Posterior chamber lens implantation combined with pars plana vitrectomy.

PURPOSE: To assess the outcome of cataract extraction and posterior chamber intraocular lens (IOL) implantation combined with pars plana vitrectomy. SETTING: Ophthalmic ward in a district general hospital. METHODS: This study evaluated seven consecutive patients who had cataract extraction, IOL implantation, and pars plana vitrectomy in one procedure. Four patients were diabetic, and three had perforating eye injuries with cataract formation and intraocular foreign bodies. RESULTS: No significant postoperative complications occurred, and the posterior chamber lenses were well tolerated. In all cases, good subjective visual improvement was achieved and visualization of the posterior pole was excellent. CONCLUSION: Combining cataract extraction with posterior chamber IOL implantation and vitrectomy in one procedure may be indicated, especially if there is traumatic rupture of the lens capsule.

Penetrating keratoplasty in the mentally retarded.

Penetrating keratoplasty is infrequently performed in the mentally retarded due to the high risk of serious post-operative complications, in particular wound rupture and severe inflammation of the graft. Graft survival is hindered by the patient's tendency for eye rubbing and possibly self-inflicted injury. Adequate nursing support is essential to ensure strict compliance with post-operative treatment. A retrospective study of corneal graft outcomes in mentally retarded patients was undertaken to assess graft survival, visual rehabilitation, post-operative complications and the influence on social behaviour. Six cases of penetrating keratoplasty performed in mentally retarded patients by one surgeon are presented. A continuous 10-0 nylon suture was employed in all cases. In 2 cases surgery was undertaken following perforation of the globe in patients with Down's syndrome. The grafts were retained in all cases and 2 patients achieved reasonably good acuity, although formal visual acuity assessment in these patients is limited. Penetrating keratoplasty in mentally retarded patients is a potentially hazardous procedure and patients require close supervision and good support care. This series demonstrates that relatively successful outcomes can be obtained in some mentally retarded patients.

Pupillary dilation and axial length measurement for preoperative assessment of intraocular lens power.

Cataract extraction is now routinely followed by insertion of an intraocular lens (IOL) which requires preoperative biometry to determine the most accurate implant power required. Biometry is generally performed just prior to surgery and may even require the patient to make a special hospital visit when day case surgery is contemplated. A prospective study was undertaken to determine the accuracy of axial length (AL) measurement through a dilated pupil. The AL of one eye of 64 patients admitted for cataract surgery was measured before and after dilation with a drop of tropicamide 1%. Our results show that there was no significant difference in the ALs before and after dilation (p = 0.10), and neither was there a difference in the average range of measurements (p = 0.70), with 78% of eyes having a difference of < +/- 0.3 mm between pre and post dilation ALs. We conclude that AL measurement performed on a dilated pupil can give an accurate result, and suggest that performing biometry on a dilated pupil following ocular assessment may be an efficient and time saving exercise.

Congenital ptosis: a good cosmetic result with redefinition and suturing of the orbital septum.

A surgical technique employing orbital septum sutures during ptosis surgery in children is described. A retrospective study of 16 children (age range 6 months to 14 years) undergoing surgery for congenital ptosis over a 6 year period was undertaken with regard to cosmetic outcome. All surgery was performed by one consultant ophthalmic surgeon with the patient under general anaesthesia. A standard levator resection was undertaken, following which the orbital septum was redefined and sutured with interrupted 5-0 catgut. This resulted in a well-defined lid crease post-operatively, with a good cosmetic outcome. The only significant post-operative complication was the occurrence of a suture-related granuloma in one patient. All achieved a good cosmetic result. A mild residual ptosis occurred in 3 cases, requiring a further procedure. Special attention to suturing of orbital septum as a separate tissue layer during levator resection for congenital ptosis gives good lid crease definition which may enhance the overall cosmetic outcome.

Ophthalmic management of Cockayne's syndrome.

Cockayne's syndrome is a rare, autosomal recessive condition which usually presents in early childhood, and is characterised by dwarfism, premature ageing, mental retardation and a typical facial appearance and body habitus. Retinal dystrophy, enophthalmos, strabismus, cataract, nystagmus and corneal opacities are associated ocular features. At a genetic level, a defect occurs in the pathway for the repair of transcriptionally active DNA, and the most common form of Cockayne's is associated with mutations in the human repair gene ERCC6. These patients pose a difficult management problem. A significant proportion will require cataract extraction at an early age, which may present technical difficulties due to enophthalmos, which is a constant finding, poor pupillary dilation and growth retardation. Also, the fitting and assessment of aphakic contact lenses during the post-operative period requires great skill. General anaesthesia in these patients may be hazardous. In particular, difficulty with endotracheal intubation should be anticipated. Two patients with Cockayne's syndrome requiring bilateral cataract extraction in early infancy are presented. The problems associated with surgery, anaesthesia and subsequent follow-up in these mentally retarded infants are discussed.

Multifocal choroidal lesions. A rare complication of herpes zoster ophthalmicus.

We document the case of a 76-year-old woman who developed mutifocal choroidal lesions as an unusual complication of herpes zoster ophthalmicus.