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To the Editor:We report a case of IgG4-related ophthalmic disease (IgG4-ROD1) in a patient who initially presented with painless, full-thickness growth of the left eyelid that was nonresponsive to ...

This study surveyed six North American zoologic institutions to collect retrospective information on the incidence of ocular disease in the giant panda. Reported information included sex and age at presentation, as well as diagnosis, treatment, duration, and clinical outcome for each episode of ocular disease. Among the 42 animals included in the survey, 10 (23.8%) had clinical ocular abnormalities reported. Multiple disease episodes were reported in four animals, with 20 clinical episodes, and one additional animal who presented with corneal scarring from historic keratitis. Age at presentation varied from 0.4 to 26 yr (mean, 11.8 yr; median, 10.4 yr). Corneal abnormalities (including corneal opacity or haze, keratitis, corneal ulcers, and bullous keratopathy) were the most common pathologies reported, followed by conjunctivitis and/or ocular discharge. Additional reported abnormalities included limbal squamous cell carcinoma and lipid degeneration. Six cases resolved without intervention. Treatment protocols included topical and/or systemic medication with or without surgical intervention, which commonly resulted in resolution with or without persistent corneal scar. The prevalence of ocular disease identified in the giant panda in this study is higher than previous publications surveying ocular disease in the family Ursidae, indicating that this is an important source of morbidity in this species.

AIM: To investigate clinicopathological features of immunoglobulin G4-related ophthalmic disease (IgG4-ROD), and analyze the recurrence rates following systemic corticosteroid administration. METHODS: We retrospectively searched clinical features, laboratory and histological findings based on the medical records of 21 patients with IgG4-ROD. All the patients examined in this study underwent surgical resection in the ocular adnexal lesions and underwent histological evaluation. This study further investigated clinical and histopathological features of 15 patients who received systemic corticosteroid after the resection. RESULTS: The mean age of the patients consisting of 7 males (33%) and 14 females (67%) was 61y. Fourteen patients were diagnosed as definitive, and 2 and 5 patients were probable and possible IgG4-ROD, respectively. Eyelid swelling was an initial symptom in 11 patients (52%) who did not show systemic involvements at a diagnosis. Fifteen patients received systemic corticosteroid administration, and all showed remission of inflammation. Among them, 10 patients did not recur, whereas 5 patients (33%) recurred during tapering. There were no significant difference between patients with or without recurrence in clinicopathological features. CONCLUSION: In this study, female patients are more predominant in IgG4-ROD. While inflammation recurs in one-third of patients, this study do not identify factors associated with recurrence after systemic corticosteroid administration.

Instability of the tear film (TF) protecting the ocular surface results in dry eye syndrome (DES), the most prevalent public health ophthalmic disease affecting the quality of life of 10 to 30% of the human population worldwide. Although the impact of the tear film lipid layer (TFLL) and of the aqueous tears (AT) to the TF stability is extensively studied, in contrast the contribution of the secretory mucins (SM) and of the membrane-associated mucins (MAM), i.e., one of the most abundant molecular classes in AT and in the corneal epithelium respectively, remains poorly defined. However, it is well known that in DES both types of mucins are quantitatively or qualitatively deficient. Numerous studies since the 1990s until now have proposed direct involvement of SM and MAM in the material properties (viscoelasticity, hydration, and protection of the ocular surface; synergistic cooperation with the rest of the TF layers; etc.) and stability of TF. These theories will be reviewed here in the context of the classical and modern in vitro and in vivo results that allow their reappraisal and in view of the novel mucin secretion enhancing pharmaceuticals, which have opened innovative routes for the therapy of DES.

