Purpose: To evaluate by ultrasound biomicroscopy (UBM) the exact position of a posterior chamber intraocular lens (PC IOL) implanted above a posterior capsule tear and to correlate the findings with the outcomes and complication rate.Setting. Department of Ophthalmology, Rabin Medical Center, Petah Tiqva, Israel.Methods; In a retrospective noncomparative case series, 36 patients (36 eyes) who had extracapsular cataract extraction (ECCE) complicated by capsular tear were evaluated. In all cases, a PC IOL was implanted above the remnant of the capsule without suturing. Ultrasound biomicroscopy was performed to study the exact position of the optic and haptic. The outcomes and complication rate were determined from patient examinations performed during a follow-up of 1 to 6 years.Results: Optic tilt was found in 20 of 36 patients (56%). In 17 patients (47%), both haptics were located in the sulcus. In 15 patients (42%), 1 haptic was observed in the sulcus and 1 in the bag or elsewhere. No correlation was found between the position of the optic and the location of the haptics. Minimal postoperative complications were observed, and only 1 patient required another surgery for a dislocated IOL.Conclusion: By UBM, half the patients had optic tilt and more than half the IOLs were not implanted in the sulcus, the intended location.

Editor,—Juvenile xanthogranuloma (JXG) is a rare disorder of infants and very young children affecting the ocular structures, particularly the iris. It is characterised by spontaneous hyphaema associated with a yellowish, poorly demarcated iris tumour and increased intraocular pressure; the aetiology is unknown.1 The ocular lesions are usually unilateral and should be differentiated from amelanotic melanoma, iris leiomyoma, haemangioma, and other iris lesions.2-4 Early diagnosis and treatment determine the final visual outcome. The aim of the present study was to describe the use of ultrasound biomicroscopy (UBM) to define precisely the location of the tumour before excision and to correlate the UBM findings with the histopathological pattern. ### CASE REPORT A 2 year old girl was evaluated for an iris lesion. Past medical history showed two events of febrile convulsions at 1 year of age. Computed …

Objective: To evaluate the displacement of retinal blood vessels during the natural course of epiretinal membrane (ERM) formation.Design: Consecutive observational case series.Participants: Thirteen patients (13 eyes) diagnosed with unilateral idiopathic ERM and 10 normal fellow eyes of the same patients served as a control group and constituted the study group.Testing: All eyes underwent digital red-free filter photography of the fundus using the Topcon Imagenet-1024 System. Photographs were taken on entry to the study and again after 8 to 13 months. Distances were measured between the major and minor blood vessel junctions at the upper and lower temporal arcades and between the disc margin and vessel junctions temporal to the macula on follow-up examinations. To clearly visualize vessel shift, both photographs of each patient were overlaid using the peripheral landmarks of major blood vessel crossings as reference points.Main Outcome Measures: The parameters measured were shifting of blood vessels caused by the ERM formation. The distances were measured in micrometers using the measurement feature of the Topcon Imagenet System.Results: Blood vessel shift (range, 30 mu m-434 mu m) was noted in all 13 eyes, but in 15 measurements the shift was less than 30 mu m and was considered as no shift. In four eyes (31%), the distances decreased in all directions, indicating contraction of the ERM. In four eyes (31%), the distances increased in all directions, indicating release of the ERMs. A mixed pattern of release and contraction of the ERM in the same eye was noted in five eyes (38%). No shift of blood vessels was noted in the control eyes. Findings on image overlay corresponded with the objective measurements.Conclusions: Noninvasive digital red-free photography is an informative tool for the objective measurement of the vessel displacement during ERM formation. Contraction and release of the ERM were noted.

