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The incidence of iris melanoma is 8% of all the uveal melanomas.1 In children and adolescents, iris melanoma accounts for 0.6–1.6% of all the uveal melanomas.2 We present a case of iris melanoma in a young boy treated with iridectomy and a phakic iris repair implant lens. A 12-year-old boy was referred to the Department of Ophthalmology, Antwerp and then to Leiden because of a melanocytic lesion on the right iris without complaints. The visual acuity was 20/20 in both the eyes. Slit-lamp examination showed a pigmented iris lesion in the inferior quadrant of the right eye with diameter of 6.8 mm. The pupil showed a visible deformation, and an abnormal vasculature was present with ectropion uvea (figure 1A). Gonioscopy revealed a flat pigmented lesion extending in the open anterior chamber angle. …

The indications for two types of pulsed Nd: YAG lasers in the treatment of vitreous pathology are reviewed. A series of 94 eyes from 93 patients were treated with the mode-locked system and 72 eyes from 71 patients were treated with the Q-switched system. A classification of vitreous pathology with prognostic value for the efficacy of treatment of both lasers is established. For the Q-switched laser the range of indications in the posterior pole is larger and fewer sessions are needed; however, complications are more frequent than with the mode-locked laser. This difference is due to the higher energy needed with the Q-switched laser to treat more severe vitreous pathology.

Central retinal artery occlusion can be caused by excessive extrinsic pressure on the eyeball during surgery. It is a rare and severe complication after elective spinal surgery. The authors report a case of central retinal artery occlusion in an adult after posterior lumbar spinal fusion in which a rectangular headrest was used.

We describe a family with an autosomal dominant form of retinal-cerebellar atrophy. There is an extreme variability in age of onset and severity of the clinical symptoms: some patients remain nearly asymptomatic throughout their entire life; others develop severe retinal and cerebellar symptoms after the age of 35 years; others suffer from a severe disorder with onset in adolescence and death during the third decade of life; in others the onset is in early childhood with prevalence of cerebellar symptoms. There is neither dementia nor epilepsy in any of the patients. Four out of five autopsies showed, a severe retinal atrophy, and all five autopsies were also characterized by (1) a cerebellar atrophy affecting the spinocerebellar and olivocerebellar tracts, the cerebellar cortex and the efferent cerebellar pathways, (2) an involvement of the pyramidal pathways and of the motor neurons of brain stem and spinal cord, and (3) an atrophy of the subthalamic nucleus and to a much lesser extent of the pallidum, with also some damage to the substantia nigra. The posterior columns are much less affected except in one patient. In this family, we have excluded linkage with the two loci for spinocerebellar ataxia, i.e., SCA1 on chromosome 6p and SCA2 on chromosome 12q as well as with the locus for Machado-Joseph disease (MJD) on chromosome 14q. A genome-wide search is currently being performed to detect the disease locus responsible.

Three eyes with preretinal macular fibrosis (PMF) were treated with the Q-switched Nd-YAG laser. The PMF was idiopathic in two eyes and associated with a vitreous hemorrhage, due to ocular trauma, in the third eye. The three eyes had in common a partial posterior vitreous detachment with vitreous traction on the macula. The Nd-YAG laser beam was focused on the detached posterior hyaloid in front of the macular region. Some holes were made in this membrane or in the adjacent collapsed vitreous cortex. Treatment increased the visual acuity in the three eyes; the vitreous remained partially detached in the two eyes with idiopathic PMF and detached completely in the eye with the secondary PMF. The disentanglement of the fovelar area was revealed by the unfolded appearance of the retinal vessels on fluoangiography.

A case is reported of a premacular retrohyaloid hemorrhage bulging into the bursa premacularis, due to a macroaneurysm secondary to hypertension. The Q-switched Nd-YAG laser is used to puncture the posterior hyaloid and drain the blood. A fast and full visual recovery is observed. The method is recommended in premacular hemorrhages without underlying proliferative diseases and where the volume of the blood does not greatly exceed 12 microliters.

A case is presented with irreversible blindness in one eye and restriction of the infratemporal visual field in the other eye, due to electrocoagulation performed for delayed bleeding after functional endoscopic sinus surgery (FESS). Although blindness due to rhinosurgery is a well-known, but rare complication, a review of the recent literature did not reveal a similar incident. The use of electrocoagulation especially under conditions of poor visualization, that may be the case in post-operative bleeding following (endoscopic) sinus surgery, is strongly discouraged.