore feasible, well tolerated, and effective.

Design: Non-randomized prospective clinical study.

Methods: A first group of 50 cases with Fuchs endothelial dystrophy underwent DMEK. Two to five weeks after the DMEK, ten cases showed no corneal clearance, so that a secondary DSEK was performed. To evaluate the latter eyes, best corrected visual acuity (BCVA) and endothelial cell density at 6 and 12 months were used as outcome parameters.

Results: At 6 months after secondary DSEK, 87% of the cases had a BCVA of ≥ 20/40 (0.5) and one eye reached 20/25 (0.8). Donor DSEK grafts endothelial cell densities averaged 2617 (± 152) cells/mm² before surgery, 1510 (± 799) cells/mm² at 6 months, and 1602 (± 892) cells/mm² at 12 months after surgery .

Conclusion: In the event of a DMEK graft failure, a secondary DSEK may be an effective back-up procedure, since it may give a clinical outcome similar to that after a primary DSEK. Especially during the surgeon's learning curve, patient information may not only be directed towards DMEK, but also DSEK visual outcomes.

Methods: Population-based, cross-sectional survey of the residents aged 40 years and older in rural Sri Lanka. ARMD was assessed on dilated fundoscopy using the International Age Related Maculopathy Epidemiology Study Group classification system.

Results: Of the 1721 subjects identified, 1375 participated (79.9%). Of the participants, 1013 were aged 50 years or older (73.6%). The prevalence of any ARMD (adjusted for study design) was 4.72% (95%CI: 2.22% - 7.20%) with 3.82% (95%CI: 1.60 – 6.04%) early ARMD and 1.70% (95%CI: 0.14 – 3.27%) late ARMD. Age (p<0.001) and Sinhalese ethnicity (p=0.016) were significantly associated with ARMD. Males had a tendency toward higher prevalence of ARMD than females; however this was not statistically significant (p=0.081). Ocular risk factors such as cortical cataract (p=0.024) and pseudophakia (p=0.003) were associated with ARMD on the univariate but not multivariate analyses. Illiteracy and the identification of social supports were significantly associated with ARMD on univariate analyses; however only social support was statistically significant after multivariate analysis (p=0.024).

Conclusions: Although the prevalence of ARMD is slightly lower in Sri Lanka than surrounding regions, it contributes to a higher proportion of visual impairment, including blindness. Risk factors include age and Sinhalese ethnicity.

Methods: Retrospective study of 50 consecutive patients with uveitis who were referred for chest HRCT because of suspicion of sarcoidosis. Clinical characteristics, laboratory findings, chest radiographs and chest HRCT scans were retrieved. HRCT scans were re-assessed for signs of sarcoidosis. Mann-Whitney and Fisher’s exact test were used for data analysis.

Results: Ten of 50 (20%) uveitis patients referred for HRCT demonstrated signs of sarcoidosis on HRCT. The median age of these patients was significantly higher than those patients with a negative HRCT (71.1 versus 44.7 years, p=0.002). The presence of peripheral chorioretinal punched out lesions and posterior synechiae were significantly related to an abnormal HRCT scan.

Conclusion: Increasing age, presence of peripheral multifocal chorioretinitis and posterior synechiae were associated with an abnormal HRCT scan.

Methods: 9 patients after MT were investigated. The Utrecht Macular Pigment Reflectometer was used to quantify the MP optical density. A Scanning Laser Ophthalmoscope (SLO) was used to identify the fovea as the centre of MP distribution and determine the retinal locus of fixation.

Results: In all patients, we identified the fovea as the centre of MP distribution. The retinal areas used for fixation were displayed by SLO fixation analysis. Comparing their spatial relationship with the fovea, five patients fixated centrally and four eccentrically up to 7.5 degrees. In those patients, microperimetry showed that the atrophy caused by choroidal neovascularization (CNV) extraction prevented central fixation.

Conclusion: The combination of MP distribution and fixation analysis permits quantifying fixation behaviour even if the fovea morphologically cannot be localized. Our results suggest that the scotoma caused by spreading chorioretinal atrophy is the main cause for reduced visual acuity after MT and therefore the MT rotation angle is crucially important.

By permitting unique optical access, the eye is particularly well suited for molecular imaging: For example, transgenic mice in which the fractalkine receptor rendered intrinsically fluorescent allowed for in vivo monitoring of myeloid immune cells within the retina and choroid by scanning laser ophthalmoscopy (SLO). Retinal cell apoptosis can be assessed by intravitreal injection of fluorescence-labeled annexin 5 in vivo, using a similar SLO technique. Intravital microscopy also allows visualizing CD11c-positive dendritic cells in transgenic mice expressing yellow-fluorescent protein in these immune cells. Adoptive transfer of fluorescence-labeled transgenic T-cells enables visualizing the infiltration of specific T cells into various eye compartments.

On the other hand, functional imaging can be provided by new MR methodologies: The deuterium MR and diffusion MRI analysis techniques permit dynamic studies of water movement in animal eyes. MRI also enables pharmacokinetic studies on ocular drug delivery, and detects biomarkers for treatment efficacy in retinopathies.

Undoubtedly, these and further molecular imaging techniques currently being developed will have fundamental impact on experimental and clinical ophthalmology and thereby on our understanding of eye disease and development of therapy in general.

Methods: A pilot randomized controlled trial with patients masked to the treatment allocation. Post-operative pain was assessed using both visual scale and verbal pain scores for one week following surgery. Additional data collected included intraocular pressure, time taken to perform the surgical procedure, per-operative and post-operative complications and dropout rates.

Results: 40 patients were recruited for the study, 21 randomised to 20G vitrectomy and 19 to 25G. In the first 12 hours following surgery, presence of significant post-operative pain (defined as >1cm on the visual analogue scale) was similar in both 20G (50%) and 25G(53%) patients. In the first week following surgery, 38 of the 527 scores (7.2%) were >1cm (median 2.1, IQR (1.3,3)), however there was evidence that ‘significant pain’ was experienced more commonly in the 20G group. There was no statistical difference in the time taken to complete the surgical procedure, however in the 25G group the time from first incision to the start of vitrectomy was significantly shorter (p= 0.043) and in the 20G group the time taken to complete the vitrectomy was quicker (p=0.047). Post-operative hypotony (IOP <6mmHg) was observed in 25% of patients in the 25G group. No patients required additional surgery for hypotony.

Conclusion: There was evidence that 25G resulted in less patient discomfort, however pain was not a prominent feature in either group. We failed to find a significant advantage in 25G for patients or surgeons.

Methods: One hundred and fourteen eyes of 114 patients with open angle glaucoma and 42 eyes of 42 normal controls were studied. The focal ERGs were elicited by a 15° stimulus spot centered on the macula, on the supero-temporal, and on the infero-temporal areas of the macula. The receiver operating characteristic curves were determined to obtain optimal cut-off values. Eyes were classified as being glaucomatous when their focal PhNRs were less than the cut-off values in either retinal area (combined criterion).

Results: The focal PhNR amplitudes were significantly reduced with an advance of glaucoma. In early glaucoma, the sensitivities of the PhNR measured for each retinal area ranged from 58.1% to 80.7%. The sensitivities were significantly increased to 90.6% and 96.9% for the focal PhNR amplitude and the focal PhNR/b-wave amplitude ratio, respectively, when the combined criterion was employed. The specificity was >90%.

Conclusions: Focal PhNRs have diagnostic ability in detecting early glaucoma with high sensitivity and specificity, especially when the combined criterion is used.

Methods: Using a stratified random cluster sample of the population of Tehran, all participants 5 years of age and older were studied with cycloplegic autorefraction thirty minutes after instilling two drops of cyclopentolate 1%. Prevalence rates of cycloplegic hyperopia for different cut points were determined, stratified by age.

Results: The prevalence rates of hyperopia as a spherical equivalent equal to or more than +0.5, +1.0, +2.0, and +3.0 diopters were 56.6 %, 28.1%, 6.3% and 2.2%, respectively. With all these definitions, the prevalence of cycloplegic hyperopia reached a minimum in the 25-35 year age group, and then significantly increased until the age of 70. Multivariable regression analysis with variables such as age, gender, diabetes, and cataract showed that only age was significantly correlated with hyperopia.

Conclusions: Although an age-cohort effect cannot be ruled out, these results provide the first population-based evidence of increasing hyperopia with age using cycloplegic refraction. The results obtained suggest that the contribution of decreasing accommodation to observed hyperopic shifts in distance refraction in longitudinal studies is small, raising the question of the underling causes of the hyperopic shift in refraction with age.

Methods: We retrospectively examined seventy-three eyes of 47 patients undergoing ICL implantation through a horizontal 3.0-mm clear corneal incision. We quantitatively investigated the amount of corneal astigmatism before and 3 months after surgery using an automated keratometer (ARK-700A, Nidek) and corneal topography (ATRAS995^TM, Carl Zeiss Meditec). The surgically induced astigmatism was assessed by vector analysis using the Holladay-Cravy-Koch formula.

Results: The corneal astigmatism was significantly increased from 1.10 ± 0.51 diopters (D) to 1.44 ± 0.57 D using the keratometer (Wilcoxon signed-rank test, p<0.001). It was also significantly increased from 1.16 ± 0.53 D to 1.45 ± 0.57 D using corneal topography (p<0.001). On the other hand, the manifest astigmatism was significantly decreased from 0.93 ± 0.60 D to 0.72 ± 0.58 D (p<0.001). The surgically induced astigmatism was 0.45 ± 0.26 D at an axis of 93.3° using the keratometer and 0.49 ± 0.26 D at an axis of 98.0° using corneal topography.

Conclusions: ICL implantation induces corneal astigmatism through a with-the-rule astigmatic shift of approximately 0.5 D, which was small but not negligible for candidates for refractive surgery.

Patients/ Methods: A retrospective study in 90 eyes of 45 patients was performed. The 45 patients were divided into group 1 (patients younger than 18 months at the time of surgery, n=25) and group 2 (patients 18 months or older at the time of surgery, n=20). The axial eye length, spherical equivalent refraction and keratometry were measured during surgery and at follow up. All outcome data in the operated eyes were compared with the outcome data of the fellow non- operated eyes. The students t-test was used for statistical analysis. Values of p< 0.05 were considered statistically significant.

Results: In group 1 the absolute growth in mm of the operated eyes was borderline statistically significant less than the fellow non- operated eyes (p=0.049). No statistically significant difference in the rate of axial growth between the two eyes was found (p=0.25). A larger myopic shift (p=3.85E-5) and a larger change in keratometry (p=0.02) was found in the operated eyes.

In group 2 no statistically significant differences were found between the two eyes.

Conclusions: We did not find a statistically significant difference in axial length growth between the operated eyes and fellow non-operated eyes in our unilateral paediatric cataract patients.

Methods: We retrospectively reviewed all consecutive records of open globe injury cases (4968 eyes in 4865 inpatients) in 15 tertiary referral hospitals in China over 5 years (January 2001 to December 2005). The information was collected from a standardized database of eye injuries from which a detailed analysis of factors influencing the incidence of endophthalmitis was performed.