Ocular images play an essential role in ophthalmology. Current research mainly focuses on computer-aided diagnosis using slit-lamp images, however few studies have been done to predict the progression of ophthalmic disease. Therefore exploring an effective approach of prediction can help to plan treatment strategies and to provide early warning for the patients. In this study, we present an end-to-end temporal sequence network (TempSeq-Net) to automatically predict the progression of ophthalmic disease, which includes employing convolutional neural network (CNN) to extract high-level features from consecutive slit-lamp images and applying long short term memory (LSTM) method to mine the temporal relationship of features. First, we comprehensively compare six potential combinations of CNNs and LSTM (or recurrent neural network) in terms of effectiveness and efficiency, to obtain the optimal TempSeq-Net model. Second, we analyze the impacts of sequence lengths on model's performance which help to evaluate their stability and validity and to determine the appropriate range of sequence lengths. The quantitative results demonstrated that our proposed model offers exceptional performance with mean accuracy (92.22), sensitivity (88.55), specificity (94.31) and AUC (97.18). Moreover, the model achieves real-time prediction with only 27.6ms for single sequence, and simultaneously predicts sequence data with lengths of 3-5. Our study provides a promising strategy for the progression of ophthalmic disease, and has the potential to be applied in other medical fields.

© 2017 American College of Veterinary Ophthalmologists Objective: To determine factors associated with sudden acquired retinal degeneration syndrome (SARDS) diagnosed within one referral population. Animals Studied: 151 dogs diagnosed with SARDS. Procedures: Breed, age, sex, and body weight were compared between dogs with electroretinogram-confirmed SARDS and dogs presented to the UC Davis Veterinary Medical Teaching Hospital (UCD-VMTH) from 1991 to 2014. Results: SARDS was diagnosed in 151 dogs, representing 1.3% of dogs presented to the UCD-VMTH for ophthalmic disease. Although dogs of 36 breeds were affected, the Dachshund (n = 31, 21%), Schnauzer (16, 11%), Pug (11, 7%), and Brittany (5, 3%) were significantly overrepresented, and the Labrador Retriever (3, 2%) was significantly underrepresented vs. the reference population (P

Microsaccade research has recently reached a critical mass of studies that allows, for the first time, a comprehensive review of how microsaccadic dynamics change in neurological and ophthalmic disease. We discuss the various pathological conditions that affect microsaccades, their impact on microsaccadic and other fixational eye movement dynamics, and the incipient studies that point to microsaccadic features as potential indicators of differential and early diagnoses of multiple clinical conditions, from movement disorders to attention-deficit hyperactivity disorder to amblyopia. We propose that the objective assessment of fixational eye movement parameters may help refine differential diagnostics in neurological disease and assist in the evaluation of ongoing therapy regimes. In addition, determining the effects of ophthalmic disease on fixational eye movement features may help evaluate visual impairment in an objective manner, particularly in young patients or those experiencing communication difficulties.

Glaucoma is an ophthalmic disease related to damage in the optic nerve and it is without symptoms in its early stages. Left untreated, it can lead to vision limitation and blindness. Eye fundus images have been widely accepted by medical personnel to examine the morphology and texture of the optic nerve head and the physiologic cup but glaucoma diagnosis is still subjective and without clear consensus among experts. This paper presents a multi-stage deep learning model for glaucoma diagnosis based on a curriculum learning strategy. In curriculum learning, a model is sequentially trained to solve incrementally difficult tasks. Our proposed model includes the following stages: segmentation of the optic disc and physiological cup, prediction of morphometric features from segmentations, and prediction of disease level (healthy, suspicious and glaucoma). The experimental evaluation shows that our proposed method outperforms conventional convolutional deep learning models from the state of the art reported on the RIM-ONE-v1 and DRISHTI-GS1 datasets with an accuracy of 89.4% and an AUC of 0.82 respectively.

A 76-year-old woman was diagnosed with thyroid-associated orbitopathy (TAO) associated with hypothyroidism at another clinic. Magnetic resonance imaging showed enlargements of the extraocular muscles. Because her best-corrected visual acuity (BCVA) was 0.01OD, she was referred to the Chiba University Hospital. She had an elevation of serum IgG4. She was diagnosed with possible IgG4-related ophthalmic disease (IgG4-ROD) accompanied by optic nerve compression with the mass. She underwent methylprednisolone pulse therapy, and, two months later, her BCVA and visual field defect were greatly improved. Our findings indicate that ophthalmologists should be aware that IgG4-ROD can be masked by lesions associated with TAO.

