Purpose To compare the incidence and severity of all grades of dysphotopsia in three types of acrylic intraocular lenses: the Acrysof MA30 BA and MA60 BM IOLs (Alcon) and the Akreos Fit one-piece IOL (Bausch and Lomb). Methods In all 111 patients were prospectively recruited who had undergone uncomplicated cataract surgery in the previous 12 months. Patients were assessed using a combination of a questionnaire and standardised provocation test, and were scored on a grading scale of 0-6 (0 indicating no glare and 6 indicating the most severe symptoms). Results The overall incidence of dysphotopsia was 77.7%. Patients with absent or mild symptoms (scoring 2 or less on the grading scale) were greater in the group implanted with the Akreos IOLs (49/65 eyes, 75%) as opposed to (44/92 eyes, 48%) of the eyes implanted with Acrysof lenses. Patients with more marked symptoms of glare as judged by scores of 5-6 were uncommon, but more prevalent in the Acrysof lenses (12/92 eyes, 13%) compared to the Akreos lenses (3/65 eyes, 4.6%) respectively. Statistically the Mann-Whitney test showed that there was significantly less dysphotopsia with the Akreos lens when compared to the Acrysof MA30 (P ¼ 0.005) and MA60 lenses (P ¼ 0.002). Conclusion This study demonstrates that dysphotopsia symptoms are commonly seen in certain brands of Acrylic IOLs. However, differences in design (not only related to the edge) significantly reduce the incidence of moderate and severe grades of dysphotopic symptoms.

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IntroductionThe Mirena intrauterine system has been licensed as a contraceptive in the United Kingdom since May 1995. The use of an intrauterine system as a primary method of contraception among women has been slowly increasing over the last few years and they now account for about 3% of contraceptive use in England. The Mirena intrauterine system now also has a license for the management of idiopathic menorrhagia. Women may be informed that the rate of uterine perforation associated with intrauterine contraceptive use is low (0-2.3 per 1000 insertions). The rate of perforation reported with the Mirena intrauterine system in a large observational cohort study was 0.9 per 1000 insertions.Case presentationIn this case report, the diagnosis of an intraperitoneal Mirena intrauterine system was noted nearly four years after its insertion, despite the patient having had a vaginal hysterectomy and admissions to hospital in the interim with complaints of abdominal pain.ConclusionThis case report demonstrates clearly that whenever there is a question of a intrauterine system having fallen out following an ultrasound scan report showing an empty uterus, clinicians should also perform an abdominal X-ray.

The diagnosis of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) in adults can be challenging. Initially, this disease can mimic embolic cerebral infarction, multiple sclerosis, and other neurological diseases on imaging studies. CADASIL is the most common hereditary cerebral angiopathy which is inherited in an autosomal dominant fashion. There is a wide variety of clinical presentations including a migraine headache, mood disturbances, cognitive dysfunction, and recurrent subcortical cerebral infarctions. This case details the hospital course and diagnosis of a 41-year-old male who initially presented with symptoms consistent with his previous diagnosis of a hemiplegic migraine who was later found to have biopsy-positive CADASIL after the symptoms failed to remit.

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Giant cell arteritis (GCA) is the most common primary systemic vasculitis in western countries in individuals over the age of 50. It is typically characterised by the granulomatous involvement of large and medium sized blood vessels branching of the aorta with particular tendencies for involving the extracranial branches of the carotid artery. Generally the diagnosis is straightforward when characteristic symptoms such as headache, jaw claudication, or other ischemic complications are present. Atypical presentations of GCA without “overt” cranial ischemic manifestations have become increasingly recognised but we report for the first time a case of GCA presenting as mild upper abdominal pain and generalized weakness in the context of hyponatremia as the presenting manifestation of vasculitis that was subsequently diagnosed by MRI scanning. This case adds to the literature and emphasises the importance of MRI in the evaluation of GCA patients without “classic” cranial ischemic symptoms.

We report a very young man with heterozygous familial hypercholesterolemia (FH) with APOE haplotype and a significant cardiac family history who underwent cardiac catheterization for intermittent episodes of exertional dyspnea and was noted to have a severe triple vessel coronary artery disease (CAD). He underwent coronary artery bypass graft (CABG) surgery which was uneventful. He was discharged on antiplatelet, beta blocker, nitrate, and statin. On routine health maintenance evaluation, he had no cardiac complaints and had been tolerating well his activities of daily living.

BackgroundSudden onset of bilateral blindness is rare; hysteria, cortical infarction or bilateral central retinal arterial occlusion can cause this.Case presentationThe authors describe a single case of sudden onset bilateral blindness in a patient with nasopharyngeal carcinoma, which is unusual. Biopsy revealed a high-grade lymphoma. After treatment the patient made a complete visual recovery, with no evidence of visual sequelae and no clear reasons for this complete recovery.ConclusionCT and MR imaging did not demonstrate any lesions invading any part of the visual pathway or even indeed the occipital cortex. High dose steroids may have reduced the mass effect of the tumour or the blindness may have been hysterical but is unlikely.