Results: 173 eyes (1 bilateral rupture of a male) removed within 24 hours after trauma were excluded. We observed that 571 eyes (571 patients) out of a total of 4795 eyes (4693 patients) developed endophthalmitis and the rate of incidence was 11.91%. Laceration was an independent risk factor for open globe injury. Primary repair within 24 hrs, tissue prolapse and self-sealing of wounds seemed to impart protective effects against the development of endophthalmitis. However, gender, age, lens breach and posterior zone of wounds were not significant. Intravitreal antibiotic and corticosteroid therapy was administered to 53 eyes (9.28%) and vitrectomy was performed on 305 eyes (53.42%). At discharge or follow-up, the proportion (16.81%) of enucleation/evisceration of eyes with endophthalmitis was higher than that (8.71%) without endophthalmitis.

Conclusions: Laceration was associatied with significantly higher risk of endophthalmitis for open globe injuries. Early primary repair, tissue prolapse and self-sealing of wounds were independent protective factors against the development of endophthalmitis.

Methods: Normal subjects and patients with various ocular diseases underwent retinal blood flow imaging using the Retinal functional imager.

Results: Twenty-eight eyes of 21 patients comprised the study population (8 eyes of 6 normal subjects and 20 eyes of 15 patients with different ocular diseases). Four patterns of retinal collateral circulation have been recognized.

1. Looped collateral pattern. This arterovenous anastomotic vessel is characterized by a link between the endings of the adjacent artery and vein, and has an appearance of loop.

2. Vertical collateral pattern. This anastomotic vessel is characterized by a connection between superior and inferior vascular systems (arterial or venous), and in its course this collateral vessel crosses the horizontal raphe.

3. H-shaped collateral pattern. This arterovenous anastomotic vessel is characterized by a connection between two adjacent vessels (artery and vein), but, unlike anastomotic vessel of the "looped" pattern, this vessel connects the middle parts of the vessels and not the endings of these vessels.

4. Cilioretinal-retinal collateral pattern. This anastomotic vessel is characterized by a link between cilioretinal artery and retinal arterial circulation.

Conclusions: The findings of this study shed a different light on the retinal circulation and have demonstrated new patterns of retinal collateral circulation evident from RFI imaging . These patterns appear to be present in normal subjects as well as in patients with various ocular diseases.

Methods: Retrospective review of seven patients (eight eyes) with MEWDS (selected based on clinical and angiographic manifestations of the disorder) examined using slit-lamp biomicroscopy and studied using fluorescein angiography (FA) and indocyanine green angiography (ICGA).

Results: In the clinically affected eyes, FA early phases revealed hyperfluorescence in 3 eyes and a combination of hyper and hypofluorescence in 5 eyes; the following relationships between FA and ICGA were found: 1) areas of early hypo- and late hyperfluorescence (staining and leakage) on FA corresponding to areas of early hypo and late hypo-,iso or hyperfluorescence on ICGA; 2) early and late hyperfluorescence (staining but very faint, if any, leakage) on FA corresponding to normal early ICGA and intermediate-late hypofluorescence; 3) areas of hypo- and hyperfluorescence on ICGA without a clear counterpart on FA.

Conclusions: Angiographic features may vary in eyes with similar clinical signs of MEWDS. Such variability could reflect the different anatomic structures involved during the natural evolution of the disease. Angiographic studies suggest that both, inner and outer choroid, are involved in this disorder. The final outcome is not affected by the initial angiographic presentation.

Methods: Ten patients with progressive geographic atrophy underwent translocation of an autologous graft of RPE, Bruch's membrane and choroid. The visual acuity (VA), reading performance, microperimetry, optical coherence tomography (OCT), fundus autofluorescence, fluorescein angiography and indocyanine green angiography were assessed.

Results: No recurrence of RPE atrophy was seen. All but one transplant were re-vascularized. Vascularization persisted throughout the 3 years follow-up. Spectral-domain OCT in some cases showed intact photoreceptors or intact outer nuclear and outer plexiform layer overlying the graft. In three cases, the grafts were positioned eccentrically; these patients did not benefit from surgery. The mean VA decreased from 20/80 (range: 20/800 to 20/40) at baseline to 20/200 (range: perception of hand movements to 20/32) at last follow-up. In two patients, VA were stable from 20/50 to 20/32 and 20/40 at the last follow-up, respectively. Postoperative complications included retinal detachment due to proliferative vitreoretinopathy, macular pucker, iritis, branch retinal vein occlusion and secondary ocular hypertension.

Conclusions: Some patients benefit for at least 3 years from a functioning RPE-choroid graft. Functional outcome in most patients, however, was limited due to complications and unfavorable patient selection.

Methods: Forty-eight eyes of 48 myopic subjects were recruited and divided into three groups according to their spherical equivalent(SE):low (- 3.0 D < SE < 0.0 D), moderate (-6.0 D < SE ≤ -3.0 D) and high (SE ≤ -6.0 D) myopia groups. All individuals underwent the imaging with the Stratus OCT.The RNFL thickness profiles were compared between the groups.

Results: The global average RNFL was significantly thinner in the high myopia group than in the low myopia group(107.4 ± 7.6 vs.115.8 ± 8.5 µm, P = 0.029 by post hoc test). For quadrant measures, the RNFL was thicker in the low myopia group than in the moderate and/or high myopia groups for the superior, nasal and inferior quadrants(all P values≤0.020). However, the temporal quadrant was thinner in the low myopia group than in the moderate and high myopia groups (P=0.001).

Conclusion: High myopes had thinner RNFLs than did low myopes, and showed different topographic profiles. Although the high myopes had significantly thinner RNFLs in the nontemporal sectors compared with the low myopes, they showed a significantly thicker RNFL in the temporal quadrant.

Methods: In two 6-month, double-masked, parallel-group studies, patients received run-in timolol (2-4 weeks) and randomised (1:1:1) to therapy. IOP was measured three times/day at baseline and weeks 2, 13, 26. In post-hoc analyses, diurnal IOP fluctuation=highest daily IOP¡§Clowest daily IOP at baseline and week 26. Fluctuation also was dichotomised: high (>6mmHg), low (¡Ü6 mmHg).

Results: 854 patients were randomised (fixed combination=278; latanoprost=287; timolol=289). Diurnal fluctuation was significantly reduced from baseline to week 26 with the fixed combination (p=0.002) but not with latanoprost or timolol monotherapy (p=0.601; p=0.097). Relative to baseline, the percentage with high diurnal IOP fluctuation at week 26 was reduced by 48% with fixed combination but increased 13% with latanoprost and 48% with timolol. Changes in IOP fluctuation and in mean IOP were significantly correlated for the monotherapies but not the fixed combination.

Conclusions: Fixed-combination latanoprost/timolol results in lower diurnal IOP fluctuation and significantly fewer patients with high fluctuation than treatment with latanoprost or timolol monotherapy. The fixed combination may have an independent effect on reducing IOP fluctuation in addition to lowering IOP.

Methods: We electroporated the tibialis anterior muscle of naive BALB/c mice with IL-4, IL-5, IFN- or a control gene and then harvested the mice blood and conjunctivas to measure eosinophil content in these tissues. To evaluate the effects of cytokine gene electroporation on the early phase reaction (EPR), cytokine gene-electroporated ragweed (RW)-immunized mice were intravenously injected with Evans blue (EB) and then challenged them with RW in eye drops. Thirty minutes later, we harvested their conjunctivas to extract EB and evaluate the EPR. Additionally, 24 hours after RW challenge, conjunctivas were harvested from cytokine gene-electroporated RW-immunized mice, which had not received intravenous injection of EB, to measure conjunctival eosinophilia.

Results: Significantly more eosinophils were detected in the blood and conjunctivas of IL-5-electroporated mice in which EC was not induced. The intensity of the EPR was significantly greater in IFN--electroporated mice. Significantly greater eosinophil infiltration was seen in the conjunctivas of IL-5-electroporated EC-developing mice.

Conclusions: It appears that systemic IL-5 and IFN- play different roles in the development of EC.

Methods: Prospective, observational study of all patients seen by the Central Australian Ophthalmology service over an 8-month period.

Results: Incidence rate of AAU in Central Australia was 35.9 cases /100,000 population per year. Forty two percent of the 1955 patients seen during the study period were Aboriginal patients, however all but one patient with AAU were Caucasian. The difference in the incidence of AAU between the Indigenous and non-Indigenous populations was statistically significant (p=0.03, Fisher’s exact test). Four of the 9 Caucasian patients with AAU were HLA-B27 positive. The single case of AAU in the Australian Aborigine was a recurrent episode of HLA-B27 positive AAU. A family history of this patient revealed that both her grandfathers were Caucasian.

Conclusion: The incidence and pattern of AAU in Central Australia is comparable to that in other geographic regions. However, AAU occurs distinctly infrequently in Australian Aborigines as compared to that in non-Indigenous population of Central Australia, further implicating the importance of genetic factors in the pathogenesis of AAU.

Methods: Central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), keratometry (K)-values, corneal diameter (CD), and axial length (AL) were obtained in 38 healthy volunteers (76 eyes) to determine the reproducibility of the Lenstar. CCT, ACD, CD, K-values, and AL measurements measured with the Lenstar were compared to the AS-OCT and IOLMaster. Intraocular lens (IOL) power calculations were done to study the significance of the difference between AL measurements.

Results: Reproducibility of the Lenstar was better than 0.9% for CCT, ACD, LT, K-values, and AL measurements. Although all correlations were highly significant (P <0.001), all comparisons showed a significant difference, except for the comparison of CD measurements using the Lenstar and IOLMaster (P=0.175). The difference in IOL power calculations for an AL of 20, 25, and 30 mm with a mean difference between Lenstar and IOLMaster AL measurements of 0.03 mm, were 0.13 D, 0.10 D, and 0.08 D, respectively.

Conclusion: Reproducibility of the Lenstar was excellent. Small but significant differences exist between the Lenstar, Visante OCT and the IOLMaster. Therefore, measurements of the the Lenstar, AS-OCT, and IOLMaster are not interchangeable. Despite the significant difference between AL measurements, there is no clinically significant difference in the IOL power calculation results.

Methods: A retrospective study of 476 eyes of 342 patients with more than 18 months of follow-up with successful stereoscopic ONH photography was conducted. All eyes had good quality HRT examinations with perfect image alignment. 51 (11 %) eyes showed progression in the stereoscopic ONH photographs between visits. The photographs were evaluated by experienced masked observers, whose inter-observer agreement (kappa) varied between 0.403 and 0.510.

Results: The change in most (13/22) of the stereometric ONH parameters showed a statistically significant correlation with progression. The parameter with the best correlation for progression (p < 0.0005) was the cup : disc area ratio. The parameter with the largest area under the ROC curve (0.726) was the vertical cup : disc ratio. The linear discriminant function with the best correlation with progression was [(12.241 x cup : disc area ratio) + (3.540 x mean cup depth) - (2.146 x horizontal cup : disc ratio) + (27.486 x average variability)]. An optimized change in the linear discriminant function value was 0.34 with a 65 % sensitivity and a 69 % specificity for progression.

Conclusions: Despite good image quality, the change in the stereometric ONH parameters did not have high sensitivity and specificity for progression detected with photographs. This indicates that the evaluation of glaucomatous progression in the ONH should not rely solely on the stereometric parameters of the HRT.

Method: Six glaucomatous retinas and six age-matched control retinas were prepared as wholemounts and stained by 4',6-diamidino-2-phenylindole solution (3µg/mL). An area corresponds to central 14 degree of the visual field was imaged. The nearest neighbour distribution was determined for cells in both normal and glaucomatous RGCL.

