Clinical assessment of the PL 20/20 Infant Vision Tester

Infant visual acuities have been a difficult measurement to obtain for a number of reasons. This study evaluates the clinical usefulness of the Infant Vision Tester, a new preferential-looking instrument. Twenty-eight infants from age 2 months to 22 months were followed on a bi-monthly basis and their visual acuities were measured. It was found that the practicing optometrist can predict approximate visual acuities and progression of acuity improvement from one age group to another. A number of helpful suggestions for proper testing environment are also suggested by the investigator.     

Measurement of apparent accommodation with a 20/20 near vision optotype

PURPOSE: The value of apparent accommodation varies with methods of measurement. To discuss the details of apparent accommodation, it is appropriate to measure it with the smallest possible near vision optotype. In the present study, we used a 20/20 near vision optotype for the measurement of apparent accommodation. SUBJECTS AND METHODS: Forty-six eyes of thirty-eight patients (45-84 years old) who had undergone cataract surgery and intraocular lens implantation, and had at least 20/20 best corrected visual acuity at near and far distances, were used in this study. After the eyes were corrected by glasses to gain the best corrected long distance visual acuity, they were forced to watch a 20/20 near vision optotype. Then we gradually added plus lenses until they could recognize the optotype. The value of apparent accommodation was recorded by subtracting the value of plus lens by which the eye could first recognize the 20/20 near vision optotype from three diopters. RESULTS: The value of apparent accommodation was 0.00-3.00 D (medium 0.50 D). Two eyes had three diopters of apparent accommodation. CONCLUSION: In the present study with correction of astigmatism and small near vision optotype, most eyes showed smaller apparent accommodation than those in previous studies. Despite that, patients with three diopters of apparent accommodation do exist. To analyze high quality visual functions, we should use the smallest possible near vision optotype for the measurement of apparent accommodation.     

20/20 vision after central retinal artery occlusion with no light perception

Central retinal artery occlusion caused complete vision loss in a 52-year-old woman. Paracentesis and CO₂ rebreathing returned vision to counting fingers. After five days of intensive therapy, vision was 20/30 and retinal perfusion sluggish. Ultimately, no cause was found but risk factors included family history of vein thrombosis, factor V Leiden mutation, mitral valve prolapse, patent foramen ovale, and smoking. The author has stated that he does not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The author also does not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Glistenings with long-term follow-up of the Surgidev B20/20 polymethylmethacrylate intraocular lens.

PURPOSE: To evaluate the incidence and progression of small refractile vacuoles in a consecutive series of patients implanted with the Surgidev B20/20 (Surgidev Corporations, Goleta, California) polymethylmethacrylate intraocular lens. METHODS: Observational case series. A 4-year prospective study of the progression of glistenings in patients implanted with the Surgidev B20/20 intraocular lenses. In a consecutive series of 51 patients (73 eyes) that received the Surgidev B20/20 intraocular lens onset, number, and location of intraocular lens glistenings, best-corrected visual acuity, and associated ocular pathology were noted. RESULTS: With mean follow-up of 98 +/- 27 months (range, 48 to 176 months), 65 of 73 (89%) eyes had intraocular lens glistenings. Glistenings increased in frequency and size with increasing follow-up (P =.001). CONCLUSION: Glistenings may occur in polymethylmethacrylate intraocular lenses with long-term follow-up, and they are progressive.     

20 rules for hard nucleus phacoemulsification

The mature cataract with hard nucleus still represents one of the most difficult task for modern phacoemulsification. The author presents some practical advise concerning both less experienced and experienced surgeons.     

Closed-angle glaucoma in 20 pairs of twins

Two pairs of twins with chronic closed-angle glaucoma identified from the Finnish Twin Cohort Study were clinically studied by the author, and 18 other pairs of twins with the disease were ascertained from the Hospital Discharge Registry of Finland. One of the clinically studied pairs was a pair of monozygotic female twins concordant for chronic closed-angle glaucoma and the other was a pair of dizygotic female twins discordant for the disease. Of the pairs of twins ascertained from the registry one was a monozygotic male pair concordant for closed-angle glaucoma. The remaining 17 pairs (12 same-sex dizygotic and 5 monozygotic pairs) were discordant for the disease. The findings support multifactorial inheritance of chronic closed-angle glaucoma.     

