The case is reported of a 31-year-old man with a retained metallic intraocular foreign body (IOFB) in the left eye who underwent magnetic resonance imaging (MRI) for investigation of a subsequent unrelated brachial plexus injury Despite the patient providing good history of IOFB, the decision to proceed with MRI was based on screening orbit X-ray which was reported as normal. A review of published reports regarding screening recommendations for MRI for patients with IOFB is provided. A minimum recommendation is for prescreening questionnaire; belief of the patient history is critical. If there is any doubt after history and examination by an ophthalmologist, then computed tomography imaging of the orbits is recommended. Whether screening by plain X-ray imaging is worthwhile is debatable as the sensitivity and specificity of this modality is poor.
Purpose: To assess the safety and intraocular pressure (1OP)-lowering activity of 2% dorzolamide (topical carbonic anhydrase inhibitor), compared to 0.5% timolol and 0.5% betaxolol eyedrops.Conclusions: Dozolamide 2% given thrice daily was well tolerated and safe, with a clinically significant effect on IOP comparable to betaxolol 0.5% twice daily, but not as great as timolol 0.5% twice daily.Key words: Dorzolamide, glaucoma, ocular hypertension, topical carbonic anhydrase inhibitor. Methods:A parallel, masked, randomised one-year clinical trial was conducted in 16 patients with open-angle glaucoma or ocular hypertension, being a subset of a multicentre study which enrolled 523 subjects. Patients had IOP > 22 mmHg in one eye at baseline following washout of ocular hypotensive medications and were then randomised in a 3:l:l ratio to receive 2% dorzolamide thrice daily, 0.5% timolol twice daily or 0.5% betaxolol twice daily respectively. IOP was measured at Hour 2 (morning peak), Hour 5 and Hour 8 (afternoon trough for dorzolamide) at baseline, Weeks 2 and 4 and Months 2, 3, 6, 9 and 12.Results: Topical dorzolamide 2% solution was well tolerated and safe. Mean IOP for dorzolamide at Hour 2 was 29.1 mmHg at baseline and 20.8 mmHg on treatment at one year, a 28.5% change. Mean IOP for dorzolamide at Hour 8 was 24.5 mmHg at baseline and 20.2 mmHg on treatment at one year, a 17.6% change. Comparable percent changes for timolol and betaxolol were 43.2/25.7 mmHg at Hour 2 and 21.9/13.5 mmHg at Hour 8 respectively.Ophthalmologists have waited many years for a topical formulation of a carbonic anhydrase inhibitor, in the hope of achieving a therapeutic reduction in intraocular pressure (IOP) without the significant systemic side effects. Dorzolamide 2% (MK-507 -Merck Research Laboratories) is one such ophthalmic preparation which may fulfil this expectation. Pilot studies have shown acceptable ocular toleration and clinically significant pressure-lowering effect when given thrice daily to normal volunteers and to patients with elevated IOP.'" A multicentre trial was conducted by Merck Research Laboratories between January 199 1 and June 1992 to assess both safety and efficacy in a larger group of patients (n = 523) over a whole year? The purpose was to compare dorzolamide 2% thrice daily with betaxolol 0.5% twice and timolol 0.5% twice daily. This paper reports the results of a single-centre subset of that multicentre study, carried out at
All 2792 patients seen in my private practice between July 1989 and September 1992 and receiving a diagnosis were coded according to the International Classification of Diseases-9 (Clinical Modification), 1979. Any procedures performed were coded according to the American Medical Association Current Procedural Terminology. Patient details and codes were filed by computer using a customised database in Foxpro 2.0 software. Those with minor refractive error or presbyopia alone and those who had no abnormality were excluded from the database. The set-up and maintenance of this diagnostic index is described and the database structure is specified. A modification of the glaucoma section of ICD-9, which better suited my needs, is presented. Examples of the potential information available from such a database is described, including some analysis of this general ophthalmic practice.
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