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Nisa Silva,1,&ast; André Ferreira,1,2,&ast; Natália Ferreira,1 Bernardete Pessoa,1,3 Angelina Meireles1,3 1Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal; 2Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, 4200-319, Portugal; 3Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, 4050-313, Portugal&ast;These authors contributed equally to this workCorrespondence: Nisa SilvaDepartment of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, Porto, 4099-001, PortugalTel +351 22 207 7500Email nisapinhosilva@gmail.comBackground: The main options for intraocular lens (IOL) placement without capsular bag support and/or zonular weakness are iris-fixated IOL and scleral-fixated IOL (SFIOL).Purpose: To describe the surgical technique and the outcomes of intrascleral knotless zigzag suture fixation of Akreos AO60 foldable IOL.Methods: Retrospective cohort study of consecutive cases.Results: Ninety-nine eyes of 92 patients were retrospectively studied. The mean age was 72.1± 15.2 years (range 18– 94), and the median follow-up duration was 19.5 months (range 3– 81). The best-corrected visual acuity improved from a mean±SD of 1.34± 0.70 logarithm of the minimum angle of resolution (logMAR) units at baseline to 0.49± 0.56 logMAR at the end of follow-up (p< 0.001). The mean±SD final SE was − 1.24± 1.82 diopters. The mean±SD prediction error was − 0.51± 1.16 diopters. The overall perioperative complications rate was 44.4% (n=44). The rate of complications requiring invasive treatment was 19.2% (n=19). The most common perioperative complications were ocular hypertension (OHT, 20.2%, n=20), and cystoid macular edema (CME, 15.2%, n=15). The rate of IOL dislocation was 7% (n=7).Conclusion: This knotless technique avoids the risks of haptics fixation but is more prone to IOL dislocation in cases of suture deterioration. Past ophthalmic history needs to be carefully considered in candidates who underwent SFIOL implantation.Keywords: intraocular lens, scleral fixation, knotless, cataract, lens luxation

AIM: To evaluate efficacy, safety and complications of 25G vitrectomy, phacoemulsification combined with intrascleral fixated intraocular lens(IOL)implantation for treatment of lens luxation.METHODS: Totally 20 patients(20 eyes)with complete lens luxation and the hardness of lens nucleus was grade 3 or above who underwent 25G vitrectomy, phacoemulsification combined with intrascleral fixated IOL implantation between May 2018 and December 2020 were analyzed retrospectively. The uncorrected visual acuity, best corrected visual acuity, intraocular pressure, the count of corneal endothelium cell, central corneal thickness and complications were observed. RESULTS: The uncorrected visual acuity and best corrected visual acuity after operation were improved than those before treatment(P0.05). There was no significant difference in central corneal thickness 2wk after operation compared with that before operation(P >0.05). There were 3 cases of low intraocular pressure and 2 cases of high intraocular pressure, but they all returned to normal at the end of follow-up. The IOL were all centered and there were no obvious eccentricity and inclination. No other complications such as vitreous hemorrhage and retinal detachment occurred.CONCLUSION: 25G vitrectomy, phacoemulsification combined with intrascleral fixated IOL implantation is a fast, safe and simple method for the treatment of complete lens luxation.

Complete posterior lens dislocation is an infrequent clinical entity. Trauma is the first cause of secondary lens dislocation. Most of the cases are unilateral, and bilateral cases are unusual. We report the uncommon case of a 70-year-old woman with evidence of a posterior bilateral dislocation of the lens in the context of an acute onset of confusional syndrome. We discuss about sensory deprivation as a trigger for acute confusion and agitation in patients with predisposing conditions. In addition, we describe the benefits that, in our experience, the refloating technique with perfluorocarbon liquid provides for the surgical approach to these cases.

Aim. Congenital corneal opacities (CCOs) are the major causes of early visual deprivation in infants. Balloon ultrasound biomicroscopy (UBM) examination is an effective method to diagnose CCO. However, whether it is suitable for children examination is still unknown.Methods. 26 Peters’ anomaly (PA) or Rieger’s anomaly (RA) infants with congenital corneal opacities (CCO) (40 eyes) underwent UBM examinations to study their imaging features.Results. Based on the results, they were divided into UBM Dx-Type I: Descemet’s membrane (DM) and endothelium have heterogenous or discontinuous echo accompanied with corneal stroma echo-enhanced or shallow anterior chamber. Type II: Type I alteration plus abnormal strand of iris extended to the border of the posterior corneal defect or iridocorneal adhesion. Type III: Type I or II combined with the abnormal hyperechoic lens, lens luxation, or keratolenticular adhesion. Type IV: echoes of the DM and the endothelium are continuous, corneal stroma echo is enhanced, and an abnormal strand of peripheral iris extends to the prominent Schwalbe line, accompanied by iris stroma or pupil heteromorphism and a shallow or flat anterior chamber.Conclusion. UBM not only could accurately evaluate the anterior segment abnormalities in CCO infants but also would be a step forward for the management of PA- and RA-associated CCO.

Nisa Silva,1,&ast; André Ferreira,1,2,&ast; Natália Ferreira,1 Bernardete Pessoa,1,3 Angelina Meireles1,3 1Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal; 2Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, 4200-319, Portugal; 3Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, 4050-313, Portugal&ast;These authors contributed equally to this workCorrespondence: Nisa SilvaDepartment of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, Porto, 4099-001, PortugalTel +351 22 207 7500Email nisapinhosilva@gmail.comBackground: The main options for intraocular lens (IOL) placement without capsular bag support and/or zonular weakness are iris-fixated IOL and scleral-fixated IOL (SFIOL).Purpose: To describe the surgical technique and the outcomes of intrascleral knotless zigzag suture fixation of Akreos AO60 foldable IOL.Methods: Retrospective cohort study of consecutive cases.Results: Ninety-nine eyes of 92 patients were retrospectively studied. The mean age was 72.1± 15.2 years (range 18– 94), and the median follow-up duration was 19.5 months (range 3– 81). The best-corrected visual acuity improved from a mean±SD of 1.34± 0.70 logarithm of the minimum angle of resolution (logMAR) units at baseline to 0.49± 0.56 logMAR at the end of follow-up (p< 0.001). The mean±SD final SE was − 1.24± 1.82 diopters. The mean±SD prediction error was − 0.51± 1.16 diopters. The overall perioperative complications rate was 44.4% (n=44). The rate of complications requiring invasive treatment was 19.2% (n=19). The most common perioperative complications were ocular hypertension (OHT, 20.2%, n=20), and cystoid macular edema (CME, 15.2%, n=15). The rate of IOL dislocation was 7% (n=7).Conclusion: This knotless technique avoids the risks of haptics fixation but is more prone to IOL dislocation in cases of suture deterioration. Past ophthalmic history needs to be carefully considered in candidates who underwent SFIOL implantation.Keywords: intraocular lens, scleral fixation, knotless, cataract, lens luxation

