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  Access statistics : Table of Contents
   2013| October  | Volume 61 | Issue 10  
    Online since November 7, 2013

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Beyond photography: Evaluation of the consumer digital camera to identify strabismus and anisometropia by analyzing the Bruckner's reflex
Sadat A. O. Bani, Abadan K Amitava, Richa Sharma, Alam Danish
October 2013, 61(10):608-611
DOI:10.4103/0301-4738.121092  PMID:24212318
Amblyopia screening is often either costly or laborious. We evaluated the Canon Powershot TX1 (CPTX1) digital camera as an efficient screener for amblyogenic risk factors (ARF). We included 138 subjects: 84-amblyopes and 54-normal. With the red-eye-reduction feature off, we obtained Bruckner reflex photographs of different sized crescents which suggested anisometropia, while asymmetrical brightness indicated strabismus; symmetry implied normalcy. Eight sets of randomly arranged 138 photographs were made. After training, 8 personnel, marked each as normal or abnormal. Of the 84 amblyopes, 42 were strabismus alone (SA), 36 had anisometropia alone (AA) while six were mixed amblyopes (MA). Overall mean sensitivity for amblyopes was 0.86 (95% CI: 0.83-0.89) and specificity 0.85 (95% CI: 0.77-0.93). Sub-group analyses on SA, AA and MA returned sensitivities of 0.86, 0.89 and 0.69, while specificities were 0.85 for all three. Overall Cohen's Kappa was 0.66 (95% CI: 0.62-0.71). The CPTX1 appears to be a feasible option to screen for ARF, although results need to be validated on appropriate age groups.
  5,271 256 1
A new Gujarati language logMAR visual acuity chart: Development and validation
Ananth Sailoganathan, John Siderov, Ebi Osuobeni
October 2013, 61(10):557-561
DOI:10.4103/0301-4738.121069  PMID:24212306
Aims: Gujarati is the main spoken language of a large proportion of the population of India. The aim of this study was to develop and validate a new Minimum Angle of Resolution (logMAR) visual acuity chart in the Gujarati language. Materials and Methods: A new Gujarati visual acuity chart was designed to logMAR specifications using Gujarati optotypes experimentally selected to have similar relative letter legibility under spherical and cylindrical defocus. The chart validation study was carried out using 153 adult subjects in a large clinical setting in India. Subjects who were literate in English and Gujarati participated in the study. Visual acuity was measured with the new Gujarati logMAR chart and a modified Early Treatment of Diabetic Retinopathy Study-(m-ETDRS) logMAR chart. The method of presentation was randomized between the charts. Repeat visual acuity was measured on a subsequent day with a second version of the Gujarati logMAR chart. Results: The Gujarati chart correlated highly with the m-ETDRS logMAR chart (r2 = 0.974). The mean visual acuity difference (Gujarati - m-ETDRS logMAR) was equal to three letters (-0.06 logMAR). The Gujarati logMAR chart also proved to be highly repeatable (r2 = 0.994, test-retest) with 95% CI of ± 0.04 logMAR. Conclusions: The new Gujarati logMAR visual acuity chart provides a valid and repeatable tool for the measurement of visual acuity in native Gujarati language speakers.
  5,243 283 -
Congenital combined eyelid imbrication and floppy eyelid syndrome: Case report and review of literature
Shivcharan Lal Chandravanshi, Mahesh Kumar Rathore, Eva Rani Tirkey
October 2013, 61(10):593-596
DOI:10.4103/0301-4738.121086  PMID:24212313
Congenital eyelid imbrication syndrome (CEIS) is an extremely rare, benign, transient, self-limiting eyelid malposition disorder. The classic triad of signs in patients with a CEIS consists of bilateral upper eyelids overriding the lower eyelids when child was in sleep, bilateral medial and lateral canthal tendon laxity and tarsal conjunctival hyperemia. We report a third case of congenital combined eyelid imbrication and floppy eyelid syndrome in healthy neonate that was resolved within a week with conservative treatment.