© 2015 American College of Veterinary Ophthalmologists. Objectives: To determine the role of equine herpesvirus (EHV) in idiopathic keratoconjunctivitis in horses and to determine whether sample collection method affects detection of EHV DNA by quantitative polymerase chain reaction (qPCR). Animals studied: Twelve horses with idiopathic keratoconjunctivitis and six horses without signs of ophthalmic disease. Procedures: Conjunctival swabs, corneal scrapings, and conjunctival biopsies were collected from 18 horses: 12 clinical cases with idiopathic keratoconjunctivitis and six euthanized controls. In horses with both eyes involved, the samples were taken from the eye judged to be more severely affected. Samples were tested with qPCR for EHV-1, EHV-2, EHV-4, and EHV-5 DNA. Quantity of EHV DNA and viral replicative activity were compared between the two populations and among the different sampling techniques; relative sensitivities of the sampling techniques were determined. Results: Prevalence of EHV DNA as assessed by qPCR did not differ significantly between control horses and those with idiopathic keratoconjunctivitis. Sampling by conjunctival swab was more likely to yield viral DNA as assessed by qPCR than was conjunctival biopsy. EHV-1 and EHV-4 DNA were not detected in either normal or IKC-affected horses; EHV-2 DNA was detected in two of 12 affected horses but not in normal horses. EHV-5 DNA was commonly found in ophthalmically normal horses and horses with idiopathic keratoconjunctivitis. Conclusions: Because EHV-5 DNA was commonly found in control horses and in horses with idiopathic keratoconjunctivitis, qPCR was not useful for the etiological diagnosis of equine keratoconjunctivitis. Conjunctival swabs were significantly better at obtaining viral DNA samples than conjunctival biopsy in horses in which EHV-5 DNA was found.

To investigate the change of serum IgG4 concentrations correlated with clinical evolution in patients with ocular adnexal marginal zone B cell lymphoma associated with IgG4-related ophthalmic disease (IgG4-ROD).Three consecutive patients with histopathologically confirmed ocular adnexal marginal zone B cell lymphoma associated with IgG4-ROD were evaluated. Two patients received radiotherapy and 1 patient received steroid therapy. Treatment outcome was evaluated by clinical symptoms, radiologic examination, and change of serum IgG4 level in these patients.All patients had elevated serum IgG4 before treatment (462, 338, and 780 mg/dL respectively.) The 2 patients who received radiotherapy achieved complete remission and the serum IgG4 decreased to 345 and 92 mg/dL, respectively. The patient who underwent systemic steroid achieved partial remission and the serum IgG4 decrease to 161 mg/dL.Our study showed elevated serum IgG4 in all patients with ocular adnexal marginal zone B cell lymphoma associated with IgG4-ROD. In addition, the elevated serum IgG4 may decrease or keep stable after treatment, accompanied by improvement in clinical symptoms and reduction of lesions.

SHG microscopy was successfully used to characterize the orientation of sutural lamellae within corneal samples by means of an epi-detection scheme. In particular, the attention was focused on the organization and orientation of corneal collagen lamellae in the first 30 mu m of the stromal layer below Bowman's membrane. In fact, it is thought that the irregular orientation of these specific lamellae, an in particular the existence of so-called sutural lamellae, affects the mechanical properties of the cornea and is responsible of the overall corneal stiffness. The methodology was tested by acquiring image stacks of the central portion of the cornea in ex vivo samples of healthy corneas, keratoconic corneas and keratoconic corneas treated with cross-linking. These samples represent a good benchmark for testing the methodology, considering that keratoconus is an ophthalmic disease in which the cornea loses its stiffness and acquires an abnormal conical shape because of a different organization of sutural lamellae. The samples were first imaged and characterized on the basis of forward/backward SHG ratio, finding a different ratio in keratoconus with respect to both the healthy cornea and cross-linked keratoconus. The inclination of corneal sutural lamellae was then characterized by means of a three-dimensional correlation analysis on SHG images, acquired using a backward detection geometry. Such method provided good discrimination capabilities, demonstrating that this approach can be used not only for diagnosing keratoconus in a very early stage, but also for performing treatment follow-up on cross-linked corneas.

