Surgical excision of periocular basal cell carcinomas.

The purpose of this study was to determine the histological clearance and clinical recurrence rates following excision of primary periocular biopsy-proven basal cell carcinomas (BCCs) in a teaching hospital in United Kingdom and compare it with other published reports. Records of consecutive patients with a biopsy proven diagnosis of primary periocular BCCs treated surgically at our hospital between 1995 and March 2003 were reviewed. Twenty seven cases (25 patients) were identified. Intra-operative frozen sections (IFS) were performed in 17 (63%) of the cases with clear margins on IFS in 16/17 (94%) of these cases. Histology revealed complete excision in 25/27 (92.5%) of cases. The results of excision of periocular BCCs in our setting particularly with IFS are comparable with other published reports. A reaudit is recommended in 5 years to allow a larger patient population with greater follow up, which would enable us to give more definitive judgment on this treatment modality.

Eye injury as a result of coat toggle trauma.

PURPOSE: To report the severity of ocular injury in three adults with blunt ocular trauma resulting from elastic corded coat toggles. DESIGN: Observational case series. METHODS: We retrospectively reviewed the case records of all patients (n=3) with blunt ocular trauma secondary to elastic corded coat toggles that presented to our department. RESULTS: Injuries included traumatic hyphaema, cataract, angle recession, vitreous haemorrhage and retinal tears. CONCLUSIONS: Significant ocular injury can result from elasticated coat toggles. The general ophthalmologist should be aware of this new method of potentially sight threatening trauma.

Comparative study of the subjective and objective grading of ptosis surgery outcomes.

AIMS: To assess the results of blepharoptosis surgery in our hospital by subjective and objective grading of the outcome and comparing them to determine their degree of corelation. METHODS: Retrospective interventional case series report supplemented by postal questionnaires and telephonic patient surveys. The study included 107 eyelids of 78 patients. Using a simple grading system, surgical outcome was objectively graded as good, suboptimal, or poor. Outcome was also defined according to the patients' perspective as good, suboptimal, or poor. Level of agreement between the subjective and objective grading of the outcome was measured using a weighted kappa analysis. RESULTS: The objective results were classed as good-68/107 (63.5%), suboptimal--18 eyelids (16.8%), and poor--21 eyelids (19.6%). The subjective results were obtainable in 91 eyelids and were good--54/91 (59.3%), suboptimal--8/91 (8.7%), and poor--29/91 (32%). A mismatch between objective and subjective outcomes was seen in 16 eyelids. We saw a statistically significant corelation between the objective grading and the patients' perspective (P<0.001). CONCLUSION: Our overall ptosis surgery results are comparable with rates previously reported. The subjective and objective outcomes of ptosis surgery may sometimes vary, but nevertheless exhibit substantive agreement when measured by this simple grading system.

Ocular manifestations of congenital lamellar ichthyosis.

PURPOSE: To describe the ophthalmic manifestations in a series of children with congenital lamellar ichthyosis. These cases presented with varying types of eyelid abnormality associated with the systemic disease. The clinical features and ophthalmic management were studied. METHODS: The case histories of three children presenting to the oculoplastic clinic were reviewed. All were diagnosed with congenital lamellar ichthyosis and under the care of the Dermatology department. Family history and pedigree analysis was performed to determine mode of genetic inheritance. Ocular examination for visual acuity, eyelid and eyelash malposition, lid function and closure were carried out. Corneal examination including tests for exposure was also done. RESULTS: All three patients had eyelid position abnormalities from the systemic disease. There was no clinical evidence of conjunctival involvement. One patient required full thickness skin grafts to treat corneal exposure secondary to lower lid ectropion. One had mild lower lid ectropion but without corneal exposure. The third case had the unusual finding of inward turning of the anterior lamella of the upper eyelid with a marked lash ptosis and only mild ectropion of the lower lid. CONCLUSIONS: Congenital lamellar ichthyosis is a heterogeneous disorder with phenotypic variability. The most common eyelid abnormality is cicatricial ectropion of the upper and mainly lower eyelids. Most cases are managed conservatively although in severe cases secondary corneal exposure may require surgical correction. In this condition, to the best of our knowledge, the tendency for the eyelids to turn inwards has not previously been described.

Short-term mortality among middle-aged cataract surgery patients.