Indications for, technique, and findings for normal and abnormal ocular ultrasound are discussed, with specific sonographic findings, images, differential diagnoses, and other considerations. Because the eye is a fluid-filled structure, ultrasound can be used as a screening test when pathology prevents direct examination. Structural abnormalities, such as lens luxation, retinal detachments, and intraocular and orbital masses, also may be defined better using point-of-care ultrasound. Details on additional ophthalmic diagnostics, treatment, and prognosis are not covered.

Purpose To describe the demographic data, evaluate the long-term refractive and anatomical outcomes, and report the incidence of complications of anterior iris (prepupillary) and posterior iris (retropupillary) fixation of the Artisan aphakia iris-claw intraocular lens (IOL). Setting Complejo Hospitalario Universitario de Santiago de Compostela, Spain. Design Retrospective case series. Methods Patients who had iris-claw IOL implantation were divided into 2 groups: Group 1 (prepupillary) and Group 2 (retropupillary). The corrected distance visual acuity (CDVA), anatomical changes, endothelial cell count (ECC), presence of cystoid macular edema (CME), and operative and postoperative complications were determined. Results The study comprised 95 eyes of 95 patients. Fifty-seven patients had prepupillary implantation and 38 patients had retropupillary implantation. Indications for surgery were IOL luxation or subluxation (n = 24), lens luxation or subluxation (n = 17), trauma (n = 15), aphakia (n = 30), and other (n = 9). The CDVA improved significantly in both groups and there were no differences between them. A significant ECC reduction was observed in both groups, with no differences between them. The incidence of CME was 16.1% (21.8% in the prepupillary group and 7.9% in the retropupillary group at 3 months and 8 months, respectively), although the difference was not statistically significant. Other postoperative complications were rare and no differences were found between groups. Conclusions Irrespective of location, the iris-claw IOL provided good visual outcomes with few complications. However, prepupillary IOL implantation seemed to contribute to greater endothelial cell loss and earlier onset of CME.

Purpose: To report a case of self-induced eye injury resulting in lens subluxation combined with avulsion of ciliary processes in a patient with Tourette Syndrome. Observation: A 14-year-old male had repeated involuntary trauma to the left side of his face. On exam, left eye lens subluxation combined with ciliary process avulsion were noted. Pars plana vitrectomy and lensectomy were performed. Conclusions and Importance: This report of self-inflicted ciliary processes detachment in Tourette Syndrome is the first of its kind. Ocular injuries reported in the literature include isolated cases of lens luxation, retinal detachment and orbital hemorrhage. Additionally, iatrogenic conjunctival laceration and corneal abrasion have been reported due to involuntary movements during clinical examination. This case provides further evidence that patients with Tourette Syndrome may be at risk of eye injury due to the involuntary jerk movements associated with this condition. Patients with involuntary tics that put their eyes at risk should be advised to wear safety eye wear to avoid eye trauma and its deleterious visual consequences. Keywords: Tourette syndrome, Ocular trauma, Ciliary processes trauma

javax.xml.bind.JAXBElement@18b5913a To present a novel and simplified surgical technique of Artisan lens implantation for intraocular lens luxation and aphakia in glaucoma patients with previous superior filtration surgery. javax.xml.bind.JAXBElement@2226246d Analysis of 12 patients with a history of previous superior filtration surgery for glaucoma, who underwent artisan lens implantation. To allow lens manipulation and implantation without alteration of the filtration bleb, the main sclerocorneal incision was performed laterally and the Artisan lens was held in place for enclavation of the iris stroma via a superior corneal incision without disturbing the filtration bleb. javax.xml.bind.JAXBElement@376d7951 Mean pre-operative visual acuity was 0.54 ± 0.85 LogMAR, and intraocular pressure (IOP) was 15.8 ± 7.7 mmHg. At the end of follow-up (11.6 ± 8.1 months), visual acuity had improved to 0.32 ± 0.57 LogMAR and intraocular pressure was 14.7 ± 5.4 mmHg. No disturbance of the filtration bleb was observed. javax.xml.bind.JAXBElement@212615c9 Artisan lens implantation can be performed successfully via a combined lateral and superior approach despite the presence of a filtration bleb at the 12 o'clock position.

Spontaneous lens absorption (SLA) is a rare complication of hypermature cataract. However, this condition has been reported in several cases of hypermature cataracts that were caused by trauma, senility, uveitic disorders such as Fuchs’ uveitis syndrome (FUS), and infectious disorders including leptospirosis and rubella. We report a case of spontaneous absorption of a hypermature cataract secondary to FUS. To our knowledge, this is the first report of SLA that was followed by dislocation of the capsular remnants into the vitreous and resulted in a misdiagnosis as crystalline lens luxation.

Objective To identify the frequency of vitreous degeneration and its association with ocular comorbidities including cataracts, lens luxation, glaucoma, and retinal detachment. Methods This is a retrospective study of 4217 dogs from the Companion Animal Eye Registry (CAER) that underwent breed screening ophthalmic examinations between 2013 and 2016. The breeds analyzed included the Italian Greyhound, Shih Tzu, Affenpinscher, Bichon Frise, Brussels Griffon, Whippets, and Greyhound. Data collected from CAER included age, gender, number of examinations, and whether vitreous degeneration, along with cataracts, lens luxation, glaucoma and/or retinal detachment were present in either or both eyes. Results The study found that breed and age are significant drivers for developing VD. Italian Greyhounds, Brussels Griffons, and Shih Tzus have a significantly higher likelihood of VD compared to the negative control breed, the Greyhound. Additionally, with every 1-year age increase, there is a 24% higher likelihood of developing VD. However, no association was identified between vitreous degeneration and cataracts, lens luxation, glaucoma, or retinal detachment. Conclusions While the study found that breed and age were significant drivers for developing VD, no association was found between VD and the other ocular comorbidities examined.

