Optical Coherence Tomography Angiography in a Patient with Optic Atrophy After Non-arteritic Anterior Ischaemic Optic Neuropathy.

A 75-year-old female noticed a lower visual field (VF) defect in the right eye. A diagnosis of non-arteritic anterior ischaemic optic neuropathy (NAION) was made. The lower VF defect in the right eye did not change after onset. Optical coherence tomography (OCT) angiograms on the disc and the macula showed decreased retinal perfusion in the upper retina of the right eye. Retinal nerve fibre layer loss and ganglion cell complex loss in the upper retina were also seen in the right eye. OCT angiography could non-invasively detect the decrease of the retinal perfusion due to NAION.

Long-Term Outcomes of Three Cases That Underwent a Muscle Transposition Procedure Without Tenotomy Caused by Abducens Palsy.

Few reports have discussed long-term outcomes of muscle transposition procedures. In this study, cases with abducens palsy treated with a muscle transposition procedure were followed for 12, 25, or 26 years. The preoperative alignments were esotropia of 65 degrees, 47 prism dioptres (PD), and 24 PD, respectively. Orthophoria was postoperatively achieved in all cases. The postoperative alignment in one case deteriorated at 8 years postoperatively, although orthophoria were maintained in the other two cases. These findings indicate that it is possible that esotropia can recur even though orthophoria was maintained for several years postoperatively in some cases that underwent a muscle transposition procedure.

Successful Repair of a Traumatic Medial Rectus Laceration with the Aid of Computed Tomography.

A 79-year-old woman suffered ocular trauma from an umbrella. Exotropia of the left eye was observed, and the left eye could not adduct to the midline. Both edges of the lacerated medial rectus were sutured together with the aid of preoperative computed tomography (CT), which showed posterior muscle belly widening due to posterior slippage toward the equator. The alignment and ocular movement were improved postoperatively. Repairing a lacerated medial rectus is difficult because its edge slips into the muscle cone posteriorly. Preoperative CT was useful in identifying the posterior portion of the lacerated muscle, enabling successful repair.

Evaluation of clinical validity of the Rabin cone contrast test in normal phakic or pseudophakic eyes and severely dichromatic eyes.

PURPOSE: To evaluate the clinical validity of the Rabin cone contrast test (RCCT; Innova Systems, Inc.) in patients with normal phakic/pseudophakic eyes and severe dichromatic colour vision deficiency (CVD). METHODS: We evaluated age-related changes in the RCCT scores in 166 phakic eyes and 34 pseudophakic eyes and the RCCT sensitivity and specificity in 28 men with severe dichromatic CVD (10 with protanopia, 18 with deutanopia) and nine age-matched controls. All participants had 20/20 or better Snellen best-corrected visual acuity (BCVA). The RCCT was used to measure the L, M and S-CCT scores (range, 0-100). RESULTS: In normal phakic eyes, the mean L, M and S-CCT scores decreased gradually with ageing, with normal levels in patients in the second to seventh decades of life and some below normal in the eighth and ninth decades of life. In normal pseudophakic eyes, the mean L, M and S-CCT scores were normal in patients in the seventh to ninth decades of life. In eyes with severe CVD, the mean L, M and S-CCT scores were, respectively, 31.5 ± 18.3, 86.0 ± 12.6 and 98.0 ± 6.3 in patients with protanopia; 92.8 ± 10.5, 50.8 ± 19.6 and 97.8 ± 5.2 in patients with deutanopia; and 99.4 ± 1.7, 98.3 ± 5.0 and 99.4 ± 1.7 in controls. The RCCT sensitivity and specificity were 100% for diagnosing the CVD type. CONCLUSION: The RCCT can be used in non-visually impaired patients up to the seventh decade of life and after cataract surgery in elderly patients. The RCCT is available for CVD screening and typing and the score has a wide distribution range even in patients with severe CVD.

Usefulness of Intravitreal Bevacizumab for Retinopathy of Prematurity with Severely Dilated Tunica Vasculosa Lentis and Poor Mydriasis.

BACKGROUND: Laser therapy has been the gold standard treatment for retinopathy of prematurity (ROP), while intravitreal bevacizumab (IVB) is reported to be of significant benefit for zone I ROP. A problem with laser therapy is that it is difficult to administer in ROP patients with severely dilated tunica vasculosa lentis and poor mydriasis. However, although IVB treatment has been performed in such severe ROP cases, only 1 report has discussed its usefulness. CASE 1: A male infant was born with a birth weight of 382 g at 23 weeks' gestation. As visualization was poor and laser therapy could not be performed due to dilated tunica vasculosa lentis and poor mydriasis, IVB (0.625 mg/0.025 mL) was administered to both eyes. Following treatment, the ROP gradually improved, with regression of the dilated tunica vasculosa lentis and improvement of the mydriasis in both eyes. CASE 2: A male infant was born with a birth weight of 698 g at 25 weeks' gestation. As laser therapy could not be performed due to severely dilated tunica vasculosa lentis and poor mydriasis, IVB (0.625 mg/0.025 mL) was administered to both eyes. Following treatment, the ROP gradually improved, with regression of the dilated tunica vasculosa lentis and improvement of the mydriasis in both eyes. CONCLUSIONS: IVB is potentially more useful than laser therapy for the treatment of severe ROP with dilated tunica vasculosa lentis and poor mydriasis.

Optical Coherence Tomography Angiography of Retinal Perfusion in Chiasmal Compression.

