Macular and peripapillary retinal nerve fibre layer thickness in adults with amblyopia.

OBJECTIVE: To evaluate macular and peripapillary retinal nerve fiber layer (RNFL) thickness in amblyopic eyes compared to the fellow eye. DESIGN: Cross-sectional study. PARTICIPANTS: 30 patients (60 eyes) older than 18 years of age with amblyopia. METHODS: Inclusion criteria included individuals older than 18 years, amblyopia, and best-corrected visual acuity (BCVA) ≤ 20/40. A complete medical history was taken and an eye examination carried out. Optical coherence tomography (OCT) was carried out on both eyes of all patients. Exclusion criteria included intraocular pressure (IOP) >23 mm Hg and eye pathology that may affect OCT measurements. The primary outcome measures were foveal thickness and average peripapillary RNFL thickness, which were compared using a paired t test. Quadrants in peripapillary scans and concentric rings in macular scans were analyzed. RESULTS: The average age was 56 years (range = 33-82 years). Visual acuity ranged from 20/40 to 20/4000 (mean = 20/275). The average peripapillary RNFL thickness was 90.6 µm (SD = 9.6 µm) in the amblyopic eye and 90.1 µm (SD = 12.1 µm) in the fellow eye (p = 0.64). The average macular thickness in amblyopic eyes was 260.1 µm (SD = 32.0 µm), and 254.7 µm (SD = 32.5 µm) in fellow eyes (p = 0.10). No statistical difference existed between peripapillary quadrants or macular concentric rings. These differences were smaller when the strabismic amblyopes were isolated. CONCLUSIONS: There does not seem to be a difference in peripapillary RNFL or macular thickness between the amblyopic eye and fellow eye.

Comparison of nonlaser nonendoscopic endonasal dacryocystorhinostomy with external dacryocystorhinostomy.

OBJECTIVE: To compare the success rate of nonlaser nonendoscopic dacryocystorhinostomy (EN-DCR) with that of externalDCR(EX-DCR). DESIGN: Retrospective chart review. PARTICIPANTS: Eighty-eight patients that underwent 102 consecutive EN-DCR or EX-DCR between November 1, 1995, and September 1, 2003. METHODS: All DCRswere performed by a single ophthalmologist. The surgical protocol remained constant, and surgical success was defined as a lack of symptoms that indicated DCR or normal canalicular irrigation. RESULTS: Eighty-eight patients were reviewed, equating to 102 cases ofDCR (56 EX-DCRand 46 EN-DCR). The average age of patients was 63.2±18.2 years old (range, 19-93 years), and the average duration of surgery was 32.1 minutes for EX-DCR and 23.3 minutes for ENDCR (p < 0.0001). Three cases of intraoperative bleed requiring nasal packing were documented in EX-DCR and 2 cases in EN-DCR. The success rates were 89.8% and 90.2% for EX-DCR and EN-DCR, respectively. There was no statistical difference between these 2 numbers. The average follow-up time was 12.8 months (median, 5 months; range, 2-97 months). CONCLUSIONS: We found that the endonasal approach to DCRs was quicker than the external approach and the success and complication rates of both methods were comparable.

Growth rates of ovarian follicles during natural menstrual cycles, oral contraception cycles, and ovarian stimulation cycles.

OBJECTIVE: To compare growth rates of ovarian follicles during natural menstrual cycles, oral contraception (OC) cycles, and ovarian stimulation cycles using standardized techniques. DESIGN: Prospective, comparative, observational, longitudinal study. SETTING: Healthy volunteers in research trials and infertility patients undergoing treatment at an academic institution. PATIENT(S): Women were evaluated during natural cycles (n = 50), OC cycles (n = 71), and ovarian stimulation cycles (n = 131). INTERVENTION(S): Serial transvaginal ultrasonography was performed to measure follicle diameter. Day-to-day growth and regression profiles of individual follicles were determined. Mean growth rates were calculated for ovulatory follicles. Mean growth and regression rates were calculated for anovulatory follicles. MAIN OUTCOME MEASURE(S): Follicle growth rate (in millimeters per day). RESULT(S): Mean follicular growth rate was greater during ovarian stimulation cycles (1.69 +/- 0.03 mm/day) compared to natural (1.42 +/- 0.05 mm/day) and OC cycles (1.36 +/- 0.08 mm/day). The interval from dominant follicle selection to ovulation was shorter during stimulation cycles (5.08 +/- 0.07 days) compared to natural cycles (7.16 +/- 0.23 days). CONCLUSION(S): Follicles grew faster during ovarian stimulation therapy compared to natural cycles or OC cycles. Greater follicular growth rates in stimulation cycles were associated with shorter intervals from selection to ovulation. The biologic effects of increased follicular growth rates and shorter intervals to ovulation on oocyte competence in women undergoing assisted reproduction remain to be determined.

Maculopathy associated with mefloquine (Lariam) therapy for malaria prophylaxis.

CASE REPORT: We report maculopathy occurring in a patient after 18 months of weekly mefloquine for malaria prophylaxis. Macular retinal pigment epithelium changes bilaterally were visually insignificant, with the patient demonstrating 20/20 corrected visual acuity bilaterally. COMMENTS: Retinal change as an adverse effect of mefloquine has not previously been reported.

Long-term refractive change after intraocular lens implantation in childhood.

BACKGROUND: To determine refractive change occurring with age in children who had cataract removal with intraocular lens implantation and in whom the immediate postoperative refraction was targeted either to match the refractive error of the opposite eye in unilateral cases, or for only a small refractive error when surgery was bilateral. METHODS: Retrospective review of the refractive error over time in 36 eyes of 25 children who underwent cataract removal (11 bilateral) with insertion of an intraocular lens from 1987 to 1998 and who had at least 4 years follow-up, but no glaucoma. RESULTS: Mean age at surgery was 5.5 years (median 5.7 y, range 1.3-12 y), with a mean follow-up of 8 years (median 6 y, range 4-16 y). The average refraction followed a logarithmic decline with age. Although eyes with unilateral surgery had a slightly faster rate of change and lower final refraction than did eyes with bilateral surgery, this difference was not statistically significant. Variation from this trend was also observed in 3 patients. When the hyperopic refractive error created immediately after surgery was small, children usually became significantly myopic when older, often creating anisometropic myopia in unilateral cases. INTERPRETATION: When implanting intraocular lenses bilaterally one should aim for a significant but balanced hyperopic correction immediately postoperatively in young patients, anticipating that there will be emmetropization with aging. Parents should be warned that variations can occur.