EUROPEAN OPHTHALMIC REVIEW – VOLUME 3 ISSUE 1 – SUMMER 2009

This edition of European Ophthalmic Review looks at the provision of eye care to one of the more desolate and unreachable parts of the world – the Himalayas. In addition, the ‘International Health’ section looks at ethnic differences in diseases such as Stevens-Johnson syndrome. From providing the most basic of care in the most difficult […]

Gene therapy is a promising therapeutic approach for the treatment of a wide array of inherited and acquired disorders. The eye is a particularly interesting target for gene delivery owing to the relatively immune-privileged status of the tissue. In the eye, gene delivery has potential applications in treating various disorders including neovascular and non-neovascular retinal […]

Perched on the southern slopes of the Himalayan mountains, Nepal is a culturally, ethnically and geographically diverse country, making it one of the major tourist destinations in the region. Eight of the world’s 10 highest mountains, including Mount Everest, are within its territory. However, despite having such tourist attractions, it remains a poor country. The […]

Stevens-Johnson Syndrome Stevens-Johnson syndrome (SJS), an acute inflammatory vesiculobullous reaction of the skin and mucous membranes, was first described in 1922.1 Stevens and Johnson, both paediatricians, encountered two boys seven and eight years of age who manifested an extraordinary, generalised skin eruption, persistent fever, inflamed buccal mucosa and severe purulent conjunctivitis resulting in severe visual […]

The optic neuropathy glaucoma affects more than 70 million people globally and is a leading cause of blindness in Europe.1,2 The most common form is chronic or primary open-angle glaucoma (POAG), which accounts for approximately 90–95% of all glaucoma cases.3 This slowly progressive disease is associated with several key risk factors, including an increase in […]

In devising the ‘ideal’ glaucoma drop, it is almost intuitive that a combination preparation of two monotherapies should be a Holy Grail in the treatment of glaucoma. Indeed, the benefits seem clear: better patient compliance, fewer daily dosages and therefore fewer adverse effects, ideally synergy of the active components, less exposure to excipients, lower cost […]

Glaucoma is one of the most severe complications after surgery for paediatric cataract, and is reported to occur in up to one-third of these eyes.1–8 The clinical presentation of glaucoma after paediatric cataract surgery is largely divided into two subtypes: early-onset secondary angleclosure glaucoma and secondary open-angle glaucoma. Secondary angle-closure glaucoma often presents with corneal […]

Laser Transmission and Absorption The choice of laser type for transscleral cyclophotocoagulation (CPC)has been based on scleral transmission rather than on efficacy at the target tissue. Since scleral transmission increases at longer wavelengths, the lasers most frequently employed in clinical practicehave been the 810nm diode and the 1,064nm neodynium: yttrium–aluminium–garnet (Nd:YAG). However, the contact application […]

Since the first description of glaucomatous optic neuropathy (GON) by von Graefe, there has been debate about the pathomechanisms involved in this damage. In the discussions that followed two questions were of great interest: first, how far is the damage a consequence of mechanical stress on the optic nerve head (ONH), and second, to what […]

Rubeosis iridis, the formation of pathological vessels in the iris, is a severe complication of ischaemic retinal diseases such as proliferative diabetic retinopathy or retinal vascular occlusion. The angiogenic cascade starts with a focal or generalised retinal hypoxia, which may appear in diabetic patients due to occlusive changes in the vessel wall and perfusion disturbances, […]

The most common outcome of infantile epiphora is spontaneous resolution,1–10 although surgical intervention in the form of syringing and probing is advocated for cases that fail to settle.11–18 More complex surgical procedures such as intubation, balloon dilatation and dacryocystorhinostomy (DCR) may be indicated when the epiphora persists. There is considerable controversy surrounding the management – […]

Topical anaesthesia (TA) for cataract surgery was first used by Koller around 1884. However, this method fell out of favour because general anaesthesia and, later, retrobulbar anaesthesia (RBA) could provide better conditions for surgery.1 At this time cataract surgery was performed using an incision of 10mm or more. Accordingly, hypotony and akinaesia were necessary. Hypotony […]

