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Congenital fibrosis of the extraocular muscles (CFEOM) is one of the congenital cranial dysinnervation disorders (CCDDs). This review discusses the characteristics of the CFEOM phenotypes and the CCDDs, the fibrosis associated with these disorders and the processes, and genes involved in the embryological development of cranial neuromuscular units. In particular, it focuses on the genetics of neural crest identity, axon guidance, and axon construction in relation to the CFEOMs and some consideration of treatment strategies.摘要: 先天性眼外肌纤维化 (CFEOM) 是一种先天性颅神经功能障碍 (CCDDs) 。本文综述了CFEOM与CCDDs的临床表型的特点, 纤维化与与这两种疾病的相关性以及在颅神经肌肉单元的胚胎发育中的相关过程及与其相关的基因。我们特别着重描述了与CFEOMs相关的神经嵴识别的基因、轴突引导和轴突构建及其针对性的治疗策略。.

The aim of this report is to increase awareness of a possible association between cranial nerve paresis and the use of sumatriptan in migraine sufferers, particularly in patients who have additional vascular risk factors. We describe a series of three cases where third nerve paresis developed in patients who were treated with the oral form of sumatriptan. All of the patients had a clear history of repetitive migraine headache and none of them had previous third nerve paresis. Among a variety of medications for the treatment of migraine, there are some drugs with vasoconstrictive effects, particularly triptans. These drugs may be a contributing factor for microvascular damage of the cranial nerves and other organs.

IntroductionDissociated tests of strabismus provide valuable information for diagnosis and monitoring of ocular misalignment in patients with normal retinal correspondence. However, they are vulnerable to operator error and rely on a fixed head position. Virtual reality headsets obviate the need for head fixation, while providing other clear theoretical advantages, including complete control over the illumination and targets presented for the patient's interaction.PurposeWe compared the performance of a virtual reality-based test of ocular misalignment to that of the traditional Lees screen, to establish the feasibility of using virtual reality technology in ophthalmic settings in the future.MethodsThree patients underwent a traditional Lees screen test, and a virtual reality headset-based test of ocular motility. The virtual reality headset-based programme consisted of an initial test to measure horizontal and vertical deviation, followed by a test for torsion.ResultsThe pattern of deviation obtained using the virtual reality-based test showed agreement with that obtained from the Lees screen for patients with a fourth nerve palsy, comitant esotropia, and restrictive thyroid eye disease.ConclusionsThis study reports the first use of a virtual reality headset in assessing ocular misalignment, and demonstrates that it is a feasible dissociative test of strabismus.

PURPOSE: We validate a video-based method of head posture measurement. METHODS: The Cambridge Face Tracker uses neural networks (constrained local neural fields) to recognize facial features in video. The relative position of these facial features is used to calculate head posture. First, we assess the accuracy of this approach against videos in three research databases where each frame is tagged with a precisely measured head posture. Second, we compare our method to a commercially available mechanical device, the Cervical Range of Motion device: four subjects each adopted 43 distinct head postures that were measured using both methods. RESULTS: The Cambridge Face Tracker achieved confident facial recognition in 92% of the approximately 38,000 frames of video from the three databases. The respective mean error in absolute head posture was 3.34°, 3.86°, and 2.81°, with a median error of 1.97°, 2.16°, and 1.96°. The accuracy decreased with more extreme head posture. Comparing The Cambridge Face Tracker to the Cervical Range of Motion Device gave correlation coefficients of 0.99 (P < 0.0001), 0.96 (P < 0.0001), and 0.99 (P < 0.0001) for yaw, pitch, and roll, respectively. CONCLUSIONS: The Cambridge Face Tracker performs well under real-world conditions and within the range of normally-encountered head posture. It allows useful quantification of head posture in real time or from precaptured video. Its performance is similar to that of a clinically validated mechanical device. It has significant advantages over other approaches in that subjects do not need to wear any apparatus, and it requires only low cost, easy-to-setup consumer electronics. TRANSLATIONAL RELEVANCE: Noncontact assessment of head posture allows more complete clinical assessment of patients, and could benefit surgical planning in future.

