DIAGNOSIS OF VORTEX VARIX USING OPTICAL COHERENCE TOMOGRAPHY AND SCLERAL INDENTATION.

PURPOSE: We report a case of a vortex vein varix diagnosed with optical coherence tomography under globe compression. METHODS: To illustrate the dynamical behavior of a vortex vein varix, optical coherence tomography was performed with and without gentle globe indentation with a cotton swab. RESULTS: A 51-year-old woman was referred by her optician for an incidental finding of a nonpigmented choroidal mass in the right eye. The patient was asymptomatic with a best-corrected visual acuity of 20/16 in both eyes. On fundoscopy, a prominent smooth pink lesion at the level of the superonasal equatorial retina could be observed in the right eye. Peripheral optical coherence tomography over the area revealed dilated choroidal vessels with an overlying healthy retina. Optical coherence tomography scan was repeated applying gentle globe indentation under which the lesion completely collapsed. CONCLUSION: This case illustrates that the diagnosis of a vortex vein varix can be made in clinics using noninvasive tools such as optical coherence tomography. The anatomical localization of the lesion and the pressure-evoked fluctuation of size and shape are important clues which lead to the diagnosis.

Binocular Visual Function in a Pre-Presbyopic Patient with Uniocular Cataract Undergoing Cataract Surgery with a Multifocal Intraocular Lens.

BACKGROUND/AIM: An increasing number of pre-presbyopic patients are undergoing uniocular cataract extraction. We aim to compare the binocular status of subjects with uniocular cataracts, implanted either with a multifocal or a monofocal intraocular lens (IOL). MATERIALS AND METHODS: Subjects were recruited from outpatient ophthalmology clinics and randomized to an IOL type. Corrected and uncorrected LogMAR distance visual acuity (VA) and near and intermediate VA using the Radner reading test were completed. The binocular tests included the Worth Four Dot Test, fixation disparity, TNO stereoacuity and foveal suppression assessment. In addition to the near activity vision questionnaire. The trial was closed early because the chosen multifocal lens had been superseded by newer models. We report two subjects, one receiving the multifocal IOL and a monofocal IOL control with the most comparable baseline characteristics. RESULTS: Both subjects experienced uncomplicated cataract surgery, showing clinically significant improved corrected distance VA, 0.06 LogMAR and -0.16 LogMAR in the monofocal and multifocal IOL, respectively. The multifocal subject had 30 seconds of arc stereoacuity indicating normal binocular vision. Only gross binocular single vision with no stereopsis was found in the monofocal IOL subject. The latter subject also had reduced near vision quality-of-life questionnaire results. CONCLUSION: This two-patient case series demonstrates greater binocular near ability, with the multifocal IOL, in the pre-presbyopic patient undergoing uniocular cataract surgery. The case series highlights the need, and methodology for investigating further the functional and quality-of-life benefits of implanting multifocal IOLs in pre-presbyopic patients, those in their twenties and thirties, undergoing uniocular cataract surgery.

RESCUE PNEUMATIC RETINOPEXY IN PATIENTS WITH FAILED PRIMARY RETINAL DETACHMENT SURGERY.

PURPOSE: To describe the outcome of a series of patients who underwent pneumatic retinopexy (PR) for recurrent retinal detachment after scleral buckling and vitrectomy. METHODS: This is a retrospective review of 42 consecutive cases who underwent secondary PR after either scleral buckling (n = 22) or vitrectomy (n = 20) between 1995 and 2011. Fisher's exact and nonparametric tests were used for comparison. RESULTS: Hundred percent of patients in the scleral buckle group and 90% of the vitrectomy group were repaired with 1 PR procedure (P = 0.67). The two patients in the vitrectomy group failed because of presumed new breaks and proliferative vitreoretinopathy. The median time between the primary procedure and PR was 8.5 days for the scleral buckle group (interquartile range, 5-55 days) and 31.5 days for the vitrectomy group (interquartile range, 21-52 days) (P = 0.003). Postoperative median visual acuity improved by more than 2 logMAR lines in both the scleral buckle group (P = 0.0008) and the vitrectomy group (P = 0.007), with no difference between groups (P = 0.19). The overall complication rate in our patients was 16%, including transient intraocular pressure rise and development of tears requiring further indirect laser retinopexy within 3 months. None of the patients had vitreous hemorrhage, subretinal gas, or endophthalmitis. CONCLUSION: Rescue PR seems to be a safe and effective method of treating recurrent retinal detachment after both unsuccessful scleral buckling and vitrectomy.

Acquired dyschromatopsia in acute myelocytic leukaemia.

