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Purpose: Ophthalmic surgery involves the manipulation of micron-level sized structures such as the internal limiting membrane where tactile sensation is practically absent. All humans have physiologic tremors that are of low amplitude and not discernible to the naked eye; they do not adversely affect the majority of the population's daily functioning. However, during microsurgery, such tremors can be problematic. In this review, we focus on the impact of physiological tremors on ophthalmic microsurgery and offer a comparative discussion on the impact of such tremors on other surgical specialties., Methods: A single investigator used the MEDLINE database (via PubMed) to search for and identify articles for inclusion in this systematic review. Ten key factors were identified as potentially having an impact on tremor amplitude: beta-blockers, muscle fatigue, robotic systems, handheld tools/micromanipulators, armrests/wrist supports, caffeine, diet, sleep deprivation, consuming alcohol, and workouts (exercise). These key terms were then searched using the advanced Boolean search tool and operators (i.e., AND, OR) available on PubMed: (*keyword*) AND (surgeon tremor OR microsurgery tremor OR hand steadiness OR simulator score)., Results: Ten studies attempted to quantify the baseline severity of operator physiologic tremor. Approximately 89% of studies accessing the impact of tremors on performance in regards to surgical metrics reported an improvement in performance compared to 57% of studies concluding that tremor elimination was of benefit when considering procedural outcomes., Conclusions: Robotic technology, new instruments, exoskeletons, technique modifications, and lifestyle factors have all demonstrated the potential to assist in overcoming tremors in ophthalmology., (© 2022. The Author(s).)

Importance: Triaging of outpatient referrals to ophthalmology services is required for the maintenance of patient care and appropriate resource allocation. Machine learning (ML), in particular natural language processing, may be able to assist with the triaging process., Background: To determine whether ML can accurately predict triage category based on ophthalmology outpatient referrals., Design: Retrospective cohort study., Participants: The data of 208 participants was included in the project., Methods: The synopses of consecutive ophthalmology outpatient referrals at a tertiary hospital were extracted along with their triage categorizations. Following pre-processing, ML models were applied to determine how accurately they could predict the likely triage categorization allocated. Data was split into training and testing sets (75%/25% split). ML models were tested on an unseen test set, after development on the training dataset., Main Outcome Measure: Area under the receiver operator curve (AUC) for category one vs non-category one classification., Results: For the main outcome measure, convolutional neural network (CNN) provided the best AUC (0.83) and accuracy on the test set (0.81), with the artificial neural network (AUC 0.81 and accuracy 0.77) being the next best performing model. When the CNN was applied to the classification task of identifying which referrals should be allocated a category one vs category two vs category three priority, a lower accuracy was achieved (0.65)., Conclusions and Relevance: ML may be able to accurately assist with the triaging of ophthalmology referrals. Future studies with data from multiple centres and larger sample sizes may be beneficial., (© 2019 Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: Bioengineering aims to produce functional tissue replacements to repair defects and has been widely investigated over the past few decades. We aimed to review the available literature on the application of tissue engineering in ophthalmology, with a particular focus on ophthalmic plastic surgery and potential applications for eyelid reconstruction., Methods: A literature search was performed on the MEDLINE database using the keywords "bioengineering," "tissue engineering," and "ophthalmology." Articles written in English were included., Results: There is a substantial body of work on tissue engineering of the cornea. Other structures in ophthalmology investigated include the conjunctiva, lacrimal gland, and orbital bone. We also discuss the potential application of tissue engineering in eyelid reconstruction., Conclusion: Tissue engineering represents the future of regenerative and reconstructive medicine, with significant potential applications in ophthalmic plastic surgery.

Purpose: Unlike ptosis, upper eyelid retraction (ULR) is not a widely reported complication of the anophthalmic socket or post-enucleation socket syndrome (PESS). The clinical entity of post-enucleation ULR is investigated., Methods: 1) Two cases of post-enucleation ULR presenting to a specialist oculoplastic center (South Australian Institute of Ophthalmology, Adelaide, Australia) are described, 2) Single forced choice survey of 22 members of the Australian and New Zealand Society of Ophthalmic Plastic Surgeons regarding their clinical experience of ULR in anophthalmia, and 3) English literature review., Results: One case of ULR occurred less than 1 year and the other several decades following enucleation, both cases underwent eyelid surgery. Eighty-two percent of oculoplastic surgeons surveyed believe ULR is a rare and late (50%) complication of anophthalmia and 13.5% had never seen a case. Ninety-five percent indicated that ptosis is more common than retraction. A literature review supports the rarity of ULR in anophthalmia and a number of etiological factors are discussed., Conclusions: Upper eyelid retraction is a rare and often late complication of the anophthalmic socket. It occurs less commonly than ptosis as part of PESS, but increased recognition and reporting may improve the understanding of its true incidence and cause.

