A new instrument for Lester Jones tube placement in conjunctivodacryocystorhinostomy.

A new trocar has been developed that increases the ease and accuracy of Lester Jones tube placement using the Cox system in conjunctivodacryocystorhinostomy (CDCR) surgery.

Optometrist referrals for cataract and "Action on Cataracts" guidelines: are optometrists following them and are they effective?

PURPOSE: To assess the information included in optometrist referrals for cataract to the Hospital Eye Service with reference to the recommendations made by the Department of Health in "Action on Cataracts" and the resultant surgical listing rates. METHODS: We prospectively collected and analysed the information included in three different types of optometrist referrals for cataract over 8 weeks. Referrals containing "full information" as recommended in "Action on Cataracts" confirmed cataract as the cause of visual loss with a detrimental effect on the patient's lifestyle, and a willingness for surgery. The referral outcomes were assessed in terms of listing rate and the reasons for not listing, for each type of referral form. RESULTS: A total of 412 referrals were analysed. Of these, 50% (208) were "conventional" referrals via the general practitioner (GP) [39% (n = 162) using the General Ophthalmic Services (GOS) 18 referral form and 11% (n = 46) an optometrist's custom letter]; 35% (n = 143) were direct referrals and 15% (n = 61) were GP referrals with no optometrist information (these results were excluded from further analysis). The listing rates for optometric referrals were 78% (n = 272) overall, 83% (n = 119) for direct and 74% (n = 153) for conventional referrals. "Full information" was included in 17% (n = 8) of letter referrals and 10% (n = 16) of GOS 18 referrals. The listing rates were 83% for referrals with full information and 73% for referrals specifying only that cataracts were the cause of visual loss. The listing rates for referrals with partial information were 78% for "cataract" plus "effect on lifestyle" and 67% for "cataract" plus "willingness for surgery". The most common reason for not listing a patient for surgery was "no effect on lifestyle", accounting for 42% (n = 32). CONCLUSION: We recommend that all referrals for cataract should confirm a detrimental effect on lifestyle and the patient's willingness for surgery, in addition to confirming cataract as the main cause of visual loss.

The control of matrix metalloproteinase-2 expression in normal and keratoconic corneal keratocyte cultures.

PURPOSE: Early phase keratoconic corneas and their cultured keratocytes abnormally produce the Mr 62,000 form of the matrix metalloproteinase-2 (MMP-2). It is known that platelet derived growth factor (PDGF) and transforming growth factor-beta (TGF-beta) are involved in the regulation of MMP activity and tissue inhibitor of metalloproteinase (TIMP) production in non-ocular tissues. The purpose of this enquiry was to determine whether these growth factors also play a role in the activity and/or production of corneal MMP-2 and TIMP, and whether their activity could account for the existence of the Mr 62,000 form of MMP-2 in keratoconic corneas. METHODS: Confluent cultures of normal and early-phase keratoconic corneal keratocytes were established and incubated in serum-free media in the presence or absence of PDGF and TGF-beta. The proteins secreted by these cells over periods of 7 days were harvested for analysis. The total protein produced was determined spectrophotometrically. MMP-2 was visualised by SDS-gelatin polyacrylamide gel electrophoresis and assayed using radiolabelled type IV collagen as substrate. The enzyme inhibitors, TIMP-1 and TIMP-2, were quantified by dot blot immunoassay. RESULTS: The addition of PDGF or TGF-beta to the culture medium of keratoconic corneal keratocytes had no significant effect on overall protein production, MMP-2 activity or on the amounts of TIMP- 1 and TIMP-2 secreted. These observations also applied to normal corneal keratocytes, with the exception that PDGF induced expression of the Mr 62,000 species of MMP-2. CONCLUSIONS: PDGF may be involved in the production of the Mr 62,000 species of MMP-2 that is abnormally produced by early-phase keratoconic corneal keratocytes.