  4,875 226 -
Ocular trauma, an evolving sub specialty
Sundaram Natarajan
October 2013, 61(10):539-540
DOI:10.4103/0301-4738.121063  PMID:24212302
  4,176 613 -
Isolated abducens nerve palsy with hyperhomocysteinemia: Association and outcomes
Virender Sachdeva, Vaibhev Mittal, Avinash Pathengay, Ramesh Kekunnaya, Amit Gupta, Bhoompally V Rao
October 2013, 61(10):598-600
DOI:10.4103/0301-4738.121089  PMID:24212315
Ischemic abducens nerve palsy usually presents as isolated cranial nerve palsy in the middle aged and elderly patients with known risk factors such as diabetes mellitus, hypertension, dyslipidemia, carotid artery disease, etc., In this report, we describe four patients with isolated abducens nerve palsy who presented with an acute onset diplopia whose detailed history and examination were suggestive of an ischemic etiology. Detailed systemic and laboratory evaluation revealed hyperhomocysteinemia as the only potential risk factor. To the best of our knowledge this is the first report of association of hyperhomocysteinemia and isolated abducens nerve palsy.
  4,406 190 -
Infectious scleritis: Clinical spectrum and management outcomes in India
Zia Sultan Pradhan, Pushpa Jacob
October 2013, 61(10):590-593
DOI:10.4103/0301-4738.121085  PMID:24212312
In this retrospective case series, we studied the predisposing factors, causative organisms, clinical spectrum, and outcomes of 12 cases of culture-proven infectious scleritis. Nine of 12 patients had a history of preceding trauma (surgical or accidental). Past surgical history included small-incision cataract surgery (4), pterygium surgery (1), and trabeculectomy (1). Six patients had multifocal scleral abscesses due to Pseudomonas, Klebsiella, or Nocardia. Only 2 patients retained useful vision (>6/18). A poor visual acuity at presentation usually resulted in a worse visual outcome (P = 0.005). Four eyes developed phthisis. The addition of surgical intervention did not result in a significantly better visual outcome than medical management alone (P = 0.209), but resulted in a higher globe preservation rate (P = 0.045). Therefore, we concluded that infection must be ruled out in cases of scleritis with preceding history of trauma, and aggressive surgical intervention improves the anatomical outcome but does not change the visual outcome.
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Pre-operative variables affecting final vision outcome with a critical review of ocular trauma classification for posterior open globe (zone III) injury
Rupesh Agrawal, Sue Wei Ho, Stephen Teoh
October 2013, 61(10):541-545
DOI:10.4103/0301-4738.121066  PMID:24212303
Purpose: To identify pre-operative variables affecting the outcome of posterior open globe (zone III) injuries. Secondary objective was to re-look at the definition or landmarks for zone III injury and its clinical significance for predicting visual prognosis following open globe injury. Materials and Methods: Retrospective review of medical records of all hospitalized patients with surgical repair of open globe injury over last 10 years at a tertiary referral eye care center in Singapore. Out of 172 eyes with open globe injury, 28 eyes (16.3%) with zone III injury was identified and reviewed further. Pre-operative visual acuity (VA) and other variables, extent of scleral wound in reference to rectus insertion, relative afferent pupillary defect (RAPD) and final vision outcome were recorded. Results: Median age was 37 years with male predilection (92.9%). Mean follow-up was 12.9 months. Pre-operative VA was no light perception (NLP) in 16 (57.1%) eyes. Final VA remained NLP in 14 eyes (50.0%). The factors contributing to poor post-operative vision based on univariate regression analysis were the presence of RAPD, poor pre-operative VA, blunt trauma, extent of trauma, associated traumatic cataract, hyphema, vitreous loss and associated vitreo-retinal trauma. Further on, zone III injuries with scleral wound limited anterior to rectus insertion (6 eyes) had better vision outcome than those with injuries extending beyond rectus insertion (22 eyes). Conclusion: Initial VA, blunt ocular trauma, visual axis involvement, loss of light perception, presence of RAPD, traumatic cataract, hyphema, vitreous loss were the important determinants for final visual outcome in patients with zone III injury. Wound extending posterior to rectus insertion has poorer outcome as those limited anterior to rectus insertion. We suggest that there may be a need to relook at zone III injuries with reference to rectus insertion for prognostic significance, and further studies are warranted.
