Retreatment Rate Following Supracor Treatment of Hyperopic Presbyopia

To report the retreatment rate and safety of presbyopia treatment using the corneal laser in situ keratomileusis (LASIK) procedure, Supracor. In this case series, bilateral LASIK using the Supracor algorithm was performed on consecutive hyperopic presbyopic patients. 

All patients were followed for a minimum of six months postoperatively. The principal outcome measures were re treatment rate, safety, efficacy in terms of uncorrected distance visual acuity (UDVA) and uncorrected reading ability (vocational reading test), patient satisfaction, stability and predictability. Results: 76 eyes of 38 patients were treated. 42% of patients (16 patients) that were treated required at least one re-treatment.

Myelinated Retinal Nerve Fibers in Children: OCT Imaging, Refractive Error and Vision

To characterize peripapillary retinal nerve fiber layers (RNFL’s) and macular retinal structure in children with unilateral myelinated retinal nerve fibers (MRNFs). We also investigated the correlation between MRNF abnormalities and refractive error/visual acuity. 

Twelve children (7-13 years old) with MRNFs were included. Fourier domain optical coherence tomography was used to image both the peripapillary RNFL and the macular retinal structures in 6 patients. Using the instrument’s segmentation software, global RNFL thickness and central subfield thickness(CST) of the macula were analyzed. Planimetry was used to quantify the MRNF area observed on fundus photography. Visual acuity and cycloplegic refractive errors (spherical equivalent) were also recorded. Results from the MRNF-affected eye were compared with the fellow eye.

Endophthalmitis Prevention, Diagnostic Procedures and Treatment

Endophthalmitis is a severe inflammation of the inner eye's structures, caused by an exogenous or endogenous infection with microorganisms which can multiply rapidly. It occurs most frequently after intraocular surgery. Moreover, it can also be a consequence of a penetrant eye injury or a hematogenous dissemination of microorganisms. The most common pathogens of this inflammation are bacteria, next to fungi and less frequently parasites. 

The occurrence, severity and clinical presentation of endophthalmitis depend on the way of infection, the number and virulence of pathogenic bacteria, as well as the patient's immunity state. The type of endophthalmitis can suggest the possible causative agent. Furthermore, it can help determine therapeutic approach or antibiotics to choose. The more virulent are the causative agents, the early the symptoms and signs of endophthalmitis appear. 

Epidermal Cyst of Upper Eyelid: A Case Report with Literature Review

Epidermal cysts are benign slow growing tumors resulting from proliferation of epidermal cells. Usually cysts are asymptomatic; however, they may become inflamed or secondarily infected. Epidermal cysts are solitary sub epithelial cysts, are slowly progressive and firm in consistency. They are most commonly seen on the face, scalp, neck and trunk. Epidermoid cysts are frequently seen on the upper eyelid, mainly on the conjunctiva or on the skin. This may be misdiagnosed as chalazion or sebaceous cyst. Surgical excision of the cyst in toto is the treatment of choice or else there will be recurrence, granulomatous reaction or foreign body reaction.

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Investigation of Electrolyte Changes in Bovine Vitreous at Different Postmortem Interval

Investigation of the changes in electrolyte level in the Bovine vitreous at different postmortem interval under two different temperature conditions. Ninety eight bovine right eyes from freshly slaughtered healthy cows were gotten from the government abattoir in Edo State, Nigeria. 

They were divided into two sets; forty nine right eyes were kept at 32°C while forty nine right eyes were kept at 4°C in a mobile refrigerator. The samples of vitreous were carefully aspirated from the bovine eyes within an hour of death of the animals. Measurements of the levels of cations (sodium and potassium) and anions (chloride and bicarbonate) were taken at various postmortem intervals of 2, 12, 24, 36, 48, 60 and 72 hours, using E110111 Flame Photometer.

Myelinated Retinal Nerve Fibers in Children: OCT Imaging, Refractive Error and Vision

Myelinated retinal nerve fibers (MRNFs) are developmental anomalies of the retina that appear as white to grey-white striated patches with feathery edges, often distributed around or contiguous with the optic disc and surrounding the vascular arcades. Based on a fundus photography study including 5789 patients, Kodama et al. reported that MRNFs occur in approximately 0.57% of the population, most often involving superior and inferior-temporal per papillary areas. No MRNFs were discovered in the macula, and 7.7% were bilateral.