Weak capsular support can make cataract significantly more challenging. The design of the BIL implant can be of assistance in coping with these cases. Two specific techniques, lasso suturing and the bean-shaped segments, can be used to stabilize the BIL capsule complex and are described in this chapter.

OBJECTIVE To describe the epidemiology and the clinical presentation of cataracts in a population of cats in France. PROCEDURES A review of medical records of cats presented to the Ophthalmology Unit of the National Veterinary School of Alfort between January 2010 and June 2017 was carried out to identify cats affected by cataracts. The signalment of affected cats, medical history, etiology of cataract, age of onset, stage of development, location of opacities, and concurrent ocular lesions were evaluated. RESULTS Of 2054 cats which were presented to the Ophthalmology Unit of the National Veterinary School of Alfort during the study period, 268 (383 eyes) were diagnosed with a cataract (13%; CI [11.3-14.7]). The median age of all cats affected by cataract was 9.5 years (range: 0.1-18.6 years). Eighteen breeds were represented. The recorded causes of cataract were uveitis (35.8%), congenital (15.7%), aging (10.8%), presumed hereditary (8.2%), trauma (7.8%), lens luxation (3.3%), glaucoma (1.5%) and diabetes mellitus (0.4%). In 16.4% of the cases, the etiology could not be determined. The domestic short-hair was significantly overrepresented in cats with uveitis-related cataract (P

Introduction Lens luxation generally happens secondary to trauma and hereditary disorders into the vitreous body. However, spontaneous dislocation especially into the anterior chamber occurs rarely. We report an unusual case with spontaneous anterior dislocation of a posterior chamber intraocular lens (IOL) 4 years after cataract surgery. Case Presentation A 42-year-old woman was referred to ophthalmology department with complaint of sudden onset blurring of vision in the left eye 4 years after cataract surgery. No history of trauma and systemic disorder was reported and no capsular fibrosis was found during eye examination. The patient underwent corneoscleral incision under general anesthesia and the IOL was extracted using a viscoelastic material. Conclusions To our knowledge, this is the first reported case in the literature. This report may imply that IOL related factors could be considered for spontaneous dislocation of intraocular lenses.

An adult, female, captive, Matshchie's tree kangaroo was diagnosed with an anterior lens luxation in the right eye and a lens subluxation in the left eye. Both eyes were treated surgically with intracapsular lens extractions. A 360° rhegmatogenous retinal detachment was diagnosed 6 months postoperatively in the left eye. Aphakic vision was maintained in the right eye 9 months postoperatively. Based on family history and the lack of antecedent ocular disease, the lens luxations were presumed to be inherited and veterinarians should be aware of this condition within the captive tree kangaroo population.

This retrospective study evaluated cases of lens luxation in dogs that were documented at the University of Zurich Veterinary Teaching Hospital between 2000 and 2011. A total 134 dogs were included in the study. This population of dogs with lens luxation represents 0.41 % of all dogs presented to the Zurich Veterinary Teaching Hospital (32'523) and 3.02 % of all dogs presented to the ophthalmology service during the same time period. The 134 dogs represented over 40 different breeds, including mixed breeds. 63 of the dogs were male, 71 were female. The 134 dogs were divided in primary lens luxation (86 of the 134 dogs, 64 %) and secondary lens luxation (48 dogs, 36 %). The most frequent causes for secondary lens luxation were glaucoma (58 %), cataract (19 %) and trauma (17 %). This study shows the predisposition for primary lens luxations in terrier breeds, Chinese Crested dogs, Pinscher and Spitz. In contrast, Siberian Huskies, Basset Hounds, Bearded Collies, Cairn Terriers, mixed breed dogs, Bolonka Zwetna, Boston Terriers, Borzoi, Doberman, Eurasian, Leonberg, Luzerner Niederlaufhund and Weimaraner suffered significantly more often from secondary lens luxation. There was no sex predilection for primary or secondary lens luxation. Dogs with primary lens luxation were on average 7.39 ± 3.02 years old, which is significantly younger than the dogs with secondary lens luxation (9.12 ± 3.38 years). Dogs with primary lens luxation showed a significantly higher rate of a bilateral development than those with secondary lens luxation (85.5 % of the dogs with primary lens luxation and only 14.5 % of the dogs with secondary lens luxation showed it in both their eyes).

Background: A 71-year-old female presented on 3 occasions with escalating pain in a congenitally blind eye. Examination revealed hypertensive uveitis with morning glory optic disc dysplasia and absence of a crystalline lens. There was no previous intraocular surgery or trauma. Intensive anti-hypertensive agents and topical steroids did not control intraocular pressure (IOP) or inflammation. Results: Dilated fundus examination on the third clinical review revealed a luxated cataractous lens on the retina. Pars plana vitrectomy and fragmatome lensectomy controlled inflammation and IOP, with resolution of ocular pain. Discussion: This is an exceptional case of phacogenic uveitis with secondary glaucoma occurring years after spontaneous crystalline lens luxation in a patient with morning glory syndrome. The embryological pathogenesis of morning glory syndrome and the significance of accelerated cataractogenesis and zonular weakness are discussed. Hypertensive uveitis with unexplained absence of a crystalline lens in a blind eye must prompt suspicion of delayed phacogenic uveitis following asymptomatic lens luxation.

The most common ocular clinical signs of Marfan syndrome are lens luxation (46.16 %) and cataract (26.92 %), which during their progression are complicated by secondary glaucoma, lenticular myopia and strabismus. Discussed information indicates to the need to improve the traditional methods of surgery in children with ocular manifestations of Marfan syndrome in order to reduce the risk of intraand postoperative complications.

