Bilateral Cataract Extraction Research Articles

Werner Syndrome: A Case Report of Two Brothers of Pangeria

Werner syndrome is considered inherited premature ageing and genomic instability syndrome. It is an autosomal recessive disorder in which aging process is accelerated starting after puberty. It is also termed as Progeria adultorum. The hallmark features are short stature, senile facies, scleroderma like skin (dry atrophic skin, mottled darkness, telangiectasia, sclerodactyly, and gangrene), cataract, hypogonadism, contractures of skin over joint, premature atherosclerosis, loss of subcutaneous fat and ulcers over feet and leg. Treatment of painful ulcers is difficult with increased risk of malignancy (fibro sarcoma in 10% of patients). Death is usually occurring in the fourth to sixth decade due to myocardial infarction or malignancy. We reported 2 brothers of Pangeria of positive consanguinity parents the older is 40 years old, short stature, senile facies with bilateral hip joint replacement, chronic leg ulcer, bilateral cataract extraction and the younger is 35 years old, short stature, senile facies, infertile, previous cataract extraction with bone deformity. The later presented to us in outpatient clinic, Internal Medicine department, Tanta university Hospital, Egypt for preoperative assessment for cataract operation. We admit the patient to investigate him and to confirm our provisional diagnosis as regard Werner syndrome. As no definite treatment for this disorder and death usually occurs in the fourth to sixth decade, early diagnosis and follow up is beneficial and screening for malignancies and associated diseases should be performed regularly.

A clinical assessment of visual performance of combining the TECNIS® Symfony Extended Range of Vision IOL (ZXR00) with the +3.25 D TECNIS Multifocal 1-piece IOL (ZLB00) in subjects undergoing bilateral cataract extraction.

PurposeTo combine the increased depth of focus of the TECNIS® Symfony intraocular lens (IOL) with a TECNIS Multifocal (MF) low-add IOL (+3.25) to enable a patient to be less dependent on corrective lenses.SettingClinic in Canada.DesignSingle-center, prospective, open-label.Materials and methodsFifty patients were enrolled for bilateral surgery. Patients were implanted with TECNIS Symfony Extended Range of Focus lens in the dominant eye, and TECNIS low-add +3.25 MF IOL in the non-dominant eye. Patients were ≥18 years of age and had best-corrected visual acuity >20/30 in both eyes, pupil size >3.5 mm, and <1.5 D of corneal astigmatism. Patients were evaluated preoperatively, operatively, and postoperatively on Day 1, Day 7, Month 1, and Month 3. Postoperative evaluations at Month 3 were completed by 32 of 50 patients enrolled, and included distance, intermediate and near visual acuity (VA), and subjective outcomes.ResultsThree months postoperatively, binocular results without correction revealed 97% (29/30) of patients had distance VA of 20/20 or better, 97% (29/30) had intermediate VA of 20/25 or better, and 94% (28/30) had near VA of 20/25 or better. At Month 3, the majority of patients reported “none” for visual symptoms of glare (30/30, 100%), halo (29/30, 96.6%), starbursts (29/30), or other – blur (30/30, 100%).ConclusionThree months postoperatively, the combination of the increased depth of focus of the TECNIS Symfony IOL with a TECNIS MF low-add (+3.25) IOL may provide excellent uncorrected VA at near, intermediate, and far distances with minimal ocular symptoms.

Bilateral identical intervals between phacoemulsification procedures performed 23 years before retinal detachment

We aim to present a case of bilateral rhegmatogenous retinal detachment (RRD) after successful phacoemulsification procedures performed 23 years before RRD onset and surgical management. A 57-year-old female presented with blurred vision due to floaters in the left eye. The patient was followed up with dilated fundus examination. The patient underwent bilateral uneventful cataract extraction 23 years before the baseline visit with the use of phacoemulsification. Dilated fundus examination revealed RRD in the left eye that was managed with a 25G pars plana vitrectomy, cryopexy, and 16% C3F8 expandable gas. Thirty-three days following the procedure in the left eye, the patient presented with RRD in the right eye. Management included a 25G pars plana vitrectomy with cryopexy and 20% SF6 expandable gas. Phacoemulsification ultrasound energy appears to bring about changes in the peripheral vitreous and retina that may manifest several decades following uncomplicated cataract extraction.

