Transvitreal biopsy is a highly accurate diagnostic procedure with a low complication rate. It is a reliable diagnostic tool in suspicious choroidal lesions greater than 2 mm thick.

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Aim To compare the performance of oral fundus fluorescein angiography with a confocal scanning laser ophthalmoscope (SLO) with intravenous fundus fluorescein angiography (IVFFA) with a fundus camera in the assessment of sight-threatening diabetic retinopathy. Patients and methods A total of 25 patients undergoing IVFFA to investigate their diabetic retinopathy were recruited. Participants returned 1 week later and an oral angiogram with the SLO was performed. Six facets of the oral and intravenous angiograms were scored and compared: visualization of the foveal avascular zone (FAZ); branch retinal identification; macular leakage; identification of microaneurysms in areas of macular leakage; peripheral nonperfusion, and leakage from neovascular complexes. Results Compared to IVFFA, the FAZ was unreliably visualized with oral angiography (Kappa 0.1, 95% CI 0-0.3). In contrast, macular leakage (Kappa 0.78, 95%, CI 0.72-0.83), identification of microaneurysms in areas of macular leakage (Kappa 0.78, 95%, CI 0.72-0.83), and neovascular complexes (Kappa 1.0) were reliably seen. Analysis of the visualization of peripheral nonperfusion was complicated by the finding that profuse dye leakage from neovascular complexes obscured the view of the peripheral retina. If the five angiograms in which this occurred were excluded, oral angiography identified 23 of the 24 eyes in which significant nonperfusion was found on IVFFA. Conclusion Oral angiography with the SLO can provide high-quality angiograms that allow judgments to be made about the presence of treatable diabetic maculopathy, proliferative diabetic retinopathy, and peripheral nonperfusion. In the presence of coexisting macular oedema, it proved to be an unreliable technique with which to investigate foveal ischaemia.

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Debris on processed ophthalmic instruments: a cause for concern AbstractPurpose To assess the quality of processed ophthalmic instruments and look for the presence of foreign material on the surface of these instruments. Methods Data were prospectively collected on the presence of debris on processed instruments in the trays used for phacoemulsification surgery. All instruments were examined under an operating microscope before use and details of the types of debris on the various instruments were noted. If debris was found, a new tray was opened to obtain a clean instrument. Results Forty-seven trays were opened for use during the study period. Deposits on instruments were found in 29 (62%) trays. These were mainly present on the intraocular lens introducers. Loose fibres were found on instruments from eight (17%) trays. Debris was found in the aspiration channels of three (6%) hand pieces. Conclusions A significant number of processed ophthalmic instruments had debris on their surfaces. To reduce the risk of intraocular inflammation and of transmission of prion diseases the instruments should go through a thorough decontamination process before sterilization. Routine mechanical cleaning at the end of surgery and ultrasonic cleaning before sterilization should reduce the occurrence of debris on the instruments. Instruments should also be inspected under the operating microscope before use.

We report a case in which posterior capsule rupture, vitreous loss, and vitreous hemorrhage were caused by a dislodged, flying cannula during phacoemulsification. We modified our surgical practice since the occurrence of this unusual complication and use Luer-lock syringes during surgery. This measure should prevent the recurrence of this complication.

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Objective-To emphasise the value of computed tomography even in the absence ofsymptoms in a case ofpenetrating injury of the upper eyelid. Methods-Case report. Results-Although clinically asymptomatic, penetration of upper eyelid was associated with intracranial penetration that left a track in the brain parenchyma. Conclusions-Computed tomography of orbit and brain is an important investigation, even in seemingly trivial eyelid injury, to reveal the full extent of the damage. (7Accid Emerg Med 1998;15:274-276) Keywords: eyelid; orbitocranial; computed tomography Penetrating orbitocranial injury can cause serious consequences and is potentially fatal. Penetration is usually caused by long, thin, and relatively hard objects. These injuries are rare and may need neurosurgical intervention.Case report A 5 year old boy was brought to the accident and emergency department with an eyelid laceration. He had fallen onto a pencil being carried in his hand. Ophthalmic examination showed presence of a laceration on the right upper eyelid with no evidence of injury to the eyeball. Exploration before suturing the wound revealed fragments of the lead of the pencil. A radio-opaque shadow seen on radiography before exploration was persistent after exploration (fig 1). Due to the possibility of this being part of the roof of the orbit computed tomography was requested. This showed a defect in the roof of the orbit and the shadow was a bony fragment. There was also a track leading from the roof of the orbit and terminating just lateral to the lateral ventricle (fig 2 ). The patient was observed and followed up by the neurosurgeons. At 10 months there were no ocular or neurological sequelae. Discussion