Objective To describe the normal ultrasonographic biometry of the Persian cat's eyes using B-mode ultrasonography. Methods In a cross-sectional study, 20 healthy Persian cats with no history of previous ophthalmic disease were examined. Ocular biometry of the left and right eyes was measured using B-mode ultrasonography. Comparison of the average measurements between left and right eyes and between vertical and horizontal planes was performed using paired-sample t test. Correlation of ocular parameters with sex, age, head circumference and eye colour was evaluated. Results Mean ± standard deviation (SD) measurements of the ocular structures of anterior chamber, lens thickness, vitreous chamber and anterior to posterior dimension of the globe in 40 eyes were 4.1 ± 0.7, 7.7 ± 0.5, 8.2 ± 0.4 and 20.7 ± 1.0 mm, respectively. No significant difference was found between the ocular biometry of the left and right eyes or the horizontal and vertical planes. Of the ocular parameters, the following had a significant positive correlation with head circumference: axial globe length, anterior chamber and lens thickness. The vitreous body had a positive correlation with age. Conclusions Regarding the breed predisposition of Persian cats to ocular problems, the present study provides baseline information for further clinical investigations of ocular abnormalities using B-mode ultrasonography.

To describe a presumptive case of immunoglobulin G4-related ophthalmic disease (IgG4-ROD) with bilateral optic nerve involvement and to review the clinical features of this entity.Case report.A 62-year-old man presented with bilateral blurred vision. He had a history of sinus surgery, and a biopsy specimen showed dense infiltration of IgG4-positive plasma cells. His visual acuity was 20/25, right eye, and 20/125, left eye. Serologies demonstrated elevated serum levels of IgG and IgG4, and computed tomography showed masses surrounding both optic nerves at the orbital apices and bilaterally enlarged infraorbital nerves. The patient underwent 2 cycles of intravenous pulse steroid therapy followed by a taper of oral steroids Three months later, vision was 20/20 in each eye and, while the serum level of IgG was within normal limits, the IgG4 level remained elevated.IgG4-ROD may involve the optic nerves resulting in vision loss. Although steroid administration is the primary treatment for this entity, slow tapering is essential to avoid relapse.

Purpose To determine longitudinal changes in the peripapillary retinal nerve fiber layer (pRNFL) thickness in patients with hypertension (HTN). Methods Participants without any ophthalmic disease were divided into two groups: an HTN group (50 eyes) that included patients with HTN for ≥5 years and a control group. After the initial visit, pRNFL thicknesses were measured four more times at 1-year intervals using spectral-domain optical coherence tomography. The pRNFL thickness was fitted using linear mixed models. Univariate and multivariate generalized linear mixed models were used to determine factors associated with pRNFL reductions over time. Results The mean ages of the HTN and control groups were 62.9 ± 6.2 and 60.7 ± 6.1 years, respectively, and they were not significantly different (P = 0.089). The baseline mean pRNFL thicknesses were 90.50 ± 8.31 and 93.90 ± 8.77 μm; they were significantly different (P = 0.049). The mean pRNFL reduction rate was -0.99 and -0.40 μm/y in the HTN and control groups, respectively; the interaction between group and duration was significant (P

ObjectiveThis study aimed to examine the natural course and relapse rate of IgG4-related ophthalmic disease (IgG4-ROD) after debulking surgery in Japanese patients.Methods and analysisThis retrospective review included patients with IgG4-ROD who did not undergo further treatment following debulking surgery. The patients were diagnosed between January 2009 and December 2018 at the Department of Ophthalmology and Pathology, Niigata University Medical and Dental Hospital. The main outcome measures included postoperative IgG4-ROD recurrence rate and differences between patients with and without recurrent disease.ResultsFifteen patients (six male, 9 female; 61.8±16.2 years) were included. Twelve patients (80.0%) had dacryoadenitis disease and three patients (20.0%) had orbital fat tissue disease. About 70%–100% of the lesion was resected in the debulking surgery and the pathological diagnosis was rendered. A definitive diagnosis was made in 13 cases (86.7%) and a probable diagnosis in 2 cases (13.3%). Patients were followed up for 39.0±25.5 months following operation. All patients had lesion volume reduction and patients with dacryoadenitis had eyelid swelling improvement after surgery. Two patients (13.3%) had disease recurrence and six patients (40.0%) had extraophthalmic lesions. There was no statistically significant difference in clinical features between relapsed and non-recurring cases.ConclusionWe observed a 13.3% relapse rate following debulking surgery in patients with IgG4-ROD who did not undergo further treatment. This rate is lower than the documented relapse rate of 30%–70% following oral prednisolone therapy. Therefore, debulking surgery may be a treatment option for IgG4-ROD.

