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SummaryReasons for performing study Equine recurrent uveitis (ERU) is a leading cause of vision loss in horses. Objectives To assess the prognosis and impact of ERU on affected horses and their owners by evaluating the signalment, treatment and outcome (including the loss of use, vision assessment and economic loss). Study design Retrospective impact study. Methods Medical records of horses presenting to the North Carolina State University Veterinary Health Complex (NCSU-VHC) with ERU between 1999 and 2014 were reviewed. Signalment, clinical signs, ophthalmic examination findings, treatments and outcomes were evaluated. Owner questionnaires were completed regarding vision, job/role, monetary value, diagnostic and treatment costs, concurrent illness and outcomes. Results Records of 224 horses (338 eyes) with ERU were reviewed. There was an overrepresentation of Appaloosas (54; 24.1%), Hanoverians (11; 4.9%) and other Warmbloods (13; 5.8%). Ninety-six eyes (28.4%) were diagnosed as blind and 38 eyes (11.2%) with glaucoma on initial evaluation. Leptospirosis titres of serum and/or aqueous humour were obtained in 88 horses and were positive in 40 horses (45.5%), with L. pomona being the most frequently isolated serovar. Globe loss at the NCSU-VHC occurred in 41 ERU eyes (12.1% of total). Owner questionnaires were evaluated in 194 horses (86.6%) and 91 horses (46.9%) were reported blind in the affected eye(s). Fifty-seven horses (29.4%) did not return to their previous role, while 61 (31.4%) performed at a reduced level. Equine recurrent uveitis decreased the monetary value of 164 horses. Twenty-nine horses (14.9%) were euthanised and 37 (19.1%) underwent change in ownership as a direct result of ERU. Conclusions The impact of ERU is attributed to the high frequency of blindness, globe loss and loss of function. Euthanasia and change of ownership are common sequelae to the progressive nature of ERU. These factors, along with financial costs of the disease, have a significant impact on affected horses and their owners. The Summary is available in Chinese – see Supporting Information.

Objective To evaluate the efficacy of intravitreal dexamethasone implant on the treatment of pseudophakic macular edema (PME). Materials and methods A retrospective, observational, descriptive study was conducted on 4 patients who received an intravitreal injection of dexamethasone implant due to PME in the period from 1st January 2013 to 31st December 2013 in the Hospital Universitario de La Ribera (Alzira, Valencia, Spain). A complete ophthalmic examination was performed on these patients. Best-corrected visual acuity (BCVA), macular thickness, and duration of the effect of the treatment were studied. Results At baseline, the mean MT was 414 μm. After dexamethasone implant, mean values of MT decreased to 330.25 μm at month one. The mean change from baseline MT was 83.75 μm. The baseline mean BCVA was 0.3 and improved to 0.575 at month one and 3. The mean duration of the effect of the treatment was 3.5 months. Conclusions Intravitreal dexamethasone implant is a possible treatment for Irvine-Gass syndrome as it improved visual acuity and reduced the macular thickness of these patients.

Large number of ophthalmological problems has been found in patients with glycogenosis type II (Pompe disease, PD). Since enzyme replacement therapy (ERT) has been introduced ophthalmic examination in the routine follow-up gained a special role in infantile-onset Pompe disease and prolonged survival. Currently a number of cases with ophthalmic disorder as the first sign of PD is known. Histopathological features of glycogen deposits in various eye structures has been described. Current review summarizes PubMed data on ophthalmopathy in PD.

The purpose of this manuscript is to report the case of a 12-year-old patient who presented for routine ophthalmic examination after congenital cataract surgery performed at 2 months of age. The patient was diagnosed with bilateral Brown-McLean syndrome by slit lamp examination. No treatment was required because the patient was asymptomatic and had a clear central cornea. This is the first described case of Brown-McLean syndrome in a pediatric patient, representing the importance of clinical examination in the pediatric age group after cataract surgery because of the risk for patients of developing peripheral edema.

During the planning meeting for the Collaborative Ocular Melanoma Study (COMS) prior to the start of patient recruitment in 1986, there was an interest expressed in determining whether a relationship existed between the presence of uveal melanoma (UM) and asteroid hyalosis (AH). To answer this question, the ophthalmic examination form (unlike the pathology form for enucleated eyes) for each COMS patient asked whether AH was present or not. Though an increased prevalence was not found, this result was never published. A recent unpublished study at the University of Wisconsin School of Veterinary Medicine indicated a higher prevalence of AH in canine eyes with UM when compared to control eyes (without tumor) enucleated for goniodysgenesis. This further increased our interest in revisiting the published literature, clinical records, and histopathology slides of the enucleated eyes from the COMS study, as well as the histopathology slides on file in the University of Wisconsin Eye Pathology Laboratory. While cases with both AH and UM were occasionally encountered in the literature, clinically, we could not find a previous study focusing on these two processes. This study was conducted to explore whether such an association exists.

Clinical case Seven-year-old male patient, affected by xeroderma pigmentosum (XP) who was referred to ophthalmology due to the presence of numerous tumors in his left eye that affected the eyelids and conjunctiva. He had a tumor in his lower eyelid that affected the free edge, creating a secondary ectropion, and several lesions with a melanocytic appearance in conjunctiva. A resection of the eyelid tumor and the conjunctival lesions were performed by placing a skin graft and amniotic membrane, respectively, as covering. Discussion XP patients have high probability of developing eye tumors. A thorough ophthalmic examination is necessary to establish an early diagnosis.

A 9-month-old female Domestic Short-haired cat was presented with a mass of three-month duration at the base of the third eyelid of the right eye (OD). Fine-needle aspiration was carried out at another clinic, revealing clear fluid. The mass soon reformed, and the cat was referred. Ophthalmic examination revealed a pale-pink, smooth, oval mass under the conjunctiva on the anterior aspect of the third eyelid. Surgical removal of the mass was performed. Histopathology revealed a large dilated cyst together with a number of small cysts lined by simple cuboidal, and low squamous epithelium with some secretory cells. Dacryops of the third eyelid lacrimal gland was diagnosed. The eye healed uneventfully after surgery, and no recurrence was seen during one year of follow-up.

A wide range of pathologies can cause papilloedema. Vestibular schwannoma is a benign and slow-growing tumour that causes symptoms and findings on ophthalmic examination when the diagnostic is delayed. The authors report a case of a 64-year-old male who presented with bilateral disc oedema secondary to a vestibular schwannoma grade 4. Obstructive hydrocephalus was not evident. The authors suggest that cerebrospinal fluid protein may have a role in the formation of optic disc oedema. A right suboccipital craniectomy was performed to remove the tumour, leading to secondary facial palsy.

