There have been profound changes in the pattern of cytomegalovirus (CMV) retinitis over the last two decades. The epidemiology and behaviour of CMV retinitis has been significantly altered by Acquired Immune Deficiency Syndrome (AIDS). It was uncommon prior to the AIDS epidemic, but soon became the most common retinal infection in AIDS patients. In the past several years, highly active anti-retroviral treatment (HAART) has achieved a dramatic improvement in the prognosis for patients infected with human immunodeficiency virus (HIV). As a result, HIV patients are living longer and have a reduced risk of CMV retinitis. Some patients with CMV retinitis who respond to HAART develop a transient symptomatic vitritis while others undergo no reactivation of their retinitis despite having no specific anti-CMV therapy. This pattern is likely to undergo further change as the treatment of HIV and CMV disease continues to improve.
AIDS-Related Opportunistic Infections ; drug therapy ; epidemiology ; Antiretroviral Therapy, Highly Active ; methods ; trends ; Antiviral Agents ; therapeutic use ; Cytomegalovirus Infections ; drug therapy ; epidemiology ; Disease Progression ; Humans ; Longevity ; Prognosis ; Remission Induction ; Risk Factors ; Treatment Outcome

Scleral necrosis and infection are serious late complications of pterygium treatment and are difficult to manage. We describe a 70-year-old Chinese male who presented with scleral necrosis and Pseudomonas aeruginosa infection 15 years after the excision of a pterygium. The infection was treated early and aggressively with intensive topical and intravenous antibiotics and the thin necrotic sclera was reinforced with a donor scleral patch graft when the scleral infection was clinically controlled. The integrity of the globe was maintained by a thin layer of sclera anterior to the graft after the graft gradually shrunk in size and retracted posteriorly. The eye was saved from possible scleral perforation and endophthalmitis. This case is reported to highlight the importance of early aggressive treatment of infection and the value of prophylactic repair of scleral necrosis in the management of these late complications of pterygium treatment.
Administration, Topical ; Aged ; Anti-Bacterial Agents ; Drug Therapy, Combination ; administration & dosage ; therapeutic use ; Humans ; Injections, Intravenous ; Male ; Necrosis ; Pseudomonas Infections ; drug therapy ; Pseudomonas aeruginosa ; Pterygium ; surgery ; Sclera ; pathology ; transplantation ; Scleral Diseases ; drug therapy ; microbiology ; Surgical Wound Infection ; drug therapy ; etiology

INTRODUCTIONThis paper reports the 1-year results of the first 2 cases of macular translocation in Singapore.

CLINICAL PICTUREA 66-year-old female and a 45-year-old male Chinese presented with subfoveal choroidal neovascularisation (CNV) in their right eyes. The woman's condition was secondary to pathological myopia while the man's was idiopathic. Their preoperative best-corrected visual acuities were 6/15-2 and 6/30, respectively.

TREATMENTBoth patients underwent macular translocation with punctate retinotomies and chorioscleral infolding (limited macular translocation) in their affected eye.

OUTCOMEBoth patients achieved effective macular translocation postoperatively. Their CNVs became extrafoveal and were ablated with conventional laser photocoagulation in the early postoperative period. They did not recur and their visual acuities improved to 6/9-1 and 6/12 at 1 year postoperatively, respectively.

CONCLUSIONMacular translocation is a new treatment modality that offers patients with subfoveal CNV a chance of improving their vision, potentially to a level that may allow reading and driving.

Aged ; Choroidal Neovascularization ; diagnostic imaging ; etiology ; surgery ; Female ; Fluorescein Angiography ; Humans ; Laser Coagulation ; Macula Lutea ; transplantation ; Macular Degeneration ; diagnostic imaging ; physiopathology ; Male ; Middle Aged ; Myopia, Degenerative ; complications ; Prognosis ; Radiography ; Severity of Illness Index ; Singapore ; Treatment Outcome ; Visual Acuity

