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EXTRAORDINARY RESULTS OF HIGH VOLUME CATARACT SURGERY IN INDIA
It is estimated that 38 million people are blind worldwide, 9 to 12 million are in India. Estimates suggest that 50-80% of these people are blind because of cataract. The need for a rapid, effective and safe cataract procedure for the developing world is obvious. Balent and co-workers report the outcome of 593 patients undergoing cataract surgery by high volume surgeons. Average surgical time for these patients was less than 4 minutes, yet best corrected visual acuity of greater than 6/18 was achieved in 94% of patients. High volume surgery is compatible with good quality outcomes. See p 1079
THE PROBLEM OF GENERIC EYE DROPS
The cost of prescription pharmaceuticals is well documented. The production of generic pharmaceuticals in the developing world is an obvious necessity. Nevertheless, Weir and associates point out that in a study of generic ciprofloxacin eye drops purchased without prescription in India, 20% were under potent. In a number of preparations the antibiotic content was sufficiently low to have a potentially adverse impact on clinical outcome. The authors suggest that more wide spread studies on the problem of under potency of generic antibiotic medicines in developed countries need to be completed. See p 1094
TOPICAL ANTIBIOTICS-STRONGER THAN YOU THINK
Topical antibiotics are ideal for external ocular infections. The risk of developing bacterial resistance in both ocular and non-ocular sites is believed to be lower with topically applied antibiotics than with systemic antibiotics. Nevertheless, Lietman and co-workers demonstrated in a study of children in western Nepal that the use of routine antibiotic prophylaxis may produce unwanted side effects. In a study of annual mass treatment with oral azithromycin the prevalence of drug resistant S pneumoniae was increased. Surprisingly topical tetracycline also increased naso-pharyngeal drug resistance. The authors conclude that topical antibiotics may have an effect on extra ocular bacterial resistance. See p 1097
HOW BEST TO PURIFY TRIAMCINOLONE ACETONIDE SUSPENSION FOR INTRAVITREAL USE?
Clinical and experimental studies have shown that intravitreal injection of triamcinolone acetonide may be a therapeutic option for neovascular, oedematous, or inflammatory disease. The use of different doses of intravitreal triamcinolone in different techniques to reduce the solvent agent, benzyl alcohol have been reported. Arumi and co-workers report an analysis of different techniques used to reduce the solvent agent benzyl alcohol. All techniques were effective in reducing the concentration of benzyl alcohol. The final concentration of triamcinolone was however, much lower than expected using filtering techniques. The pore size inversely influenced the final concentration. Centrifugation is recommended by the authors as the best way to purify the drug. See p 1112
TREATMENT OF PERIORBITAL HAEMANGIOMAS
Hemangiomas of infancy are common benign tumors that may affect the periorbital tissues. Amblyopia may result from occlusion, strabismus or induced anisometropia. The use of intralesional steroids has been advocated by some authorities to reduce the refractive error induced by the haemangioma. Fredrick and co-workers systematically reviewed the literature for corticosteroid treatment of periorbital haemanagiomas of infancy and concluded that intralesional therapy may reduce refractive error while the efficacy of topical steroids is unclear. They further emphasize that objective ophthalmic data in the patient’s prior to and after therapy are sparse and that more studies are needed to determine the relative efficacy of different steroids and their administration. See p 1134
INTERMEDIATE UVEITIS-ITS IMPACT ON PATIENTS
Intermediate uveitis is a type of chronic relapsing uveitis characterised by vitritis, peripheral retinal vasculitis, systoid macular edema and the absence of significant chorioretinal inflammation. Dick and co-workers studies the quality of life and visual function in patients with intermediate uveitis. In this study of 42 patients the majority of patients maintained good visual function and quality of life. See p 1161
RISK FACTORS FOR MACULAR DEGENERATION
Some authorities have suggested that age-related macular degeneration comes about as the result of a non-specific systemic inflammation. The possibility that increased levels of C-reactive protein might correlate with the presence of age-related macular degeneration has been considered. However, McGwin and co-workers performed a cross-sectional study of older adults from four communities in the United States. In this study there was no evidence that C-reactive protein levels were associated with age-related macular degeneration. This data does not support the theory that non-specific systemic inflammation is a major etiologic factor in age-related macular degeneration. Several recent supports have reported conflicting data as to whether or not the use of statins is protective in preventing age-related macular degeneration. Smeeth and co-workers report a study of more than 18,000 people with diagnosed age-related macular degeneration in the United Kingdom. In this study short and medium term statin use was not associated with a decreased risk of age-related macular degeneration. See pp 1166 and 1171