[Changes in accommodation in children with hyperopic anisometropia and unilateral amblyopia after laser refractive surgery and pleoptic treatment]. / Izmenenie akkomodatsii u detei s gipermetropicheskoi anizometropiei i odnostoronnei ambliopiei posle refraktsionno-lazernoi operatsii i pleopticheskogo lecheniya.

PURPOSE: This study comparatively analyzes the state of accommodation in children with hyperopic anisometropia and amblyopia after femtosecond laser-assisted in situ keratomileusis (Femto-LASIK) combined with pleoptic treatment, and after conventional pleoptic treatment. MATERIAL AND METHODS: The first group consisted of 30 children with medium and high hyperopia, high and medium amblyopia, and anisometropia greater than 3.0 diopters, who underwent Femto-LASIK in the amblyopic eye. The second group consisted of 28 children with similar local status, who were prescribed traditional correction and received conservative treatment. The follow-up period was 1.5 years. RESULTS: After 1.5 years, higher visual acuity (p<0.05) was achieved in the first group. A significant increase in the coefficient of accommodative response (CAR) was observed in the operated amblyopic eyes in group 1 - by 0.1±0.02 c.u. compared to the control group (p<0.05). In both groups there was an upwards trend for the coefficient of microfluctuations (CMF) in the amblyopic eye, but in the first group CMF increased more significantly (p<0.05). The objective accommodative response (OAR) and positive relative accommodation (PRA) of the amblyopic eye showed a double increase - by 1.0±0.23 and 0.9±0.38 diopters, respectively, at the end of treatment in the first group. The increase in similar indicators in the second group was insignificant (p<0.05). In children of the first group the difference in ciliary muscle thickness (CMT) of the amblyopic eye with disabled and enabled accommodation increased by 0.04±0.01 mm (p<0.05) in the anterior part of the ciliary muscle at the levels of CMTmax and CMT1. CONCLUSION: The data obtained in this study indicate the strong effect of refractive laser surgery in combination with pleoptic treatment on improving the visual acuity and the state of accommodation of the amblyopic and paired dominant eyes in children with hyperopic anisometropia, in contrast to conventional methods of treatment.

Knobloch syndrome associated with Polymicrogyria and early onset of retinal detachment: two case reports.

BACKGROUND: Knobloch Syndrome (KS) is a rare congenital syndrome characterized by occipital skull defects and vitreoretinal degeneration. Retinal detachment (RD) often occurs at the end of the first decade of life or later. Aside from occipital skull defects, central nervous system abnormalities are uncommon. CASE PRESENTATIONS: We report on two siblings with KS. The first, a seven month old male, presented with nystagmus and was found to have a serous RD and a tessellated retinal appearance. His sister had a history of multiple visual abnormalities and had a similar retinal appearance although no signs of RD, but retina staphylomas. Genetic testing performed on both siblings showed a mutation in COL18A1, diagnostic of KS. MRI of both siblings demonstrated polymicrogyria but did not show occipital defects. CONCLUSIONS: Although several families with KS have been described previously, our case is noteworthy for several reasons. The RD observed in our first patient occurred at an early age, and we find evidence of only one patient with KS who had an RD identified at an earlier age. The findings of polymicrogyria are not characteristic of KS, and we found only a few previous reports of this association. Additionally, we review potential treatment options for this condition.

[Analysis of corneal biomechanical changes after femtosecond laser-assisted laser in situ keratomileusis in children with hyperopic anisometropia]. / Analiz biomekhanicheskikh izmenenii rogovitsy posle lazernogo intrastromal'nogo keratomileza s femtolazernym soprovozhdeniem u detei s gipermetropicheskoi anizometropiei.

