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Case reports The cases concern a 4 year-old boy and 25 year-old female with 20/20 visual acuity, who presented with a unilateral non-pigmented macular lesion, temporal to the fovea, a torpedo shaped defect in the retinal pigment epithelium (RPE). Optical coherence tomography showed attenuation of the RPE signal, and in the second patient there proved to be a neurosensory detachment, RPE atrophy, and thinning of the retinal layers. The lesion was hypoautofluorescent and hyperfluorescent on fluorescein angiography. Discussion Torpedo maculopathy is an asymptomatic characteristic lesion which should be considered in the differential diagnosis of macular lesions in children and young patients.

Resumen Casos clinicos Varon de 4 anos y mujer de 25 anos, con agudeza visual de 1, que presentaban una lesion macular unilateral, temporal a la fovea, hipopigmentada, en forma de torpedo. La tomografia optica de coherencia mostraba atenuacion de la senal del epitelio pigmentario (EPR), y en la mujer un desprendimiento neurosensorial, atrofia del EPR y adelgazamiento de las capas retinianas. La lesion era hipoautofluorescente e hiperfluorescente con la angiografia fluoresceinica. Discusion La maculopatia en torpedo es una lesion asintomatica caracteristica, a considerar en el diagnostico diferencial de las lesiones maculares en ninos o pacientes jovenes.

PURPOSE A guidelines for the management of retinal vein occlusion is presented. This is necessary because at this moment several therapeutic alternatives have been developed although their role is not yet sufficiently defined. METHODS Review of the literature for evidence published up to date. Relevant literature was identified and the level of evidence graded. Evidence was then assessed for consistency, applicability and clinical impact. The information was contrasted with those guides published in other countries. RESULTS Taking into account the different options of treatment that are currently used, several modes of action are suggested. The role of the various complementary examinations are discussed and it is recommended that criteria for the treatment are based on clinical, angiographic, and tomographic findings. CONCLUSIONS Although there is no overall consensus, these guidelines promote a good standard of clinical practise and provide an update of the management of retinal vein occlusion.

Purpose: A guidelines for the management of retinal vein occlusion is presented. This is necessary because at this moment several therapeutic alternatives have been developed although their role is not yet sufficiently defined. Methods: Review of the literature for evidence published up to date. Relevant literature was identified and the level of evidence graded. Evidence was then assessed for consistency, applicability and clinical impact. The information was contrasted with those guides published in other countries. Results: Taking into account the different options of treatment that are currently used, several modes of action are suggested. The role of the various complementary examinations are discussed and it is recommended that criteria for the treatment are based on clinical, angiographic, and tomographic findings. Conclusions: Although there is no overall consensus, these guidelines promote a good standard of clinical practise and provide an update of the management of retinal vein occlusion. © 2010 Published by Elsevier Espana, S.L.

Objective To compare the incidence of diplopia after topical or regional injection anesthesia in cataract surgery. Study design Retrospective, noncomparative interventional case series. Participants and methods Three thousand five hundred forty-two consecutive cataract surgeries, performed from March 1998 to December 2001, were studied. Main outcome measures Incidence and mechanisms of diplopia. Results Two thousand one hundred twenty-two patients were operated under regional and 1420 under topical anesthesia. Twenty-four cases of diplopia were observed, 21 (87.5%) in the regional group and 3 (12.5%) after topical anesthesia ( P = 0.005). Eleven cases (45.8%) were secondary to motility problems, all in the regional anesthesia group ( P = 0.006). Eight cases (33.3%) were secondary to refractive errors or intraocular lens luxation, 5 after regional and 3 after topical anesthesia ( P = 0.88). Five cases (20.8%) were secondary to fusion loss, all in the regional anesthesia group ( P = 0.06). Conclusions In our study, topical anesthesia was associated with a lower incidence of diplopia relative to regional injection anesthesia. No cases of diplopia secondary to fusion loss or muscle damage were found after topical anesthesia surgery.

Background We studied the incidence and clinical characteristics of persistent diplopia related to anaesthesia for cataract surgery in a general hospital. Methods This was a retrospective review of anaesthesia for 3587 cataract surgeries. Of all the cases of diplopia referred to the ocular motility clinic after cataract surgery, those involving anaesthesia-related diplopia lasting longer than 1 month were studied. Results During the study period, 3450 cataract surgeries were performed by phacoemulsification and 137 by extracapsular extraction. Retrobulbar block was used in 2024 cases, peribulbar block in 98, topical anaesthesia in 1420 and general anaesthesia in 43. Twenty-six cases of persistent diplopia were found (0.72% incidence), nine of which (0.25%) were considered to be related to anaesthetic factors; five of the latter involved the left eye. Five were caused by paresis of the inferior rectus muscle and three by fibrosis. In one patient, the inferior oblique muscle was affected. Anaesthesia was by retrobulbar block in eight cases (0.39%) and by peribulbar block in one. No diplopia was found in patients who had topical or general anaesthesia. Treatment was with surgery in two patients and with prisms in six. One patient continues to be studied. Conclusions Persistent diplopia can occur after cataract surgery using retrobulbar block predominantly through direct damage to the inferior rectus muscle. The overall incidence of anaesthesia-related diplopia in this series was 0.25%.