Opthalmology & Visual Sciences publications
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Item Metadata only Punctal-canalicular stenosis associated with mitomycin-C for corneal epithelial dysplasia(Elsevier Science Inc, 2003) Billing, K.; Karagiannis, A.; Selva-Nayagam, D.Purpose
To report a case of punctal-canalicular stenosis after topical mitomycin C use for corneal dysplasia. To the authors' knowledge, this association has not previously been described.Design
Observational case report.Method
A 62-year-old woman was noted to have a right inferotemporal corneal dysplastic lesion. She received a topical course of mitomycin-C 0.04% four times a day, which subsequently invoked a toxoallergic reaction. One month later, the patient developed right-sided epiphora.Results
Probing demonstrated complete stenosis of the right lower canaliculus, 5 mm from the punctum.Conclusion
Mitomycin-C use may lead to lacrimal apparatus fibrosis and symptomatic epiphora when inciting a toxoallergic reaction.Item Metadata only Orbitofrontal cholesterol granuloma: percutaneous endoscopic-assisted curettage(Headley Brothers Ltd, 2003) Selva-Nayagam, D.; Lai, T.; Krishnan, S.This paper describes the use of endoscopic visualization in curettage of orbital cholesterol granuloma (OCG). Two males aged 54 and 50 years presented with orbitofrontal cholesterol granulomas arising in the superolateral frontal bone and abutting the dura. The granulomas were approached via a superior eyelid crease incision and a 70 degree rigid endoscope was used to visualize curettage of the granuloma from the inner surface of the frontal bone and the dura. Both patients made an uncomplicated recovery and there was no recurrence at eight months and two years follow up. Percutaneous endoscopic curettage is an alternative to blind curettage, lateral orbitotomy or frontal craniotomy for OCG.Item Metadata only Polymorphous low-grade adenocarcinoma of the lacrimal gland(Amer Medical Assoc, 2004) Selva-Nayagam, D.; Davis, G.; Dodd, T.; Rootman, J.Item Metadata only Orbital decompression for gross proptosis associated with orbital lymphangioma(Lippincott Williams & Wilkins, 2004) Hsuan, J.; Malhotra, R.; Davis, G.; Selva-Nayagam, D.A 14-year-old boy with 11 mm of proptosis and exposure keratopathy secondary to an orbital lymphangioma underwent surgical debulking with a carbon dioxide laser through a lateral orbitotomy combined with a 3-wall orbital decompression. The proptosis was reduced by approximately 2 mm as a result of the debulking procedure, but a further 5 mm reduction was achieved with the orbital decompression. No serious adverse effects were encountered. Bony orbital decompression may be a useful alternative treatment in patients with severe proptosis secondary to orbital lymphangioma.Item Metadata only Beware of the unilateral red eye: don't miss blinding uveitis(Australasian Med Publ Co Ltd, 2005) Durkin, S.; Casey, T.A 6-year-old girl presented to her general practitioner with a red left eye. She reported no pain or irritation, but did have difficulty seeing into the distance with blurring of vision in the affected eye. Associated with this symptom was the onset of neck stiffness with limitation in neck flexion and rotation. This had increased gradually over the preceding month and was most problematic in the morning. There were no associated fevers, rashes, gastrointestinal or genitourinary symptoms. She had been well in the past, was not taking any medications, and her vaccinations were up to date. Her elder sister had been diagnosed with juvenile idiopathic arthritis (JIA) at the age of 18 months, her mother had type 1 diabetes mellitus. A maternal aunt had been diagnosed with rheumatoid arthritis 4 years earlier. Examination revealed inflamed palpebral conjunctivae in the left eye, and mild restriction in the range of neck rotation and flexion. There were no other findings. The patient was diagnosed with conjunctivitis and intermittently prescribed chloramphenicol eye drops over 3 months. The neck discomfort continued over this period, despite physiotherapy. Ultrasonography of the neck showed no abnormalities apart from “unusual lymphadenopathy”. This finding prompted a referral to a paediatric oncologist who believed uveitis should be considered in light of the child’s family history of JIA. She was referred for an ophthalmologist’s opinion. At ophthalmological review, her vision was 6/7.5 in the right eye and 6/12 in the left eye. There was band keratopathy (see Box 1) present in the region of the visual axis and the pupil was adherent to the lens by posterior synechiae. The child’s vision continued to deteriorate to 6/24 in the left eye despite treatment with topical dexamethasone 0.1% and atropine 1%. She was referred to the rheumatology service. The rheumatologist found that the child had an elevated erythrocyte