Strabismus precipitated by monovision.

PURPOSE: To present patients who had the onset of strabismus or the recurrence of strabismus after converting to a monovision system of seeing. DESIGN: Retrospective interventional case series. METHODS: Clinical records of 12 patients from the private practice of the corresponding author of this paper (Z.F.P.) were reviewed. Patients obtaining monovision via contact lenses, LASIK, and cataract surgery with posterior chamber intraocular lenses were studied if their monovision produced a new strabismus or was related to the recurrence of a previous strabismus. RESULTS: All patients were first treated by converting the monofixing near eye to distance vision and then using reading glasses for near work. Of the 12 patients, 7 regained their fusion by doing away with monovision and 5 required surgery to reestablish motor or sensory control. All of the surgery patients obtained an excellent alignment but 1 did not regain sensory fusion. CONCLUSION: Monovision is successful for the far majority of patients who try it. However, in patients with a previous history of strabismus or those with significant phorias, caution should be used in recommending monovision, and if monovision is elected, keeping the anisometropia to small levels such as 1.25 to 1.50 diopters (D) might lessen the chance of producing strabismus post monovision. The majority of our patients developed strabismus after 2 years of monovision, telling us that while a trial of monovision with a contact lens prior to surgery may suggest that the patient could tolerate monovision, it is not a guarantee.

IgA orbital plasmacytoma in multiple myeloma.

The authors report a case of orbital plasmacytoma in a 48-year-old man with known multiple myeloma. He presented with proptosis, diplopia, and decreased vision of the left eye for several weeks. He had been previously treated for IgA lambda multiple myeloma with chemotherapy, radiation, and autologous stem cell transplant. After a left orbitotomy, flow cytometry revealed a tumor rich in plasma cells expressing CD138 with equivocal lambda light chain expression. The patient underwent orbital radiation, with improvement of vision and disc edema OS. The patient is currently undergoing salvage chemotherapy for relapse of multiple myeloma. This is the third reported case of IgA myeloma involving the orbit.

Collagen-based dermal fillers: past, present, future.

The demand for dermal fillers and the variety of dermal fillers available have evolved dramatically during the past 2 decades. Collagen was the first material to be approved by the U.S. Food and Drug Administration (FDA) for injection into facial scars, furrows, and lines. Bovine collagen (95% type I and 5% type III collagen) was approved in 1981; buffered collagen Zyderm I and Zyderm II followed by Zyplast were FDA approved and released shortly thereafter. This article will focus on the historical benefits and risks of collagen injections and the typical outcomes. With the advent of hyaluronic acid products and other options, the risks of collagen and limited benefit have caused a marked loss of market share. Specifically, allergy is a major concern. As a result, two rounds of skin testing are required adding inconvenience and delay for both the practitioner and patient. Furthermore, a negative skin test does not guarantee allergic reactions or other more serious side effects will not occur. Finally, the perceived clinical efficacy is often short lived despite histopathologic assessments showing that collagen persists at best 9 months.

Cost-utility analysis of screening and laser treatment of retinopathy of prematurity.

PURPOSE: Retinopathy of prematurity (ROP) is a major cause of lifelong blindness beginning in infancy. Utility analysis is used to describe the effect of illness and medical intervention on an individual's quality of life during the course of a lifetime. In this study, cost-utility analysis is used to evaluate the cost-effectiveness of both screening and laser photoablation for ROP. METHODS: Data from 2 neonatal intensive care units were recorded for infants screened and treated for ROP between March 4, 2004, and January 5, 2006. The cost model was developed using procedures classified by Current Procedural Terminology and the costs paid for by the Centers for Medicare and Medicaid Services for 2006. Visual acuities were obtained from 10-year post-laser data and from the 10-year post-CRYO-ROP untreated cohort. RESULTS: During the study period, 515 infants received screening and treatment for ROP. They required a mean 3.4 exams per infant; 11.2% received laser photoablation. Mean visual acuities were 0.5 (Snellen 20/40) for laser-treated eyes and 0.20 (Snellen 20/100) for those who did not receive treatment. The cost-effectiveness of screening and laser photoablation of ROP in 2006 is $650/quality-adjusted life years. When discounted 3% per year for the time value of money, the cost is $1,565/ quality-adjusted life years. CONCLUSIONS: The screening and laser photoablation of ROP continue to be extremely cost-effective medical interventions.