BACKGROUND AND OBJECTIVE: To evaluate the retinal perfusion in patients with chiasmal compression using optical coherence tomography angiography (OCTA). PATIENTS AND METHODS: Retinal perfusion was evaluated using OCT angiograms in eight eyes of four patients with visual field (VF) defects due to chiasmal compression treated by tumor resection. The retinal perfusion in the area corresponding to the quadrants of the VF defects was investigated in each image. The vessel density was defined as the percentage area occupied by the vessels in the image. RESULTS: The decreased peripapillary retinal perfusion correlated with the quadrants of the VF defects on OCT angiograms in all patients. The binarized vessel density decreased, corresponding to the degree of VF defects in all patients. CONCLUSIONS: A decrease in peripapillary retinal perfusion correlates with the quadrants of the VF defects due to chiasmal compression. This decrease can be noninvasively measured by OCTA. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:724-729.].

A new subset of deutan colour vision defect associated with an L/M visual pigment gene array of normal order and -71C substitution in the Japanese population.

In 524 Japanese individuals with deutan colour vision defect, 76 had a normal-order pigment gene array, where the L gene is at the first position and the M gene(s) is located downstream. Of these 76 individuals, 69 had a -71A>C substitution in the M gene without any other mutation. Because the expression of L/M genes is up-regulated by thyroid hormone (T3) in human retinoblastoma WERI cells, we examined the effects of T3 on promoter activity; T3 increased the activity of the -71A promoter 2-fold, but it had no effect on the -71C promoter. Similarly, the -71C promoter was much less activated by T3 than the -71A promoter in HEK293 cells expressing thyroid hormone receptor isoform ß2. Such a weak response of the -71C promoter to T3 may cause a decrease in the number of M cones and/or the density of M pigment during the differentiation of M cones. The average Rayleigh match midpoint was 18.9 ± 4.1 in 162 ordinary deuteranomaly individuals, but was 37.3 ± 9.1 in 63 deuteranomaly individuals with -71C. The -71A>C substitution was found to be specific to eastern Asia. These results suggest that there may be a new subset of deuteranomaly associated with -71C in the Japanese (and probably eastern Asian) population(s).

Evaluation of acquired color vision deficiency in glaucoma using the Rabin cone contrast test.

PURPOSE: To evaluate acquired color vision deficiency in glaucoma by using the Rabin cone contrast test (RCCT). METHODS: Twenty-seven eyes of 27 patients with glaucoma (glaucoma group) and 27 eyes of 27 normal subjects (control group) were included in this study. Long (L), medium (M), and short (S) CCT scores (L CCTs, M CCTs, and S CCTs, respectively) were measured using the RCCT in both groups. Visual field examinations were performed with Humphrey automated perimetry using the Swedish interactive thresholding algorithm 30-2, and the mean deviation (MD) was evaluated. The macular ganglion cell/inner plexiform layer (GCIPL) thickness was measured using high-definition optical coherence tomography in the glaucoma group. RESULTS: The mean M CCTs and S CCTs in the glaucoma group were significantly lower (P<0.05 for both comparisons) than in the control group (M CCTs, 80.7±16.8 vs. 91.9±8.22; S CCTs, 83.9±19.5 vs. 97.4±3.77, respectively); the L CCTs did not differ significantly (P=0.065) from those of the controls (91.8±12.8 vs. 97.4±3.50, respectively). The M CCTs and S CCTs were correlated significantly with those of MD (M CCTs, r=0.47; S CCTs, r=0.44; P<0.05 for both comparisons) and GCIPL thickness (M CCTs, r=0.70; P<0.0001; S CCTs, r=0.57; P<0.01). CONCLUSIONS: The chromatic discrimination thresholds measured by RCCT in the glaucoma group were significantly different from those measured in the control group and were correlated with the MD and GCIPL thickness. The RCCT may be useful for evaluating acquired color vision deficiency in glaucoma and may help advance current understanding of the pathophysiology of glaucomatous damage.

Surgical results of a muscle transposition procedure for abducens palsy without tenotomy and muscle splitting.

PURPOSE: To report a simple muscle transposition procedure without tenotomy or muscle splitting to treat abducens palsy. DESIGN: Retrospective, interventional, consecutive case series. METHODS: Nine patients with esotropia resulting from abducens palsy whose eyes could not abduct beyond the midline underwent this muscle transposition procedure, in which a suture was inserted through the temporal margin of each vertical rectus muscle. The same monofilament suture also was inserted into each inferotemporal or superotemporal sclera. The lateral margin of each vertical rectus muscle was transposed superotemporally or inferotemporally and was sutured onto the sclera. All 9 patients underwent unilateral muscle transposition, and 6 of the 9 underwent a medial rectus muscle recession combined with muscle transposition in the same eye. RESULTS: The surgical correction by muscle transposition alone ranged from 24 to 36 prism diopters, and that by muscle transposition and recession of the medial rectus muscle ranged from 50 to 62 prism diopters. The mean correction was 46.3 ± 13.1 prism diopters per eye. All paretic eyes could abduct beyond the midline. No major vertical ductional disturbances developed. Anterior segment ischemia did not occur in any patients. CONCLUSIONS: This procedure, which achieved the same corrective results as other popular procedures, is simple to perform because it requires only a suture from the muscle to sclera. Tenotomy or splitting of the transposed muscles is unnecessary.

A new muscle transposition procedure to correct cyclodeviation without tenotomy.

The authors developed a new surgical procedure for use in treating pure cyclodeviation. This procedure was accomplished by a simple muscle transposition technique without tenotomy. Satisfactory postoperative results were achieved without postoperative complications. This procedure may be useful for treating cyclodeviations, with minimal risk of surgical complications, particularly anterior segment ischemia.