There are over 300 million people living in the world today who are visually impaired and a further 45 million who are blind. The large majority (90%) of these people live in developing countries, and up to 75% of blindness are avoidable. With cataracts being the major cause of blindness and visual impairment, many ophthalmic aid programmes are aimed at alleviating the enormous burden caused by this readily treatable disease. Having said that, caution should be exercised that short surgical visits to remote rural areas that are not coordinated with local national eye care managers should be discouraged because they do little for the development of sustainable eye care programmes. With this in view, it has become imperative to design blindness prevention and ophthalmic support programmes that are workable, comprehensive, economical and sustainable., (© 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.)

Background: The purpose of the study is to compare characteristics of Aboriginal patient hospital admissions with non-Aboriginal admissions to the Ophthalmology Unit of the Royal Adelaide Hospital., Methods: A retrospective review of separation data was undertaken of hospital inpatient and day surgery admissions to the Royal Adelaide Hospital Ophthalmology Unit for the period July 1997 to January 2005., Results: There were 11 944 admissions to the Ophthalmology Unit (including inpatients and day surgery cases), of which 273 (2.29%) were Aboriginal patients. Of the total, 2779 (23.3%) patients were admitted for at least 24 h (inpatients), and 9165 (76.7%) stayed less than 24 h (mostly day surgery cases). Aboriginal patients comprised 6.8% of inpatient admissions, and 0.9% of admissions less than 24 h. The average age of Aboriginal patients (52.9 years) was significantly less than non-Aboriginal patients (62.6 years; P < 0.0001). The median length of stay for Aboriginal patients was 5 days compared with 3 days in non-Aboriginal patients. Aboriginal patients were more likely to be from interstate (RR 10.3 P < 0.0001), more likely to have diabetes mellitus (RR 2.7 P < 0.0001), and more likely to be admitted for cataract surgery (RR 4.18 P < 0.0001) and lid disorders (RR 6.04 P < 0.0001) than non-Aboriginal patients., Conclusion: Aboriginal patients admitted to the Ophthalmology Unit were younger in age, more frequently from interstate, and had longer admissions than non-Aboriginal patients. These results have important implications for ophthalmic health-care planning.

Minimally invasive "keyhole" surgery performed using endoscopic visualization is increasing in popularity and is being used by almost all surgical subspecialties. Within ophthalmology, however, endoscopic surgery is not commonly performed and there is little literature on the use of the endoscope in orbital surgery. Transorbital use of the endoscope can greatly aid in visualizing orbital roof lesions and minimizing the need for bone removal. The endoscope is also useful during decompression procedures and as a teaching aid to train orbital surgeons. In this article, we review the history of endoscopic orbital surgery and provide an overview of the technique and describe situations where the endoscope can act as a useful adjunct to orbital surgery.

Purpose: Ophthalmic surgery involves the manipulation of micron-level sized structures such as the internal limiting membrane where tactile sensation is practically absent. All humans have physiologic tremors that are of low amplitude and not discernible to the naked eye; they do not adversely affect the majority of the population's daily functioning. However, during microsurgery, such tremors can be problematic. In this review, we focus on the impact of physiological tremors on ophthalmic microsurgery and offer a comparative discussion on the impact of such tremors on other surgical specialties. Methods: A single investigator used the MEDLINE database (via PubMed) to search for and identify articles for inclusion in this systematic review. Ten key factors were identified as potentially having an impact on tremor amplitude: beta-blockers, muscle fatigue, robotic systems, handheld tools/micromanipulators, armrests/wrist supports, caffeine, diet, sleep deprivation, consuming alcohol, and workouts (exercise). These key terms were then searched using the advanced Boolean search tool and operators (i.e., AND, OR) available on PubMed: (*keyword*) AND (surgeon tremor OR microsurgery tremor OR hand steadiness OR simulator score). Results: Ten studies attempted to quantify the baseline severity of operator physiologic tremor. Approximately 89% of studies accessing the impact of tremors on performance in regards to surgical metrics reported an improvement in performance compared to 57% of studies concluding that tremor elimination was of benefit when considering procedural outcomes. Conclusions: Robotic technology, new instruments, exoskeletons, technique modifications, and lifestyle factors have all demonstrated the potential to assist in overcoming tremors in ophthalmology. [ABSTRACT FROM AUTHOR]

A 48-year-old man presented following an episode of sudden onset simultaneous inferior altitudinal visual loss in his left eye and visual obscuration with shimmering in the inferonasal quadrant of the right eye. Clinical examination demonstrated left superior hemiretinal artery occlusion and an area of focal dynamic spasm along the right superior temporal branch retinal artery, the arteriolar spastic cycle was about 2 sec in duration. Hematological (including complete blood count, thrombophilia screen, vasculitic screen and serum magnesium), carotid, and cardiac investigations were normal. He was given acetazolamide 500 mg orally, timolol maleate 0.5% eye drops once daily and sublingual amyl-nitrate 0.8 mg, and maintained on felodipine 10 mg/day and aspirin 100 mg/day. The area of focal arteriolar spasm in the right eye resolved over two months. To our knowledge there are no prior reports of photographically documented dynamic focal retinal vascular spasm on a MEDLINE and PUBMED search.

