Superior oblique tendon thinning as a surgical treatment for Brown syndrome.

PURPOSE: To evaluate the results of a superior oblique thinning technique for the treatment of congenital Brown syndrome. METHODS: The medical records of consecutive patients at a single institution who were diagnosed with congenital Brown syndrome and underwent superior oblique thinning were retrospectively reviewed. In all cases, the prism cover test was used to assess ocular alignment. Standardized nine-gaze photographs were used to evaluate ocular rotations. Ocular torsion was measured using fundus retinography. Intraoperatively, all patients showed a positive forced duction test for elevation from adduction that became negative after a strongly maintained traction test maneuver. RESULTS: A total of 21 eyes of 20 consecutive patients (mean age, 5.8 ± 2.5 years) were included. Preoperatively, 16 patients were orthotropic in primary position; 4, hypotropic. Postoperatively, all patients were orthotropic in primary position. Limitation of elevation in adduction improved from -3.4 ± -0.6 (range, -2 to -4) to 0.6 ± 1 (range, 0 to -3; P < 0.01). Fundus retinography showed >1° change in ocular torsion after surgery in 3 of 6 patients (P > 0.5). Superior oblique underaction or hypertropia did not occur. No superior oblique palsy appeared in any patient. There were no changes beyond 3 months postoperatively except for 1 patient who relapsed 9 months after surgery and 1 patient who improved after 4 years. CONCLUSIONS: Superior oblique thinning is effective in improving elevation in adduction and hypotropia in primary position in patients with Brown syndrome associated with a thickened superior oblique tendon.

Meridional aniseikonia-causes, symptoms, and therapies.

BACKGROUND: The term aniseikonia refers to the two eyes' appreciating different image sizes when viewing the same object. Meridional aniseikonia can occasionally cause significant distortion of the binocular spatial sense in perceptive patients. METHODS: The medical records of 3 adult patients who complained of binocular spatial distortion consistent with meridional aniseikonia were reviewed retrospectively. Detailed descriptions of symptoms, ocular findings, and management are reported. RESULTS: Each patient had undergone a refraction-altering surgical procedure, and each complained of binocular spatial distortion characterized by a trapezoidal view of square or rectangular shapes. Each patient improved following management of the astigmatic correction. CONCLUSIONS: Patients requiring a new astigmatic correction following cataract or corneal surgery may complain of binocular spatial distortion caused by meridional aniseikonia.

Visual acuity, contrast sensitivity, subjective quality of vision, and quality of life with 4 different multifocal IOLs.

PURPOSE: This prospective, randomized, double-masked, clinical trial was designed to evaluate visual acuity, contrast sensitivity, subjective quality of vision, and quality of life in 47 patients symmetrically, and randomly, implanted with 4 different IOL designs (SN6AD1, SN60D3, ReZoom NXG1, and Tecnis ZMA00), 3 months after cataract intervention. METHODS: Binocular corrected and uncorrected distance visual acuity, binocular distance corrected (BCNVA) and uncorrected (UCNVA) near visual acuity, binocular distance corrected (BCIVA) and uncorrected (UCIVA) intermediate visual acuity, photopic, mesopic, and mesopic with glare contrast sensitivity, quality of vision, and quality of life were evaluated. RESULTS: Statistically and clinically significant differences were found in BCNVA and UCNVA at 33 cm between high and low add power IOLs, while diffractive SN6AD1 lenses achieved better UCNVA at 40 cm than refractive ReZoom IOLs. Asphericity and low add power were found to improve BCIVA. Contrast sensitivity was similarly compromised in all IOL models, although diffractive optics and aspheric profiles performed better in mesopic conditions. All IOL types received similar overall satisfaction and quality of life scores. Whereas ReZoom patients depended on their spectacles for near tasks, intermediate vision was spectacle independent. Photic phenomena were present in all IOLs, albeit more frequent in ReZoom IOLs. CONCLUSIONS: The present results, which reflect IOL characteristics in optics, profile, and add power, may contribute to help surgeons decide on the type of IOL most suitable for each patient, especially those with high visual demands at near and intermediate distances.

Combined retinal detachment and candida chorioretinitis.

To report a case of slowly progressive traction and rhegmatogenous retinal detachment after successfully managed candida chorioretinitis. A 44-year-old immunocompromised woman was treated with voriconazole for fungal chorioretinitis. Six months after onset she developed a combined retinal detachment. Slow progression of retinal detachment was observed and vitrectomy was performed. The macular area remained attached and visual acuity was maintained. Ophthalmologists should be aware of this unusual complication after the resolution of active candida chorioretinitis.