Prenatal Ultrasonographic Diagnosis of Cataract: In Utero Manifestations of Cryptic Disease.

To report and review our experience with antenatal evaluation for fetuses diagnosed with congenital cataract. We retrospectively identified pregnancies diagnosed with fetal cataract during antenatal ultrasound. Evaluation of fetal eyes included intraocular anatomy and biometry. Data on fetal malformations, serology and fetal karyotype were collected. 8 cases, identified over the course of 10 years, were reviewed. Week 15 was the mean time for diagnosis (range 11 - 34). Extraocular anomalies were demonstrated in 6 cases (central nervous system, cardiac and renal systems). Additional intraocular abnormalities were detected in two cases: one fetus had persistent hyperplastic primary vitreous and another had bilateral retinal detachment. All cases but one involved cataracts in both eyes. The unilateral case was associated with microphthalmic aphakia. All cases had negative serology for TORCHs. 7 out of the 8 fetuses were terminated. The only one who survived developed in utero cataracts secondary to maternal steroid therapy. He underwent bilateral cataract extraction during the first weeks of life and ophthalmologic evaluation at 2 years of age was unremarkable, without any visual impairment. In most cases, fetal cataract was associated with additional abnormalities, both intra- and extra-ocular. In instances when cataracts are isolated, we suggest conducting a detailed and thorough in utero ophthalmic examination in order to improve antenatal parental counselling.

Bilateral implantation of +2.5 D multifocal intraocular lens and contralateral implantation of +2.5 D and +3.0 D multifocal intraocular lenses: Clinical outcomes

To assess the clinical visual outcomes of bilateral implantation of Restor +2.5 diopter (D) multifocal intraocular lenses (IOLs) and contralateral implantation of a Restor +2.5 D multifocal IOL in the dominant eye and Restor +3.0 D multifocal IOL in the fellow eye. Multicenter study at 8 investigative sites. Prospective randomized parallel-group patient-masked 2-arm study. This study comprised adults requiring bilateral cataract extraction followed by multifocal IOL implantation. The primary endpoint was corrected intermediate visual acuity (CIVA) at 60 cm, and the secondary endpoint was corrected near visual acuity (CNVA) at 40 cm. Both endpoints were measured 3 months after implantation with a noninferiority margin of Δ = 0.1 logMAR. In total, 103 patients completed the study (53 bilateral, 50 contralateral). At 3 months, the mean CIVA at 60 cm was 0.13 logMAR and 0.10 logMAR in the bilateral group and contralateral group, respectively (difference 0.04 logMAR), achieving noninferiority. Noninferiority was not attained for CNVA at 40 cm; mean values at 3 months for bilateral and contralateral implantation were 0.26 logMAR and 0.11 logMAR, respectively (difference 0.15 logMAR). Binocular defocus curves suggested similar performance in distance vision between the 2 groups. Treatment-emergent ocular adverse events rates were similar between the groups. Bilateral implantation of the +2.5 D multifocal IOL resulted in similar distance as contralateral implantation of the +2.5 D multifocal IOL and +3.0 D multifocal IOL for intermediate vision (60 cm), while noninferiority was not achieved for near distances (40 cm).