  3,176 489 -
Long-term change in central corneal thickness from a glaucoma perspective
Nikhil S Choudhari, Ronnie George, Ramesh Ve Sathyamangalam, Prema Raju, Rashima Asokan, Lokapavani Velumuri, Lingam Vijaya
October 2013, 61(10):580-584
DOI:10.4103/0301-4738.119338  PMID:24145562
Aim: To investigate the longitudinal change in central corneal thickness (CCT) over 3 years in patients with glaucoma. Materials and Methods: The Chennai Glaucoma Follow-up Study, an offshoot of the Chennai Glaucoma Study, was designed to evaluate the progression of glaucoma. A cohort of participants in the Chennai Glaucoma Study that were suffering from glaucoma or were at a higher risk for glaucoma underwent comprehensive ophthalmic evaluation at the base hospital at 6-month intervals during the years 2004 to 2007. The CCT (average of 10 readings) was measured between 11 am and 1 pm on any given day using an ultrasonic pachymeter. Patients with a history of ocular surgery, corneal disease and usage of topical carbonic anhydrase inhibitor were excluded. No patient was a contact lens wearer. Results: One hundred and ninety-six patients (84 male, 112 female) met the inclusion criteria. We analyzed data from the right eye. The mean age of the patients was 59.97 ± 9.06 years. Fifty-nine (30.1%) of the patients were diabetic. The mean change in CCT (CCT at first patient visit - CCT at last patient visit) was 3.46 ± 7.63 μm. The mean change in CCT was 0.75 μm per year (R 2 = 0.00). Age, gender, intraocular pressure at the first patient visit and diabetic status had no significant influence on the magnitude of change in CCT. Conclusion: A carefully obtained CCT reading by a trained examiner need not be repeated for at least 3 years as long as the ocular and systemic factors known to affect the measurement of CCT are constant.
  3,143 262 -
Human intraretinal myelination: Axon diameters and axon/myelin thickness ratios
Thomas FitzGibbon, Zoran Nestorovski
October 2013, 61(10):567-575
DOI:10.4103/0301-4738.121075  PMID:24212308
Purpose: Human intraretinal myelination of ganglion cell axons occurs in about 1% of the population. We examined myelin thickness and axon diameter in human retinal specimens containing myelinated retinal ganglion cell axons. Materials and Methods: Two eyes containing myelinated patches were prepared for electron microscopy. Two areas were examined in one retina and five in the second retina. Measurements were compared to normal retinal and optic nerve samples and the rabbit retina, which normally contains myelinated axons. Measurements were made using a graphics tablet. Results: Mean axon diameter of myelinated axons at all locations were significantly larger than unmyelinated axons (P ≤ 0.01). Myelinated axons within the patches were significantly larger than axons within the optic nerve (P < 0.01). The relationship between axon diameter/fiber diameter (the G-ratio) seen in the retinal sites differed from that in the nerve. G-ratios were higher and myelin thickness was positively correlated to axon diameter (P < 0.01) in the retina but negatively correlated to axon diameter in the nerve (P < 0.001). Conclusion: Intraretinally myelinated axons are larger than non-myelinated axons from the same population and suggests that glial cells can induce diameter changes in retinal axons that are not normally myelinated. This effect is more dramatic on intraretinal axons compared with the normal transition zone as axons enter the optic nerve and these changes are abnormal. Whether intraretinal myelin alters axonal conduction velocity or blocks axonal conduction remains to be clarified and these issues may have different clinical outcomes.
  3,006 234 1
Surgical outcomes of inverted internal limiting membrane flap technique for large macular hole
Prabhushanker Mahalingam, Kumar Sambhav
October 2013, 61(10):601-603
DOI:10.4103/0301-4738.121090  PMID:24212316
We are presenting the initial results of inverted internal limiting membrane (ILM) flap technique for large macular hole. Five eyes of five patients with large diameter macular hole (>700 μm) were selected. All patients underwent inverted ILM flap technique for macular hole. Anatomical closure and functional success were achieved in all patients. There was no loss of best-corrected visual acuity in any of the patients. Inverted ILM flap technique in macular hole surgery seems to have a better hole closure rates, especially in large diameter macular holes. Larger case series is required to assess the efficacy and safety of this technique.