AIM: to analyze corneal hysteresis (CH) and corneal resistance factor (RF) readings obtained with the Reichert Ocular Response Analyzer (ORA) before and after hyperopic femtolaser-assisted laser in situ keratomileusis (FS-LASIK) in children with anisometropia as well as to establish factors that may cause changes in these parameters. MATERIAL AND METHODS: CH and RF were evaluated before and 1.5 years after FS-LASIK performed on amblyopic eyes of 28 patients aged 6-14 years. Preoperatively, there was a correlation between CH and RF (r=0.41, p=0.03). No correlation was found between CH and age (r=-0.02, p=0.82) or between CH (r=0.00, p=0.98), RF (r=0.04, p=0.83), and cornea thickness. RESULTS: The mean preoperative CH was 12.56±1.21 mmHg, RF 12.31±1.57 mmHg. Postoperatively, a statistically significant change occurred to both CH (by 0.97±1.51 mmHg, p=0.002) and RF (by 1.42±1.55 mmHg, p=0.000). No correlation was found between CH before and after surgery (r=0.11, p=0.57) as well as between the ablation depth and changes in CH (r=0,04, p=0.83) and RF (r=0.21, p=0.28). Regression analysis showed that the extent of CH (r2=0.52, p=0.00) and RF (r2=0,48, p=0.00) changes was closely related to their preoperative values. CONCLUSION: The statistically significant relative change in CH and RF after hyperopic FS-LASIK was 8% and 12%, respectively. CH and RF changes correlated with their preoperative values, but not with the ablation depth or cornea thickness.

Myelinated nerve fiber-associated local scleral excavation and induced axial myopia.

PURPOSE: To investigate the association between the distributions of local scleral excavation and myelinated nerve fibers (MNF) and to elucidate the pathogenic mechanism of axial myopia in eyes with MNF. METHODS: In six eyes of six pediatric patients with MNF, the distribution of the MNF on fundus photography was compared with the regional excavation of the sclera on linear scans across the fovea and a peripapillary circular scan of spectral domain optical coherence tomography. RESULTS: The tilting of Bruch membrane on vertical scan of spectral domain optical coherence tomography was associated with the major distribution of MNF (κ = 1, Cohen's kappa coefficient). The area of MNF of 12 clock-hour segments and focal scleral excavation on circular scan of spectral domain optical coherence tomography were significantly correlated (P < 0.001, generalized estimating equation). The deepest direction of the circular scan was correlated with the direction of MNF vector defined as the average of the MNF direction weighted by the MNF area along 12 clock-hour segment (P < 0.036, Spearman correlation test). CONCLUSION: Localized scleral excavation was strongly associated with the distribution of the MNF. This result indicates that the retinal areas deprived of visual stimulation by the MNF contribute to the development of axial myopia through local effects on the underlying sclera in early life.

Longitudinal increase in anisometropia in older adults.

PURPOSE: Anisometropia shows an exponential increase in prevalence with increasing age based on cross-sectional studies. The purpose of this study was to evaluate longitudinal changes in anisometropia in all refractive components in older observers and to assess the influence of early cataract development. METHODS: Refractive error was assessed at two time points separated by approximately 12 years in 118 older observers (aged 67.1 and 79.3 years at the two test times). Anisometropia defined as greater than or equal to 1.00 D was calculated for all refractive components. The subjects had intact ocular lenses in both eyes throughout the study. Lens evaluations were performed at the second test using the Lens Opacities Classification System III. RESULTS: All refractive components approximately doubled in prevalence of anisometropia. Spherical equivalent anisometropia changed from 16.1 to 32.2%. Similar changes were found for spherical error (17 to 38.1%), primary astigmatism (7.6 to 17.8%), and oblique astigmatism (14.4 to 29.7%). Many who did not have anisometropia at the first visit subsequently developed anisometropia (e.g., 26.3% for spherical error and 22.9% for oblique cylinder). The onset of anisometropia occurred at all ages within the studied age range, with no particular preference for any one age. A small number lost anisometropia over time. Individual comparisons of refractive error changes in the two eyes in combination with nuclear lens changes showed that early changes in nuclear sclerosis in the two eyes could account for a large proportion of anisometropia (~40%), but unequal hyperopic shift in the spherical component in the two eyes was the primary cause of the anisometropia. CONCLUSIONS: Anisometropia is at least 10 times more common in the elderly than in children, and anisometropia develops in all refractive components in the oldest observers. Clinicians need to be aware of this common condition that could lead to binocular vision problems and potentially cause falls in the elderly.

Factors associated with progressive anisometropia after bilateral intraocular lens implantation in patients with pediatric cataract.

