Survey of Ophthalmology - Articles in Press

Can't Hear, Can't See, and Too Sore to Play - Corrected Proof

2010-01-18

Abstract: A 52-year-old man developed transient, migratory polyarthralgias in the presence of hearing loss. He then developed persistent leukocytosis and thrombocytosis. His initial transient, bilateral visual obscurations happened in context with bilateral disk edema and an enlarged blind spot. Visual symptoms progressed to vision loss and multiple branch retinal artery occlusions. It was not until later in the disease progression that gastrointestinal symptoms occurred. Electron microscopy of duodenal biopsies confirmed a diagnosis of Whipple disease.

Techniques of Upper Eyelid Reconstruction - Corrected Proof

Ana M.S. Morley, Jean-Louis deSousa, Dinesh Selva, Raman Malhotra — 2010-01-18

Abstract: Reconstruction of the upper eyelid is one of the greatest challenges facing the orbitofacial surgeon. This comprehensive review outlines the principles of reconstruction and the range of techniques available. Methods of assessing upper eyelid defects are discussed, and an algorithm for reconstruction based on defect size and lamellar involvement is given. The review contains numerous detailed examples of reconstructive techniques, including secondary intention healing, local flaps, distal flaps, simple and composite grafts, occlusive and non-occlusive methods, and canthal fixation. Eyebrow and eyelash reconstruction is also covered.

Drug-induced Optic Neuropathy—TB or Not TB - Corrected Proof

Monika Pradhan, Dianne Sharp, Stephen Best, Andrea Vincent, Michael Vaphiades — 2010-01-18

Abstract: Autosomal dominant optic atrophy is an inherited optic neuropathy manifesting with variable penetrance and expressivity. Other genetic and environmental factors are postulated to contribute to more marked visual loss in some affected individuals. Optic neuropathy is also a known adverse effect of ethambutol therapy for tuberculosis. This case report demonstrates an atypical presentation of ethambutol toxicity, with progressive profound loss of vision despite drug cessation. A subsequent diagnosis of autosomal dominant optic atrophy was made when the proband's sons presented with mild visual disturbances and color vision defects, confirmed with electrophysiology and OPA1 gene mutational analysis. This case emphasizes the importance of avoiding potentially neurotoxic therapy in predisposed individuals and the influence of environmental factors in patients with inherited optic neuropathies.

Orbital Involvement in Castleman Disease - Corrected Proof

2010-01-13

Abstract: Castleman disease is a quite uncommon lymphoproliferative disorder usually occurring in the lymph nodes. Rarely, Castleman disease develops in an extranodal anatomic location. We report on the first biopsy-proven case of multicentric plasma cell type of Castleman disease involving the orbital areas in a human herpes virus 8 (HHV-8)-unassociated/ human immunodeficiency virus (HIV)-seronegative 70-year-old man suffering from Parkinson disease. The diagnosis was established on the basis of morphologic, immunophenotypic, and molecular findings of a lymph node and orbital soft tissue biopsy. We additionally provide a review of all previously published cases of Castleman disease with an orbital involvement, discussing the distinctive characteristics and potential associations with regard to their counterparts at other sites. Although Castleman disease involving the orbit is an exceptionally rare occurrence that may present initially with ocular signs and symptoms, this should be included in the complete differential diagnosis of orbital mass lesion.

Blue-blocking IOLs Decrease Photoreception without Providing Significant Photoprotection - Corrected Proof

Martin A. Mainster, Patricia L. Turner — 2009-11-02

Abstract: Violet and blue light are responsible for 45% of scotopic, 67% of melanopsin, 83% of human circadian (melatonin suppression) and 94% of S-cone photoreception in pseudophakic eyes (isoilluminance source). Yellow chromophores in blue-blocking intraocular lenses (IOLs) eliminate between 43 and 57% of violet and blue light between 400 and 500 nm, depending on their dioptric power. This restriction adversely affects pseudophakic photopic luminance contrast, photopic S-cone foveal threshold, mesopic contrast acuity, scotopic short-wavelength sensitivity and circadian photoreception. Yellow IOL chromophores provide no tangible clinical benefits in exchange for the photoreception losses they cause. They fail to decrease disability glare or improve contrast sensitivity. Most epidemiological evidence shows that environmental light exposure and cataract surgery are not significant risk factors for the progression of age-related macular degeneration (AMD). Thus, the use of blue-blocking IOLs is not evidence-based medicine. Most AMD occurs in phakic adults over 60 years of age, despite crystalline lens photoprotection far greater than that of blue-blocking IOLs. Therefore, if light does play some role in the pathogenesis of AMD, then 1) senescent crystalline lenses do not prevent it, so neither can blue-blocking IOLs that offer far less photoprotection, and 2) all pseudophakes should wear sunglasses in bright environments. Pseudophakes have the freedom to remove their sunglasses for optimal photoreception whenever they choose to do so, provided that they are not encumbered permanently by yellow IOL chromophores. In essence, yellow chromophores are placebos for prevention of AMD that permanently restrict a pseudophake's dim light and circadian photoreception at ages when they are needed most. If yellow IOLs had been the standard of care, then colorless UV-blocking IOLs could be advocated now as “premium” IOLs because they offer dim light and circadian photoreception roughly 15–20 years more youthful than blue-blocking IOLs.

Blue-Blocking IOLs: A Complete Review of the Literature - Corrected Proof

Bonnie An Henderson, Kelly Jun Grimes — 2009-10-30

Abstract: Intraocular lenses (IOLs) that block both ultraviolet and blue wavelength light (<500 nm) were introduced in the 1990s. Since then, the potential benefits and harm from blocking blue light has been debated. We report the results of a complete review of all peer-reviewed published studies regarding the impact of blocking the transmission of blue light. Fifty-six published reports on subjects related to blue-blocking lenses including sleep disturbance, visual outcomes, cataract surgery, lens transmittance, sunlight exposure, and macular disease were found in peer reviewed journals from 1962 to 2009. Eleven reports specifically compared visual outcomes between blue-blocking IOLs and non-blue-locking IOLs. Of these, 10 independent studies (10/11, 91%) concluded that there are no significant effects of blue-blocking IOLs on various meters of visual performance including visual acuity, contrast sensitivity, color perception, and photopic, mesopic, and scotopic sensitivities. Only one group of authors reported that the use of blue-blocking IOLs may have detrimental effects on scotopic vision and circadian rhythms. However, the actual clinical significance of these potential negative effects on scotopic vision and on sleep patterns is uncertain. The benefits of blocking the transmission of blue light to the macula and the relationship between progression of age-related macular degeneration remain unclear. However, the published studies clearly state that the use of blue-blocking IOLs is not detrimental in visual acuity, color perception, and contrast sensitivity. The reported potential negative effects on scotopic vision and sleep disturbance appear to be minimal and may not be clinically relevant.