We report a case of pulsating enophthalmos secondary to orbital varix associated with orbital bony defects. A 64-year-old female with pulsating enophthalmos of the right eye was found to have a right orbital mass with bony defects of the orbit. Valsalva maneuver failed to induce proptosis. The diagnosis of orbital varix was confirmed by exploratory orbitotomy. During general anesthesia for orbitotomy, proptosis of the right eye was noted. Ophthalmologists should be aware of the association between orbital varices and cranial bony defects and encephaloceles. Proptosis induced by general anesthesia and positive pressure ventilation suggests an underlying distensible venous anomaly.

We describe a vertical lid split orbitotomy approach to perform optic nerve sheath fenestration which was done in a patient with idiopathic intracranial hypertension. A vertical lid split incision was used to enter the superomedial orbit and approach the optic nerve sheath. This approach resulted in a successful nerve sheath fenestration, with improvement in the patient′s symptoms. The vertical lid split incision provides access to the optic nerve sheath with minimal morbidity and may be an option for optic nerve sheath decompression.

Abstract Background This paper reports population-based data on the prevalence and causes of visual impairment among children and adults in Botucatu, Brazil. Methods A population-based cross-sectional study was conducted involving a random start point and then systematic sampling of an urban Brazilian population in the city of Botucatu. There were approximately 3 300 individuals aged 1 to 91 years who were eligible to participate in the study. Of this sample, 2485 (75.3%) underwent ophthalmic examination. The ophthalmic examination included uncorrected (presenting) and best corrected distance visual acuity using standardized protocols. The primary cause of decreased visual acuity was identified for all patients with visual impairment. Results Presenting low vision and presenting blindness were found in 5.2% (95% CI: 4.3–6.1) and 2.2% (95% CI: 1.6–2.8) of the population, respectively. Unilateral presenting low vision and unilateral presenting blindness were found in 8.3% (95% CI: 7.2–9.5) and 3.7% (95% CI: 2.9–4.4) of the population respectively. Best corrected low vision was found in 1.3% of the population (95% CI: 0.9–1.7) and best corrected blindness was discovered in 0.4% of people (95% CI: 0.2–0.7). The main cause of presenting low vision was refractive error (72.3%) and cataract was the most prevalent cause of blindness (50%). Conclusion The main causes of low vision and blindness in this Brazilian city were uncorrected refractive errors, cataract, and retinal diseases. Programs to further reduce the burden of visual impairment need to be targeted toward the correction of refractive error and surgery for cataracts.

Aims To describe the outcomes and complications for composite eyelid grafts in a large case series over a 9-year period. Method A retrospective study of all patients who underwent a composite graft for eyelid reconstruction between January 2000 and May 2009. A composite eyelid graft involves the excision of a full thickness pentagonal wedge from the donor eyelid, which is inserted into the recipient eyelid defect. The orbicularis muscle is discarded from the composite graft. Initial diagnosis, complications, postoperative eyelid contour and colour were recorded. Results Forty-two patients were identified in the study period; the mean age was 69 years. Reconstruction following basal cell carcinoma excision was the commonest indication for surgery. Thirty-five composite grafts were performed for lower eyelid defects and seven for upper lid defects. The average size of the grafts was 9.1 (range 7e12) mm. Five patients required two grafts to reconstruct the defect. Thirty-six (86%) patients achieved a satisfactory contour and 33 (78%) patients had good matching skin colour. Partial dehiscence occurred in five patients and three patients had bulkiness of the graft postoperatively. We had no episodes of graft failure, although two patients had skin necrosis, which resolved. Conclusion Composite eyelid grafts when combined with mobilisation of the recipient orbicularis muscle can result in good preservation of eyelid function with satisfactory cosmesis. [ABSTRACT FROM AUTHOR]

To examine the concentrations of elastic fibres in Whitnall ligament and the intermuscular transverse ligament (ITL), and to examine the anatomic relationships between Whitnall ligament and its surrounding structures. Observational anatomic study. Full thickness sagittal sections of 12 upper eyelids (6 right and 6 left), fixed in 10 % buffered formalin, were studied in 10 Asian cadavers (mean age at death: 77.1 years, range: 62-92 years). We analysed the concentrations of elastic fibres in Whitnall ligament and the ITL, as well as examined the relationship between Whitnall ligament and the connective tissue septa, the ITL and the levator palpebrae superioris (LPS) muscle. Concentrations of elastic fibres in Whitnall ligament and the ITL, relationship between Whitnall ligament and its surrounding structures. The concentration of elastic fibres in Whitnall ligament was low compared to the ITL. In most specimens, both Whitnall ligament and the ITL were loosely attached to the LPS muscle through areas of adipose tissue or cavities. Although in all specimens, connective tissue septa were demonstrated next to Whitnall ligament, they were more often directed parallel to the ligament rather than radially to it. Both Whitnall ligament, with its low concentration of elastic fibres, and the ITL, with its high content of elastic fibres, show loose attachments to the LPS muscle through areas of adipose tissue or cavities. Whitnall ligament may work as the check ligament of the LPS muscle as well as part of the pulley system with the ITL. [ABSTRACT FROM AUTHOR]