OBJECTIVES: To identify factors associated with progressive anisometropia after bilateral intraocular lens (IOL) implantation in patients with pediatric cataract. METHODS: Clinical and standardized questionnaire data were collected for Sixty-eight patients with pediatric cataract (136 eyes) who underwent bilateral IOL implantation and at least 1 year of follow-up. Univariate and multivariate linear regression models were used to identify factors associated with postoperative anisometropia. RESULTS: The median age at IOL implantation was 3.2 years (range: 1-12.4 years), and median follow-up time was 5.7 years (range: 1.1-14 years). At 1 month postoperatively and at the last follow-up, there were 19 (27%) and 31 (46%) cases of anisometropia ≥1 D, 9 (13%) and 15 (22%) cases of anisometropia ≥2 D, and 2 (3%) and 9 (13%) cases of anisometropia ≥3 D, respectively. Compared with 1 month postoperatively, the amount of anisometropia increased in 45 (67%) patients. Greater anisometropia one year or more after bilateral IOL implantation was associated with larger intereye difference in IOL power (P = 0.032, 95%CI 0.013 to 0.285), intereye difference in preoperative axial length (P = 0.018, 95%CI -1.247 to -0.123), presence of strabismus (P = 0.017, 95%CI 0.063-0.601), anisometropia at 1 month postoperatively (P = 0.001, 95%CI 0.126-0.478), and intereye difference in axial length at the last follow-up (P = 0.047, 95%CI 0.005-0.627). CONCLUSION: Anisometropia might progress after bilateral IOL implantation in patients with pediatric cataract. Greater intereye difference in IOL power, presence of strabismus might increase the potential of progressive anisometropia.

[Treating anisometric amblyopia with HTS Amblyopia iNet Software--preliminary results]. / Tratamentul ambliopiei anisometropice cu programul hts amblyopia iNet--rezultate preliminare.

Amblyopia or "lazy eye" represents a disorder of the visual system characterized by poor vision in an eye that is otherwise physically normal. Anisometropia, the condition in which the two eyes have an unequal refractive error, is considered the second most common cause of amblyopia. The purpose of this study is to determine the efficiency of HTS Amblyopia iNet Software by studying the progress of visual acuity, contrast sensitivity and stereopsis vision in anisometropic amblyopic children. 5 patients (age: 5-13 years), treated with HTS Amblyopia iNet Software at OftaTotal Clinic from Sibiu, between 2010-2013, participated in this clinical trial. Initially, visual acuity ranged from 0.25 to 0.8, contrast sensitivity from 1.35 to 1.65 Log. Unit. and 1 patient presented stereoscopic vision. After treatment, visual acuity ranged from 0.8 to 1, contrast sensitivity from 1.35 to 1.95 Log. Unit., also all patients presented stereoscopic vision. HTS Amblyopia iNet Software represents an effective modern approach in the treatment of anisometropic amblyopia.

Optimal amount of anisometropia for pseudophakic monovision.

PURPOSE: To determine the optimal target anisometropia for pseudophakic monovision. METHODS: Thirty-five bilaterally pseudophakic patients who received monofocal intraocular lenses were included in the study. Binocular corrected distance visual acuity (CDVA) and binocular distance-corrected near visual acuity (DCNVA) and stereoacuity were measured after simulating 1.00, 1.50, and 2.00 diopters (D) of monovision by adding the appropriate spherical lens to the nondominant eye. We presumed that mean binocular DCNVA of 20/40, binocular CDVA of 20/25, and stereoacuity <100 seconds of arc (arc sec) were necessary for successful monovision. RESULTS: With no anisometropia, mean binocular DCNVA was 20/97, binocular CDVA was 20/20, and mean stereoacuity was 71 arc sec. With 1.00 D of monovision, mean binocular DCNVA was only 20/60, although binocular CDVA and mean stereoacuity were sufficient. With 1.50 D of monovision, binocular DCNVA was 20/38, binocular CDVA at other distances exceeded 20/21, and stereoacuity was 100 arc sec, which was a 29-arc sec reduction. With 2.00 D of monovision, binocular DCNVA reached 20/31, but stereoacuity was 158 arc sec, which was an 87-arc sec reduction. The number of patients who met the criteria for successful monovision was significantly greater with 1.50 D of monovision than with 1.00 or 2.00 D of monovision (P=.0134). CONCLUSIONS: Pseudophakic monovision with anisometropia of 1.50 or 2.00 D provides useful binocular visual acuity from far to near. However, because stereopsis with 2.00 D of monovision is substantially impaired, approximately 1.50 D of anisometropia is thought to be optimal for successful monovision.