Clinical case A case is presented of an 85-year-old woman living in a geriatric residence, who was admitted to the emergency department of our hospital with a spontaneous expulsive choroidal hemorrhage in her left eye. There was no a history of ophthalmic disease, and the patient only reported having intracapsular cataract surgery in both eyes 25 years ago, and that she also became blind in her left eye in the past few years. Discussion Non-surgical spontaneous expulsive choroidal hemorrhage is a very rare and disastrous clinical event. The predisposing factors involved are: advancing age, vascular illness (especially atherosclerosis), glaucoma, and severe corneal damage.

Ocular calcification is a biological mineralization. It is also a well-known human ophthalmic disease but is a complex process because the pathophysiology of calcium deposition in ocular tissues depends on site-specific factors. Calcified deposits in the eyes are asymptomatic lesions; a serious consequence of ocular plaques is the potential partial or total loss of vision in the affected eye. Therefore, a better understanding of the exact compositional components and origin of calcified plaques in different eye tissues is necessary and merits exploration. The present review article includes information on different diagnostic or analytical techniques to examine human ocular calcification collected and compiled from 2005 to 2013, together with data on the application of vibrational spectroscopy in ophthalmology studies from 1990 onwards. This overview of ocular calcification is mainly focused on two aspects: the pathogenesis and mechanism of calcification in different ocular tissues and biomedical ...

Keratoconus is an ophthalmic disease in which the cornea acquires an abnormal conical shape that prevents the correct focusing on the retina, causing visual impairment. The late diagnosis of keratoconus is among the principal causes of corneal transplantation surgery. In this study, we characterize the morphology of keratoconic corneas by means of the correlation of SHG images, finding that keratoconus can be diagnosed by analyzing the inclination of lamellae below Bowman’s membrane. In addition, imaging performed with both sagittal and “en face” geometry demonstrated that this morphological features can be highlighted both ex vivo and in vivo.

Efficient treatment of ocular diseases can be achieved thanks to the proper use of ophthalmic formulations based on emerging pharmaceutical approaches. Among them, microtechnology and nanotechnology strategies are of great interest in the development of novel drug delivery systems to be used for ocular therapy. The location of the target site in the eye as well as the ophthalmic disease will determine the route of administration (topical, intraocular, periocular, and suprachoroidal administration) and the most adequate device. In this review, we discuss the use of colloidal pharmaceutical systems (nanoparticles, liposomes, niosomes, dendrimers, and microemulsions), microparticles (microcapsules and microspheres), and hybrid systems (combination of different strategies) in the treatment of ophthalmic diseases. Emphasis has been placed in the therapeutic significance of each drug delivery system for clinical translation.

Keratoconus is an ophthalmic disease in which the cornea acquires an abnormal conical shape that prevents the correct focusing on the retina, causing visual impairment. The late diagnosis of keratoconus is among the principal causes of corneal transplantation surgery. In several previous studies, a different organization sutural lamellae was observed in keratoconic corneas compared to healthy corneas. This study is intended to investigate this anomaly by means of Second Harmonic Generation (SHG) microscopy, using an optical scheme relevant for clinical applications. In particular, we propose a method based on 3D correlation of SHG image stacks, able to appreciate statistical differences in the orientation distribution of sutural lamellae between healthy and keratoconic corneas. The proposed method offers the potential for diagnosing keratoconus in an early stage.

