Acquired central disruption of fusional amplitude

Acquired central disruption of fusional amplitude is characterized by a complete loss of fusional amplitude, the patient maintaining fusion for only a moment under test conditions before breaking to constant diplopia. Under normal viewing conditions, the patient has constant diplopia with both eyes open. Patients who have bilateral superior oblique palsy may mimic this loss of fusion and constant diplopia, but they are distinguished by fusing readily on the troposcope, which compensates for the excyclotorsion, in contrast to prisms, which do not remove the double vision. Case reports document an association with convergence palsy, an infranuclear unilateral superior oblique palsy, and a nonparetic acquired strabismus in visual adults. Head trauma is the usual cause.     

Clinical and immunocytochemical findings in a case of melanoma-associated retinopathy

OBJECTIVE: To describe an unusual case of melanoma-associated retinopathy (MAR). DESIGN: Retrospective, observational case report and experimental study. PARTICIPANTS: A 61-year-old man with a history of cutaneous melanoma, acquired bilateral central scotomas, and night blindness. INTERVENTION: Serial full-field electroretinography (ERG) and Goldmann perimetry were performed. Serum was screened for cancer-associated retinopathy (CAR) antibodies by Western blotting. Sections of human and rat retina were examined by immunofluorescence microscopy to determine whether retinal cells were reactive with this patient's serum. A metastatic workup was performed. MAIN OUTCOME MEASURES: Electroretinography, Goldmann visual field testing, and immunocytochemistry were performed. RESULTS: The results were as follows: (1) The ERG showed a profound loss of the b-wave amplitude and a "negative" b-wave characteristic of congenital stationary night blindness; (2) a central scotoma and peripheral constriction were identified on Goldmann visual field tests; (3) as in other patients with MAR, bipolar cells in human and rat retinas were immunolabeled with this patient's serum; and (4) a previously unsuspected focus of metastatic melanoma was discovered. CONCLUSIONS: Recognition of this condition may help to identify an occult focus of metastatic melanoma.     

Prospective analysis of emergency ophthalmic referrals in a Canadian tertiary teaching hospital

Objective

This study was conducted to analyze data from emergency ophthalmology referrals after hours from different hospitals to identify the most common pathologies and compare accuracy of diagnoses. Additionally, examination findings, including visual acuity (VA), intraocular pressure (IOP), and pupils from referring service and ophthalmic examination, were compared to assess agreement.

Multifocal versus monofocal intraocular lenses for age-related cataract patients: a system review and meta-analysis based on randomized controlled trials

We compare multifocal intraocular lenses (MFIOLs) to monofocal IOLs for visual acuity (VA), contrast sensitivity, and adverse events using data from 21 randomized controlled trials with 2951 subjects. There was no statistical difference between uncorrected distance VA and corrected distance VA. Compared with monofocal IOLs, MFIOLs showed a better performance on uncorrected intermediate VA measured at 60 cm and uncorrected near VA; the mean differences were -0.06 (95% confidence interval [CI]: -0.10, -0.03) and -0.13 (95% CI: -0.20, -0.07). Distance-corrected intermediate VA and distance-corrected near VA were measured wearing distance correction. MFIOLs performed better than monofocal IOLs on distance-corrected intermediate VA at 60 cm and distance-corrected near VA; the mean differences were -0.09 (95% CI: -0.12, -0.06) and -0.31 (95% CI: -0.43, -0.19). The contrast sensitivity of the MFIOL group was lower than that of the monofocal IOL group; mean difference was -0.06 (95% CI: -0.11, -0.02). More patients were spectacle free in the MFIOL group; the risk ratio was 2.86 (95% CI: 1.73, 4.73). More patients were troubled by glare and halos in the MFIOL group; the risk ratios were 1.91 (95% CI: 1.24, 2.95) and 3.08 (95% CI: 2.11, 4.49). We conclude that, compared with monofocal IOLs, MFIOLs give patients better near vision and intermediate vision at 60 cm, both corrected and uncorrected. Patients undergoing MFIOLs implantation are more likely to be spectacle free but have a higher risk of glare, halos, and lower contrast sensitivity.