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All the patients (73) in the Rheumatology Department five year study of second line therapy who have taken hydroxychloroquine (Plaquenil) for rheumatoid arthritis for longer than 18 months were reviewed. These patients have their treatment dosage carefully monitored and have been receiving regular ophthalmic examinations. Most patients still taking the drug were assessed with a battery of tests for evidence of retinal toxicity. No retinal toxicity causing visual loss was found. On the basis of these results and a review of the recent literature we no longer routinely screen patients for hydroxychloroquine retinal toxicity in Cardiff.

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It has been shown that the wearing of contact lenses prescribed for the optical correction of unilateral aphakia is not well maintained in patients fitted with either scleral lenses (Ruben, I962; Bonnet, Gerhard, and Massin, I966) or microcorneal lenses (Bonnet and others, I966). Some of the causes for this failure of contact lens wear were analysed by Gerhard and Bronner (i965), who found that the failure rate was independent of the type of contact lens fitted.In the patients who are unable to tolerate the contact lens because of irritation or who experience difficulty in its handling, it would be reasonable to expect that a more satisfactory long-term binocular visual result would be obtained by the use of an intraocular acrylic lens implant. Such an implant would have no advantage in patients intolerant of the lens because of heterotropia and, although the difference in retinal image size between the phakic and the correlated aphakic eye is reduced from an average of 6 -99 per cent. with a contact lens to 1-92 per cent. with an intraocular lens (Girard, Friedman, Moore, Blau, Binkhorst, and Gobin, I962), good binocular vision is usually achieved by either method. Girard and others (I962), including his co-author C. D. Binkhorst, therefore concluded that a contact lens should be tried first in all cases in preference to an intraocular lens, and this approach is now widely accepted.However, Binkhorst and Leonard (i967), in reporting the results of 208 implantations of the iris-clip pseudophakos (Binkhorst, 1959), concluded that primary implantation of this device at the time of the cataract extraction is preferable to its secondary implantation, as surgical corneal dystrophy occurred in five eyes (7-1 per cent.) with secondary implantation and none with primary implantation. In a subsequent paper (Binkhorst, Gobin, and Leonard, I969), it was stated that a contact lens should not be used to correct post-traumatic aphakia in children, because the authors considered that this reduced the chance of binocular re-education (Binkhorst and Gobin, I967).The justification for primary implantation of an intraocular lens to correct unilateral aphakia would be greater if it were possible to predict before the cataract extraction that successful contact lens wear was improbable. The present study, undertaken in an attempt to define factors which might militate against the successful wearing of a contact lens in unilateral aphakia, consists of the analysis of data relating to such patients fitted with a contact lens by one of us (E.M.T.L.) at the Cardiff Royal Infirmary between i96i, when the service was commenced, and the end of I966.Material and Methods A circular and questionnaire were sent to the last known address of each patient with unilateral aphakia who was fitted with contact lenses at the Cardiff Royal Infirmary between I 96 I and I 966 inclusive. Patients who failed to reply to the first circular were sent a further copy and those who

Scleral penetration with a suture needle is a well recognised risk of the surgical treatment of strabismus and may result in serious intra-ocular complications. The risk should be reduced by loop recession, a procedure derived from the adjustable suture technique. In practice in many cases this operation has also been found to have other advantages compared to a conventional recession. The surgical details of loop recession are described and the results obtained in 62 patients reviewed.