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.     

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.     

20/20 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.     

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.     

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.     

A 20-year series of orbital exenteration

We reviewed patient records of 99 consecutive orbital exenterations performed between 1969 and 1988. Patients ranged in age from 2 to 86 years (mean, 55.9 years). Classification of cases on histopathologic criteria showed 32 exenterations were performed for squamous cell carcinoma originating in the paranasal sinus (13), skin (12), conjunctiva (six), and lacrimal sac (one). Orbital exenteration was performed for treatment of other epithelial malignancy in basal cell carcinoma (eight), sebaceous carcinoma (six), adenoid cystic carcinoma (five), undifferentiated carcinoma (four), adenocarcinoma (two), intraepithelial carcinoma of the conjunctiva (two), benign mixed tumor (one), and transitional cell carcinoma (one). Exenterations were performed for melanoma of the conjunctiva (ten), nasosinus (three), skin (two), orbit (two), and choroid (one). Exenterations were also performed as treatment for mucormycosis (five), meningioma (three), fibrosarcoma (two), rhabdomyosarcoma (two), hemangiopericytoma (two), orbital cellulitis (one), fibrous histiocytoma (one), schwannoma (one), lymphangioma (one), benign lymphoepithelial lesion (one), and undifferentiated malignancy (one).     

Intraoperative breakage of 20-gauge Tano forceps

PURPOSE: To report three cases with breakage of a 20-gauge kryptonite forceps during vitreoretinal surgery. DESIGN: Interventional case report. METHODS: Pars plana vitrectomy that included a membrane peeling was performed in three patients through standard ports with 20-gauge vitrectomy systems. The peeling procedure was attempted with the end-gripping kryptonite forceps. RESULTS: Intraoperatively, the branch/tip broke and dropped onto the posterior pole. Removal of the broken part was uncomplicated, and the subsequent clinical course was unremarkable. In one case, the handle and branch/tip part were exchanged inadvertently. In the other two cases, neither an exchange nor a maladaptation of the parts was noted. CONCLUSION: An exchange of the hand piece and gripping end may increase the risk of breakage and retinal damage. The delicate gripping tips, however, may break because of inadequate maintenance and/or aging of the material. Intraoperative visual and functional examination is recommended before intraocular use.     

眼眶减压术20眼临床分析

目的：探讨眼眶减压术对经保守治疗无效的甲状腺相关性眼病的临床疗效与合并症。方法：对12例20眼的术前临床表现、术后的疗效与并发症进行随访并统计。结果：三壁减压使眼球后退6－8mm,外下壁减压后退4－6mm,内下壁减压后退3－5mm。14／16眼（87．5％）角膜损害痊愈,2／16眼（12．5％）好转。17／20眼（85％）视力提高,3／20眼（15％）无改善。并发症包括2眼复视,5眼眶下神经损害,1眼眶继发出血。结论：眼眶减压术对保守治疗无效的甲状腺相关眼病是一种有效、安全、并发症少的治疗手段。可用于继发角膜损害,压迫视神经与要求美容 的病例。     

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.