With an ageing population, it is commonplace for vitreoretinal (VR) surgeons to encounter patients on oral anticoagulation and antiplatelets, including dual oral antiplatelet therapy. Some VR surgeons routinely stop warfarin, aspirin or clopidogrel, a thienopyridine adenosine diphosphate (ADP) antagonist, prior to VR procedures on the assumption that they increase the risk of bleeding and may […]

Rupture is the most severe form of mechanical globe trauma and represents 32% of all open-globe injuries, according to the US Eye Injury Registry (USEIR) and the surveillance arm of the American Society of Ocular Trauma (ASOT).1 In the USEIR, 25% of ruptured eyes presented with no light perception vision and only 10% had greater […]

Aniridia is an uncommon congenital bilateral disease caused by mutation of the PAX6 gene. It is an ocular disorder that involves the cornea, anterior chamber, lens, retina and optic nerve.1 Although aniridic keratopathy has traditionally been attributed to limbal stem cell deficiency, current evidence based on clinical observations and animal models of aniridia suggests that […]

Until recently, the only goal of cataract surgery was the removal of an opaque crystalline lens and its replacement with an artificial intraocular lens (IOL). Reduced phacoemulsification energy, smaller incisions and improved IOL designs have turned cataract surgery into an extremely safe and successful procedure, and nowadays more than 90% of patients achieve visual acuity […]

In recent years, reduced corneal biomechanics was identified as an important element in the pathogenesis of various corneal diseases. The biomechanical characteristics of a connective tissue such as strength and resistance against mechanical stress are indispensable prerequisites to maintaining regular shape and function. Intra- and intermolecular cross-links between collagen molecules are essential elements of these […]

Infections, inflammation and trauma to the cornea and ocular surface can culminate in loss of corneal transparency and subsequent compromise of visual function. This can have significant associated physical and psychological morbidity, as well as a profound socioeconomic impact.1,2 The major causes of corneal inflammation and scarring include microbial keratitis,3 chemical and thermal injuries,4,5 persistent […]

Pigment-epithelial-derived factor (PEDF) is an extracellular 50kDa secreted glycoprotein of the serpin family. In contrast to most other serpins, which are protease inhibitors, PEDF does not seem to exert inhibitory actions against any known proteases.1,2 Only very few other serpins are considered to be non-inhibitory, including ovalalbumin and angiotensinogen. Interestingly, one product of angiotensinogen, angiotensin […]

Of our large visual field only a small fraction – located in the fovea – is used for acute vision. This highly specialised part of the retina contains virtually no other elements than tightly packed cone photoreceptors. Initially, small parts of the peripheral visual field are affected in diseases such as age-related macular degeneration (AMD), […]

Central serous chorioretinopathy (CSCR) is an idiopathic syndrome of young to middle-aged adults, with men affected more commonly than women. CSCR is characterised by serous detachment of the neurosensory retina with focal and multifocal areas of leakage at the level of the retinal pigment epithelium (RPE) predominantly affecting the macular area. Patients often complain of […]

Retinal Repair and Regeneration Throughout life, tissues and organs constantly repair and replace cells to maintain optimal function. The central nervous system (CNS) – the brain, retina and spinal cord – was conventionally thought, because of poor response to damage, to have only limited ability to repair; however, even without damage how can a set […]

Obstruction of the lacrimal apparatus commonly causes sufferers to present with symptoms of epiphora, for which they are commonly referred to ophthalmology departments. In those units where collaboration with otorhinolaryngology occurs, the distal site of obstruction is usually dealt with. However, in this article we aim to update the reader on the causes and current […]

In recent years, no other drugs have been received with such enthusiasm as the group of tumour necrosis factor-α (TNF-α)- blocking agents. Why are these drugs so interesting for uveitis patients, and is it possible to see superiority of one of the drugs in this group over the others? Juvenile Idiopathic Arthritis-associated Uveitis When specialists […]