Subjective visual experience during phacoemulsification cataract surgery under sub-Tenon's block

In a prospective survey, 121 patients received sub-Tenon's block and were interviewed on the same day after their phacoemulsification cataract surgery regarding their visual experience in the operated eye during surgery. Majority of patients (81%) reported that they could see some light during surgery and various colours were seen by 56%. Movements of various descriptions were also reported by 40% of patients. The majority of patients (93%) found the visual experience acceptable but 4% thought it to be unpleasant and 3% found it frightening. Patients undergoing phacoemulsification surgery under sub-Tenon's block experience a variety of visual sensations and some patients may be frightened. All patients should receive appropriate preoperative warning.

Intraocular caterpillar hairs (setae): clinical course and management

Ophthalmia nodosa is a well-documented condition. We present a case in which a live caterpillar was rubbed into a patient's eye and, after relentless penetration of the hairs into the globe, vitrectomy was required. We discuss the differing clinical features of these injuries, the mode of penetration and the treatment options.

Clinical experience with a fixed dose combination therapy of timolol and pilocarpine used twice daily in the management of chronic open angle glaucoma

Twenty-five eyes of 25 patients with primary chronic open angle glaucoma deemed controlled for 12 months were converted from timolol 0.25% or 0.5% b.d. and pilocarpine 2% q.i.d. to a combination drop (TP2) of combined timolol 0.5% and pilocarpine 2% given b.d. Mean intraocular pressures (IOP) were 18.68 +/- 2.84 mmHg at 1 month, 18.81 +/- 2.56 mmHg at 3 months and 18.56 +/- 2.01 mmHg at 6 months. These values were significantly higher than the initial IOP of 17.48 +/- 2.2 mmHg (p values 0.0006, 0.0001 and 0.0004 respectively). However, 1 month following reconversion to initial therapy the IOP was 17.68 +/- 2.67 mmHg, which was not significantly higher than the initial IOP (p = 0.46). In addition, of 8 eyes uncontrolled during the course of the study, 6 became controlled following reconversion to initial treatment. Combination therapy of TP2 b.d. cannot be recommended to control IOP satisfactorily in patients maintained on timolol 0.25% or 0.5% b.d. and pilocarpine 2% q.i.d.

A prospective study of oral Nadolol in the management of patients with newly diagnosed chronic simple glaucoma

Thirty patients with newly diagnosed chronic open angle glaucoma were initially treated with once daily oral Nadolol at a dose of 20 mg. This was increased to 40 mg where control was considered inadequate. Topical therapy was then added as necessary if control was still not maintained. Significant decreases in intra-ocular pressure (IOP) were achieved with a dose of 20 mg, but there was no significant further reduction when the dose was increased to 40 mg. One patient was controlled throughout the study period with 40 mg Nadolol daily and 4% Pilocarpine four times daily. At best, only temporary control was achieved in the remaining 29 patients. Intra-ocular pressures were measured 24 hours after the previous dose of Nadolol in 13 patients who were controlled for a minimum of 1 month on Nadolol alone and then again 3 hours after their normal dose. Control of IOP was lost in all patients at 24 hours pre-dose but was regained by 3 hours post-dose. Four patients were withdrawn because of mild side effects attributable to the beta-blocking action of Nadolol. The treatment regime used in this study was ineffective at controlling the IOP in the group of patients studied. A once daily regime of Nadolol does not control IOP over a full 24 hours.

Postmyelographic abducent nerve palsy in association with the contrast agent iopamidol

Lateral rectus palsy is an uncommon event following contrast myelography. We report such a case, which fortunately proved to be transient, and speculate on its aetiology in terms of the anatomy of the sixth cranial nerve and the possible toxic effects of the contrast agent Iopamidol (Isovue; ER Squibb and Sons, Princeton, New Jersey, USA; Niopam, E Merk, U.K.).

Ocular shedding of herpes simplex virus

The presence, frequency, and relationship of ocular and oral shedding of herpes simplex virus to previous herpes keratitis was investigated. This was to determine if a history of herpes keratitis predisposes to shedding of the herpes simplex virus into the tear film and/or mouth. Swabs were collected from the eyes and mouth of two groups of patients thrice weekly over a two- to four-month period. Group A comprised nine patients with a history of herpes labialis, group B 15 patients with a history of herpes keratitis. Herpes simplex virus type 1 was isolated from 1.33% of mouth specimens but was not identified in any of the ocular specimens. There was no significant difference between groups A and B in terms of ocular or oral shedding. Oral shedding appears to be independent of a previous herpes keratitis. The tear film is an unlikely source of virus in persons either with no history of herpes keratitis or between attacks in those patients with a history of previous herpes keratitis.

Diabetic retinopathy: different risk factors for exudates and haemorrhages

The retinae of 137 patients were examined ophthalmologically and for visual acuity at diagnosis of non-insulin dependent diabetes and again in 1982 and 1983, approximately 7 and 8 years later, when colour photographs were also taken. In 1983, 46% were without detectable retinopathy, 32% had haemorrhages (including microaneurysms) only, 4% exudates alone and 18% both lesions. Those with haemorrhages were more hyperglycaemic than those without retinopathy and those with exudates only. Indeed, those with exudates alone had lower mean glucose levels than those without retinopathy (p less than 0.05). Patients with exudates (+/- haemorrhages) had a lower percentage of the fatty acids of plasma cholesterol esters as linoleate than those without (p less than 0.05) but this did not hold for those developing haemorrhages. Different risk factors appear to operate in different features of diabetic retinopathy. In some respects exudate formation may be more akin to macro than to micro angiopathy.