Uveitis in children: about 20 cases

INTRODUCTION: Uveitis in children is rare: 3%-8% of all cases. It requires the same diagnostic and etiological processes as uveitis in adults, with additional difficulties at examination and a sometimes insidious progression. MATERIAL AND METHODS: Retrospective study of 20 cases of childhood uveitis from 1995 to 2000. All patients received an ophthalmologic examination and an etiological search, with specific and/or symptomatic treatment and follow-up lasting from 6 months to 5 years. RESULTS: The 20 children presenting uveitis were 4-16 years old, with etiologies as follows: 8 cases of Beh?et's disease, 2 cases of Vogt-Koyanagi-Harada's disease, 1 case of sarcoidosis, 1 case of uveitis associated with coeliac disease, 1 case of toxoplasmosis, 1 case of sympathetic ophthalmia, 1 case of uveitis with streptococcal infection, 3 cases of ocular toxocarosis, and 2 cases with unknown etiology. Treatment based on the etiological findings was started in the cases of toxoplasmosis and uveitis from streptococcal infection. The others were treated with high- and then digressive-doses of corticosteroids. ANALYSIS: We have noted the high incidence of Beh?et's disease in our series. Progression was marked by frequent recurrence for one case of Vogt-Koyanagi-Harada's syndrome and one case of toxoplasmosis. This study also revealed a few cases of complicated cataract. DISCUSSION: Clinical characteristics, diagnosis, and treatment of uveitis in children are discussed.     

20 unusual presentations of accommodative esotropia.

PURPOSE: This paper will discuss several unusual presentations of accommodative esotropia. METHODS: A total of 20 patients with unusual case histories who presented with accommodative esotropia were studied retrospectively. These patients were separated into 3 categories. The first contained children who had their onset of accommodative esotropia after a traumatic event such as head trauma or ocular trauma. The second involved infants between 3 and 5 months of age who presented with accommodative esotropia. The third showed the onset of accommodative esotropia associated with diabetic ketoacidosis. (There were no other metabolic disorders associated with accommodative esotropia.) RESULTS: All patients resolved their esotropia with glasses initially but 2 did require surgery several years after the onset of the esotropia. CONCLUSIONS: Children under 5 months of age with intermittent esotropia and/or significant amounts of hyperopia should have the diagnosis of accommodative esotropia considered as the etiology of their esotropia. Children with the onset of esotropia associated with trauma who have significant amounts of hyperopia should also have accommodative esotropia considered as an etiology of their crossing.     

Sutureless Transconjunctival 20 Gauge Pars Plana Vitrectomy

Purpose: Sutureless Transconjunctival 20 Gauge Vitrectomy (20G STV) is a technique that reduces the operating time and the post-operative inflammation. Patients and method: Eighty-four eyes underwent this new technique. Conjunctival diathermy over the ports before sclerostomy produced adhesions adequate to stop transoperative conjunctival chemosis. The MVR blade introduced into the conjunctiva-sclera in a bevelled direction. The tunnel incision that was created left without a suture at the end of the operation. Results: Three patients (3,5%) had hypotony (2-6mmHg) on day 1 that was normalized 3 days later. Two of them had a bleb formation and the rest a very minor leakage through a flat conjunctiva. No other serious complications occurred as a result of this novel transconjunctival approach. Also there were no differences in visual acuity, intraocular pressure, redetachments, or inflammations between the patients who underwent this technique and the patients having the conventional 20-gauge pars plana technique. Conclusion: 20G STV is a safe and practical technique for the full spectrum of vitreoretinal surgery. It makes the surgery quicker and is well tolerated by patients.