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Ergonomic Challenges of Employees Using Computers at Work

Ergonomically designed workstations have direct bearing on the comfort and safety of office computer users. Tremendous usage of computers in most offices of emerging economies have however, not seen accompanying applications of ergonomics in the design of computer workstations despite the numerous benefits. Injuries and discomforts therefore have higher propensity to occur since most offices formally designed for paper based work now accommodate computer workstations, without corresponding redesigning.

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Concomitant Intraocular and Orbital Space-Occupied Lesions

Concomitant intraocular and orbital space-occupied lesions are relatively rare and this is the first report stressing the underlying causes of concomitant intraocular and intra orbital lesions. In this paper, we present cases showing both intra ocular and orbital soft tissue masses and highlight their clinical, pathological and imaging features. In clinical practice supplementary space-occupied disorders that might involve both intraocular and orbital tissues require consideration.

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Contact Lenses: Out with the Old/In with the New?

To answer this question: I certainly hope not, at least not always. Without a doubt over the past several years the contact lens industry has brought forth numerous new materials, designs, and modes of contact lens manufacturing. But that should not translate into a universal switch from the “old” to the “new”. I would like to share some specific instances where older lens materials and designs should still have a place in your practice.

Although without a question newer more oxygen permeable rigid gas permeable (RGP) materials have been key to the introduction of such modalities as overnight wear of Ortho keratology lenses, these materials often have some less advantageous attributes. Although we often only consider oxygen permeability (Dk) and lens wettability when selecting a RGP material, one should also consider that such materials often have lower material hardness and greater modulus.

Central Retinal Artery Occlusion with Patent Cilioretinal Artery

A 35 year old female presented with sudden painless decrease of vision in her right eye. Visual acuity in her right eye was 6/12 on distant Snellen’s acuity chart. A relative afferent pupillary defect was noted. Fundus examination in right eye showed optic disc swelling, retinal opacification and retinal edema with a perfused area of retina (Figure 1, arrowhead) at posterior pole suggestive of central retinal artery occlusion with patent cilioretinal artery.

A detailed medical history revealed that she had taken a dose of depot progesterone three months back for contraception. Complete haemogram, coagulation profile and lipid profile was normal. Carotid Doppler showed presence of a thrombus in right internal carotid artery for which she is under care of cardiologist. Central retinal artery occlusion with a patent cilioretinal artery presents with constriction of visual fields but central vision is preserved.

Addressing Keratoconus disorder using as permeable lenses

Keratoconus is a progressive corneal disorder resulting in thinning and stiffening of the central and Para central cornea. This would lead to protrusion. Although exact cause of this disorder is not known yet, genetical and environmental causes are considered responsible in causing this corneal disease. Keratoconus can be managed with spectacles and contact lenses in the early stages and it may deman surgical intervention in the advanced stage. However, corneal stability and rehabilitation can be achieved using gas permeable lenses.

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Management of Epiphora

Epiphora is a common presenting problem in ophthalmological clinical practice. There are multiple causes for epiphora. Canalicular obstruction/stenosis is common and increases with age with a female preponderance. In this first case series which used Mini Monoka stents to treat epiphora, there was a high success rate in improvement of epiphora. Further research is warranted to further validate its use into routine clinical practice.

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Surgical Management of Glaucoma in Sturge-Weber Syndrome

Sturge-Weber syndrome (SWS) or encephalo-trigeminal hemangiomatosis is a sporadic, mesodermal phakomatosis characterised by hemangiomas involving many parts of the body, particularly ocular, intracranial and facial cutaneous structures. Glaucoma is a common feature, with an incidence of 30%-71% in patients with Sturge-Weber syndrome. The aim of study was to evaluate the surgical outcomes in terms of intraocular pressure control, maintenance of visual acuity and complications of glaucoma surgeries, in eyes with Sturge-Weber syndrome and to evaluate risk factors leading to surgical failure.

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Ocular Surface Temperature and Tear Film Matrix Metalloproteinase-9 Concentration in Sjögren Syndrome Patients

Sjogren‘s syndrome (SS) is a systemic autoimmune disease characterized by polyglandular tissue destruction mainly affecting the salivar and lacrimal glands. Severe dry eye signs,including low tear volume, tear instability, inflammation of the ocular surface tissues and increased corneal staining are the main ocular manifestations of SS. Different diagnostic techniques have been developed to evaluate and diagnose dry eye syndrome; however, many of these test are invasive.