Background: To determine normal exophthalmometric values for a Sri Lankan population and investigate their demographic, physical, refractive and ocular biometric correlates. Methods: The Kandy Eye study was a population-based, cross-sectional study. By randomized cluster sampling, 1721 eligible participants, who were 40 years old and over were identified; 1375 participated. Exophthalmometry was performed with Hertel's exophthalmometer. Participants' demographics including age, gender and ethnicity were recorded. Height, weight, body mass index, non-cycloplegic refraction and ocular biometry were measured with standardized methods. Summary statistical analysis was performed for exophthalmometric values and relationships with other factors were tested using Pearson product–moment correlation coefficient analysis, standard single and multiple linear regression analysis. Results: A total of 1341 subjects were included in the analysis. Exophthalmometric values for the population had a mean of 15.82 mm, standard deviation of 2.73 mm and range of 10.46–21.28 mm. Exophthalmometric values for men were significantly higher than women. There were no significant differences between the racial groups' exophthalmometric values (Sinhalese, Tamils, Moors). Exophthalmometric values were significantly correlated with age, gender, height, weight, body mass index, base and axial length but not to refractive spherical equivalents. Only gender, weight, base and axial length were independent predictors for exophthalmometric values after adjusting for confounders. Conclusion: In this Sri Lankan population, our study provided the first reported estimates of a normal exophthalmometric range and determined gender, weight, base and axial length as its correlates. Sri Lankans are the first population to demonstrate this relationship between weight and exophthalmometric values and also showed that refraction is not a cause for pseudo-proptosis. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to determine the cataract surgical coverage and investigate the barriers to cataract surgery as reported by those with cataract-induced visual impairment in rural Myanmar. Methods: A cross-sectional, population-based survey of inhabitants 40 years of age and over from villages in the Meiktila District (central Myanmar); 2481 eligible participants were identified and 2076 participated. Data recording included corrected visual acuity, dilated slit lamp examination and stereoscopic fundus examination. Lens opacity was graded using the Lens Opacities Classification System III. Participants with cataract-induced visual impairment (acuity < 6/18 in better eye) were also invited to respond to a verbal questionnaire about barriers to cataract surgery. Results: Cataract surgical coverage for visual acuity cut-offs of <6/18, <6/60 and <3/60 was 9.74%, 20.11% and 22.3%, respectively, for people and 4.18%, 9.39% and 13.47%, respectively, for eyes. Cataract surgical coverage was higher for men than women, but gender was not associated with refusal of services. Of the 239 who responded to the extra questionnaire, 216 were blind or had low vision owing to cataract. Three quarters refused referral for surgery: cost and fear of surgery were the most frequently reported barriers. Conclusion: Cost plays a large role in the burden of cataract in this region. Implementation of educational programmes, reforms to local health service and subsidization of ophthalmic care may improve the uptake of cataract surgery. [ABSTRACT FROM AUTHOR]

Enophthalmos can be defined as a relative, posterior displacement of a normal-sized globe in relation to the bony orbital margin. Non-traumatic enophthalmos has a wide variety of clinical presentations and may be the first manifestation of a number of local or systemic conditions. It may present with cosmetic problems such as deep superior sulcus, pseudoptosis or eyelid retraction; or functional problems such as diplopia or exposure keratopathy. There are three main pathogenic mechanisms: structural alterations in the bony orbit; orbital fat atrophy; and retraction. Evaluation of enophthalmos patients includes orbital imaging and a thorough ophthalmic and systemic examination. In this review, we discuss the presenting features of non-traumatic enophthalmos and include a brief description of the more important causes. An approach to the clinical evaluation of these patients is also discussed together with a brief overview of the principles of management. [ABSTRACT FROM AUTHOR]

Purpose: To determine the central corneal thickness (CCT) and its demographic associations among Aboriginal people attending eye clinics in remote South Australia. Methods: A clinic-based cross-sectional study was conducted involving opportunistic sampling of patients. Eligible participants underwent measurement of CCT by ultrasound pachymetry. The results were compared with a group of Caucasian control patients. Results: All patients (189) who were invited to participate in the study had their CCT measured. The mean age was 44.8 ± 14.5 years, and women comprised 57.7% of the sample. The control group consisted of 115 Caucasian participants. The mean age was 47.1 ± 14.8 years, and women accounted for 55.7% of the sample. Mean CCT for Aboriginal participants was 514.9 ± 30.5 μm in the right eye and 515.6 ± 30.5 μm in the left eye ( t = 1.1, P = 0.3). Mean right CCT for Caucasian participants was 544.6 ± 31.9 μm and mean left CCT in this group was 547.1 ± 32.2 μm ( t = 4.6, P < 0.001). There was a significant difference between the right ( t = 8.4, P < 0.001) and left ( t = 8.8, P < 0.001) CCT of Aboriginal and Caucasian participants. Conclusions: The CCT among Aboriginal patients attending eye clinic in remote South Australia was significantly thinner than that of a Caucasian control group. Thinner corneas among this group of Aboriginal patients may indicate a need to adjust intraocular pressure according to CCT and to be more vigilant for glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: To report the risk factors associated with primary open-angle glaucoma (POAG) in the Burmese population. Methods: The Meiktila Eye study, a population-based cross-sectional study, included inhabitants 40 years of age and over from villages in the Meiktila District. Of 2481 eligible participants identified, 2076 participated in the study and sufficient examination data to diagnose glaucoma in at least one eye was obtained in 1997 participants. The ophthalmic examination included slit-lamp examination, tonometry, gonioscopy and dilated stereoscopic fundus examination. Definitions adhered to the International Society for Geographic and Epidemiological Ophthalmology's recommendations. Univariate and multivariate analyses of potential risk factors were performed. Results: The overall prevalence of POAG was 2.0% (95% CI 0.9–3.1). In the univariate analysis, increasing age ( P = 0.024), spherical equivalent ( P = 0.01), axial length ( P = 0.023) and intraocular pressure (IOP; P < 0.001) were significantly associated with POAG. And in the multivariate analysis, myopia <0.5 D ( P = 0.049), increasing age and IOP ( P < 0.001) were significant risk factors for POAG. Conclusion: POAG in this Burmese population was associated with increasing age, axial myopia and IOP. [ABSTRACT FROM AUTHOR]