A 25-year-old female presented to a local hospital for acute onset of a central scotoma in the left visual field. She was visited by the neurologist, and a diagnosis of left retrobulbar optic neuritis was made. Magnetic resonance imaging scan was normal. Ophthalmic examination revealed a multiple evanescent white dot syndrome. After a description of the case, a brief differential diagnosis between these two entities is made. The neurologist should be aware of this uncommon condition.

Aim To compare the peripapillary retinal nerve fiber layer (RNFL) thickness measured via optical coherence tomography (OCT) between different groups of myopia severity and controls. Methods This was a prospective cross-sectional study. All subjects underwent a full ophthalmic examination, refraction, visual field analysis and A-scan biometry. Myopic patients were classified as low myopia (LM) [spherical equivalent (SE) from greater than -0.5 D, up to -3.0 D], moderate myopia (MM; SE greater than -3.0 D, up to -6.0 D) and high myopia (HM; SE greater than -6.0 D). The control group consisted of emmetropic (EM) patients (SE from +0.5 D to -0.5 D). A Zeiss Cirrus HD-OCT machine was used to measure the peripapillary RNFL thickness of both eyes of each subject. The mean peripapillary RNFL thickness between groups was compared using both analysis of variance and analysis of covariance. Results A total of 403 eyes of 403 subjects were included in this study. The mean age was 31.48±10.23y. There were 180 (44.7%) eyes with EM, 124 (30.8%) with LM, 73 (18.1%) with MM and 26 (6.5%) with HM. All groups of myopia severity had a thinner average RNFL than the EM group, but after controlling for gender, age, and axial eye length, only the HM group differed significantly from the EM group (P=0.017). Likewise, the superior, inferior and nasal RNFL was thinner in all myopia groups compared to controls, but after controlling for confounders, only the inferior quadrant RNFL was significantly thinner in the HM group, when compared to the EM group (P=0.017). Conclusion The average and inferior quadrant RNFL is thinner in highly myopic eyes compared to emmetropic eyes. Refractive status must be taken into consideration when interpreting the OCT of myopic patients, as RNFL thickness varies with the degree of myopia.

Purpose: To measure the choroidal thickness by enhanced depth imaging optical coherence tomography (EDI-OCT) in normal eyes. Methods: In a prospective case series, 208 eyes of 104 normal Iranian subjects were enrolled. Complete ophthalmic examination was performed. Inclusion criteria were best corrected visual acuity (BCVA) ≥20/20, ≤ ±1 diopter of refractive error in either spherical or cylindrical components, normal intraocular pressure (IOP) and no systemic or ocular diseases. The choroidal thickness was measured by EDI-OCT subfoveally, and 1500 μm and 3000 μm nasal and temporal to the fovea. Results: Mean age was 34.6 ± 9.8 years (range, 18–57 years). Mean subfoveal choroidal thickness was 363 ± 84 μm. Choroidal thickness was 292 ± 76 and 194 ± 58 μm at 1500 and 3000 μm nasal to the fovea, respectively, and 314 ± 77 and 268 ± 66 μm at 1500 and 3000 μm temporal to the fovea, respectively. There was no statistically significant difference in the choroidal thickness between sexes and laterality of the eyes. Choroidal thickness at fovea (P < 0.001) and at all extrafoveal locations decreased significantly for every 10 years increase in age. Conclusion: In normal Iranian subjects participating in this study, mean choroidal thickness was comparable with other reports.

Eye complaints in children can differ significantly from those seen in adults. Not only is there the challenge in performing a complete ophthalmic examination, which can vary in success based on age and cooperation, but also knowing when to refer to the emergency department or to an ophthalmologist. These secrets will help improve a practitioner’s comfort level and also cover some of the common pitfalls one may encounter when managing pediatric ophthalmic problems in the urgent care setting.

Purpose: To evaluate the relative frequencies, clinical profile, and treatment outcomes of paediatric orbital tumours in Upper Egypt. Materials and Methods: In a retrospective, non-comparative, case series study, the authors reviewed the medical records of all children evaluated at Sohag University Hospital, from September 2014 till August 2017, with the diagnosis of orbital tumours and tumour-like lesions. The final diagnosis in each case was established by a combination of history, ophthalmic examination findings, imaging studies, and histopathologic examination if biopsy was performed. Results: A total of 92 orbital lesions were included in this study, which were classified into the following major categories: Cystic (28 cases, 30.4%), vascular (13 cases, 14.1%), Lipomatous (10 cases, 10.9%), inflammatory (9 cases, 9.8%), neurogenic (7 cases, 7.6%), lymphoid/leukemic (6 cases, 6.5%), myogenic (5 cases, 5.4%), lacrimal gland (5 cases, 5.4%), secondary (4 cases, 4.3%), metastatic (3 cases, 3.3%), and histiocytic (2 cases, 2.2%) orbital lesions in order of frequency. The clinical features and treatment outcomes of these lesions will be discussed. Conclusion: A variety of benign and malignant paediatric orbital tumours may be seen in clinical practice. Management of these tumours requires a multidisciplinary approach. Early diagnosis and prompt treatment provide good cosmetic and functional results, and prevent visual loss in the majority of those children.

Purpose To check if optical biometry can detect eventual corneal power (Km) and axial length (AL) cataract surgery-related changes that could influence the refractive outcome. Methods Patients scheduled for sequential bilateral cataract surgery between January and September 2017 were included in the present study. One hundred ninety-six eyes of 98 patients (48 males) were selected. Before surgery of the first eye, patients underwent a complete ophthalmic examination, including IOLMaster biometry; the same evaluations were repeated in both eyes the day before the fellow eye cataract surgery, performed at least 2 months after the first one. The differences in Km and AL in the first operated eyes were evaluated, and the fellow eyes were used as controls. Results Km differences in the operated eyes ranged from -1.97 to +0.98 diopter (D) (mean = -0.02 ± 0.36 D) (P = 0.89); in the nonoperated eyes they ranged from -0.6 to +0.7 D (mean = 0 ± 0.20 D) (P = 0.91). The AL differences (pseudophakic option) in the operated eyes ranged from -0.35 to +0.15 mm (mean = -0.10 ± 0.08 mm) (P < 0.001); with the aphakic option they ranged from -0.24 to + 0.26 mm (mean = 0.01 ± 0.08 mm) (P= 0.38). In the nonoperated eyes, the AL differences ranged from -0.04 to +0.06 mm (mean= 0 ± 0.02 mm) (P = 0.02). Conclusions The modern phaco-technique seems not to induce changes in Km and AL, supporting the hypothesis that the differences in AL are due to an incorrect estimation in pseudophakic eyes. Translational Relevance The results of our study may improve the AL measurements in pseudophakic eyes.