Wait times and volume of cataract surgery in Ontario: 2000—2012

ObjectiveTo review cataract surgery trends and wait times in Ontario. DesignRetrospective analysis of health records. MethodsOntario Health Insurance Plan billing service claims between 2000 and 2012 were analyzed for the yearly number of cataract surgeries, alone and in combination with other procedures. The number of Ontarians with cataracts was estimated by applying composite prevalence curves derived from published population data. This was then used to calculate the yearly number of procedures per 1000 Ontarians with cataracts. ResultsPer 1000 people with cataract, the rate of cataract extraction increased 18.9% overall from 2000 to 2012, increasing by 38.3% from 2000 to 2006 and decreasing by 14.6% from 2006 to 2012. Mean wait times for cataract surgery decreased by 45.8% from 2006 to 2009 and increased 28.5% from 2009 to 2013. The proportion of surgeries that were same-day bilateral cataract extraction increased 2.21-fold from 2000 to 2012 but represented only 0.82% of total cataract surgeries in 2012. In 2000, 3% of cataract surgeries were combined with other procedures, and this decreased to 1.8% in 2012. Of these combinations, the rates of combined glaucoma filtration procedures decreased by 44.3%, anterior vitrectomy decreased by 32.5%, posterior vitrectomy increased by 58.3%, and corneal transplantation decreased by 10.7% during this time period. ConclusionsThe yearly rate of cataract surgery has decreased since 2006, and wait times have increased from 2009. Same-day bilateral cataract extraction represented less than 1% of the total cataract surgical volume. Rates of cataract combined with posterior vitrectomy have increased (58%), whereas anterior vitrectomy at the time of cataract surgery decreased (33%).

Hypotony as a Hazard of Trabeculectomy with Mitomycin C

This lady was myopic with right eye manifest refraction spherical equivalent of -2.00 and left eye manifest refraction spherical equivalent of -8.00 dioptres. The left eye was amblyopic as a result of this anisometropia. This lady had had bilateral uncomplicated cataract extractions by phacoemulsification with intraocular lens implantation and subsequently bilateral neodymium yttrium aluminium garnet or Nd: YAG laser posterior capsulotomies.

Comparison between Subjective Sensations during First and Second Phacoemulsification Eye Surgeries in Patients with Bilateral Cataract.

Purpose. To evaluate and compare the subjective sensations reported by patients during first and second cataract extractions. Methods. Consecutive patients undergoing bilateral sequential cataract extraction using phacoemulsification were recruited. Following cataract surgery, patients completed questionnaires designed to evaluate subjective sensations, including anxiety, eye bulges, pain, and light sensitivity. Changes in painful sensations experienced by patients between the two surgeries were also recorded. Comparisons were also performed for each subjective sensation between different age groups (<50, 50–59, 60–69, 70–79, and >79 years). Results. A total of 127 patients were included in the final evaluation. Statistical comparison of the results showed that there were significant differences in perception of anxiety, eye bulges, and pain scores between the first and second cataract surgeries (P < 0.05). However, there was no statistically significant difference for light sensitivity scores between the two surgeries (P = 0.555). The differences in anxiety, perception of eye bulges, pain, and light sensitivity scores between both the surgeries showed no correlation with age (P > 0.05 for all). Conclusions. Our research confirms the common observation that patients with bilateral cataracts often report more ocular discomfort during the second surgery. There are, therefore, additional factors that should be considered upon treating patients with bilateral cataracts, and the provision of preoperative counseling could play an important role in providing adequate patient care.

Effect of bilateral sequential cataract extraction on intraocular pressure in non-glaucomatous Asian eyes

Background/aimsTo determine the effect of cataract extraction on intraocular pressure (IOP) of both eyes in patients undergoing sequential cataract extractions.MethodsRetrospective review of 116 consecutive treatment-naive non-glaucomatous patients who underwent sequential...

The influence of a prolonged interoperative period on binocular vision after bilateral cataract extractions.

