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Purpose: A case of linear IgA disease is reported to alert ophthalmologists and physicians to this unusual cause of chronic cicatrizing conjunctivitis. Methods: Clinical records of a patient suffering from linear IgA disease were reviewed. Results: A 65-year-old woman with a complicated medical history experienced rapidly progressive chronic cicatrizing conjunctivitis leading to corneal perforation. Undiagnosed gingivitis and palatal ulceration had been present for 5 years prior to the onset of ocular symptoms and vitamin C deficiency had followed the consequent dietary restrictions. A diagnosis of linear IgA disease was made on conjunctival biopsy, which demonstrated linear deposits of IgA along the epithelial basement membrane. The perforation was managed successfully with a conjunctival pediculate flap. Control of the inflammation was achieved with systemic prednisolone and cyclophosphamide but at the expense of serious systemic side-effects. Conclusions: Linear IgA disease causes progressive conjunctival cicatrization in many affected individuals. Although dapsone generally controls the inflammation, heavier systemic immunosuppression was required in this case. Involvement of skin or other mucosal surfaces may become symptomatic before the conjunctivitis, and physicians must be educated to refer patients for ophthalmological review on diagnosis. Conversely, ophthalmologists encountering ocular linear IgA disease should be aware of the possibility of other mucosal involvement requiring physician intervention.

Arthrogryposis multiplex congenita refers to a group of birth defects characterised by multiple joint contractures. The syndrome is caused by neuropathic disease, myopathic disease, or any other cause of decreased fetal joint mobility. Multiple and usually symmetric joint abnormalities with associated muscular and soft tissue hypoplasia are noted at birth. A variety of associated congenital anomalies affecting many organ systems are frequently found. Ocular and orbital findings have been described in patients with arthrogryposis but corneal disease has only rarely been reported. We present corneal findings in two patients with arthrogryposis and discuss the implications for disease pathogenesis. Previous ophthalmologic reports are also reviewed.

Purpose: The present study examines the impact of cataract on visual disability (VD) and how cataract surgery alters VD. Methods: Fifty-six patients were assessed pre- and at 3 months post-cataract surgery. Cataract severity was measured with the Lens Opacities Classification System ill (LOCS III). Visual disability was assessed by questionnaire. The relationship between LOCS III scores and total VD score was examined with linear regression. Repeated measures analysis of variance was used to determine whether the pre- and postoperative VD scores were different. Results: The VD score was found to relate more closely to the LOCS III score in the least affected eye than in the most affected eye. The VD score is related to nuclear opacity (P=0.01), and posterior subcapsular cataract (PSC; P=0.0004), but not to cortical cataract (P=0.51) (r2= 0.43). The VD score is significantly greater before surgery (mean ±SD) 1.81 +0.67) than after (1.19 ± 0.21; P± 0.001). Conclusions: Nuclear and PSC cataracts cause more visual disability than cortical cataracts. Visual disability is significantly reduced by cataract surgery.

Up to one-half of patients with anterior uveitis suffer from related systemic diseases. The common associations are the seronegative arthropathies and, in children, juvenile chronic arthritis. Anterior uveitis may also occur in the context of sarcoidosis or Behcet's disease. Syphilis and tuberculosis remain a significant problem for specific populations and may be the cause of anterior uveitis in these groups. By thorough clinical history and the correct selection and interpretation of simple investigations, it is generally possible for the ophthalmologist to make or exclude a systemic diagnosis, predict the ocular prognosis and direct selected patients to the appropriate physician. Diseases that threaten the patient's wellbeing must certainly be recognized. In the present review we present a method for identifying the systemic associations of anterior uveitis.

Purpose:To compare the cost of conventional extracapsular cataract surgery and phacoemulsification at Flinders Medical Centre. Methods:The costs of the two forms of cataract surgery were assessed over a 12-month period. During this period 410 cataract operations were performed. Setting:The cataract surgery was carried out in a dedicated day surgery unit in a teaching hospital. Outcome measure:The direct, indirect and tangible costs were measured. Results:Conventional extracapsular cataract surgery with posterior chamber lens implant costs $1000.85 and phacoemulsification with lens implantation costs $1231.00. Conclusions:Although conventional extracapsular surgery generates slightly lower costs than phacoemulsification, the cost difference is small. In generating these figures, some assumptions must be made and the real difference may prove to be less than this.

We report a case of Fusarium solani keratitis which highlights the difficulties often associated with management of fungal corneal infections. This case demonstrates several unusual and interesting features: the occurrence of deep fungal pathology after superficial injury, the difficulties encountered in attempting to isolate and identify the causative organism, and the protracted course taken by an organism often noted to be rapidly destructive. These features necessitated an individual approach to therapy, employing unconventional medical and surgical techniques to achieve a satisfactory outcome.

Corneal surface abnormalities are commonly encountered in ophthalmology and are manifestations of a wide range of underlying disease processes. The diversity of both clinical presentation and morphological appearance requires a systematic approach to the identification and management of these superficial corneal changes. Accurate diagnosis of superficial keratopathy requires skillful observation to seek the most characteristic clinical sign, a deductive thought process based on a knowledge of disease patterns, and occasionally the use of laboratory procedures to confirm the working diagnosis. We have classified changes of the corneal surface into five categories based on the clinical pattern (punctate, dendritic, plaque, vortex, and linear). We show how pattern recognition, with the aid of clinical presentation, history, and appropriate investigations, can lead to accurate diagnosis and initiation of proper management.

Forced-choice preferential looking (FPL) is a behavioural technique for the estimation of visual acuity in preverbal children. We have constructed an electromechanical FPL apparatus controlled by a microprocessor requiring just one operator. Sixty-three babies aged between six weeks and eleven months were evaluated with an overall success rate of 83% in obtaining an acuity measurement. FPL is a practical method for measurement of infant visual acuity in the ophthalmic clinic setting.

In the Australian Corneal Graft Registry's first 18 months of operation, May 1985 to November 1986, data supplied by 53 surgeons relating to 322 graft recipients have been entered and analysed with respect to: the most common presenting diseases (primarily keratoconus, bullous keratopathy and corneal opacities), risk factors (especially prior sensitisation to HLA antigens, corneal vascularisation, past or present anterior segment inflammation and history of raised intraocular pressure [IOP]), donor and recipient sex, cause of donor death, storage procedures for donor eyes, operative procedures accompanying the grafts themselves, and preliminary indications of overall graft survival by actuarial analysis. It is hoped that the establishment of this Registry will not only reinforce the use of actuarial graft survival analysis as the method of choice for transplantation surgeons wishing to monitor the survival of their patients and grafts, but will also provide a useful service for the Australian ophthalmic community in general.

Summary A reduction in anterior chamber depth was observed in 10 of 25 patients in whom scleral buckling was performed as a surgical treatment for retinal detachment. In one case this reduction was enough to precipitate angle closure glaucoma. Pre-operative assessment of the drainage angle and the anterior chamber depth is necessary for the recognition of predisposed individuals.