Three had undergone successful DCR before the diagnosis of Giant fornix syndrome was made. Nine had corneal vascularisation and scarring before referral. Five had suffered spontaneous perforation or thinning. As in this case, all had deep upper fornices and associated changes of age-related dehiscence of the levator aponeurosis and universally, S. aureus was the inhabitant.He postulated that gradual deepening of the upper fornix owing to age-related disinsertion of the levator aponeurosis allowed for the accumulation of a bacterialaden protein coagulum within a capacious upper fornix. Persistent reinoculation of the tear lake by low-grade bacteria from the fornix, severe conjunctivitis from 'toxic' bacteria and the development of a pseudomembrane, may enhance the coagulum and also exacerbate the ptosis and deepening of the upper fornix. This environment leads to severe ocular surface inflammation.This case highlights the need to consider a deep upper fornix, present in many of our patients with age-related levator disinsertion and orbital fat atrophy, as the source of a recurrent (often unilateral) purulent discharge. In addition, we suggest that CT imaging is beneficial in excluding frontal sinus fistulae and foreign bodies in such cases, and the presence of air in the deep upper fornix of this patient on CT scan is a new sign of GFS, not described previously.Reference 1 Rose GE. The giant fornix syndrome: an unrecognised cause of chronic, relapsing, and grossly purulent conjunctivitis.
One of the most common indications for the fitting of therapeutic contact lenses is bullous keratopathy, a painful condition often iatrogenic in origin and more usually encountered in elderly patients. A retrospective study of 30 patients fitted with therapeutic lenses for the condition and followed up for at least a year showed that the symptoms of bullous keratopathy were reduced in most cases. There was a higher incidence of suppurative keratitis (13 per cent) than has been reported in previous series. The prescribing of prophylactic antibiotics was haphazard in the series, and the authors suggest further study is needed to determine their precise role.
A prospective, randomised study was performed on 52 patients undergoing routine limbal extracapsular cataract surgery to compare the effect of 10/0 nylon and 9/0 elastic polypropylene sutures on post-operative astigmatism. Both the magnitude and the axis of the astigmatism were measured by keratometry and refraction pre-operatively and at regular intervals for 3 months post-operatively. Both groups showed an increase in the magnitude of astigmatism immediately post-operatively. The polypropylene group showed a more rapid decrease in astigmatism over the first 7 days and subsequent stabilisation, although the only significant (p < 0.05) difference in astigmatism between the two groups was at 1 week post-operatively. Both groups showed 'with-the-rule' astigmatism immediately post-operatively, although more of the polypropylene group developed 'against-the-rule' astigmatism by the end of the study. Despite an early reduction in post-operative astigmatism in the polypropylene group, early spectacle prescribing would not be recommended because of the shift in the axis of astigmatism. In addition, the polypropylene group had a 4 times greater incidence of iris prolapse compared with the nylon group.
The final part of a prospective, controlled study of elastic polypropylene suture for cataract surgery was undertaken. The aim was to determine the change in induced astigmatism at 30 months after extracapsular cataract surgery and to assess the long-term safety of the suture material. Thirty-two of 44 patients were reexamined for changes in astigmatism. The results of all examinations were subjected to vector analysis. Both the elastic polypropylene group and the nylon control group continued to show an increase in the against-the-rule component of astigmatism. There was no statistical difference (p < 0.5) between the two groups at 30 months post-operatively, though the shift was greater in the polypropylene group. Wound security was similar for both groups but the polypropylene group had a higher incidence of giant papillary conjunctivitis (24%) due to exposed suture ends. The nylon suture was hydrolysed in 89% of that group and all patients were asymptomatic.
A 70-year-old woman presented to the Eye Casualty department with a 10-day history of worsening pain and redness in her right eye, associated with progressively reduced vision. History revealed that the patient had recently completed a course of chemotherapy for metastatic breast cancer. Anterior examination of the right eye revealed a vascularised iris mass causing pupillary distortion, intraocular inflammation and raised intraocular pressure. She was diagnosed with a right iris metastasis secondary to breast cancer. Ocular management consisted of topical steroids and intraocular pressure-lowering agents, which improved her ocular symptoms. She subsequently received primary radiotherapy, which has successfully reduced the size of the tumour.
Summary: Extracapsular cataract extraction and implantation of a Binkhorst 2-100p intraocular lens were performed on 50 patients. The majority of the patients achieved a corrected postoperative acuity of 6/9. Operative-immediate postoperative and late postoperative complications are discussed. The commonest postoperative complication was the formation of a dense capsular membrane which required capsulotomy in 9 patients. Suggestions are put forward for improving the result of this rewarding operation. IntroductionThere has been, and still is, much controversy about intraocular implants. In 1976, after carefully questioning other surgeons experienced in implant surgery, we embarked on this form of surgery. We chose one of the longer established lenses, the Binkhorst 2·100p (Binkhorst 1973), because it was simple in design, it clipped to the iris immediately around the pupil without impinging on the angle or ciliary body, and had a small area of contact with the tissues. The other major decision was to carry out extracapsular extraction with the implantation. There were four reasons for choosing this. The first was the firmer support offered to the intraocular lens as opposed to after intracapsular extraction, and suturing was unnecessary. Furthermore, there was much less movement of the lens inside the eye, reducing chances of damage to the neighbouring tissues. Secondly, there was minimal risk of vitreous loss. Thirdly, implantation could be more or less guaranteed to the patient. Fourthly, there appeared to be less late macular oedema and retinal detachment than with the intracapsular procedure (Jaffe 1979, Kratz 1979.We realized, however, that there were obvious problems with the extracapsular extraction. It was known to be more time-consuming~nd there was the well known difficulty of removing adequate anterior capsular and cortical lens material giving rise to opaque late membrane formation. About 20% of such extractions are reported to require capsulotomy (Gilson et al. 1979, Jaffe 1979.
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