Infrared thermal images have been used in the last decades for measuring the ocular surface temperature, since its main advantage is being a non-invasive test. Another factor, which could influence the ocular surface temperature, is inflammation. o corroborate this relationship between ocular surface temperature and inflammation would be interested to measure another inflammatory molecules and ocular surface temperature in the same visit. Study was performed only in women patients with the aim to avoid any bias due to gender. Central corneal temperature in Sjögren Syndrome patients was higher than in healthy patients.

Hemolytic Uremic Syndrome Complicating Invasive Streptococcus pneumoniae Infections: Tunisian Experience

Hemolytic uremic syndrome (HUS), characterized by the triad of micro-angiopathic hemolytic anemia, thrombocytopenia, and acute renal insufficiency, is a common cause of acute renal failure in children. It usually follows an episode of gastroenteritis with enterotoxigenic Escherichia coli and is termed typical HUS. However, HUS is also a complication of invasive pneumococcal infection. Reasons for not diagnosing this condition include the absence of a specific laboratory test, the lack of consistent case definitions, unfamiliarity, a misdiagnosis of disseminated intravascular coagulation (DIC), and cases with micro-angiopathic hemolytic anemia and only mild renal injury.

The aim of our study is to describe the epidemiology, the treatment and the evolution of HUS after invasive pneumococcal infections in Tunisia. Cases were identified between 2008 and 2016. Infection with S. Pneumoniae was confirmed with culture of cerebrospinal fluid, pleural fluid, or blood. Eight children fulfilled our criteria for inclusion in the study. Primary patterns were fever, respiratory signs, neurological signs and uncommon patterns. Pneumonia was a presenting feature in 6 of 8 cases (75%), two patients had confirmed pneumococcal meningitis.

Mini Monoka Stent Insertion for the Management of Epiphora Secondary to Canalicular Obstruction or Stenosis

A retrospective study was performed selecting consecutive patients at Hobart Eye Surgeons, from Oct 2007 to Mar ’08 who had Mini Monoka stents inserted for epiphora secondary to confirmed obstruction/stenosis in either inferior or common canaliculus. 

These patients had their stents routinely removed after six weeks. There were a total of 36 eyes (31 patients) included in the study and 31 eyes (83.7%) showed subjective improvement in epiphora. One patient was lost to follow up and 5 eyes showed no improvement. In this first case series which used Mini Monoka stents to treat epiphora, there was a high success rate in improvement of epiphora. Further research is warranted to further validate its use into routine clinical practice.

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Concomitant Intraocular and Orbital Space-Occupied Lesions

Concomitant intraocular and orbital space-occupied lesions are relatively rare and this is the first report stressing the underlying causes of concomitant intraocular and intra orbital lesions. In this paper, we present cases showing both intraocular and orbital soft tissue masses and highlight their clinical, pathological and imaging features. 

Based upon the findings, the presence of a lesion involving both the orbit and eye should be included when a diagnosis of retinoblastoma, idiopathic inflammatory pseudo tumor, lymphoma, and/or Sturge- Weber syndrome is proposed.

Need for the cost-effective techniques to detect and cure open angle glaucoma in Mexico

A transversal study estimated the cost of open angle glaucoma during the first year as $1,144,611,537 USD per annum in Mexico. The study that assessed the socio-economic costs in 30 most populous places of the country suggests the need for cost-effective method that could facilitate the early detection of open angle glaucoma with visual disability.

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Photodynamic Therapy with Verteporfin, a Novel Treatment Option for Retinal Arterial Macro aneurysm

First described by Robertson in 1973. RAMs are acquired, localised dilatations of an arteriole within the radius of the 3rd branch of the retinal arterial tree. Current treatment options are controversial and of unproven benefit.

We present the case of a 76-year old gentleman with progressive vision loss from a unilateral RAM who responded favourably to treatment with PDT using Verteporfin. To the best ofour knowledge, there are no previously published reports on the use of PDT in treating RAM.

In accordance with the declaration of Helsinki, the patient provided informed consent prior to participation. We certify that all applicable institutional and governmental regulations concerning the use of human volunteers were followed during this research.

