Amblyopia in the phakic eye after unilateral congenital cataract extraction

The treatment of unilateral congenital cataract remains a challenge because form deprivation early in life leads to amblyopia. Visual outcomes after congenital cataract extraction have improved dramatically with earlier surgery, greater attention to optical correction of the aphakia, and part-time occlusion therapy of the phakic eye. A published review of unilateral congenital cataract studies between 1988 and 2004 found that 88% of patients with primary intraocular lens implantation achieved 20/200 or better visual acuity and a mean of 20% achieved 20/40 or better visual acuity. Improved outcomes are attributable, in part, to surgical intervention at an earlier age. It has been shown that surgical intervention during the first 6 weeks of age is associated with a better visual prognosis than surgery at a later age. In this report, we describe a patient with unilateral congenital cataract treated with cataract extraction and intraocular lens implantation at 8 weeks of age who had a better visual outcome in his operative eye than in his phakic eye.     

Congenital unilateral ocular fibrosis syndrome secondary to benign congenital tumor

Congenital unilateral fibrosis, blepharoptosis and enophthalmos syndrome is one of the rare forms of congenital fibrosis of extraocular muscles. The nature and cause of such unilateral inflammation leading to fibrosis is unknown. Prenatal orbital penetration has been proposed as a cause of this syndrome. We report a case of this rare syndrome associated with an adjacent sinus tumor.     

单眼视网膜静脉阻塞患者对侧眼黄斑功能的多焦视网膜电图检测

目的 观察单眼视网膜静脉阻塞(RVO)患者对侧眼黄斑功能的变化.方法 对比分析24例经荧光素眼底血管造影(FFA)确诊为单眼RVO患者的24只对侧眼及18位正常受试者18只正常眼的多焦视网膜电图(mfERG)检测结果,比较两组受试者黄斑功能的差异.采用罗兰RETIsean电生理仪记录mfERG,将记录图形分别按照6个同心圆和4个象限对P1、N1波的振幅密度及潜伏期进行比较和分析.结果 RVO患者对侧眼在中心第1、2环处P1、N1波的振幅密度显著低于正常眼,差异有统计学意义(t=4.520,2.147;P＜0.05);其它各环、各象限振幅密度及潜伏期在两组间均未见明显差异(P＞0.05).结论 与正常眼相比,RVO患者对侧眼黄斑中心凹视功能受损.     

Defective processing of motion-defined form in the fellow eye of patients with unilateral amblyopia.

The following three measurements were made on a group of 20 pediatric and 5 adult patients with unilateral amblyopia: (1) speed threshold for recognizing motion-defined dotted letters; (2) recognition acuity for isolated solid letters of 4% contrast; and (3) Snellen line acuity for high-contrast letters. Normal limits were established with a group of 30 pediatric and 10 adult control subjects. The main finding was that, in amblyopic children, a high percentage (83%, 15 of 18) of fellow eyes showed a degraded ability to recognize motion-defined letters, even though Snellen acuity and 4% letter acuity were normal for age. The fellow eyes of all nine patients with strabismic amblyopia showed this pattern of loss, as did four of six fellow eyes of patients with anisometropic amblyopia and two of three fellow eyes of patients with anisometropic plus strabismic amblyopia. Only two clinically unaffected eyes were normal for motion-defined letters. These eyes belonged to patients with anisometropic amblyopia. Eighteen of the 19 previously amblyopic eyes tested were abnormal for motion-defined letters even though Snellen acuity was within normal limits for 6 of these eyes. In adults, only one of five fellow eyes failed the motion-defined letter test. It was concluded that the degradation of form perception associated with amblyopia can be different for luminance-defined and motion-defined form and that defective processing of motion-defined form is common in the fellow eyes of children with unilateral amblyopia.     

The risk of fellow eye visual loss with unilateral retinal pigment epithelial tears

To identify the magnitude of risk of fellow-eye visual loss, we reviewed the records of 43 patients with unilateral central visual loss caused by a tear of detached retinal pigment epithelium seen in our institution over a period of one to 13 years. Loss of vision because of complications of age-related macular disease occurred in 16 of 43 patients (37%) in the first year, seven of 23 patients (30%) in the second year, and eight of 16 patients (50%) in the third year. An additional five patients lost visual acuity between the third and eighth years of follow-up. The cumulative risk of loss of visual acuity was 37% in one year, 59% in two years, and 80% in three years. Visual loss occurred in 29 of the 36 eyes as a result of a complication of retinal pigment epithelial detachment. The magnitude of risk to the fellow eye was greater than has been documented in unselected age-related macular degeneration.     

Amblyopia in unilateral congenital ptosis: early detection by sweep visual evoked potential

Background: Fixation preference assessment is a clinical tool widely used to determine amblyopia in young infants and children. It is our clinical experience that this tool underestimates amblyopia. The purpose of this study was to compare the results of sweep visual evoked potentials to fixation preference assessment in cases of unilateral ptosis. Methods: Sweep visual evoked potentials were performed in 17 children with unilateral ptosis thought to have equal acuity by fixation preference asessment. Binocular and monocular sweep visual evoked potentials were recorded to square-wave gratings of 80% contrast counterphase modulated at 6 Hz. A range of spatial frequencies from 1 to 30 cycles per degree were presented over a 10-s period. Resolution acuity was determined as the zero-microvolt intercept of linear regression analysis on the visual evoked potential amplitude versus spatial frequency. Results: Nine of the 17 children had interocular resolution acuity differences ranging from 0.8 to 2 octaves by sweep visual evoked potential testing. This correlates to a Snellen equivalent interocular difference of 2 to 7 lines and clinical amblyopia. Conclusion: This study confirms our clinical impression that children who are unable to preform recognition acuity tasks and are thought to have equal vision by fixation preference assessment often have 2 or more lines of Snellen acuity difference (amblyopia) when they are finally old enough to be tested by Snellen methods. It also implies that amblyopia precedes refractive errors and strabismus in unilateral ptosis cases. Clinical methods to determine amblyopia other than fixation preference assessment need to be explored with a view to earlier detection, better definition and treatment of amblyopia.     