sedimentation rate of 43 mm/hour (normal range, 0–20 mm/hour), but the C-reactive protein concentration was within normal limits at 4 mg/L (normal range, 0–10 mg/L). The antinuclear antibody (ANA) titre was strongly positive at over 1:2560, and showed a homogenous pattern. The double-stranded DNA titre (Farr assay) was within normal limits at < 5 U/mL (normal range, < 11 U/mL). The extractable nuclear antigen screen was negative. Treatment with non-steroidal anti-inflammatory drugs resulted in little improvement, so therapy with oral prednisolone and pulse methylprednisolone was commenced. We saw her when she was admitted for the first of 3 methylprednisolone pulses (625 mg intravenously). Vision in the right eye was 6/9 and in the left it was 6/36. Topical medication was continued and the vision in the left eye improved modestly to 6/24. She was then discharged on topical treatment, and systemic treatment with 2.5 mg methotrexate weekly was commenced. This increased to 7.5 mg weekly over one month. At the most recent review, conducted at the time of the final dose of intravenous methylprednisolone, the vision was stable at 6/6, the intraocular pressure was within normal limits and the anterior chamber appeared quiet, the band keratopathy had partially resolved, but the posterior synechiae remained. The neck symptoms had resolved.Item Metadata only Lash ptosis caused by Latanoprost(Elsevier Science Inc, 2005) Casson, R.; Selva-Nayagam, D.Purpose
To report a case of lash ptosis caused by latanoprost.Design
Observational case report.Methods
Retrospective chart review.Results
A 61-year-old, ocular hypertensive man who was using latanoprost OU presented with trichomegaly and bilateral lash ptosis. The lash ptosis had not resolved 6 months after stopping latanoprost, and anterior lamellar repositions were performed. At last follow-up, 8 months after surgery, the lids were in a normal position, but the trichomegaly had reduced only slightly.Conclusions
Lash ptosis should be considered as a possible complication of latanoprost therapy.Item Metadata only Sebaceous gland carcinoma of the eyelid presenting as a conjunctival papilloma(Blackwell Publishing Asia, 2005) Khong, J.; Leibovitch, I.; Selva-Nayagam, D.; Dodd, T.; Muecke, J.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.Item Metadata only Deep lamellar keratoplasty in the treatment of keratoconus(Karger, 2006) Pakrou, D.; Fung, S.; Selva-Nayagam, D.; Chehade, M.; Leibovitch, I.Purpose
To present our experience with a series of patients treated with deep lamellar keratoplasty (DLK) for keratoconus (KC).Design
A single surgeon, prospective, consecutive series.Method
The study included all patients with KC who underwent DLK between March 1999 and November 2003 at the Royal Adelaide Hospital. The parameters evaluated included patients' demographics, pre- and post-operative best corrected visual acuities, post-operative keratometry, and intra- and post-operative complications.Results
There were 22 patients (23 eyes); 10 females and 12 males, with a mean age of 35 +/- 13 years (median, 33.5; range, 17-73). The median follow-up period was 13 months (range 7-38). In 89% (16/18) of eyes which underwent DLK, and in which a visual acuity could be obtained, a best corrected visual acuity of at least 6/12 was recorded. There were two episodes of Descemet's membrane perforation (8.7%), in which the procedure was converted to penetrating keratoplasty without complications. One patient developed a double anterior chamber, which resolved spontaneously without consequences.Conclusion
The visual outcomes and complication rates seen in our series are comparable to the recent published literature. Hence DLK can be considered as a suitable alternative to penetrating keratoplasty for the surgical treatment of KC.Item Metadata only Ethmoidal pneumocele following drainage of an ethmoidal mucocele(Taylor & Francis The Netherlands, 2008) Gupta, A.; Durkin, S.; Muecke, J.; Casson, R.; Wormald, P.; Selva-Nayagam, D.Ethmoidal pneumocele is a rare condition with little known about its etiology. We report a 5-year-old boy who had recurrent right orbital cellulitis, non-axial proptosis, and inferolateral globe displacement. Initial radiological investigations demonstrated an ethmoidal mucocele. There was complete resolution of inflammatory signs with endoscopic drainage of the mucocele; however, repeat CT revealed a residual pneumocele with continued proptosis and lateral displacement of the globe. This case illustrates the potential for chronic sinusitis and iatrogenic drainage of an ethmoidal mucocele to progress to a pneumocele.Item Metadata only South Australian adolescent ophthalmic sun protective behaviours(Nature Publishing Group, 2008) Pakrou, N.; Casson, R.; Fung, S.; Ferdowsi, N.; Lee, G.; Selva-Nayagam, D.Aims To study student's knowledge of the effects of