New developments in ophthalmology 1. advances in cataract surgery

Cataract extraction constitutes the largest workload in ophthalmic units throughout the world. In 1995-6, more than 156,000 cataract operations were performed within the National Health Service in England and Wales. Extracapsular cataract extraction with insertion of an intraocular lens has been the most widely used method from 1982 until recently2. This requires a wide incision through which the lens is extracted and the new intraocular lens is inserted. Technological advances have led to the increasing use of an ultrasonically driven oscillating needle to emulsify the lens [phacoemulsification] combined with an automated irrigation/aspiration system and the insertion of a foldable intraocular lens

Sub-tenon versus peribulbar anaesthesia for cataract surgery

The aim of this study is to compare the efficacy of sub-Tenon anaesthesia with peribulbar anaesthesia in terms of intraoperative pain and ocular movement during cataract surgery. Prospective, cohort study. A total of 50 patients were enrolled in the study between 1[st] July 2002 until 31 December 2002. 25 patients were randomly assigned to peribulbar anaesthesia [group A] and 25 patients sub-Tenon anaesthesia [group B]. The surgeon observed and recorded whether there was eye movement during surgery or not. The movement was graded as: no movement, slight movement, moderate movement and full range of movement. Postoperatively, patients were asked whether they felt pain during surgery or not. Pain perception was graded as: no pain, slight discomfort, slight pain, moderate pain, severe pain, excruciating pain and unbearable pain. The effect of the type of anaesthesia on eye movement and pain perception was measured. Pearson Chi square test was used to determine the statistical significance for pain perception and eye movement. Pain perception was similar in both groups. The effect of type of anaesthesia on ocular movement was better in the sub-Tenon group. Sub-Tenon anaesthesia is more effective in terms of ocular movement than peribulbar anaesthesia. Considering this and the known complications associated with peribulbar anaesthesia, the author recommends the use of sub- Tenon anaesthesia for cataract surgery

Ocular cicatricial pemphigoid

The author describes herein a case who presented with deterioration of vision, chronic conjunctivitis and scarring, symblephera formation, obliteration of lacrimal puncti and inferior fornices. To the author's best knowledge, this is the first case of OCP to be reported from Bahrain. Cases of OCP can easily be missed in our part of the world where chronic trachoma is prevalent. The author emphasises the importance of early diagnosis and management of this blinding disorder