Proteomics, a highly sophisticated way to study the protein profile of various biological tissues or fluids, has hitherto had a relatively limited role ophthalmic science. Of the few proteomic studies that have been performed, liquid chromatography, electrophoresis gel separation and mass spectrometry have been utilized to investigate the proteome of several different eye structures and fluids from both humans and animal models. Ophthalmic proteomic studies have so far attempted to identify proteins unique to the eye, to investigate protein changes due to the onset of various diseases and to identify proteins that could act as markers of disease. Proteomics has the potential to improve the way in which eye disease is diagnosed and potentially even treated by identifying novel pathogenic pathways that may be susceptible to therapeutic manipulation. The aim of this review is to give an overview the current and potential application of proteomic science to ophthalmic research.

Pterygium, a common ophthalmic disease that is caused by fibrovascular growth of conjunctiva and conjunctival melanocytic nevi that is another conjunctival disease, are detected by Raman spectroscopy in the present study. We find that there is an obvious increase in the intensity at the peak of 1,583 cm(-1) that is assigned to C=C unsaturated fatty acids stretch of lipids in the pterygium tissue, and 1,639 cm(-1) also increased which belongs to amide I. Also, PCA (Principal Component Analysis) was used to classify the normal conjunctiva from the pterygium tissue. For the conjunctival melanocytic nevi, the intensity of Raman spectrum region between 1,550 cm(-1) and 1,650 cm(-1) that belong to protein has increased, which indicates that the content of protein in conjunctival melanocytic nevi is more richer than the normal ones.

Strabismus is a common ophthalmic disease with a relatively high prevalence (4%). It is one of the most common vision disorders in preschool children. If it is not timely diagnosed and well treated, strabismus would cause amblyopia, and even permanent vision loss. The diagnosis is thus essential. However, most of the diagnosis methods, such as cover testing, are conducted manually by an ophthalmologist. The examination cost is relatively high and the results are subjective. In this paper, we propose an eye tracking method for strabismus diagnosis. This method allows us to develop an objective and automatic strabismus diagnosis system that could significantly increase the examination efficiency and reduce the cost. Experimental results demonstrate the effectiveness of the proposed eye tracking method for strabismus diagnosis.

The impression exists that picture acuity scores may overestimate function when subjects are switched to letter charts. This has not been systematically investigated. The aims of this study were to validate both printed crowded Kay picture (pCKP) and computerised CKP (cCKP) logMAR test acuity measurements against gold standard ETDRS letter chart scores. A total of 30 adult subjects with various ophthalmic disease and 40 amblyopic children underwent test and re-test visual acuity measurements using the ETDRS chart, the pCKP logMAR test, and the cCKP acuity scores taken, using the COMPlog visual acuity measurement system. Bland and Altman methods were employed. Computerised and printed Kay picture acuity scores agreed well. Both Kay picture test measurements were systematically biased when compared with ETDRS chart measurements. No significant proportional bias was found. The test retest variability (TRV) of all three tests was found to be similar between ±0.14 and 0.16 logMAR in both groups. All three tests were similarly replicable and computerised Kay pictures appear to be a valid alternative to hard copy Kay pictures. Kay picture acuity measurements were systematically biased when compared with the gold standard ETDRS. Measurement error means that differences of up to 0.16 logMAR may be observed in clinically stable patients when re-measured using the same technique. A combination of TRV and systematic bias can however lead to differences of up to 0.40 logMAR in stable amblyopic patients when switched from CKPs to ETDRS chart acuity measurements.

The purpose of this study was to evaluate and establish the mean values of IOP in healthy adult sheep using an applanation tonometer. Information on age, sex, and breed was obtained for all animals included in this study. Twenty five healthy sheep (Ovis aries), of the same breed (Texel), male or female, with three years of age, received an ophthalmic examination in both eyes, including pupillary reflexes, Schirmer tear test, slit lamp biomicroscopy, and fluorescein staining. For all ophthalmic testing, animals were gently physically restrained, with no pressure in the jugular area and the eyelids were carefully open. IOP was measured by applanation tonometry (Tonopen XL). The same examiner performed the tonometry; measurements were taken three times for each eye, and their average was recorded as the IOP of the animal. Statistical analysis was performed using paired t-test and values of P < 0.05 were considered significant. The mean intraocular pressure in the whole group of 50 eyes was of 16.36 +/- 2.19 mm Hg. The mean (SD) IOP in the right eye was of 15.96 +/- 2.02 mm Hg, while the mean (SD) IOP in the left eye was of 16.76 +/- 2.32 mm Hg. Significant differences in IOP were not found between right and left eyes. The applanation tonometer was adequate for measuring the intraocular pressure in sheep. Reference data will assist in diagnosing testing for ophthalmic disease in sheep, as¹ well as promote further studies in this area.