  2,751 352 1
Comparison of visual field test results obtained through Humphrey matrix frequency doubling technology perimetry versus standard automated perimetry in healthy children
Sibel Kocabeyoglu, Salih Uzun, Mehmet Cem Mocan, Banu Bozkurt, Murat Irkec, Mehmet Orhan
October 2013, 61(10):576-579
DOI:10.4103/0301-4738.119322  PMID:24145558
Aims : The aim of this study was to compare the visual field test results in healthy children obtained via the Humphrey matrix 24-2 threshold program and standard automated perimetry (SAP) using the Swedish interactive threshold algorithm (SITA)-Standard 24-2 test. Materials and Methods: This prospective study included 55 healthy children without ocular or systemic disorders who underwent both SAP and frequency doubling technology (FDT) perimetry visual field testing. Visual field test reliability indices, test duration, global indices (mean deviation [MD], and pattern standard deviation [PSD]) were compared between the 2 tests using the Wilcoxon signed-rank test and paired t-test. The performance of the Humphrey field analyzer (HFA) 24-2 SITA-standard and frequency-doubling technology Matrix 24-2 tests between genders were compared with Mann-Whitney U-test. Results: Fifty-five healthy children with a mean age of 12.2 ± 1.9 years (range from 8 years to 16 years) were included in this prospective study. The test durations of SAP and FDT were similar (5.2 ± 0.5 and 5.1 ± 0.2 min, respectively, P = 0.651). MD and the PSD values obtained via FDT Matrix were significantly higher than those obtained via SAP (P < 0.001), and fixation losses and false negative errors were significantly less with SAP (P < 0.05). A weak positive correlation between the two tests in terms of MD (r = 0.352, P = 0.008) and PSD (r = 0.329, P = 0.014) was observed. Conclusion: Children were able to complete both the visual test algorithms successfully within 6 min. However, SAP testing appears to be associated with less depression of the visual field indices of healthy children. FDT Matrix and SAP should not be used interchangeably in the follow-up of children.
  2,469 225 -
Determinants of severity at presentation among young patients with early onset glaucoma
Viney Gupta, Rajat M Srivastava, Ramanjit Sihota, Jasbir Kaur, Sandip Kumar, Digvijay Singh
October 2013, 61(10):546-551
DOI:10.4103/0301-4738.121064  PMID:24212304
Aim : The aim of this study was to evaluate the clinical, socio-economic, and demographic factors associated with the severity at presentation among juvenile primary open angle glaucoma (JOAG) patients. Materials and Methods : Age at diagnosis, family history, baseline intraocular pressure (IOP), access to health-care, socio-economic status, and glaucoma awareness among 80 unrelated JOAG patients presenting between 10 years and 40 years of age were analyzed for their association with the severity at presentation. Severity at presentation was graded based on worse eye visual field using the advanced glaucoma intervention study score and on binocular visual field defects at presentation. Results : Patients with a positive family history presented 4 years earlier (P = 0.045, confidence interval [CI]: 0.09-8.8) compared to those without a family history. Lower socio-economic status (Odds ratio [OR] 5.7, P = 0.01, CI: 1.5-22), and higher baseline IOP (OR 7, P = 0.003, CI: 1.9-26) were associated with severe glaucomatous visual field defect at presentation. A negative family history was associated with a 10 times likelihood of presenting with a severe glaucomatous field defect (OR 0.1, P = 0.007, CI: 0-0.5). Conclusions : Clinical, socio-economic, and demographic factors are contributory to the severity at presentation among young patients with early onset glaucoma. Presence of a family history is associated with an earlier presentation among these patients and a reduced risk of the severe presentation.
  2,168 371 -
Evaluation of changes in retinal nerve fiber layer thickness and visual functions in cases of optic neuritis and multiple sclerosis
Rohit Saxena, Gopal Bandyopadhyay, Digvijay Singh, Sumit Singh, Pradeep Sharma, Vimla Menon
October 2013, 61(10):562-566
DOI:10.4103/0301-4738.121071  PMID:24212307
Context: Retinal nerve fiber layer (RNFL) thinning has been demonstrated in cases of optic neuritis (ON) and multiple sclerosis (MS) in Caucasian eyes, but no definite RNFL loss pattern or association with visual functions is known in Indian eyes. Aim : To evaluate RNFL thickness in cases of ON and MS, and to correlate it with visual function changes in Indian patients. Settings and Design: Cross-sectional case-control study at a tertiary level institution . Materials and Methods: Cases consisted of patients of (i) typical ON without a recent episode (n = 30:39 ON eyes and 21 fellow eyes), (ii) MS without ON (n = 15;30 eyes) while the controls were age-matched (n = 15; 30 eyes). RNFL thickness was measured using the Stratus 3 °CT. The visual functions tested included the best-corrected visual acuity (BCVA), contrast sensitivity, stereopsis, visual evoked responses, and visual fields. Statistical analysis used: Intergroup analysis was done using ANOVA and Pearson's correlation coefficient used for associations. Results: RNFL thickness was reduced significantly in the ON and MS patients compared to the controls (P-0.001). Maximum loss is in the temporal quadrant. Lower visual function scores are associated with reduced average overall RNFL thickness. In ON group, RNFL thinning is associated with severe visual field defects while contrast sensitivity has strongest correlation with RNFL in the MS group. Conclusions:RNFL thickness is reduced in ON and MS cases in a pattern similar to Caucasians and is associated with the magnitude of impairment of other visual parameters. Contrast sensitivity and stereoacuity are useful tests to identify subclinical optic nerve involvement in multiple sclerosis.