Lens injury due to traumas may present as loss of capsule integrity, cataract, lens subluxation, or lens luxation. In addition, lens subluxation and lens luxation may occur in pseudophakic patients due to trauma. Clear corneal, scleral or sclero-corneal phacoemulsification surgery, pars plana vitrectomy, pars plana vitrectomy with phaco-fragmentation, or pars plana vitrectomy with removal through corneal incision techniques are used in the treatment of lens injury due to traumas. Intraocular lens can be implanted in the bag, sulcus, or anterior chamber during the surgery. Depending on the circumstances, scleral fixated intraocular lenses or iris-claw lenses may also be preferred. Rehabilitation of such patients is not of a great concern today, with the advanced level of vitreoretinal surgery and cataract surgery techniques and with the current state of technology. (Turk J Ophthalmol 2013; 43: 51-4)

Purpose Successful recuperation of vision of a blind eye (cataract?) after forceful rubbing of the eye (producing luxation of the lens?) has been mentioned in the Holy Bible in the 1rst Century (C.). Methods In the 18th C. (1789) the aspiration of cataract was considered. In the 19th C. extracapsular cataract removal was practised but the formation of secondary cataract could not be prevented. In 1917 Prof. Ignacio Barraquer developed a suction cup to remove the cataract ‘in toto’, only possible in case of mature cataract and weak zonule. In 1958 Joaquin Barraquer started to inject alphachymotrypsin into the posterior chamber for enzymatic zonulolysis permitting removal of the lens after 2 min. High optical correction was imperative. Results Ridley recommended extracapsular extraction and introduction of a +20 D lens between the posterior capsule and the iris. Lens luxation into the vitreous cavity or the anterior chamber was a danger. Strampelli suggested a three-point anterior chamber lens but contact with the endothelium increased the danger of corneal decompensation. Binkhorst suggested iris fixation. Conclusions At present, placement of the lens in the capsule, centered with the pupil, is preferred, permitting good near and distance vision without glasses.

Primary lens luxation (PLL) is a well-recognized, painful and potentially blinding inherited ocular condition in dogs. We screened PLL-affected dogs of 30 different breeds, to identify those which carried a previously described c.1473+1 G>A mutation in ADAMTS17 that is associated with PLL in Miniature Bull terriers, Lancashire Heelers, and Jack Russell terriers. This ADAMTS17 mutation was identified in PLL-affected dogs from 14 additional breeds. PLL-affected dogs from some breeds (most notably the Shar pei and the Brittany spaniel) did not carry the G1473+1A ADAMTS17 mutation, indicating they must suffer from a genetically distinct form of the condition. We also estimated the frequency of this ADAMTS17 mutation in some of the breeds. Our findings indicate the mutation segregates in a large number of different breeds of dog, many of which are terriers or breeds with terrier co-ancestry, but some of which have more diverse origins. Our results also indicate that the mutation is present at high frequency within most of the breeds in which it segregates. In the miniature bull terrier breed estimates of mutation frequency ranged from 0.27 to 0.39, corresponding to 7.3-15.2% PLL-affected dogs in this breed. We also identified an increased risk of PLL associated with heterozygosity at ADAMTS17, suggesting that carriers carry a low risk of developing PLL.

Objectives: To describe bilateral lens instability in 10 related domestic shorthair cats over three generations. Methods: Complete ophthalmic examinations were performed. Lentectomies were carried out. Sections of affected lenses focused on the equatorial area were examined by transmission electron microscopy. The potential involvement of several candidate genes (ADAMTS17, ADAMTSL4, ADAMTS10 and FBN1) known to be associated with lens luxation in other species was investigated. Results: The group of animals included 10 related cats, nine of them being affected by lens instability over three generations. Transmission electron microscopy showed the presence of zonular material at the lens equator. Signs of lens instability were not associated with other ocular disease. Analysis of the pedigree suggests a dominantly inherited condition. A mutation in ADAMTS17 was excluded, but a possible association between the condition and a microsatellite flanking FBN1 indicates this gene should be considered a strong candidate responsible for primary lens luxation in this pedigree. Clinical Significance: These observations suggest an inherent zonular defect unrelated to extraneous factors. The family relationship is compatible with a possible genetic basis, and the pedigree suggests that the condition could be dominant. Data also suggest the mutation in the FBN1 gene could be responsible for primary lens luxation in this pedigree of cats.

This report describes a long-horned cowfish, which was diagnosed with buphthalmia and lens sub-luxation in the right eye, conditions that progressed to complete anterior lens luxation and secondary keratoconus. Three months after the initial evaluation, a pigmented mass was observed protruding from the vitreous. An enucleation was performed under general anesthesia. Ocular histopathology revealed an iridociliary melanoma. Reports of intraocular melanomas are extremely rare in fish. To the authors' knowledge, this is the first report of an iridociliary melanoma that led to buphthalmia, lens luxation, and keratoconus in a fish. Histological findings of lens luxation are also demonstrated. Due to the presence of a complex suspensory apparatus involving the teleost lens, this report speculates that lens luxation is a more devastating disease process in teleosts than in mammals.

A family from Turkey with congenital ectopia lentis, likely occurring as an autosomal recessive trait, is presented. No systemic disorders such as homocysteinuria, Marfan's or Weill-Marchesani's syndromes were found in any of the patients. However, all patients except one were less than 2 years old when first examined so that lens luxation must have happened very early in life. Besides almost total lack of zonular threads the patients presented anomalies of ocular dimensions with increased corneal diameters and axial lengths, and in several cases glaucomatous distension of the optic discs could also be found. A possible explanation for these buphthalmic changes and their relation to lens luxation taking place very early in life is proposed. The importance of early diagnosis and treatment is discussed.

Summary Secondary lens luxation is an infrequent consequence of equine recurrent uveitis (ERU). This Case Report describes a pony with posterior lens luxation with associated glaucoma, thought to be secondary to ERU.

Objective: To examine ultrasonographic abnormalities in eyes with traumatic hyphema obscuring intraocular structures. Design: Retrospective clinical study. Setting: The ophthalmology services of a private practice and university veterinary teaching hospital. Animals: Twenty-two dogs, 6 cats, 3 horses, and 2 birds. Measurements and main results: Medical records were reviewed for signalment, history, ophthalmic examination, ultrasonographic findings, treatment, and outcome in all patients that presented to the ophthalmology service with trauma-induced hyphema obscuring intraocular structures. Thirty-three patients were included and there were 35 affected eyes (17 left and 18 right). Abnormalities noted on ophthalmic examination included hyphema obscuring intraocular details beyond the iris (100%), corneal laceration (23%), iris prolapse (23%), fibrin clotting within the anterior chamber (17%), and subconjunctival and periocular bruising (17%). Ocular ultrasonography revealed the presence of either vitreous hemorrhage or a retinal detachment in 32 of 35 eyes (91%) with traumatic hyphema. Of the remaining 3 eyes, ocular ultrasonography revealed a lens luxation with posterior eye wall rupture in 1 eye and collapsed globes in the other 2 eyes. Twelve eyes were enucleated and 23 were treated medically. Ten of the medically treated eyes were lost to follow-up. Blindness was noted in all the affected eyes upon their final discharge and recheck examination. Conclusions: Ocular ultrasonography revealed vitreous hemorrhage or a retinal detachment in 32 eyes (91%) with traumatic hyphema. Blindness was noted on the last available examination of every eye. The prognosis for vision in an eye with traumatic hyphema obscuring intraocular detail is poor.