Results: We observed clustered RGC loss in human glaucoma on a background of diffuse loss. The mean nearest neighbour distance (NND) of the glaucomatous retinas was significantly higher compared with controls (p<0.001). The distribution of NND in glaucomatous retinas was skewed to the higher values with a higher positive kurtosis relative to controls. The quantitative analysis of the pattern of cell loss is supported by the visual inspection of the patterns of cell loss.

Discussion: Nearest neighbour analysis is consistent with the presence of two patterns of cell loss in the RGCL in glaucoma. While the diffuse of cell loss can account for an overall reduction in the RGC population and additional non random pattern is consistent with the hypothesis that RGC loss has a local influence on the viability of surrounding cells.

Methods: Twenty eyes with glaucomatous optic neuropathy and a SAP VF defect involving the central 16 test points (at least one point with p<1% in the 24-2 VF) were enrolled. Eyes with diseases other than glaucoma were excluded. All patients underwent SLO-MP and SAP of the central 10 degrees. Results from each eye were divided into 4 quadrants for analysis. Normal and abnormal quadrants by SAP were compared to the corresponding normal and abnormal quadrants by SLO-MP. Regression analysis was used to correlate the mean threshold values (dB) of SLO-MP and SAP in each quadrant. Macular optical coherence tomography (OCT) was performed when there was a disagreement between functional tests.

Results: Mean age and VF mean deviation were 60.8±13.4 years and –7.3±6.1 dB, respectively. There was a significant correlation between SLO-MP and SAP results in all quadrants (r2≥0.68, p<0.001). All abnormal SAP quadrants had a corresponding abnormal SLO-MP quadrant. However, 21% of the normal SAP quadrants had an abnormal corresponding microperimetry result; a corresponding significant reduction in total macular thickness measured by OCT was present in 75% of these quadrants.

Conclusions: Macular sensitivity evaluated by SLO-MP correlates significantly with SAP paracentral VF defects. SLO-MP detected retinal sensitivity reduction in areas of OCT structural damage with normal SAP and suggests that subtle paracentral functional deficits may be present in many more eyes with established glaucoma than generally assumed.

Methods: 243 patients drawn from the Flinders Eye Centre cataract surgery waiting list self-administered the CSS. Rasch analysis was used to investigate the following properties of the CSS: measurement a single construct (unidimensionality), discrimination between strata of patient ability (person separation) and targeting of item difficulty to person ability.

Results: The CSS discriminated four strata of patients. However, some items did not contribute towards measurement of a single construct indicating a secondary dimension. This comprised three mobility items, which formed a separate valid subscale. Elimination of these items resulted in the CSS being a unidimensional measure. However, further item deletion was required as some more items did not appear to measure the same construct. The resultant 9-item measure was unidimensional.

Conclusions: The CSS consists of two separate unidimensional constructs: mobility and visual disability. The reduced 9-item measure has good psychometric properties and is unidimensional. The CSS is essentially a measure of visual disability and not cataract symptoms as it is claimed to be.

Methods: All patients in this study fulfilled these criteria:

1) Multiple attacks in one eye or attacks in both eyes (at least three total attacks)

2) A minimum of twelve months of neuro-ophthalmic follow-up

3) Serological abnormalities or skin biopsy changes consistent with AON

4) No diagnosis of a defined collagen vascular disease or neurological autoimmune disease throughout follow-up, with the exception of one patient, later shown to be shown to be neuromyelitis optic antibody positive.

Results: Nine cases were found (female=7, male =2, ages 8-74). One case received corticosteroids alone, the others received corticosteroids in combination with methotrexate/gammaglobulin (n=1), methotrexate (n=1), gammaglobulin (n=1), chlorambucil (n=2), cyclophosphamide (n=1), azathioprine/chlorambucil (n=1), and one received multiple combinations of agents. Criteria for diagnosis are proposed.

Conclusion: As AON is quite rare, no formal recommendation can be made regarding its best therapy, although there is a suggestion that chlorambucil, although potentially toxic, may yield long term remission.

Methods: Seventy-four eyes with closed stage 2 or 3 macular holes were recruited from a randomized clinical trial comparing (1) vitrectomy without ILM peeling, (2) vitrectomy with 0.05 % isotonic ICG-assisted ILM peeling, and (3) vitrectomy with 0.15 % trypan blue-assisted ILM peeling. Contrast-enhanced Stratus optical coherence tomography was used to assess central foveal thickness (CFT), central photoreceptor layer thickness (CPRT), central photoreceptor layer disruption (PRD) and relative reflectivity of the outer nuclear layer (ONL-RR). Outcomes were correlated with best-corrected visual acuity (BCVA) 12 months after surgery.

Results: BCVA was correlated with CPRT and PRD. Regression analysis and receiver operating characteristics curve analysis showed that CPRT > 33 µm (odds-ratio = 12.5) and PRD < 177 µm (odds-ratio = 9.86) were highly predictive for regaining reading vision (≥ 69 early treatment of diabetic retinopathy study letters) 12 months after surgery. No significant difference was found in postoperative macular morphology between subgroups.

Conclusions: Poor vision after 12 months despite macular hole closure was associated with attenuation and disruption of the foveolar photoreceptor matrix. The extent of attenuation and disruption was independent of peeling and staining.

ClinicalTrials.gov Identifier: NCT00302328

Methods: In this retrospective clinical chart review of patients with Behçet's disease that were treated with CsA or infliximab, we collected information on the number of acute episodes of uveitis, visual acuity and adverse side effects that occurred during the 6 months prior to and after the initiation of CsA (n=20) or infliximab (n=17).

Results: The number of acute episodes of uveitis during the 6 months before and after initiation of CsA and infliximab were 3.3 ± 2.4 and 1.2 ± 1.2, and 3.1 ± 2.7 and 0.4 ± 1.0, respectively (P<0.005). The number of episodes after infliximab administration was significantly lower as compared to that seen for CsA (P<0.05). During the 6-month treatment period, there were no significant differences noted in the improvement of the visual acuity between the two therapies. After CsA administration, neurological symptoms and renal toxicity were seen in one patient each, while after the infliximab administration, an infusion reaction and leucopenia were seen in one patient each.

Conclusion: During the initial 6 months of treatment, infliximab proved to be more effective in reducing acute episodes of uveitis in Behçet's disease.

Methods: A retrospective study of 46 DCRs with silicone intubation performed for patients with epiphora associated with a clinically patent lacrimal drainage system. All patients underwent pre-operative DCG and LS which were evaluated for presence, site and severity of delayed clearance. DCGs were also evaluated for reflux and anatomical abnormalities. Postoperative success was determined by subjective resolution of epiphora. Patients with persistent symptoms were offered Lester Jones Tube (LJT) insertion after establishment of a patent anastomosis to syringing and normal ostium on nasal endoscopy. Statistical analysis was performed using the Chi-square and Fisher’s exact tests to determine whether there was any association between surgical outcome and pre-operative resistance to lacrimal syringing, DCG and LS findings.

Results: 29 cases (63%) reported subjective surgical success after 11 months’ average follow-up. There was a statistically significant association between increased resistance to syringing pre-operatively and successful DCR (p=0.012). Of the 17 eyes that failed, all had patent anastomoses, and 7 went on to have LJT insertion with complete resolution of symptoms.

Conclusion: The majority of patients with patent but non-functional lacrimal drainage systems will be helped by DCR surgery, with greater success rates in those with significant reflux on pre-operative syringing. For patients with residual epiphora functional success can reach 100% with subsequent LJT insertion.

Methods: A population based cross sectional study in 2006 selecting subjects aged 50 years and older through a random multi-stage cluster sampling and door-to-door enumeration. Ophthalmic examination included visual acuity assessment and refraction, and anterior and posterior segment examination of the eyes carried out by a trained ophthalmologist and two ophthalmic assistants at centralized locations.

Results: The survey examined 5,138 of 5,196 persons enumerated (response rate of 86.8%). The mean age of subjects was 61 ± 9.2 years, and 2701 (52.6%) subjects were women. The age-sex adjusted prevalence of blindness (best presenting vision < 6/60) and visual impairment (better-eye presenting visual acuity of < 6/18 to > 6/60) were 4.6% (95% CI 3.4 - 5.8) and 18.9 % (95% CI 16.4 – 21.4), respectively. Blindness was significantly lower in the hills (3.3%) compared to the plains (5.8%) regions (OR 0.6; 95% CI: 0.4-0.9). The primary causes for blind eyes were cataract (n = 228, 48.1%), refractive error (n= 149, 31.4%), retinal disorders (n= 19, 4.0%) and corneal opacity (n= 18, 3.8%). The overall cataract surgical coverage was 66.6%. Cataract surgical coverage was not significantly associated with age, sex, literacy or District.

Conclusion: Although the prevalence of blindness and visual impairment is lower than 10 years ago, particularly among women, correctable blindness due cataract and refractive error (79.5% of blind people) remains a significant population health problem in Lumbini Zone and Chitwan District.

Material and methods: Consecutive patients above the age of 12 years attending a vision center were included. A vision technician (VT) determined visual acuity and performed slit lamp examination, applanation tonometry and undilated fundus examination followed by a 20-1 FDT screening test. VT and FDT findings were compared to the gold standard of masked comprehensive examination by an ophthalmologist. Sensitivity, specificity and predictive values were calculated.

Results: 1764 of 1829 patients fulfilling the inclusion and exclusion criteria were analysed. The VT had sensitivity and specificity of 68 % and 90 % for detection of significant ocular disease; corresponding values for FDT alone were 87.8 % and 79 %. Seventy-one of the 115 patients having significant ocular pathology missed by the vision technician were detected by FDT. A positive finding by the vision technician and/or positive FDT had a positive predictive value of 47%.

Conclusions: An examination by a vision center technician within the accepted WHO model may usefully leverage limited ophthalmological capacity in emerging economies. Adjunctive FDT testing may further improve VT referral efficiency.

Methods: Three patients with acute vascular occlusion of the posterior pole received a single intravitreal EPO injection of 2000 U. Immediately before the injection and over the ensuing three months, these patient were closely monitored by measuring visual acuity, visual fields, intraocular pressure, the electroretinogram, the hematocrit and serum EPO levels.

Results: Over the observational period, most parameters remained unchanged except for a short-term rise of serum EPO levels, which, however, did not exceeded normal serum levels. We did not observe injection-related toxicity.

Conclusion: Based on this limited set of data, a single EPO injection of 2000 U, a dose adapted from previous in vivo studies, is feasible and seems to induce no obvious damage. Hence, further investigations of this therapeutic approach appear justified.

Aim: To study how the enlargement develops as a function of time.

Methods: 11 subjects were trained by stimulating the border area of their visual field defect using a Goldmann perimeter. We assessed the visual field border location with dynamic Goldmann perimetry before, after and during training (after each 10th training session). To monitor eye fixation, a video-based eye-tracker was used during each complete perimetry session.

Results: We found that visual field enlargement during training is actually a gradual shift of the visual field border, which was independent of the type of stimulus-set used during training. The shift could be observed while eye fixation was good.

Conclusion: Visual detection training leads to a decrease of detection thresholds in the affected visual field areas and to visual field enlargement. Training effects can be generalized to important daily-life activities like reading.

