Journal Contents
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General OphthalmologyPrognostic Value of Magnetic Resonance Imaging in Monosymptomatic Optic Neuritis Dunker S. and Wiegand W. Ophthalmology Nov 1996;103(11):1768-1773 The authors looked at a small series of patients with acute optic neuritis. These 22 patients were imaged acutely and remotely (avg. 4.2 years later) using an older MRI technique called STIR (short-time inversion recovery). Newer techniques, specifically the GUY-1 protocol (named after John Guy of UF in Gainesville, Florida), which uses frequency-selected pulses to suppress the signals obtained from orbital fat, detect optic nerve lesions in nearly 100% of patients with optic neuritis. The authors started the study before these new protocols were reported. Switching mid stream would prevent comparison between the early and late MRIs. The results:
What's it all come down to? Bigger lesions do worse. Lesions involving the bony canal have a worse outcome. The study shows promise and should be repeated with a larger sample size using present day imaging techniques.
General OphthalmologyEXTRACAPSULAR CATARACT EXTRACTION AND INTRAOCULAR LENS IMPLANTATION IN EYES FILLED WITH SILICONE OIL Weinberger D. Kremer I. Lichter H. Axersiegel R. Yassur Y. Journal of Cataract & Refractive Surgery. 22(4):403-406, 1996 May Extracapsular cataract extraction with posterior chamber intraocular lens implantation was performed in five phakic eyes filled with silicone oil following vitreoretinal surgery. Silicone oil migration was prevented during surgery using an anterior chamber maintaining system and a self-sealed corneoscleral tunnel incision. The posterior capsule opacified within 3 months in all patients, and neodymium:YAG capsulotomy or discission was performed in a diamond-shaped pattern. No silicone-related complications were found, including silicone oil migration into the anterior chamber. There were no difficulties visualizing the peripheral retina during funduscopy. [References: 11]
General OphthalmologyGlaucoma Care and Conformance with Preferred Practice Patterns - Examination of the Private, Community-based Ophthalmologist Hertzog L., Albrecht K., LaBree L. and Lee P. Ophthalmology July, 1996;103:1009-13 The authors previously reported how well academic centers conformed to the American Academy of Ophthalmology's Preferred Practice Patterns: Primary Open-Angle Glaucoma. In this article, they examined 192 records of patients first diagnosed with chronic open angle glaucoma between 1989 and 1993 from eight Los Angeles private practices. It is notable that the researchers did not make any judgments regarding appropriateness of the diagnosis. The data recorded included when intraocular pressure measurements, gonioscopy, pupil examination, disc photos/drawings and visual fields were performed. They looked at the interval between follow-up appointments and compared them to the recommended intervals according to severity and/or level of control of glaucoma. Findings:
From this paper, we note there is a particular need to examine this issue on a national level. If the results hold true for the nation, there are not enough initial gonioscopy's performed and unstable glaucoma is not being followed-up aggressively enough. The authors suggest including these PPP Recommendations in future medical record software programs. A solution for today's busy practitioner may be found in the glaucoma flow sheet proffered by John Tanton, MD as an excellent way to closely follow our glaucoma patients.
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