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SummaryThe functional anatomy of the normal choroidal circulation in man is described from scanning electron microscopic examination of methyl methacrylate microvascular casts. Distal and para-optic short posterior ciliary arteries supply wedge-shaped areas of choroid. Regional variations in choriocapillary morphology are well recog nised; the lobules are densely packed at the posterior pole with a high capillary to inter-capillary ratio. Choroidal capillaries are flattened providing a large surface area for metabolic exchange with the retinal pigment epithelium. In acute choroidal ischaemia (from a variety of systemic disease), wedge shaped choroidal lesions may correspond to occlusion of short posterior ciliary arteries and geographic or focal lesions to occlusion of choroidal arterioles or choriocapillary lobules. MethodsThe anatomy of the choroidal circulation was examined from methyl methacrylate micro vascular casts prepared according to standard methods.42 The entire orbital contents and intracavernous part of the internal carotid artery were exenterated at autopsy 36-4 1 l hours post mortem (preserving the lids in situ). The ophthalmic artery was canulated, Primary infusion of phosphate buffered saline (PBS) was followed by gluteraldehyde 0.5% in PBS, at infusion pressures of 120-175 mmHg at physiological temperatures. Casting was achieved by secondary pedusation with 25-50 mls thinned methyl methacrylate resin (using a base of Batson's no.17, Polysciences) injected under manometric control until the resin hardened (7-10 minutes). The sur rounding tissue was corroded in six Molar pot assium hydroxide which was changed regularly and the casts washed in distilled water and air dried. The casts were gold sput ter coated (50 nm) and dissected appro· priately to include examination of the choroid. Ocular casts were examined by the scanning electron microscope (Hitachi S-520, Tokyo, Japan) either whole or as dissected fragments mounted on an aluminium stub, at 20 kv and magnifications of x22 to x1.3k. ResultsThe main findings are illustrated in Figure�

National Eye Research Centre, Above and Beyond, and Moorfields Eye Charity.

Aim: To evaluate current clinical practice in the UK in the management of the anophthalmic socket; choice of enucleation, evisceration, type of orbital implant, wrap, motility pegging and complications. Methods: All consultant ophthalmologists in the UK were surveyed by postal questionnaire. Questions included their practice subspecialty and number of enucleations and eviscerations performed in 2003. Specific questions addressed choice of implant, wrap, motility pegging and complications. Results: 456/896 (51%) consultants responded, of which 162 (35%) had a specific interest in oculoplastics, lacrimal, orbits or oncology. Only 243/456 (53%) did enucleations or eviscerations. 92% inserted an orbital implant after primary enucleation, 69% after non-endophthalmitis evisceration, whereas only 43% did so after evisceration for endophthalmitis (50% as a delayed procedure). 55% used porous orbital implants (porous polyethylene, hydroxyapatite or alumina) as their first choice and 42% used acrylic. Most implants inserted were spherical, sized 18-20 mm in diameter. 57% wrapped the implant after enucleation, using salvaged autogenous sclera (20%), donor sclera (28%) and synthetic Vicryl or Mersilene mesh (42%). A minority (7%) placed motility pegs in selected cases, usually as a secondary procedure. 14% of respondents reported implant exposure for each type of procedure and extrusion was reported by 4% after enucleation and 3% after evisceration. Conclusions: This survey highlights contemporary anophthalmic socket practice in the UK. Most surgeons use porous orbital implants with a synthetic wrap after enucleation and only few perform motility pegging. E nucleation or evisceration is performed for various endstage eye diseases. The aim is to remove the diseased eye, provide adequate comfort, replace volume and give good functional and cosmetic appearance.Two surveys have been conducted to evaluate trends in the management of the anophthalmic socket among oculoplastic surgeons in North America 1 2 and one among ocularists in Germany.3 As there is sparse comparable information for the UK, we aimed to collect information of enucleation and evisceration management by postal survey of all consultant ophthalmologists in the UK regarding their preferred clinical practice. MATERIALS AND METHODSA questionnaire of anophthalmic socket management in the year 2003 was sent in April and May 2004 to all 896 consultant ophthalmologists in the UK, listed by The Royal College of Ophthalmologists, regardless of their subspecialty. Respondents were requested to return their completed questionnaire in a prepaid envelope, no reminders were sent and anonymity was maintained. Data management and analysis was performed using Microsoft Access and Excel software. RESULTSOf the 896 consultant ophthalmologists in the UK, 456 responded giving a response rate of 51%. Of these 456, 321 (70%) had an interest in more than one ophthalmic subspecialty. But, overall, 135 (30%) had a special interest in one or more of oncology, oculoplastics, lacrimal or orb...

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Background/aims: The management of lower eyelid retraction can be challenging, and established techniques to correct it are not always successful. Previous reports have suggested a role for the ultrathin high density porous polyethylene lower eyelid spacer (Medpor LES) in such patients. The authors report the experience of three surgeons implanting Medpor LES over 1 year, and ascertain whether such implants are a safe and effective alternative to autogenous spacers. Methods: A prospective, interventional, non-comparative case series of consecutive patients. Surgical indications for Medpor LES were noted. Preoperative and postoperative lower marginal reflex distance (L-MRD), vertical palpebral aperture (PA), lagophthalmos, and scleral show inferior to the limbus (LSS) were recorded, together with major and minor complications. Results: 32 patients (35 eyelids) had a Medpor LES inserted, 22/32 under local anaesthetic, and nine with adjunctive procedures. Mean follow up was 22 months (range 15-28 months). The Medpor LES was effective in reducing the palpebral aperture (p,0.001) and lagophthalmos (p = 0.04) and raising the lower eyelid height by reducing both L-MRD (p = 0.006) and LSS (p,0.001). However there were major complications in 7/32 patients and minor complications in 8/32, most requiring further surgery. Final outcome was good in 24/35 eyelids and satisfactory in 5/35. Conclusions: Despite a good or satisfactory final outcome in the majority of patients, the value of this technique is limited by complications, and should be reserved for those unsuitable for safer techniques.

This study used strict criteria to assess functional and anatomical outcomes of primary ext-DCR and thus provide baseline measures of success with a minimal follow-up of 6 months. When canalicular disease was excluded, results for PANDO were higher. Surgery performed by the specialist lacrimal surgeon had higher success rates than when performed by trainee.

London SummaryThe morphology of the circle of Haller and Zinn and its variations were examined using methyl-methacrylate microvascular corrosion casting of human orbits obtained at post-mortem. It was found to be an elliptical microvascular anastomosis formed by branches of the medial and lateral para-optic short posterior ciliary arteries. The ellipse was divided into superior and inferior parts by the entry points of these branches into the eye, providing an altitudinal blood supply to the retrolam From 'Moorfields Eye Hospital, City Road, London. 2Institute of Ophthalmology,