Pupil size in Jewish theological seminary students.

PURPOSE: To investigate the authors' clinical impression that pupil size among myopic Jewish theological seminary students is different from pupil size of similar secular subjects. METHODS: This cross-sectional study was conducted on 28 male Jewish theological seminary students and 28 secular students or workers who were matched for age and refraction. All participants were consecutively enrolled. Scotopic and photopic pupil size was measured by means of a Colvard pupillometer. Comparisons of various parameters between the groups were performed using the two-sample t-test, Fisher exact test, a paired-sample t-test, a two-way analysis of variance, and Pearson correlation coefficients as appropriate. RESULTS: The two groups were statistically matched for age, refraction, and visual acuity. The seminary students were undercorrected by an average of 2.35 diopters (D), while the secular subjects were undercorrected by only 0.65 D (p<0.01). The average pupil size was larger in the religious group under both scotopic and photopic luminance. This difference was maintained when the two groups were compared according to iris color under both conditions, reaching a level of statistical significance (p<0.0001). There was a significant difference in photopic pupil size between dark and light irises (p=0.049), but this difference was not maintained under scotopic conditions. CONCLUSIONS: The average pupil size of young ultraorthodox seminary students was significantly larger than that of matched secular subjects. Whether this is the result of intensive close-up work or of apparently characteristic undercorrection of the myopia is undetermined.

Axial length, refractive error, and keratometry in patients with branch retinal vein occlusion.

PURPOSE: To evaluate ocular parameters that may predispose to the development of branch retinal vein occlusion (BRVO). METHODS: This prospective study included patients with unilateral BRVO evaluated in the authors' clinic. The mean period from the acute phase was 2.29 +/- 1.57 years (range 1-6 years). All patients underwent a complete ophthalmologic examination including subjective refraction, axial length measurements, and keratometry readings. The fellow eye served as a control in each patient. The variables of interest were compared between the affected eye and the fellow eye using the parametric t-test and the nonparametric Wilcoxon test. RESULTS: Twenty-four consecutive patients (14 women, 10 men, mean age 62.4 years) were included in the study. The mean axial length in the affected eye was significantly shorter compared to the mean fellow eye length. No difference was found between the two eyes in mean subjective refraction or mean keratometry readings. CONCLUSIONS: The authors found that eyes with BRVO have a shorter axial length compared to the fellow eye in the same patient.

Capsular bag distension associated with sulcus implantation of intraocular lenses.

Capsular bag distension syndrome after endophacoemulsification and in-the-bag intraocular lens (IOL) implantation has been reported. We describe 2 cases in which sulcus implantation of a posterior chamber IOL caused marked capsular bag distension. Both cases resolved with conservative treatment or a neodymium:YAG posterior capsulotomy.

Iris retraction syndrome associated with nonrhegmatogenous retinal detachment.

PURPOSE: To present the first documentation of iris retraction syndrome in eyes with nonrhegmatogenous retinal detachment. PATIENTS AND METHODS: One patient with age-related macular degeneration and another with panuveitis developed exudative retinal detachment with iris retraction configuration. Ultrasound biomicroscopy was performed to investigate the anatomic relationship of structures in the anterior segment of the eye. RESULTS: Ultrasound biomicroscopy demonstrated a severe backward bowing of the peripheral iris with irido-ciliary body and irido-zonular contact as well as broad iris lens touch. The iris retraction syndrome resolved after pupil dilation and disruption of the pupillary adhesions in both cases. The retinal detachment resolved several months later, without surgery. CONCLUSION: Iris retraction syndrome appears not to be exclusive to rhegmatogenous retinal detachment but can present in eyes with exudative - nonrhegmatogenous retinal detachment. Thus, when the configuration of the iris shows bowing in patients with retinal detachment, iris retraction syndrome should be considered and prompt pupil dilation should be carried out.

Silicone oil for complicated retinal detachment in the pediatric population.

We presented our results with silicone oil in vitreoretinal surgery in pediatric patients. The retinas reattached in 58% but corneal opacification occurred in 75% and glaucoma in 25%. Our results indicate that silicone oil should be considered in otherwise hopeless cases of retinal detachment surgery in children.