Femtosecond LASIK combined with astigmatic keratotomy for the correction of refractive errors after penetrating keratoplasty.

BACKGROUND AND OBJECTIVE: To evaluate the outcomes of femtosecond laser in situ keratomileusis (LASIK) compared to combined LASIK and astigmatic keratotomy in the treatment of refractive errors following penetrating keratoplasty. PATIENTS AND METHODS: A retrospective review was performed on 18 eyes of 16 patients who underwent LASIK for visual rehabilitation after penetrating keratoplasty. Seven eyes (38.8%) had undergone paired relaxing incisions with topographic guidance prior to LASIK performance. RESULTS: Preoperative uncorrected visual acuity was 20/100 or worse in 13 eyes (72.2%) and best-corrected visual acuity (BCVA) was 20/40 or better in 15 eyes (83.3%). After LASIK, uncorrected visual acuity was 20/40 or better in 10 eyes (55.5%) and BCVA was 20/40 or better in 17 eyes (94.4%). Three eyes (16.6%) had a loss of 1 to 2 lines of BCVA. No difference in visual outcomes was noted in eyes undergoing LASIK and astigmatic keratotomy versus LASIK alone. An increased complication rate was noted in patients who also underwent astigmatic keratotomy and was associated with flap creation. CONCLUSION: Femtosecond LASIK is effective in reducing ametropia after penetrating keratoplasty. Astigmatic keratotomy might complicate flap creation in LASIK; therefore, photorefractive keratectomy should be considered for patients who had previous astigmatic keratotomy to reduce astigmatism.

Correcting post-keratoplasty anisometropia with the implantable collamer phakic intraocular lens.

BACKGROUND: We evaluate the Visian Implantable Collamer Lens (Staar, Monrovia, CA, USA) phakic intraocular lens for treating post-keratoplasty anisometropia. METHODS: Case series of three eyes (2 phakic and 1 pseudophakic). RESULTS: The mean age was 47.3 years (range 30-73 years), with a minimum of 3-month follow up. The mean preoperative spherical equivalent was -8.75 ± 5.17 D (-4.00 to -14.25 D) improving to -0.29 ± 1.21 D postoperatively (range 0.75 to -1.625 D). Mean logMAR uncorrected visual acuity improved from 1.66 ± 0.60 (6/240) preoperatively to 0.41 ± 0.52 (6/15(2) ). Mean logMAR best spectacle-corrected visual acuity improved from 0.32 ± 0.15 (6/12) preoperatively to 0.10 ± 0.11 (6/7.5). Anisometropia improved from a difference of 6.37 ± 2.59 D preoperatively to 2.09 ± 1.37 D postoperatively, and there were no complications. CONCLUSION: Our technique for this clinical indication shows that the Visian Implantable Collamer Lens is a safe and effective alternative for treating post-keratoplasty anisometropia.

Imposed anisometropia, accommodation, and regulation of refractive state.