  2,221 270 1
Optical coherence tomographic findings in optic nerve hypoplasia
Daruchi Moon, Tae Kwann Park
October 2013, 61(10):596-598
DOI:10.4103/0301-4738.121088  PMID:24212314
We investigated a case of unilateral optic nerve hypoplasia using spectral domain optical coherence tomography (SDOCT). Optical coherence tomography was done on both eyes using 5-line Raster scan for the fovea to analyze the retinal nerve fiber layer thickness, inner retinal layer thickness, outer retinal layer thickness, and optic disc cube scan for the disc. Retinal nerve fiber layer thickness, inner retinal layer thickness, and outer retinal layer thickness were manually measured at 21-points of each five lines, and results were compared between both eyes. Retinal nerve fiber layer thickness and inner retinal layer thickness of optic nerve hypoplasia were significantly thinner than the opposite eye, but there was no significant difference in the thickness of the outer retinal layer between both eyes.
  2,289 170 1
Clinical utility of 18 Fluorodeoxyglucose (FDG)-PET/CT scans in patients with suspect ocular tuberculosis
Salil Mehta
October 2013, 61(10):603-605
DOI:10.4103/0301-4738.121091  PMID:24212317
Systemic imaging of patients with suspect ocular tuberculosis include chest X-rays and computed tomography (CT) scans. Reports have suggested a role for 18 fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) scans. We report on the clinical utility of 18 FDG PET/CT in two patients. Case 1: A 38-year-old female patient presented with recurrent anterior uveitis. A 18 FDG-PET scan revealed metabolically active supraclavicular and chest lymph nodes. An aspiration cytology of the cervical lymph node revealed caseating granulomas suggestive of tuberculosis. Case 2: A 58-year-old female patient presented with recurrent anterior uveitis. A 18 FDG-PET scan revealed metabolically active lymph nodes in the neck. A biopsy of the cervical lymph node revealed epithelioid granulomas suggestive of tuberculosis. Both patients were started on standard antitubercular therapy with a subsequent marked reduction of activity. PET/CT scans may suggest the sites of safe high-yield biopsies.
  2,142 161 1
20G silicone rod as monocanalicular stent in repair of canalicular lacerations: Experience from a tertiary eye care centre
Susanta Chatterjee, Suryasnata Rath, Aravind Roy, Eliya Shrestha
October 2013, 61(10):585-586
DOI:10.4103/0301-4738.121080  PMID:24212309
To evaluate the outcome of 20G silicone rod as monocanalicular stent in canalicular lacerations. Retrospective case series involving patients between July 2006 and June 2010. Fourteen canalicular repairs in 12 consecutive patients were done in the study period. Eleven were male and mean age was 30.5 years. A single canaliculus was involved in 10 patients and associated injury to the globe was noted in 3 patients. The median lag time between injury and repair was 3 (range 1-9) days. The mean duration of stenting was 6.9 (SD 3.2) weeks. Spontaneous extrusion of monocanalicular stent occurred in 3 patients. Patency on syringing was noted in 10 (70%) canaliculi over a median follow up of 7 (range 2-17) months. 20G silicone rod may be used as an effective and economical alternative in canalicular lacration repairs.
  1,990 217 -
Pigmented paravenous chorioretinal atrophy with Coat's like response
Manish Tandon, Dhananjay Shukla, Rubina Huda, Kim Ramasamy
October 2013, 61(10):586-588
DOI:10.4103/0301-4738.121083  PMID:24212310
Pigmented paravenous chorioretinal atrophy (PPCRA) is an uncommon retinal disorder of unknown etiology that is neither well understood nor classified. We report an atypical case of PPCRA, associated with Coat's like response (CLR) in a 64-year-old man of Asian origin. Both the eyes were involved, though asymmetrically.
