Purpose Keratoconus affects all races, yet very little infonnation exists as to the relative frequency in patients of different ethnic origin. We aimed to establish the incidence and severity of keratoconus in Asian and white patients.Methods The hospital records of the ophthalmology department of a large Midlands hospital with a catchment population of approximately 900 000 (87% white, 11% Asian, 2% other) were examined retrospectively for the 10 year period from 1989 to 1998.Results For the age group 10--44 years the prevalence of keratoconus in Asians and whites was 229 and 57 per 100 000 respectively, a relative prevalence of 4 to 1. The incidence of keratoconus in the same age group was 19.6 and 4.5 per 100 000 per year respectively, a relative incidence of 4.4 to 1. Asians were significantly younger at presentation compared with whites (mean 22.3 ± 6.5 vs 26.5 ± 8.5 years, p < 0.0001). A first corneal graft was carried out on 14% of the Asian and 15% of the white patients. Of those having grafts, Asians were significantly younger than white patients at the time of diagnosis (mean 19.1 ± 4.8 vs 25.7 ± 7.3 years, p = 0.005) and at operation (mean 21.4 ± 5.0 vs 28.7 ± 7.7 years, p = 0.004). The interval from diagnosis to operation, though shorter for Asians, was not significantly different (mean 1.8 ± 1.4 vs 2.5 ± 1.7 years, p = 0.2). ConclusionThe results show previously unrecognised racial differences in the hospital presentation of keratoconus in the UK.Compared with white patients, Asians have a fourfold increase in incidence, are younger at presentation and require corneal grafting at an earlier age.
Andrew Blaikie and colleagues discuss the Arclight, a cheap, portable device for use in low and middle income countries that was inspired by a Christmas article in The BMJ
SUMMARY Acute corneal ulceration in malnourished children is the commonest cause of childhood blindness in Northern Nigeria and usually develops after measles. Other severe diseases in malnourished children rarely precipitate corneal ulceration. A survey in a school for blind children showed that 69 % of the children were blind from corneal disease, and a survey of children with corneal scars showed that at least 42 % were caused by ulceration after measles. The clinical appearance of the active ulcers was very varied. The serum retinol-binding protein and prealbumin levels in children with corneal ulcers following measles were below normal, but a group of malnourished children without eye complaints following measles were found to have even lower levels. Thus a specific deficiency of vitamin A does not appear to be the primary cause of these ulcers, though it may be a contributory one. A specific measles keratitis and secondary herpes simplex infections may be local factors contributing to this ulceration, and there is nearly always a background of protein calorie malnutrition. Racial factors may also be of some significance.
A 37-year-old married woman who had been suffering from rheumatoid arthritis for I 7 years was first seen in March, I967, complaining of intermittent diplopia for one month. When seen by the casualty officer she was found to have vertical diplopia in laevo-elevation, but surprisingly a Hess screen chart plotted the next day ( Fig. i) In the next few months these intermittent symptoms became more constant and the patient noticed vertical diplopia on looking down and to the left and on reading; a Hess chart plotted on August i6, I967, now showed slight but definite evidence of a right superior oblique weakness (Fig. 2, opposite).A fortnight later she complained that the diplopia had suddenly altered, so that she was liow experiencing double vision on looking up and to the left rather than down and to the left. On clinical examination she was found to have restriction of elevationi in adduction of the right eye with a down-drift of the right eye on adduction, and the diagnosis of a superior oblique sheath syndrome was made; this was confirmed by the Hess chart plotted at that time (Fig. 3, opposite).One month later, she complained that the double vision was again evident on looking down and to the left, but this gradually improved, and on January 6, 1968, she complained only of occasional diplopia on looking down and to the left. After another 3 months, however, she complained that the diplopia was more noticeable, although similar in type (i.e. most marked on laevo-depression) and
Transient myopia occurs after a variety of noxious stimuli to the eye. Although individual case reports are quite common, the condition is apparently only rarely seen. It has been noted as a toxic reaction to various drugs, in A case is described below in which transient myopia, unaffected by cycloplegia, occurred after the administration of aspirin (acetylsalicylic acid). There was associated shallowing of the anterior chamber, an increase in the antero-posterior diameter of the lens, a slight rise in the intraocular pressure, and some retinal oedema. A search of the literature revealed only one previous report of transient myopia after aspirin (Korol, I962), which was associated with a transient rise in intraocular pressure; no definite conclusions were reached concerning the mechanism. Case reportA 39-year-old man with previously normal vision presented at the Bristol Eye Hospital complaining of blurred vision since waking that day. The previous evening, hoping to ward off a cold, he had taken eight aspirin tablets with a small glass of whisky (2-7 g. acetylsalicylic acid in all). ExaminationThe visual acuity was 6/6o in the right eye and 6/36 in the left, but improved on refraction to 6/6 in each eye with -325 D sph. The anterior chambers were shallow, the pupil reactions normal, and the ocular media clear. The intraocular pressures were 28 mm.Hg in the right eye and 29 mm.Hg in the left by applanation. Gonioscopy showed very narrow angles with possible irido-corneal contact superiorly.A general physical examination showed nothing abnormal and there were no signs of a cold or other virus infection. It was felt that ciliary spasm and forward displacement of the iris-lens diaphragm was the most likely explanation for the myopia and therefore, in spite of the narrow anterior chamber angle, cycloplegic drops (cyclopentolate) were instilled and the patient carefully observed. One hour later the retinoscopy remained unchanged and the myopia persisted. The anterior chamber remained shallow but the intraocular pressures had fallen to 24 mm.Hg in each eye. The anterior
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