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Clinical features of isolated inferior rectus paralysis
Published in Jan-Tjeerd de Faber, 28th European Strabismological Association Meeting, 2020
Case 4: 64-year-old man was refered to our department for evaluation of binocular vertical diplopia. He noted diplopia in primary and inferior gaze that he was able to eliminate with a face turn to left and chin-down head posture . He had been diagnosed as having diabetes mellitus. His neurological history was unremarkable. His visual acuity was 20/30 without correction. In slit-lamb examination, grade 1 nuclear sclerosis was detected in two eyes. Pupils were equal, round and reactive to light, with no relative afferent pupillary defect. Ductions of left eye were normal. The right eye had moderate limitation of depression particularly in abduction. In primary gaze, there were 8 prism diopters hypertropia and 4 prism diopters exotropia in right eye (Figure 7). There was no blepharoptosis. Other cranial nerve testing were unremarkable. Ophthalmoscopic findings were normal bilaterally. Right isole inferior rectus paralysis was diagnosed. Single fiber electromyelography revealed myastania gravis. We could not treat this patient because of social insurancy problem. He was unavalible for follow-up. We learned that systemic corticosteroid treatment was planed but he did not receive the medication. He died because of systemic respiratuar complication of myastenia gravis.
Vitreoretinal surgery for idiopathic epiretinal membranes
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
H Richard McDonald, Robert N Johnson, Robert N Johnson, Everett Ai, J Michael Jumper, Arthur D Fu
Initially, postvitrectomy cataracts do not have the classic yellowish-brown appearance of significant nuclear sclerosis. Rather, there is subtle pale greenish-gray opalescence. Patients usually begin to require increasingly myopic refractive correction 6–12 months before the cataract becomes obvious. Posterior subcapsular cataracts are not seen following surgery in the absence of iatrogenic lens damage or gas–fluid exchange. The cause of postoperative nuclear sclerosis remains unclear.
Special Senses
Published in Pritam S. Sahota, James A. Popp, Jerry F. Hardisty, Chirukandath Gopinath, Page R. Bouchard, Toxicologic Pathology, 2018
Kenneth A. Schafer, Oliver C. Turner, Richard A. Altschuler
The anatomy of the lens is well documented in the literature (Hockwin et al. 1991; Samuelson 2007). Basically, the lens is surrounded by a capsule that is divided into anterior and posterior aspects. A single cell layer of lenticular epithelium is located beneath the anterior capsule. Lenticular epithelial cells constantly divide in the proliferative zone, move to the equator, and elongate in the region of the nuclear bow to constantly form lens fibers. The lens fibers elongate and meet at the anterior and posterior suture lines. Lens fibers are constantly moving inward toward the nucleus, resulting in continuous compression of the lens nucleus and eventually hardening (nuclear sclerosis) in aged animals. The anterior lens epithelium continues to deposit basement membrane so that the anterior capsule thickens as an animal ages.
Risk factors for complications during phacoemulsification cataract surgery
Published in Expert Review of Ophthalmology, 2020
Manpreet Kaur, Nithya Bhai, Jeewan S. Titiyal
Modifications of surgical techniques for nuclear emulsification have been described for management of complicated cataract cases including posterior polar cataract, dense nuclear sclerosis, white cataract and subluxated cataract. Capsular hooks may be used to stabilize the bag in cases with subluxated cataract, and capsular tension rings or segments may be inserted based on the extent of subluxation. In eyes with corneal opacity in peripheral or paracentral area with at least half of the cornea clear so as to allow sufficient visibility for surgery, phacoemulsification alone can suffice. Adequate coaxial illumination is the key for an uncomplicated surgery. Primary chop is recommended in these cases with nuclear sclerosis grade 2 or higher, while in advanced cataract, creating an eccentric crater followed by chopping is preferred[92]. Endoilluminator can be used as an oblique source of illumination in cases with corneal opacities to enhance intraoperative visualization[93]. Extracapsular cataract extraction may be preferred in cases with extremely dense nuclear sclerosis.
Usher Syndrome and Color Vision
Published in Current Eye Research, 2018
Anne Kurtenbach, Gesa Hahn, Christoph Kernstock, Stephanie Hipp, Ditta Zobor, Katarina Stingl, Susanne Kohl, Crystel Bonnet, Saddek Mohand-Saïd, Ieva Sliesoraityte, José-Alain Sahel, Isabelle Audo, Ana Fakin, Marko Hawlina, Francesco Testa, Francesca Simonelli, Christine Petit, Eberhart Zrenner
It is difficult to know to what extent our results are influenced by ocular media opacities, which were not graded and can lead to tritan errors. USH syndrome subjects, like those with RP, are known to be more likely to develop cataracts compared with the normal population.12,28,33,34 In this study, only five patients (two USH1, three USH2) had cataracts, who were excluded from the analysis. Most studies, find no difference in the prevalence of cataract in USH1 and USH2 subtypes,12,14,20,34 so ocular media opacities are unlikely to be the reason for the difference in the polarity of errors in our two USH groups. As age was taken a covariant in the analysis comparing USH1 and USH2 types, an effect of this on the results would not be expected. Nevertheless, patients with nuclear sclerosis or mild yellowing of the lens were not excluded, so that it cannot be ruled out that this factor, if affecting vision, will play a role in the results. The results show that color vision defects begin around 25–30 years of age on average, for both USH types. (Figures 1 and 3), which is in line with reports on the decline of other visual parameters.15,20,35
Branch retinal vein occlusion following cataract surgery
Published in Clinical and Experimental Optometry, 2018
Silvio Polizzi, Francesco Barca, Tomaso Caporossi, Gianni Virgili, Stanislao Rizzo
A 64‐year‐old woman was referred to our clinic for cataract evaluation in the right eye. Her medical history was positive for well‐controlled hypertension. She had surgery for a macular hole in the right eye and a prior BRVO in the left eye. On examination, her visual acuity (VA) was 6/120 in the right eye and 6/7.5 in the left. The anterior segment examination demonstrated 3+ nuclear changes in the right and 1+ nuclear sclerosis in the left eye. Intraocular pressure (IOP) was 15 mmHg in the right eye and 16 mmHg in the left. Fundus examination of the right eye revealed epi‐ and peri‐papillary local venous narrowing, tortuous blood vessels at the posterior pole, arteriovenous (A/V) crossing changes and loss of the normal foveal reflex. In the left eye, arteriovenous crossing changes, tortuous blood vessels at the posterior pole, collateral vessels and some small hard exudates inferonasal to the macula were present. Optical coherence tomography (OCT) showed notching of the foveal tissue with disruption of inner segment ellipsoid band in the right eye and mild macular oedema below the fovea in the left. After discussing the risk and benefits of cataract surgery, the patient decided to undergo phacoemulsification with intraocular lens (IOL) implantation. The surgery was performed under topical anaesthesia, without any complications.