Background The implantation of scleral fixated sutured posterior chamber lenses enables lens implantation in the absence of adequate lens capsule support. Anterior chamber lenses and their side effects can also be avoided, particularly in cases of unilateral aphakia and contact lens incompatibility. Methods This study is a retrospective analysis of 119 scleral fixated sutured posterior chamber lenses implanted in 115 patients. Seventy-nine cases of damaged zonula or damaged lens capsule and 17 cases of corneal decompensation secondary to anterior chamber lenses were the main indications for the suture fixation. The mean follow-up was 23 months (6–83 months). Results In 50% of all cases, improved visual acuity was achieved. Twenty-four percent of patients showed unchanged visual acuity, while 26% had poorer vision postoperatively, mainly because of corneal decompensation following anterior chamber lens explantation. The main postoperative complication was transient rise of intraocular pressure, occurring in 44% of the cases. Conclusions In most cases improved or comparable postoperative visual acuity was achieved. The main complication observed was postoperative glaucoma, especially in patients with pre-existing glaucoma.

Objective—To characterize heritability and mode of inheritance of cataracts and primary lens luxation in Jack Russell Terriers. Animals—872 Jack Russell Terriers from which buccal epithelial cells were collected and phenotypes for cataracts and lens luxation were determined and an additional 1,898 Jack Russell Terriers without phenotypic information used to complete pedigree relationships and that were included in the analyses. Procedures—Narrow-sense heritabilities and genetic correlation for cataracts and lens luxation were modeled by use of threshold analysis, whereas complex segregation analysis was used to characterize mode of inheritance. For the analyses, dogs < 6 years old, unless confirmed as having cataracts or lens luxation, were classified as an unknown phenotype. The possible involvement of an HSF4 mutation in cataracts was determined by DNA sequencing. Results—Cataracts and primary lens luxation were highly heritable and genetically correlated, and neither was controlled by a single gene. Cataracts were not associated with an HSF4 mutation. Conclusions and Clinical Relevance—Analysis of the data indicated that concerted selection against both cataracts and primary lens luxation when choosing breeding animals can be used to improve ocular health in Jack Russell Terriers.

The goals of canine cataract and lens instability surgery should be to ensure a small incision, minimal tissue trauma, shortened surgical time, maintenance of the anterior chamber, and restoration of emmetropia through the use of a stable intraocular lens specifically designed for the canine eye. While this is usually the case with routine phacoemulsification and in-the-bag intraocular lens implantation, it is often not the case with lens instability, lens luxation or large posterior capsular ruptures. In such cases the incisions are often larger, surgical time and tissue trauma are excessive, and the patient is often left aphakic. The goal of this paper is to present a modified ab externo technique designed to allow removal of the lens and placement of a ciliary sulcus sutured IOL through a small incision, with minimal trauma and shortened surgical time. Use of this technique may allow more canine patients to be emmetropic postoperatively. In addition, the ease of this procedure may encourage earlier removal of an unstable lens and decrease the risk of secondary glaucoma and retinal detachment that occur in association with lens luxation.

Objective—To determine outcome of initial conservative management for primary lens luxation and evaluate topically administered demecarium bromide miotic treatment for prevention of anterior lens luxation, glaucoma, and vision loss in dogs. Design—Retrospective case series. Animals—34 dogs with primary lens luxation. Procedures—Medical records of affected dogs were reviewed for times to anterior luxation, luxation of the lens in the opposite eye, development of glaucoma, and vision loss. Results—At 4 to 6 weeks and at 3 months after diagnosis of lens instability (subluxation or posterior luxation), 100% (34/34 and 29/29, respectively) of conservatively managed eyes retained vision. At 1 year after diagnosis of lens instability, 80% (16/20) of conservatively managed eyes retained vision, and at 2 years after diagnosis of lens instability, 11 of 19 conservatively treated eyes retained vision. The only significant effect of miotic treatment was to delay anterior lens luxation in eyes with lens instability. Miotic treatment did not significantly affect the time from anterior lens luxation in 1 eye to anterior luxation in the other eye, time to onset of glaucoma, or time to loss of vision in eyes with an unstable lens. Conclusions and Clinical Relevance—Prophylactic topically administered miotic treatment may be effective at delaying anterior luxation of an unstable lens in eyes affected by primary lens instability. Conservative medical management of dogs with primary lens instability is a reasonable alternative to surgical removal of a subluxated or posteriorly luxated lens via intracapsular lens extraction.

Primary lens luxation (PLL), a painful and blinding inherited condition, is common in several breeds of terrier. Here we have examined the Veterinary Medical Database of patient encounters and Canine Eye Registration Foundation (CERF) cases records for the last 10 years and found the diagnosis recorded in 85 breeds. We have performed association analysis using a genome-wide microsatellite screen to map mutations underlying the condition in miniature bull terriers and Lancashire heelers. These studies show microsatellite alleles in disequilibrium with disease status with highest support in a 6.3-Mbp region in the central part of chromosome 3 (-log P(max) = 6.4). The same region also shows an association to the disease in Tibetan terriers. Tight junction protein-1 (TJP1) is a positional candidate to contain the PLL mutation. All recognized exons and splice junctions of TJP1 have been sequenced from affected, obligate carrier and control Lancashire heeler dogs. Several polymorphisms have been found, but these are not likely to cause the disease.