BACKGROUND: Patients with haematological malignancy are referred to the ophthalmologist either with visual symptoms or to exclude orbital or intraocular involvement after the diagnosis has been established. This report describes a patient with acute myelocytic leukaemia (AML) whose presenting symptom was dyschromatopsia. METHODS: A 52-year-old female, previously in good health, presented with a disturbance of colour vision. On examination, there was bilateral reduction in visual acuity, impaired colour vision and severely constricted visual fields. Electrophysiological testing and colour contrast sensitivity (CCS) assessment were performed. RESULTS: CCS showed bilateral threshold elevation in the tritan axis of both eyes, right worse than left. Pattern ERG showed marked macular dysfunction in the right eye, but was normal in the left eye. Full-field ERGs fell within the normal range. Pattern VEPs were reduced in the right eye, without peak time shift; flash VEPs showed bilateral delay. Investigation showed severe anaemia, and a bone marrow biopsy confirmed a diagnosis of acute AML. There was symptomatic improvement in visual acuity and colour vision following blood transfusion and initiation of chemotherapy. CONCLUSION: This appears to be the first case report of dyschromatopsia in AML with symptomatic improvement following treatment. The case lends support to previously suggested hypotheses of chromatic visual disturbance in association with presumed hypoxia.

Using spectral-domain optical coherence tomography imaging to identify the presence of retinal silicone oil emulsification after silicone oil tamponade.

PURPOSE: To describe small hyperreflective areas using spectral-domain optical coherence tomography (SD-OCT) imaging in eyes that have had silicone oil tamponade. METHODS: Retrospective case series of 11 eyes of 11 patients. The authors retrospectively identified patients who underwent vitrectomy and silicone oil tamponade secondary to a rhegmatogenous retinal detachment (nine patients), panuveitis with retinal necrosis (one patient), or recurrent full-thickness macular hole surgery (one patient) who had manifestations of silicone oil emulsion on SD-OCT imaging. Patients were monitored during the postoperative period by clinical examination and using SD-OCT. A model eye in which emulsified silicone oil had been injected in the anterior chamber was used to obtain anterior segment SD-OCT images for comparison. RESULTS: The mean age of our patients was 50 years (range, 39-76 years). In eight eyes, the SD-OCT examination was carried out after silicone oil removal, and in three eyes, the SD-OCT examination was carried out with the oil in situ. Of the nine eyes treated for rhegmatogenous retinal detachment, five had a relieving retinectomy for advanced anterior proliferative vitreoretinopathy or for traumatic retinal incarceration (one eye). The eye treated for full-thickness macular hole had a vitrectomy, internal limiting membrane peel, and silicone oil injection for recurrent macular hole. Ten eyes showed hyperreflective, spherical, tiny droplets using SD-OCT imaging. These were thought to represent silicone oil droplets intraretinally or underneath epiretinal membranes, and one eye showed hyperreflective areas subretinally (retina detached). One additional patient was found to have tiny intravitreal silicone oil droplets after silicone oil removal. Similarly, the silicone oil appeared as multiple hyperreflective spherical droplets as detected by SD-OCT. Anterior segment studies of silicone oil emulsification in the experimental model revealed a similar appearance to that seen with in vivo SD-OCT imaging. CONCLUSION: The authors have found small hyperreflective areas intraretinally, subretinally, and underneath epiretinal membranes on SD-OCT in eyes that have had silicone oil tamponade for a variety of indications. The authors have seen a similar appearance when silicone oil emulsification is examined in vivo. The authors conclude that the hyperreflective areas are likely (but not certain) to be very small bubbles of emulsified silicone. Further studies are required to determine the incidence, clinicopathologic, and functional significance of probable silicone oil emulsification and deposition within the retinal layers.

Palinopsia as the initial manifestation of non-hodgkin's lymphoma.

A 37-year old general practitioner thought to be in good health presented to the ophthalmology department with palinopsia, headaches and transient visual obscurations. A CT scan revealed a large destructive lesion centred on the occiput and stealth guided excisional biopsy of the occipital lesion showed diffuse large B cell, Non-Hodgkin's lymphoma (NHL) infiltration. To the best of our knowledge this is only the second report of a patient with NHL presenting with palinopsia.

Orbital cysticercosis, case report and review.

Orbital cysticercosis is secondary to an infestation by cysticercus cellulosae, the larval form of Taenia solium.Orbital cysticercosis may present with a wide spectrum of clinical findings and result in significant ocular morbidity. Although traditionally thought to be only prevalent in endemic regions with poor sanitation, immigration requires even ophthalmologists practicing in industrialised counties to be aware of this masquerading condition's presentation and treatment.We report the clinical manifestation of a case of orbital cysticersosis that presented with recurrent orbital inflammation for almost a year. We also present a literature review of the different ocular manifestations, diagnostic and treatment modalities.

Opacification of Array SA40N silicone multifocal intraocular lens.

We report opacification of 2 multifocal intraocular lenses (IOLs). Patients with these IOLs may be more likely to require IOL explantation than those with monofocal IOLs.