Purpose: To report 3 patients with adult-onset orbital Langerhans cell histiocytosis (LCH). Design: Retrospective interventional case reports. Participants: Three adult patients with orbital LCH. Methods: Case reports from 2 different clinics and review of the scientific literature. Main Outcome Measures: Clinical course and radiologic and histologic findings. Results: Three healthy patients, aged 20 to 36 (mean, 27) years, presented with biopsy-proven unilateral orbital LCH. The initial presenting complaints were mainly orbital pain and headache with or without orbital swelling and minimal effect on ocular movements. There was radiologic evidence of disease centered on the greater wing of sphenoid bone in all cases. Biopsy via lateral canthotomy was performed with LCH confirmed based on histologic and immunohistochemical findings. There was no evidence of disease elsewhere on systemic investigations. One patient had curettage and intralesional corticosteroids, 1 patient had a craniotomy for more complete resection of the lesion, and the third patient was referred for radiotherapy. All patients achieved complete resolution of symptoms and signs. None of the patients demonstrated any evidence of distant or recurrent disease at follow-up. Conclusions: Orbital LCH in adults is a rare, usually unifocal, and relatively benign disease most commonly affecting the greater wing of sphenoid bone, where there is still active bone marrow in young adults. There is no consensus on cause or therapy, but our reported cases show that several treatment modalities are effective. [Copyright &y& Elsevier]

Background: This study aims to determine the sociodemographic characteristics of the Ophthalmology Outpatient Clinic at the Royal Adelaide Hospital, to ascertain satisfaction levels with aspects of care, and determine if patient satisfaction levels can be increased by the provision of information letters prior to appointment. Methods: New patients attending Ophthalmology Outpatient Clinic were surveyed regarding sociodemographic information and satisfaction levels. Participants received an introductory letter prior to their clinic appointment, and were compared with controls. Responses were analysed using Mann–Whitney U-tests. Satisfaction scores regarding waiting times, clinic environment, doctors, nurses, clerical staff and general satisfaction were correlated with demographic data using Spearman correlation coefficient analysis and chi-squared statistics. Ordinal logistic regression and non-parametric rack testing determined differences between the two groups. Results: Positive correlations were identified between patient-estimated actual waiting time, ratings of waiting times, booking efficiency, information given, intention to return to, recommend the clinic, to comply with advice given, and higher ratings of the overall quality of the service, and satisfaction levels. Negative qualitative comments correlated with lower ratings of satisfaction and quality of the service. The intervention group showed statistically significantly higher ratings of the wait in clinic and the overall quality of the service. Satisfaction ratings of the clinic staff were also higher in the intervention group. Conclusions: Ophthalmology outpatients are more likely to be happy with their health care if they are satisfied with waiting times, and are more likely to return to the service and comply with advice, thus improving health outcomes. Provision of information regarding the outpatient clinic structure and estimated waiting times is a simple, cost-effective method of improving patient satisfaction levels and altering perceptions of waiting times. [ABSTRACT FROM AUTHOR]

Background: To determine the prevalence of trachoma and diabetes-related eye disease within the adult Aboriginal population screened by the South Australian Eye Health Program between 1999 and 2004 inclusive. Methods: The South Australian Eye Health Program visited 22 Aboriginal communities in remote South Australia. Visiting ophthalmologists and optometrists systematically collected data on the cohort of adult patients seen over the period 1999–2004. Prevalence and grade of trachoma according to World Health Organization classification and the prevalence and degree of diabetic retinopathy according to the Early Treatment Diabetic Retinopathy Study and National Health and Medical Research Council guidelines were recorded. Results: A population of 1651 Aboriginal patients was examined. Sixty-two per cent were female and 38% were male. Twenty patients (1.2%) had evidence of active trachoma with 260 (15.7%) patients having either lid scarring, trichiasis or corneal opacity. There was no significant association between gender and the prevalence of trachoma ( P = 0.48). Seven hundred and seventy-one patients within the examined population had diabetes mellitus (46.70%). Significantly more women than men were affected and prevalence increased with age ( P < 0.0001). One hundred and sixty-nine patients (22%) with diabetes mellitus had features of diabetic retinopathy, and of these patients 77 had background diabetic retinopathy (46%) and 92 (54%) had either proliferative diabetic retinopathy or maculopathy. Prevalence of clinically significant macula oedema among those with maculopathy (14 of 50 patients) was 28%. Conclusions: The data suggest that although trachoma is still endemic in this South Australian Aboriginal population the prevalence and severity are less than previously reported. Diabetes mellitus has a high prevalence within this population and great potential for detrimental visual sequelae. [ABSTRACT FROM AUTHOR]

