Michael B. Shapiro

The Ocular Features of Down's Syndrome

A combined prospective and retrospective study of patients with Downs syndrome showed that these patients have narrowed and slanted palpebral fissures but that the fissures are of normal height. Patients with Downs syndrome also had increased prevalences (compared with control subjects) of blepharitis (23 of 53 patients or 46%), strabismus (23 of 53 patients or 43%), nystagmus (five of 53 patients or 9%), light-colored and spotted irides (46 of 53 patients or 87% and 43 of 53 patients or 81%, respectively), keratoconus (eight of 53 patients or 15%), cataracts (seven of 53 patients or 13%), severe myopia (13 of 48 patients or 27%), and astigmatism of more than 3 diopters (12 of 48 patients or 25%).

The efficacy of SimulVue and Unilens RGP aspheric bifocal contact lenses in the treatment of esotropia associated with a high accommodative convergence/accommodation ratio

PURPOSE This was a prospective study assessing the efficacy of the SimulVue bifocal contact lens and the Unilens RGP aspheric multifocal contact lens (Unilens, Largo, Fla.) in the treatment of high accommodative convergence/accommodation (AC/A) esotropia in an adolescent and postadolescent population. METHODS Those patients meeting the inclusion criteria were fit with contact lenses with use of full cycloplegic refraction and later retested by an examiner masked to the previous binocular status. Particular attention was given to the sensory status and the motor fusion of each patient in their bifocal spectacles and then in their bifocal contact lenses. All patients were followed up for at least 6 months after the contact lenses were fitted. RESULTS Five of the six patients demonstrated larger angles of esophoria or tropia at near with the contact lenses than with bifocal spectacles. The only patient who maintained excellent stereopsis in bifocal contact lenses was the one who normalized her AC/A ratio during this study and no longer required a bifocal in her spectacle correction for fusion. The two patients who initially had no stereopsis but good alignment in spectacle correction had a large esotropia at near fixation with bifocal contact lenses. CONCLUSIONS The SimulVue and Unilens RGP aspheric bifocal contact lenses did not adequately treat adolescent patients who had esotropia associated with a high AC/A ratio.

Visual disturbances associated with oval-optic poly(methyl methacrylate) and round-optic silicone intraocular lenses

Abstract A prospective, randomized, double‐masked clinical trial of 182 patients compared the frequency of visual disturbances associated with two small incision intraocular lenses (IOLs): the Alcon MZ20BD 5 mm × 6 mm oval‐optic poly(methyl methacrylate) (PMMA) IOL and the STAAR AQ1016 round‐optic silicone IOL. The samples were similar at baseline. There were no significant differences in visual acuity, mean keratometric cylinder, or surgically induced cylinder between the two groups postoperatively. Patients completed a satisfaction questionnaire and visual symptom inventory of ten items three months postoperatively. Those with the oval‐optic PMMA IOL reported significantly more visual symptoms than those with the roundoptic silicone IOL (P = .03). The oval‐optic group reported three symptoms more frequently: reflections, halos or rings around lights, and objects at arm’s length appearing blurry (P ≤ .010). The status of the fellow eye (cataract or pseudophakic) did not differ by randomization group, and the distribution of visual symptoms did not differ by status of the fellow eye. Frequency and severity of visual complaints were modest overall; only 1 % in each group was unsatisfied with the visual results.

Neuronal Ceroid Lipofuscinosis: A Retinal Trypsin Digest Study

Neuronal ceroid lipofuscinosis, also known as the Batten-Vogt syndrome, is clinically manifested by seizures, loss of intellect, and deterioration of vision. The retinal histopathologic and ultrastructural changes have been well-described. This report adds the findings of trypsin digest preparation of the retinae in three such patients with varying duration of this disease. Acellular retinal capillaries, or ghost vessels, were observed, and the degree of this change correlated with the duration of clinical symptoms. These changes, as well as the histopathologic abnormalities, are discussed.

The M-property of flag varieties

Abstract We consider arbitrary “generic” arrangements of high-dimensional Schubert cells in the series of real flag varieties PT∗ P n and prove the coincidnece of the sum of Betti numbers of these arrangements with the sum of Betti numbers of their complexifications. We give an example of the violation of this property in the case of arrangements in G 2,4 . We also prove degeneration of the Mayer-Vietoris spectral sequence in the E 1 term for some class of configurational spaces.

Radial Keratotomy for Intolerable Myopia After Penetrating Keratoplasty

Radial keratotomy was used to treat intolerable myopia in nine patients aged 56 to 86 years who had previously undergone penetrating keratoplasty and intraocular lens placement. The degree of myopia ranged from -5.25 to -9.25 diopters spherical equivalent before radial keratotomy. An eight-cut radial keratotomy with either a 4.0- or 4.50-mm central clear zone was performed on all patients. One year after the radial keratotomy, the spherical equivalent ranged from -1.25 to +1.63 diopters, which rendered all patients spectacle tolerant. Endothelial cell counts done before and one year after radial keratotomy demonstrated no marked loss of endothelial cell density. No complications were seen as a result of the radial keratotomy.