The occurrence of primary open-angle glaucoma in the fellow eye of patients with unilateral angle-cleavage glaucoma

The late onset of glaucoma occurs in approximately 7% of eyes with traumatic angle cleavage. We studied 13 patients who developed glaucoma in the angle-cleavage eye at an average of 34 years following trauma. Ten of the 13 patients had 270 degrees or more of angle cleavage. At the time of the initial diagnosis of angle cleavage glaucoma, there were no optic disc or visual field abnormalities in the fellow eyes. After a mean follow-up of 7.7 years, all 13 patients were reevaluated. In addition to standard examination techniques, all underwent disc photos, goniophotos, and Octopus perimetry. Seven of 13 patients (55%) had either frank glaucomatous or suspicious Octopus visual field abnormalities in the fellow eyes. Patients with angle-cleavage glaucoma appear to have at least a 50% chance of developing open-angle glaucoma in the non-traumatized fellow eyes.     

Nature and risk of neovascularization in the fellow eye of patients with unilateral retinal angiomatous proliferation

PURPOSE: To determine the nature and risk of neovascularization in the fellow eyes of patients with unilateral retinal angiomatous proliferation (RAP), a neovascular form of age-related macular degeneration (AMD). METHODS: A consecutive series of 52 patients diagnosed with unilateral RAP were studied retrospectively. Clinical biomicroscopic examination, fluorescein angiography, and indocyanine green angiography were used to evaluate all patients for the development of neovascular manifestations in the fellow eye. RESULTS: Neovascularization developed in the fellow eye in 52 patients over the follow-up period (range, 2-36 months). All patients developed neovascular manifestations of RAP in the fellow eye. Twenty-one patients (40%) developed a RAP lesion within 1 year; 29 (56%), within 2 years; and 52 (100%), within 3 years. At the time of diagnosis of neovascularization in the fellow eye, 8 patients (15%) had a stage I RAP lesion, 36 (70%) had a stage II RAP lesion, and 8 (15%) had a stage III RAP lesion. Other characteristic findings in these patients included the presence of preretinal, intraretinal, and subretinal hemorrhages in 49 patients (94%) and pigment epithelial detachments in 41 patients (79%). CONCLUSIONS: In patients diagnosed with unilateral RAP lesions, the form of neovascularization that develops in the fellow eye is virtually always RAP. The annual and accumulative risk of neovascularization in the fellow eye is higher in patients with RAP than in those with other forms of neovascular AMD. These new findings enhance our understanding of the clinical spectrum of RAP in terms of its natural course and visual prognosis and may possibly offer useful information to establish future treatment options.     

The fellow eye in patients with unilateral retinal detachment: findings and prophylactic treatment

During a 4-year period, 1978-1981, 312 patients were operated on for unilateral rhegmatogenous detachment of the retina. Of the fellow eyes, 11% showed moderate (VA 0.15-0.4) and 5% severe (VA less than or equal to 0.1) visual impairment. Of the fellow eyes 49% were myopic (- 1.0 D. or more), and aphakia was present in 14%. Details of the peripheral fundus were adequately recordable for 260 fellow eyes. Degenerations considered to predispose to retinal detachment were found in 98 eyes (38%): lattice degeneration in 54 (21%), granular tuft in 17 (7%), retinal tear(s) in 12 (5%), and retinoschisis in 15 (6%). Prophylactic treatment of predisposing degenerations was performed in 91 of the 98 eyes using cryo- or photocoagulation (argon laser). No intra- or permanent post-operative complications were noticed. One of the treated fellow eyes (1.1%) detached 10 months after prophylactic treatment due to new tears. In the untreated group, 6 of the 221 eyes detached (2.7%). The difference was not statistically significant, but the groups were not comparable because 93% of the eyes showing predisposing degenerations were treated. None of the eyes treated for retinal breaks or lattice degeneration has detached. In these cases prophylactic treatment of the fellow eye is recommended. In most eyes cryocoagulation seems to be preferable to photocoagulation.     

The fellow eye in retinal detachment

The examination findings of the fellow eye of 534 patients affected by a unilateral retinal detachment are reported. Nearly 90% of these eyes showed degenerative areas and about 20% showed one or more retinal breaks. These findings are quite different from those reported in examinations of random eyes and suggest that fellow eyes are high risks that often need prompt prophylactic treatment.

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Zusammenfassung Die vorliegende Arbeit berichtet über die Untersuchung des Partnerauges von 534 Patienten, die von einseitiger Ablatio retinae betroffen waren. Fast 90% dieser Augen zeigten degenerative Areale und ungefähr 20% hatten einen oder mehrere Netzhautrisse.Diese Befunde sind recht unterschiedlich von Zufallsbefunden und zeigen, daß Partneraugen ein hohes Risiko haben und oft eine prompte prophylaktische Behandlung benötigen.

     

Computerized tomography in the diagnosis of the congenital fibrosis syndrome

A patient with congenital ptosis and inferior rectus fibrosis is described. Marked atrophy of the left inferior rectus muscle was demonstrated by orbital computerized tomography (CT). Computerized tomographic findings in this patient and a series of 20 patients with no ocular disease and normal motility indicate that CT is a valuable tool for the evaluation of extraocular muscle size when qualitative comparison is made between corresponding muscles in the same patient.