PURPOSE: To investigate the short-term mortality of middle-aged patients undergoing cataract surgery in the United Kingdom (UK), to compare this with the expected mortality for the UK population of similar age and to try to identify at-risk groups. METHODS: In a retrospective study, the 5-10 year mortality of all middle-aged patients undergoing cataract surgery between 1989 and 1993 was determined. Expected mortality was calculated from UK Interim Life Tables for 1991. Cox's regression analysis was performed using age, sex and self-assigned ethnic group as variables. RESULTS: From the 709 patients in the study group, there were 86 deaths. This is significantly greater than expected (p < 0.01). Ethnic minority status (hazard ratio = 1.72, confidence interval = 1.12-2.64) and male sex (HR = 1.68, CI = 1.08-2.63) were found to be significantly associated with early mortality (p < 0.05). CONCLUSIONS: This study suggests that, for some middle-aged patients, cataract is associated with a reduced life expectancy and may be a feature of premature ageing, reflecting systemic ill-health. Screening these and younger patients for systemic disease when they present with cataract provides the best opportunity to affect this increased mortality. The findings of this study are particularly relevant for patients from ethnic minority groups.

Exogenous Nocardia asteroides endophthalmitis following cataract surgery.

We present a case of Nocardia asteroides endophthalmitis following cataract surgery. It is the second to be reported and the first in which vision has been preserved. Symptoms commenced 5 days after surgery and there followed a chronic relapsing anterior uveitis which lasted for 4 months. Nocardia asteroides was finally cultured from an aqueous aspirate and a combination of specific antimicrobial treatment and surgery resulted in a satisfactory visual outcome. Exogenous nocardial intraocular infection is rare and must be distinguished from fungal infection as the organism is resistant to antifungal agents.

Deterioration in the accuracy of the pulsair non-contact tonometer with use: need for regular calibration.

The Pulsair non-contact tonometer (Keeler Pulsair: Keeler UK) has been shown to be a versatile instrument particularly suitable for screening for raised intraocular pressure. Although demonstrated to be accurate initially when compared to the Goldmann applanation tonometer no study has examined its long-term accuracy. Comparisons of three Pulsair tonometers with different degrees of usage with the Goldmann tonometer are described. Measurements were obtained from 64, 116, and 223 eyes in three separate comparative studies. Correlation coefficients of between 0.78 and 0.90 were obtained, the least used instrument being significantly more accurate than the two more extensively used instruments. Taking the Goldmann tonometer as the standard tonometer, and the aim to detect intraocular pressures of greater than 21 mmHg, sensitivities of 40%, 48%, and 85% for the three Pulsair tonometers respectively were shown. The Pulsair tonometer appears liable to a long-term drift in accuracy with use, and we suggest that provision is made for the regular re-calibration of the instrument.

Infectious mononucleosis presenting as bilateral acute dacryocystitis.

A case of infectious mononucleosis presenting as bilateral acute dacryocystitis in a 7-year-old girl is reported. Acute dacryocystitis is uncommon in this age group, and an underlying systemic illness should be suspected particularly when it is bilateral.

A closed microsurgical technique for anterior vitrectomy using a continuous air infusion.

A new technique of anterior vitrectomy using a continuous air infusion is described. It has a number of advantages over conventional techniques and is recommended for the management of vitreous loss during cataract extraction. The vitreous gel is displaced posteriorly by the surface tension of an air bubble. The identification of vitreous strands is facilitated by the air/vitreous interface. Air in the anterior chamber reduces the refractive power of the cornea, providing direct visualisation of the posterior segment.

Extracapsular cataract extraction and posterior chamber lens implantation in patients with primary chronic angle-closure glaucoma: effect on intraocular pressure control.

Twenty-three eyes of 22 consecutive patients with primary chronic angle-closure glaucoma (PCACG) undergoing extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation were studied prospectively to assess the effect of ECCE on intraocular pressure (IOP) control. For comparison, a group of 21 eyes with open angle glaucoma (OAG) which had undergone ECCE were reviewed retrospectively. The PCACG group had a low incidence of acute post-operative IOP elevations (9%), and long-term the majority (65%) achieved an IOP less than 21 mmHg off all glaucoma medications. In the OAG group the IOP control was largely unaffected. We recommend that eyes with cataract and PCACG should be considered for ECCE as a first procedure rather than combined cataract and filtering surgery.

Corneal mosaic patterns--morphology and epidemiology.

The corneas of 1485 consecutive patients were examined for the presence of a mosaic pattern. One hundred and ninety-nine peripheral mosaic patterns, ten posterior crocodile shagreens and two cloudy dystrophies were found. Peripheral mosaic pattern is age related and distinct from corneal arcus. Posterior crocodile shagreen is also age related and in one case was found to be unilateral. The morphology of the mosaic patterns is discussed.