PURPOSE: To determine the effects of imposed anisometropic retinal defocus on accommodation, ocular growth, and refractive state changes in marmosets. METHODS: Marmosets were raised with extended-wear soft contact lenses for an average duration of 10 weeks beginning at an average age of 76 d. Experimental animals wore either a positive or negative power contact lens over one eye and a plano lens or no lens over the other. Another group wore binocular lenses of equal magnitude but opposite sign. Untreated marmosets served as controls and three wore plano lenses monocularly. Cycloplegic refractive state, corneal curvature, and vitreous chamber depth were measured before, during, and after the period of lens wear. To investigate the accommodative response, the effective refractive state was measured through each anisometropic condition at varying accommodative stimuli positions using an infrared refractometer. RESULTS: Eye growth and refractive state are significantly correlated with the sign and power of the contact lens worn. The eyes of marmosets reared with monocular negative power lenses had longer vitreous chambers and were myopic relative to contralateral control eyes (p < 0.01). Monocular positive power lenses produced a significant reduction in vitreous chamber depth and hyperopia relative to the contralateral control eyes (p < 0.05). In marmosets reared binocularly with lenses of opposite sign, we found larger interocular differences in vitreous chamber depths and refractive state (p < 0.001). Accommodation influences the defocus experienced through the lenses, however, the mean effective refractive state was still hyperopia in the negative-lens-treated eyes and myopia in the positive-lens-treated eyes. CONCLUSIONS: Imposed anisometropia effectively alters marmoset eye growth and refractive state to compensate for the imposed defocus. The response to imposed hyperopia is larger and faster than the response to imposed myopia. The pattern of accommodation under imposed anisometropia produces effective refractive states that are consistent with the changes in eye growth and refractive state observed.

[Clinical observation on the relation between laser in situ keratomileusis treating myopic anisometropia and binocular vision].

OBJECTIVE: To analyze the effect of LASIK on visual quality of anisometropia, and evaluate its clinical value in the view of visual quality. METHODS: Prospective observational case series. Assayed the naked vision, glasses-corrected vision and binocular vision of 45 cases with anisometropia >or= 2.25D before and after the operation of LASIK. RESULTS: 91.57% of the eyes after the operation reached the vision >or= 0.8, which says a significant improvement for binocular vision after the operation (P < 0.05). There was a significant difference on diopter between the pre-operation and post-operation (P < 0.05). As for anisometropia, there was no significant difference between simultaneous binocular visions (P = 0.431), but there was of great significance among combined, short and long distance stereopsis visions (P = 0.000). Binocular vision deteriorated as anisometropia increased (P < 0.05). The short distance stereopsis visions of LASIK-treated myopic anisometropia were better than that of glasses-corrected patients (P < 0.05). CONCLUSION: The operation of LASIK can improve the visual quality and resume the binocular vision. LASIK can correct anisometropia and its therapeutic efficacy deserves to confirm.

Marcus Gunn Jaw-Winking Syndrome Associated with Morning Glory Disc Anomaly.

Marcus Gunn jaw-winking syndrome (MGJWS) is a rare form of congenital blepharoptosis and one of the congenital cranial dysinnervation disorders (CCDD). In addition, morning glory disc anomaly (MGDA) is a congenital optic disc anomaly of unknown etiology. The present report is the first to describe an association between MGJWS and MGDA in an otherwise healthy 7-year-old boy. He also had counting finger vision, anisometropia, esotropia, and monocular elevation deficiency in the same eye. In the literature, both MGJWS and MGDA have been reported to be associated with Duane retraction syndrome, a form of CCDD.

Interocular axial length difference and age-related cataract.

PURPOSE: To evaluate interocular differences in axial length and its relation to increasing axial length and postoperative refractive predictability in patients with age-related cataract. SETTING: Moorfields Eye Hospital, London, United Kingdom. METHODS: Preoperative biometry and postoperative refractive outcomes were analyzed in a consecutive series of 1537 patients who had uneventful bilateral phacoemulsification. In 1379 patients with bilateral data, the difference in axial lengths between eyes and the magnitude of postoperative anisometropia were compared between 1.0 mm incremental groups of axial length using the longer eye as the index eye. The postoperative refraction prediction error in 1457 left eyes was assessed in similar axial length groups. RESULTS: The difference in axial length was 0.3 mm or greater in 331 patients (24%). Axial length asymmetry between eyes increased with an increase in axial length in the index eye (P<.001). The 95th centile of the axial length difference was 0.5 mm when the longer eye was 22.0 mm or less and 4.0 mm when it was 28 mm or greater. There was also an increase in postoperative anisometropia with increasing axial length (P = .003). The median was 0.34 D (interquartile range [IR], 0.25-1.11) when the longer eye had an axial length of less than 28.0 mm and 0.66 D (IR, 0.16-0.66) when the longer eye had an axial length of 28.0 mm or more. In left eyes, there was an increase in biometry prediction error with an increase in axial length (P = .006). CONCLUSION: An increase in axial length was associated with greater asymmetry between eyes and more postoperative anisometropia, especially in eyes with an axial length greater than 28.0 mm.