Methods: In a prospective, interventional, clinical trial, 29 consecutive patients (29 eyes) with choroidal neovascularization (CNV) secondary to AMD received 3 initial monthly intravitreal injections of ranibizumab. During this loading regimen, best corrected visual acuity (BCVA) and microperimetry (MP) testing, as well as optical coherence tomography (OCT) and fluorescein angiography (FA) were performed using a standardized protocol and the results correlated.

Results: Significant morphological and functional therapeutic effects were observed as early as 1 week following the first treatment. Throughout the loading dose period, central retinal thickness (CRT) including intraretinal cysts and subretinal fluid decreased fast and significantly (p<0.01), PEDs resolved less rapidly. The mean leakage area by FA decreased (p<0.01) and retinal function (BCVA and MP) increased significantly (p<0.01 respectively). However, the change in morphology and function was only significant between baseline and week 1. There was no significant additional morphological or functional benefit following the second and third injection.

Conclusion: The initial administration of intravitreal ranibizumab in neovascular AMD induces a significant effect on intra- and subretinal fluid and visual function, subsequent injections have a less pronounced effect. It remains to be determined whether this loading regimen is mandatory in all patients or if a single dose regimen could lead to a comparable functional and morphological retinal improvement.

Methods: 40 consecutive patients who attended oculoplastic clinics with ptosis and 22 patients with normal lid function were recruited. In each subject levator function was recorded first by the conventional means (measuring total upper eyelid excursion between the extremes of down-gaze and up-gaze). Levator function was then also assessed using our novel 2 Phase approach in which upper eyelid excursion is measured separately between down-gaze and primary position (Phase 1), and between primary position and up-gaze (Phase 2).

Results: In normal patients and most of the patients with ptosis the majority of lid movement and hence levator function occurs between down-gaze and the primary position (Phase1). In those patients with ptosis and levator-superior rectus synkinesis a higher proportion of lid movement occurred on up-gaze (Phase2).

Conclusion: The 2 Phase measurement of lid movement highlights levator function in differing gaze positions and facilitates the identification of those patients with levator superior rectus synkinesis.

Methods: Consecutive patients with definite or suspected glaucoma, uncooperative for reliable IOP measurement in clinic, and required EUA were included in this study. IOPs were measured after intramuscular injection (5mg/Kg), or intravenous injection(2mg/kg) of ketamine using a Perkins applanation tonometer. Three measurements were taken from each eye. The IOPs were rechecked after sevoflurane, given for maintenance anaesthesia. Mean IOPs were used for analysis. Paired t-test was used to assess the differences in IOPs for the whole group and one-way ANOVA test for the three subgroups (ketamine IOP < 20mmHg, 20mmHg – 30mmHg, >30mmHg).

Results: The records of eight patients (16 eyes) were available for review. The mean age was 55.42 ± 25 months (26 – 89 months). Seventy data-points from both eyes (35 EUAs) were used for the analysis. The mean IOP after sevoflurane (17± 10mmHg) was statistically lower than after ketamine (24.4± 12.7mmHg, p < 0.001). The percentage difference was 28.5 ± 20.8% (95% CI; 23.5, 33.4). The difference between the subgroups was not statistically significant (p= 0.192).

Conclusion: Sevoflurane lowers IOPs significantly when compared with IOPs measured after ketamine. This difference is independent of the IOP level. It may be important to use ketamine as the induction anesthetic agent, when accurate IOP measurement is necessary during EUA for children.

Methods: 40 eyes underwent KTP alternatively to invasive cosmetic reconstructive surgery. Corneal staining with mineral micronized pigments was performed using either an intralamellar or superficial technique.

Results: One year postoperatively, all but two patients (95%) were satisfied. Pigmented eyes were improving patient's appearance. 8 cases needed a second KTP. 2 patients with preoperative corneal edema did not obtain an adequate cosmetic appearance due to progressive pigment clearance observed from 6 months postoperatively. 3 eyes with traumatic aniridia observed good cosmetic outcome and a significant reduction in glare.

Conclusion: KTP achieves good cosmetic results and is associated with high patient satisfaction, avoiding extensive and mutilating reconstructive surgery.

Methods: Routinely collected hospital statistics were analysed for England, using the Hospital In-patient Enquiry and Hospital Episode Statistics from 1968-2004, and for the Oxford National Health Service Region using the Oxford Record Linkage Study from 1963-2004.

Results: Annual English admission rates for surgery were around 5 episodes per 100 000 population in the 1960s, rising gradually to about 10 per 100 000 in the early 1990s, and then more sharply to 30 by 2004. The ORLS shows that multiple admissions per person were rare, which confirms that the observed increase represents a real increase in the number of people treated. Annual English rates for buckle procedures declined to around 6 episodes per 100 000 population in 2004 whereas vitrectomy surgery rose to around 26 in 2004.

Conclusion: Vitreo-retinal surgery has developed over the last 40 years in England, rapidly so over the past 15. Vitrectomy surgery has become much more common in England and buckle surgery has shown a steady decline. We demonstrate statistically significant geographical variation in the annual rate of surgery, currently, between local authorities in England.

Patients and methods: 10,892 first year students from 63 secondary schools within 30km from the base hospital were interviewed and had a visual acuity screening test. Students failing the 6/12 - line in either eye were defined as having ‘poor eyesight’ and referred to the base hospital where an optometrist re-tested visual acuity and refracted them. An ophthalmologist examined students with visual acuities of 6/12 or worse in either eye and visual impairment was defined as VA ofworse than 6/12 with best correction. Associations between optic neuropathy, socio-economic status and educational results were investigated.

Results: Students ages ranged from 12-22 years , mean 15.2 years and 50.6% were male. The prevalence of optic neuropathy was 0.3% (sd=0.051). The condition affected older students and was associated with the family having fewer economic possessions (car, computer,TV). Optic neuropathy accounted for 19/33 (58%) of bilateral visual impairment cases. No effect of the disease on educational performance was identified.

Conclusion: Optic neuropathy remains a significant problem in this population and can now be termed endemic rather than epidemic.

Methods: The study was carried out in parallel with a Rapid Assessment of Avoidable Blindness survey. Villages within Kilimanjaro Region were selected on a probability-proportional-to-size basis. Key informants in each village were trained to identify children with any vision problems; a visiting team assessed the children to determine visual status and arranged for further assessment as needed at hospital. Files of children at schools for the blind in the Region were reviewed to identify children in schools from the selected study villages.

Results: Among the 95,040 children in the 72 villages sampled, 13 children were identified as blind; an additional 3 children were found in the schools for the blind. The prevalence of blindness was 0.17 per 1,000 children; the causes of blindness varied but there was no vitamin A or measles-related corneal blindness and only 1 case of unoperated cataract.

Discussion: The low prevalence of blindness in children suggests that efforts at reducing childhood blindness in Kilimanjaro Region have been effective. Planners there should focus on community-based approaches to ensure that blind children have appropriate rehabilitation services and educational placement. While it remains impractical to carry out large childhood blindness surveys, this approach attached to a RAAB survey may be useful for generating information for planning services.

Methods: Images from 1253 patients with observable / referable retinopathy and 6333 patients with non-referable retinopathy were obtained from three grading centres. All images were reference graded and automated disease / no disease assessments were made based on microaneurysm detection and combined microaneurysm, exudate and haemorrhage detection.

Results: Introduction of algorithms for exudates and haemorrhages resulted in a statistically significant increase in the sensitivity for detection of observable / referable retinopathy from 94.9% (95% confidence interval, 93.5-96.0) to 96.6% (95.4-97.4) without affecting manual grading workload.

Conclusion: Automated detection of exudates and haemorrhages improved the detection of observable / referable retinopathy.

Methods: Retrospective review of clinical records of patients with AS.

Results: Nine patients with AS were identified, of whom three had no eye findings, four showed classic features of AS, and two had new findings, bull’s eye and vitelliform maculopathy. The genetic mutation responsible for the disease in the patient with vitelliform subretinal deposits was identified.

Conclusions: Patients with AS can present with a variety of ophthalmic manifestations. Bull’s eye maculopathy and vitelliform deposits can be features of AS. The mechanism of these new macular findings remains unknown. Possible pathophysiologic overlap with other maculopathies including age-related macular degeneration is discussed.

Methods: Retrospective noncomparative interventional case series. Seven consecutive cases (7 eyes) of pseudophakic bullous keratopathy were treated with DSEK using pediatric donor tissue and followed up for 12 to 18 months. Data collected included best spectacle-corrected visual acuity, spherical equivalent refractive error, corneal astigmatism, corneal curvature, and endothelial cell density.

Results: DSEK was successfully performed in 6 out of 7 eyes with pediatric donor graft; 1 pediatric donor graft perforated during dissection. All pediatric tissue was unfolded with "hitch suture" technique and supported with plenty of air. No graft dislocation occurred. At 12 months postoperatively, cornea was clear in all eyes; best spectacle-corrected visual acuity ranged from 20/67 to 20/32; average spherical equivalent refractive error was 1.9±0.5 diopters; average corneal astigmatism was 2.2±0.6 diopters; average corneal curvature was 45.2±1.6 diopters; and average endothelial cell density was 2247.7±74.3 cells/mm² (41.4±3.7% of endothelial cell loss).

Conclusion: With high postoperative endothelial cell counts, low graft dislocation rate, and absence of high myopic shifts, pediatric donor tissue can be successfully used in DSEK.

To investigate the importance of a larger stimulus field for pattern electroretinography (PERG) in evaluating macular function in Stargardt disease, and to determine the relationship between PERG and spectral-domain optical coherence tomography (SD-OCT).

Design: Prospective, nonrandomized, interventional case series.

Methods: Sixty-eight patients were studied prospectively in institutional clinical practices. Immediately after excision of orbital mass lesions, the removed tissue was stabilized under the hand of the surgeon, and biopsied with a 23 or 25 gauge needle. The samples were processed for cytopathologic examination with Cytospin®; after this, the excised specimens were submitted for routine histologic examination. The cytopathologic diagnoses were compared with the final histopathologic diagnoses.

Results: Six out of 68 lesions were excluded and the remaining 62 cases were divided into 4 groups as primary malignant, primary benign, secondary malignant and inflammatory lesions, based on histopathologic diagnoses. In 43 cases the cytopathologic and histopathologic diagnoses were the same with a concordance rate of 69%. Among the malignant tumors, the cytopathologic diagnoses correlated with the histopathologic diagnoses in 14/14 and 17/27 cases of metastatic /secondary and primary orbital malignancies, respectively. Of 11 primary benign tumors, 2 cytopathologic diagnoses correlated with histopathology. In inflammatory lesions, the cytopathologic diagnoses were matched with the histopathologic diagnoses in 10/10 biopsies.

Conclusion: Even when the sampling error is eliminated with an "in vitro FNAB" technique the concordance rates between histopathologic and cytopathologic diagnoses varied considerably among different types of orbital mass lesions. FNAB diagnoses were most reliable in metastatic and secondary malignancies and inflammatory lesions and least reliable in benign orbital lesions.

Methods: Medline searches were performed to identify articles with combinations of the following words: phacoemulsification, training, curriculum, virtual reality and assessment. Further articles were obtained by manually searching the reference lists of identified papers.

