Amniotic membrane transplantation in ocular surface disorders.

The term ocular surface disorders indicate a close relationship between the conjunctival and corneal epithelium in many corneal and external diseases. The human amniotic membrane has a thick basement membrane and an avascular stromal matrix and its first ophthalmic use was reported by deRoth for conjunctival surface reconstruction. It was subsequently used for different ophthalmic reasons. Amniotic membrane transplantation can be used in a number of conditions eg, as a graft to replace damaged ocular surface stromal matrix or as a patch to prevent unwanted inflammatory insults from gaining access to the damaged ocular surface. Amniotic membrane can be utilised in persistent of recurrent corneal epithelial and stromal defects; in cases of corneal perforation due to ulcer or melting; after conjunctival excision for acquired melanosis, neoplasia, etc; in cases of pemphigoid, Stevens-Johnson syndrome, chemical bums; in cases of symblepharon, in dry eyes or in large leaking filtering blebs.

The efficacy of topical administration of brimonidine to reduce ischaemia in the very early stage of diabetic retinopathy in good controlled type-2 diabetes mellitus.

It is now proved that diabetic micro-angiopathy is caused by ischaemia at the capillary bed of retina due to reduced capillary blood flow in long standing type-2 diabetes mellitus. Deranged metabolic process due to chronic hypoxia at the tissue level produces visual and vascular dysfunction. Brimonidine tartrate, an alpha-2 agonist which is commonly used in glaucoma to protect retinal ganglion cells from pressure related ischaemia induced cell apoptosis, is administered in very early stage of non-proliferative diabetic retinopathy to reduce ischaemia at the capillary bed of retina. Improved visual acuity and decreased micro-aneurysm formation, which indicate elimination of ischaemic stimulus at the tissue level, are seen in long standing type-2 diabetes mellitus.

An unusual presentation of medial sphenoid wing meningioma.

A young woman of 26 years attended eye OPD with the complaints of complete and rapid loss of vision of her righ eye and progressive dimness of vision of left eye, frontal headache and nausea for last two months. On eye examination, she was found to have no perception of light to her right eye. Ophthalmoscopy examination revealed primary optic atrophy in right eye and marked papilloedema to her left eye. CT scan of brain showed space occupying lesion in right parasellar region with sellar and suprasellar extension with involvement of right anterior clinoid process suggesting medial sphenoid wing meningioma. The patient underwent surgery and the histopathology proved the diagnosis as meningioma. The case of medial sphenoid wing meningioma in a young female producing rapid Foster Kennedy syndrome is reported for its unusual presentation.

Estimation of tear glucose level and its role as a prompt indicator of blood sugar level.

Tear glucose level was measured by glucose oxidase method to determine the relationship between tear glucose and corresponding blood glucose levels in 200 patients. It was observed that this test had a definite value in finding the hyperglycaemics semiquantitatively.

An unusual case of a retained metallic arrowhead in the orbit and sphenoidal sinus.

A case of retained metallic arrowhead in orbit and sphenoidal sinus through an unusual route is reported. The eyeball was removed because of a possible risk of sympathetic ophthalmia.

Revolutions in ophthalmology.

Cataract is the major cause of blindness worldwide. The transition of couching of cataract to most modem phaco-emulsification gained popularity with more scientific capsulorhexis. Ongoing research is taking place with laser technologies for removal of cataract. Surgery has an important role in advanced corneal diseases. Corneal transplantation is the most successful form. The refractive errors can be corrected by laser-assisted in-situ keratomileusis, intrastromal corneal rings and phacic intra-ocular lenses. Current research is going on to identify the gene responsible for glaucoma and once this is identified, medical therapy can be developed to control the disease. Thermocautery or photocoagulation and indenting the globe so as to bring the choroid nearer the break by scleral buckling forms the basis of modern surgery of retinal detachment. Vitreoretinal diseases, macular degeneration, diabetic retinopathy are no longer considered problematic. We are optimistic that more clinical breakthroughs are expected in the 21st century with new advances of ophthalmic researches.

Ocular injuries.

A total of 800 cases of ocular injuries were studied during the period from January, 1982 to December, 1985 at the department of eye, North Bengal Medical College and Hospital, Darjeeling. Major ocular injuries (n = 248) required hospitalisation. The rest 552 cases had minor injuries and treated at outpatients' department. The incidence of age, sex, mode of injury, interval between injury and first observation, structural damage were studied in all these cases.

Fine needle aspiration cytology of ophthalmic lesions.

Forty cases of ophthalmic lesions were subjected to fine needle aspiration cytology for pre-operative diagnosis which included retinoblastomas (5 cases), inflammatory and neoplastic lesions of the eyelid and lacrimal glands (29 cases) and extra-ocular orbital lesions (6 cases) inclusive of 3 cases of rhabdomyosarcomas. The lesions were distributed in both the eyes almost in equal proportions. Histological confirmation was obtained in 85% of cases; false positive in only one case with malignant neoplasm of the eyelid and false negative also in only one case with inflammatory pseudotumour which were, histologically, proved to be adenoma of tarsal gland and lymphocytic lymphoma respectively.