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A new technology enables fast production of waveguide (SPIM-WG) based high performance optical devices with very low loss, precisely organized refractive index, arbitrarily variable cross-sections and high coupling efficiency.

Purpose: To determine the ultrastructural localisation of glycosaminoglycans (GAGs) in the extraocular muscles (EOMs) of patients with thyroid-associated ophthalmopathy (TAO) and to see whether the quantity and type of GAGs present in blood and urine are markers of the disease., Methods: Biopsies of affected EOMs were taken and studied by transmission electron microscopy (TEM). These were either fixed conventional for TEM, or in 0.5% tannic acid and others for immunogold staining. Serum hyaluronan (HA) was measured using a radioimmunoassay in patients with TAO as well as control subjects, and urinary GAG levels assessed by photometric quantitation of hexuronic acid after reaction with carbazole. The excretion pattern of the urinary GAGs was determined by discontinuous electrophoresis., Results: TEM showed that there is a marked expansion of the endomysial space in TAO EOM biopsies as compared with non-TAO strabismus specimens. This is caused by an increased number of collagen fibres, interspersed with a granular amorphous material surrounding striated collagen fibres shown to be hyaluronan by immunogold staining. In contrast, serum hyaluronan concentrations were similar in TAO and control patients, although there was a statistically significant difference in the urinary GAG excretion between the two groups of patients examined. By discontinuous electrophoresis, chondroitin sulphate and heparan sulphate were present in both patients and controls., Conclusion: GAGs and in particularly HA are present at the EOM level in patients with recently inactive TAO. However, serum levels of HA and urinary GAGs are not sensitive indicators for their presence within the EOMs.

The purpose of the study was to identify those patients with thyroid eye disease and upper eyelid retraction who would benefit from Henderson's procedure (myotomy of Muller's superior tarsal muscle with graded division of levator aponeurotic fibres on the anterior tarsal plate). The clinical records of patients attending the Thyroid Clinic of Moorfields Hospital who had undergone Henderson's procedures were reviewed. Twenty-two patients (19 women, 3 men) had Henderson's procedures at age 35-69 years (mean 49.9), with a mean follow-up of 4.55 years. Eleven patients had bilateral upper eyelid surgery, 11 unilateral (33 eyelids). The pre-operative vertical palpebral apertures ranged from 11 to 19 mm (mean 13.95); the post-operative vertical palpebral apertures ranged from 8 to 15 mm (mean 11.45), a mean reduction of 2.5 mm (p < 0.001). Eight of twenty-two patients (36%) had further eyelid surgery and 3 of 22 (14%) had further surgery recommended because of persistent upper eyelid retraction, abnormal eyelid contour (lateral flare) and asymmetry. It is concluded that Henderson's procedure should be reserved for those patients with minor degrees of almost symmetrical upper eyelid retraction who do not have abnormalities of their eyelid contour.

In this paper methods of visualisation of the extraocular muscle changes in thyroid eye disease are discussed. The histopathology of extraocular muscle biopsies has been studied by both light and electron microscopy to show the type of cellular infiltration and the amorphous material in the extracellular matrix. A series of questions to which answers have not yet been found concerning thyroid eye disease are posed which may help to direct new research projects. Finally, in the last part of the paper, the surgical results in a series of 41 patients having ocular muscle surgery for diplopia and/or compensatory head postures due to thyroid eye disease are described. The conclusions drawn from these results are that one should maintain the patient euthyroid, establish by orthoptic measurements that the ocular movements have been stable for at least 6 months, treat by recessing tight muscles using adjustable sutures, and aim to undercorrect the vertical deviation at the time of adjustment.

A new scoring system for Hess charts is described. Scores for both horizontal and vertical deviations are calculated from the displacement of individual points on the Hess chart, using weighting factors for the centre, inner and outer zones. The scoring system was validated in a group of 24 patients undergoing surgery for paralytic or restrictive strabismus. Subjective scores were obtained from patients both before and after corrective surgery, and corresponding Hess charts were scored using the new system. There was a good correlation between the changes in subjective and objective score. Our scoring system has applications in both research and clinical practice, allowing objective analysis of changes in muscle balance in a variety of motility disorders.

The best systemic treatment of dysthyroid ophthalmopathy remains high dosage Prednisolone. Other methods of immunosuppression such as Azathioprine and Cyclosporin A have proved disappointing, as has plasmapheresis. Other localised means may be used and these are radiotherapy to the retrobulbar tissues or orbital decompression. These methods may be used in addition to or instead of high dose Prednisolone but some surgeons prefer to try Prednisolone as a first measure.

Following reports of a high incidence of chorioretinal scarring related to the Faden Procedure, a retrospective study was carried out at Moorfields Eye Hospital. One hundred unselected Faden procedures were followed up with orthoptic and fundoscopic examination. Our indications and technique for performing this operation are described. A 7% incidence of chorioretinal scarring was noted; this compares well with previously published figures for conventional squint surgery and this operation should therefore be considered safe.

Thirty-four patients with surgically treated bilateral superior oblique palsy are presented. The patients are divided into three groups: Symmetrical palsies, Asymmetrical palsies, A group in whom the bilaterality was initially masked. Bilaterality should be suspected in all cases of traumatic IVth nerve paresis, and particularly in cases with a large 'V' pattern, excyclo deviation of more than 10 degrees on down-gaze and when right hypertropia switches to left hypertropia on lateral down-gaze. Bilateral Harada-Ito procedures alone 'cured' 11 of 17 patients (65 per cent) in groups 1 and 2, and is the operation of choice in acute bilateral superior oblique palsy. Cyclo deviation was reduced by a mean of 5.5 degrees in the primary position and by 6-10 degrees in down-gaze. Patients initially managed with other surgery had a more complicated surgical course and required more operations. Seven patients who initially demonstrated only gross fusion recovered good fusion after Harada-Ito surgery.