The association of atopic dermatitis (AD) with cataract formation was first reported in 1914 (1). Despite this early recognition, a unifying explanation for cataract progression in patients with AD is lacking. A cataract is an opacity of the lens which can lead to loss of vision. The general classification of cataract includes nuclear, cortical and posterior subcapsular subtypes. The atopic cataract (AC) typically begins as a posterior and ⁄ or anterior subcapsular opacity with eventual development into a fully mature cataract (2,3) (Figs. 1 and 2). They are most often bilateral and are primarily seen in adolescents and young adults. Although cataracts are known to be associated with AD, this seems to be an underappreciated phenomenon. CASE REPORTAn 18-year-old, Filipino American male, was followed for a longstanding history of asthma, allergic rhinitis, food allergy, and AD. His asthma was well controlled with inhaled corticosteroids (ICS). His AD had been present since childhood, and controlled with topical emollients, pimecrolimus 1% cream, and cetirizine. There was no other significant past medical history.At age 15 he described decreasing visual acuity. At this time an optometrist diagnosed him with an early cataract in his left eye. Over the next 12 months, his vision worsened to the extent that it was performance limiting in school and fell outside of the legal driving limits. Two years after his initial unilateral cataract diagnosis; he was diagnosed with visually significant bilateral cataracts. He denied eye pruritis, burning, discharge, redness or eyelid dermatitis. He denied any application of topical steroid medications to the face or around the eyes. He remained on a moderate dose of inhaled corticosteroid for asthma (fluticasone propionate ⁄ salmeterol diskus 250 lg ⁄ 50 lg), and a nasal corticosteroid for allergic rhinitis. Physical exam revealed postinflammatory hyperpigmentation on his face and periorbital region. The patient had diffuse xerosis over his trunk and extremities. He admitted to frequent tapping or rubbing of his face and body because of pruritis.After the development of the second cataract an extensive laboratory workup to rule out a systemic cause of progressive cataracts was unrevealing. Upon presentation to the ophthalmologist, the patient's visual acuity was 20 ⁄ 60 right eye and 20 ⁄ 100 left eye. The anterior ocular exam showed moderate hyperkeratosis of the eyelid skin, healthy bulbar conjunctiva, palpebral conjunctiva with fine papillae and corneal epithelium with only few punctuate epithelial erosions indicating mild ocular surface involvement. The changes in the left lens were denser than the right lens, both including a whitish nuclear sclerosis with posterior and anterior subcapsular changes in a rosette formation as well as wrinkling of the anterior lens capsule (Fig. 3). No lens ⁄ zonule instability

Objective: This case report presents a patient with central retinal artery occlusion (CRAO) who was successfully treated with hyperbaric oxygen (HBO 2) but subsequently suffered a recurrence of his visual loss. Methods: CRAO may be treated successfully with HBO 2 if treatment is undertaken promptly after the onset of vision loss. The goal of HBO2 therapy is to oxygenate the ischemic inner retinal layers via diffusion from the hyperoxygenated choroidal circulation until recanalization of the central retinal artery occurs. Results: A 71-year-old man presented with hand motion vision and fundus findings of CRAO in his left eye. Treatment with HBO 2 was initiated approximately 9.5 hours after loss of vision. The patient experienced return of vision to a near-normal level during HBO 2. His vision loss recurred, however, 15 minutes after the HBO 2 session. There was a delay to follow-up HBO 2 treatments, and the improvement of vision that resulted from these subsequent HBO 2 sessions was much less than that experienced during his initial HBO 2 treatment. Conclusions: Recovery of vision during initial HBO 2 treatment indicated that this patient's retina had not yet suffered irreversible ischemic damage at that point in time. CRAO patients with a good result from initial HBO 2 treatment should be admitted to a stroke center and should have their visual status monitored hourly. Should vision loss recur, aggressive use of intermittent 100% normobaric and hyperbaric oxygen is indicated to preserve retinal function until central retinal artery recanalization occurs. An evidence-based management plan for such patients is presented.

The following topics are discussed in this article. A historical review of the evolution of breast cancer imaging from thermography through digital breast tomosynthesis, molecular breast imaging, and advanced breast magnetic resonance imaging. Discussion of multiple clinical trials, their strengths, and weaknesses. Historical perspective on the Mammography Quality Standards Act and its relationship with development and implementation of the Breast Imaging-Reporting and Data System (BI-RADS).

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