To evaluate the influence of the extent of the interoperative period on binocular vision function in patients after consecutive bilateral cataract extractions and intraocular lens implantation. The study included patients operated due to bilateral cataract. Presence of asthenopic symptoms, distance and near squint angle, fusional amplitudes, stereopsis, and convergence were evaluated. Preoperative, interoperative, and postoperative differences in best-corrected visual acuity between eyes were also noted. Multivariate analysis was conducted in order to establish the relation between the interoperative period and binocular status. The study included 104 patients (74 female, 30 male, mean age 69.9 years, range 32-88). Mean interoperative period was 20.3 ± 12.9 months, range 1.5-47.7. Prolongation of the interoperative interval had a significant negative impact on stereopsis measured by TNO (R2 = 0.215, p = 0.001) and Randot (R2 = 0.179, p = 0.001) stereotests, as well as for near point of convergence (R2 = 0.09, p = 0.002). It was also related, but not independently, to reduction in fusional amplitudes, mainly for distance (R2 = 0.18, p = 0.001 for divergence and R2 = 0.12, p = 0.001 for convergence). Asthenopic symptoms were reported by 17 (16.3%) patients. The incidence of exophoria was significantly (p = 0.002) higher in patients with an interoperative interval longer than 24 months. The length of the interoperative period influences the status of binocular vision in patients after bilateral cataract extraction. It is also connected with an increased number of patients with asthenopic symptoms and exophoria.

More than 10 Years of Experience with Immediate Sequential Bilateral Cataract Extraction (ISBCE)—A Retrospective Study

Background: To evaluate the safety of immediate sequential bilateral cataract extraction (ISBCE) with respect to indications, visual outcomes, complications, benefits and disadvantages. Methods: This is a retrospective review of all ISBCEs performed at Kantonsspital Winterthur, Switzerland, between April 2000 and September 2013. The case notes of 500 eyes of 250 patients were reviewed. Of these 500 eyes, 472 (94.4%) had a straight forward phacoemulsification with posterior chamber intraocular lens implantation; 21 (4.2%) had a planned extracapsular cataract extraction; 4 (0.8%) had an intracapsular cataract extraction and 3 (0.6%) had a combined phacoemulsification with trabeculectomy. Results: Over 66% of eyes achieved improved visual acuity (at least 3 Snellen lines) following ISBCE. Median preoperative best corrected visual acuity (BCVA) was 0.5 LogMAR; the interquartile range was [0.4, 1] LogMAR. At one week control the median BCVA was 0.3 LogMAR, IQR [0.1, 0.5] LogMAR. At one month the median BCVA was 0.15 LogMAR, IQR [0.05, 0.3] (p < 0.01). There were no sight-threatening intraoperative or postoperative complications observed. Conclusions: ISBCE is an effective and safe option with high degree of patient satisfaction. The relative benefits of ISBCE should be balanced against the theoretically enhanced risks.

Clinical outcomes after bilateral implantation of an apodized +3.0 D toric diffractive multifocal intraocular lens

To assess visual outcomes after bilateral implantation of an apodized +3.0 diopter (D) addition power toric diffractive multifocal intraocular lens (IOL). Five study sites in Europe and South America. Cohort study. Patients had bilateral implantation of the AcrySof(®) IQ ReSTOR(®)+3.0 D toric multifocal IOL. Inclusion criteria were age from 21 to 70 years, need for bilateral cataract extraction or refractive lens exchange, and regular corneal astigmatism from 0.75 to 2.5 D. Six-month evaluations included spherical equivalent (SE), refractive and corneal cylinder, visual acuity at various distances, defocus testing, reading speed, and IOL rotation. Forty-four of 49 patients completed the 6-month visit. The mean SE (88 eyes) was 0.09 D ± 0.49 (SD) at 6 months (± 1.00 D in 95.2%). The mean refractive cylinder decreased from 1.07 ± 0.71 D to 0.33 ± 0.44 D (≤ 0.50 D in 78.6% and ≤ 1.00 D in 92.9%). The mean binocular uncorrected visual acuity was 0.04 ± 0.08 logMAR at preferred near (≈ 39 cm), 0.07 ± 0.09 logMAR at 40 cm, 0.09 ± 0.11 logMAR at 60 cm, and 0.05 ± 0.10 logMAR at 4 m. The mean corrected reading speed increased from 125.43 ± 33.58 words per minute (wpm) to 132.68 ± 23.69 wpm. The mean IOL rotation was 2.20 ± 4.34 degrees. Six months after implantation of the toric multifocal IOL, patients had significantly reduced SE and refractive cylinder, good visual acuity across distances, increased reading speed, and minimal IOL rotation.