Results: Thus far phacoemulsification training outside the operating room (OR) included wetlabs and micro-surgical skills courses. These methods have been criticized for being unrealistic, inaccurate and inconsistent. Virtual reality (VR) simulators have the ability to teach phacoemulsification psychomotor skills as well as to carry out objective assessment.

Other ophthalmic surgical skill assessment tools such as Objective Assessment of Skills in Intraocular Surgery (OASIS) and Global Rating Assessment of Skills in Intraocular Surgery (GRASIS) are emerging. Assessor bias is minimised by using video-based assessments which have been shown to reduce subjectivity. Dexterity analysis technology such as the Imperial College Surgical Assessment Device (ICSAD) and virtual reality simulators can be used as objective assessment devices.

Conclusion: Improvements in technology can be utilized in ophthalmology and will help address the increasingly limited opportunities for training and assessment during training and throughout one’s career (re-training and re-validation). This will inevitably translate into enhanced patient care.

Methods: All newly diagnosed glaucoma patients at the University Hospitals-NHS, Aberdeen, and South Glasgow University Hospitals-NHS, in 2006, were included. Glaucoma was severe at presentation if there was a repeatable visual field loss with a Mean Deviation index greater than 12 dB in the Humphreys visual fields test or an absolute paracentral scotoma within the central 5 degrees of the visual fields. Home address was used to determine the Scottish Index of Multiple Deprivation (SIMD) rank. The SIMD rank, demographics and severity of glaucoma at presentation was investigated using general linear modelling.

Results: There were 48 patients with severe glaucoma and 74 patients with non-severe glaucoma. In four the severity could not be determined. Severity of glaucoma at presentation was significantly associated with SIMD rank, being most severe in patients from areas with the lowest ranks (p=0.026). Age was a significant factor (p=0.024) with severe glaucoma being more common in elderly patients.

Conclusions: Age and socio-economic deprivation were associated with severity of glaucoma at presentation, with patients from areas of higher socio-economic deprivation presenting with more advanced glaucoma.

Design: Prospective cohort study.

Setting: UK Hospital Children’s Eye and Orthoptic Departments.

Participants: An inception cohort of 460 children aged under 12 years with previously untreated X(T) (mean age 3.6 years, 55.9% girls) recruited from 26 UK Hospital Children’s Eye Clinics and Orthoptic Departments.

Main outcome measures: Participants received a standard ophthalmic examination at recruitment and orthoptic assessment at 3-monthly intervals thereafter. The influence of severity of exotropia (control measured by Newcastle Control Score (NCS) and angle of strabismus, visual acuity, stereoacuity) and age on the type of management was investigated.

Results: Within the first 12 months following recruitment, 297 (64.6%) children received no treatment, either for impaired visual acuity or for strabismus. 96 (21%) children had treatment for impaired visual acuity. 89 (19.4%) received treatment for strabismus (22 of whom also received treatment for defective visual acuity); in 54 (11.7%) treatment was non surgical and in 35 (7.6%) eye muscle surgery was performed.

Children with poor (score 7-9) control of strabismus at recruitment were more likely to have surgery than children with good (score 1-3) control (p<0.001). Children who had no treatment were younger (mean 3.38 years) than those who were treated (mean 4.07 years) (p<0.001).

Stereoacuity and size of the angle of strabismus did not influence the type of management received.

Conclusions: X(T) can be a presenting sign of reduced visual acuity. Most children with well controlled X(T) receive no treatment within 12 months following presentation.

Method: Children with both SOP and AHP, who underwent extraocular muscle surgery for correction of AHP were recruited. The patients received complete ophthalmic and orthopaedics examinations. Residual AHP was classified according to severity of face turn, head tilt and chin elevation.

Results: 32 children with mean age at operation of 82.6 months were recruited, with mean follow up of 37.9 months. 65.6% patients had a postoperative vertical deviation of less than three prism dioptres. 34.4% patients had resolved (0 degree), 34.4% had mild (0-10 degrees), and 31.3% had significant residual torticollis (greater than 10 degrees). 33.3% of the patients with significant residual torticollis had ocular causes. The mean age at operation for the patients with residual torticollis (95.9 months) was older than those without torticollis (79.9 months) (p=0.018). Residual torticollis was found to be related to sternocleidomastoid tightness (p=0.013).

Conclusion: The success rate for eliminating significant AHP after strabismus surgery for patients with congenital SOP was 68.8%. Early surgery was associated with a better outcome. Association was also found between sternocleidomastoid tightness and AHP. Multidisciplinary approach is recommended in the management of torticollis as ophthalmic and orthopaedic comorbidities can coexist.

Purpose: To study the microbiological and clinical profile of patients with microbial keratitis living in nursing homes.

Methods: A retrospective analysis of hospital records, from 1996 to 2006, of patients who had microbial keratitis, and were living in nursing homes, was undertaken. Main parameters evaluated were clinical and microbiological profile and final visual outcome.

Results: Of 66 patients included in this study, 39 were females and 27 were males with mean age of 81±11 years (range: 46-97). The major ocular and systemic factors associated with the occurrence of microbial keratitis were the presence of dry eyes (26%) and rheumatoid arthritis (81%) respectively. A positive bacterial culture was obtained in 54 (82%) cases with Staphylococcus being the most prevalent isolate (48%). Seven patients had positive culture for herpes virus. Surgical intervention had to be performed in 31(47%) of cases mainly in the form of botox injection for induction of ptosis (n=9, 27%), keratoplasty (n=8, 24%), tarsorrhaphy (n=5, 15%), or glue (n=3, 9%). The mean pre-treatment and post-treatment visual acuity was counting fingers and 6/60 respectively.

Conclusions: Microbial keratitis in patients living in nursing homes is usually caused by Staphylococcus and is associated with dry eyes and ocular surface disease. Surgical intervention is required in majority of cases with poor visual outcome.

Purpose: To report the efficacy of the Wies procedure (transverse blepharotomy and marginal rotation) in the management of trichiasis or cicatricial entropion of the upper or lower eyelid.

Methods: A retrospective chart review was performed of all cases of Wies eyelid rotations supervised or performed by one surgeon for cicatricial entropion or trichiasis of the upper or lower eyelids over a 17 year period to assess the indications, success rate and complications of the procedure. Where follow-up was less than 6 months, telephone interviews were conducted to assess patient satisfaction with the surgery. Patients not meeting these criteria were excluded from the final analysis. Success was defined as no recurrence of the entropion or trichiasis and/or patient satisfaction at least 6 months postoperatively. Statistical analysis was performed using a chi square test.

Results: We identified 126 eyelids (77 upper lids, 49 lower lids) in 89 patients (53 single eyelid, 33 multiple eyelids) that underwent a Wies procedure with a minimum follow-up period of 6 months. The mean follow-up period was 67 months (range 6-188 months). The overall success rate was 85%. 13 eyelids (10%) developed complications. 18 eyelids (14%) developed recurrences that required a second procedure. 10 of these second procedures were repeat Wies procedures, 1 of which was followed by electrolysis. All of these second Wies procedures were successful.

Conclusions: The Wies procedure (transverse blepharotomy and marginal rotation) is reasonably successful in managing trichiasis and cicatricial entropion of either upper or lower eyelids.

Aim: To evaluate the relation between vision-related quality of life (VR-QOL) and visual function in patients undergoing vitrectomy, gas tamponade, and cataract surgery for macular hole (MH).

Methods: The 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) was self-administered by 32 patients with MH (age 66.2 ± 5.4 years) preoperatively and at 3 months postoperatively. Clinical data were collected including logMAR best corrected visual acuity (BCVA), severity of metamorphopsia, and letter contrast sensitivity. The severity of metamorphopsia was evaluated by the M-Charts (Inami Co., Tokyo, Japan). Macular hole index was measured using optical coherence tomography. The presence and severity of cataract were graded using the Lens Opacities Classification System III reference standards. Multiple regression analysis was performed to investigate the relationship between various explanatory variables and VFQ-25 questionnaire scores. Explanatory variables tested were the severity of metamorphopsia, visual acuity, letter contrast sensitivity, macular hole index, and grade of cataract.

Results: Vitrectomy for MH significantly improved VFQ-25 composite score as well as subscale scores such as general vision, near activities, distance activities, social functioning, mental health, and dependency (p<0.05, Wilcoxon signed-rank test). Multiple regression analysis revealed that, both preoperatively and postoperatively, the severity of metamorphopsia had a significant correlation with VFQ-25 composite score (p<0.05), whereas other explanatory variable did not. Also, changes in the severity of metamorphopsia was the single variable that was significantly relevant to changes in VFQ-25 composite score (p<0.01).

Conclusion: Vitrectomy for MH significantly improved VR-QOL. The severity of metamorphopsia was significantly associated with both preoperative and postoperative VR-QOL.

Background: Pain is a common feature of microvascular ischemic ocular motor cranial nerve palsies (MP). The natural history of pain in this condition has not been studied. The purpose of this report is to define the pain spectrum in isolated MP, with special reference to diabetics versus nondiabetics.

Design and methods: Retrospective and prospective chart review was performed on 87 patients with acute onset MP of a single cranial nerve (CN III = oculomotor, CN IV = trochlear, or CN VI = abducens) that progressively improved or resolved over 6 months.

Results: Five of the 87 patients had two events, making the total number of events 92. There were 48 (52.2%) CN VI palsies, 39 (42.4%) CN III palsies, and 5 (5.4%) CN IV palsies. Thirty-six (41%) patients had diabetes. Pain was present in 57 (62%) events. The majority of diabetics and non-diabetics had pain. Pain preceded diplopia by 5.8 days (±5.5) in one third of events. There was a trend towards greater pain with CN III palsies but this was not statistically significant. Patients who experienced severe pain tended to have pain for a longer duration (26.4 ± 21.7 days versus 10.8 ± 8.3 and 9.5 ± 9 days for mild and moderate pain, respectively). There was no correlation between having diabetes and experiencing pain.

Conclusions: The majority of MP are painful, regardless of the presence or absence of diabetes. Pain may occur prior to or concurrent with diplopia. Nondiabetics and diabetics presented with similar pain characteristics, contrary to the belief that diabetics have more pain associated with MP.

Aims: To compare event-based glaucoma progression analysis (GPA) I with new GPA II software and pattern deviation-based trend analyses (visual field index [VFI]) to detect progression in a glaucoma population.

Methods: A retrospective study that included 90 eyes of 90 patients with a minimum of five reliable visual field tests and a follow-up period of at least 2 years.

Results: Event-based GPA II detected progression in 16.7% of eyes in which trend analysis VFI failed. GPA detected progression 6.8 months earlier than VFI. GPA I and II showed excellent agreement (k=0.94). Agreement between VFI and mean deviation (MD) linear analysis and with GPA criteria was k=0.52 and k=0.48, respectively. Mean rates of progression of MD and VFI were -0.41 dB and -1.30% annually, respectively (rho=0.824; P < 0.0001). Using VFI, mean follow-up time was 6.12 and 4.89 years (P= 0.004) and mean number of visual field tests was 7.33 and 6.01 (P= 0.023) in eyes with and without progression, respectively.

Conclusions: Event-based software GPA I and II had an excellent agreement. Event analysis showed earlier and greater sensitivity for detecting progression than VFI analysis and both had only moderate agreement. Trend analysis VFI is likely to detect progression in patients with a greater number of visual field tests and a longer follow-up time. The VFI analysis seems to be more accurate than MD analysis for determining rate of progression.

