No abstract

This study demonstrates the difficulty of developing a guideline for screening and treatment of anisometropia. Even though there seems to be a correlation between type and degree of anisometropia in a majority of patients, there is also a significant number of cases that do not follow this pattern. Another important observation is the presence of binocular vision at the first evaluation as a good prognostic indicator for visual recovery with optical correction alone, even without penalization therapy.

Purpose: Report of a case of retinal and vitreous metastases of a systemic melanoma, possibly arising in the lung, that responded favourably to radiotherapy. Case Report: Retinal and vitreous metastases were demonstrated in a 57-year-old woman during routine follow-up after surgical resection of a melanoma presumed to be a primary pulmonary melanoma. After a 7-week observation period, which confirmed the progressive nature of the intra-ocular lesions, the patient was treated by external beam radiotherapy at a dose of 35 Gy delivered in 14 fractions of 2.5 Gy. Complete disappearance of the vitreous invasion and progressive elimination of the retinal invasion were observed over a period of 9 months. Final visual function was 20/25. Review of Published Cases: A review of the literature identified 28 cases of melanoma with metastases to the retina and vitreous. In almost all of these cases, the primary tumour was a cutaneous melanoma and the mean patient survival following the diagnosis of intra-ocular metastases was 22 months. Retinal metastases, as in the case reported here, present a vascular tropism and tend to develop around veins. These metastases are generally unilateral and may be either solitary or multiple. Tumour invasion of the vitreous occurred by means of isolated cells forming a suspension of aggregates or spherules. Vitreous haemorrhage and irreducible neovascular glaucoma leading to functional impairment, which requires enucleation, were both the most frequent and the most serious complications of these metastases. Treatment is always palliative and is effective in cases with limited retinal and vitreous invasion, as in the case reported here. Conclusions: Metastatic melanoma in the retina and vitreous is a rare entity and can lead to functional impairment and enucleation because of neovascular glaucoma. As treatment is only effective in cases with limited invasion, systematic screening is recommended in all patients with a metastatic cutaneous melanoma presenting with suggestive ocular symptoms.

Pattern electroretinogram response and contrast sensitivity were evaluated in two groups of diabetic patients by means of psychophysical and electrophysiological methods. The first group consisted of subjects suffering from diabetic retinopathy in various stages of evolution; the second was composed of diabetic patients with no fundus alterations and with good visual acuity. In both groups of patients, when the pattern electroretinogram was altered, contrast sensitivity was also abnormal.

Neuro-ophthalmological assessment, including red-free light retinography, in conjunction with simultaneous visual evoked potential (VEP) and pattern electroretinogram (PERG) recordings were performed in 10 Friedreich’s ataxia patients: 9 patients showed marked VEP abnormalities. Moderate PERG amplitude reduction, with normal latencies, was related to mild and scattered fiber loss revealed by red-free light retinography. The initial part of the visual pathways does not seem to be the main site of electrophysiological abnormalities as demonstrated by the greater extent and relative independence of VEP versus PERG alterations. Primary axonal degeneration of the optic nerve and tracts cannot account for all features of VEP abnormalities, thus implying some dysfunction in succeeding visual structures as well.