A painful eye is not normal, is commonly associated with various sensations, and the accompanying symptoms may be indicative of an ocular emergency. Among those, accompanying vision problems and/or redness of the eyeball require special attention to prevent blindness. A differential diagnosis should be made at presentation by careful ophthalmic examination. Proper management should be instituted in a timely manner to obtain maximum benefit in a patient presenting with acute pain in the eye. This chapter aims to provide an overview on current approaches in an eye with acute pain and glaucoma, scleritis, uveitis, and corneal problems.

Posterior microphthalmos is a rare ocular disorder characterized by disproportionately short vitreous length and numerous posterior segment findings. We report a rare coexistence of bilateral macular hole with posterior microphthalmos in a 15-year-old girl. Detailed ophthalmic examination and investigations including B scan ultrasonography and optical coherence tomography were performed. Ophthalmic examination showed bilateral high hyperopia. Best corrected visual acuity was 6/18 in each eye with correction of +12 D in right eye and +10 D in left eye. Ocular biometry measurements showed short total axial length (16.3 mm both eyes) with remarkable shortening of posterior segment (9.3 mm right eye; 9.28 mm left eye) but normal anterior segment parameters. Anterior chamber depth and horizontal corneal diameter were within normal range. Fundus evaluation revealed bilateral macular hole. Optical coherence tomography finding was compatible with bilateral lamellar macular hole in both eyes. B scan ultrasonography showed sclerochoroidal thickening with foreshortening of vitreous cavity. A variety of posterior segment manifestations associated with posterior microphthalmos have been reported but macular hole is an extremely rare association. This finding is noteworthy and probably among very few in literature.

Ocular toxicology pertains to toxicological effects on the eye of drugs administered topically, periocularly, intraocularly, or systemically. The ophthalmic examination is able to provide detailed in-life information and is used in combination with clinical observations, clinical pathology, and histopathology to assess potential toxicologic effects. The ophthalmologist must be familiar with the wide range of species used in the field of toxicology, be familiar with the anatomic variations associated with these species, be able to differentiate an inherited or a breed-related finding from a study-related effect, be competent with the required ophthalmic equipment, and be capable of examining this wide range of animals.

Purpose. This study compares the results of Y-split recession versus de Decker’s (modified Cüppers) Faden techniques of medial rectus (MR) muscles for the management of essential infantile esotropia (IET).Patients and Methods. Fifty patients had IET divided into Group A who underwent Y-split recession of MR muscles and Group B who underwent de Decker’s Faden technique of MR muscles. All patients had complete ophthalmic examination done including deviation angle measurement and met the inclusion criteria of the study. Operations were performed using general anesthesia. Patients were followed up at day 1, week 1, and months 1, 3, and 6 after operation.Results. The mean age distribution for group A was 21.56 months (SD 12.55) and for group B was 21.4 months (SD 12.35), and the mean postoperative follow-up interval was 6 months for both groups. The preoperative maximum angle of deviation in both groups ranged from 15 to 40 degrees, while the minimum angle of deviation ranged from 10 to 20 degrees. Immediately postoperatively both groups showed 88% of patients with satisfactory results (within 10 degrees of orthotropia). Group A showed two patients (8%) with ET and one patient (4%) with exotropia (XT). For group B, it showed one patient (4%) with ET and two patients (8%) with XT. Three patients in each group underwent a second intervention. All patients remained within the satisfactory range.Conclusion. The results of this study suggest that both techniques show comparable results for the correction of IET.

A simple presentation of ‘swollen eye’ could be the result of a panoply of diseases. Most of these conditions are difficult to treat and management, rather than treatment, may be required. This chapter explains the processes of ophthalmic examination, approaching infraorbital sinusitis, approaching conjunctivitis and differentiating globe enlargement and exophthalmos. Case examples: Conure with squamous cell carcinoma; Budgerigar with a retrobulbar mass; Magpie with avian poxvirus.

Chorioretinian coloboma often raises clinical issues leading sometimes to some confusion. Nevertheless, diagnosis must be as accurate as possible for several reasons: the association of some congenital anomalies of the papilla with other neurologic, endocrine and systemic disorders as well as issues in differential diagnosis between it and other ophthalmic disorders. We report a clinical case of a 6 year old child, the first boy in a family with 2 children, with bilateral papillar coloboma and without other associated malformations. Patient?s history: normal birth and updated immunisation status. His father and his 4-year-old sister underwent ophthalmic examination which was unremakable. However his mother had diverge strabismus in the right eye.Keywords: Chorioretinian coloboma, bilateral, child

To investigate the association of nailfold capillaroscopy, heart rate variability (HRV), and clinical characteristics of glaucoma with the plasma matrix metalloproteinase-9 (MMP-9) level in normal-tension glaucoma (NTG).We conducted a prospective, cross-sectional study on 25 patients with NTG. Subjects with systemic diseases were excluded. The patients underwent a complete ophthalmic examination and were referred to the Rheumatology Department, where nailfold capillaroscopy and HRV assessment were performed. The patients were assigned to the lowest and highest HRV groups according to the standard deviation value of the qualified normal-to-normal intervals of the HRV assessment. Blood samples from all the subjects were assayed for MMP-9 concentrations.The systemic MMP-9 level was significantly associated with the nailfold capillaroscopy result (ρ = 0.439, p = 0.032). Of the 25 patients, seven had optic disc hemorrhage (ODH). The mean MMP-9 concentration was 4375.6 ± 2923.2 pg/ml in ODH patients and 5932.1 ± 1265.4 pg/ml in patients without ODH. However, there was no significant association of HRV parameters or disc hemorrhage with the systemic MMP-9 level.The systemic MMP-9 level was associated with the nailfold capillaroscopy results in patients with NTG but had no direct association with ODH.

Purpose To assess choroidal thickness in patients with migraine and compare them with healthy controls, using spectral-domain optical coherence tomography (OCT). Methods In this prospective case-control study, choroidal thicknesses of 20 newly diagnosed migraine patients and 20 age- and sex-matched healthy subjects were measured using a high-speed, high-resolution frequency domain (FD) OCT device (λ = 840 nm, 26.000 A-scans/s, 5 µm axial resolution). All patients underwent a complete ophthalmic examination before the measurements. OCT measurements were taken at the same time of day (9:00 AM), in order to minimize the effects of diurnal variation. Results There was a statistically significant difference in median choroidal thickness between the migraine patients (277.00 [interquartile range (IQR) 85.75] µm) and controls (301.00 [IQR 90.50] µm) (p = 0.012). There were significant differences at all measurement points (pConclusions The decreased choroidal thickness of patients with migraine might be related to the vascular pathology of the disease. Further studies are needed to evaluate the etiopathologic relationship between choroidal thickness and migraine.