Asymmetry in optic disc morphometry as measured by confocal scanning laser ophthalmoscopy in subjects with hyperopic anisometropia.

PURPOSE: To determine whether there is an asymmetry in optic nerve head morphometry in subjects with hyperopic anisometropia. METHODS: Seventeen men and 20 women with a mean age of 31.43 +/- 2.73 (standard error of mean) years underwent a complete eye examination and optic nerve head topography with the Heidelberg Retina Tomograph II (Heidelberg Engineering, GmBH, Heidelberg, Germany). Differences in optic nerve head parameters between anisometropic eyes and fellow eyes were evaluated using the paired-sample t test or Wilcoxon signed rank test and the correlations between refraction, visual acuity, and disc parameters were evaluated with Spearman's correlation coefficient. RESULTS: The median refractive errors of hyperopic anisometropic and fellow eyes were +4 D (range: +2.0 to +7.50 D) and 0 D (range: 0 to +4 D), respectively. The mean best-corrected visual acuity of the amblyopic eyes was 0.43 +/- 0.25. The mean disc area of the anisometropic eyes (1.69 +/- 0.35 mm2) was significantly smaller than the fellow eyes (2.01 +/- 0.42 mm2) (P < .001). The differences between eyes in mean cup area, rim area, rim volume, and cup shape were statistically significant (P < .05). In aniosmetropic eyes, refractive error (r = -0.406; P = .013) and visual acuity (r = 0.347; P = .035) showed significant correlations with rim area. CONCLUSION: Hyperopic anisometropia is associated with a remarkable interocular difference in optic disc size and other topographic parameters.

[Anisometropia and aniseikonia--unsolved problems of cataract surgery]. / Anisometropie und Aniseikonie--ungelöste Probleme der Kataraktchirurgie.

BACKGROUND AND PURPOSE: Aniseikonia is one of the relevant unsolved problems of modern cataract surgery and may cause severe functional problems such as deteriorated binocular vision, diplopia or headaches. The aim of the present study is to assist the clinician as to how to estimate lateral magnification in a pseudophakic eye and how to reduce or eliminate aniseikonia. METHODS: Based on the characterisation of a centred optical system in the paraxial space, the optical system eye is modelled with 2 x 2 matrices and the lateral magnification is extracted. This method is applied on the "thin lens model" as well as the "thick lens model" and illustrated in detail with 4 working examples. Additionally, we demonstrate how a predefined lateral magnification (e. g., from the contralateral eye) can be realised during cataract surgery by calculating an appropriate combination of an IOL and a spectacle correction. WORKING EXAMPLES: In example 1 the lateral magnification of the reference eye following cataract surgery is determined. In example 2 we estimate the lateral magnification behaviour that is expected after cataract surgery using the same IOL as in example 1. Example 3 gives an overview of how the magnification varies if the IOL position in the eye, the geometry of the lens or the central thickness is changed. Example 4 shows how to calculate an appropriate combination of an IOL and spectacle correction to realise an eikonic imaging of both eyes. CONCLUSION: The present study should sensitise ophthalmic surgeons for the still unsolved problem of aniseikonia after cataract surgery and should give them a simple mathematical tool to help determine object-image magnification and show how to reduce or eliminate aniseikonia during cataract surgery.

A Randomized Trial of a Binocular iPad Game Versus Part-Time Patching in Children Aged 13 to 16 Years With Amblyopia.

