Field defect due to posterior cortical paraxial lens opacity. A case report.

A 60-year-old man had variable visual acuity especially in the right eye for 2 years. The right field of vision showed a hemianopic defect on the nasal side (in addition to reduced visual acuity which was due to nuclear cataract). A localized posterior cortical cataract on the temporal side of the right lens accounted for the nasal field defect since the defect disappeared almost completely on dilatation of the pupil, and completely after cataract extraction. Asymmetrical opacities in the optical media far enough anterior or posterior to the plane of the pupil will produce asymmetrical field defects. (An opacity close to the plane of the pupil will produce concentric constriction.)

Late reoperations for squint.

Ten patients in the age range 2 to 22 years are described who had operations initially for squint in childhood. Nine had had concomitant convergent strabismus and one divergent. All presented again in adult life with a cosmetic complaint, but two also had diplopia. Reoperations were done, age range 14 to 43. These ten were all the "late reoperations" for squint which were done during the four year period 1972 to 1976 by one consultant (C.I.P.). Technically these late reoperations were not difficult, through the amount of change predictable in position of the eyeball could be only approximate. Recession +/- advancement +/- resection of horizontal recti were done in all cases. In one case no medial rectus was identified attached to the eyeball; a mass of tissue behind the caruncle was mobilised and sutured to the globe with resultant good movement. To avoid tethering of the eye by scarred conjunctiva, vertical conjunctival incisions were often converted at suturing to (see article) shaped wounds. The absence of any new cases of diplopia (the two who had it preoperatively retained it without aggravation) is attributed to the fact that all cases were under-corrected, i.e., no convergent or divergent squint was converted into a divergent or convergent squint respectively, so that the non-corresponding image remained within the area of suppression, which probably extends only to the vertical meridian in a squinting eye.