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This funduscopic image shows right eye optic disc swelling, retinal haemorrhage, and venous tortuosity (arrows), all suggestive of central retinal vein occlusion; and a lack of retinal perfusion over …

Background/aims This was a cross-sectional survey to find the prevalence of visual impairment and eye diseases among adults with Down syndrome (DS) in Hong Kong. Methods 91 DS patients over the age of 30 were recruited through the Hong Kong Down Syndrome Association. Each patient was provided with a complete ophthalmological assessment including best corrected visual acuity, refraction, slit lamp and fundus examination. Results In our sample, 56.6% had normal vision to mild vision impairment, 33.7% and 7.2% had moderate and severe vision impairment, respectively, and 2.4% were blind. The mean presenting distant LogMAR visual acuity was 0.66 (Snellen equivalent 20/90), and the best corrected LogMAR visual acuity was 0.48 (Snellen equivalent 20/60). Significant refractive errors were found in 86.3% of the eyes, with spherical equivalent corrections ranging from −23.25D to +3.00D. Myopia and astigmatism were prevalent and found in 59.3% and 72.7% of the eyes, respectively. Blepharitis and chalazion were found in 44% of the eyes, while corneal problems were present in 27.5%. There were low incidences of infective keratitis (0.5%), keratoconus (0.5%) and Brushfield spots (1.1%). Cataracts were found in 72.2% of the eyes; 26.1% were congenital and 44.9% were age-related. Fundal abnormalities were present in 49.5% of the eyes. Conclusions There is a high prevalence of vision impairment among Chinese DS adults. Uncorrected refractive errors, high myopia and cataracts are the main visually debilitating ophthalmological abnormalities. Vision may be improved through the simple use of glasses and early treatment of age-related cataracts.

Background: To date there has been no randomised controlled trial demonstrating the safety and efficacy of macular relocation surgery (MRS) for age related macular degeneration (AMD). Vision can be improved in some patients and made worse in others despite successful surgery or because of complications. Purpose: To determine which patients would benefit from MRS. Methods: Twenty nine patients with exudative AMD took part in a prospective, non-comparative, interventional study. Macular relocation surgery involved phacoemulsification, vitrectomy, 360° retinotomy, excision of choroidal neovascular membrane, and macular relocation using an infusion of 5-fluorouracil and low molecular weight heparin as adjuvant to prevent proliferative vitreoretinopathy. Patients underwent protocol refraction preoperotively and six-monthly postoperatively by designated optometrists. Preoperotive fundus fluorescein angiograms were read by masked observers and the lesions were classified according to a set protocol. The main outcome measures were visual improvement, final vision of better than 20/400, reading speed, critical print size. Logistic and multiple stepwise linear regressions were used to identify independent factors which predicted the main outcomes. Results: Preoperative visual acuity (20/120 or worse) and lesion type (predominantly classic or submacular haemorrhage) were significantly associated with visual improvement (coefficient of regression B = 26.8, p, link_to_OA_fulltext

Aims: To report on the use of trypan blue (TB) 0.06% for staining the internal limiting membrane (ILM) and epiretinal membrane (ERM) during vitrectomy and report on their histology. Method: 14 consecutive patients with idiopathic macular hole or macular pucker (seven patients each) were prospectively recruited for ILM or ERM peel respectively. After pars plana vitrectomy and induction of posterior vitreous detachment, 0.5 ml TB 0.06% in phosphate buffered saline (VisonBlue) was injected over the posterior pole in an air filled eye and left for 2 minutes. The stained tissue was peeled with intraocular forceps. Specimens were evaluated using histochemical and immunohistochemical methods. Results: The average follow up was 4.4 months. Internal limiting membranes and epiretinal membranes were stained satisfactorily in all cases and removed successfully. Eight patients (57%) had improvement of 2 or more Snellen lines. All seven macular holes closed. In the ERM cases, no residual membranes were observed clinically, at the latest follow up. No complicatians relating to the use of the dye were encountered intraoperatively or postoperatively. Of the 14 procedures, nine (four macular hole and five macular pucker) yielded sufficient tissue for histopathological evaluation. Histological and immunohistological assessment revealed that the morphology of these specimens was similar to that observed in macular hole ILM and macular pucker ERM removed without the aid of dye. Conclusion: TB staining facilitated the identification and delineation of ILM and ERM removal during the surgical management of macular holes and macular pucker. The visual outcome of this series and the specimens removed suggest they are no different from those without TB staining. Its use in posterior segment appears to be safe but further studies are required to investigate its long term safety., link_to_OA_fulltext

In this study, PDT was shown to be effective in preventing visual loss fewer than eight letters in pathologi- cal myopia in the first year when com- pared with sham treatment. 10 However, 17 They found that patients under the age of 40 had significant better visual outcome than patients over the age of 40. Their results need to be interpreted carefully, as they included both juxtafoveal and sub- foveal cases. The authors nonetheless raised the important point that the visual prognosis of CNV secondary to patholo- gical myopia was not always consistent. The angiographic features of the CNV in patients over the age of 40 had a more profuse angiographic leakage. Other inves- tigators have studied the effect of age on the visual outcome of treatment of CNV secondary to pathological myopia with PDT. Axer-Siegel et al, in a retrospective study, found that 50% of the older age group and 20% of the younger age group had visual loss of 15 letters or more, and the difference was significant; however, 8% of the younger patients in the series of Axer-Siegel et al continued to lose 15 or more letters despite treatment with PDT. 18

We read with great interest the article by Tack et al on the effect of the selective serotonin reuptake inhibitor (SSRI) citalopram on symptoms in patients with irritable bowel syndrome (IBS) ( Gut 2006; 55 :1095–103). The usefulness of the results of this study are however debatable. Several previous studies have investigated the effect of tricyclic antidepressants and SSRIs on functional gastrointestinal symptoms. Because of errors or lack of clarity in study design, inclusion of very selected patient populations and, above all, small sample sizes, their role in the treatment of patients with IBS in daily clinical practice remains unclear. The study of Tack et al , as already correctly pointed out by Creed in his commentary ( Gut 2006; 55 :1065–7), also suffers from major shortcomings in study design, poor description of study population and no information on whether or not subjects and physicians/investigators were blinded and, if yes, how. Nevertheless, Creed claims that this study provides useful information on the effect of citalopram on the primary outcome measure—number of days per week with abdominal pain. What is relevant for patients as well as physicians is the risk of reduction in the number of days with abdominal pain after citalopram treatment. From the results of this study a relative risk of abdominal pain can be …