Subjective Outcomes After Bilateral Implantation of an Apodized Diffractive +3.0 D Multifocal Toric IOL in a Prospective Clinical Study

To assess subjective outcomes after bilateral implantation of an aspheric apodized diffractive +3.0 diopter (D) multifocal toric intraocular lens (IOL). This was a prospective, single-arm, 6-month study conducted at five study sites in Europe and South America. Forty-nine patients requiring bilateral cataract extraction or refractive lens exchange and IOL implantation in both eyes with preoperative regular corneal astigmatism of 0.75 D or greater and 2.5 D or less received bilateral AcrySof ReSTOR +3.0 D toric IOLs (Models SND1T3, SND1T4, or SND1T5; Alcon Laboratories, Inc., Fort Worth, TX). Subjective questionnaires were administered preoperatively and 6 months postoperatively. Patient subjective experience with visual tasks at all distances improved from the preoperative visit to the 6-month visit. At the 6-month visit, 90% (36 of 40) of respondents reported complete freedom from corrective wear compared with 14% (6 of 43) pre-operatively. On a scale of 0 (worst) to 10 (best), the mean score that patients rated their uncorrected vision was 7.9 ± 1.9 at 6 months (n = 37) compared with 3.6 ± 2.0 at the preoperative visit (n = 38). Six months following bilateral implantation of the AcrySof ReSTOR +3.0 D toric IOL revealed improved subjective experience, increased spectacle freedom, and higher satisfaction when compared with the preoperative baseline.

Long-term outcome after bilateral cataract surgery in infants with congenital cataract

To evaluate the long-term visual outcome and complications after bilateral congenital cataract surgery performed prior to 12 months of age. A prospective case study. 31 cases (62 eyes) of bilateral congenital cataract were included.All patients received bilateral cataract extraction combined with primary capsulotomy and anterior vitrectomy simultaneously.After the operation, all patients wore aphakic glasses during the follow-up period.The unilateral and bilateral visual acuities (VA) at the last visit were determined and post-operative complications were evaluated, and the relationship between bilateral VA and the length of the follow-up period was also analyzed. The median age at surgery was 3.0 M (0.5 to 11 M) , the median follow-up period was 4.0 years (3.0 to 8.5 years). 37 out of 62 eyes (59.68%) achieved unilateral best corrected visual acuity equal or better than 0.3. 27 among 31 cases (87.1%) achieved binocular best corrected visual acuity equal or better than 0.3.Binocular best corrected visual acuity improved with the increase in the follow-up period and the patients' age (R(2) = 0.135,P = 0.0024) .Post-operative complications included strabismus (7 cases, 22.58%), nystagmus (13 cases, 41.94%), optical opacity (3 cases, 9.68%), ocular hypertension (1 cases, 3.23%). Surgery for congenital cataracts performed prior to 12 months of age is safe, and most of the subjects can achieve functional vision acuity. As these children age, the bilateral best corrected visual acuity can still keep improving.

Anaesthesia with and without dexmedetomidine for a child with multiple congenital anomalies posted for bilateral cataract extraction

Anaesthesia with and without dexmedetomidine for a child with multiple congenital anomalies posted for bilateral cataract extraction