Keratoconus Management: Role of GP Contact Lenses

Keratoconus is a corneal disorder progressive characterized by thinning and steepening of the central and Para central cornea, which leads to protrusion. The exact cause of the disease remains to be fully elucidated although its etiology probably is multi factorial with a genetic predisposition to keratoconus influenced by external environmental factors (eye rubbing and atopy) with different systemic involvement. In the early stages, keratoconus can be managed with spectacles or contact lenses (CL), but when keratoconus progresses, other surgical techniques are often required.

For example, anterior lamellar (dDALK) or penetrating keratoplasty (PK) permit than 3 of 4 patients achieve best-corrected visual acuity of 20/40 or better. Intra corneal ring segment(ICRS) are proposed to increase corneal stability and decrease the astigmatism a symmetry normalizing the corneal contour with slight improvement of patients’visual acuity. Corneal collagen cross-linking (CXL) is a common technique proposed to reduce disease progression with a light improvement of visual acuity (1 to 2 Snellen lines).

Best treatment for Retinal arterial macro aneurysms (RAM)

Retinal arterial macro aneurysms (RAM) are acquired hemorrhagic or exudative focal dilations of retinal arterial branches. Treatment options that are currently available didn’t have proven benefit or high success rate. Recent studies have shown that photo dynamic therapy (PDT) is highly effective and can be used as an adjunct in the management of RAM.

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Challenges in the Management of Glaucoma in a Patient with Severe Ocular Surface Disease: A Case Report

Ocular surface disease (OSD) is a significant problem for glaucoma patients worldwide, who will require long-term topical treatment. The risk of OSD increases with age, with a reported prevalence of up to 60%. The severity and burden of OSD also increase with the number of topical anti-glaucoma medications used in treatment due to multiple, daily exposures of the ocular surface (OS) to toxic active compounds in the drug itself, other components of the formulation or preservatives. 

The presentation of OSD varies depending on its severity, but usually includes symptoms of dry eyes, allergy and distorted vision, which can be debilitating and affect quality of life. The clinical signs of the diseaseinclude tear-film instability, toxic kerato conjunctivitis, eyelid abnormalities and allergic manifestations. However, the lack of concordance between symptoms and signs often makes the diagnosis of OSD and assessment of its severity challenging.

Effect of Caffeine Intake on Retinal Microsurgical Performance

To assess the effects of prior caffeine intake on tremor control and internal limiting membrane peeling proficiency of experienced retinal surgeons using a microsurgical simulator. Experienced vitreo retinal surgeons were included. On two separate days, each subject underwent a test on a level 4 anti-tremor test and internal limiting membrane peeling test on a microsurgical simulator (Eye-Si/ Series 199, VR Magic, Software 2.9, Mannheim, Germany) first with no caffeine intake and after 40 minutes of taking an oral dose of caffeine (200 mg and 400 mg). 

Each subject underwent blood pressure and heart rate measurements before and 40 min after caffeine intake. The same technician measured both surgical performances. Mean age was 46.4 ± 10.1 years. All subjects were male. The mean anti-tremor results were: baseline scores 61.2 ± 19.15, 200 mg 61.6 ± 12.63 and 400 mg 75.4 ± 15.09. The mean internal limiting membrane peeling results were: baseline score 55.9 ± 5.46, 200 mg 54.8 ± 10.05 and 400 mg 62.6 ± 9.63. Blood pressure and heart rate remained stable. 

Contact Lenses: Out with the Old/In with the New?

To answer this question: I certainly hope not, at least not always. Without a doubt over the past several years the contact lens industry has brought forth numerous new materials, designs, and modes of contact lens manufacturing. But that should not translate into a universal switch from the “old” to the “new”. I would like to share some specific instances where older lens materials and designs should still have a place in your practice.

Although without a question newer more oxygen permeable rigid gas permeable (RGP) materials have been key to the introduction of such modalities as overnight wear of Orthokeratology lenses, these materials often have some less advantageous attributes. Although we often only consider oxygen permeability (Dk) and lens wettability when selecting a RGP material, one should also consider that such materials often have lower material hardness and greater modulus. 

Superior versus Inferior Conjunctival Autograft Using Fibrin Glue in Management of Primary Pterygium: Clinical and Histopathological Results

Pterygium is a fibrovascular growth of the conjunctiva extending across the limbus to invade the cornea at a variable distance. The exposure to ultraviolet rays is a presumed a etiology and hence it is more common in people in countries with hot cimate.

