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Refractive changes in silicone filled eyes.

In this study we examined refractive changes of 34 eyes in 34 patients treated with silicone oil injection. Six patients presented with aphakic retinal detachment, another 14 were rendered aphakic after silicone oil injection, one was pseudophakic and 13 were still phakic at the time of writing this report. Silicone oil in the vitreous cavity induced a myopic shift in aphakic eyes and a hypermetropic shift in phakic eyes. This tended to render phakic high myopes and aphakes closer to emmetropia. The resultant refraction was dependent on the shape of the silicone oil bubble inside the eye and influenced by the posture of the patient. In phakic patients the ability to accommodate was markedly reduced.

Accommodation, Ocular↗

Gyrate atrophy of the choroid and retina with hyperornithinaemia, cystinuria and lysinuria.

The case of a 45-year-old woman with gyrate atrophy of the choroid and retina is documented. Additional features in this case, to the authors' knowledge not previously described in gyrate atrophy, are massive cystinuria, massive lysinuria, axial hypermetropia and diabetes. Gyrate atrophy is a rare autosomal recessive degenerative disease of the choroid and retina and is accompanied by defective ornithine metabolism. Simell and Takki demonstrated the association with hyperornithinaemia in 1973. The main metabolic features are those of hyperornithinaemia and ornithuria caused by a deficiency of the mitochondrial matrix enzyme, ornithine aminotransferase (OAT). The responsible human gene has been localised to chromosome 10. Despite the generalised deficiency of OAT, the literature indicates significant pathological involvement of the eye only. Ophthalmological features of the disease are myopia (up to 10-20 dioptres), night blindness, constricted visual fields and complicated cataracts. The clinical picture has been detailed previously by various authors. The case of a 45-year-old woman with gyrate atrophy and hyperornithinaemia is documented here. She has been followed up for 12 years and fully investigated. Additional features in this case, to our knowledge not previously described in gyrate atrophy, are massive cystinuria, massive lysinuria, axial hypermetropia and diabetes.

Adult↗

Photorefractive keratectomy in refractive accommodative esotropia.

Photorefractive keratectomy (PRK) was performed on a 19-year-old man with hyperopic astigmatism and refractive accommodative esotropia. The patient was orthophoric while wearing spectacles, but had an esotropia of 30 prism dioptres at near and distance vision without spectacles. The best corrected visual acuity of the right eye was 20/50 and of the left eye was 20/20. The excessive accommodative convergence of the patient was eliminated by correcting the hyperopic refractive error by performing PRK, and the patient became orthophoric after the treatment.

Adult↗

Acute acquired comitant esotropia: a prospective study.

PURPOSE: To define the clinical characteristics of patients presenting with acute onset esotropia and features suggestive of possible underlying central nervous system pathology. To assess the prognosis for the return of binocular function and to consider the most appropriate management. METHODS: A prospective clinical study was carried out of all patients presenting to the department of paediatric ophthalmology at a university teaching hospital over the period January 1994 to April 1997. Each patient underwent a full ophthalmological examination (including assessment of sensory status). All patients were referred to a paediatric neurologist for examination and CT and/or MRI scan. RESULTS: Ten patients presented during the study period. Uncorrected hypermetropia and/or decompensated monofixation syndrome were the commonest aetiological factors. One patient was found to have a cerebellar tumour. In 5 patients prescription of the full hypermetropic correction alone was sufficient to restore binocularity. Five patients required bilateral medial rectus recession. Binocular function was restored in all cases--in 5 cases with bifoveal fusion. CONCLUSION: Decompensation of a pre-existing phoria or monofixation syndrome appears the commonest aetiology. Prescription of the full hypermetropic correction found at cycloplegic refraction forms an essential part of initial management. No single clinical sign can reliably indicate the rare patient harbouring a tumour. A high index of suspicion should be maintained and neuro-imaging considered in the absence of expected findings such as hypermetropia or fusion potential or in the presence of atypical features or neurological signs.

Acute Disease↗

Silicone intraocular lens compression and double lens implants in diseased eyes.