Increased crystalline lens thickness and phacomorphic glaucoma in patients with Fanconi anemia.

We describe 2 siblings with Fanconi anemia (FA). One developed phacomorphic glaucoma, and both had increased crystalline lens thickness, features that have not been reported in patients with FA. The possible pathogenesis and clinical implications of the findings are discussed.

Incidence and risk factors of Nd:YAG capsulotomy after phacoemulsification in non-diabetic and diabetic patients.

PURPOSE: To estimate the cumulative incidence and identify the risk factors of posterior capsule opacification (PCO) that required Nd:YAG capsulotomy in non-diabetic and diabetic patients. METHODS: Retrospective case-note review of 806 consecutive patients that underwent phacoemulsification and intraocular lens (IOL) implantation, 327 (40.6%) of whom were diabetic. RESULTS: The cumulative incidence of Nd:YAG capsulotomy were 10.6%, 14.8%, 21.2% and 28.6% in non-diabetic patients; and 9%, 9.4%, 15.3% and 5.3% in diabetic patients after 1, 2, 3 and 4 years, respectively. A multivariate Cox regression analysis showed that, over the follow-up period, diabetes mellitus was associated with a decreased risk of Nd:YAG capsulotomy (hazard ratio [HR]=0.69; 95% confidence interval [CI] 0.47-0.99; P=0.047), whereas age of 65 years or younger (HR=1.58; 95% CI 1.09-2.27; P=0.02), polymethylmethacrylate (PMMA) (HR=3.98; 95% CI 1.60-9.95; P=0.003) or plate-haptic silicone IOLs (HR=3.75; 95% CI 1.60-8.80; P=0.002) in comparison with three-piece silicone IOLs, postoperative inflammation (HR=2.62; 95% CI 1.56-4.42; P<0.001) and pars plana vitrectomy (HR=1.85; 95% CI 1.20-2.83; P=0.005) were associated with an increased risk. Subgroup analysis showed that in non-diabetic patients, male gender (HR=1.63; 95% CI 1.04-2.57; P=0.03) was an additional risk factor and in diabetic patients there was no significant association between diabetes type, duration or retinopathy grade and the risk of Nd:YAG capsulotomy. CONCLUSION: Although diabetes mellitus appears to be associated with a lower long-term incidence and a decreased risk of Nd:YAG capsulotomy, younger age, pars plana vitrectomy, postoperative inflammation, plate-haptic silicone and PMMA IOLs in addition to male gender in non-diabetic patients appear to be associated with a greater risk. Estimation of the incidence and risk factors of PCO should help in patient counselling and to design methods to reduce or prevent its development.

Hydrophobic acrylic and plate-haptic silicone intraocular lens implantation in diabetic patients: pilot randomized clinical trial.

PURPOSE: To compare the capsular and uveal reaction after implantation of a plate-haptic silicone intraocular lens (IOL) (C11UB, Chiron) and a hydrophobic acrylic (AcrySof MA60, Alcon) IOL in diabetic patients. SETTING: Moorfields Eye Hospital and St. Thomas' Hospital, London, United Kingdom. METHODS: Thirty-five diabetic patients were recruited consecutively and randomly assigned to have implantation of either of the 2 IOLs. The percentage area of posterior capsule opacification (PCO), anterior capsule contraction (ACC), and postoperative inflammatory indices (flare and cells) were assessed objectively at 2 to 3 weeks, 6 months, and 1 year. Between-group and within-group analyses were conducted using the Student t test or Mann-Whitney test and Friedmann test, respectively. RESULTS: Between-group analysis showed the percentage area of PCO was significantly greater in patients with plate-haptic silicone IOLs at 6 and 12 months (P = .002). At 6 months, ACC was significantly greater in the plate-haptic group (P = .04), but the difference was not significant at 12 months. There was higher flare in the hydrophobic acrylic IOL group than in the plate-haptic silicone IOL group at 2 to 3 weeks (P = .08). Within-group analysis showed that over the follow-up period, the plate-haptic silicone group, but not the hydrophobic acrylic group, had a progressive increase in PCO (P = .003). In the hydrophobic acrylic group, but not the plate-haptic silicone group, there was a significant reduction in the mean anterior chamber flare value (P = .01). There was no significant difference in visual acuity or contrast sensitivity at any postoperative visit. CONCLUSION: In diabetic patients, hydrophobic acrylic IOLs can lead to an increased flare in the early postoperative period but they seem to be more favorable than plate-haptic silicone IOLs because the latter lead to more PCO.

Anterior uveitis and congenital fibrosis of the extraocular muscles in a patient with Noonan syndrome.

We describe a patient with Noonan syndrome who presented with Human Leukocyte Antigen B27-associated recurrent acute anterior uveitis and manifestations of congenital fibrosis of the extraocular muscles, which has not been reported before.