Surgical removal of the pterygium is the permenant treatment; however recurrence is the main issue. Simple excision leads to high rates of recurrence which are reported to be as high as 89%. Free conjunctival autograft which was first described by Kenyon et al. shows a low recurrence rate of 5.3%. Since then, many subsequent studies have found this surgical technique to be safe and effective in reducing the number of recurrences after pterygium surgery.

Automatic Measurement of Choroidal Thickness with Swept-Source Optical Coherence Tomography for Clinical Follow-Up in Acute Vogt-Koyanagi-Harada Disease

Vogt-Koyanagi-Harada (VKH) syndrome is a bilateral granulomatous uveitis that typically presents with distinct clinical features based on the duration and stage of the disease. The acute stage of VKH is characterized by diffuse choroiditis, multifocal areas of subretinal fluid and/or bullous serous retinal detachments, with or without neurologic (headaches, meningismus) or auditory (tinnitus, hypoacusia) symptoms. 

The convalescent stage of the disease develops 12 weeks after onset and is characterized by resolution of retinal detachments with disappearance of cells from the anterior chamber and the vitreous, with characteristic pigmentary changes in the macula and sunset glow fundus. The chronic/recurrent phase is characterized by clinical signs of disease activity in the anterior segment of the eye with anterior granulomatous uveitis and dermatologic signs (vitiligo, alopecia, poliosis).

Photodynamic Therapy with Verteporfin, a Novel Treatment Option for Retinal Arterial Macroaneurysm

First described by Robertson in 1973. RAMs are acquired, localised dilatations of an arteriole within the radius of the 3rd branch of the retinal arterial tree. Current treatment options are controversial and of unproven benefit. We present the case of a 76-year old gentleman with progressive vision loss from a unilateral RAM who responded favourably to treatment with PDT using Verteporfin. To the best of our knowledge, there are no previously published reports on the use of PDT in treating RAM. 

In accordance with the declaration of Helsinki, the patient provided informed consent prior to participation. We certify that all applicable institutional and governmental regulations concerning the use of human volunteers were followed during this research.

Aqueous Humor Outflow Structure and Function Imaging At the Bench and Bedside: A Review

Anterior segment glaucoma clinical care and research has recently gained new focus because of novel imaging modalities and the advent of angle-based surgical treatments. Traditional investigation drawn to the trabecular mesh work now emphasizes the entire conventional aqueous humor outflow (AHO) pathway from the anterior chamber to the episcleral vein. AHO investigation can be divided into structural and functional assessments using different methods. 

The historical basis for studying the anterior segment of the eye and AHO in glaucoma is discussed. Structural studies of AHO are reviewed and include traditional pathological approaches to modern tools such as multi-model two-photon microscopy and optical coherence tomography. Functional assessment focuses on visualizing AHO itself through a variety of non-real-time and real-time techniques such as aqueous angiography. Implications of distal outflow resistance and segmental AHO are discussed with an emphasis on melding bench-side research to viable clinical applications. 

Ischaemic Optic Neuropathy - Arteritic

Ischaemic optic neuropathy (ION) is the commonest adult optic nerve disorder encountered worldwide and can be expected to increase in incidence in our ageing population. The condition has been classified as a) anterior (AION) affecting the optic nerve head and b) posterior (PION) involving that portion of the optic nerve behind its immediate retrolaminar portion. Furthermore there are two pathological varieties of the disease c) Arteritic (AAION) almost exclusively associated with Giant Cell Arteritis (GCA) and d) Non arteritic (NA-AION or less correctly NAION) usually associated with diabetes, hypertension and hyper cholesterol laemia. A recent treatise on the subject runs to more than 600 pages.

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These are the proteins in humans that are associated with Cross-Linked Actin Networks in Trabecular Meshwork Cells

The majority of the aqueous humor, which is produced by the ciliary body, is drained through the conventional outflow pathway. In this pathway, the aqueous humor flows from the posterior chamber to anterior chamber and exits the eye through the trabecular mesh work(TM), a multilayered tissue in the iridocorneal angle of the eye.

