Sher A. Aslam

Implantation of the Black Diaphragm Intraocular Lens in Congenital and Traumatic Aniridia

OBJECTIVE To evaluate the biometry accuracy, visual outcomes, and long-term changes in intraocular pressure after implantation of the black diaphragm intraocular (BDI) lens in cases of aniridia. DESIGN Retrospective, interventional case series. PARTICIPANTS Forty eyes of 35 patients with aniridia (15 eyes of congenital origin and 25 as a result of trauma). METHODS Patient demographics, clinical evolution, and treatment were analyzed for each case undergoing implantation with the Morcher 67F BDI lens (Morcher GmBH, Stuttgart, Germany). MAIN OUTCOME MEASURES Biometry accuracy, visual outcome, and the development of glaucoma and other complications in these eyes over a mean of 3.5 years. RESULTS Using the recommended A constant of 118.7, the mean biometry prediction error was -0.12+/-0.44 diopters (D), with a mean absolute error of 1.47+/-0.29 D, equivalent to 80% of target eyes being within 2 D of predicted refraction. The prevalence of glaucoma increased from 10 (25%) of 40 eyes before surgery, to 22 (55%) of 40 eyes at 1 year after surgery. The best-corrected visual acuity in logarithm of the minimum angle of resolution (logMAR) units improved significantly in the 25 eyes with traumatic aniridia, from 1.34+/-0.22 to 0.54+/-0.16 (20/400 to 20/70; P<0.001). In contrast, no significant improvement was seen in the 15 eyes with congenital aniridia, whose preoperative logMAR visual acuity of 1.17+/-0.14 improved to 1.01+/-0.21 (20/300 to 20/200; P = 0.20). CONCLUSIONS Biometry is reasonably accurate when implanting the BDI lens for aniridia. Glaucoma is the main complication and occurred immediately after surgery, suggesting a possible direct mechanical effect of the large BDI lens. Significantly better visual outcomes were seen when using the 67F BDI lens for traumatic aniridia compared with congenital aniridia. Implantation of the BDI lens in congenital aniridia therefore should be approached with caution, because the recreation of an iris diaphragm does not confer the expected optical benefits in these eyes.

Ocular features of Sjogren–Larsson syndrome

Sjogren–Larson syndrome is a rare autosomal recessive neurocutaneous disorder characterized by a triad of intellectual disability, spastic diplegia or tetraplegia and congenital ichthyosis with associated ocular features, which include pigmentary changes in the retina. The usual presentation of crystalline maculopathy is from the age of 1–2 years onwards. Herein, a case of Sjogren–Larson syndrome in a 25‐year‐old woman is presented to highlight the ocular findings.

Pilot study and functional results following implantation of the M-flex 630F multifocal intraocular lens.

In the 1930s, Stiles and Crawford discovered experimentally that a pencil of light rays entering near the pupil center would appear perceptually brighter than the same pencil entering closer to the pupil edge. This property, the Stiles-Crawford effect of the first kind (SCE 1), was attributed to the ‘‘directional sensitivity’’ of cone photoreceptors. Cone outer segments are more likely to catch (capture) photons that travel parallel to their long axes than photons that strike at an oblique angle (Figure 1, A). In refractive surgery, optical aberrations caused by an ametropic cornea overlying the pupil can cause unwanted conscious perceptions such as starbursts around point light sources. Some investigators believe that the SCE 1 mitigates the effect of these CORRESPONDENCE

Systemic tuberculosis presenting with acute transient myopia: a case report

IntroductionTransient myopia has been reported to occur in a number of conditions, either ocular in origin or associated with an underlying systemic cause. We present a rare case of this abnormality occurring in the setting of systemic tuberculosis.Case presentationA 29-year-old Indian woman presented with sudden onset blurred distance vision and fever. Examination revealed visual acuity of counting fingers in both eyes improving to 6/9 with pinhole with N5 reading acuity. Anterior segment examination revealed narrow angles on gonioscopy. Posterior segments were normal. Systemic examination revealed a fluctuant mass in her left loin, aspiration of which yielded pus which was culture-positive for Mycobacterium tuberculosis. The Mantoux test elicited a strongly positive reaction. Chest X-ray and magnetic resonance imaging of the brain were unremarkable. Computed tomography scan and magnetic resonance imaging of the spine and abdomen revealed a large psoas abscess communicating with the loin mass. Two vertebrae were involved but not the spinal cord or canal.ConclusionTransient myopia is a rare presenting feature of systemic tuberculosis. A postulated mechanism in this patient is that development of a uveal effusion related to systemic tuberculosis caused anterior rotation of the iris-lens diaphragm, thereby inducing narrowing of the angle and acute myopia.

