Periocular migration of hard contact lenses.

Six cases are presented in which hard contact lenses have migrated into the periocular soft tissues, four into the eyelid, one into the orbit and one which spontaneously reappeared on the cornea 12 years after the patient had last worn contact lenses. Some possible mechanisms of this phenomenon and a review of the literature are presented.

Cutting the cost of cataract surgery--a financial audit.

We have analysed the cost of disposable equipment used during cataract surgery by eight different surgeons over a six-month period in the same hospital. By comparing the costs of single-use items used by each surgeon we highlight how significant savings can be made by change of technique (without an adverse effect on surgical outcome).

Ocular injury and infection in dental practice. A survey and a review of the literature.

Dental surgeons, dental surgery assistants and patients are at risk of eye injury during certain dental procedures. We have reviewed the literature to reemphasise these hazards and have conducted a survey to determine how often injuries occur and what measures are taken to prevent them.

Q-switched neodymium YAG laser vitreolysis in the therapy of posterior segment disease.

We describe our experience of ten cases of posterior segment vitreolysis, using the short-pulse neodymium YAG (Yttrium Aluminium Garnate) laser. Eight patients had proliferative diabetic retinopathy, one patient had had an intraocular foreign body removed and one patient had had uveitis. Of the ten, five patients had macular traction retinal detachments, three patients had progressive traction retinal detachments threatening the macula and two patients had recurrent vitreous haemorrhages from mechanical traction on areas of fibrovascular proliferation. Eight of the patients were successfully treated. One macular retinal detachment failed to flatten and a tear was found which may have been iatrogenic. In one patient with a traction retinal detachment significant traction was relieved but the detachment failed to flatten completely. We discuss the indications, techniques, difficulties and complications. Our experience suggests that this technique has an important role in the treatment of selected patients, sparing patients conventional vitrectomy, or making possible the treatment of those for whom vitrectomy has been contraindicated or refused. Anterior defocusing of the YAG would be a useful modification of current laser systems and improved aiming systems desirable for the future.

Extensive argon laser photocoagulation in the treatment of proliferative diabetic retinopathy.

A group of 20 patients (28 eyes) with proliferative retinopathy who required extensive argon laser photocoagulation to induce regression of new vessels is presented. The mean number of burns applied to each eye was 7225, with a maximum of 11,513. These were delivered in a mean of nine sessions over a mean period of 22.9 months. Twenty-five eyes (89%) had a final visual acuity of 6/18 or better. The remaining three eyes (11%) had severely reduced vision attributable to complications of proliferative diabetic retinopathy (traction retinal detachment involving the macula in two eyes and ischaemic maculopathy and a persistent vitreous haemorrhage in the third). Large amounts of confluent argon laser photocoagulation may be necessary for the elimination of new vessels in some patients, and it is our view that laser photocoagulation should be continued until regression of new vessels occurs. This is compatible with the retention of functional vision and good visual acuity.

The Ciapryna coaxial cannula.

We describe a high quality, reusable, coaxial irrigation aspiration cannula for cortical cleansing during cataract surgery. Its advantages are that it is cheap, resterilisable, atraumatic, and has a rapid inflow, low-pressure irrigation rate enabling faster and safer aspiration of soft lens matter.

Eligibility for thrombolytic therapy in acute myocardial infarction.

In a district general hospital's coronary care unit (CCU) 197 patients with chest pain were admitted over a 6-month period and in 131 an acute myocardial infarction (AMI) was confirmed. 67 (51%) were eligible for thrombolytic therapy, on criteria laid down for a trial of streptokinase. Criteria for thrombolysis were not fulfilled in 41 (31%) and 12 patients (9%) had contraindications. These results suggest that around half of all patients with AMI and about one-third of patients presenting with chest pain and admitted to a CCU would be suitable for thrombolytic therapy. These data do not support the view that such therapy may be applicable to only a small minority of patients with AMI.

Long term follow-up of inferior myocardial infarction. Prognostic significance of precordial ST segment depression.

A group of 123 consecutive patients with acute transmural inferior myocardial infarction were compared according to the presence or absence of precordial ST segment depression on admission to hospital. There was a significant increase in mean age, peak creatine kinase levels, and the incidence of left ventricular failure and high grade atrioventricular block in the group with precordial ST segment depression. There was also an increase in in-hospital mortality in this group but this difference was not significant. Despite these differences in in-hospital progress, during a follow-up period of over two years there was no difference in long term mortality, recurrence of angina, or subsequent cardiac-related admissions between the two groups.

Neodymium-YAG laser in ophthalmic practice--principles and early experience.

We show our early experience with the Q Switched Neodymium-YAG Laser. Selected cases from the clinical spectrum of patients treated over nine months are discussed with regard to technique, results and possible complications. We feel that the YAG Laser will make an important contribution to ophthalmic care but further research and assessment are required before its full value and safety are ascertained.

Management of retinal detachment following congenital cataract surgery.

Retinal detachment complicating previous congenital cataract surgery poses problems in management, especially related to difficulties in ophthalmoscopic visualization of breaks. The recent introduction of closed microsurgical techniques has significantly improved the prognosis in such cases.