Occlusion of one eye of kittens (monocular deprivation) results in a severe and permanent loss of visual acuity in that eye, which parallels closely the vision loss characteristic of human amblyopia. We extended earlier work to demonstrate that amblyopic vision loss can be either blocked or erased very fast by a 10 day period of total darkness following a period of monocular deprivation that begins near birth and extends to at least 8 weeks of age. The parameters of darkness were strict because no visual recovery was observed after 5 days of darkness. In addition, short periods of light introduced each day during an otherwise 10 day period of darkness obliterated the benefits. Despite recovery of normal visual acuity, only one-quarter of the animals showed evidence of having attained normal stereoscopic vision. A period of total darkness may catalyse and improve treatment outcomes in amblyopic children. A 10 day period of total darkness has been shown to either block or erase the severe effects on vision of a prior short period of monocular deprivation (MD) in kittens depending on whether darkness is contiguous or is delayed with respect to the period of MD. We have extended these earlier findings from kittens for which the period of MD began at 1 month and lasted for 1 week to more clinically relevant situations where MD began near birth and lasted for ≥ 6 weeks. Despite the far longer MD and the absence of prior binocular vision, all animals recovered normal visual acuity in the previously deprived eye. As before, when the period of darkness followed immediately after MD, the vision of both eyes was initially very poor but, subsequently, the acuity of each eye increased gradually and equally to attain normal levels in ∼ 7 weeks. By contrast, when darkness was introduced 8 weeks after MD, the visual acuity of the deprived eye recovered quickly to normal levels in just 1 week without any change in the vision of the fellow (non-deprived) eye. Short (15 or 30 min) periods of illumination each day during an otherwise 10 day period of darkness obliterated all the benefits for vision, and a 5 day period of darkness was also completely ineffective. Measurements of depth perception indicated that, despite possessing normal visual acuity in both eyes, only about one-quarter of the animals showed evidence of having attained normal stereoscopic vision.

Benign apocrine lesions have been described in the anogenital region, although according to the World Health Organisation convincing examples of anal apocrine adenocarcinomas have not been published. This report describes the case of an invasive apocrine adenocarcinoma arising in a benign adenoma in the perianal region of a 45 year old woman. The origin and invasiveness are supported by histological and immunohistochemical studies.

Objective or Purpose To assess whether stereopsis outcomes of patients with accommodative esotropia with high AC/A were improved after treatment with bifocal glasses as compared to single vision lenses. Design Retrospective cohort study. Participants Patients seen in the department of Ophthalmology at Boston Children's Hospital between 2006 and 2014 with accommodative esotropia with high AC/A (esotropia eliminated or decreased to within 10Δ at distance with full hyperopic correction); near angle (in full hyperopic correction) >10Δ more than distance angle); evidence of stereopsis, binocularity (on worth 4 dot testing), or improvement in near angle with +3.00 lenses; at least 4 years of records available for review. Methods, Intervention, or Testing Use of bifocal or single vision glasses. Charts were retrospectively reviewed. Stereopsis was log transformed for statistical analysis. Linear and logistic regression was used to control for confounders. Main Outcome Measures Stereopsis at final follow-up, difference in stereopsis between final and initial visits, and progression to strabismus surgery. Secondary outcomes include final near and distance deviations. Results Of the 180 patients who met inclusion criteria, 77 used bifocals and 103 used single vision lenses. Bifocals did not improve stereopsis outcomes compared to single vision lenses. In both groups, stereopsis was similar at initial and final visits, with similar improvement in both groups. Children in the bifocal group had a 3.6-fold higher rate of strabismus surgery than children in the single-lens group (p=0.04.) Additionally, children in the bifocal group had near deviations 4Δ greater than those with single lenses at final follow-up, even after controlling for age and initial deviations (p=0.02.) These results did not change if surgical patients were eliminated, or in the subgroup with initial distance deviation of 0Δ in full hyperopic correction. Conclusions Despite their widespread use, there is no evidence that bifocals improve outcomes in children with accommodative esotropia with high AC/A. In our retrospective review, children in bifocals had higher surgical rates and a smaller improvement in the near deviation over time. While our results suggest that eliminating bifocals could reduce the cost and complexity of care while potentially improving quality, prospective, randomized, controlled trials are needed to determine whether a change in practice is warranted.

Purpose To determine the prevalence of choroidal abnormalities (CAs) and Lisch nodules (LNs) in children who met the clinical diagnostic criteria (CDC) alone and those with a molecularly confirmed diagnosis (MCD) of neurofibromatosis type 1 (NF1), and to ascertain any differences between the groups. Methods This was a cross-sectional observational study. All children who met the CDC and/or had MCD of NF1 and underwent eye examination were included. At least two CAs or LNs between the two eyes were set as a threshold to define the presence of either abnormality. Frequencies alongside 95% confidence intervals (CIs) were calculated. The relationship between patient age and the presence of LNs and/or CAs was estimated using logistic regression. Results The study cohort included 94 patients; CAs (64%) were more prevalent than LNs (41%) (0.22; 95% CI, 0.08–0.36; P = 0.0023). The probability of the presence of LNs was lower than that of CAs across all ages (odds ratio = 0.37; 95% CI, 0.20–0.69; P = 0.00173). CAs were exclusively found in 37% of patients and LNs in 16%; 80% had either CAs or LNs, or both. In the CDC group ( n = 41), the difference in prevalence (CAs = 68%, LNs = 51%) did not attain statistical significance (0.17; 95% CI, −0.06 to 0.40; P = 0.18). In the MCD group ( n = 53), the difference in prevalence (CAs = 60%, LNs = 34%) was significant (0.26; 95% CI, 0.006–0.47; P = 0.023). Conclusions CAs were more frequent than LNs in pediatric NF1 patients regardless of age and MCD status. Combining ophthalmological exams with near-infrared imaging will increase the diagnostic reach in pediatric NF1. Translational Relevance CAs detected on near-infrared imaging are objective biomarkers in NF1. They are more prevalent and detected earlier in the pediatric population compared with LNs. Hence, the presence of CAs should be routinely ascertained in children suspected with NF1.