Aims To objectively quantify the thickness of peripapillary choroid using spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI) followed by a novel automated choroidal segmentation software in Asian eyes and to evaluate its systemic and ocular determinants. Methods We recruited 520 subjects (1040 eyes) from the Singapore Malay Eye Study, a cross-sectional population-based study. Subjects underwent standardised detailed ophthalmic examination including SD-OCT (Spectralis) with EDI for measurement of peripapillary choroidal thickness (PPCT). Results The mean age of the subjects was 66.7±10.4 years (range 47–88 years) and the mean spherical equivalent was −0.01±2.28 D (range −18.50 to +7.00 D). The intra-session repeatability of PPCT measurements at four quadrants using automated choroidal segmentation software was excellent (intraclass correlation coefficient 0.9998–0.9999). The overall mean PPCT was 136.2±56.8 µm. Peripapillary choroid showed geographical differences among the four quadrants, being thickest in the superior quadrant (150.5±59.6 µm), followed by the nasal (143.5±58.4 µm) and temporal quadrants (139.4±68.9 µm), and thinnest in the inferior quadrant (111.3±51.7 µm). Among the range of ocular and systemic factors studied, shorter axial length (p=0.002), younger age (p=0.018), lower triglyceride level (p=0.015) and the presence of diabetes (p=0.036) were the only significant predictors of thicker peripapillary choroid. Conclusions Using novel automated choroidal segmentation software, we provide reliable objective measurements of PPCT in a population-based setting. Shorter axial length, younger age, lower triglyceride levels and the presence of diabetes are the factors independently associated with thicker PPCT. These factors should be taken into consideration when interpreting Spectralis EDI SD-OCT-based PPCT measurements in clinics.

We report a presumed damage to the left superior rectus (SR) muscle following a dog bite injury that resulted in a marked weakness of elevation and vertical diplopia. A 30-year-old male presented in October 2010 following a dog bite around his left superotemporal orbit. An ophthalmic examination was unremarkable. The patient immediately complained of vertical diplopia, which did not settle during a period of observation lasting approximately 9 months following the attack. An orthoptist examination confirmed a marked restriction of upgaze. A diagnosis of isolated SR injury, secondary to the dog bite, was suspected. A left Knapp procedure was performed. The surgery was uneventful with scar tissue found around the SR. Three months following his surgery, the patient was orthophoric in both primary positions and in the downgaze with a residual 20-prism dioptre hypotropia in the upgaze. Our patient was unusual in that the bite weakened the SR in isolation. We also show the successful management of this novel case using a simple Knapp procedure.

Purpose: To report three cases of optic nerve aplasia (ONA). Case Report: Herein three subjects with ONA are described, two subjects had unilateral involvement. In one of these cases, the fellow eye had an associated persistent hyperplastic primary vitreous (PHPV). The third patient had bilateral ONA with multiple intracranial anomalies. Previous reports are reviewed and reported findings are summarized. Orbital and brain magnetic resonance imaging (MRI) were normal in two of our cases and loss of corpus callosum in the third case. Narrow optic nerve was observed on the right side and normal appearance in other two patients. Conclusion: The diagnosis of optic nerve abnormalities in children requires a thorough ophthalmic examination and proper ancillary testing. Although MRI is valuable in the diagnosis of associated central nervous system anomalies, the optic nerve may appear in normal size and course on MRI images and thus one may not be able to diagnose ONA in eyes with opaque media.

Purpose: To evaluate retinal sensitivity over hard exudates in correlation with the spectral domain optical coherence tomography (SD-OCT) findings in eyes with diabetic retinopathy. Methods: Twelve eyes of 10 patients with hard exudates associated with diabetic retinopathy were enrolled in this study. All subjects underwent a complete ophthalmic examination including SD-OCT (Copernicus, Zawiercie, Poland) and microperimetry (MP1; Nidek Technologies, Padova, Italy). Retinal sensitivity was measured, over the areas with hard exudates and compared to corresponding locations devoid of hard exudates, using a semi-automatic program. The size of the hard exudate plaque was measured using the measurement software in the microperimeter. Retinal thickness in the area of the hard exudates and foveal thickness were measured using SD-OCT. Results: Mean retinal sensitivity over hard exudates was 4.97 ± 4.17 dB which was significantly ( P = 0.0001) reduced as compared to locations devoid of hard exudates. No significant correlation (r=-0.23, P = 0.45) was found between the size of the hard exudates and retinal sensitivity. A significant negative correlation was found between retinal sensitivity and retinal thickness at the area of the hard exudates (r=-0.65, P = 0.05), and between retinal sensitivity and foveal thickness (r=-0.91, P = 0.001). Conclusion: In eyes with diabetic retinopathy, retinal sensitivity was reduced due to the presence of hard exudates in the outer retinal layers and retinal thickening but this was not correlated with the size of the hard exudates.

A complete ophthalmic examination is not routinely performed on infants with Miller–Dieker syndrome (MDS, chromosome 17p13.3 microdeletion). The authors present the cases of four cousins with MDS who also carried a 16p13.3 microduplication (not associated with Rubinstein–Taybi syndrome). Retinopathy of prematurity-like proliferative peripheral retinopathy (PPR) was detected in two male first cousins, but was not detected in the female half-cousins. PPR in the first infant resolved by 4 months, but the second infant's PPR progressed, requiring photocoagulation followed by lens-sparing vitrectomy. While ocular abnormalities are more prevalent and severe in other lissencephalopathies, the PPR in these MDS infants underscores the sight-saving potential of performing an ophthalmologic exam with early molecular testing for all lissencephaly infants.

