Is it mandatory to treat amblyopia prior to surgery in esotropia?

PURPOSE: To determine whether presence of amblyopia has any influence on the outcome of motor and sensory success in cases of esotropia. METHODS: 100 patients were taken for this study. Patients were divided into two groups of 50 each. Amblyopia was fully treated in group I and patients in group II underwent surgery before full treatment of amblyopia. Motor success (+/- 10 PD of orthophoria) was assessed three months after surgery and at the child's most recent visit by comparing the motor alignment at 6 meter and 0.33 meter distance using accommodative target in primary position. Sensory success was assessed by comparing the frequency of detectable stereoacuity. RESULTS: There was no significant difference in motor success (84% vs 75%) and sensory success (55% vs 50%) whether amblyopia was fully treated or partially treated. CONCLUSION: It is not mandatory to treat ambloypia prior to surgery, unless it is a case of infantile esotropia with moderate amblyopia and amblyopia therapy is continued post operatively.     

Is it possible to diagnose lymphoproliferative lesions by fine needle aspiration biopsy?

Despite the fact that fine needle aspiration biopsy (FNAB) is a commonly employed method in modern oncological diagnostic management, it has found no extensive use to diagnose lymphoproliferative lesions of the orbit and eye adnexa. Benign and malignant lymphoproliferative lesions and pseudotumor have a very similar clinical course. Microscopicaly, the lesions are also similar and hence even on histology it is difficult to differentiate between these conditions based on the morphology. We believed, that routine cytology and flow cytometry and/or PCR method in materials obtained in the course of FNAB are fast and sensitive methods and in many cases allow to avoid a surgical biopsy.     

Optimizing lens constants specifically for short eyes: Is it essential?

Purpose:Optimization of lens constants is a critically important step that improves refractive outcomes significantly. Whether lens constants optimized for the entire range of axial length would perform equally well in short eyes is still a matter of debate. The aim of this study was to analyze whether lens constants need to be optimized specifically for short eyes.Methods:This retrospective observational study was conducted at a tertiary care hospital in Central India. Eighty-six eyes of eighty-six patients were included. Optical biometry with IOLMaster 500 was done in all cases and lens constants were optimized using built-in software. Barrett Universal II, Haigis, Hill-RBF, Hoffer Q, Holladay 1, and SRK/T formulae were compared using optimized constants. Mean absolute error, median absolute error (MedAE), and percentage of eyes within ±0.25, ±0.50, ±1.00, and ±2.00 diopter of the predicted refraction, of each formula were analyzed using manufacturer’s, ULIB, and optimized lens constants. MedAE was compared across various constants used by Wilcoxon signed-rank test and among optimized constants by Friedman’s test. Cochran’s Q test compared the percentage of eyes within ± 0.25, ±0.50, ±1.00, and ± 2.00 diopter of the predicted refraction. A value of P < 0.05 was considered statistically significant.Results:Optimized constant of Haigis had significantly lower MedAE (P < 0.00001) as compared to manufacturers. However, there was no statistically significant difference between ULIB and optimized constants. Postoptimization, there was no statistically significant difference among all formulae.Conclusion:Optimizing lens constants specifically for short eyes gives no added advantage over those optimized for the entire range of axial length.     

Does infantile esotropia arise from a dissociated deviation?

Tonus refers to the effects of baseline innervation on musculature in the awake, alert state.(1) Since the normal anatomical resting position of the eyes is one of exodeviation, extraocular muscle tonus plays a vital physiologic role in establishing ocular alignment. Under normal conditions, binocular esotonus is superimposed on the baseline anatomical position of rest to maintain approximate ocular alignment, save for a minimal exophoria that is easily overcome by active convergence. When binocular visual input is preempted early in life, monocular fixation may give rise to a larger dissociated esotonus that gradually drives the 2 eyes into a "convergent" position, resulting in infantile esotropia.(2).     

Is cheating with automatic perimetry possible?

INTRODUCTION: Automatic perimetry examination requires the patient's cooperation, but the programs used check response validity. This study evaluated the possibility of patient cheating on this examination. MATERIALS AND METHOD: This study investigated 27 visual fields of automatic perimetry with patients who had no ophthalmological history. Each subject had to reproduce a visual field loss that was observed for 5 minutes (two diffuse losses, five fields reflecting hemianopsia, four reflecting quadranopsia, two tubular losses, five nasal steps, nine absolute and arciform losses). The 24-2 Fastpac of the Humphrey field analyzer and the G2 of the Octopus perimeter were used for this study. RESULTS: Simple deficits were easy to reproduce, but visual field defects are often deeper and simulated test results tend to be too perfect. On the other hand, complex defects such as arciform scotoma or nasal steps were more difficult to reproduce. Visual field defect simulations were exaggerated beyond what was reasonable. CONCLUSION: This study reports on whether it is possible to cheat with automatic perimetry. The different parameters analyzed by computer programs are not able to detect cheating patients.     

Is it safe to discharge treated proliferative diabetic retinopathy patients from the hospital eye service to a community screening programme?

Purpose

To investigate the distribution of new vessels (NV) in patients treated with pan-retinal photocoagulation for proliferative diabetic retinopathy (PDR). To assess whether it is safe to discharge treated PDR patients to the NHS Diabetic Eye Screening Programme (DESP) which uses two mydriatic 45° fields of each eye.

Methods

Consecutive treated PDR patients undergoing fundus fluorescein angiography between July 2010 and October 2011 for the purpose of looking for NV were included. The distribution of NV was mapped. In particular it was noted whether NV occurred in the area covered by the DESP standard screening images.

Results

A total of 76 patients (108 eyes) met the inclusion criteria for the study. Leaking NV were found inside the DESP fields in 89% of study patients. In 108 eyes with leaking NV, there were a total of 35 NVD and 336 NVE. NV were found within DESP fields in 83% of eyes. Of the 336 NVE, 54% occurred within and 46% outside DESP standard fields. There was no statistically significant difference in the retinal quadrant distribution of NVE.

Conclusions

If these findings apply to the whole treated PDR population, NVE would be identified in 89% of patients undergoing DESP screening. This would support stable treated PDR patients being monitored within the DESP. We found no preferential clustering of NV within quadrants or between posterior and less posterior retina suggesting that there would be no benefit to the DESP of taking an additional field or graders concentrating on one particular quadrant more than another.