The +10 diopter lens occluder.

BACKGROUND: It would be useful to be able to visualize the eye under cover during the cover test. Used as an occluder, a +10 diopter (D) lens will permit such visualization. It is important to know if a +10D lens creates dissociation that is qualitatively similar to an opaque occluder. METHODS: The angle of strabismus was measured in 33 patients with esotropia. Seventeen had intermittent exotropia, and 15 had dissociated vertical divergence with both an opaque occluder and a +10D lens used as an occluder. The findings were then compared. RESULTS: In 64 of the 65 patients participating in this study, the measurements obtained with the 2 occluders agreed within 3 prism diopters on repeated testing. In the remaining patient, the measurements differed by 5 prism diopters. In all patients, the dissociated eye could be clearly visualized through the +10D lens. CONCLUSION: A +10D lens permits excellent visualization of the dissociated eye and provides measurements that are qualitatively similar to those obtained with a standard occluder. Arch Ophthalmol. 2000;118:1071-1073

Diplopia secondary to aniseikonia associated with macular disease.

OBJECTIVE: To provide an explanation for diplopia and the inability to fuse in some patients with macular disease. METHODS: We identified 7 patients from our practices who had binocular diplopia concurrent with epiretinal membranes or vitreomacular traction. A review of the medical records of all patients was performed. In addition to complete ophthalmologic and orthoptic examinations, evaluation of aniseikonia using the Awaya New Aniseikonia Tests (Handaya Co Ltd, Tokyo, Japan) was performed on all patients. RESULTS: All patients were referred for troublesome diplopia. Six of the patients had epiretinal membranes and 1 had vitreomacular traction. All 7 patients had aniseikonia, ranging from 5% to 18%. In 5 of the patients the image in the involved eye was larger, and in the other 2 patients it was smaller than in the fellow eye. All patients had concomitant small-angle strabismus and at least initially did not fuse when the deviation was offset with a prism. Response to optical management and retinal surgery was variable. CONCLUSIONS: Aniseikonia caused by separation or compression of photoreceptors can be a contributing factor to the existence of diplopia and the inability to fuse in patients with macular disease. Concomitant small-angle strabismus and the inability to fuse with prisms may lead the clinician to the incorrect diagnosis of central disruption of fusion. Surgical intervention does not necessarily improve the aniseikonia.

Rapamycin inhibits corneal allograft rejection and neovascularization.

OBJECTIVE: To investigate the immunosuppressive effect of rapamycin in prolonging allograft survival in the rat model of orthotopic allogeneic penetrating keratoplasty. DESIGN: Thirty inbred Lewis rats received corneal allografts from Brown Norway donors. Animals were divided into two rapamycin treatment groups and one allogeneic control group. RESULTS: By the second week after surgery, all of the control animals had experienced allograft failure due to allograft rejection. However, allografts in seven of 10 animals in the low-dose treatment group and allografts in seven of nine animals in the high-dose treatment group remained clear. In addition, corneal neovascularization was markedly reduced in the treated animals. CONCLUSIONS: The systemic administration of rapamycin prolongs corneal allograft survival and significantly inhibits the neovascular component of rejection in the rat model of orthotopic allogeneic penetrating keratoplasty.