Abscessed porous polyethylene (Medpor) orbital implant: a case report.

We report the evolution of clinical features of orbital implant infection in a 42-year-old man. Despite appropriate treatment recurrent conjunctival dehiscence could not be prevented. Explanation of the implant resulted in complete resolution of symptoms. Histopathological examination confirmed focal necrotising acute inflammation with the presence of colonies of the organism in the deep substance of the implant.

Late-onset visual decline following successful treatment of subfoveal choroidal neovascularisation with photodynamic therapy.

Photodynamic therapy (PDT) has been shown in large studies to be capable of achieving closure of choroidal neovascularization (CNV), thereby resulting in stabilization of visual acuity. We report a series of four patients with classic CNV treated with PDT with good initial result but subsequent severe visual loss that may be related to a change in the morphology of the subretinal scar.

Pyogenic granuloma following silicone punctal plugs: report of two cases.

PURPOSE: To report two cases of pyogenic granuloma following silicone punctal plugs. METHODS: Interventional case reports. RESULTS: The authors report two cases of pyogenic granuloma secondary to silicone punctal plugs and their lacrimal sequelae following surgical removal in one case and conservative treatment with removal of the plug alone in another. The former case developed no lacrimal sequelae while the second case developed punctal scarring. Spontaneous loss of plugs was common to both the cases. CONCLUSIONS: Patients with punctal plugs should be informed about plug-related problems and encouraged to report them.

Verteporfin photodynamic therapy of choroidal neovascularization in angioid streaks: one-year results of a prospective case series.

PURPOSE: To report the 12-month results on the use of verteporfin photodynamic therapy (PDT) in the treatment of choroidal neovascularization (CNV) secondary to angioid streaks. STUDY DESIGN: Five-center prospective case series. METHODS: Patients with CNV secondary to angioid streaks who were treated with PDT were recruited and followed up at 3-month intervals for 12 months, with the addition of visits at 1.5 and 4.5 months if deemed appropriate by the investigator. Best-corrected visual acuity (BCVA) was measured at each visit after full refraction or with their current distance spectacles using Early Treatment Diabetic Retinopathy Study logarithm of the minimum angle of resolution charts. Stereoscopic fundus fluorescein angiography was used to determine baseline lesion characteristics and location. RESULTS: Twenty-two patients were recruited (23 eyes, 16 with subfoveal CNV and 7 with juxtafoveal; all classic no occult). Seventeen patients (77%) had angioid streaks secondary to pseudoxanthoma elasticum. In the subfoveal group, median BCVA at baseline was 49 letters (approximate Snellen equivalent, 20/100) and was 46 at 12 months (approximate Snellen equivalent, 20/125). Twelve of 16 eyes (75%) lost fewer than 8 letters, whereas 14 of 16 eyes (88%) lost fewer than 15 letters. The mean CNV greatest linear dimension (GLD) was 2520 microm at baseline. At 12 months, 7 of 16 eyes with subfoveal CNV at baseline were leaking (GLD = 3220 microm; P = 0.62). The mean number of treatments in the first 12 months was 2.9. In the juxtafoveal group, the median BCVA at baseline was 66 letters (approximate Snellen equivalent, 20/50) and was 51 letters at 12 months (approximate Snellen equivalent, 20/100). Two of 7 eyes (29%) gained 8 or more letters at the 12-month examination, whereas 4 of 7 eyes (57%) lost more than 15 letters. The mean CNV GLD at baseline was 1890 microm. At 12 months, 1 of 7 eyes with juxtafoveal CNV at baseline was leaking. Choroidal neovascularization progressed from juxtafoveal to subfoveal location during the follow-up period in 4 of 7 eyes. The mean number of treatments in the first 12 months was 3.4. No side effects were noted in either patient group. CONCLUSIONS: This small series suggests that treatment of CNV secondary to angioid streaks with verteporfin PDT seems to limit visual loss in most patients through the first 12 months of follow-up, particularly in those with subfoveal lesions at baseline.

Eye nutrient products for age-related macular degeneration: what do they contain?

BACKGROUND AND PURPOSE: Patients are increasingly well informed about the availability of antioxidant products and the claims made for their benefits in age-related macular degeneration (AMD). Consequently, their use is becoming widespread. The purpose of this study is to conduct a survey of the commonly encountered products, and to compare their ingredients with the current Age-Related Eye Disease Study (AREDS) recommendations. METHODS: A search was undertaken for products sold as 'eye nutrients' at local pharmacies and health food shops, and for products advertised via the Internet. Information about these products was collated and analysed. RESULTS: We identified 22 eye nutrient products. Analysis of their constituents showed that, although over 75% contained all the constituents used in AREDS, only two matched the dosage profiles recommended in the study. CONCLUSION: The authors draw no conclusion on the efficacy of nutritional supplements in the prevention of AMD. In order to advise their patients, ophthalmologists should be familiar with these products. The compiled list in this paper should provide a useful reference for them.

Measurements of linear dimensions on fundus photographs: comparison between photographic film and digital systems.

PURPOSE: The aim of this study is to compare linear fundal landmarks measurements of standard photographic film with colour digital fundal images. METHODS: Pairs of fundus fluorescein images were acquired with a digital system and photographic film on 10 patients. Each pair of images was assessed independently by two observers who calculated the distance between two selected points on each image using easily identifiable landmarks. Measurements made using film images were compared to measurements made using the corresponding digital images. Agreement between the two methods of measurements was assessed using a linear correlation and graphical method. RESULTS: The patients were divided into two groups based on the field setting on the digital software. In Group 1, the correlation coefficient was 0.99 and in Group 2 it was 0.98, indicating a high level of agreement between measurements with the computer measuring tool for digital images compared to photographic films using a standard reticule. CONCLUSION: On the basis of the strong correlation between linear fundal landmark measurements between standard photographic film and colour digital fundal images, we conclude that the measurements from the digital images are acceptable for diagnostic and therapeutic purposes. Although there was a tendency for the measurements to be less accurate with increasing distances measured.

Use of inhaled nitrous oxide for minor eyelid surgery: a placebo-controlled study.

BACKGROUND: Pain from local anaesthetic injection for minor eyelid surgery can often be severe enough to be the most unpleasant part of the procedure. This study was aimed at assessing the efficacy of 50 : 50 N(2)O/O( 2) (Entonox) in relieving such pain. METHODS: In this randomised placebo-controlled double blind trial, 100 patients were randomised to receive either Entonox or air. Questions regarding pain during the administration of local anaesthetic, discomfort during the procedure and side effects experienced were asked by an investigator who was blinded to the type of gas inhaled. RESULTS: The difference in pain score between the Entonox and control groups was not statistically significant (p = 0.474). The difference in discomfort score between the two groups was also not statistically significant (p = 0.948). More side effects were noted with Entonox than with air (p = 0.003, statistically significant). However, this was not clinically significant. CONCLUSION: Entonox has been used effectively in different specialties for pain relief. However, our study was unable to show this beneficial effect in relieving pain from local anaesthetic injections for minor eyelid surgery.