To estimate the prevalence of posterior embryotoxon (PE) in the general ophthalmic clinic and to identify any features of PE that suggest that it is pathological rather than physiological. Over 700 consecutive patients of all ages were examined with the slit lamp during their routine eye clinic appointment. Patients with posterior embryotoxon were invited to return for full ocular examination including keratometry, corneal topography, and gonioscopy. In all, 49 out of 723 patients were found to have PE. This gives a prevalence of 6.8% with an age range of 18 months to 95 years. There was a higher prevalence in the younger age group of 22.5% (age range 18 months to 20 years) compared to 5.9% in the older age range (21–95 years). A total of 29 patients with PE returned for further examination. Six patients had glaucoma (two with Axenfeld's syndrome and one with aniridia), and one had ocular hypertension. In all, 20 patients had bilateral PE on slit-lamp examination, which increased to 24 with gonioscopy. The majority of the PE was seen temporally (97.9%) and limited to a few clock hours. Gonioscopy showed that eight patients with PE had associated inferior pigmentation of schwalbes line. This large series found the prevalence of PE the general ophthalmic clinic to be 6.8%. Its presence should prompt careful anterior segment examination, including gonioscopy, to identify any associated abnormalities that may carry a risk of glaucoma. Children should also be assessed for any associated systemic or genetic abnormality.

What is the clinical problem? Children with a significant esotropia for near but a smaller or no deviation for distance. What is the controversy? There are two treatment strategies. Patients may be managed either with optical correction (bifocal glasses) or with surgery. What are the important issues? Are we treating a homogeneous group? What are the objectives of treatment? What are the outcome measures? Is one treatment strategy more effective than the other? What are the complications of each treatment strategy? Can we create an evidence based treatment strategy? Much of the controversy that has arisen in the management of convergence excess esotropia results from differences in definition. A review of the literature reveals a number of studies concerning the management of convergence excess esotropia which are clearly dealing with different, although related, conditions. This makes comparison of outcomes difficult. The major difference in management is the use of optical treatment in North America (mainly bifocal glasses), whereas in Europe the same condition is more likely to be treated with surgery. Miotics are no longer used to treat this condition. The objective of this review is to determine whether there is evidence to suggest one form of treatment is more effective than the other. Does it depend on definition? Are some patients with convergence excess esotropia more effectively managed with optical correction and some with surgical correction? What are we trying to achieve with treatment and at what point do we concur that a treatment has been a success or failure? Does the method of bifocal management affect the outcome? Are some surgical strategies more effective than others? Convergence excess esotropia is a condition characterised by an esotropia which is greater for near fixation than for distance fixation. It was first described by Donders in 1864.1 Most consider that, …

Background: Amblyopia (lazy eye) affects the vision of approximately 2% of all children. Traditional treatment consists of wearing a patch over their ‘good’ eye for a number of hours daily, over several months. This treatment is unpopular and compliance is often low. Therefore results can be poor. A novel binocular treatment which uses 3D technology to present specially developed computer games and video footage (I-BiT™) has been studied in a small group of patients and has shown positive results over a short period of time. The system is therefore now being examined in a randomised clinical trial. Methods/design: Seventy-five patients aged between 4 and 8 years with a diagnosis of amblyopia will be randomised to one of three treatments with a ratio of 1:1:1 - I-BiT™ game, non-I-BiT™ game, and I-BiT™ DVD. They will be treated for 30 minutes once weekly for 6 weeks. Their visual acuity will be assessed independently at baseline, mid-treatment (week 3), at the end of treatment (week 6) and 4 weeks after completing treatment (week 10). The primary endpoint will be the change in visual acuity from baseline to the end of treatment. Secondary endpoints will be additional visual acuity measures, patient acceptability, compliance and the incidence of adverse events. Discussion: This is the first randomised controlled trial using the I-BiT™ system. The results will determine if the I-BiT™ system is effective in the treatment of amblyopia and will also determine the optimal treatment for future development. Trial registration: ClinicalTrials.gov identifier: NCT01702727 Keywords: Amblyopia, I-BiT™, Randomised clinical trial, Lazy eye, Child, Visual acuity, Binocular