sunlight on the eyes, as well as their sun protective behaviours. Methods In total, 40 students aged 13–18 years were surveyed in South Australia, during August–September 2004, using a standardized previously used survey. Scores were calculated regarding knowledge about ultraviolet light, sunlight effects on eyes, as well as eye and body protection. Risk factor scores were produced for each student. The data were analysed by the analysis of variance (ANOVA), as well as the Cochran–Mantel–Haenszel methods. Results were compared to the same survey conducted in 1995 in Queensland Australia. Results This group demonstrated a moderate level of knowledge, similar to the 1995 survey. Students in the older age groups demonstrated significantly higher knowledge. The majority of students (74% ) owned a pair of sunglasses; however, 44.5% almost never wore their glasses. The reported frequency of wearing sunglasses was significantly related to advertising, believing sunglasses protect the eyes, as well as personal, family, and peer attitudes towards wearing sunglasses. Conclusion The results of our survey suggest no significant change in knowledge and behaviours of students, compared to the 1995 survey. We feel it is imperative that adolescents be made more aware of the damaging effects of sunlight and the benefits of eye protection. Health promotion campaigns should target the youth and consider that as a group, they are significantly influenced by the media, peers, and family attitudes.Item Metadata only (MS) Subconjunctival Loa loa worm(Elsevier Ltd., 2008) Jain, R.; Chen, J.; Butcher, A.; Casson, R.; Selva-Nayagam, D.Item Metadata only Metastatic renal cell carcinoma presenting as a circumscribed orbital mass(Wichtig Editore, 2008) Mudiyanselage, S.; Prabhakaran, V.; Davis, G.; Selva-Nayagam, D.Metastatic renal cell carcinoma presenting as a circumscribed orbital massItem Metadata only Polyethylene gel in the subcutaneous tissue of rats: Histopathologic and systemic evaluation(Taylor & Francis The Netherlands, 2008) Schellini, S.; Zimmermann, G.; Hoyama, E.; Pellizon, C.; Padovani, C.; Selva-Nayagam, D.Purpose
To evaluate the histological and systemic response to subcutaneous injection of polyethylene gel in rats.Methods
Twenty-one white male rats were divided into 3 groups (G): G1 and G2 received subcutaneous polyethylene gel injection in the dorsal midline and were sacrificed at 30 and 60 postoperative days, respectively. G3 was not exposed to the polyethylene gel and was sacrificed after 60 days. Blood levels of lactate dehydrogenase (LDH), creatine kinase (CK), and alkaline phosphatase (ALP) were evaluated. The heart, kidney, liver, adrenal gland, injection site, and adjacent tissues were histologically examined. The results were submitted to statistical analysis.Results
There was no clinical evidence of extrusion, reduction of the injected volume, or abnormalities in the adjacent tissues. Blood levels of CK and LDH were normal and similar in all groups. ALP levels were significantly lower in G2 than in G1 and G3. The systemic organs were normal on histological examination in the 3 groups evaluated. Microscopically, the polyethylene gel was surrounded by a thin pseudocapsule formation and minimal inflammatory cell response, which decreased from G1 to G2.Conclusion
The subcutaneous injection of polyethylene gel in rats elicited minimal local inflammatory response and no systemic side effects.Item Metadata only Orbital tuberculosis: A review of the literature(Taylor & Francis The Netherlands, 2008) Madge, S.; Prabhakaran, V.; Shome, D.; Kim, U.; Honavar, S.; Selva-Nayagam, D.Purpose: To provide an up-to-date review of the clinical presentations, investigations, and management of orbital tuberculosis (OTB). Methods: Systematic review of the literature concerning OTB, limiting the results to English-language peer-reviewed journals. Results: Seventy-nine patients from 39 publications were identified as cases of OTB. The condition presents in one of five forms: classical periostitis; orbital soft tissue tuberculoma or cold abscess, with no bony involvement; OTB with bony involvement; spread from the paranasal sinuses; and tuberculous dacryoadenitis. The ocular adnexa, including the nasolacrimal system and overlying skin, may also be involved. Conclusions: Diagnosis can be difficult and may necessitate an orbital biopsy, in which acid-fast bacilli (AFB) and characteristic histopathology may be seen. Growth of Mycobacterium tuberculosis (mTB) from such a specimen remains the gold standard for diagnosis. Ancillary investigations include tuberculin skin tests and chest radiography, but more recently alternatives such as whole blood interferon-γ immunological tests and PCR-based tests of pathological specimens have proven useful. The management of OTB is complex, requiring a stringent public health strategy and high levels of patient adherence, combined with long courses of multiple anti-tuberculous medications. The interaction of the human immunodeficiency virus (HIV) with TB may further complicate management.Item Metadata only Delayed complications of silicone implants used in orbital fracture repairs(Taylor & Francis The Netherlands, 2008) Warrier, S.; Prabhakaran, V.; Davis, G.; Selva-Nayagam, D.Purpose