Στην παρούσα δημοσίευση παρουσιάζεται το δεύτερο μέρος μιας βιβλιογραφικής ανασκόπησης σχετικά με τη μεθοδολογία της κλινικής εξέτασης του οφθαλμού του σκύλου και της γάτας στην κτηνιατρική πράξη. Η οφθαλμολογική εξέταση αποτελεί σημαντικό τμήμα της γενικότερης κλινικής εξέτασης. Η πραγματοποίηση της με συστηματικό τρόπο και μεθοδικότητα διευκολύνει τον κλινικό κτηνίατρο στη διάγνωση του. Επιπλέον, συνιστάται να αντιμετωπίζεται το όργανο της όρασης ως μέρος του συνόλου που πάσχει, και όχι αυτόνομα, παρά τις ιδιαιτερότητες στη δομή και τη λειτουργία του. Η πλειονότητα των διαγνώσεων στην κτηνιατρική οφθαλμολογία βασίζεται σε ανατομικές παρατηρήσεις, οπότε η άριστη γνώση του φυσιολογικού, σε συνδυασμό με απλές κατά βάση τεχνικές, τις οποίες μπορεί να εφαρμόσει ο κλινικός κτηνίατρος, έχουν ως αποτέλεσμα την κατανόηση των παθολογικών ευρημάτων, τη σωστή διάγνωση και βεβαίως την αποτελεσματική αντιμετώπιση. Η ενδελεχής κλινική εξέταση των οφθαλμών περιλαμβάνει:(i) τη λήψη πλήρους ιστορικού (προσδιορισμός των χαρακτηριστικών του ζώου και διαλεύκανση των αιτίων προσκόμισηςστο κτηνιατρείο), (ϋ) την εξέταση του ζώου στο φως της ημέρας με επισκόπηση (αρχική παρατήρηση κεφαλής και οφθαλμών και εξέταση έκτου σύνεγγυς), ψηλάφηση (οριοθέτηση του βολβού,δακτυλική τονομέτρηση, απώθηση βολβού, αναστροφή των βλεφάρων)και νευρο-οφθαλμολογική αξιολόγηση (αντανακλαστικό απειλής, κόρης, κερατοειδούς, οφθαλμο-κεφαλικό, οφθαλμο-καρδιακό), (iii) την εξέταση των εξωτερικών (βολβός, βλέφαρα και βλεφαρικά χείλη, επιπεφυκότος, σκληρός χιτώνας, δακρυϊκό σύστημα) και εσωτερικών (κερατοειδής χιτώνας, πρόσθιος θάλαμος, ίριδα,φακός, υαλοειδές σώμα, χοριοειδής χιτώνας και αμφιβληστροειδής,οπτική θηλή) επί μέρους στοιχείων του οφθαλμού σε σκοτεινό δωμάτιο, (iv) τη δοκιμασία Schirmer για τη λειτουργικότητα των δακρυϊκών αδένων, (ν) τη χρήση οφθαλμικών χρωστικών (φλουορεσεΐνη, ερυθρό της Βεγγάλης), (vi) τη λήψη υλικού γιακυτταρολογική και μικροβιολογική εξέταση και την παρακέντηση (αποτύπωμα ιστού ή απόξεση από τον επιπεφυκότα και τον κερατοειδή για αποφολιδωτική κυτταρολογική εξέταση, καλλιέργειες μικροβίων ή μυκήτων και αναρρόφηση υγρού πρόσθιου θαλάμου ή υαλοειδούς σώματος), (vii) την τονομέτρηση (δακτυλική, εμβυθισης ή επιπέδωσης), (viii) τον έλεγχο της διαβατότητας του ρινοδακρυϊκου συστήματος, (ix) την οφθαλμοσκόπηση (άμεση ή έμμεση)και (χ) την αξιολόγηση της όρασης με βάση το αντανακλαστικό απειλής, την κίνηση ανάμεσα από αντικείμενα, την όραση σε διαφορετικές εντάσεις φωτός και τη διερεύνηση των οπτικών πεδίων., This is the second part of a review paper on the ophthalmic examination in dogs and cats. Ocular examination is an important aspect of the complete physical examination process; therefore, routine practice of an ophthalmic examination protocol enables the clinician to catalogue his findings and conclude to a diagnosis. Although the eye is a unique and highly complex organ in terms of structure and function, it should never be viewed and examined as an isolated organ, but rather than as a part of the whole, since a great number of systemic diseases reflect on to the eyes. A correct diagnosis in veterinary ophthalmology is often based on anatomical observations and the use of various simple additional ophthalmologic techniques. These may be easily learnt and applied in veterinary practice. The use of these techniques would assist the clinician in establishing a diagnosis and developing a rational treatment. Thorough and systematic ophthalmic examination includes: (i) accurate case history evaluation (signalment and primary complaint), (ii) eye and annexa examination in a lighted room by means of initial observation and close-up inspection, palpation (consisting of exploring the boundaries of the orbit, digital tonometry, eyelid eversion and globe retro pulse) and neuroophthalmologic assessment (including menace response, papillary light reflexes, corneal, oculocephalic and oculocardiac reflex),) (iii) detailed examination of the external (globe, eyelids and margins, nictitating membrane, conjunctiva, sclera, lacrimal system) and internal (cornea, anterior chamber, iris and pupil, lens, vitreous body, choroid and retina, optic nerve) ocular structures of both eyes, working from anterior to posterior, in a dark room, (iv) tear film production measurement (Schirmer Tear Test), (v) vital dyes use (fluorescein and Rose-Bengal stain), (vi) corneal and conjunctival scrapings (impression smears for exfoliative cytology), collection of specimens for microbiological examination, as well as of aspirates (aqueous humor from the anterior chamber or vitreous paracentesis from the posterior chamber), (vii) tonometry (digital, indentation or applanation), (viii) evaluation of the nasolacrimal drainage apparatus, (ix) ophthalmoscopy (direct or indirect) and (x) vision testing (based on menace reaction, moving objects, obstacle course and visual field evaluation).

The aim of this study is to determine the amount of tear secretion in sheep with infectious keratoconjunctivitis and healthy ones in the Siirt region by Schirmer tear test and phenol red thread tear test. A total of 47 Romanov sheep, consisting of sheep with infectious keratoconjunctivitis (n = 6) and healthy sheep (n = 41), constituted the study material. Phenol red thread tear test followed by Schirmer tear test was performed on both eyes of the animals, properly taken at a control visit on their feet. The Schirmer tear test and phenol red thread tear test values were measured as 18.83 +/- 5.29 mm/min and 22.22 +/- 6.09 mm/s in the right eyes and 18.41 +/- 7.15 mm/min and 20.83 +/- 5.72 mm/s in the left eyes, respectively, in healthy animals. The Schirmer tear test and phenol red thread tear test values were measured as 17.33 +/- 4.27 mm/min and 18.83 +/- 4.36 mm/s in the right eyes and 17.33 +/- 7.55 mm/min and 20.17 +/- 4.58 mm/s in the left eyes, respectively, in animals with infectious keratoconjunctivitis. The phenol red thread tear test measurement averages were found to be significantly higher than the Schirmer tear test measurement averages (P > 0.05). The amount of normal tear secretion was determined in Romanov breed sheep by the phenol red thread tear test and Schirmer tear test and there was no statistically significant difference in animals with infectious keratoconjunctivitis (P > 0.05). Siirt Üniversitesi Veteriner Fakültesi - 2016/02/14

Purpose To investigate the relationship between lens power and age as well as the relationship between lens power and axial length (AL) in Chinese children and adolescents. Methods The participants underwent a comprehensive ophthalmic examination that included AL, cycloplegic refraction, and Pentacam measurements. The crystalline lens power was calculated using Bennett's formula and then compared among the children of different age groups, refractive statuses, and AL categories. The association of lens power and AL was analyzed using multiple regression. Results A total of 1992 children and adolescents aged 6- to 18-years old were included. The difference in lens power was greater before 10-years old, followed by a relatively smaller difference in children aged 10 to 14 years and the difference in lens power came to a near plateau in adolescents after 14-years old. The negative association between lens power and AL was found to be more evident in nonmyopes than in myopes irrespective of age (younger than 10 years: nonmyopes: β = -1.499, myopes: β = -0.872; older than 10 years: nonmyopes: β = -1.288, myopes: β = -0.390, all P < 0.001). Conclusions The lens power in children and adolescents aged 6 to 18 years exhibited three stages. The association between lens power and AL differed between the nonmyopes and myopes. These findings suggested that less reduction in lens power might be associated with both growing age and increasing AL in myopes.