Purpose : The authors report the novel use of the video-endoscope as an adjunct in teaching orbital surgery, in particular within the sub-periosteal orbital space. This is of most use during situations where visualisation is of critical importance and direct supervision is not possible. Materials and Methods : This technique was used for 16 cases of orbital surgery during a 12-month period. There were 5 orbital fracture repairs, 8 orbital decompressions (4 via a swinging eyelid and 4 via a transcaruncular approach), an infraorbital nerve biopsy, an eosinophilic granuloma and an orbitofrontal cholesterol granuloma. All procedures were performed by the trainee under consultant supervision with the endoscope being used when direct visualisation was not possible for the consultant. A rigid Storz 3-chip video-endoscope with 0, 30 and 70-degree tips was used to enable visual supervision. Results : The endoscope was of particular use in procedures involving the posterior orbital floor, orbital roof and medial orbital wall. It also enabled safe supervision of curettage of an orbital roof lesion which abutted the dura. The technique was easy to use; it provided good local illumination and a magnified view for supervision. Conclusion : This technique is a valuable adjunct in allowing the trainee to safely perform selected complex orbital surgery under video-endoscopic supervision. [ABSTRACT FROM AUTHOR]

PURPOSE To describe two patients with orbital lymphoma mimiching optic nerve meningioma. METHODS Retrospective case review. RESULTS Both patients presented in their sixth decade with gradually increasing proptosis and decreasing vision. Computerized tomography revealed homogeneous masses encasing th optic nerves, which in conjunction with the clinical presentations were felt to represent optic nerve meningiomas. Biopsy, however, led to a diagnosis of lymphoma of mucosal-associated lympoid tissue origin in one and a well-differentiated non-Hodgkin's lymphoma in the other. CONCLUSION Orbital lymphoma surrounding the optic nerve may mimic the clinical and radiological appearance of an optic nerve meningioma. [ABSTRACT FROM AUTHOR]

Background: Thyroid orbitopathy is characterized by spontaneous remissions and exacerbations. Although data on the natural history are scarce, the active phase is usually self-limited, encompassing an average period of 18−36 months. Late reactivation, defined as active orbitopathy occurring after more than 5 years of quiescent disease, appears to be an uncommon and poorly documented event. The aim of the present study was to assess the incidence and characteristics of late reactivation of thyroid orbitopathy within a tertiary referral orbital clinic. Methods: A retrospective case review was conducted of patients with thyroid orbitopathy seen at the Royal Adelaide Hospital Orbital Clinic between 1996 and 2001. Results: From 193 cases of thyroid orbitopathy, eight cases (5%) of late reactivation were identified. The mean age of patients was 51 years (range 32−76 years) with a female to male ratio of 3:1. All cases presented with proptosis and seven demonstrated increased diplopia and gaze restriction. Signs of soft tissue inflammation were seen in three cases. All were euthyroid at presentation with a past history of thyroid orbitopathy and hyperthyroidism. One patient had an association of smoking with reactivation but the remainder had no discernible precipitants. The average interval between the initial orbitopathy and reactivation was 12 years (range 6−30 years). Computed tomography revealed enlarged extraocular muscles in seven cases and two showed partial response to treatment with low dose radiotherapy and steroids. The average length of disease activity was 14 months (range 9−18 months). Conclusion: Late reactivation of thyroid orbitopathy appears to be an uncommon phenomenon. It may occur under euthyroid conditions with no obvious precipitants and often presents as a reactivation of myopathy. [ABSTRACT FROM AUTHOR]

Abstract Haemangiopericytoma (HPC) of the orbit is a rare tumour occurring in all age groups and presenting with slowly progressive proptosis, ocular motility impairment and visual loss. Although most are benign tumours that are resectable at diagnosis, one-third of these tumours demonstrate malignant features and recur locally or metastasize, usually with a fatal outcome. In 1995, a morphologically unique variant, termed lipomatous haemangiopericytoma (L-HPC), was described. Only one case has been reported previously arising in the orbit. In this paper, a case is reported of L-HPC occurring in the orbit and consider the prognostic implications of this HPC variant. [ABSTRACT FROM AUTHOR]