The management of diabetic macular oedema is changing. The therapeutic armamentarium for DMO includes a new group of drugs that inhibit vascular endothelial growth factor (VEGF). These antiVEGF agents are already being used widely in DMO in clinical practice despite the fact that several phase III trials on these drugs are still underway. There are no established protocols on the use of these agents in DMO but short-term results are appealing. This review provides an update on the use of antiVEGF agents in DMO.

While intravitreal delivery of antiVEGF agents is a relatively safe procedure, the long-term local and systemic effects of these agents in the diabetic population remain unknown. In this regard, this review also highlights the need for close surveillance of the use of these drugs in this high-risk population.

Evidence in the recent literature has highlighted the importance of central corneal thickness (CCT) in relation to several ocular and non-ocular conditions. Most notably, thinner CCT has been identified as a risk factor for open-angle glaucoma. Despite having an extensive knowledge of the structure and function of the cornea, little is known about the pathways that determine CCT. There is data to suggest however, that CCT has a strong genetic component. Heritability studies conducted in twins and family pedigrees indicate that CCT is one of the most highly heritable human traits, whilst data from a diverse range of ethnic groups shows clear ethnic-related differences in CCT. Extreme CCT measurements have also been associated with rare genetic diseases. Whilst there is strong evidence supporting a genetic component to normal CCT variation, to date, no genes have been identified. This review investigates the current literature surrounding this topic and explores the significance of understanding the genetics of CCT and how this might benefit the field of open-angle glaucoma treatment and research.

Aim: To determine if reduced light dose photodynamic therapy (PDT) combined with bevacizumab will decrease the number of bevacizumab treatments required over six months compared to bevacizumab monotherapy in neovascular age-related macular degeneration (AMD).

Methods: Thirty-six patients with neovascular AMD were recruited for this randomised, double-masked, controlled clinical trial. Patients received intravitreal bevacizumab plus PDT using a light dose of either 25 J/cm² (group 1) or 12 J/cm² (group 2), or intravitreal bevacizumab plus sham PDT (group 3). Patients returned monthly for possible retreatment with bevacizumab or combination therapy (with a three-month minimum interval between combination treatments); retreatment decisions were primarily based on optical coherence tomography. The main outcome measure was the mean number of bevacizumab treatments required over six months.

Results: Patients required a mean of 2.8 bevacizumab treatments in group 1 and 2.5 in group 2, compared to 5.1 in group 3 (p=0.005 and p<0.001, respectively).

Conclusions: Combination bevacizumab and 25-J/cm² or 12-J/cm² PDT significantly reduced the number of bevacizumab treatments required over six months. This study was powered to examine number of treatments, but not visual acuities. Nevertheless, visual acuities responded favourably in all three groups. Further studies will be helpful to explore visual outcomes.

This clinical trial was registered on ClinicalTrials.gov, Identifier NCT00359164.

Optic neuropathy is a visually disabling condition and has both primary and secondary etiology. In the later group, paraneoplastic lesions are a rare but important sub-group with many documented cases in literature. Almost all of these associations have been with small cell carcinoma of the lung1-4. We report a previously unreported case of bilateral optic neuropathy which was found to be secondary to a Papillary renal cell carcinoma.

Rhegmatogenous retinal detachment (RRD) is a potentially blinding condition. Obtaining an accurate estimate of RRD incidence in the population is essential in understanding the healthcare burden related to this disorder.

Methods: A systematic review of all population-based epidemiology studies of RRD published between January 1970 and January 2009 from Medline database searches was performed.

Results: RRD incidence demonstrates significant geographic variation and has been reported between 6.3 and 17.9 per 100,000 population. For studies with a sample size >300 the median annual incidence per 100,000 population was 10.5 (IQR 8.1 - 13.2) and mean proportion of bilateral RRD was 7.26%. Overall, the mean prevalence of lattice degeneration was 45.7% (SD–20.3%) and myopia was 47.28% (SD-12.59%).

Conclusions: Estimates of RRD incidence have varied three-fold but inclusion criteria and other design features have differed across studies making direct comparisons difficult. The overall incidence of RRD is not yet well established, more incidence studies of adequate methodology are needed to explore temporal changes in incidence. RRD incidence varies with ethnicity and is strongly associated with increasing age, myopia and certain vitreo-retinal degenerations. Due to changes in cataract surgery trends, the proportion of pseudophakic RRD presenting to specialised centres appears to be increasing.

A 58 year-old African American male was referred to ophthalmic oncology clinic for bilateral optic nerve calcification detected incidentally on a CT scan. The patient had no significant past medical history. The CT scan also showed extensive dural calcification, involving the falx cerebri and tentorium. After a normal eye examination that revealed 20/15 vision in both eyes and normal optic nerve function and appearance, the patient underwent B-scan ultrasonography and MRI. The calcification was localized to the optic nerve sheaths with no abnormal enhancement or optic nerve signal intensity abnormality on MR imaging. These findings were inconsistent with bilateral optic nerve sheath meningiomas, and the patient was diagnosed with idiopathic dural optic nerve sheath calcification.

Pterygium is an ocular surface disease of humans attributed to chronic ultraviolet-B (UV-B) exposure. Clinically, the condition involves invasive centripetal growth with associated inflammation and neovascularization. Prior clinical studies focused primarily on the clinical characteristics and surgical management of pterygia and, due to this fact, the pathogenesis of pterygia remains incompletely understood. However, considerable progress in this area has been achieved, providing additional insight into this complex disease. This recent evidence implicates anti-apoptotic mechanisms, immunological mechanisms, cytokines, growth factors, extracellular matrix modulators, genetic factors, viral infections, and other possible causative factors. Limited investigation regarding differences in pathogenesis of primary and recurrent pterygia has been performed. We summarize many of these recent discoveries concerning the pathogenesis of pterygia and describe reported differences between primary and recurrent pterygia.

A 56 year old woman with a history of exposure to tuberculosis presented with rapid visual loss following a prolonged period of malaise and intermittent headache. Despite clinical and ultrasonographic evidences of bilateral posterior scleritis, there were no other signs of ocular inflammation. Subsequent investigations confirmed a diagnosis of active tuberculosis. She was treated initially with quadruple anti-tuberculous therapy. The addition of pulsed intravenous methyl prednisolone was followed promptly by improvement in ocular symptoms with resolution of B scan abnormalities. This case demonstrates that posterior scleritis may present with minimal inflammatory signs, the importance of considering tuberculosis in the differential diagnosis of posterior scleritis and the role of additional steroid in the treatment of tuberculous scleritis.

Background: Intrastromal corneal ring segments (ICRS) are used in the treatment of keratoconus. We report a case of microbial keratitis, occurring three months following ICRS implantation.

Methods: A 40 year old woman presented to our department with microbial keratitis in her left eye three months following bilateral ICRS insertion for keratoconus. Best corrected visual acuity (BCVA) was 1/60. Slit lamp examination revealed infiltrates around the superior ring segment and microcystic corneal edema. The fellow eye revealed ICRS with no pathology. Corneal scrapings were obtained for microscopy and cultures, and intensive treatment was commenced with topical antibiotics. The clinical picture worsened over next 24 hours with development of hypopyon. The ICRS were removed 48 hours after admission and sent for culture.

Results: The patient’s symptoms improved and the hypopyon resolved following implant removal. Staphylococcus epidermidis was isolated from the corneal scrapings. The patient was discharged on topical vancomycin, tobramycin and fluorometholone. At last review (12 weeks), BCVA was 1/60 with corneal stromal haze at the site of the implant.

Conclusions: Infection following implantation of ICRS is a rare but serious complication that can occur many months after the initial procedure. Once infection is suspected, removal of the implants may be considered.

Background/aims: To compare the effectiveness and side effect profile of two doses of interferon alpha2b (IFN2b) eye drops (1 million international units (IU)/ml versus 3 million IU/ml) in the treatment of ocular surface squamous neoplasia (OSSN).

Methods: Retrospective case series.

Results: Thirty-five eyes were identified over an 11 year period (1996-2007). Twenty-one eyes (19 patients) with conjunctival intraepithelial neoplasia (CIN) were treated with 1 million IU/ml of topical IFN-2b; 12 eyes (9 patients) with CIN were treated with 3 million IU/ml. Two patients with squamous cell carcinoma (SCC) were treated with topical interferon, one with 1 million IU/ml and one with 3 million IU/ml. Baseline demographic information was not statistically different between the two groups. In patients with CIN, topical therapy eliminated disease in 81% of eyes in the 1 million IU/ml group versus 92%, in the 3 million IU/ml group, p=0.41. The median time to OSSN resolution was 2.8 months in the 1 million IU/ml group and 1.9 months in the 3 million IU/ml group, p=0.55. Neither eye with SCC responded to interferon therapy. Topical therapy was well tolerated. After median follow up of 24 months, three recurrences were seen in eyes successfully treated with topical therapy.

Conclusion: In our study, there were no significant differences between the 1 million IU/ml group and the 3 million IU/ml group for the treatment of CIN.

Purpose: To report the diagnostic capability of macular parameters in early glaucoma.

Material and methods: In a Cross-sectional observational study, two groups of subjects (early glaucoma and normals) who satisfied the inclusion and exclusion criteria were recruited. The diagnosis of early glaucoma was based on a glaucomatous appearance of the optic disc correlating with visual field defects (fulfilling at least two of three Anderson and Patella's criteria, with Mean Deviation less than or equal to - 6 dB (decibels). Normals had normal optic disc and fields with intraocular pressure < 22 mm Hg. All patients underwent a complete ophthalmic evaluation including visual field examination (24-2 / 30-2 SITA standard program) and imaging with Stratus OCT 3. Sensitivity, specificity, area under receiving operating characteristic curve (AUROC) and likelihood ratio were calculated for various macular parameters.

Results: 56 eyes (56 patients) with early glaucoma and 75 eyes (75 normals) were analysed. Both outer inferior average volume (p = 0.003) and thickness parameters (p=0.002) were statistically significantly lower in the glaucoma group. Outer inferior average volume had a "best combination" of sensitivity and specificity (56% and 79% respectively). Both outer inferior average volume and thickness parameters yielded the best AUROC’s of 0.66.

Conclusions: Outer inferior macular thickness and volume parameters in early glaucoma are significantly different from normals. The moderate sensitivity and specificity suggests that role of macular parameters in the diagnosis of early glaucoma is limited.

A 20-year-old moderately myopic female with near normal visual acuity was referred to us for complaints of photopsia and painless visual field loss in her right eye for 3 years which had accelerated in the prior 7 months. A relative afferent pupillary defect, 1+ cells in the anterior vitreous, multiple round grayish-yellow punched out lesions in the temporal retinal periphery and a dense temporal field defect were noted in the right eye. Spectral domain optical coherence tomography (OCT) revealed photoreceptor outer segment abnormalities typical of acute zonal occult outer retinopathy (AZOOR). The dual diagnosis of multifocal choroiditis and panuveitis (MFP) and AZOOR was made. Treatment with a subtenon injection of triamcinolone in the affected eye as well as oral immunosuppression with mycophenolate mofetil was initiated.

This case demonstrates that AZOOR should be considered in the differential diagnosis of cases of progressive visual field loss with minimal funduscopic changes, particularly when associated with a history of photopsia. It also emphasizes that two different entities of the AZOOR-complex are possible in the same eye. The higher resolution of the spectral domain OCT versus time domain OCT can play an important role in the diagnosis of AZOOR-complex disorders.