PURPOSE: To assess the outcomes of double lens implants in hyperoptic eyes with associated pathology. METHOD: Double lens implants were used in 4 eyes of 4 patients each with a different ophthalmic or neuro-ophthalmic disease. Biometry was performed in the standard contact fashion and lens power formulae used included SRK/T, Holladay and Hoffer Q. RESULTS: Average spherical equivalent refraction improved from +6.875 D to +0.38 D. Absolute average prediction error was greatest for SRK/T (2.65 D) and least for Holladay (1.73 D). Refractive suprises were influenced by the underlying disease process. One patient showed central lens compression. CONCLUSION: Underlying disease can produce biometry errors. Structural ophthalmic or neurological disease is not a contraindication to the use of double lens implants. Double lens implants are useful to correct refractive error in the presence of underlying disease.

Adult↗

Up-shoot in adduction has no prognostic value for decompensation in refractive accommodative esotropia.

PURPOSE: To assess whether up-shoot (elevation) in adduction has any prognostic value for the functional outcome of binocular vision in fully refractive accommodative esotropia (RAET). METHODS: A retrospective study was performed on 58 patients initially diagnosed with RAET who were followed for at least 4 years. RESULTS: Without glasses, up-shoot in adduction with or without a V pattern was detected in 22 of 51 patients who maintained normal binocular alignment during the whole follow-up and in 3 of 7 patients who lost normal binocular vision and showed a manifest esotropia despite glasses at any time of the follow-up. Up-shoot in adduction was still present through glasses only in 3 patients among these 25 cases. Two of these remained fully compensated with glasses during the considered period. The third case developed up-shoot in adduction after decompensation of a previously compensated strabismus. CONCLUSIONS: Up-shoot in adduction is not a common sign in RAET. When present, it does not necessarily represent a negative prognostic sign for preservation of normal binocular vision through glasses in this condition. Up-shoot in adduction can develop after the loss of alignment in some decompensated patients. There is therefore no evidence in favour of a cause-effect relationship between up-shoot in adduction and loss of binocularity in RAET.

Accommodation, Ocular↗

Peripapillary atrophy in elderly Chinese in rural and urban Beijing.

PURPOSE: To determine peripapillary atrophy in elderly Chinese in an urban and rural regions of Beijing. METHODS: The Beijing Eye Study a population-based, cross-sectional cohort study, included 4,439 subjects out of 5,324 subjects who were asked to participate (response rate 83.4%). Mean age was 56.2+/-10.6 years (range, 40-101 years). Colour optic disc photographs (30 degrees ) were morphometrically examined. Peripapillary atrophy was divided into alpha zone and beta zone. RESULTS: Optic disc photographs were available for 4,027 (90.7%) subjects. Alpha zone and beta zone, respectively, were present in 2,867 (71.2%) subjects and 802 (19.9%) subjects, respectively, measuring 0.52+/-0.64 mm(2) and measuring 0.46+/-1.82 mm(2). Both zones were significantly widest and found significantly (P<0.001) most often in the temporal peripapillary region, followed by the temporal inferior region, the temporal superior region, and finally the nasal region. Size of both zones was significantly correlated with optic disc size (P<0.001), age (P<0.001), and myopic refractive error (P<0.001). Both zones increased significantly with decreasing uncorrected visual acuity (P<0.001) and decreasing best-corrected visual acuity (P<0.001). They did not vary significantly (P=0.10; and P=0.78) between male and female subjects. In multivariate analysis, the relationships between both zones and age, myopic refractive error, disc size, and uncorrected and best-corrected visual acuity remained statistically significant (P<0.001). CONCLUSIONS: Alpha zone and beta zone of peripapillary atrophy, respectively, occur in about 70 and 20%, respectively, of elderly Chinese. As peripapillary atrophy changes in glaucomatous optic neuropathy, these normative data may be helpful for glaucoma detection.

Adult↗

A longitudinal study of cycloplegic refraction in a cohort of 350 Japanese schoolchildren. Anisometropia.