GLOMERULAR MEMBRANOUS NEPHROPATHY AND WERNER SYNDROME: A CASE REPORT

To the Editor: Werner syndrome (WS) is a rare, autosomal-recessive, progeroid disorder. WS clinical signs include short stature; stocky trunk with slender extremities; beaked-shaped nose; premature bilateral cataracts; grayish hair and baldness; localized calcification; weak, high-pitched voice; premature atherosclerosis; and diabetes mellitus.1,2 The major causes of death in people with WS are cardio- and cerebrovascular events and neoplasm. Kidney involvement with end-stage renal disease (ESRD) has been described in two cases.3,4 Herein is presented a case of WS complicated by chronic renal failure due to idiopathic membranous glomerulonephritis (IMN). A 41-year-old woman was admitted to the nephrology department because of chronic renal failure and nephrotic syndrome. The diagnosis of WS was made clinically at the age of 28 and was genetically proven some years later. She had a medical history of premature bilateral cataract extractions, squeaky hoarse voice, sparse and gray hair on her scalp (Figure 1), hyperkeratosis, slender extremities, and scleroderma-like alterations of the skin. Her height was 144 cm, weight 37 kg, and blood pressure 160/90 mmHg. At the first examination, her blood test results showed hemoglobin 8.4 g/dL (normal range 13–17.5 g/dL), urea 76 mg/dL (normal range 20–50 mg/dL), serum creatinine 1.6 mg/dL (normal range 0.7–1.5 mg/dL) with an estimated glomerular filtration rate (e-GFR) of 27 mL/min, glucose 212 mg/dL (normal range 70–110 mg/dL), serum cholesterol 332 mg/dL (normal range 70–220 mg/dL), and serum albumin 2.8 g/L (normal range 3.5–5.5 mg/dL). Urinalysis showed 10 to 15 leukocytes and 30 to 40 red blood cells per high-power field and more than 300 mg/dL of albumin. Her 24-hour urinary protein excretion was 5.23 g. Antinuclear antibodies (ANA) and antineutrophil cytoplasm antibodies (ANCA) were negative using the immunofluorescence technique. Serology for hepatitis B surface antigen and anti-hepatitis C antibodies were negative. Serum complement (C3 and C4) levels were normal. Abdominal ultrasonography showed kidneys of normal size. (A) Photographs of the patient showing the beak-like appearance of the face and dyed sparse dry hair (arrow). (B) Light microscopy of renal biopsy, the thickened glomerular basement membrane is evident (hematoxylin-eosin stain, × 40). A renal biopsy was performed, which identified idiopathic membranous nephropathy (Figure 1B). The patient was managed conservatively: close monitoring of blood pressure, periodic renal function testing, salt restriction, diuretics, and antihypertensive medications (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and statins); corticosteroids were not prescribed. She improved over the next 12 weeks. Her proteinuria dropped to 1.5 g/24 hours, and renal function stabilized (e-GFR 30 mL/min). The correlation between WS and renal impairment has rarely been reported, and only in a few cases was ESRD reported.3,4 To the knowledge of the authors, this is the first case of WS associated with renal impairment with histology documenting overt glomerulonephritis such as IMN. It is unknown whether this coexistence is the result of the same genetic disorder or a simple coincidence. There is some evidence of a role of at least two genetic loci other than “Werner syndrome, RecQ helicase-like” helicase, including tumor necrosis factor-alpha and phospholipase A2 receptor polymorphic variants5 in both pathologies. Further clinical and genetic studies will elucidate this possible genetic correlation. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Granata A provided the clinical case and made the diagnosis. Floccari F and Gallieni M wrote the letter. Mignani R furnished medical expertise in WS (first diagnosis and clinical follow-up). Sponsor's Role: No sponsors.

Pain perception in sequential cataract surgery: Comparison of first and second procedures