This is a report of an 11-month-old dog with recurrent corneal ulceration over the preceding three months. The cause was confirmed to be a single ectopic cilium in a rare location—the lower eyelid palpebral conjunctiva. Surgical excision of the aberrant hair was required for resolution of the disease process. This report demonstrates the importance of a systematic clinical approach to corneal ulceration in dogs, highlighting the importance of a complete history and ophthalmic examination. In non-healing or recurrent corneal ulceration in young dogs, exploration for ectopic cilia is important. Magnification and a good light source are essential in such cases. Surgical excision is curative and the prognosis is good.

The purpose of this study was to establish reference ophthalmic findings in the common kestrel (Falco tinnunculus). Twenty healthy adult kestrels were included in this study. Ophthalmic examinations included slit lamp biomicroscopy, fundus exam, Schirmer tear test, conjunctival bacterial culture and isolation, corneal touch threshold, tonometry, and corneal diameter measurement. Mean tear production was 7.4 ± 3.27 mm/min, and mean intraocular pressure measured via applanation tonometry was 10.5 ± 3.15 mm Hg. In addition, the mean corneal touch threshold was 29.8 ± 20.1 mm, and the mean corneal diameter was 9.8 ± 1.1 mm. Of the 25 conjunctival swabs, 23 (92%) yielded bacterial growth. Most of these bacteria were gram positive (69.6%); the most predominant genus was Staphylococcus. This study presents reference values for ophthalmic examinations in common kestrels.

Summary Correlations in retinal vein occlusion (RVO) patients between macular vascular densities in the superficial and deep capillary plexuses obtained using OCT-Angiography (OCTA) and the data from conventional examination (visual acuity and peripheral retinal non perfusion on fluorescein angiography) might reveal new insights in the pathogenesis of vascular damage. Through a retrospective, observational study of RVO patients with who underwent a comprehensive ophthalmic examination including FA and OCTA a significant correlation between automatically quantified macular vascular density on OCTA and peripheral non-perfusion on FA was demonstrated; OCTA could help in identifying high-risk RVO patients who may benefit from further evaluation using FA.

Purpose. To compare laser peripheral iridotomy (LPI) with trabeculectomy as an initial treatment for primary angle-closure glaucoma (PACG) with peripheral anterior synechiae (PAS) ≥ 6 clock hours. Methods. Patients were drawn from two randomized controlled trials. 38 eyes of 38 patients (PAS ≥ 6 clock hours) were treated with LPI (group 1) while 111 eyes of 111 PACG patients (PAS ≥ 6 clock hours) underwent primary trabeculectomy (group 2). All patients underwent a comprehensive ophthalmic examination at baseline and at postoperative visits and were followed up for a minimum of one year. Results. Group 2 had higher baseline IOP (45.7 ± 14.8 mmHg versus 34.3 ± 14.3 mmHg) than group 1 and more clock hours of PAS (10.4 ± 1.9 versus 9.0 ± 2.2). IOPs at all postoperative visits were significantly lower in group 2 than in group 1 (p=0.000). Five eyes in group 1 required trabeculectomy. 17 of the 38 eyes in group 1 (44.7%) required IOP-lowering medications as compared to seven of the 111 eyes in group 2 (6.3%). Cataract progression was documented in 2 eyes (5.3%) in group 1 and 16 eyes (14.4%) in group 2. Conclusions. Primary trabeculectomy for PACG (PAS ≥ 6 clock hours) is more effective than LPI in lowering IOP.

Purpose To study AMD Drusenoid Deposits “L”, Lipid type, with morphology-structural software and see all the input of this software on their morphology, volume, evolution knowledge and understanding Methods 166 eyes of 83 patients, 30 men, 53 women, with AMD Drusenoid Deposits “L”, Lipid Type (soft Drusen, Drusenoid PED “L”). Deposits were evaluated by Autofluorescence, IR imaging, OCT (Spectralis HRA-OCT, spectral domain OCT) and Morphology-Structural software (M-S software). ETDRS visual acuity (VA), complete ophthalmic examination with Fundus exam were added. M-S software let: grading (semi-automatized Drusenoid deposit volume and contours analyze, 3D deposit reconstruction); measurements (volume(in μm3), density (grey levels of deposits)(Statistic moments of pixel intensities: mean, median, minimum, maximum, average, standard deviation, skewness and kurtosis), structure (structural measures, texture parameters),(Haralick texture measurements for distances of 1 to 10 pixels), composition (differential density calculation). Grading, measurements (volume, density) let analyze Drusenoid Deposit “L”, their evolution, 4 years follow-up Results M-S software allows AMD Drusenoid Deposits “L”, Lipid Type (soft Drusen, Drusenoid PED) analyze, follow-up: topography, volume, density, evolution, for each cut, layer, eye, patient, and patient to patient. Therefore M-S software enable Drusenoid Deposits comparison, evolution for each patient and patient to patient. So M-S let assay AMD progression, assess evolution Drusenoid deposits “L” to atrophy and its occurrence period and intensity Conclusions Morphology-Structural Software contribute to and improve AMD Drusenoid deposits “L”, Lipid type, study and knowledge, therefore AMD understanding.

Summary Correlations in retinal vein occlusion (RVO) patients between macular vascular densities in the superficial and deep capillary plexuses obtained using OCT-Angiography (OCTA) and the data from conventional examination (visual acuity and peripheral retinal non perfusion on fluorescein angiography) might reveal new insights in the pathogenesis of vascular damage. Through a retrospective, observational study of RVO patients with who underwent a comprehensive ophthalmic examination including FA and OCTA a significant correlation between automatically quantified macular vascular density on OCTA and peripheral non-perfusion on FA was demonstrated; OCTA could help in identifying high-risk RVO patients who may benefit from further evaluation using FA.

