The effect of topical beta-adrenoceptor blocking agents on pulsatile ocular blood flow.

Thirty-three ocular hypertensive patients (21 with primary open angle glaucoma and 12 glaucoma suspects) were randomly assigned to receive either timolol, levobunolol or betaxolol in one eye. Pulsatile ocular blood flow (POBF) was measured before treatment (baseline) and 2 hours after drop administration. After 1 week of regular twice-daily dosage, POBF was measured again both immediately before and 2 hours after drop instillation. All measurements were made by an investigator masked to treatment. POBF increased by 11% (p = 0.09) at week 0 after levobunolol administration, and by 22% (p = 0.20) at week 1 before drop administration compared with baseline. It dropped by 23% and 25% (p = 0.04 and 0.06, respectively) before and after betaxolol administration at week 1. Although POBF was reduced in the timolol group, this change was not significant. These results can not be explained uniformly by changes in intraocular pressure or blood pressure. The relevance of these measurements to visual function in glaucoma is not known.

Anterior chamber angle configuration before and after iridotomy measured by scheimpflug video imaging.

Anterior chamber angles were measured before and after laser iridotomy in 12 patients with narrow angles using Scheimpflug video image analysis. The angle increased from a mean of 15.3 +/- 2.5 degrees (mean +/- SD) to 21.2 +/- 3.3 degrees following iridotomy. This difference was significant (p < 0.0005). There was no significant change in the depth of the axial anterior chamber. This instrument may be useful as an adjunct to clinical examination, particularly when an objective, quantitative grading of anterior chamber angle changes is required.

Ocular fundus lesions in sports divers using safe diving practices.

Ocular fundus fluorescein angiography was performed on 26 divers, who had used safe diving practices for at least 10 years, and on seven controls. There was no significant difference in the incidence of macular abnormalities between these groups and those of a previous study. Adherence to safe diving practice confers some protection against the macular abnormalities known to occur in divers with a history of decompression sickness.

The effects of adrenaline, hyaluronidase and age on peribulbar anaesthesia.

In a prospective, randomised, masked trial, 91 patients undergoing intraocular surgery received an anaesthetic mixture containing lignocaine hydrochloride 2% and bupivacaine hydrochloride 0.5%. In addition group 1 had hyaluronidase (50 i.u./ml) and adrenaline (1:200,000), group 2 had hyaluronidase alone, group 3 had adrenaline alone and group 4 had neither. The groups were compared regarding the quality of operating conditions. Hyaluronidase had a substantial beneficial effect though there was no significant difference related to the use of adrenaline. Anaesthesia was less effective in patients under the age of 65 years.

Intra-ocular pressure changes using the laryngeal mask airway and tracheal tube.

Intra-ocular pressure was measured before and throughout airway establishment with either the laryngeal mask airway or tracheal tube. Similar measurements were made on removal of either airway and the amount of coughing noted in the first minute after removal. There was a significantly smaller increase in intra-ocular pressure (p less than 0.001) using the laryngeal mask airway, both on placement and removal, than with the tracheal tube. Postoperative coughing was significantly reduced using the laryngeal mask airway (p less than 0.001). There was a significantly greater rise in heart rate using the tracheal tube (p less than 0.01) probably related to an increased cardiovascular response. The laryngeal mask airway is recommended as an alternative to tracheal intubation in routine and emergency intra-ocular surgery.

Acute glaucoma in the presence of patent neodymium: YAG laser iridotomies.

Nd:YAG laser iridotomy is being used in the treatment of angle closure glaucoma with increasing frequency. Failure is uncommon, but 3 cases are presented here in which intra-ocular pressure rose despite a patent iridotomy. Possible reasons for this are discussed.

Traumatic hyphaema in a haemophiliac.

A case is presented of a 9-year-old haemophiliac boy who sustained a traumatic hyphaema with secondary haemorrhage. Conservative management was successful in preventing complications, and normal vision was retained.

Screening for hydroxychloroquine retinal toxicity: is it necessary?

All the patients (73) in the Rheumatology Department five year study of second line therapy who have taken hydroxychloroquine (Plaquenil) for rheumatoid arthritis for longer than 18 months were reviewed. These patients have their treatment dosage carefully monitored and have been receiving regular ophthalmic examinations. Most patients still taking the drug were assessed with a battery of tests for evidence of retinal toxicity. No retinal toxicity causing visual loss was found. On the basis of these results and a review of the recent literature we no longer routinely screen patients for hydroxychloroquine retinal toxicity in Cardiff.

Spontaneous regression of a conjunctival intraepithelial neoplastic tumor.

A case history is presented documenting regression of a limbal intraepithelial neoplastic lesion following diagnostic biopsy of a small specimen and removal of an adjacent basal cell papilloma of the eyelid.