The material of the present study was composed of 30 eyes with luxatio lentis occurring in 20 dogs. Unilateral lens luxation was determined in a half of the animals while bilateral luxation was determined in the other half. Lenses in 19 of the 30 eyes were luxated in the anterior direction (63.3%), three were luxated in the posterior direction (10%) and eight were subluxated (26.6%). The distribution of patient dogs based on the breeds showed that the incidence of lens luxation was higher in Terrier, Cocker Spaniel and crossbreed dogs compared to the other breeds. The results of etiological classification of the diseases which are generally seen in older dogs (on average 7.2 years old) were as follows: congenital in two patients, primary luxation in four patients, and second - ary luxation in 14 patients. Secondary luxations diagnosed in 14 animals were determined to have developed as a result of trauma in two dogs, glaucoma in one dog, uveitis in one dog, and senile degeneration and/or cataract in 10 dogs. Bilateral (two dogs) and unilateral (five dogs) intracapsullar lens extraction (ICLE) was applied to these animals. The primary disease was to be kept under control by treating those with secondary lens luxation for uveitis or glaucoma. A severe progressive intraocular inflammation developed in one patient. Enucleation was conducted on this patient due to buphthalmus developing in a short time. These results may be helpful to small animal veterinarians dealing with this disease which results in blindness unless early diagnosis and surgical treat - ment are conducted.

Background We encountered a rare patient with lens luxation in which the lens had become stuck on the optic disc. Findings obtained during vitreous surgery suggested that the luxated lens had become stuck on the optic disc via residual vitreous gel. Case presentation An 88-year-old Japanese man experienced lens luxation into the inferior vitreous cavity while undergoing treatment for glaucoma in his left eye. Because no inflammation was present upon examination, we observed the patient without prescribing any additional medications except for the eye drop treatment for glaucoma. Two years later, the patient revisited our clinic after suddenly noticing a visual disturbance in his left eye. A fundus examination revealed that the luxated lens had become stuck on the optic disc and displayed no changes in relation to the patient’s head position or eye movement. Subsequently, vitreous surgery was performed to remove the luxated lens. During the surgery, we observed an aggregation of vitreous gel between the luxated lens and the optic disc. The luxated lens was successfully mobilized by pushing with a vitreous cutter and then extracted through a corneoscleral incision using perfluorocarbon liquid. At 4 months after surgery, the patient’s visual acuity had improved to 20/25. Conclusions The findings of this study suggest that the luxated lens had become stuck on the optic disc via residual vitreous gel on the optic disc. The surgical procedure of extracting the luxated lens through a corneoscleral incision using perfluorocarbon liquid was found to be both safe and effective.

Purpose: We categorize weak zonule during capsulorhexis. Design: Retrospective interventional case series. Methods: The study examined 5447 consecutive eyes of 3527 cases that underwent phacoemulsification (PEA) and intraocular lens (IOL) implantation between March 2006 and March 2014 at Showa University Fujigaoka Hospital, Kanagawa, Japan. Weak zonule was categorized based on findings at capsulorhexis and difficulty in performing continuous curvilinear capsulorhexis (CCC). The categorization definitions were as follows: (1) Group N (normal) with no or slight lens movement at the start of the CCC and no difficulty in performing CCC, (2) Group W (weak) with moderate lens movement frequently accompanied by fold formation during CCC and some difficulty in performing CCC, (3) Group VW (very weak) because of severe lens movement and difficulties with the initial puncture, CCC can be performed with the aid of a highly retentive and cohesive ophthalmic viscoelastic device (OVD; Healon 5®), and (4) Group EW (extremely weak) with zonular deficiency in addition to the Group VW criteria and accounted for the cases of severe phacodonesis, lens subluxation, lens luxation into the anterior chamber, and dropped nucleus into the vitreous cavity that could be categorized preoperatively. We examined capsule stabilization device use during PEA, surgical lens removal, and IOL fixation in each group. Results: We defined 5098 eyes as Group N, 251 eyes as Group W, 55 eyes as Group VW, and 43 eyes as Group EW. As the zonule became weak, the use of the capsule stabilization device increased in PEA and intracapsular cataract extraction, and scleral suture fixation of IOL increased. Pars plana vitrectomy for lens removal was performed in 5 eyes (11.63%) categorized as Group EW. Conclusions: The categorization of weak zonule at CCC may be useful for selecting an appropriate capsule stabilization device and procedure during cataract surgery.

Background: The intravitreal injection of dispase has been shown to be a valuable method for induction of experimental PVR. The goal of the present study was to gain additional information about potential side effects associated with this method. Methods: Twenty-one pigmented rabbits received a single injection of dispase under topical anesthesia to one eye only, contralateral eyes served as untreated control. The animals were injected with doses from 0.045 to 0.065 units of dispase: 8 animals received 0.045 units, 9 animals 0.055 units and 4 animals 0.065 units. Results: Proliferative vitreoretinopathy occurred in 81% of the treated eyes. In 90% cataract formation was observed. Lens luxation was present in 47.3% of the cataract eyes. Conclusion: Intravitreal injection of dispase resulted in the reproducible induction of PVR in addition to cataract formation and lens luxation. Whether these effects may all be associated with a toxic reaction or whether the proliferative changes are solely triggered by endogenous reactions similar to the pathomechanism of human PVR and whether the cataract formation and the lens luxation may be avoided by changing the method of injection require further investigation.

Ocular ultrasonography is a practical and valuable examination tool for horse eyes with anterior opacities that preclude ophthalmoscopy of deeper structures. Ultrasonography is indicated in cases of periocular trauma, exophthalmos, corneal masses, corneal edema and/or infiltrates, cataracts, and anterior uveitis. Transducers of 7 to 10 MHz may be used to identify and characterize cataracts, lens luxation, lens rupture, vitreal opacities, retinal detachment, endophthalmitis, microphthalmos, buphthalmos, and periorbital masses. High-resolution ultrasonography, using frequencies of 20 MHz and greater, provides improved detail of anterior segment structures. Ultrasound image artifacts are common, requiring knowledge of ocular anatomy and basic ultrasonographic principles for accurate interpretation.