Purpose To investigate potential differences in the retinal nerve fiber layer (RNFL) thickness, macular thickness and foveal thickness between amblyopic eyes and normal fellow eyes on spectral domain optical coherence tomography (SD-OCT). Methods A cross-sectional study of patients ≥10 years of age with unilateral amblyopia resulting from an anisometropic, strabismic or deprivative cause. Comprehensive ophthalmic examination was completed and the retinal structures of both eyes were measured using SD-OCT. We compared the measurements obtained between the amblyopic eye and the fellow normal eye in each subject. Results Twenty-six unilateral amblyopia patients with a mean age of 29.92 ± 14.19 years old participated in the study, of which 17 (65.4%) were classified as anisometropic, 7 (26.9%) as strabismic, and 2 (7.7%) as deprivative. For the amblyopic eye and fellow normal eye, respectively, the mean RNFL thickness was 95.87 ± 14.56 μm and 97.87 ± 14.56 μm (P = 0.628), the mean macular thickness was 270.87 ± 14.43 μm and 275.60 ± 14.43 μm (P = 0.251) and the mean foveal thickness was 250.59 ± 27.82 μm and 242.91 ± 27.82 μm (P = 0.332). SD-OCT assessments revealed no statistically significant differences between both eyes. Conclusions Using SD-OCT, there were no significant changes in the retinal structure of amblyopic eyes. Therefore, amblyopia does not seem to have a profound structural effect on the retinal nerve fiber layer, the macula, or the fovea.

Background To evaluate the macular sensitivity changes after half-dose photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSCR). Methods Eighteen patients (26 eyes) with chronic CSCR were recruited in the same hospital between April 2011 and December 2012. All patients were treated with one session of half-dose PDT after complete ophthalmic examination. Macular sensitivity examination was performed at baseline and 1, 3 and 6 months post-treatment. Mean sensitivity (MS) of the central 10 degrees (10°) and 4 degrees (4°), mean deviation (MD) and pattern standard deviation (PSD) on automated static perimetry (Humphrey Field Analyzer II-750) were used for analysis. Results There was significant improvement of the 10°MS from baseline (29.76 ± 1.51 dB) to 1 month (31.74 ± 1.56 dB), 3 months (31.51 ± 1.38 dB) and 6 months (31.19 ± 1.61 dB) after treatment (P

Parasitic infestations of the external eye are uncommon and more often prevalent in tropical and developing countries. We present three cases with ocular infestation caused by three different arthropods admitted to the ophthalmology department of a tertiary health care centre during two months. The first case was infected with the larvae of Oestrus ovis , the second case with Phthiriasis palpebrarum , and the third case with a tick, Ixodes ricinus. All patients in this report were living in city center of Bursa, one of the most industrialized cities of Turkey. Ocular ectoparasitic infestations should be taken into consideration in differential diagnosis of conjunctivitis, blepharitis and eyelid mass, even if patients living in urban areas. Due to the rarity of ocular ectoparasitic infestations and overlapping symptoms with more commonly occuring ophthalmic conditions, a careful ophthalmic examination is required to avoid misdiagnosis and delay in treatment.

To present ophthalmic patient time-tradeoff vision utilities for quantifying vision-related quality-of-life when the fellow eye still has good vision. These utilities are important for performing reliable cost-utility analyses.Consecutive time-tradeoff vision utilities were obtained from ophthalmic patients with good vision (20/20-20/25) in one eye and vision ranging from 20/20 to no light perception in the fellow eye over a 15-year period from 2000 through 2014.Five hundred eighty-six ophthalmic participant interviews from Wills Eye Hospital, New York Eye and Ear Hospital, and ophthalmology office practices in Pennsylvania and New Jersey.Participants underwent a full ophthalmic examination, after which time-tradeoff vision utilities were obtained by personal interview by the authors using a standardized, validated instrument.Time-tradeoff vision utilities.Mean time-tradeoff vision utilities were as follows in participants with good vision (20/20-20/25) in at least one eye and the following visions in the fellow eyes: no light perception, 0.79; counting fingers to light perception, 0.87; 20/200 to 20/400, 0.88; 20/60 to 20/100, 0.88; 20/30 to 20/50, 0.87; and 20/20 to 20/25, 0.94.In people with good vision (20/20-20/25) in one eye, the associated mean time-tradeoff vision utility is a remarkably consistent 0.87 to 0.88 when vision in the fellow eye ranges from 20/30 to light perception. Vision of 20/20 to 20/25 in the fellow eye results in a significantly higher associated utility of 0.94 (P0.01), whereas vision of no light perception in the fellow eye results in a significantly lower utility of 0.079 (P0.01). These utilities are important for calculating reliable patient value (quality-adjusted life-year) gains in ophthalmic cost-utility analysis populations in which there is unilateral and bilateral disease involvement.

Rationale: Occlusive cerebrovascular disease is the most common cause of homonymous hemianopia (HH) with macular sparing. Patient concerns: A 61-year-old man came to our ophthalmology clinic complaining of right-side hemianopia. Ophthalmic examination, visual field (VF) examination, and brain magnetic resonance imaging (MRI) were performed. Diagnoses: He had right HH without macular sparing on the initial VF test. And brain MRI 6 days after the visual symptoms began revealed a left occipital infarction. Interventions and Outcomes: Thirty-seven days after the onset, his follow-up 24-2 VF examination showed HH with bilateral macular sparing, which was not apparent in the initial VF examination. About 4 months after the stroke, his central 10-2 VF examination also showed HH with bilateral macular sparing. Lessons: We report a case of HH with a dramatic improvement in central vision several days after an occipital infarction. To our knowledge, this is the first case to show macular sparing developing after several days.

Background Two female breast cancer patients developed epiphora after administration of cyclophosphamide and/or anthracyclines based 2-day chemotherapy regimen. An ophthalmologist was consulted and no apparent cause was found. Case description Patients were managed by ciprofloxacin eye drops. Chemotherapy induced ocular complications are not uncommon, but under reported. Although epiphora is a mild reaction, if severe however, it can interfere with daily activities. Patients having chemotherapy induced ocular toxicity should go for ophthalmic examination to pick up ocular adverse effects of anticancer drugs and treat them at an early stage.

Luiz Cláudio Santos de Souza Lima,1 Adalmir Morterá Dantas,2 Guilherme Herzog Neto,1 Eduardo França Damasceno,1 Helena Parente Solari,1 Marcelo Palis Ventura1 1Department of General Surgery, Federal Fluminense University, Niteroi, 2Department of Ophthalmology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil Purpose: To compare anisometropic hypermetropic amblyopic and strabismic amblyopic responses to pattern electroretinogram (PERG) and pattern visual evocated potential (PVEP). Materials and methods: Fifty-six patients – 18 hypermetropic anisometropic amblyopic children (mean age 9.70±2.5 years), 19 strabismic amblyopic children (mean age 10.30±2.6 years) and 19 normal emetropic subjects (mean age 10.10±2.2 years) – were enrolled in this study. After routine ophthalmic examination, PERG and PVEP were recorded in response to checks reversed at the rate of two reversals/second stimulating macular area. Results: The difference between hypermetropic anisometropic amblyopia and strabismus amblyopia with respect to P100/P50/N95 wave latencies (P=0.055/0.855/0.132) and P100/P50/N95 amplitudes (P=0.980/0.095/0.045) was not statistically significant. However, there was a significant statistical difference between strabismic amblyopia group and controls for P100/P50/N95 latencies (P=0.000/0.006/0.004). Conclusion: Our findings indicated that despite clinical differences between anisometropic amblyopic and strabismic amblyopic patients, no differences were found in the responses of PVEP and PERG. The abnormal components of the PVEP and PERG in amblyopic subjects could reflect a retinal dysfunction in the visual pathway. Keywords: amblyopia, strabismus, pattern electroretinogram, pattern visual evocated potential, anisometropia

Dear Editor,We would like to thank Beuy Joob and Viroj Wiwanitkit for their interest in our work. They have raised pertinent questions in their article which we would like to address.We concur with...