Summary A perception exists amongst referring veterinarians and the lay public that blue-eyed horses have increased frequency of ocular disease. The aim of this retrospective study was to assess the prevalence of ocular disease in horses with blue or heterochromic eyes relative to those with brown eyes. The medical records of horses presenting to either the Comparative Ophthalmology services or Equine Medicine/Surgery services at 2 institutions were reviewed. Signalment, ocular and nonocular diagnoses were recorded. Ocular disease was divided into 4 categories: adnexa, cornea, intraocular/orbit and squamous cell carcinoma (SCC). Owners were contacted by telephone to confirm iris colour. Chi-square analysis was used to compare group proportions. A total of 164 eyes of horses with ocular disease and 212 eyes of horses without ocular disease were included. Blue eyes were equally common in the ocular disease and nonocular disease groups (P = 0.265). There was no significant difference in the proportion of blue- and brown-eyed horses when comparing the adnexal and corneal (P = 0.548), corneal and intraocular/orbit (P = 0.379) and adnexal and intraocular/orbit (P = 0.843) categories. A significant difference was detected in the proportion of blue-eyed horses between the adnexal (P = 0.000), corneal (P = 0.033), intraocular/orbital (P = 0.000) and SCC categories, with a higher proportion of blue-eyed horses in the SCC than in the other 3 groups. Horses with blue or heterochromic irides are more likely to develop ocular SCC than horses with brown irides, but are not more likely to have adnexal, corneal or intraocular/orbital disease or to be presented for evaluation of ophthalmic disease. Veterinarians should consider the results of this study when answering questions from the lay public regarding the predisposition of blue-eyed horses to ocular disease.

Neuro-ophthalmic disease can cause a wide array of visual impairments. Management should include neuro-ophthalmic examination, patient education regarding visual prognosis, and evaluation of visual function. Often, low vision examination and rehabilitation are useful adjuncts to the neuro-ophthalmic evaluation. Components of a low vision examination pertaining to neuro-ophthalmology are discussed. Specific low vision management strategies are reviewed for patients with visual acuity loss, visual field loss, decreased contrast sensitivity, and ocular motor disturbances caused by neuro-ophthalmic disease.

A 5-yr-old, male Brazilian rainbow boa (Epicrates cenchria cenchria) presented with a partial spectacle avulsion that progressed to full spectacle avulsion following ecdysis. A porcine small intestinal submucosal graft was sutured over the cornea to protect the globe and allow the spectacle to regenerate. Treatment included topical antibiotic and lubricant ophthalmic medications. The porcine small intestinal submucosal graft was shed during ecdysis 30 days after placement, revealing peripheral regeneration of the spectacle with a 1- to 2-mm crust covering a presumed central defect. At the next ecdysis 39 days later, the spectacle had completely regenerated. Application of a porcine small intestinal submucosal graft in combination with topical antibiotic and lubricant ophthalmic medications for treatment of complete spectacle avulsion was successful in allowing spectacle regeneration and was well tolerated by the rainbow boa in this case.

Immunoglobulin G4-related disease (IgG4-RD) is a recently recognized inflammatory disease of unknown etiology. It characterized by distinctive histopathological appearance of dense IgG4-positive lymphoplasmacytic infiltrates, storiform fibrosis, and obliterative phlebitis in one or more organs, simultaneously or subsequently. In cases of ocular adnexal involvement, unique clinicohistopathological features were delineated by recent studies, and IgG4-related ophthalmic disease (IgG4-ROD) is generally recognized as the disease name. A significant proportion of previous labeled idiopathic orbital inflammations and Mikulicz's disease are now consistent with a diagnosis of IgG4-ROD. Increasing studies have accumulated regarding its epidemiology, diagnosis, clinical features, treatment, and the association between lymphoma. In this review, we summarize our present understanding of IgG4-ROD.