The intereye difference of cycloplegic refraction was determined in a cohort of 350 rural Japanese schoolchildren aged 6 to 11 years. The intereye spherical difference remained statistically unchanged throughout 5 years, with mean value ranging from 0.21 to 0.28 D, median from 0.15 to 0.20 D, and the 95th percentile from 0.58 to 0.85 D. The prevalence of 1.0 D or greater spherical anisometropia was up to 3.1%. Linear regression analyses of the longitudinal data from individual children revealed that 295 (84.3%) children and remained unchanged while 55 (15.7%) showed significant increase or decrease in the amount of anisometropia with increasing age. The intereye astigmatic difference was also statistically unchangeable, with mean value ranging from 0.28 to 0.36 D, median from 0.20 to 0.39 D, and the 95th percentile from 0.70 to 0.90 D. The prevalence of 1.0 D or greater astigmatic anisometropia was up to 4.3%. There was a significant correlation between the spherical and astigmatic anisometropia. The results show the current state of intereye refractive difference in Japanese schoolchildren, demonstrating that it remains unchanged and significant anisometropia is rare during school age.

Anisometropia↗

Ocular components values and their intercorrelations in Saudi Arabians.

There are no previous studies on the dimensions of ocular components and their intercorrelations in adult Saudi Arabians. In this study ocular components were measured by ultrasonography and keratometry in 152 adult Saudis. Their ages ranged from 16 to 50 years. The males had significantly longer anterior chamber depth (ACD), vitreous chamber depth (VCD), axial length (AL) and axial length/corneal radius ratio (AL/CR) than females. However, females had non-significantly steeper corneas than males. The AL/CR ratio had the highest correlation with refractive error. Corneal radius of curvature was positively correlated with VCD and AL. Lens thickness was negatively correlated with the VCD, AL and AL/CR ratio. Myopes had significantly deeper ACD, VCD, and higher AL/CR ratio than nonmyopes. Myopes had significantly thinner lenses than hyperopes. The average values of the optical components and their intercorrelations are similar to reported values obtained from subjects of other races but with comparable refractive errors.

Adolescent↗

Criteria for prescribing optometric interventions: literature review and practitioner survey.

The core function of optometrists is the prescribing of refractive corrections, yet a literature review revealed a lack of evidence-based research on criteria for determining when a refractive correction is required. The reported criteria used by practising optometrists were investigated using a questionnaire to survey prescribing habits for borderline hypermetropia, presbyopia, astigmatism, and horizontal and vertical heterophoria. Thirty-eight questionnaires were returned and the results analysed. We calculated the 'cut off' point above which the anomaly would be corrected over 50% of the time that it was encountered. There was a large variation for each category, but it was clear that the presence or absence of symptoms was an important factor for most optometrists when deciding whether to correct a small error. It was found that for symptomatic patients, most optometrists would correct an anomaly if it reached: +1.00 D of hypermetropia, a reading addition of +0.75 D for presbyopia, -0.75 DC of astigmatism, 1.5 prism dioptres (Delta) of horizontal aligning prism, and 1 Delta of vertical dissociated heterophoria. For asymptomatic patients, optometrists would not correct any of the hypermetropic anomalies or heterophorias that were specified in our questionnaire. However most would correct a presbyopic error of +1.50 D or above, or an astigmatic error of -1.50 DC or above, even in the absence of symptoms. These results were compared with previously published guidelines.

Adult↗

The relationship between the Stiles-Crawford effect of the first kind (SCE-I) and myopia.

The Stiles-Crawford effect of the first kind (SCE-I) was measured on both emmetropic and myopic subjects at six different retinal locations. The results revealed a number of significant discrepancies in receptor alignment between the groups of different refractive errors. In myopic subjects, the receptors in the nasal retina (i.e. between the fovea and the optic nerve head) were found to be aligned nasally towards the optic nerve head, whereas the receptors in the temporal retina were aligned towards the centre of the exit pupil. In emmetropic subjects, the receptors across the retina were finely tuned towards the centre of the exit pupil. The magnitude of the receptor displacement in myopic subjects was found to be directly associated with the length of the eyeball.

Adolescent↗

[Scheimpflug photographic imaging following implantation of anterior and posterior chamber phakic intraocular lenses: preliminary results].