To compare pain and anxiety between first and second cataract extractions under topical anesthesia with monitored anesthesia care. University ophthalmology clinic. Cohort study. Consecutive adults having bilateral sequential clear corneal cataract extraction using phacoemulsification under topical anesthesia with monitored anesthesia care were recruited. Exclusion criteria included baseline eye pain, poor comprehension, and complicated cataract extraction. Patients completed 4 short perioperative surveys with each cataract extraction as follows: the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the State-Trait Anxiety Scale (STAI) preoperatively and a 0-to-10 visual analog scale pain survey twice after surgery. Pain and difference in pain were the primary outcomes. Of the 65 patients who completed the study, 26 (40%) reported higher visual analog scale pain scores for the second cataract extraction. Overall, the median pain score was 0 (range 0 to 6) for the first cataract extraction and 1 (range 0 to 9) for the second (P = .004). By 1 day postoperatively, the pain scores were similar (median 0; range 0 to 9; P = .58). Both APAIS and STAI anxiety scores decreased between surgeries (P = .003 and P < .001, respectively). Although cataract extraction remained relatively painless under topical anesthesia with monitored anesthesia care, there was a subtle increase in pain in the second surgery relative to the first. This appears to be associated with decreased preoperative anxiety and may be related to the amnestic effects of intravenous sedation. These data may explain a common operative observation. No author has a financial or proprietary interest in any material or method mentioned.

Long-term visual acuity and initial postoperative refractive error in pediatric pseudophakia

Objective: To examine the long-term best-corrected visual acuity (BCVA) in children who, during the amblyogenic period, underwent cataract extraction with intraocular lens (IOL) implantation and to see if initial postoperative refractive error following cataract extraction correlates with long-term BCVA. Design: Retrospective chart review. Participants: Thirty-six eyes of 26 patients were included in the study. At least 2 years of follow-up, an age < 8.5 years at time of IOL implantation, an ability to participate in subjective visual acuity measurement, and an absence of congenital glaucoma and significant trauma were required for inclusion in the study. Methods: Retrospective review of pseudophakic patients' charts at a tertiary care centre, with attention to initial and long-term pseudophakic refractive error, long-term BcVa, total myopic shift, length of follow-up, age at IOL implantation, and unilateral or bilateral cataract extraction with IOL implantation. Results: Initial pseudophakic spherical equivalent (SE) showed asignificant nonlinear relationship with most recent BCVA in unilateral cases and no relationship in bilateral cases (interaction p = 0.001). Unilateral cases with initial pseudophakic SE between +1.75 D and +5.00 D showed better long-term BCVA than those with values below +1.75 D or above +5.00 D; this was irrespective of the refractive error of their fellow eye. Conclusions: In patients receiving lens implants in the first 8 years of life, we recommend aiming for low early postoperative hyperopia, taking into consideration each patient's situation and age.

Sturge-Weber syndrome: decrease in intraocular pressure after transpupillary thermotherapy for diffuse choroidal haemangioma

To report intraocular pressure (IOP) reduction after selective and partial destruction of diffuse choroidal haemangioma (DCH) by transpupillary thermotherapy (TTT) using an 810 nm infrared diode laser in two patients with Sturge-Weber syndrome (SWS) having late-onset juvenile glaucoma (LOJG). An interventional small case series. Laser spots (diameter, 1 mm) were applied to the tumour surface located outside the posterior pole. Energy level (600-1700 mW) and exposure time (1-4 seconds) were increased stepwise until the tumour exhibited a greyish discoloration. The treatment was split into 2-4 sessions. Before TTT, both patients had uncontrolled LOJG with an IOP of 23 mmHg (Case 1) and 45 mmHg (Case 2) in spite of topical medications. In both cases, TTT led to normalization of IOP to 15 mmHg and 24 mmHg, respectively, and stopped the progression of LOJG during a follow-up period of 6 years (Case 1) and 1 year (Case 2). Visual loss or other complications were not observed. Our study highlights the close link that exists between LOJG and DCH in SWS. A single treatment modality such as TTT may both reduce IOP in LOJG and help to prevent exudative retinal detachment in DCH. We believe that TTT is a good therapeutic option for SWS patients who have both DCH and LOJG.

Discoloration of nail beds and skin from minocycline

A 49-year-old man presented with “bruising” of the fingernails and facial skin. He had recalcitrant rosacea and had undergone bilateral cataract extraction, but had no other significant medical history. He had not noticed a propensity to bruise, impairment of wound healing or any excessive