HIV disease has a long and relatively asymptomatic incubation period before the onset of AIDS. The ophthalmic manifestations of AIDS are well recognized. Little is known of the incidence or range of ophthalmic disease seen in the latent period of HIV disease. A retrospective analysis of 125 case notes of HIV 1 antibody positive patients was undertaken. Of these, 15 (12%) had previously attended the ophthalmic department, at which stage their HIV status was unknown. Eight patients were diagnosed as being HIV positive within twelve months of attending the ophthalmic department. There was a predominance of ophthalmic infections, as opposed to trauma which is the commonest cause for ophthalmic casualty referral. Some of the ophthalmic presentations seen were the initial presenting sign of HIV disease. There were also cases of serious trauma and a mixture of other ophthalmic diseases. We discuss these ophthalmic findings and their relevance to HIV disease.

A patient, 64-year-old, is referred for the treatment of a giant rhinophyma. He refused any treatment during eight years. The interest of this case report is the size and the weight of the rhinophyma, the obstruction of the nasal airways and the resulting social disturbance. This exceptional clinical rhinophyma was associated with an otophyma, a zygophyma and ophthalmic disease. To our knowledge, this clinical presentation has never been reported before. The management of the rhinophyma and the otophyma was surgical excision, secondary healing followed by a full thickness skin graft associated to a fullface mechanical dermabrasion.

Objective To evaluate the pharmacokinetics of topically applied ciprofloxacin 0.3% ophthalmic solution in tears of healthy horses. Animal studied Twenty healthy, adult, mixed-breed horses. Procedures Twenty study horses were confirmed free of ophthalmic disease by complete ophthalmic examination. Seventy microliters of 0.3% ciprofloxacin (Ciloxan) was placed in the ventral cul-de-sac of each eye using a microliter syringe and 19-g cannula. Population kinetics were carried out by sampling the tear film from the lower cul-de-sac of each eye with tear test strips at 5, 10, 15 and 30 min and 1, 2, 4 and 6 h post administration for a total of five samples at each time-point. Sample collection time was 15 s. Concentrations of ciprofloxacin were determined using high performance liquid chromatography. Results Mean (+/-SD) of the Schirmer tear test results from all eyes was 23.4 +/- 4.8 mm wetting in 1 min. Mean concentration of ciprofloxacin in the tears at 5 min post administration was 498.4 +/- 266.8 microg/g. Mean concentration rapidly declined and began to plateau at 30 min. The mean tear concentrations of ciprofloxacin at 30 min and at 1, 2, 4 and 6 h were 66.6 +/- 56.0, 60.25 +/- 55.7, 42.25 +/- 30.9, 36.25 +/- 32.0, and 45.5 +/- 46.5 microg/g, respectively. Conclusions The pharmacokinetics of ciprofloxacin in normal horses are similar to those in rabbits and humans. Topical application of ciprofloxacin resulted in a mean tear concentration of ciprofloxacin that remained above the MIC(90) levels for most pathogenic bacteria for 6 h post administration.

PURPOSE OF REVIEW Confocal microscopy's role within ophthalmology has been evolving since the introduction of this technology in 1955. The purpose of this review is to describe the confocal microscope and illustrate its recent ophthalmic applications. RECENT FINDINGS Numerous investigators have used confocal microscopy to research ophthalmic disease and to find new diagnostic applications. This review will describe the development and uses of this technology. The cornea was the first ophthalmic tissue to be imaged due to its transparency, although, tissues, such as conjunctiva, are now being studied. This article will review normal confocal corneal appearance and discuss a wide range of recent applications that include corneal infections, dystrophies and disease. Furthermore, this article will discuss recent developments in refractive surgery, ocular surgery and various miscellaneous discoveries. SUMMARY Confocal microscopy is developing into a powerful research and diagnostic tool in ophthalmology. The future uses of this novel technology will evolve and is increasingly becoming a vital tool in the ophthalmologist's armamentarium.