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Journal: The British journal of ophthalmology


BACKGROUND/PURPOSE: Light-chain deposition disease (LCDD) is a rare condition characterised by deposition of monoclonal immunoglobulin light chains (LCs) in tissues, resulting in varying degrees of organ dysfunction. This study reports the characteristic clinical ocular findings seen in advanced LCDD upon development of ocular fundus changes. This is the first report to describe this entity in vivo in a series of patients. METHODS: A case series of ocular fundus changes in three patients with kidney biopsy-proven LCDD. All patients underwent best corrected visual acuity (BCVA) exam, perimetry, colour fundus photography and fluorescein angiography; two patients underwent indocyanine green angiography, optical coherence tomography, ultrasound and electroretinography; and one patient underwent fundus autofluorescence. RESULTS: Three patients, 53-60 years old at initial presentation, were studied. All three presented with night blindness, poor dark adaptation, metamorphopsia and visual loss. Examination revealed serous and serohaemorrhagic detachments, multiple retinal pigment epithelial (RPE) tears, diffuse RPE degeneration and progressive fibrotic changes. Neither choroidal neovascularisation nor other vascular abnormalities were present. Final best corrected visual acuity (BCVA) ranged from 20/40 to 20/300. CONCLUSIONS: Progressive LC deposition in the fundus seems to damage RPE pump function with flow disturbance between choroid and retina. This pathogenesis can explain the evolution to RPE detachments and subsequent rips and progressive retinal malfunction.

Concepts: Immune system, Fluorescein angiography, Retinitis pigmentosa, Immunoglobulin light chain, Fundus camera, Ophthalmology, Eye, Retina


Evaluation of 1-year safety profile of intravitreal ranibizumab 0.5 mg in neovascular age-related macular degeneration (NV-AMD) within routine clinical practice.

Concepts: Ranibizumab, Macular degeneration


Binocular diplopia is a debilitating visual symptom requiring immediate intervention for symptomatic control, whether or not definitive treatment is eventually possible. Where prismatic correction is infeasible, the current standard is occlusion, either by a patch or an opaque contact lens. In eliminating one problem-diplopia-occlusive techniques invariably create another: reduced peripheral vision. Crucially, this is often unnecessary, for the reduced spatial resolution in the periphery limits its contribution to the perception of diplopia. Here, we therefore introduce a novel soft contact lens device that instead creates a monocular central scotoma inversely mirroring the physiological variation in spatial acuity across the monocular visual field, thereby suppressing the diplopia with minimal impact on the periphery. We compared the device against standard eye patching in 12 normal subjects with prism-induced binocular diplopia and 12 patients with binocular diplopia of diverse causes. Indexed by self-reported scores and binocular perimetry, the scotogenic contact lens was comparably effective in eliminating the diplopia while significantly superior in acceptability and its impact on the peripheral visual field. This simple, inexpensive, non-invasive device may thus be an effective new tool in the treatment of a familiar but still troublesome clinical problem.

Concepts: Scotoma, Binocular vision, Lens, Visual field, Vision, Visual perception, Perimetry, Eye


Age-related macular degeneration (AMD) remains the most common cause of visual loss among subjects over 50 years of age in the developed world. The Irish Longitudinal study on Ageing (TILDA) is a population-based study of subjects aged 50 years or older, designed to investigate factors that influence ageing, and has enabled this investigation of the prevalence of AMD in the Republic of Ireland (ROI).

Concepts: Ageing, Republic of China, United Kingdom, Macular degeneration, United States, Republic, Republic of Ireland


Uveal melanoma represents ∼85% of all ocular melanomas and up to 50% of patients develop metastatic disease. Metastases are most frequently localised to the liver and, as few patients are candidates for potentially curative surgery, this is associated with a poor prognosis. There is currently little published evidence for the optimal management and treatment of metastatic uveal melanoma and the lack of effective therapies in this setting has led to the widespread use of systemic treatments for patients with cutaneous melanoma. Uveal and cutaneous melanomas are intrinsically different diseases and so dedicated management strategies and therapies for uveal melanoma are much needed. This review explores the biology of uveal melanoma and how this relates to ongoing trials of targeted therapies in the metastatic disease setting. In addition, we consider the options to optimise patient management and care.

Concepts: Disease, Medicine, Lung cancer, Chemotherapy, Uveal melanoma, Cancer, Metastasis, Melanoma


To assess the efficacy and safety of latanoprostene bunod (LBN) compared with latanoprost 0.005%, and to determine the optimum drug concentration(s) of LBN in reducing intraocular pressure (IOP) in subjects with open angle glaucoma or ocular hypertension.

Concepts: Latanoprost, Trabecular meshwork, Ophthalmology, Ocular hypertension, Intraocular pressure, Glaucoma


To reassess the association between near work, outdoor exposure and myopia in children through an objective approach.


To evaluate the association between consumption of coffee, tea or soft drinks, and glaucoma in the participants of the 2005-2006 National Health and Nutrition Examination Survey (NHANES).

Concepts: Antioxidant, Genetics, 1970s music groups, Coffee, Tea, Caffeine


Poppers are volatile alkyl nitrite compounds that are inhaled to enhance sexual experience and for their psychoactive effects. A less well-known side effect is foveal maculopathy, which has emerged following changes in their chemical composition. It is unclear if certain individuals are more susceptible to retinal damage or if there is a relationship between pattern of inhalation and brands used.

Concepts: Functional groups, Alkyl nitrites, Inhalant


BACKGROUND: Retinal prosthesis systems (RPS) are a novel treatment for profound vision loss in outer retinal dystrophies. Ideal prostheses would offer stable, long-term retinal stimulation and reproducible spatial resolution in a portable form appropriate for daily life. METHODS: We report a prospective, internally controlled, multicentre trial of the Argus II system. Twenty-eight subjects with light perception vision received a retinal implant. Controlled, closed-group, forced-choice letter identification, and, open-choice two-, three- and four-letter word identification tests were carried out. RESULTS: The mean±SD percentage correct letter identification for 21 subjects tested were: letters L, T, E, J, F, H, I, U, 72.3±24.6% system on and 17.7±12.9% system off; letters A, Z, Q, V, N, W, O, C, D, M, 55.0±27.4% system on and 11.8%±10.7% system off, and letters K, R, G, X, B, Y, S, P, 51.7±28.9% system on and 15.3±7.4% system off. (p<0.001 for all groups). A subgroup of six subjects was able to consistently read letters of reduced size, the smallest measuring 0.9 cm (1.7°) at 30 cm, and four subjects correctly identify unrehearsed two-, three- and four-letter words. Average implant duration was 19.9 months. CONCLUSIONS: Multiple blind subjects fitted with the Argus II system consistently identified letters and words using the device, indicating reproducible spatial resolution. This, in combination with stable, long-term function, represents significant progress in the evolution of artificial sight.

Concepts: Four-letter word, Euphemism, Prosthetics