Minimum vision standards for employees are used in manufacturing,[1]transport industries,[2, 3]the emergency[4] and armed services1.[5]Traditionally, these have applied to colour vision, visual acuity and refractive error, with the later addition of visual fields for driving.[6]Vision standards are often historic and differ between countries, and their validity may be questioned as technological advances obviate some visual tasks.[7]Furthermore, entry standards applied to uncorrected acuity are being bypassed by advances in refractive surgery. This is of special significance in the armed services, where operational constraints must be taken into account. Our understanding of the interplay between visual demands at work and the effects of refractive surgery is evolving. Vision standards and official policies on refractive surgery should be understood in relation to the work environment, by both surgeons and patients. Performance-based and parametric tests are helping to define vision standards in a variety of occupations. Surgical correction of refractive errors can in many cases allow previously ineligible candidates to pursue their chosen occupation.

Background: Neovascular age-related macular degeneration (AMD) has a poor prognosis if left untreated, frequently resulting in legal blindness. Ranibizumab (Lucentis^®; Novartis Pharma AG, Basel, Switzerland; Genentech Inc., South San Francisco, CA, USA) is approved for treating neovascular AMD. However, further guidance is needed to assist ophthalmologists in clinical practice to optimise treatment outcomes.

Methods: An international retina expert panel assessed evidence available from prospective, multicentre studies evaluating different ranibizumab treatment schedules (ANCHOR, MARINA, PIER, SAILOR, SUSTAIN, and EXCITE) and a literature search to generate evidence based and consensus recommendations for treatment indication and assessment, re-treatment, and monitoring.

Results: Ranibizumab is indicated for choroidal neovascular lesions with active disease, the clinical parameters of which are outlined. Treatment initiation with three consecutive monthly injections, followed by continued monthly injections, has provided the best visual-acuity outcomes in pivotal clinical trials. If continued monthly injections are not feasible after initiation, a flexible strategy appears viable, with monthly monitoring of lesion activity recommended. Initiation regimens of fewer than three injections have not been assessed. Continuous careful monitoring with flexible re-treatment may help avoid vision loss recurring. Standardised biomarkers need to be determined.

Conclusion: Evidence-based guidelines will help to optimise treatment outcomes with ranibizumab in neovascular AMD.

An asymptomatic 56 year old caucasian woman was referred when her optometrist noted an area of ‘hyperaemia’ in the centre of her right optic disc at a routine visit. On presentation, her visual acuities were 6/9 in each eye, with normal intraocular pressures. Fundoscopy revealed a right optic disc macroaneurysm. 9 months later, the visual acuity of the right eye suddenly deteriorated to 6/60 and an inferior altitudinal field defect was demonstrated. Fundal examination revealed an area of haemorrhage overlying the aneurysm and a superior branch retinal artery occlusion. Spontaneous rupture of the aneurysm involving the proximal part of the superior branch of the central retinal artery was thought to have led to secondary closure of the distal vasculature. Examination 3 months later revealed complete resolution of the aneurysm and visual acuity had improved to 6/12.

A 42-year-old woman was diagnosed with both Fuchs heterochromic uveitis (FHU) and ocular toxoplasmosis. She developed severe glaucoma and underwent trabeculectomy. In the perioperatieve period, she was treated with pyrimethamine and foline acid. Aqueous humour was collected and examined for rubella virus and Toxoplasma gondii by Goldmann-Witmer coefficient (GWC) and PCR. PCR results were negative, however, GWC values were positive (>3) for both pathogens. After 17 months cataract surgery was performed. By then the GWC for T. gondii had become negative, but the GWC for rubella virus was still positive.

The present case highlights the clinical and laboratory diagnosis of FHU and ocular toxoplasmosis. It also demonstrates the existence of two uveitis entities, FHU and Toxoplasmosis, in a single patient.

Background/aims: Scant consideration has been given to the variation in structure of human amniotic membrane (AM) at source or to the significance such differences might have on its clinical transparency. Therefore, we applied our experience of quantifying corneal transparency to AM.

Methods: Following elective caesarean, AM from areas of the fetal sac distal and proximal to the placenta was compared to freeze-dried AM. The transmission of light through the AM samples was quantified spectrophotometrically, also measured were tissue thickness by light microscopy and refractive index by refractometry.

Results: Freeze-dried and freeze-thawed AM samples distal and proximal to the placenta differed significantly in thickness, percent transmission of visible light and refractive index. The thinnest tissue (freeze-dried AM) had the highest transmission spectra. The thickest tissue (freeze-thawed AM proximal to the placenta) had the highest refractive index. Using the direct summation of fields method to predict transparency from an equivalent thickness of corneal tissue, HAM was found to be up to 85% as transparent as human cornea.

Conclusion: When preparing AM for ocular surface reconstruction within the visual field, consideration should be given to its original location from within the fetal sac and its method of preservation, as either can influence corneal transparency.

A 74 year-old Caucasian man developed gradual bilateral visual loss after diagnosis of metastatic cutaneous melanoma. Fundus exam revealed multiple serous detachments of the neurosensory retina in both eyes. Electroretinography was normal. Serologic testing showed autoantibodies to interphotoreceptor retinal binding protein (IPBP). This represents an unusual variant of MAR (melanoma associated retinopathy) syndrome.

Evidence of a link between Alzheimer’s disease (AD) and glaucoma has emerged from studies showing that patients with AD may have a significantly increased occurrence rate of glaucoma. In addition, it has been reported that patients with AD exhibit optic nerve degeneration and loss of retinal ganglion cells. In spite of intensive research, the clinical and genetic relationships between AD and glaucoma remain obscure. It is unclear whether the clinical correlation between the two diseases might be due to shared risk factors or the influence of one disorder on the other. Interestingly, certain observations may provide a clue towards a better understanding of the high rate of comorbidity reported between AD and glaucoma. In this article, we hypothesize that there may be a causal relationship between AD and glaucoma that may be explained by decreased cerebrospinal fluid pressure (CSFP) in patients with AD. A very recent study reported the intriguing new observation that mean CSFP was 33% lower in subjects with primary open-angle glaucoma compared with that of nonglaucomatous controls. It was noted that this observation supports the concept that an abnormal high trans-lamina cribrosa pressure difference, whether the result of elevated intraocular pressure, reduced CSFP, or both, plays an important role in glaucomatous optic nerve damage. Interestingly, it was also reported that a substantial proportion of AD patients have very low CSFP. Therefore, we hypothesize that an abnormal high trans-lamina cribrosa pressure difference may explain why patients with AD have a greater risk for developing glaucoma.

The pathogenesis of acute and recurrent anterior uveitis is poorly understood. Here we present recent evidence for the hypothesis that this disease may be associated with activation of receptors of the innate immune system, such as Toll like receptors (TLR), by pathogen associated molecule patterns (PAMPs), such as lipopolysaccharide (LPS), derived from triggering Gram negative bacteria. Acute anterior uveitis results in ocular tissue damage and the release of endogenous molecules (Damage associated molecular patterns- DAMPs), such as heat shock proteins (HSP) and S100 proteins that can also activate TLRs and thus perpetuate or reactivate intraocular inflammation.

The concept of "open" and "closed" intraocular surgery is discussed particularly with respect to ocular anesthesia. While topical anesthesia is possible for closed surgery of limited duration and manipulation such as phacoemulcification, in cases of open intraocular surgery (nuclear expression cataract surgery, penetrating keratoplasty, trabeculectomy) a good sensory and motor block and control of the orbicularis by block or speculum is very important to avoid positive vitreous pressure and its complications. We highlight the importance of administering additional anesthesia when converting from topical anesthesia phacoemulsification to nuclear expression to try to prevent positive vitreous pressure and vitreous loss.

We describe a case of ciliary body mass with pigment dispersion to the vitreous. Differential diagnosis and management of patients with such lesions are addressed.

A child developed solar maculopathy while being treated with methylphenidate (Ritalin) for attention deficit hyperactivity disorder (ADHD). The patient was evaluated by color fundus photography, fluorescein angiography and optical coherence tomography (OCT). OCT images demonstrate localized loss of the hyper-reflective layer normally attributed to the photoreceptors’ outer segments and partial loss of the retinal pigment epithelial hyper-reflective layer. Central nervous system stimulants including methylphenidate can cause mydriasis, increasing the risk of macular damage during sungazing. Methylphenidate is widely used for ADHD. The present case highlights long term retinal findings in solar retinopathy, their differential diagnosis and the potential hazardousness of sungazing during methylphenidate therapy.

Purpose: To examine the visual outcome and identify risk factors for developing postoperative uveitis, macular oedema and Nd:YAG capsulotomy after phacoemulsification and intraocular lens (IOL) implantation in patients with uveitis.

Method: This is a retrospective review of the medical records of 101 eyes of 101 patients. One eye was randomly selected for inclusion in patients who had bilateral surgery. Patients with juvenile arthritis, kerato-uveitis and lymphoma-associated uveitis were excluded.

Results: At the first postoperative and final visits, visual acuity was significantly better (p<0.001) and 64.4% and 71.3% of patients, respectively, achieved >=2 lines of visual improvement. The cumulative probability of doubling of the visual angle was 52% over 6 years of follow-up and this occurred at a higher rate in the presence of preoperative retinal or optic nerve lesions [HR=4.49; 95% confidence interval (CI) (1.41 to 14.29)]. Within 3 months postoperatively, uveitis was more likely in female patients [OR=6.21 (1.41, 27.43)] and in the presence of significant intra-operative posterior synechiae [OR=8.43 (1.09, 65.41)]; and macular oedema was more likely in patients who developed postoperative uveitis [OR=7.45 (1.63, 34.16)]. Nd:YAG capsulotomy occurred at a higher rate in patients aged 55 years or younger [HR=2.28; 95% CI (1.06, 4.93)] and in those with hydrogel IOLs [HR=3.71(1.04, 13.20)] and at a lower rate in patients who had prophylactic systemic corticosteroids [HR=0.25 (0.11, 0.59)], with plate-haptic silicone IOLs [HR=0.23 (0.08, 0.64)] and 3- piece silicone IOLs [HR=0.19 (0.05, 0.74)] in comparison with PMMA IOLs.

Conclusion: The majority of patients with uveitis achieve improvement of visual acuity after phacoemulsification but an increasing rate of visual loss occurs in those with pre-existent macular or optic nerve lesions. Identifying patients at risk of postoperative complications should help in patient counselling and to pre-empt these complications by using preoperative prophylactic corticosteroids, careful IOL selection and postoperative intensive corticosteroids.

We report about a child who developed a head tilt and unusual oculo-motor findings following otitis media with adjacent intracranial venous thrombosis, progressive worsening of papilledema with subsequent retinal nerve fiber layer and optic nerve atrophy.

We describe a 5 year old child who was found to have bilateral optic disc swelling in association with superficial optic disc haemorrhages, investigated and diagnosed with idiopathic intracranial hypertension. His optic disc appearances remained unchanged despite treatment. A B-mode ultrasound B scan and auto-fluorescence study confirmed the presence of optic disc drusen. Fundus fluorescein angiography excluded optic disc oedema.

