1/6. Reduced accommodative function in dyskinetic cerebral palsy: a novel management strategy.A 9-year-old boy with dyskinetic cerebral palsy secondary to neonatal encephalopathy is described. He presented with blurring of near vision which had begun to impact on his school work. Objective assessment of accommodation showed that very little was present, although convergence was almost normal. The near-vision symptoms were completely removed and reading dramatically improved with the provision of varifocal spectacles. Varifocal lenses provide an optimal correction for far, intermediate (i.e. for computer screens), and near distances (i.e. for reading). Managing this type of patient with varifocal spectacles has not been previously reported. It is clearly very important to prescribe an optimal spectacle correction to provide clear vision to optimize learning.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/6. Spontaneous resolution of infantile esotropia.PURPOSE: To report the spontaneous resolution of infantile esotropia in 3 patients. methods: The clinical histories and the results of ophthalmologic examinations in 3 patients with infantile esotropia were reviewed and analyzed with reference to the literature. RESULTS: All 3 patients with infantile esotropia were diagnosed with 25 to 30 PD of esotropia before the age of 6 months. All of them had insignificant refractive errors. Against medical advice, they were not brought in for follow-up examinations. At the age of 34 months to 59 months, the esotropia of the patients had changed into exophoria, esophoria less than 4 PD, or orthophoria. All patients eventually showed dissociated vertical deviation and overaction of the inferior oblique muscles. Of the 2 cooperative patients, 1 consistently identified Titmus stereograms with 3000 seconds of arc and fused Worth 4 dots at near and at distance. The other patient could not identify stereo targets and suppressed one eye on Worth 4 testing at distance, though she showed no suppression at near. CONCLUSION: In these cases, infantile esotropia with a relatively small angle may spontaneously resolve without any treatment. However, all these patients showed poor stereoacuity, dissociated vertical deviation, and overaction of the inferior oblique muscles.- - - - - - - - - - ranking = 0.66666666666667keywords = near (Clic here for more details about this article) |
3/6. Measuring corneal power for intraocular lens power calculation after refractive surgery. Comparison of methods.PURPOSE: To find a more accurate and predictable method for intraocular lens (IOL) power calculation in eyes after refractive surgery. SETTING: Department of ophthalmology, Kangnam St. Mary's Hospital, Seoul, korea. methods: The accuracy of the following methods for calculating IOL power in 132 eyes after PRK or LASIK was compared: manual keratometry, hard contact lens, refraction-derived keratometry at the corneal plane, and the refraction-derived keratometry at the spectacle plane. Based on this comparison, the IOL power was calculated in the 2 eyes of a patient using refraction-derived keratometry at the spectacle plane with the SRK II formula. cataract surgery with IOL implantation was then performed. RESULTS: The largest corneal power values were obtained using a manual keratometer and the smallest using refraction-derived keratometry at the spectacle plane (P <.001). In the patient having cataract surgery with IOL implantation, near target refraction was achieved with minimal error in IOL power. CONCLUSIONS: If the corneal power is known before refractive surgery, the use of the smallest value of those obtained using refraction-derived keratometry and the hard contact lens method is recommended. However, if the corneal power before refractive surgery is unknown, the use of the hard contact lens method is recommended.- - - - - - - - - - ranking = 0.33333333333333keywords = near (Clic here for more details about this article) |
4/6. Refractive outcomes after cataract surgery with primary lens implantation in infants.AIMS: To show the refractive outcomes, accuracy of intraocular lens power selection, and visual outcomes and complications in infants undergoing cataract surgery. methods: The refraction (spherical equivalent) of 14 operated eyes in 8 children aged <1 year was plotted over time. Preoperative and final recorded visual acuities were assessed. RESULTS: The median follow-up was 37.25 months. The median initial postoperative refraction was ( )6.75 dioptres. CONCLUSIONS: Refractive outcomes for each eye were not entirely predictable and were variable between infants. However, there was a consistent pattern in each infant who underwent bilateral surgery, with both eyes following a similar pattern of refractive change with time: a decreasing myopic shift was seen in 8 eyes, possibly demonstrating emmetropisation. The two unilateral cases appeared to show a linear myopic shift. 4 eyes in 2 patients did not follow a myopic shift curve and one of these patients showed an early trend towards increased hyperopia. Definite causes for this erratic refractive change were not identified. A postoperative refraction >4.5 dioptres avoided early onset myopia. The range of difference between postoperative and predicted refraction using SRK-T was (-)2.85 to 2.97 dioptres. Most of the visual results are encouraging compared with historical data in older children.- - - - - - - - - - ranking = 0.33333333333333keywords = near (Clic here for more details about this article) |
5/6. Enlargement of the blind spot caused by papilledema.Blind spot enlargement in papilledema has been attributed to either mechanical disruption of the integrity of the peripapillary percipient elements by the swollen optic disk or to the Stiles-Crawford effect. We investigated the possibility that blind spot enlargement in papilledema is caused, at least in part, by a refractive scotoma due to peripapillary hyperopia. We reduced the enlarged blind spot in a patient with focal peripapillary hyperopia, without papilledema, to near normal size by using progressively stronger plus lenses. Similarly, with the addition of plus sphere, we reduced the size of the blind spot in five of six patients with papilledema, but in none of our normal subjects.- - - - - - - - - - ranking = 0.33333333333333keywords = near (Clic here for more details about this article) |
6/6. Complications of combined radial thermokeratoplasty and incisional keratotomy.PURPOSE: To report complications of radial thermokeratoplasty (RTK) when used in combination with either radial keratotomy (RK) or astigmatic keratotomy (AK). methods: RTK is a technique for the surgical correction of hyperopia and presbyopia. 600 degrees C burns are applied to the peripheral cornea for 0.3 seconds using a specialized cautery probe. The thermal energy generated shrinks stromal collagen and flattens the peripheral cornea. The central cornea is steepened producing a myopic shift. RESULTS: Two patients who had RTK in combination with either RK or AK are reported. Patient 1 was bilaterally hyperopic and presbyopic. The patient had RTK performed on the left eye in an attempt to make that eye myopic. The goal was to allow the left eye to be used for near vision. After RTK, the left eye was significantly overcorrected. The patient then had RK in the left eye which resulted in profound overcorrection with return of hyperopia. Postoperatively, examination revealed gaping of the RK incisions and poor epithelial wound healing. The patient also complained of severe ocular pain. Despite suturing the RK incisions, the eye remained hyperopic. The patient underwent two additional RTK procedures which failed to correct the induced hyperopia. The second patient had induced hyperopic astigmatism after undergoing RK. RTK was then performed to correct the hyperopia. However, the result was a worsening of the astigmatism. Two t-cut astigmatic keratotomies were then performed which improved the astigmatism but subsequently exacerbated the hyperopia. A second RTK procedure was then performed; however, it failed to correct the induced hyperopia. CONCLUSIONS: RTK is an unproved surgical technique for the correction of hyperopia and presbyopia that needs much further evaluation before broad clinical application can be supported.- - - - - - - - - - ranking = 0.33333333333333keywords = near (Clic here for more details about this article) |