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In cases experiencing a 2 line loss in acuity, the main causes were glaucoma progression (9 cases) and macula oedema (4 cases). Visual loss was unrelated to total treatment dose (mean 99.7J), initial acuity or initial IOP level. IOP was controlled at final follow-up in 39/49 (79.6%) with no cases of hypotony. 3Conclusions: The majority of these eyes with difficult to manage glaucoma retained their good visual acuity over long-term follow-up after undergoing diode laser cyclophotocoagulation. The proportion losing 2 Snellen lines is in line with that reported following trabeculectomy or tube surgery. These results suggest a possible role for the use of transscleral cyclodiode in selected eyes with significant visual potential. Further controlled prospective studies are required to better define this role.

SummaryOBJECTIVES To understand the reasons for poor cataract surgery uptake in people with blindness or severe visual impairment in rural South Africa. METHODSMETHODS A qualitative analysis of detailed, domiciliary interviews with a community-based random sample of elderly Zulus who were blind or severely visually impaired as a result of operable cataract, who had previously been invited for surgery but had failed to attend. RESULTS RESULTSFear of surgery and a fatalistic attitude to the inevitability and irreversibility of blindness in old age were the main reasons for failure to attend for surgery. There was a lower level of disability and perceived need than had been assumed for people with such poor visual acuity. Non-surgical western style health care for systemic illness was common but few patients had sought any form of assistance for their poor vision. Issues of cost and accessibility were relatively unimportant.CONCLUSIO N CONCLUSION Provision of affordable and accessible cataract surgery for the blind and severely visually impaired members of a community does not guarantee that it will be taken up. Other barriers to surgery may be revealed when practical issues such as cost and accessibility are addressed. Perceptions of visual disability among subjects with cataract may differ from simple objective clinical standards.

Compliance with treatment is poor and patients underestimate their level of defaulting when questioned.

The Stratus OCT normative database may be misleading in highly myopic eyes from Caucasians resulting in a substantial proportion of false positive errors. Particular caution is needed when the RNFL appears to be below the normative database normal limit at the upper or lower poles or on the nasal side of the disc. Stratified normal databases are required for accurate diagnosis of conditions resulting in nerve fibre loss such as chronic glaucoma.

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Postoperative intervention is a frequent occurrence after modern glaucoma surgery. This requires intensive postoperative follow-up and is a labour-intensive undertaking. Despite interventions in our group of patients, IOP in the intervention group was always higher than in the group that required no intervention.

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