To report a series of patients who developed late complications secondary to silicone implants used in orbital fracture repairs and review the literature.Design
Retrospective interventional case series.Methods
Analysis of records of patients who developed complications following repair of orbital wall fractures with silicone implants.Results
Over a 5-year period, 4 patients were seen with complications arising from a silicone orbital implant. There were 3 males and 1 female whose ages ranged from 41-73 years. The time interval between initial insertion of implant and development of complications was 1.5, 6, 10, and 20 years. The complications noted were worsening diplopia, recurrent orbital cellulitis, lower lid retraction with restricted upgaze, and orbital abscess. Computed tomographic scans demonstrated the implant in all cases. Histologic examination revealed nonspecific chronic inflammation and fibrosis in all cases and foci of squamous epithelium in one case. Treatment included surgical removal of the implant, resulting in complete resolution or significant improvement in symptoms and signs in all cases.Conclusion
The use of silicone implants is associated with a wide range of complications, which may occur many years following the original surgery. Surgical removal of the implant usually leads to resolution of symptoms. Given the potential of silicone implants to cause delayed complications, their use in orbital fracture repair is not recommended.Item Metadata only Anterior chamber depth and primary angle-closure glaucoma: an evolutionary perspective(Blackwell Publishing Asia, 2008) Casson, R.Anterior chamber depth is an inheritable trait which is affected by age, gender and race. Over 30 years ago, Alsbirk proposed that the shallow anterior chamber, which was typical of the Greenlandic Inuit, and which brings the iris in proximity to the cornea, may have evolved as a thermoregulatory adaptation to resist corneal freezing. Here, this hypothesis is revisited. Recent population genetic data which provide evidence for migration patterns of early humans are discussed and the notions of natural selection and ocular adaptation to cold climates are considered. Problems with the hypothesis are examined, but the idea that the shallow anterior chamber has a thermoregulatory role appears sound and suggests that shallow anterior chambers may have evolved in Homo sapiens living in north-east Asia during the last Ice Age.Item Metadata only Maintenance of portable operating microscopes in developing countries: the Myanmar experience(Blackwell Publishing Asia, 2008) Goold, L.; Staples, B.; Muecke, J.; Newland, H.Item Metadata only Torsten Nils Weisel(Blackwell Publishing Asia, 2008) Simon, S.; Selva-Nayagam, D.; Crompton, J.Item Metadata only Bioenergetic-based neuroprotection and glaucoma(Blackwell Publishing Asia, 2008) Schober, M.; Chidlow, G.; Wood, J.; Casson, R.Primary open-angle glaucoma (POAG) is a pressure-sensitive optic neuropathy which results in the death of retinal ganglion cells and causes associated loss of vision. Presently, the only accepted treatment strategy is to lower the intraocular pressure; however, for some patients this is insufficient to prevent progressive disease. Although the pathogenesis of POAG remains unclear, there is considerable evidence that energy failure at the optic nerve head may be involved. Neuroprotection, a strategy which directly enhances the survival of neurons, is desirable, but remains clinically elusive. One particular form of neuroprotection involves the notion of enhancing the energy supply of neurons. These `bioenergetic' methods of neuroprotection have proven successful in animal models of other neurodegenerative diseases and conditions, including Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis and traumatic brain injury, but have been relatively unexplored in glaucoma models. This review focuses on some of the potential approaches for bioenergetic neuroprotection in the retina, including increasing the energy buffering capacity of damaged cells, decreasing the permeability of the mitochondrial membrane pore and free radical scavenging.Item Metadata only Cataract surgical coverage and self-reported barriers to cataract surgery in a rural Myanmar population(Blackwell Publishing Asia, 2008) Athanasiov, P.; Casson, R.; Newland, H.; Shein, W.; Muecke, J.; Selva-Nayagam, D.; Aung, T.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.