Computerised data of 110,236 Singaporean males aged 15 to 25 (mean 17.75) years who underwent compulsory medical examination from April 1987 to January 1992 were used to estimate the prevalence and severity of myopia among young Chinese, Malay, Indian and Eurasian Singaporean males with different educational levels. The prevalence and severity of myopia amongst the groups with different educational levels were compared. These groups were fairly well-matched for important known confounding factors such as age, sex, race and degree of urbanisation of place of residence. Our data showed a positive association between educational attainment and both the prevalence and severity of myopia. Both the prevalence of myopia and the proportion of myopes with severe myopia were in general higher among those with more years of formal education.
Adolescent ; Adult ; China ; ethnology ; Cohort Studies ; Cross-Sectional Studies ; Educational Status ; Humans ; India ; ethnology ; Malaysia ; ethnology ; Male ; Myopia ; epidemiology ; Prevalence ; Refraction, Ocular ; Retrospective Studies ; Singapore ; epidemiology ; Visual Acuity

Computerised data of 110,236 Singaporean males aged 15 to 25 (mean 17.75) years who underwent compulsory medical examination from April 1987 to January 1992 was used to estimate the prevalence of myopia among young Chinese, Malay, Indian and Eurasian Singaporean males. The prevalence of myopia amongst the different racial groups was compared after they had been matched for important known confounding factors such as age, sex, educational attainment and degree of urbanization of place of residence. The estimated myopia prevalence was 48.5% in Chinese, 34.7% in Eurasians, 30.4% in Indians and 24.5% in Malays. The overall myopia prevalence rate for all races combined was 44.2%. Within each educational group, the Chinese generally had the highest myopia prevalence whilst the Malays generally had the lowest. Myopia prevalence among the Indians tended to be between that of the Chinese and the Malays. Having matched the various racial groups for age, sex, educational attainment and degree of residential urbanization, it would appear that racial and cultural differences are major influences responsible for the difference in myopia prevalence observed amongst the different races.
Adolescent ; Adult ; Asia ; ethnology ; Cross-Sectional Studies ; Europe ; ethnology ; Humans ; Male ; Myopia ; ethnology ; Prevalence ; Retrospective Studies ; Singapore ; epidemiology

Permanent visual loss is a well established major sequela of idiopathic intracranial hypertension (IIH). It is often insidious and frequently unnoticed by patients with IIH. It is vital to monitor these patients with serial perimetric and visual acuity tests because visual loss can be halted and occasionally reversed if treatment is begun early. We report a case of IIH with an empty sella turcica and polycystic ovary syndrome who developed visual field loss over ten years. This report illustrates the importance of close ophthalmic monitoring and detailed neurological and endocrinological evaluation to prevent complications in such patients.
Adult ; Chronic Disease ; Empty Sella Syndrome ; complications ; diagnosis ; Female ; Humans ; Polycystic Ovary Syndrome ; complications ; diagnosis ; Pseudotumor Cerebri ; complications ; diagnosis ; Vision Disorders ; diagnosis ; etiology

INTRODUCTIONThe visual sensations many patients experience during cataract surgery under local anaesthesia have received little attention until recently. This paper reviews the recent studies on this phenomenon, discusses its clinical significance and suggests novel approaches to reduce its negative impact on the surgery.

METHODSLiterature review.

RESULTSMany patients who have cataract surgery under retrobulbar, peribulbar or topical anaesthesia experience a variety of visual sensations in their operated eye during surgery. These visual sensations include perception of light, movements, flashes, one or more colours, surgical instruments, the surgeon's hand/fingers, the surgeon and changes in light brightness. Some patients experience transient no light perception, even if the operation is performed under topical anaesthesia. The clinical significance of this phenomenon lies in the fact that approximately 7.1% to 15.4% of patients find their visual experience frightening. This fear and anxiety may cause some patients to become uncooperative during surgery and trigger a sympathetic surge, causing such undesirable effects as hypertension, tachycardia, ischaemic strain on the heart, hyperventilation and acute panic attack. Several approaches to reduce the negative impact of patients' visual experience are suggested, including appropriate preoperative counselling and reducing the ability of patients to see during surgery.

CONCLUSIONSThe findings that some patients find their intraoperative visual experience distressing have a major impact on the way ophthalmologists manage their cataract patients. To reduce its negative impact, surgeons should consider incorporating appropriate preoperative counselling on potential intraoperative visual experience when obtaining informed consent for surgery.

Anesthesia, Local ; Anxiety ; Cataract Extraction ; psychology ; Counseling ; Fear ; Humans ; Intraoperative Period ; Phacoemulsification ; Vision, Ocular