WOS: 000405083400007, PubMed: 28604573, Purpose Our objective was to evaluate the diagnostic value of a handheld pupillometer in differentiating eyes with pseudoexfoliation syndrome (PXS) from healthy controls. Methods This population-based, cross-sectional study was conducted in the province of Eskisehir, Turkey. Subjects 40 years of age and older were randomly recruited using stratified two-stage cluster sampling from the database of the Turkish Statistical Institute office in Eskisehir. Recruitment took place between June and October 2014. The inclusion criteria were healthy subjects who did not have a previous diagnosis of glaucoma or other issues affecting pupil dynamics. After an extensive ophthalmic examination, pupillometry was performed under standard photopic room lighting conditions. After pupillometry, the pupil was dilated and digital images of the anterior segment were taken for confirmation of PXS. An inter-eye pupil diameter difference of 0.4 mm was defined as pupil asymmetry. Results Of the 2356 invited subjects, 2017 agreed to participate (85.6%), and 1559 subjects were eligible for the study. An age-matched subgroup consisting of 529 healthy controls was randomly selected to compare with the 60 subjects who were diagnosed with PXS. The mean pupil diameters of subjects with PXS and healthy controls were 3.57 0.68 mm and 3.68 +/- 0.63 mm, respectively (P = .652). In the ROC analysis, the precision of pupil diameter in discriminating PXS was low (AUC 0.56, sensitivity 14%, specificity 94%). Pupil asymmetry increased the chances of having PXS by 3.46-fold. Conclusions Pupillometry performed poorly in the detection of PXS scoring a positive predictive value of 26%.

Purpose: This study aimed to share the results of patients who underwent anterior tarsal flap rotation combined with anterior lamellar reposition because of cicatricial upper eyelid entropion, and to determine the effectiveness and reliability of this surgical technique. Methods: Fifteen eyes of 11 patients (2 right eyes; 5 left eyes; and 4 bilateral eyes) on whom we performed anterior tarsal flap rotation surgery combined with anterior lamellar reposition because of cicatricial entropion were included in this study. The medical records of the patients were analyzed retrospectively, and the causes of cicatricial entropion as well as the preoperative and postoperative ophthalmic examination findings were recorded. Normal anatomical appearance and function of eyelid were considered to have been achieved. Results: The mean age was 59.81 ± 18 years. The mean follow-up period was 21.72 ± 14 months (range, 5-43 months). The causes of cicatricial entropion were postoperative cicatrices development due to multiple electrolyzes for trichiasis and/or distichiasis in 7 eyes, trachoma in 6 eyes, and trauma in 2 eyes. Irritation and watering were detected in all patients preoperatively, whereas corneal opacity and erosion were detected in 10 patients and epithelial erosion was detected in one patient. Full anatomical and functional success was achieved for all patients. Conclusion: Anterior tarsal flap rotation combined with anterior lamellar reposition in the repair of cicatricial entropion was found to be an effective and reliable alternative surgical procedure. RESUMO Objetivo: Compartilhar os resultados dos pacientes submetidos à rotação de retalho tarsal anterior, combinados com a reposição lamelar anterior devido à entrópio cicatricial da pálpebra superior e determinar a eficácia e a confiabilidade desta técnica cirúrgica. Métodos: Foram incluídos neste estudo quinze olhos de 11 pacientes em quem realizamos cirurgia de rotação de retalho tarsal anterior combinada com reposição lamelar anterior devido ao entrópio cicatricial. Os registros médicos dos pacientes foram analisados retrospectivamente e as causas da entrópio cicatricial, bem como os achados do exame oftalmológico pré-operatório e pós-operatório foram registrados. A integridade anatômica e funcional da pálpebra foi considerada como sucesso cirúrgico. Resultados: A idade média foi de 59,81 ± 18 anos. O período médio de seguimento foi de 21,72 ± 14 meses (intervalo 5-43 meses). As causas da entrópio cicatricial foram o desenvolvimento de cicatrizes pós-operatórias devido a eletrólises múltiplas para triquíase e/ou distiquiase em 7 olhos, tracoma em 6 olhos e trauma em 2 olhos. Todos os pacientes foram tiveram irritação e lacrimejamento pré-operatório, enquanto que 10 pacientes apresentavam opacidade e erosão da córnea e 1 paciente apresentava apenas erosão epitelial. O sucesso total anatômico e funcional foi alcançado em todos os casos. Conclusão: A rotação do retalho tarsal anterior combinada com a reposição lamelar anterior no reparo da entrópio cicatricial é um procedimento cirúrgico alternativo efetivo e confiável.

A 42-year-old female presented with unilateral visual loss associated with systemic symptoms of fever and headache. Although initial ophthalmic examination revealed a unilateral neuroretinitis, investigation for infectious and non-infectious causes of neuroretinitis were negative. At our examination, retinal imaging (suggestive of bilateral involvement) along with the results of lumbar puncture (pleocytosis) and clinical findings was consistent with a diagnosis of Vogt-Koyanagi-Harada disease. The patient was treated with intravenous steroids with prompt resolution of her symptoms. Vogt-Koyanagi-Harada disease may present atypically and should be considered in the differential diagnosis of neuroretinitis.

Diagnosing bradyopsia can be challenging in young children because structural ophthalmic examination is typically normal and visual acuity can improve with pinhole despite no significant refractive error. This case series highlights the clinical presentations and features of 5 affected children (3 Arab families) who harbored the same homozygous RGS9 frameshift mutation, which seems to represent a founder effect for the Arabian Peninsula.

Based on the Beijing Eye Study 2011, a detailed ophthalmic examination was performed including spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging for measurement of subfoveal choroidal thickness (SFCT) and relative height of posterior scleral staphyloma. OCT images were obtained in 103 highly myopic eyes (≤−6.00 diopters) and 227 normal eyes. The mean SFCT in highly myopic eyes was 110.6 ± 85.2 μm (range, 3 to 395 μm). The SFCT of high myopia without posterior scleral staphyloma(55 eyes) was 157.79 ± 85.18 μm, which was significantly greater than that (54.94 ± 49.96 μm) of high myopia with posterior scleral staphyloma (48 eyes) (P