An unusual eyelid lump: unsuspected embedded contact lens for up to 40 years. Two cases and literature review.

The purpose of this study is to report two patients with retained rigid gas-permeable contact lenses (RCLs) that had become integrated into the upper eyelid tissues, to provide a brief literature review and to discuss possible aetiologies. The methods used in this study are as follows: retrospective review of clinical records and review of the literature. Two contact lens wearers presented with an upper eyelid mass, one after previous loss of a lens and the other 40 years after a failed trial of RCL wear; this latter case appears to be the longest delay in diagnosis reported in the ophthalmic literature. Although extremely rare, the presence of an upper tarsal lump in a RCL wearer should raise possibility of an embedded contact lens, particularly where the contour is suggestive in size or shape. Ultrasonography or magnetic resonance imaging may show characteristic changes. It is probable that RCL migration into periocular tissues occurs by entrapment above the upper tarsal border and integration, by local tissue necrosis, into the tarsus or pretarsal space.

Effect of posterior capsular opacification on visual function in patients with monofocal and multifocal intraocular lenses.

PURPOSE: To compare the effect of posterior capsular opacification (PCO) on visual function in patients with monofocal and multifocal intraocular lenses (IOLs). METHODS: Thirty-three consecutive patients with clinically significant PCO, 24 with monofocal, and nine with multifocal IOLs, were recruited. Patients with concurrent cause of visual loss or pupillary distortion were excluded. LogMAR high- and low-contrast (10%) distance visual acuity (VA), logMAR near VA, Pelli-Robson contrast sensitivity (CS), colour confusion index (CCI), and the presenting symptoms were compared between the two groups. RESULTS: There was no significant difference between the proportions of patient with different PCO grade in the two groups. At presentation, high- and low-contrast distance VA were significantly greater in the multifocal group (0.40 vs 0.20; P=0.04 and 0.34 vs 0.98; P=0.006), whereas near VA, CS, and CCI were not significantly different between the two groups. After capsulotomy, the above visual functions were not significantly different between the two groups. Blurred distance and near vision were the most common presenting symptoms (95.8 and 100% in the monofocal group and 88.9 and 66.7% in the multifocal group). A greater proportion of patients in the monofocal group had blurred near vision (100 vs 66.7%) and, whereas the symptoms in the majority of patients in the monofocal group were moderate to severe, they were mild to moderate in the multifocal group. CONCLUSION: The effect of PCO on visual function in the two groups seems to be comparable, although patients in the multifocal group appear to present with earlier loss of visual function.

Effect of illumination on visual function after monofocal and multifocal intraocular lens implantation.

PURPOSE: To compare best-corrected visual acuity (BCVA) and contrast sensitivity (CS) under different levels of illumination in patients who had monofocal and multifocal intraocular lenses (IOLs) and to establish the effect of different lighting conditions on vision in the two groups of patients. METHODS: We retrospectively reviewed 27 patients who underwent phacoemulsification for age-related cataract and IOL implantation of either monofocal (SI30NB; n=10, 37%) or multifocal (SA40N; n=17, 63%) IOLs. Binocular distance and near BCVA and CS were tested using logMAR and Pelli-Robson charts that were externally illuminated with 20, 200, 400, and 1600 lux, and were compared using repeated-measures analysis of variance. A questionnaire was administered to establish the lighting preference in the two groups and the effect of lighting conditions on their vision. RESULTS: Binocular distance and near BCVA and CS significantly increased with increasing illumination from 20 to 200 lux in the monofocal (mean=0.04 vs -0.07; P=0.006; 0.37 vs 0.26, P=0.002 and 1.47 vs 1.60, P=0.01) as well as in the multifocal group (mean=0.03 vs -0.12, P<0.001; 0.38 vs 0.23, P<0.001 and 1.47 vs 1.61, P=0.002). No significant difference in BCVA or CS was found between the two groups at any of the four illumination levels. Both groups had similar lighting preference, but 43.8% of patients in the multifocal group experienced subjective worsening of their vision in bright outdoor lights. CONCLUSIONS: Distance and near BCVA and CS improve with increasing illumination in patients with monofocal and multifocal IOLs, but remain comparable in the two groups under common levels of indoor illumination. Patients with multifocal IOLs may experience worsening of their vision in bright outdoor lights.

Granulomatous uveitis in neurological disease.

Five women with granulomatous uveitis were diagnosed as having probable multiple sclerosis. Three of the women developed curious iris nodules that resolved with topical prednisolone acetate treatment. The association of granulomatous type uveitis, with or without iris nodules, should alert the ophthalmologist to inquire about neurological symptoms attributable to multiple sclerosis.

Klebsiella and acute anterior uveitis.

Samples of the faeces of 153 consecutive patients presenting with acute anterior uveitis (AAU), and of 47 controls were examined for the presence of Klebsiella pneumoniae. No increase in the carriage rate of klebsiella was found in the AAU patients as compared with the controls. Furthermore no increase was found in any group of patients whether subdivided by HLA-B27 status, sex, or presence of ankylosing spondylitis (AS). No difference was found between patients having their first attack of AAU and those with recurrences.

Acute anterior uveitis, ankylosing spondylitis, back pain, and HLA-B27.

One hundred and sixty-nine patients with acute anterior uveitis were studied for the presence of HLA-B27 tissue type, radiological evidence of ankylosing spondylitis, and a history of back pain. 60% were male; 45% were HLA-B27+. The male:female ratio in the HLA-B27+ group was the same as in the whole group. 24% had radiological evidence of ankylosing spondylitis, and, of these, 83% were HLA-B27+ while 17% were HLA-B27-. There was a definite correlation between the severity of the ankylosing spondylitis and preponderance of males in the HLA-B27+ group of patients. Significant back pain occurred in 60% of HLA-B27+ patients but in only 14% of HLA-B27- patients. The importance of the selection of patients and of consistency in the use of diagnostic criteria in studies relating to ankylosing spondylitis and acute anterior uveitis is stressed.

Early fundus fluorescein angiographic findings and sequelae in traumatic retinopathy: case report.

A 44-year-old man involved in a minor road traffic accident developed traumatic retinopathy in both eyes. We present the unusual early angiographic findings and the late sequelae of persistent ring scotomata. The previous work on the retinal pathophysiology is reviewed, and we suggest that the total clinical picture in traumatic maculopathy may often be a combination of the 'angiopathic retinal trauma' of Purtscher and the 'commotio retinae' of Berlin, that is, a combination of haemodynamic forces leading to vascular damage in the nerve fibre layer and of direct mechanical forces leading to photoreceptor destruction.