In primary open angle glaucoma (POAG), glucocorticoid-induced ocular hypertension (GC-OHT), and glucocorticoid induced glaucoma (GIG), the outflow resistance at the TM is increased, which causes intraocular pressure (IOP) elevation. Elevated IOP is the major risk factor for the development and progression of glaucoma that leads to irreversible visual loss that can cause blindness. 

Can coffee intake affect the Retinal Microsurgical Performance?

Coffee is one of the most widely consumed nonalcoholic beverages in the world. Caffeine in coffee acts on central nervous system through A1 and A2 subtypes of the adenosine receptors that help in increasing alertness, vigilance and reducing fatigue. However Caffeine consumption is highly discouraged prior to Retinal Microsurgery by micro surgeons as caffeine can cause potential adverse effects.

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Aqueous Humor Outflow Structure and Function Imaging At the Bench and Bedside: A Review

Anterior segment glaucoma clinical care and research has recently gained new focus because of novel imaging modalities and the advent of angle-based surgical treatments. Traditional investigation drawn to the trabecular mesh work now emphasizes the entire conventional aqueous humor outflow (AHO) pathway from the anterior chamber to the episcleral vein. AHO investigation can be divided into structural and functional assessments using different methods. 

The historical basis for studying the anterior segment of the eye and AHO in glaucoma is discussed. Structural studies of AHO are reviewed and include traditional pathological approaches to modern tools such as multi-model two-photon microscopy and optical coherence tomography. Functional assessment focuses on visualizing AHO itself through a variety of non-real-time and real-time techniques such as aqueous angiography. Implications of distal outflow resistance and segmental AHO are discussed with an emphasis on melding bench-side research to viable clinical applications. 

Paediatric Aphakic Glaucoma: A Diagnostic and Management Challenge

Pediatric aphakic glaucoma is a potentially blinding condition, which poses significant management challenges - the patient is young and treatment must aim to preserve vision for perhaps 80 years or more of life expectancy. The purpose of this study is to highlight that early detection is important to improve the prognosis for these patients and their families. Misdiagnosis of this condition may adversely affect vision preservation. 

However, diagnosis can be difficult, especially when children may demonstrate vague symptoms such as irritability, photophobia and epiphora which themselves may further impair clinical co-operation. Despite considerable advances in techniques employed in paediatric cataract surgery, aphakic glaucoma continues to occur and remains notoriously challenging to manage. We present a case of glaucoma after cataract surgery that masqueraded as corneal infection which was challenging to diagnose and treat. Prompt recognition of pediatric aphakic glaucoma and intraocular pressure (IOP) control has resulted in a favorable clinical outcome, thus far.

Fundus Auto fluorescence and Enhanced Depth Imaging Spectral-Domain Optical Coherence Tomography in Hunter Syndrome-New Insights

Hunter syndrome or mucopolysaccharidosis type II is a rare progressive multi-systemic disorder, caused by an abnormal storage of glycosaminoglycans (GAGs) in almost every cell type, including most ocular tissues. Patients have a short life expectancy and ocular manifestations can be present early in the course of disease. To report the fund us auto fluorescence and tomographic ocular findings in Hunter syndrome. A 18-year-old male patient with Hunter syndrome with progressive nyctalopia was submitted to color fundus photography, blue fundus auto fluorescence (FAF), fluorescein angiography (FA) and spectral domain optical coherence tomography with enhanced-depth imaging (EDI-SD OCT). 

Results and discussion: Fundus examination and wide-field fluorescein angiogram revealed normal optic discs and bilateral pigmentary atrophic changes at the mid periphery with macular sparing. SD OCT revealed a retinal thinning due to external retinal atrophy affecting the photoreceptor layer beyond the parafoveal area. Although a prominent central external limiting membrane (ELM) was present, both the ellipsoid zone band and ELM could not be tracked beyond the central 2-mm and 2.5 mm diameter ring, respectively. EDI-SD OCT revealed a highly irregular choroid, especially in its outer boundary, probably due to GAG scleral deposition. Blue FAF presented a symmetric hyper auto fluorescent parafoveal ring that corresponded to the area where the ELM was present in the absence of the ellipsoid band.

Impact of Amblyopia Treatment on Vision-Related Quality Of Life

Treatment of amblyopia during childhood can have both positive and negative impacts in later life. The treatment of amblyopia could influence Vision-related Quality of Life in adults and children, particularly social relationships and emotions. For example, children with a history of occlusion were 35% to 37% more likely than children without visual defects to have suffered from verbal or physical bullying at school. Many parents associate occlusion treatment with a decrease in children’s self-confidence because of poor vision during occlusion and report greater distress and more conflict at home.