Lipid lowering drugs in diabetes: lipid lowering has ophthalmic benefits.

EDITOR—Lipid lowering treatment in diabetes has ophthalmic benefits.1 Diabetic maculopathy is a common cause of loss of sight in diabetic patients and is characterised by retinal oedema and lipid exudates. The use of atorvastatin in diabetic maculopathy has recently been shown in a randomised controlled trial to decrease visible lipid exudates and …

A vascular anomaly seen in suprachoroidal haemorrhage

cification are very typical, but intraocular tumours with calcification are mostly retinoblastomas and choroidal osteomas. This is reflected by the fact that in the literature we found only six cases of calcification in intraocular melanomas. Kellner et al. (1993) reported three cases (from 1300 treated cases) of small choroidal melanomas with calcification-like echographic patterns after brachytherapy. Kiratli & Bilgic (2001) described ultrasonic sign of intratumoural calcification in a juxtapapillary melanoma after fractional transpupillary thermotherapy. These two reports suggest that calcification of intraocular melanomas is mostly related to destructive therapeutic interventions. Additionally, calcification in a choroidal melanoma was reported by Jensen & Andersen (1974). They described spontaneous regression of a choroidal melanoma with dot-like multiple calcifications close to the surface of the tumour. Our case is somewhat similar to that reported by Chan et al. (1995), who described a choroidal melanoma case with Bruch’s membrane-related calcification. In contrast to that report, however, we did not find osteocytes related to the calcium deposit; in our case it was a pure calcification, not bone formation. Our case shows that intratumoural calcification can occur spontaneously, without influence from previous therapeutic interventions. Furthermore, by histopathological examination the tumour showed neither signs of regression nor evidence of necrosis. The cause of calcium deposition is unknown. Histopathology did not reveal ischaemic changes or necrosis in or around the area of calcification. Although secondary drusen of the overlying pigment epithelium can show calcification (Yanoff & Fine 1982), this explanation seems improbable because of the intratumoural localization of the calcium deposit. A preexisting calcification (e.g. idiopathic sclerochoroidal calcification) at the level of the Bruch’s membrane is also a possibility. It is worth noting also that this feature occurred in the tumour of an unusually young patient. We conclude that although it is true that intratumoural calcification is rare in choroidal malignant melanoma, ultrasonic signs of a calcified area within a tumour do not contradict or exclude a diagnosis of malignant melanoma. Because echography is the most informative imaging method for blind eyes with opaque media, this finding may be of value in avoiding diagnostic errors.

Undiagnosed Type 2 Diabetes Mellitus Presenting with Orbital Cellulitis

The authors describe the case of a 48 years old woman who presented with a one week history of a painful, swollen left eye with proptosis and diplopia. A computed tomography (CT) scan showed features of left orbital cellulitis, and blood tests and urinalysis confirmed the diagnosis of diabetes mellitus. The infection resolved following a course of intravenous antibiotics and with glycaemic control. To our knowledge, undiagnosed diabetes mellitus presenting with orbital cellulitis has not previously been reported.

Arterial occlusion after scleral buckling

We present a report of a young man with bilateral retinal dialyses in whom surgery, in the form of scleral buckling, was initially performed only to one eye. Post-operatively, he developed features of combined central retinal and distal choroidal artery occlusions in the operated eye. Postulated mechanisms for this complication included a period of systemic hypotension during surgery, and previously undiagnosed polycythaemia and activated protein-C resistance which were found on subsequent haematological investigations, these being risk factors for thrombosis. This case serves to highlight the need for caution in performing simultaneous bilateral scleral buckling surgery without routine haematological screening, due to the extremely rare but potentially devastating effects of bilateral vascular occlusion.

Lipid-lowering therapy is associated with resolution of exudates in diabetic maculopathy

Diabetic maculopathy is a common cause of loss of sight in patients with diabetes mellitus and is characterised by retinal oedema and lipid exudates. The use of lipid-lowering therapy in diabetic maculopathy has recently been shown in a small randomised controlled trial 1 to decrease visible lipid exudates and also have a positive effect on the visual outcome of affected patients. We present three cases of diabetic maculopathy seen in ophthalmic outpatients which highlight striking anatomical changes and reduction in retinal exudates associated with the lowering of serum lipids.