PURPOSE: To describe the role of ultrasound biomicroscopy in the detection and localization of foreign bodies in anterior ocular segment foreign body after trauma.METHODS: In a prospective study, ultrasound biomicroscopy was performed in five eyes of five consecutive patients with suspected anterior ocular segment foreign body.RESULTS: In all five eyes, ultrasound biomicroscopy detected and precisely localized small foreign bodies (metallic in two eyes, stone in one eye, plastic in one eye, and ceramic in one eye) in the cornea (one eye), superficial sclera (one eye), and anterior ocular segment (three eyes). Operative procedures to remove the intraocular foreign bodies (three cases) were guided by the ultrasound biomicroscopy information.CONCLUSIONS: Ultrasound biomicroscopy is a noninvasive method for detecting anterior segment intraocular foreign bodies after perforating trauma. It can be used to accurately diagnose foreign bodies and assist in surgical management, particularly when direct visualization is obscured because of the trauma. In eyes with partial-thickness corneoscleral lacerations or sealed full-thickness corneoscleral laceration and suspected anterior ocular segment foreign body, ultrasound biomicroscopy is a safe and effective method for detecting and localizing foreign bodies in the anterior ocular segment. (Am J Ophthalmol 1998; 126:197-202. (C) 1998 by Elsevier Science Inc. All rights reserved.).

Objective: Pseudotumor cerebri (PTC) in children has a wide spectrum of clinical presentations, from headache, which may be posterior and associated with nausea, vomiting or diplopia, to nonspecific headache, which may not be posterior and related or unrelated to other symptoms. In children with nonspecific headache, supportive evidence for diagnosis may be required before invasive procedures such as lumbar punctures are performed. Ultrasonography of the optic nerves (USON) is a noninvasive examination that can provide information about optic nerve changes, including those resulting from increased intracranial pressure. The applicability of USON in the diagnosis and follow-up of PTC was examined.Study design: Seventeen children were referred to our service because of a clinical suspicion of PTC, suggested by the presence of swollen optic nerve discs and/or headache, without clinical evidence of another cause. All had normal brain computed tomography and/or magnetic resonance imaging results before referral. Each child was examined with USON while in the supine position and with a 30-degree head tilt and underwent a lumbar puncture. USON was repeated on follow-up evaluation.Results: The diagnosis of PTC was confirmed by lumbar puncture in 10 children and ruled out in 6 children. Overall, the USON results correlated with an increased opening pressure on lumbar puncture in 11 children. Conclusion:We noted an excellent correlation between the clinical results and the USON findings in PTC, and in many cases repeated lumbar punctures could be avoided. USON is more easily applied than a lumbar puncture, without the accompanying risks. It may be used as an indicator of increased intracranial pressure, as well aas a follow-up tool. However, further studies are required before the accuracy of USON can be fully established.

A 2-month-old female infant with intractable congenital glaucoma and diffuse corneal opacification underwent trabeculectomy with 5-fluorouracil (5-FU) injection in both eyes followed by penetrating keratoplasty (PKP) combined with partial cyclocryotherapy in the right eye. The latter procedure was undertaken despite the B-scan ultrasonographic finding of extensive optic disc cupping in order to provide the infant with some degree of improved visual function. The anatomic and functional results are discussed.

Two months after cataract surgery, subconjuctival would gaping developed in our patients as a result of trauma and was resutured. Subsequently, corneal edema and a retrocorneal membrane were noticed. During penetrating keratoplasty, a thick fibrous membrane was found growing from the posterior corneal surface into the anterior and posterior chambers. Histopathologic studies revealed fibrous down-growth from the corneal stroma through a gap in Descemet's layer, forming a retrocorneal membrane.

The records of 103 patients hospitalized for acute pulmonary edema were reviewed to determine the relationship between short-term outcome and time of presentation to the emergency department. Although only 17% of the patients arrived in the emergency department during the early afternoon hours, half of the deaths in the study occurred in this group. Patients presenting between noon and four PM had a significantly higher incidence of acute myocardial infarction (76% v. 28%, p=0.03) and death (47% v. 9% p=0.03) compared with patients presenting at other times. Differences in the pathophysiology of daytime versus nocturnal acute pulmonary edema may account for some of the variation in outcome.