Objective To determine the prevalence of secondary glaucomas in dogs associated with cataract formation, lens luxation or displacement, cataract surgery, uveitis, hyphema and intraocular neoplasia. Methods Information was obtained from the Veterinary Medical Data Base (VMDB) from all veterinary medical teaching hospitals in North America from March 1964 to March 2003. Secondary glaucomas were diagnosed at the same examination or after the primary diagnosis was made, and included those associated with cataract formation, lens luxation, cataract surgery, uveitis of unknown cause, hyphema of unknown cause, and intraocular neoplasia. The data were evaluated by decade, breed, gender and age of presentation. Results A total of 1 592 831 dogs were presented, and 9695 canine secondary glaucomas. Secondary glaucoma associated with cataract formation represented 81% of all the canine secondary glaucomas. Breeds (n = 7890 dogs) predisposed to secondary glaucoma and cataracts had an overall prevalence of 0.5%, but nearly 20% of all the cataractous dogs developed secondary glaucoma in at least one eye. For the years 1994–2003, these breeds included the American Cocker Spaniel; Boston Terrier; Toy, Miniature and Standard Poodle; English Springer Spaniel; Bichon Frise; and Labrador Retriever. The other forms of secondary glaucoma occurred less frequently, and included those glaucomas with lens luxation or displacement (779 dogs; 12.0%), postcataract surgery (528 dogs; 5.1%), with uveitis from unknown cause (399 dogs; 7.1%), with hyphema from unknown cause (117 dogs; 7.3%), and with intraocular neoplasia (19 dogs; 3.5%). The risk of the secondary glaucomas from 1984 to 2002 was highest after the intracapsular lens extraction (ICLE), less in the extracapsular technique (ECLE), and lowest for the phacoemulsification/phacofragmentation method. Conclusion Prevalence of the canine secondary glaucomas ranges from 0.25% (1964–1973), 0.46% (1974–1983), 0.79% (1984–1993), to 0.80% (1994–2003) and are as frequent as the primary or breed-related glaucomas during these same time periods.

Purpose To define the indications for equine ocular ultrasonography and to provide representative ultrasonographic images of lens and posterior segment diseases. Methods Retrospective study. Equine medical records dating from January 1983 to March 2001 were reviewed. All cases that: (1) had a lens and/or posterior segment abnormality; and (2) received a complete ophthalmic examination and ocular ultrasonography were included. Results Forty-three cases (n = 64 eyes) out of 112 total cases of equine lens and/or posterior segment abnormalities qualified. The following conditions were identified ultrasonographically in order of decreasing frequency: cataracts, vitreal opacities, retinal detachment, lens luxation, endophthalmitis, microphthalmos, choroiditis, lens rupture, lenticonus, buphthalmos and phthisis bulbi. Ultrasonography often enabled diagnoses to be made in the presence of anterior opacities in both surgical (pre and/or postoperatively) and nonsurgical cases. Additional ocular conditions were identified in adults with cataracts more frequently than in foals with cataracts. Conclusions Cataracts were the most common lens abnormality identified in horses that received ocular ultrasound examination. Cataracts were commonly found in association with other ocular abnormalities. Ultrasonography was a practical and effective method of evaluating the lens and posterior segment, particularly in cases with anterior opacities. Ultrasonography also provided critical information with regard to the potential for surgical removal of cataracts and was a valuable component of postsurgical follow-up.

Purpose We report the case of a 41-year-old woman with bilateral lens subluxation and medically uncontrolled glaucoma in whom Marfan syndrome (MFS) was diagnosed. Methods The patient underwent complete clinical eye and systemic examinations and blood samples were drawn for mutational screening of fibrillin 1 gene (FBN1). Results The patient was diagnosed with MFS on a clinical basis and according to the Ghent criteria and the genetic testing revealed a novel heterozygous mutation in the FBN1 gene. The patient required pars plana vitrectomy with lensectomy and Ahmed valve implantation in the vitreous cavity to control her severe glaucoma. Conclusions The diagnosis of a bilateral lens luxation must be followed by complete systemic examination and genetic analysis of the FBN1 gene in order to discard MFS due to its severe systemic complications. Frequently, the condition causes an aggressive secondary glaucoma that requires surgical treatment with lensectomy, vitrectomy, and drainage device implantation in order to avoid its devastating progression toward glaucomatous optic atrophy.

This article addresses the management of patients with cataracts or lens luxation. It explains the selection of patients for cataract surgery, as well as the state-of-the-art surgical technique for cataract removal and the required after-care. Furthermore the treatment modalities for lens luxation are discussed. The second part of the article focuses on the nursing aspects of these conditions and, in particular, the necessary after-care following intraocular surgery. Possible short- and long-term complications are discussed, including the management of visually impaired and blind dogs.

Vision is an important sense, not only for people, but also for our dogs. Ocular health, therefore, is an important aspect of veterinary medicine. This article gives an overview of the ocular lens ...

Sixty-two healthy adult donkeys were included in this study, giving a total of 124 eyes for examination. The weight of the donkeys was estimated and an ultrasonography of the eyes was performed using a curvilinear transducer. Ocular measurements were taken in a horizontal plane and included the following values: globe axial length (GAL), anterior chamber depth (ACD), vitreous body depth (VD), lens diameter (LDi) and lens depth (LDe). The mean and sds for each measurement are reported in mm: GAL 34.22±2.05; ACD 3.01±0.58; VD 20.20±1.63; LDi 17.96±1.66 LDe 11.06±0.71. Gender was not a variability factor for ocular biometry in donkeys, while the weight was directly related to the ultrasonographic ocular values. Lens dimensions represented an exception and further investigation should be carried out to verify a possible correlation with age rather than weight. This is the first paper reporting reference data for ocular biometry in donkeys. The ultrasonographic evaluation of the equine eye is a manageable procedure that is easy to perform and can provide information not always obtainable with direct ocular examination. It allows the imaging of intraocular and retrobulbar structures and the diagnosis of some important disorders involving these areas (Scotty and others 2004, Michau 2005, Dietrich 2007). Ocular ultrasound is also indicated where it is impossible to directly visualise (eg, with an ophthalmoscope) posterior structures of the globe in cases of corneal oedema or ulceration, cataract or ocular masses (Withcomb 2002). Ultrasound can be used to investigate enophthalmos, buphthalmos or exophthalmos in cases of ocular protrusion and suspicion of disparity in globe size (Withcomb 2002). The most common diseases that can be detected or confirmed with ultrasound are corneal diseases, cataract, lens luxation, intraocular cysts or masses, glaucoma and retinal detachment (Reef 1998, Withcomb 2002). Although horses and donkeys can be affected by …

