As we near the end of this century, refractive cataract surgery has become a reality through concerted contributions from ultrasonic phacoemulsification, foldable intraocular lens (IOL) implantation technology and keratorefractive surgery. As we enter the new millennium, our sights are set on realizing another dream: accommodative IOL surgery. Towards achieving this goal, many advances have been made in both techniques and technology of cataract removal. Lasers in particular have been under investigation for cataract removal for nearly two decades. The technology has now reached a stage where cataract can indeed be removed entirely with laser alone. Neodymium:YAG and erbium:YAG are the laser sources currently utilized by manufacturers of laser phaco systems. Initial clinical experience reported in the literature has served to highlight the capabilities of lasers and the need for further refinement. Despite the excitement associated with the availability of this alluring new technology for cataract removal, it is necessary to develop more effective laser systems and innovative surgical techniques that optimize its capabilities if laser phaco surgery is to be a genuine improvement over current techniques.

Purpose: To evaluate the efficacy of pH-adjusted bupivacaine in conjunction with medial orbital periconal block (periocular anaesthesia). Methods: Sixty consecutive patients undergoing primary vitreoretinal surgery were enrolled prospectively. Results: Adequate anaesthesia and akinesia with no intraoperative supplementation was achieved in 53 eyes (88.3%). Factors influencing intraoperative supplementation were combined vitrectomy with scleral buckling (p=0.005) and duration of surgery of more than 2 hours (p=0.001). No ocular or systemic complication resulted. Conclusion: pH-adjusted periocular anaesthesia is safe and effective in patients undergoing primary vitreoretinal surgery.

Purpose: To study the optic disc size in eyes with ocular hypertension (OHT) in comparison to primary open-angle glaucoma (POAG) and normals. Methods: Optic disc photographs obtained with the Nidek 3dx NM camera were digitized (Nikon^™ coolscan) and disc area calculated using Littmann correction in a randomly chosen eye of 28 OHT, 42 POAG and 30 normal subjects. OHT was defined as increased intraocular pressure with no disc or field changes suggestive of glaucoma with open angles. Results: The optic disc area in OHT was 9.47 ± 1.09 mm2; 12.27 ± 2.87mm² in POAG; and 12.11 ± 2.83 mm² in normal individuals. Conclusion: Using magnification corrected morphometry and the criteria for OHT diagnosis, the optic disc area in OHT was significantly smaller (p<0.0001) in POAG and normals.

Purpose: To assess the prognosis for recovery of vision in patients with blindness due to head injury, and to analyse the predictive value of visual evoked potential (VEP). Methods: One hundred consecutive patients with unilateral/ bilateral blindness as a result of minor head injury were studied with regard to their visual status, CT scan, MRI scan and serial VEPs. Steroids were given to those presenting within one month of injury, 5 patients among them received methyl prednisolone. Transethmoidal decompression was done in 6 patients. Results: Visual improvement was recorded in 23 patients. Initial VEP failed to reveal any wave in 29 patients and was abnormal in 71. All the 14 patients in whom VEPs were repeatedly normal, irrespective of initial VEP status, showed varying degrees of visual improvement and none of the 15 patients with persistently negative VEPs showed visual improvement. Conclusion: Recovery of VEP from no response to abnormal wave or abnormal wave to normal VEP were indicators of relatively good visual prognosis. Overall, 23 patients showed visual improvement, but did not return to normal. Mode of injury, CT findings and timing of surgery did not influence the outcome.

Purpose: A single blind prospective randomised study to determine the effect of Viscoat retained in the eye on intraocular pressure (IOP) after phacoemulsification. Methods: 82 patients were randomly selected to receive either Viscoat, a viscoelastic composed of 3% sodium hyaluronate (mol wt 500,000 daltons), and 4% chondroitin sulfate (mol wt 25,000 daltons) or Provisc, a viscoelastic compound composed of 1% sodium hyaluronate (mol wt 4,00,000 daltons) during phacoemulsification. In those patients receiving Viscoat the viscoelastic in the anterior chamber only was removed, whereas in those receiving Provisc attempts were made to remove the material entirely. The IOP was measured on the first postoperative day, 16-20 hours after surgery. Results: The mean postoperative IOP in the Viscoat group was 22.37 ± 9.0 mmHg and in the Provisc group was 19.67 ± 6.95 mmHg. Five patients in the Viscoat group had pressure elevations above 30 mmHg as opposed to three in the Provisc group. Conclusions: The two viscoelastics cause equivalent pressure elevations postoperatively. In the Viscoat group there were five patients with IOPs above 30 mmHg. We recommend that Viscoat should be aspirated from both the anterior chamber and the capsular bag following routine phacoemulsification.

Purpose: To review our experiences on the laboratory investigations of viral and chlamydial conjunctivitis, congenital cataract and acute retinal inflammations seen from 1990 to 1998 at Sankara Nethralaya, Chennai, India. Methods: Conjunctival swabs/scrapings from 1061 patients with conjunctivitis were investigated. Nested polymerase chain reaction (nPCR) and restriction fragment length polymorphism (RFLP) techniques were applied on 74 conjunctival swabs during the 1996 outbreak of acute viral conjunctivitis. The occurrence of Rubella virus in 86 lens aspirates of congenital cataract was investigated. Tests were performed for the association of Herpes simplex virus (HSV), Varicella zoster virus (VZV) and Cytomegalovirus (CMV) with acute retinal inflammation in 32 patients. Results: The causative agents of conjunctivitis were Adenovirus in 13.8%, HSV in 2.2% and C. trachomatis in 20.9% of the patients. Epidemics were due to Adenovirus type 4 in 1991, type 3 in 1992-93 and type 7a in 1996. PCR was 37.9% more sensitive in detecting Adenovirus than virological methods. RFLP identified the conjunctivitis epidemic strain of 1996 as Adenovirus 7a. Rubella virus was isolated from 8.1% of lens aspirates from congenital cataract. Nineteen of the 32 patients with acute retinitis had confirmed virus infections (VZV: 8; HSV: 5; and CMV: 6) and the rapid detection of the virus agent helped institute specific chemotherapy resulting in useful vision in some patients. Conclusion: Laboratory investigations for diagnosis of viral and C. trachomatis ocular infections were useful in establishing the aetiology and determining the incidence of causative agents of specific ocular diseases

Qualitative research was the preserve of social scientists before making inroads into medical sciences, as the medical fraternity was wedded to evidence-based medicine. Qualitative research methods are now being increasingly used in medicine. The goal of qualitative research is to help in the understanding of social phenomenon in their natural settings. These methods help to unravel mysteries relating to complex human interactions and to study the role of human behaviour in health and disease. Recent evidence points to the complementary roles of qualitative and quantitative methods in medical research. Qualitative methods include observations, interviews, focus groups, projective techniques, analysis of personal documents and accounts, sorting and ranking, and case studies. This communication describes the application of qualitative methods in ophthalmic research