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Epiretinal membrane peeling improves vision in the majority of patients with significant symptoms, even if preoperative visual acuity is not substantially reduced. Surgery improves functional vision including metamorphopsia not measurable by visual acuity, and thus assessment of functional vision should be included in surgical case planning.

1Purpose: To examine quality of life and associated factors in people with Age-Related Macular 2 Degeneration (AMD). 3Methods: 145 AMD participants (mean age 78.0 ±7.7 years) and 104 age-and gender-matched 4 controls (mean age 78.1 ± 5.8 years) comprised the study populations for this case-control study. 5Depressive symptoms were measured with the Goldberg Anxiety and Depression (GAD) scale; 6 general health and daily functioning was assessed with the Medical Outcomes Study Short Form 36 7 and questions relating to assistance required for daily living activities. 8

Our experience and the results of the meta-analysis suggest that macular hole surgery should be offered as early as possible once full-thickness neuroretinal defect occurs.

Aims: To identify the contributory factors associated with different sites of occlusion and the presence or absence of optic nerve head swelling (ONHS). Methods: 874 cases of retinal venous occlusion (RVO) were prospectively examined at a tertiary referral centre and classified according to three defined sites of occlusion: arteriovenous crossing RVO (AV-RVO); optic cup RVO (OC-RVO); and optic nerve sited RVO. Optic nerve sited RVOs were further divided on the basis of presence (ONHS-RVO) and absence (NONHS-RVO) of ONHS. RVOs not occurring at any of the defined sites were grouped as no-site RVO (NS-RVO). Important clinical parameters were compared among four of the five subgroups by multivariate analysis of variance and χ 2 test (NS-RVO excluded). Results:The overall multivariate analysis of variance for differences in the mean age, systolic and diastolic blood pressure, body mass index, and intraocular pressure (IOP) among the four subgroups were highly significant (p <0.0001). The F ratios indicated that the differences in the mean age and IOP accounted for this statistical trend. The mean age was statistically significantly lower in the ONHS-RVO group compared to the rest of the groups (p <0.0001). The mean age was significantly higher in OC-RVO compared to the AV-RVO group (p <0.05). The mean IOP was significantly higher in OC-RVO than in the rest of the groups (p <0.01 to 0.0001), while it was also higher in the NONHS-RVO group compared to the ONHS-RVO and AV-RVO groups (p <0.0001). The prevalence of primary open angle glaucoma (POAG), sex, laterality, involvement of the fellow eye, smoking and hypertension were compared by χ 2 tests. POAG was significantly more prevalent in the OC-RVO group than in the rest of the groups (p <0.0083), while it was also significantly more prevalent in the NONHS-RVO group compared to AV-RVO or ONHS-RVO (p <0.0083) groups. Smoking was significantly more prevalent in AV-RVO than in the rest of the groups (p <0.05). The proportion of male sex was significantly higher in ONHS-RVO compared to the AV-RVO group (p <0.05). Hypertension was significantly more prevalent in the AV-RVO than in the ONHS-RVO or NONHS-RVO groups (p <0.05). Conclusion: A new classification of RVO based on the site of occlusion and ONHS has been evaluated. The higher prevalence of hypertension and smoking in AV-RVO suggests a particular importance of cardiovascular risk factors in this group. The association of POAG with CRVO has been confirmed, but only for those cases without ONHS. A distinctive relation between raised IOP and OC-RVO has been demonstrated, suggesting a causal association. RVOs with ONHS tend to occur in younger people, with a higher proportion of males, and a lower prevalence of hypertension and POAG, suggesting that other causal factors may be important in this group. The new scheme resolves the confusion in the literature regarding classification of RVO, and has diagnostic, causal, prognostic, and therapeutic implications.

Locally administered steroids have a long history in ophthalmology for the treatment of inflammatory conditions. Anterior segment conditions tend to be treated with topical steroids whilst posterior segment conditions generally require periocular, intravitreal or systemic administration for penetration. Over recent decades, the clinical applications of periocular steroid delivery have expanded to a wide range of conditions including macular oedema from retino-vascular conditions. Formulations have been developed with the aim to provide practical, targeted, longer-term and more efficacious therapy whilst minimizing side effects. Herein, we provide a comprehensive overview of the

Purpose: Activated protein C (APC) resistance has recently been reported as conferring a sevenfold increase in the risk of venous thrombosis. It is linked to a genetic mutation in the factor V gene which occurs commonly (about 2% to 4% of the community have the mutation). Glaucoma patients with nerve fibre layer (NFL) haemorrhages on the optic disc and patients with central retinal vein occlusion (CRVO) were tested for APC resistance to determine if there was an association. Methods:Twenty-three patients with glaucomatous NFL haemorrhages and 23 patients with CRVO were tested. The CRVO cases included 11 with relatively young age of onset (mean 45.1 +_ 6.9 years) without conventional vascular risk factors. Eighty randomly selected Red Cross blood donor samples and 33 staff members were tested as controls. Clotting times with and without exogenous APC were recorded and an APC ratio determined. Cases with APC resistance were tested to confirm that they had the factor V Leiden gene. Results:No cases of APC resistance were identified in the glaucoma patients and only one of the younger CRVO patients tested positive, but four of 113 controls tested positive. The difference in prevalence between groups is not significant. The mean APC ratios for the three groups were very similar: NFL haemorrhages 5.46(*1.62), CRVO 5.70(+1.56), controls 5.34(f1.19) p>0.5. Conclusion:There was no clear association detected between glaucomatous NFL haemorrhages or CRVO and APC resistance in this sample of patients. This negative finding is important due its known association with venous thrornbosis elsewhere in the body. Activated protein C (APC) resistance has recently been reported as conferring a fivefold to tenfold increase in the risk of systemic venous thrombosis.lJ It is linked to a genetic mutation in the factor V gene which is found in about 50% of familial thr0mboses.l The mutation, which involves a single nucleotide substitution of adenine for guanine, is known as Factor V Leiden. It occurs commonly in the community, (2% to 4% of the European populat i~n . )~ Carrier rates are reported as highest among Greeks (7%) and as extremely low in Asians, Africans and American Indians4 The substitution eliminates the protein C cleavage site in factor V, which prevents it from inactivating the coagulation factors Va and VIIIa. Other defects in the anticoagulant system, such as deficiencies of protein C, protein S, and antithrombin 111, have only been associated with 5% of all familial thromboses.' Therefore, APC resistance is to date the most highly significant risk factor identified in familial thrombosis. Key words:In glaucoma, the principal factor associated with nerve damage appears to be elevated intraocular p r e s s~r e .~-~ However, some patients have progressive disease despite normalised IOP8 and a large proportion of glaucoma patients never have an elevated TOP.' It is therefore possible that damage is occurring via another mechanism, such as impaired circulation.The frequent observation of nerve fibre layer (NFL) haem...

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