Treatment for 'A' or 'V' pattern esotropia by slanting muscle insertion.

BACKGROUND: Patients with 'A' or 'V' pattern esotropia without vertical muscle overaction have traditionally been treated with medial rectus recession and vertical transposition of the muscle insertions. METHOD: Seven cases are presented treated by slanting muscle insertions, whereby the lower margin of the medial rectus is preferentially recessed more than the upper margin in esotropia, and the upper margin is recessed more than the lower margin in A esotropia. RESULTS: All seven patients had their A or V patterns eliminated, with six achieving good alignment in all positions of gaze. CONCLUSION: The slanting muscle insertion should be considered as an alternative technique in all cases of A or V pattern esotropia.

Tono-Pen tonometry in normal and in post-keratoplasty eyes.

Oculab Tono-Pen tonometry was compared with Goldmann applanation tonometry in 82 eyes of 82 patients with normal corneas and in 54 eyes of 54 patients who had undergone penetrating keratoplasty and whose corneas did not preclude the use of Goldmann tonometer. We found that the intraocular pressure (IOP) in 48% of the eyes with normal corneas and in 57% after keratoplasty has different measurements with Goldmann and Tono-Pen pressures of 3 mm Hg or more. Despite the correlation between the Goldmann tonometer and the Tono-Pen in the group of eyes with normal corneas (r = 0.83) as well as in the group of eyes after keratoplasty (r = 0.79) the Tono-Pen tended to significantly overestimate the Goldmann tonometer reading (p < 0.0001). The mean difference between the two instruments was highest across the lower IOP range (< 9 mm Hg) in the group of eyes after keratoplasty. Because the mean absolute values of the paired differences between Goldmann and Tono-Pen measurements varied significantly across all IOP intervals it was not possible to establish a correction factor which could be used when comparing the two measurements. Based on this study the Tono-Pen consistently overestimated the actual IOP in an unpredictable manner. Where possible Goldmann measurements of the IOP are still to be preferred.

Atropine in keratoplasty for keratoconus.

A prospective study of 83 eyes in 76 consecutive patients undergoing keratoplasty for keratoconus is presented in which 1% atropine was routinely given at the end of surgery. No case of permanent mydriasis was seen. The syndrome described in the literature of fixed, dilated pupil after the use of atropine in keratoplasty no longer seems to exist and the warning against strong mydriatics appears unwarranted.

Pigmented pupillary pseudomembranes as a complication of argon laser iridotomy.

Two cases are reported in which pupillary pigment occlusion occurred after argon laser iridotomy, reducing visual acuity and preventing fundus visualization. Laser-induced inflammation and subsequent long-term miotic therapy are probably responsible for this complication. Periodic pupillary dilatation is recommended in eyes that require miotics to control their intraocular pressure after laser iridotomy.

Orbital haemorrhage induced by labour.

A case of acute orbital haemorrhage induced by labour is reported in a woman giving birth for the eighth time. The diagnosis was confirmed by computed tomography. The haemorrhage subsided spontaneously within three weeks. The mechanism of orbital haemorrhage following certain kinds of strain is discussed.

Clearing of corneal argyrosis by YAG laser.

A 75-year-old woman with corneal argyrosis was treated by a Q-switched Nd-YAG laser iridotomy after acute angle closure glaucoma. Each laser shot caused clearance of the argyrotic deposits anterior to the iridotomy site. The same effect was seen when a preventive iridotomy was performed in the other eye. The areas of clear cornea remained unchanged for a follow-up period of eight months.

Pterygium and basic tear secretion.

In order to investigate the correlation between the occurrence of pterygium and dryness of the eyes, a Schirmer's No. 1 test was done on both eyes in 60 patients with unilateral pterygia. No difference was found between the mean basic secretion of tears in the diseased eyes (15.33 +/- 8.09 mm) and the fellow eyes (15.65 +/- 7.89 mm), and both were in the normal range for this test. This data suggest that dryness of the eyes cannot be regarded as the cause of pterygium.

Bilateral Duane's syndrome associated with crocodile tears.

The rare association of two syndromes of paradoxical innervation, bilateral Duane's retraction syndrome and congenital crocodile tears is presented. This association assumes a central localization to explain both anomalies.