Koklanis et al. conducted a study in Australia on the psychosocial impact of amblyopia and its treatment from both the children’s (aged 3 to 15 years) and parents’ perspectives. The investigators performed a semi-structured interview with both children with amblyopia andtheir parents. In addition, parents were asked to complete a psychological inventory, the Behaviour Assessment System for Children. 

Prologue to the Special Issue: Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss among people age 50 and older. Based on the presence or absence of blood vessels, it is classified intotwo types, wet and dry. In the past decades, significant progress has been made in understanding the molecular mechanisms underlying wet AMD, and several robust therapeutic drugs were developed to block the development of new blood vessels and leakage from the abnormal vessels with favorable clinical effect.

In contrast, there are no approved treatments for dry AMD and the mechanisms are not completely known. However, it has been approved that genetics, complement dysregulation, oxidative stress, mitochondria DNA damage were involved in the mechanisms. Variety of scientific studies, including gene replacement therapy, retinal cell transplantation, pharmaceutical intervention and vitamin dietary supplementation, hold promise in developing treatment to prevent or slow the progression of the disease. In the clinical aspect, multiple clinical studies and trials have been done to further our knowledge of AMD, and on-going studies are raising hopes for improved treatments.

Balancing Patient and Practitioner Goals in Contact Lens Fitting

Patients generally are seeking three things from their contact lens wearing experience, vision, comfort, and convenience. In addition, some individuals will be looking to seek these goals with a minimum of “out of pocket” expense. As an eye care provider our goal incontact lens fitting is to provide for optimal ocular health while also establishing a vision correction modality that maximizes clear binocular vision. However, there may be situations when we need to strike a balance between what patients can and will do, as contrasted with what might otherwise seem the ideal situation.

There is a wealth of published data that clearly indicates that patients do not always replace their lenses with the frequency we would like. Sometimes this is due to negligence, but often the underlying motivation is simply cost. We need to remind ourselves that the replacement period for most contact lenses is not dictated by the FDA, but is based on recommendations made by the manufacturer. 

Bilateral Chronic Central Serous Chorioretinopathy (CSCR) Induced by Long-Term Testosterone Treatment

Purpose: We reported a rare case of bilateral chronic central serous chorioretinopathy (CSCR) induced by longterm exogenous testosterone treatment. Method: A case report. Result: A 52-year-oldman with medical history of diabetes mellitus, hypertension, diabetes insipidus and hypogonadism presented to our ophthalmologic clinic with unstable blurred vision of right eye for more than 5 years and vision loss of left eye since childhood injury. Optical coherence tomography (OCT) showed subfoveal fluid in both of his eyes. 

Fluorescein angiography (FA) revealed fluorescein in multiple leaking points around the arcade area, which appeared hyper fluorescence not only in early phase but sustained fluorescein pooling till late phase in both eyes. According to his medical records, he received intramuscular testosterone injection every two weeks as treatment of hypogonadism for more than 10 years. His serum level of testosterone was higher than normal range. After focal photocoagulation in his right eye combined with decreasing frequency of testosterone intramuscular injection, the subfoveal fluid in both of his eyes totally resolved with vision improvement. 

Focal Necrosis in Orbital Pleomorphic Adenoma

Pleomorphic adenomas (PA) are common benign tumours of the lacrimal gland. Necrosis in PA is unusual and should raise a suspicion and screen for malignancy. We hereby present a casereport of pleomorphic adenoma with necrotic foci in the orbit of a 44-year-oldlady and a review of current literature for focal necrosis in orbitalpleomorphic adenoma.

Lacrimal gland tumours are rare entities that only comprise 9% of orbital lesions. Of those 9% of cases, only 10% are pleomorphic adenomas. Pleomorphic adenomas (PA) are the most common benigntumours of the lacrimal gland, which exhibit pleomorphism of epithelialcomponents. However there are certain histological characteristics in pleomorphic adenomas, which may raise suspicion of atypia and prompt further investigation. Auclair and Ellis ET al. has noted that areas of necrosis, hyper cellularity, hyalinization, cytological atypia, capsule extension or violation may be predictors of malignancy.