Sir, The Tutoplast process is a scientific method of virally inactivating, preserving, and sterilising human tissue, which can be safely used as an allograft. The Tutoplast pericardium patch graft (Innovative Ophthalmic Products, Inc., Costa Mesa, CA, USA), supplied by IOP Ophthalmics in the United Kingdom, is comprised of low-profile collagen with a multi-directional matrix for superior surgical handling and suture utility. The literature describes successful Tutoplast pericardium utilisation in the management of Peyronie's disease,1 as a patch graft in glaucoma, and corneal surgery,2, 3 to cover exposed scleral buckles4 and oculoplastic surgery.5 We report the novel use of this material for cosmetically unacceptable scleral translucency following strabismus surgery.

Purpose To determine whether the first day review is essential in management of patients following uncomplicated phacoemulsification with intraocular lens implantation. Patients are routinely seen on the day following surgery. This can produce logistical problems in patient attendance that can necessitate an overnight stay. If the first day review were abandoned this would lead to an increased uptake of day case surgery and a reduction in health care costs. Methods A retrospective cohort study was performed on all cases of uncomplicated phacoemulsification with intraocular lens implant surgery over a 6 month period. Slit lamp examination findings on the first postoperative day were reviewed. Visual acuity, corneal clarity, anterior chamber activity, intraocular pressure and configuration of the pupil were recorded. Any cases that failed to meet predetermined criteria underwent full case-note review. The subsequent management of these patients was analysed. Results Of the 201 cases of uncomplicated surgery, 74 cases (37%) failed to meet the study criteria and underwent review. Of these only 12 (6%) had their management altered as a result of the first day post-operative findings. This was entirely due to raised intraocular pressure. Visual acuity, corneal oedema and activity in the anterior chamber all improved on subsequent follow-up. Conclusions The first day review of uncomplicated phacoemulsification with lens implant surgery provides the opportunity to treat raised intraocular pressure. A prospective randomised study is needed to identify means to prevent the post-operative intraocular pressure rise before we are able to consider abandoning the first review.

Posterior lenticonus tends to be unilateral and there is no evidence that this is a familial condition. We report three cases of bilateral posterior lenticonus in boys. The mothers of all three cases had posterior lenticular changes, less severe than their sons. We suggest that bilateral posterior lenticonus may be inherited in an X-linked fashion.

Retinal toxicity attributable to intravitreal use of aminoglycosides for endophthalmitis has been reported. Campochiaro and Conway reported 101 cases of retinal damage due to intravitreal aminoglycosides.1 Amikacin, an aminoglycoside, is in widespread use in the United Kingdom for the treatment of Gram negative organisms in endophthalmitis. We report a case of macular toxicity following the use of intravitreal amikacin for postoperative endophthalmitis, outline mechanisms of retinal toxicity, and offer alternatives to amikacin. We believe that enough evidence now exists to support a change in the current Royal College of Ophthalmologists' endophthalmitis treatment guidelines that are based on the Endophthalmitis Vitrectomy Study.2 A 69 year old white woman presented 1 day after uneventful right phacoemulsification and intraocular lens implantation with a vision of …

We thank Doft et al for their useful and expert opinion.1 The choice of which agent to use to empirically treat Gram negative organisms implicated in endophthalmitis remains controversial. As amikacin has been proved to cause macular infarction, we think one should look at viable alternatives. Ceftazidime is already in widespread use in the United Kingdom and appears not …