Conhecida como uma das mais importantes causas de cegueira nos eqüinos, a uveíte recorrente eqüina (URE) caracteriza-se por repetidos episódios de inflamação ocular interrompidos por períodos variáveis de quiescência clínica. Muito embora diversos fatores tenham sido relacionados à ocorrência de URE, acredita-se que a doença se desenvolva pela ação de agentes como Leptospira interrogans e a microfilária do nematóide Onchocerca cervicalis, em conseqüência de reações imunomediadas intra-oculares. Os sinais clínicos da fase aguda, como epífora, blefarospasmo, fotofobia, hiperemia conjuntival, miose, opacidade corneana e do humor aquoso, hifema e hipópio, podem ser encontrados em diferentes graus. Os sinais da fase crônica podem incluir sinéquias, alterações na forma e pigmentação normais da íris, luxação ou subluxação do cristalino e catarata, entre outros. O tratamento tem como principais objetivos a redução da inflamação uveal, a preservação da motilidade da pupila e a prevenção de seqüelas que levem à cegueira, e consiste, fundamentalmente, no uso de drogas antiinflamatórias e midriáticos e cicloplégicos. O prognóstico, quanto à conservação da visão, está na dependência da intensidade e freqüência dos episódios recorrentes e do sucesso do tratamento. Known as the leading cause of blindness in horses, equine recurrent uveitis (ERU) is characterized by several attacks of intra-ocular inflammation alternated with variable periods of clinical quiescence. Although many factors have been related to ERU it seems that Leptospira interrogans and the microfilaria of Onchocerca cervicalis play an important role in the pathogenesis through an immune-mediated mechanism. Clinical findings in the acute phase include variable degrees of epifora, blepharospasm, photophobia, conjunctival hyperemia, miosis, corneal opacity, aqueous flare, hyphema, and hypopyon. Clinical findings consistent with chronic phase include synechiae, changes in shape and pigmentation of the lens, cataract and lens luxation or subluxation. The principal goals of treatment are reduction of uveal inflammation, preservation of pupil's motility, and prevention of blindness. Therapy consists mainly of antiinflamatory and mydriatics/cycloplegic drugs. The prognosis for preservation of vision varies with severity and frequency of recurrencies, and the success of the treatment.

Purpose: To propose a new classification of capsular block syndrome (CBS) to improve understanding of the etiology and provide effective treatment. Setting: Shohzankai Medical Foundation, Miyake Eye Hospital, Nagoya, and Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan. Methods: Three groups of eyes with CBS were reviewed: eyes originally reported and diagnosed as having CBS; eyes experiencing CBS after hydrodissection and luxation of the lens nucleus; and eyes with CBS accompanying liquefied aftercataract or capsulorhexis-related lacteocrumenasia. Results: In all 3 groups, the CBS occurred in eyes with a -continuous curvilinear capsulorhexis (CCC). It was characterized by accumulation of a liquefied substance within a closed chamber inside the capsular bag, formed because the lens nucleus or the posterior chamber intraocular lens (IOL) optic occluded the anterior capsular opening created by the CCC. Depending on the time of onset, CBS can be classified as intraoperative (CBS seen at the time of lens luxation following hydrodissection), early postoperative (original CBS), and late postoperative (CBS with liquefied aftercataract or lacteocrumenasia). The etiology of the accumulated substance and the method of treatment are different in each type. Conclusion: Capsular block syndrome is a complication of cataract/10L surgery that can occur during and after surgery. Correctly identifying the type of CBS is crucial to understanding the nature and effective treatment of this disorder.

In a twenty five-year-old female patient, we observed bilateral lens dislocation into the vitreous body that occurred spontaneously as a result of Marfan's syndrome and megalocornea, when she was 8 years old. Corneal diameters were 14 mm in the right eye and 13.5 mm in the left eye. Slit-lamp examination revealed miosis and iridodonesis. Fundus examination revealed bilateral inferior lens dislocation into the vitreous body. There was no lens induced posterior uveitis in either eye. This patient demonstrated that lens dislocation into the vitreous body can be present for a long time without causing any intraocular inflammation.

This chapter will focus on the management of some of the more common feline eye diseases encountered in first-opinion practice, notably conjunctivitis, corneal ulceration, uveitis, glaucoma and lens luxation. Quick reference guide: Enucleation.

BACKGROUND Gilles de la Tourette syndrome is a neurological disorder characterized by motor and vocal tics. Extreme forms of this disease manifest themselves with self-mutilating behavior and foul language. HISTORY AND SIGNS A 59-year-old man, treated for Gilles de la Tourette syndrome, presented with visual loss after an attack during which he punched his right eye with his fist. On examination visual acuity was decreased to finger counting but could be improved to 1.0 with an S + 13D lens. There was vitreous prolaps into the anterior chamber and pigment was noted in the vitreous cavity. The complete dislocated lens could be seen ophthalmoscopically in the inferior fundus of the eye. THERAPY AND OUTCOME The patient was treated with vitrectomy and phacoemulsification through the pars plana. An additional encircling band was placed due to peripheral retinal tears in the inferior quadrants. Visual rehabilitation was achieved with a secondary implant of a retropupillary iris-claw lens nine months later. DISCUSSION Self-inflicted injuries are common in Gilles de la Tourette syndrome. Ocular lesions described in the literature comprise isolated cases of orbital hemorrhage, retinal detachment and permanent severe visual loss. Lens luxation has not been described before, and is probably due to weakened zonulae induced by repeated trauma. Treatment with a retropupillary iris-claw lens is the preferred therapy as it reduces the risk of endothelial touch during repeated trauma on the eye.

THE main purpose of the British Veterinary Association/Kennel Club/international Sheep Dog Society (BVA/KC/ISDS) Eye Scheme is to ensure that there is no evidence of hereditary eye disease in dogs which are used for breeding. In order to achieve this aim it is important not only that all dogs which are to be used for breeding are examined under the scheme, irrespective of whether there are known inherited eye problems within the breed, but that the scheme is kept under active review with regard to the inherited eye diseases and breeds which should be included. The conditions currently certified under the scheme are reviewed in this article. They comprise the congenital inherited conditions of goniodysgenesis/primary glaucoma, persistent pupillary membrane, persistent hyperplastic primary vitreous, retinal dysplasia, collie eye anomaly and congenital cataract, along with non-congenital inherited types of cataract, primary lens luxation, generalised progressive retinal atrophy and central progressive retinal atrophy. For some of the congenital inherited problems, litters of puppies are screened to establish the status of the whole litter. For dogs of any age, individual certificates are issued with respect to the known inherited eye disease(s) for the breed under examination.