Nocardia is a rare cause of ocular infections and most commonly occurs secondary to trauma. Systemic Nocardiosis may have ocular involvement in rare cases. We report a case of disseminated nocardiosis with orbital apex involvement and endophthalmitis in an immunocompromised patient. The patient presented with respiratory sepsis, and later developed complete ptosis and ophthalmoplegia in the left eye. This was on the background of treatment with high-dose prednisolone. Magnetic resonance imaging showed enhancement of the entire clivus, extending into the left orbital apex and cavernous sinus. The patient was initially treated empirically for CNS tuberculosis. Bronchoscopic cultures returned positive for Nocardia farcinica, and the patient was treated with trimethoprim/sulfamethoxazole and weaned off previous corticosteroids. [ABSTRACT FROM AUTHOR]

An unusual presentation of sebaceous carcinoma of the eyelid is described in a 96-year-old man who presented with a large papillomatous palpebral conjunctival lesion in the left upper eyelid. The patient underwent a shave excision of the lesion, followed by a full thickness excision with paraffin section margin control. Histopathology revealed a sebaceous gland carcinoma with no evidence of pagetoid spread. Although rare, sebaceous gland carcinoma should be considered in the differential diagnosis of a conjunctival papilloma. [ABSTRACT FROM AUTHOR]

Reports on the case of a 21-year-old man with bilateral congenital trigemino-abducens synkinesis. Familial history of orbital or ocular trauma, strabismus or amblyopia; Etiology of congenital aberrant innervations.

The article announces that Torsten Nils Weisel has received the Nobel Prize in Ophthalmology.

Objectives: To present the surgical outcomes and postoperative complications in a series of patients who underwent upper lid surgery using autogenous hard palate grafts (HPGs) or free tarsal grafts (FTGs) as posterior lamella replacement material. Design: Retrospective, comparative, interventional case series. Patients: Thirty-one consecutive patients who were operated in 2 oculoplastics centers between July 2000 and January 2005. Methods: All patients’ clinical records were reviewed. Main Outcome Measures: Postoperative upper eyelid contour and viability, ocular discomfort, keratopathy, and corneal edema, as well as assessment for donor site complications and final graft dimensions. Results: There were 31 patients who underwent upper lid surgery (15 HPGs, 16 FTGs). The complications in the HPG group included corneal edema or transient keratopathy (13.3%), partial graft dehiscence (13.3%), upper lid retraction (13.3%), and necrosis of the overlying skin flap (6.7%). There were no significant postoperative complications in the FTG group during a mean follow-up period of 13.5±5 months. Donor site complications included 2 cases of mild upper lid retraction and central peaking. There were an average of 17% decrease in FTG vertical height and a 24% decrease in HPG vertical height during the follow-up period. Conclusion: Hard palate grafts may be associated with a higher rate of complications in upper lid surgery relative to FTGs, although most complications are temporary. Graft contraction could be reduced by oversizing. [Copyright &y& Elsevier]

Purpose: To report the incidence of orbital cellulitis after orbital blowout fracture. Design: Retrospective, noncomparative, interventional case series. Participants: All patients with orbital cellulitis and a history of recent orbital fracture. Methods: A medical record review of clinical history, imaging studies, and surgical and treatment outcome was performed. Main Outcome Measures: Resolution of orbital cellulitis and surgical and imaging findings. Results: Four patients (3 male; mean age, 30 years [range, 4.5–58]) were treated for orbital cellulitis complicating orbital fracture. All patients had evidence of paranasal sinusitis before or after the orbital injury, and 2 also reported forceful nose blowing after sustaining orbital trauma. Although 3 patients received prophylactic oral antibiotics after the fracture, this failed to prevent infection. Sinusitis commenced 1 to 2 weeks before and as late as 5 weeks after orbital injury. All patients were treated with IV antibiotics. Two developed an orbital abscess that required surgical drainage; 1 patient improved after an endonasal maxillary antrostomy. One patient improved on IV antibiotics alone and underwent fracture repair at a later stage. These 4 patients represent 0.8% of all cases of orbital fractures treated in the study period. Conclusions: Orbital cellulitis is a rare complication of orbital fracture, and seems to be more common when paranasal sinus infection preexists or occurs within several weeks of the injury. Oral antibiotics given after the orbital injury may not prevent orbital cellulitis or abscess formation. Surgery may be required to drain orbital abscess or in nonresolving cellulitis to drain the paranasal sinuses. Fracture repair, if indicated, should be delayed, particularly if an alloplastic implant is used. [Copyright &y& Elsevier]

The role of radiotherapy in ophthalmic practice continues to grow. This growth has seen an expansion of indications for radiotherapy, a refinement of the modalities that can be used and a reduction in the ocular and adnexal complications that result from this form of therapy. The compendium of indications for radiotherapy in ophthalmology continues to grow and now includes many conditions such as the treatment of lid and adnexal disease, ocular surface disorders and both benign and malignant disease of the posterior segment and optic pathways. The radiotherapeutic modalities employed to manage these conditions are numerous and include both radioactive plaques (brachytherapy) and external beam radiation techniques. New techniques such as stereotactic radiosurgery are delivering benefits in the management of conditions such as optic nerve sheath meningioma, where the treatment of this blinding and occasionally life-threatening intracranial neoplasm now results in fewer adverse affects. The purpose of this review is to give a brief overview of the indications and treatment modalities, and a more in-depth discussion of the potential side-effects when radiotherapy is used for ocular and periorbital disease. [ABSTRACT FROM AUTHOR]