BACKGROUND: For the correction of refractive errors lenticular procedures are increasingly used in addition to corneal refractive surgery. One of those techniques is the implantation of intraocular lenses into phakic eyes (pIOL). Due to the close neighborhood of the implant to delicate intraocular structures, exact positioning and high postoperative stability are required. Scheimpflug photography has been shown to be a suitable instrument for the biometry of the anterior eye segment and the examination of IOL position. PATIENTS AND METHODS: Four anterior chamber phakic IOLs (pIOLs) (Bausch & Lomb NuVita) and 7 posterior chamber pIOLs (Staar ICL) were examined 1 week, 1 month and 3-6 months following implantation. At each examination 1 Scheimpflug slit image and 1 infrared retroillumination image were taken using the anterior eye segment analysis system EAS-1000 (Nidek Co., Gamagori, Japan). Evaluation of the images was performed with a personal computer and the software provided by the manufacturer. The distance of the pIOL to cornea and human lens was calculated and incidence and amount of pIOL rotation around the optical axis and potential crystalline lens opacification were assessed. RESULTS: The distance between the anterior chamber pIOL and the cornea 1 week after implantation was 1.61 +/- 0.10 mm. The distances between the myopic posterior chamber pIOL and the human lens were 0.34 +/- 0.11 mm and between the hyperopic posterior chamber pIOL and the human lens 0.26 and 0.29 mm, respectively. The values were constant over a period of 3-6 months. The pIOL showed no movement or change of position around the optical axis. There was no detectable cataract formation in the human lens. CONCLUSIONS: All implanted phakic anterior and posterior chamber IOLs showed a stable position in the eye within the observation period. Scheimpflug photography is proved to be a useful technique for the postoperative evaluation of the positioning of phakic IOLs.

Anterior Chamber↗

[Flap Amputation in Mycobacterium chelonae Keratitis after Laser-in-situ Keratomileusis (LASIK)].

BACKGROUND: Keratitis due to Mycobacterium chelonae after laser-in-situ keratomileusis (LASIK) is a rare, but severe complication. In the following report, we present clinical findings, microbiological investigation, treatment and outcome of the first case of Mycobacterium chelonae reported in Europe. PATIENT AND METHODS: A 52-year old woman presented with atypical unilateral keratitis after LASIK. Mycobacterium chelonae keratitis was diagnosed by microbiological investigation. Interface irrigation and treatment with topical and oral antibiotics was performed. RESULTS: Despite intensive treatment, flap removal was necessary to control the infection. Best-corrected visual acuity dropped from preoperatively 1.0 to postoperatively 0.2. CONCLUSION: The diagnosis of mycobacterial keratitis after laser-in-situ keratomileusis is often delayed due to atypical clinical appearance. Therefore consideration of atypical pathogens and rapid microbiological diagnosis is necessary to provide adequate treatment.

Anti-Bacterial Agents↗

Effect of soft contact lenses on the measurements of intraocular pressure with non-contact pneumotonometry.

PURPOSE: To evaluate the effect of soft contact lenses with different lens power on the measured value of the intraocular pressure with non-contact pneumotonometry. METHODS: 120 eyes (80 healthy volunteers: 50 women, 30 men, aged 22 to 61 years) were included in this study. Intraocular pressure was measured with a pneumotonometer Canon X-10 before and after insertion of the Ciba Vision Focus Night&Day soft contact lens. We used contact lenses with different lens power of + 0.25 D, + 1.00 D, + 4.00 D, - 1.00 D, and - 4.00 D. The averages of three measurements were taken as representative IOP values that were statistically evaluated. RESULTS: IOP measured over myopic lenses of - 1.00 and - 4.00 D showed lower values within the mean range of 1 mm Hg. The difference between the measurements over the myopic lenses was mostly smaller than +/- 2 mm Hg (78% when using - 1.00 D and 90% when using - 4.00 D contact lens). All the differences using + 0.25 D contact lens were smaller than +/- 2 mm Hg. The difference was considerably higher in measurements over + 1.00 and + 4.00 hyperopic contact lenses and showed strong increase with the lens power. CONCLUSIONS: In our study we showed that intraocular pressure can be reliably measured with non-contact pneumotonometry over myopic lenses or hypermetropic lenses with small lens power. This suggests that non-contact pneumotonometry is a useful method in patients wearing therapeutic contact lenses and contact lens wearers who, when measuring the eye pressure, would not need to remove the contact lenses before the examination.

Adult↗