  1,768 153 -
The effects of renal transplantation on diabetic retinopathy: Clinical course and visual outcomes
Rupak Roy, Manmath K Das, Bikramjit P Pal, Suguneswari Ganesan, Rajiv Raman, Tarun Sharma
October 2013, 61(10):552-556
DOI:10.4103/0301-4738.121067  PMID:24212305
Purpose: To elucidate the clinical course of diabetic retinopathy (DR) after renal transplantation (RT) in a hospital based cohort. Design: Retrospective study. Materials and Methods: A total of 56 eyes of 28 patients, who had DR and end stage renal disease (ESRD) due to diabetes and had undergone RT, were included in this study. Diagnosis and management of DR was carried out according to early treatment of diabetic retinopathy study (ETDRS) guidelines. DR outcome was defined as worsening if there was >2 step increase in the grade of DR or need for intervention such as laser (macular or pan retinal) or vitreoretinal surgery, improvement for <2 step change while stabilization was defined if DR remained within these two limits. Results: The mean age of the patients were 48.9 years. The mean duration of diabetes in the study group was 12.7 years. The patients were followed-up for a mean period of 52.2 ± 43.6 months. The pre-transplant mean Best corrected visual acuity (BCVA) was 0.4876 log MAR units and post-transplant mean BCVA was 0.4858 (P = 0.05). However, there was a significant visual improvement in first 20 months of renal transplant (P = 0.03). Worsening of DR was noted in 16 (32%) eyes whereas improvement was seen in 4 (8%). However, majority of eyes 30 (60%) had stable retinopathy at the final follow-up. Conclusions: RT stabilized the retinopathy status in the majority of patients although in a minor subset the disease course was unpredictable.
  1,552 274 -
Infestation of the lacrimal sac by Rhinosporidium seeberi: A clinicopathological case report
Bipasha Mukherjee, Ashwin Mohan, V Sumathi, Jyotirmay Biswas
October 2013, 61(10):588-590
DOI:10.4103/0301-4738.121084  PMID:24212311
Rhinosporidium seeberi , till recently known as a fungus, has been reclassified as a protistan parasite. It infects humans and many animal species. The authors describe a rare case of oculosporidiosis with involvement of the lacrimal sac exhibiting features of idiopathic orbital inflammatory disease in a young male patient. Clinical features, pathophysiology, and management of lacrimal sac rhinosporidiosis have been discussed.
  1,558 180 -
Severe visual loss following waterload for transabdominal ultrasound
Harsh Kumar, Taru Dewan, Shashi Vashisht, Akhila Prasad
October 2013, 61(10):612-612
DOI:10.4103/0301-4738.121093  PMID:24212319
  1,340 138 -
Migraine is a marker for systemic disease
Natarajapillai Venugopal, MR Sriram Gopal
October 2013, 61(10):613-613
DOI:10.4103/0301-4738.121094  PMID:24212320
  1,322 154 -
Completion rates of anterior and posterior continuous curvilinear capsulorrhexis in pediatric cataract surgery for surgery performed by trainee surgeons with the use of a low-cost viscoelastic
Sumita Agarkar, Chongtham S Devi
October 2013, 61(10):614-615
DOI:10.4103/0301-4738.121097  PMID:24212322
  873 134 -
Comment on "Effect of dacryocystorhinostomy on systemic adverse effects of topical timolol maleate"
Cynthia Arunachalam
October 2013, 61(10):613-614
DOI:10.4103/0301-4738.121095  PMID:24212321
  744 122 -
Association of extensive myelinated nerve fibers and high degree myopia: Case report
Elvan Yalcın, Ozlem Balcı, Ziya Akıngol
October 2013, 61(10):606-607
DOI:10.4103/0301-4738.118455  PMID:24088642
Unilateral extensive myelination of the peripapillary nerve fibers may be associated with anisometropic myopia, strabismus, and reduced vision. Myelination of optic nerve fibers terminate at lamina cribrosa. Yet in some patients, myelination progresses into the peripapillary retinal nerve fibers and may affect the visual acuity. In this report, we described 4 patients. All patients presented extensive peripapillary myelinated nerve fibers associated with myopic anisometropia. After routine ophthalmic and orthoptic examinations, all patients underwent treatment for amblyopia through correction with spectacles, contact lenses, and the occlusion of the good eye. Corrected visual acuity improved in 1 patient, but 3 patients had no increase in visual acuity despite treatment with full cycloplegic refraction and appropriate patching. Probably because of structural abnormalies of the macula, visual results are often disappointing with appropriate correction of the refractive error and occlusion.
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