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THE NEW WAY TO TREAT PARASELLAR MENINGIOMAS
Intracranial meningiomas are slow growing tumours that traditionally have been treated by surgical excision. Recent studies have suggested that they are radiosensitive. Fractionated stereotactic radiotherapy is one of the newer treatments that neurosurgeons have been using against meningiomas at the base of the skull. Behbehani and coworkers report the results of 13 patients treated with this therapy for parasellar meningiomas. The preliminary findings suggest that it is safe and effective. See p 130
PDT THERAPY FOR INFLAMMATORY CHOROIDAL NEOVASCULARISATION
Some patients with ocular inflammatory disease will develop choroidal neovascularisation. The standard approach in these patients has been the use of systemic immunosuppression. Regrettably, this is not always successful. Leslie and coworkers report the results of six patients with inflammatory choroidal neovascularisation who failed to respond to systemic immunosuppression and later underwent PDT therapy. In this study PDT appeared to a useful option in the management of these patients. See p 147
ARE THERE ANY RISKS OF ATROPINE THERAPY IN THE TREATMENT OF MYOPIA?
The use of topical atropine solution has recently been studied in an attempt to slow or halt the progression of myopia in children. A beneficial effect of atropine therapy has been reported. The question arises whether the use of atropine chronically is associated with photic damage or toxic damage to the retina. Luu and coworkers performed multifocal ERGs on 48 children receiving atropine once daily for 2 years. In this study daily atropine use over 2 years for the treatment of myopia was found to have no significant effect on retinal function as demonstrated by the recording of multifocal ERGs. See p 151
AUGMENTED TRABECULECTOMY AS A TREATMENT FOR CHILDREN WITH GLAUCOMA
The treatment of glaucoma in children is difficult. Many surgical approaches have been studied including goniotomy, trabeculotomy, and trabeculectomy. Ehrlich and coworkers report the results of 29 eyes treated with augmented trabeculectomy as the primary procedure. In this study augmented trabeculectomy with mitomycin C and 5-fluorouracil appeared to be an effective primary procedure. Visual outcomes in these patients are also dependent on vigorous and early amblyopic therapy. See p 165
IS THE CAROTID ARTERY THE PROBLEM?
The term normal tension glaucoma is used for patients with typical glaucomatous damage of the optic nerve and visual field loss in spite of normal measured intraocular pressures. Various mechanisms have been proposed although controversy surrounds all of them. Ogata and coworkers studied 103 eyes of 54 Japanese patients diagnosed with normal tension glaucoma. Neuroradiological findings of magnetic resonance images were studied. A significantly higher percentage of normal tension glaucoma patients had optic nerve compression of the internal carotid artery on MRI studies than the controls. The authors suggest that at least one cause of low tension glaucoma may be compression of the optic nerve by the internal carotid artery. See p 174
WHAT ARE COTTON WOOL SPOTS?
Cotton wool spots are accumulations of axoplasmic debris within adjacent bundles of ganglion cell axons. It is generally held that this reflects focal ischaemia from arterial occlusion. McLeod reviews the evidence for this thesis. He suggests that credible evidence to support this view is lacking. He further suggests that cotton wool spots should be viewed as nothing more than sentinels of retinal nerve fibre layer pathology. He suggests that the term cotton wool sentinels might be a better term than cotton wool spots. See p 229