Does upper lid blepharoplasty improve contrast sensitivity?

PURPOSE: To assess the effect of upper eyelid blepharoplasty surgery on contrast sensitivity. METHODS: A prospective study was performed. Pre- and postoperative contrast sensitivity measurements were taken on patients undergoing routine upper eyelid blepharoplasty surgery. The patients were selected for surgery on the basis of a functional visual field effect from dermatochalasis. Contrast sensitivity was measured using a Pelli-Robson chart, read at 1 m under standard lighting conditions. This produces a result in log contrast sensitivity. Other data collected included visual acuity and an automated 60:4 visual field. A paired t test was used to assess the change in contrast sensitivity. RESULTS: 28 eyes of 14 patients underwent upper eyelid blepharoplasty surgery. The mean preoperative log contrast sensitivity was 1.49, and the mean postoperative log contrast sensitivity was 1.64. The mean increase in log contrast sensitivity was 0.14 (range 0-0.45). The increase in log contrast sensitivity was statistically significant (p = 0.00002). CONCLUSIONS: Dermatochalasis is well known to cause visual field defects in many patients. Anecdotally, patients often report that their vision is brighter following upper eyelid blepharoplasty. The authors have demonstrated a significant increase in contrast sensitivity in patients who have undergone upper eyelid blepharoplasty surgery. This information may be of use in justifying blepharoplasty surgery in the future.

Successful Surgical Intervention for Childhood Pterygium Using a Conjunctival Autograft.

Childhood pterygia are extremely rare and no consensus currently exists regarding surgical management in cases of significant symptomatology. The authors describe a case of a childhood pterygium in a 9-year-old boy successfully treated with a superior conjunctival autograft. At 6 months of follow-up, no signs of recurrence were detected and the patient reported marked improvement in symptoms. Use of this technique may be beneficial in certain cases of childhood pterygia.

Superior retinal detachment in an oil-filled eye with a colobomatous optic disc.

BACKGROUND: Optic disk pits are known as congenital cavitary defects associated with serous detachment of the retina; 75% of such cases do not resolve spontaneously, and surgical management is required. The use of gas or oil tamponade in these cases has been associated with detachment of the retina attributed to the passage of intravitreal gas or fluid via the disk pit and into the subretinal space. Prophylactic peripapillary laser retinopexy is therefore recommended peroperatively to create a barrier to fluid flow between the vitreous cavity and the subretinal space. METHODS: Case report. RESULTS: We report a case of optic nerve coloboma and serous macular detachment with redetachment of the retina that occurred many months after initial gas and then oil tamponade. The patient developed a superior retinal detachment containing oil in an oil-filled eye in the absence of retinal breaks. To our knowledge, superior retinal detachment containing oil in an oil-filled eye with an optic disk pit has not been described previously. CONCLUSION: This case raises an interesting discussion on both the pathophysiology of redetachment associated with optic disk pits and their management.

Still confused about rose bengal?

We have surveyed the ophthalmic literature of the last five years in an attempt to evaluate the use and usefulness of Rose Bengal staining as an aid to differential diagnosis in dry eyes. Included both as a criterion and as an adjunct measure of disease progression, Rose Bengal scores of patients with different dry eye conditions overlap, sometimes to a considerable extent. A mechanistic link between staining with this dye and disease etiology is unlikely; however, Rose Bengal could be a surrogate marker of changes in ocular surface physiology. The question whether the extent and pattern of staining with Rose Bengal provide the clinician with information not available from other tests, and in particular from fluorescein staining of the ocular surface, has to be answered positively, though the nature of this information is not clearly understood. A more widespread recognition that Rose Bengal is not a vital dye is necessary in order not to bias the interpretation of experimental results.

Normal but not altered mucins activate neutrophils.

Interactions between leucocytes and their surroundings are mediated through oligosaccharide epitopes, some of which are also expressed on ocular mucins. Neutrophils represent the majority of immune cells in the proinflammatory environment of the ocular surface during sleep. We have tested whether changes in mucin glycosylation, as occur in dry eyes, influence the phenotype and activation of neutrophils. Peripheral blood leucocytes were circulated over equal concentration mats of ocular surface mucins purified from normal volunteers and dry-eye patients, and in sequence over normal and pathological mucins in all combinations. Non-adherent cells were tagged with monoclonal fluorescent antibodies to leucocyte determinants and analysed by flow cytometry. Oxidative burst, assessed with dihydrorhodamine, was followed in cells and supernatant. At a speed similar to that of leucocyte traffic in the retina, normal mucins caused a decrease in neutrophil cathepsin G fluorescence, a decrease that was not observed with mucins from patients with Meibomian gland disease or Sjogren syndrome. No effect was detected at a higher flow. Supernatant and cells collected after circulation over normal mucin showed increased rhodamine fluorescence, indicative of oxidative burst. Fluorescence could also be observed in intact cells adherent to dry-eye mucins. Non-adherent cells could be activated with phorbol 12-myristate 13-acetate after flow over any mucin or combination of mucins. Differences in neutrophil activation after exposure to normal and pathological mucins highlight reciprocal influences at the interface between local and systemic immunity.

Defining the content of patient questionnaires: reasons for seeking laser in situ keratomileusis for myopia.

PURPOSE: To determine the relative importance of patients' motives for having laser in situ keratomileusis (LASIK) for myopia. SETTING: The Corneal Diseases and Excimer Laser Research Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland. METHODS: Twenty-one cards printed with potential reasons for having LASIK and 3 blank cards for respondents to include additional motives were posted to 71 patients who had myopic LASIK. The cards were ranked by each respondent in order of personal importance and returned for analysis. RESULTS: The response rate was 77.5%. The mean age of the 19 male and 37 female respondents was 41.7 years +/- 9.3 (SD) and the mean preoperative spherical equivalent, -9.26 +/- 4.58 diopters. The primary reasons for seeking treatment (percentage of respondents ranking topic within the top 5) were improvement of unaided social vision (69.1%), intolerance to spectacles/contact lenses (65.5%), and freedom from spectacles/contact lenses (61.8%). Almost 70% of respondents ranked 1 of these reasons as the most important. General inconvenience of spectacles/contact lenses and the desire to pursue sports and leisure activities also ranked high (52.7% and 36.4%, respectively). CONCLUSIONS: Consistent with previous work, better unaided vision, combined with the inconvenience of or intolerance to spectacles or contact lenses, provided the main incentives to have LASIK for myopia, while improved cosmesis was relatively unimportant (29.1%). The results of this study will allow the design of satisfaction questionnaires that are better directed toward establishing satisfaction of specific, relevant functional and psychological aspects of refractive surgery that are important to patients.