Recent advances in ophthalmology

These are exciting times for ophthalmology with developments in recent years taking place across a spectrum of eye diseases from the front to the back of the eye.peer-reviewe

Antimalarials and the eye

Following the first reports in 1954 of the beneficial effects of chloroquine in cases of lupus erythematosus, this drug and its numerous derivatives have been used extensively in the treatment of systemic and discoid lupus erythematosus and rheumatoid arthritis. The small dosage of chloroquine used in the prophylaxis of malaria is comparatively free from any serious side effects; higher dosage administered over a prolonged period of time for chronic connective tissue disorders gives rise to concern and requires careful monitoring.peer-reviewe

Ocular onchocerciasis

A case report of a patient who was admitted to the City Hospital, Edinburgh in September 1974 is described. The patient who while on vacation in Ibadan, Nigeria had been feeling generally unwell, and for several months had transient acute ocular symptoms such as photophobia and watering and itching of both eyes. The diagnosis indicated that the patient was suffering from ocular onchocerciasis, an anomaly caused by infection by the threadworm onchocerca volvulus. This is a parasitic worm that is found in two continents, in Central and West Africa, and in parts of Central America, Columbia, Ecuador, Peru and Guatemala. The clinical features and ocular findings of this case are studied and discussed.peer-reviewe

Light coagulation in diabetic retinopathy

The various techniques used by the light coagulation equipment in diabetic retinopathy are described, specifically the Zeiss White Light Coagulator, the O`Malley Log 2 Portable Light Coagulator and the Argon Laser, of which the laser is a more recent development. The aim of treatment is to break the cycle of neovascularisation, bleeding and fibrosis; an attempt is made to produce fibrosis on the flat retina before bleeding has occurred. The operative techniques are explained, whereby the complications of treatment are outlined, such as hemorrhage and retinal detachment.peer-reviewe

Low tension glaucoma

Eyes with low tension glaucoma are significantly more myopic and have a greater axial length than open angle glaucoma. For pathological cupping and glaucomatous field defects to occur in large eyeballs, the ocular tension needs to be only slightly raised. In small eyeballs the critical level of ocular tension for the development of field defects needs to be higher to offset the lower susceptibility of the optic disc. The treatment of low tension glaucoma is directed towards reduction in the ocular tension by medical or surgical methods.peer-reviewe

A search for near infrared counterparts of 3 pulsar wind nebulae

While pulsar wind nebulae (PWNe) and their associated isolated pulsars are commonly detected at X-ray energies, they are much rarer at near infrared (nIR) and optical wavelengths. Here we examine three PWN systems in the Galactic plane - IGR J14003-6326, HESS J1632-478 and IGR J18490-0000 - in a bid to identify optical/nIR emission associated with either the extended PWNe or their previously detected X-ray point sources. We obtain optical/nIR images of the three fields with the ESO - New Technology Telescope and apply standard photometric and astrometric calibrations. We find no evidence of any extended emission associated with the PWNe in any of the fields; neither do we find any new counterparts to the X-ray point sources, except to confirm the magnitude of the previously identified counterpart candidate of IGR J18490-0000. Further observations are required to confirm the association of the nIR source to IGR J18490-0000 and to detect counterparts to IGR J14003-6326 and HESS J1632-478, while a more accurate X-ray position is required to reduce the probability of a chance superposition in the field of the latter.Comment: Accepted to A&A (4 pages, 1 figure

Concordance of gout management with European League against Rheumatism recommendations in hospital practice

Aim: To assess the concordance of gout management with the European League Against Rheumatism (EULAR) gout recommendations in hospital practice. Methods: This was a retrospective review of case notes of patients presenting to rheumatology outpatients between June and December 2009 under the care of 2 consultant rheumatologists. Data collected consisted of demographics, time lag to specialist referral, comorbidities, details about acute and recurrent attacks, lifestyle advice and use of urate lowering therapies. Documented management was assessed for concordance with the EULAR recommendations. Results: Thirty consecutive patients (27 males, 3 females) attending Rheumatology clinic at Mater Dei Hospital were recruited. Mean age at the time of survey was 59.4 ± 10.7 years, while mean age at diagnosis was 51.1 ± 14 years. Documentation of lifestyle advice was recorded for alcohol reduction (83%), weight loss (43%), diet (13%), and exercise (13%). Adequate control of comorbidities was attained in hyperlipidaemia (71%), diabetes mellitus (55%) and hypertension (30%). Advice about smoking cessation was given to 37%. Uric acid levels below target were achieved in 47%. The mean uric acid level at time of survey was 379 ± 146 μmol/l. This was significantly less than that at presentation (p=0.001). Conclusions: Current treatment of gout is poorly concordant with many of the EULAR recommendations. Documentation of lifestyle modifications advice is infrequent except for alcohol reduction. A significant number of patents on allopurinol still have hyperuricaemia implying that more aggressive management is required to improve standard of care. A proforma has been developed to make and help sustain the necessary improvements.peer-reviewe

Infrared identification of high-mass X-ray binaries discovered by INTEGRAL

Since it started observing the sky, the INTEGRAL satellite has discovered new categories of high mass X-ray binaries (HMXB) in our Galaxy. These observations raise important questions on the formation and evolution of these rare and short-lived objects. We present here new infrared observations from which to reveal or constrain the nature of 15 INTEGRAL sources, which allow us to update and discuss the Galactic HMXB population statistics. After previous photometric and spectroscopic observing campaigns in the optical and near-infrared, new photometry and spectroscopy was performed in the near-infrared with the SofI instrument on the ESO/NTT telescope in 2008 and 2010 on a sample of INTEGRAL sources. These observations, and specifically the detection of certain features in the spectra, allow the identification of these high-energy objects by comparison with published nIR spectral atlases of O and B stars. We present photometric data of nine sources (IGR J10101-5654, IGR J11187-5438, IGR J11435-6109, IGR J14331-6112, IGR J16328-4726, IGR J17200-3116, IGR J17354-3255, IGR J17404-3655, and IGR J17586-2129) and spectroscopic observations of 13 sources (IGR J10101-5654, IGR J11435-6109, IGR J13020-6359, IGR J14331-6112, IGR J14488-5942, IGR J16195-4945, IGR J16318-4848, IGR J16320-4751, IGR J16328-4726, IGR J16418-4532, IGR J17354-3255, IGR J17404-3655, and IGR J17586-2129). Our spectroscopic measurements indicate that: five of these objects are Oe/Be high-mass X-ray binaries (BeHMXB), six are supergiant high-mass X-ray binaries (sgHMXB), and two are sgB[e]. From a statistical point of view, we estimate the proportion of confirmed sgHMXB to be 42% and that of the confirmed BeHMXB to be 49%. The remaining 9% are peculiar HMXB.Comment: Accepted for publication in A&A (in press