Recent Advances: Ophthalmology

BMJ 1996;312:889-892 (6 April)

Education and debate

Hamish M A Towler, consultant ophthalmic surgeon,^a Susan Lightman, professor of clinical ophthalmology ^b

^a Forest Healthcare, Whipps Cross Hospital, London E11 1NR, ^b Institute of Ophthalmology and Moorfields Eye Hospital, London EC1V 2PD

Correspondence to: Mr Towler.

Summary points

Use of self sealing, sutureless wounds; foldable intraocular lens implants; continuous curvilinear capsulorhexis; and improved techniques of phacoemulsification within the lens capsular bag in cataract surgery have substantially reduced the period of visual rehabilitation and rapidly accelerated attainment of optimum visual acuity
Photorefractive keratectomy has been heralded as the cure for myopia, but it can have substantial side effects and not all patients respond in a predictable manner
Injecting botulinum toxin into a muscle to produce transient neuromuscular paralysis has been used for certain types of strabismus, essential blepharospasm, induction of ptosis to protect the cornea, and, more recently, nystagmus
New treatments for subretinal choroidal neovascularisation associated with age related macular degeneration include foveal ablation by laser photocoagulation and radiotherapy, but dietary zinc supplements, interferon alfa, and subretinal surgery have proved disappointing
Cytomegalovirus can now be treated by implanting a device inside the eye that slowly releases ganciclovir for up to nine months, which avoids the side effects associated with systemic treatment
Full thickness macular holes can be successfully closed by vitrectomy combined with intraocular gas tamponade