This Issue of Acta

Abstract

The guest editorial in this issue, by Leila Laatikainen, deals with litigation in ophthalmology. This has been a big issue particularly in the United States. Laatikainen describes how a society-financed insurance system can decrease the problem, ensuring that patients can be compensated for damage occurring in the health care system without the need of retrieving compensation from or putting unnecessary blame on individuals working in health care. The editorial refers to the very interesting article by Mavroforou and Michalodimitrakis, on the liability of ophthalmologists. These authors discuss reasons for medical litigation. They emphasise the important role of clear communication and proper documentation, and discuss the value of signed informed consent forms. The occurrence of secondary cataract after IOL implantation with various lens types are subjects for ever continuing discussions among ophthalmologists. Stordahl and Drolsum, compared two modern lenses in a large material of cataract surgeries finding distinct differences between the lenses. One of the lenses was associated with a capsolotmy rate of only 2.7% after a mean follow-up of 23 months. Laser interferometry is used frequently instead of ultrasound A-scan to measure axial length prior to cataract surgery and IOL implantation. Goyal et al. report interesting results after a study of 100 patients; the two techniques gave different estimates, but laser interferometry was the more reproducible, and therefore may improve the accuracy of axial length measurements in clinical settings. Suominen and coworker discuss a different tool of analysis of importance for visual outcomes after surgery. They have devised a new index estimating the accuracy of refractive surgery. There are three glaucoma papers in the current issue. Wishart et al. report two very large series of patients operated by viscocanalostomy or deep sclerectomy. The results were encouraging with final mean IOP in the range of 15–17 mmHg, and few complications. Stewart and coworkers report a comparison between two fixed combinations of timolol and dorzolamide versus timolol and pilocarpine. The results indicate that the latter combination, which has been very popular in the Nordic countries can provide a reduction of IOP similar to that of the former, which has appeared on the market more recently. Kotikoski and coworkers studied the effect of a single dose of isosorbide-5-mononitrate on aqueous flow in healthy volunteers, and observed no change. Teär-Fahnehjelm and coworkers studied a group of children with reduced visual acuities caused by serious posterior ocular malformations (optic nerve hypoplasia and optic nerve colobomas). They found that neonatal hypoglycaemia was common in patients with optic nerve hypoplasia and was associated with severe visual impairment. Screening for diabetic retinopathy is an important, high-volume task for the ophthalmic health care system today. In the Nordic countries screening is most often photo-based, but in many countries nonophthalmologists perform such screening with ophthalmoscopy. Verma and coworkers studied the performance of general physicians and optometrists. There was good agreement among the diagnoses of these categories of personnel, and those of opthalmologists. This method of diabetic screening may be of particularly great value in countries with a shortage of ophthalmologists. Olopatadine is a drug that has become available for treatment of allergic conjunctivitis in recent years. Yalali et al. compare the results achieved with this drug to those of ketorolac or placebo. Both drugs were effective, and symptoms of itching were lower in the olopatadine group. Three articles deal with ocular tumours. Cohen and coworkers compared metastasis free survival after enucleation and stereotactic radiotherapy of choroidal melanomas. There was no statistically significant difference between the two study groups. As expected large tumour size and ciliary body location were associated with poor survival. Kodjikian et al. report two families and provide a literature review on unusual familial uveal melanomas. Palazzi and coworkers report oncogenic human papillomavirus types 16 and 35 in 28% of 43 tumour specimens from children with unilateral retinoblastoma. Intravitreal triamcinolone has been increasingly used for a variety of ocular disorders. The group of Jonas has been very active in research in this area. In the Diagnosis and Therapy in Ophthalmology Section they report morphological and functional changes after such intravitreal triamcinolone injections in patients with retinal vein occlusion with persisting cystoid macular edema. Visual acuity improved, and OCT and fluoresceing angiography showed normalization of retinal thickening and CME. There are two case reports in this issue: one describing permanent cortical blindness after hepatic encephalopathy, the other describing bilateral, combined retinal and choroidal detachments in a patient c-ANCA-positive scleritis. And there are many interesting letters to the editor in the current issue.