Ultra-wide-field scanning laser ophthalmoscopy assists in the clinical detection and evaluation of asymptomatic early-stage familial exudative vitreoretinopathy.

PURPOSE: This study aims to investigate the ability of the ultra-wide-field scanning laser ophthalmoscope (UWF SLO) in clinically detecting and evaluating asymptomatic early-stage familial exudative vitreoretinopathy (FEVR). METHODS: We retrospectively reviewed 163 eyes of 83 asymptomatic family members of 48 patients with FEVR. UWF SLO imaging (Optos® PLC, Scotland, UK) was performed on asymptomatic family members as a preliminary screening test for fundus anomalies, and the findings were compared with subsequent examinations using indirect fundus ophthalmoscopy in full mydriasis, fluorescein angiography (FA), fundus autoflourescence, and genetic sequencing. RESULTS: A total of 86 eyes of 43 asymptomatic family members were clinically diagnosed with early-stage FEVR, and 17 of the affected 43 family members were also genetically diagnosed. Compared with FA as a standard, the UWF SLO was highly effective in diagnosing FEVR with a sensitivity and specificity of 93.0 % and 97.5 %, respectively. The UWF SLO was able to diagnose early-stage FEVR in 93.0 % of eyes, and guided the selection of therapies in 46.5 % of the eyes studied. CONCLUSION: UWF SLO is a valuable imaging tool for detecting fundus anomalies related to early-stage FEVR, and this tool can assist in the clinical diagnosis and evaluation of early-stage FEVR in asymptomatic family members of patients with FEVR.

[Integrated therapy of congenital cataract to prevent blindness and low vision].

Congenital cataract is a major cause of treatable blindness in the pediatric population worldwide. Advances in microsurgical techniques have significantly increased the success rate of surgery. However, visual rehabilitation outcomes are not always satisfactory even after a successful surgery. Due to delayed surgery, irrational aphakic correction, and lack of amblyopic training, a large number of infants in China remain blind or low-visioned after cataract surgery. Appropriate timing of surgical intervention, rational surgical methodology as well as systematic optical correction and amblyopic training are critical for the prevention of blindness and low vision in congenital cataract.

[Investigations on cyclotorsion changes following strabismus surgery in superior oblique palsy patients].

OBJECTIVE: To investigate cyclotorsion changes after strabismus surgery in superior oblique palsy patients. METHODS: Forty patients (50 eyes) underwent myotomy of inferior oblique (15 patients, 15 eyes), partial myectomy of inferior oblique (15 patients, 15 eyes) or myotomy of inferior oblique combined with inferior rectus recession on the other eye (10 patients, 20 eyes) for treatment of monocular superior oblique palsy. Objective cyclotorsion were examined pre-operation, as well as 1, 7, 30, and 90 d post-operation with fundus photograph and quantitive measurement. Vertical deviation and ocular movement were also assessed before and after surgery. Fundus photograph were also examined in 30 normal persons (60 eyes) without strabismus. RESULTS: The fovea-to-disc angle of normal people was 6.7°±2.5° in the right eye, 5.9°±2.3° in the left eye, and 12.6°±4.3° when combined. The cyclotorsion angle was not statistically significant between two eyes (t=1.29, P=0.20). For the monocular superior oblique palsy patients, preoperative fovea-to-disc angle was 14.3°±6.6° in the affected eyes, 12.2°±4.8° in the fellow eyes, and 26.5°±10.3° when combined. The objective cyclotorsion was also not statistically significant between two eyes (t=1.64, P=0.11). The comparison of total cyclotorsion angle of both eyes showed significant difference between normal people and patients. The fovea-to-disc angle of 1, 7, 30 and 90 d after operation were 11.7°±4.3°, 11.9°±4.9°, 13.5°±5.2° and 15.9°±3.6° respectively. The comparison of objective ocular cyclotorsion for both eyes showed significant difference pre- and post-operation (F=40.13, P<0.01). There is a gradual increasing trend of postoperative excyclotorsion angle with the prolonged time. There were statistically significant difference between 90 d and 1 d, 7 d after surgery. The two inferior oblique weakening procedures, myotomy of inferior oblique and partial myectomy of inferior oblique produced equitable amount of incyclotorsion shift with no statistical difference. The difference between the cyclotorsion change induced by myotomy of inferior oblique and inferior rectus recession in counter side was also not statistically significant. CONCLUSIONS: Monocular superior oblique palsy patients had fundus excyclotorsion change that was nearly equally distributed between two eyes. Weakening the inferior oblique and inferior rectus could correct ocular excyclotorsion, the regression trend was observed 90 d after surgery. Both myotomy and partial myectomy of inferior oblique were equally effective in the correct of ocular cyclotorsion and vertical deviation.

[Surgical treatment of myopic strabismus fixus by modified Yokoyama's surgery].

OBJECTIVE: To evaluate the surgical results of modified Yokoyama's procedure for treating myopic strabismus fixus. METHODS: Retrospective analysis of records of 5 patients (7 eyes) with high myopic strabismus. Pre- and postoperative orthoptic measurements were recorded and analyzed. Anatomic relationships between the muscle cone and globe were analyzed using MRI or CT scan. The surgical procedure is a modification of Yokoyama's technique and medial rectus muscle was also recessed. RESULTS: The average axis length of 7 eyes was 32.62 mm (SD1.84). The mean preoperative horizontal deviation was 82.86 PD (SD 37.62) esotropia and mean vertical deviation was 20 PD (SD 7.91) hypotropia. All patients had marked limitation of elevation and abduction. Displacement of the lateral rectus inferiorly and superior rectus medially was demonstrated in each patient by CT or MRI scan of the orbits and by observation during surgery. After surgery, the supertemporal dislocation of globe was improved. Both the horizontal and vertical deviations decreased significantly, and the abduction and sursumduction motility were also improved gradually. The average follow-up was 5 months, all patients achieved satisfactory results and remained stable. CONCLUSIONS: In high myopic patients, if the deviant paths of the LR and SR muscles were demonstrated by MRI or CT scan, the surgical procedure to restore the dislocated globe back into the muscle cone by uniting muscle bellies of the superior rectus and lateral rectus muscles is effective and recommended.

Clinical features of posterior microphthalmic and nanophthalmic eyes.

AIM: To clinically differentiate nanophthalmos (NO) and posterior microphthalmos (PM) and to explore the mechanisms related to papillomacular folds (PMF). METHODS: Medical records of 34 unrelated patients with microphthalmos (54 eyes) from April 2009 to October 2017 were retrospectively reviewed. RESULTS: Fourteen eyes of 7 unrelated patients with NO and PM were included in the study. The presenting age of the NO cohort was significantly higher compared with the PM cohort (NO: 27±16y; PM: 3.7±0.6y). PMF was more likely to occur in cases with PM than in NO (25% in NO, 100% in PM). The anatomic features of PMF from optical coherence tomography (OCT) included: ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer and outer nuclear layer. In eyes without an apparent PMF (these were all NO eyes), rudimentary fovea without a foveal pit was noted. Four eyes that were NO developed angle closure glaucoma. Three NO eyes developed exudative retinal detachment and were successfully treated with lamellar sclerectomy. CONCLUSION: Posterior segment changes are pervasive both in PM and NO. Complications like angle closure glaucoma and exudative retinal detachment are likely to occur in eyes with NO but not with PM. Detailed OCT analysis found that PMF was partially a neural retinal issue, suggesting that redundancy of retinal issues involved only inner retinal layers.