Purpose: To describe 2 patients with orbital invasion by maxillary ameloblastoma, a rare odontogenic tumor that is not commonly encountered in ophthalmic practice. Design: Retrospective, interventional case report. Methods: Two patients who were diagnosed with maxillary ameloblastoma several years ago sought treatment for new-onset ocular and orbital signs and symptoms. Main Outcome Measures: Clinical and radiological findings and outcome. Results: In the first patient, tumor recurrence with orbital invasion was diagnosed, and the patient underwent a total orbital exenteration. No recurrence was noted after 18 months of follow-up. The second patient had intracranial involvement with orbital invasion and underwent an extensive resection through an intracranial approach. No recurrence was noted after a 6-month follow-up period. Conclusions: Although a slow-growing tumor, maxillary ameloblastoma can recur after surgical excision and can be locally aggressive; it can invade the orbit and result in significant ocular morbidity. Ophthalmologists should be aware of this tumor and should monitor these patients closely when orbital invasion is suspected. [Copyright &y& Elsevier]

Purpose: To examine the microscopic anatomic features of lower eyelid retractors in Caucasians, specifically looking for an anatomic division of the retractors into 2 layers, as is present in the Asian eyelid. Design: Experimental anatomic study. Participants: Seven Caucasian cadavers (13 lower eyelids: 7 right and 6 left). Methods: Sagittal full-thickness sections of the cadaveric lower eyelids were prepared and stained with Masson''s trichrome. The specimens were examined microscopically to discern the configuration of the lower eyelid retractors. Micrographs were obtained with a digital camera system attached to the microscope. Main Outcome Measures: Histologic findings of the lower eyelid retractors in Caucasians. Results: Although 2 specimens were excluded because anatomic details were severely disrupted during slide preparation, all the other samples demonstrated clear double layers of the lower eyelid retractors. Conclusions: The lower eyelid retractors in Caucasians consist of clear double layers. In this regard, no differences were detected between Caucasian and Asian eyelid anatomic features. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Abstract. Introduction: Trichilemmal carcinoma (TLC) is a rare adnexal tumour related to the external hair sheath. We describe the first case of TLC on the upper eyelid to be treated with Mohs micrographic surgery. Case Report : A 65-year-old man presented with a 2-month history of a firm 4 mm left upper eyelid nodule. An incisional biopsy revealed an infiltrative, lobulated tumour composed of large, polygonal, clear cells. A diagnosis of trichilemmal carcinoma was made and the patient underwent Mohs micrographic surgery. At follow-up 2 years later, there was no evidence of recurrence. Conclusion The pathogenesis of TLC remains unclear, with actinic damage, longterm low dose irradiation and transformation from benign trichilemmoma having been postulated. Trichilemmal carcinomas must be differentiated from other malignant clear cell tumours of the eyelid and the correct diagnosis made promptly as TLC takes an indolent clinical course, in which metastasis is a rare event, despite the tumour's cytologically malignant appearance. We recommend Mohs micrographic surgery as a treatment modality for this tumour, due to its potential for locally aggressive growth and local recurrence. [ABSTRACT FROM AUTHOR]

Objective: To describe the prevalence of trachomatous trichiasis and corneal opacity (CO) within central Myanmar. Design: Population-based cross-sectional ophthalmic survey. Participants: Random, stratified, cluster sampling of the inhabitants ≥40 years of age from villages in the Meiktila District was performed; 2481 eligible participants were identified and 2076 participated in the study. Methods: Visual acuity was measured using an E Snellen chart at 6 meters. Lid, ocular surface, and anterior segment examinations were performed at the slit lamp. Main Outcome Measures: Trachoma was graded as trachomatous trichiasis (TT) or CO according to the World Health Organization grading system. Results: The population prevalence of trachoma (TT and CO) was 2.6% (95% confidence interval [CI]. 1.67%–3.42%). For every 1-year increase in age, the odds of trachoma increased by 5.3% (95% CI, 4.9%–5.7%). There was no significant effect of gender on the prevalence of trachoma (P = 0.5). No formal schooling was a strong predictor of trachoma (odds ratio, [OR], 4.9; 95% CI, 3.9–6.1), and having <3 children in the house was protective (OR, 0.75; 95% CI, 0.61–0.93); however, neither occupation nor the number of people in a household had an effect on trachoma. Conclusions: The prevalence of blinding trachoma in central Myanmar remains relatively low. This is a tribute to the success of the Burma Trachoma Control Program and demonstrates the need for such a program to remain an integral part of public health care and community health services to further diminish the prevalence of this condition. This will be facilitated by a focus on trachoma risk factors and further research into the prevalence of inflammatory trachoma within the pediatric population. [Copyright &y& Elsevier]