As illustrated by this case the clinical differentiation of pseudopapilloedema from true papilloedema can be challenging. Characteristic retinal nerve fiber layer (NFL) haemorrhages do occur in association with ODD and should not preclude the diagnosis. We highlight the combined use of B-mode ultrasound and fluorescein angiography for the accurate diagnosis and differentiation of optic disc drusen and true optic disc swelling. These readily available investigations may render more invasive ones unnecessary.

A 48 year-old man presented with typical symptoms and signs of optic neuritis right eye. However, vision deteriorated to no light perception with the development of retinal vascular occlusions despite treatment with intravenous steroids. Serial MRI demonstrated enlarging lesions involving right optic nerve/chiasm, corpus callosum, and cerebellum. A superficial optic nerve biopsy showed atrophy. Cerebellar biopsy revealed the diagnosis of anaplastic astrocytoma (WHO Grade III). The case demonstrates that malignant optic nerve glioma of adulthood may be multicentric in nature and mimic optic neuritis clinically. We recommend a full-thickness optic nerve biopsy to help avoid a false-negative outcome.

A 64 year old Caucasian male was referred in 2005 with a 4 month history of left non-axial proptosis. He had previously undergone local resection of a left uveal melanoma in 1977 followed by plaque radiotherapy for suspected recurrences in 1981 and 1991. Biopsy of a pigmented fornix lesion confirmed recurrence and orbital imaging showed massive retrobulbar orbital extension. Metastasis screening was negative and an extended orbital exenteration was performed with the aim of curative treatment. Histological examination and cytogenetic analysis of the tumour demonstrated low grade characteristics with a favourable prognosis. This case highlights the natural history and treatment of uveal melanoma with late orbital recurrence, the importance of meticulous ocular examination and advances in prognostication of this tumour.

We present a report of a young man with bilateral retinal dialyses in whom surgery, in the form of scleral buckling, was initially performed only to one eye. Post-operatively, he developed features of combined central retinal and distal choroidal artery occlusions in the operated eye. Postulated mechanisms for this complication included a period of systemic hypotension during surgery, and previously undiagnosed polycythaemia and activated protein-C resistance which were found on subsequent haematological investigations, these being risk factors for thrombosis. This case serves to highlight the need for caution in performing simultaneous bilateral scleral buckling surgery without routine haematological screening, due to the extremely rare but potentially devastating effects of bilateral vascular occlusion.

Case Report: A 75-year-old Japanese woman was referred to us for persistent irritation in September 2006. She reported a history of foreign body sensation in the left eye for 4 years. Slit lamp examination revealed hypertrophy, hyperemia, and pronounced fluorescein staining of the superior bulbar conjunctiva in the left eye (Figure 1-A, B). Schrimer's test results were 2 mm in the right eye and 1 mm in the left eye. The diagnosis of SLK with aqueous deficiency dry eye was made based on these findings. Initially, treatment was attempted with 0.1% fluorometholone and 0.1% sodium hyaluronate eyedrops without success. Punctal plugs inserted to the upper and the lower puncta provided little symptomatic relief.

The authors report two uncommon cases of chronic granulomatous blepharo-conjunctivitis as a recurrence of Leishmania (Viannia) braziliensis cutaneous leishmaniasis (CL). Patients were otherwise healthy immunocompetent adults, as revealed by a positive cutaneous delayed-type hypersensitivity (DTH) reaction to Leishmania-derived antigens and a typical cell-mediated immunity-induced granulomatous reaction that had effect on the control of parasite replication at the lesions. This rare cause of ocular involvement should be considered in areas where Leishmania is endemic.

Acute posterior multifocal pigment placoid epitheliopathy (APMPPE) is characterized by acute painless visual loss in association with multiple, flat, cream-colored lesions with indistinct margins located in the posterior pole at the level of the retinal pigment epithelium (RPE) or choroid. The condition is typically bilateral, affects patients under the age of 30 years, and has a good visual prognosis.1 We report a case of APMPPE in a child following administration of the live, attenuated varicella vaccine Varivax (Merck & Co., Inc., Whitehouse Station, New Jersey).

A 30 year-old African-American woman with systemic lupus erythematosus (SLE) developed severe bilateral optic disc swelling followed several months later by progressive visual field loss. Neuroimaging revealed no abnormalities but a lumbar puncture revealed increased intracranial pressure (ICP), an elevated concentration of protein in the cerebrospinal fluid (CSF). Her condition did not improve despite medical therapy with leflunomide, methotrexate, prednisone, and rituximab. Consideration was given to an optic nerve sheath fenestration or a ventricular shunt procedure. She was referred to the clinic for neuro-ophthalmologic assessment and recommendations. Because of the elevated concentration of protein in her CSF, treatment was initiated with intravenous followed by oral corticosteroids. Despite this treatment, the patient’s visual fields continued to deteriorate, associated with severe, persistent bilateral disc swelling. As surgery carried a high risk of failure, more aggressive medical therapy was pursued. After rheumatologic consultation, the patient started monthly (total 6) treatments with intravenous cyclophosphamide. Her visual fields dramatically improved and the papilledema resolved. This case highlights the challenges of managing papilledema and vision loss and the potential role of cyclophosphamide in the setting of SLE-associated pseudotumor cerebri syndrome.

Purpose: To analyze the visual outcomes,intraoperative and postoperative complications of Cionni ring implantation in eyes with a subluxated lens associated with Marfan Syndrome.

Methods: This case series comprised 15 eyes of 12 patients aged 19 to 56 years with a subluxated lens secondary to Marfan's syndrome operataed at the departament of ophtalmology, Toronto Western Hospital between 2003 and 2007. A 2-eyelet Cionni ring and an AcrySof®(Alcon) foldable intraocular lens (IOL) was implanted in 13 eyes. The Cionni ring was secured in position with a transscleral suture knotted to the ring's hook, avoiding peripheral perforation of the capsular bag. Two eyes had trans scleral IOL fixation in the ciliary sulcus. Best-corrected visual acuity (BCVA), wavefront evaluation of eye aberration, and complication rates were analyzed.

Results: In all eyes capsular bag centration was excellent. Preoperative visual acuity ranged from 20/50 to counting fingers, and improved to better than 20/40 in all eyes. Mean follow up duration was 14 + 9.49 months. The most frequent postoperative complication was posterior capsule opacification, which occurred in 3 eyes (18.7%), 2 of which required a neodymium:YAG posterior capsulotomy. No eye developed retinal detachment. Total eye aberration, tilt and high-order aberrations with a 6-mm pupil diameter decreased significantly after surgery (n=5): Total eye aberration decreased from a mean of 14.8 + 5.5 preoperatively to 2.1+ 4.3 microns after the operation. Tilt was decreased from 4.1+ 2.5 to 0.12+ 2.1 microns ,and high-order aberrations decreased from 4.37+ 3.8 microns, before the operation, to 1.47+ 3.5 after the operation.

Conclusion: Cionni ring implantation is an acceptable procedure to correct limited lens subluxation, preserves the capsular bag, and has few complications (during 14 months of follow up)in patients with Marfan Syndrome.

Background/Aims: To determine the risk of non- arteritic anterior ischemic optic neuropathy (NAION) after cataract extraction (CE) in the fellow eye of patients with prior unilateral NAION.

Design: Retrospective, cohort study.

Methods: Medical records of patients with NAION evaluated in our institution between January 1, 1986 and December 31, 2001 were reviewed to determine the onset of NAION and the time of CE. Cases were excluded if the date of NAION and CE was unreliable or if fellow eye CE was performed before the unilateral NAION. Statistical analysis was performed by including fellow eye CE as a time dependent covariate in a Cox proportional hazards regression model of fellow eye NAION incidence.

Results: Of the 325 eligible patients, 9 (53%) of 17 NAION patients who underwent CE in the fellow eye developed fellow eye NAION, and 59 (19%) of 308 NAION patients who did not undergo CE in the fellow eye developed fellow eye NAION. Cataract extraction in the fellow eye increased the risk of NAION occurrence in the fellow eye by 3.6 times (Cox regression, p=0.001).

Conclusions: Patients with unilateral NAION are at a significantly higher risk of developing NAION in the fellow eye after CE.

Purpose: To examine the visual outcome and identify risk factors for developing postoperative uveitis, macular oedema and Nd:YAG capsulotomy after phacoemulsification and intraocular lens (IOL) implantation in patients with uveitis.

Method: This is a retrospective review of the medical records of 101 eyes of 101 patients. One eye was randomly selected for inclusion in patients who had bilateral surgery. Patients with juvenile arthritis, kerato-uveitis and lymphoma-associated uveitis were excluded.

Results: At the first postoperative and final visits, visual acuity was significantly better (p<0.001) and 64.4% and 71.3% of patients, respectively, achieved >=2 lines of visual improvement. The cumulative probability of doubling of the visual angle was 52% over 6 years of follow-up and this occurred at a higher rate in the presence of preoperative retinal or optic nerve lesions [HR=4.49; 95% confidence interval (CI) (1.41 to 14.29)]. Within 3 months postoperatively, uveitis was more likely in female patients [OR=6.21 (1.41, 27.43)] and in the presence of significant intra-operative posterior synechiae [OR=8.43 (1.09, 65.41)]; and macular oedema was more likely in patients who developed postoperative uveitis [OR=7.45 (1.63, 34.16)]. Nd:YAG capsulotomy occurred at a higher rate in patients aged 55 years or younger [HR=2.28; 95% CI (1.06, 4.93)] and in those with hydrogel IOLs [HR=3.71(1.04, 13.20)] and at a lower rate in patients who had prophylactic systemic corticosteroids [HR=0.25 (0.11, 0.59)], with plate-haptic silicone IOLs [HR=0.23 (0.08, 0.64)] and 3- piece silicone IOLs [HR=0.19 (0.05, 0.74)] in comparison with PMMA IOLs.

Conclusion: The majority of patients with uveitis achieve improvement of visual acuity after phacoemulsification but an increasing rate of visual loss occurs in those with pre-existent macular or optic nerve lesions. Identifying patients at risk of postoperative complications should help in patient counselling and to pre-empt these complications by using preoperative prophylactic corticosteroids, careful IOL selection and postoperative intensive corticosteroids.

Background: Because Optical Coherence Tomography (OCT) is widely used for diagnosis and monitoring of ocular pathology, especially in the elderly, we studied the influence of cataract on image quality and macular retinal thickness.

Methods: In 29 patients scheduled for cataract surgery, pre- and postoperative OCT scans were obtained. Cataracts were categorized as nuclear, posterior or cortical. Parameters for image quality (signal-to-noise ratio (SNR), signal strength (SS)) and macular thickness were compared. A three-level expert grading scale was used to evaluate the discriminative abilities of SNR and SS.

Results: Nuclear cataracts (n=12) provided better pre-operative scans (higher SNR/SS) than posterior (n=7) and cortical (n=10) cataracts (p < 0.004). Post- operatively SNR and SS increased significantly in all patients (p < 0.001). The SNR was better at discriminating poor from acceptable and good scans than SS (AROC: 0.879 and 0.810 resp.). Postoperative macular thickness overall showed a statistically significant increase (p = 0.005), most evident in patients with posterior cataracts (p = 0.028).

Conclusions: OCT imaging is influenced by cataract; image quality is reduced pre-operatively and macular thickness measurements are slightly increased post-operatively. In individual patients, OCT scans remain reliable for gross clinical interpretation, even in the presence of cataract.