PURPOSE: To compare visual acuity (VA) improvement in teenagers with amblyopia treated with a binocular iPad game vs part-time patching. METHODS: One hundred participants aged 13 to <17 years (mean 14.3 years) with amblyopia (20/40 to 20/200, mean ∼20/63) resulting from strabismus, anisometropia, or both were enrolled into a randomized clinical trial. Participants were randomly assigned to treatment for 16 weeks of either a binocular iPad game prescribed for 1 hour per day (n = 40) or patching of the fellow eye prescribed for 2 hours per day (n = 60). The main outcome measure was change in amblyopic eye VA from baseline to 16 weeks. RESULTS: Mean amblyopic eye VA improved from baseline by 3.5 letters (2-sided 95% confidence interval [CI]: 1.3-5.7 letters) in the binocular group and by 6.5 letters (2-sided 95% CI: 4.4-8.5 letters) in the patching group. After adjusting for baseline VA, the difference between the binocular and patching groups was -2.7 letters (95% CI: -5.7 to 0.3 letters, P = .082) or 0.5 lines, favoring patching. In the binocular group, treatment adherence data from the iPad device indicated that only 13% of participants completed >75% of prescribed treatment. CONCLUSIONS: In teenagers aged 13 to <17 years, improvement in amblyopic eye VA with the binocular iPad game used in this study was not found to be better than patching, and was possibly worse. Nevertheless, it remains unclear whether the minimal treatment response to binocular treatment was owing to poor treatment adherence or lack of treatment effect.

Rapidly progressive idiopathic lenticular astigmatism.

A myopic 43-year-old woman with early nuclear sclerotic cataract developed more than 11.0 diopters (D) of astigmatism over a 6-month period. This was found to be lenticular in origin. Phacoemulsification with intraocular lens implantation was performed, resulting in residual astigmatism of 0.75 D. To our knowledge, this is the first case of rapidly progressive lenticular astigmatism in an otherwise healthy eye with early nuclear sclerotic cataract.

[Correction of secondary anisometropia after retinal detachment and LASIK surgery]. / Corrección de anisometropía secundaria tras cirugía de desprendimiento de retina y LASIK.

CASE REPORT: A male with cylindrical anisometropia secondary to retinal detachment (RD) surgery in the right eye (OD) was referred for contact lens (CL) fitting. His refraction was OD -1.25 -2.75 x 60 degrees VA 1.0 and OS +0.25 VA 1.2. He was complaining of diplopia with spectacles. Seven years prior to the RD surgery, he had undergone LASIK without complications. The diplopia was eliminated after a CL was fitted according to his corneal topography. DISCUSSION: RD surgery can cause anisometropic refractive changes. In patients with diplopia and asthenopia, spectacles are not well tolerated. CL fitting according to post-LASIK corneal geometry succeeded in refractive correction with less anisometropic symptoms.

[Laser in situ keratomileusis for treatment of high hyperopic anisometropia in children].

OBJECTIVE: To assess the safety, efficacy, predictability and stability of the laser in situ keratomileusis (LASIK) procedure in high hyperopic anisometropia with amblyopia in pediatric patients and to study the effect of amblyopic therapy after the surgery. METHODS: This is a prospective and self-control study which included 42 children with high hyperopic anisometropic amblyopia. The age of the children ranged from 6 to 14 years. LASIK was performed in the eyes with higher degree of hyperopic under topical or general anaesthesia using the Summit's SVS Apex plus (L mask for simple hyperopia, 9 eyes; P mask for hyperopia and astigmatism, 12 eyes) and the Lumenis's Allegretto Wave (21 eyes). Postoperative visual acuity, refraction and the binocular vision were analyzed. Minimum follow-up period was 6 months; 24 children had a 2-year follow-up. RESULTS: In eyes with +3.00 diopters (D) to +7.50 D preoperatively, the postoperative refraction in 66.6% of eyes was within +/- 1.00 D of the expected correction. From 6 to 24 months postoperatively, there was a mean variation from +0.67 to + 0.99 D in cycloplegic equivalent refraction. Best spectacle-corrected visual acuity (BSCVA) of distance and reading did not decrease after the surgery. The mean BSCVA of distance was 0.40 +/- 0.28 (P < 0.001) and reading BSCVA was 0.78 +/- 0.39 (P < 0.001) 2 years after the surgery. Simultaneous vision, fusion, stereopsis and heterophoria were improved 2 years postoperatively. CONCLUSIONS: LASIK is a safe and effective procedure for the correction of high hyperopic anisometropia in children who cannot tolerate contact lens. This procedure provides a satisfactory predictability and refractive stability results 2 years postoperatively. The effects of amblyopia therapy can be improved after the surgery.