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Propranolol produced a clinically significant reduction in the infants' refractive error and anisometropia. The reduction in the total refractive error and anisometropia has not been evident in previous analyses, which have concentrated on the change in the "cylinder" as the principal outcome measure.

We report a case of rat bite fever (Streptobacillus moniliformis) in a young man who presented generally unwell with pyrexia, vomiting, arthralgia and deranged liver function. Two weeks before his illness he had disposed of a dead rat but was not bitten by it. This zoonotic infection was treated with broad spectrum antibiotics and he made a complete recovery. It is a rarely diagnosed but likely common infection given the frequent contact between humans and rodents. In the past, confirmation of the organism has been difficult due its dislike of culture mediums, but the advent of polymerase chain reaction (PCR) testing has allowed reliable isolation. Appropriate treatment is important because there is an associated mortality from secondary endocarditis.

treating the effects of vascular leakage and capillary non-perfusion, clearly it would be preferable to reverse the root cause of the pathology if possible. Kohner showed in 1976 [2] that systemic streptokinase was beneficial in CRVO, with approximately a 3 Snellen line benefit in favour of the treated group. However, this was balanced against a 15% vitreous haemorrhage rate-at the time an untreatable and often blinding complication as it pre-dated modern vitrectomy techniques. The study was also limited by small sample size and wide inclusion criteria, with patients included despite presenting many days after the onset of symptoms. Several authors since have considered "primary" intervention by other methods, including tissue plasminogen activator [3] , haemodilution [3] , and low molecular weight heparin [4,5]. Whilst these have shown promise, they are limited by a lack of standardisation, and in particular a wide variation in time to treatment, often up to 30 days. It is tempting to make an analogy with the recent change in the management of acute stroke. Whereas management had previously been mainly supportive, the focus is now on timely (within 4 hours) thrombolysis, often at regional centres. Whilst funding such a service may be an issue, the current NICE-approved therapies in CRVO, Lucentis and Ozurdex, are costly at £26,200 and £22,831 per QALY respectively. The real-world cost is unknown as both licenses are open-ended, therapy is usually prolonged, and it may be associated with serious complications. We therefore suggest that Kohner's idea is worth revisiting.

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