1/182. Improvement of visual function in an adult amblyope. PURPOSE: In this case report, the efficacy of occlusion therapy was investigated in a strabismic amblyope above the currently accepted age for treatment. Success was assessed not simply by a change in visual acuity, but by examining a number of parameters which relate to both sensory and motor aspects of visual function. methods: As well as routine orthoptic and optometric evaluation, additional tests were administered as follows: high and low contrast LogMAR Crowded Acuity, repeat letter acuity, and hyperacuity measurements. RESULTS: A functional loss in each of the tests used was demonstrated, and occlusion therapy appeared to improve all aspects of the amblyopia, with a significant difference in pre- and post-therapy results. CONCLUSIONS: The results of this study suggest that: (1) occlusion therapy can produce substantial improvements in visual function in adult amblyopia; (2) many aspects of visual function can improve beyond the traditional critical periods for development in amblyopia; and (3) with good patient compliance and cooperation, age should not be the critical factor in the initiation of treatment for amblyopia. ( info) |
2/182. amblyopia: the condition, the challenge and the cure. 1. amblyopia needs to be detected early for the patient to have the greatest chance of total vision correction. 2. Compliance with treatment for amblyopia, while not medically complex, may be difficult both socially and emotionally. 3. Support and education, provided by programs such as Prevent blindness America's eye Patch Club, facilitate compliance and, therefore, the cure. ( info) |
3/182. Giant hairy nevus: preventable cause of amblyopia. An infant with a congenital giant hairy nevus causing occlusion of the visual axis of the right eye is presented. The nevus was removed at the early age of three weeks because of concern that the child would develop deprivation amblyopia. Since such nevi can undergo malignant changes, early removal may be justified for that reason alone. ( info) |
4/182. adie syndrome: evidence for refractive error and accomodative asymmetry as the cause of amblyopia. PURPOSE: To report objective changes in accommodation in a child with adie syndrome. methods: A child aged 2 years 10 months when initially examined was found to have good visual acuity in both eyes, a low degree of hypermetropia (isometropic), and Adie pupil presumed to be caused by chicken pox that had occurred 2 months earlier. amblyopia developed but responded well to treatment, which involved correction of the refractive error and occlusion therapy. Objective changes in the refraction of the eye were measured on the Canon R1 autorefractor at 3.8 m and 33 cm. RESULT: The degree of accommodation in the affected eye when both eyes were open was markedly reduced. CONCLUSION: The presence of isometropic hypermetropia, which remains uncorrected when adie syndrome is present, can lead to the development of amblyopia in a child. ( info) |
5/182. Surgical excision of selected amblyogenic periorbital capillary hemangiomas. To report the successful surgical excision of well-circumscribed capillary hemangiomas of the eyelid and orbit inducing occlusion amblyopia in 2 cases with immediate improvement of the patient's symptoms. A 2-month-old girl was diagnosed with a massive, amblyogenic orbital tumor which was removed intact via an inferior transconjunctival orbitotomy after magnetic resonance imaging (MRI) revealed a well-defined mass filling the entire inferior orbit. Histopathologic examination confirmed the diagnosis of orbital capillary hemangioma. A 1-month-old girl developed occlusion amblyopia due to an enlarging subcutaneous tumor of the left upper eyelid. The discrete mass was excised via an eyelid crease approach and confirmed to be an eyelid capillary hemangioma. There were no short-term or long-term complications in either case. In both cases, immediate resolution of occlusion amblyopia and cosmetic disfiguration was achieved. The final visual acuities were 20/20 at 5 years in the first patient and 20/30 at 4 years follow-up in the second patient. Orbital and eyelid capillary hemangiomas can induce profound permanent amblyopia. If the tumor is well-circumscribed, confirmed with orbital imaging, then surgical excision, with immediate resolution of amblyogenic factors, can be considered as a treatment option. ( info) |
6/182. Congenital trigeminal anesthesia in two siblings and their long-term follow-up. PURPOSE: To alert ophthalmologists to congenital trigeminal anesthesia as a cause of corneal scarring and amblyopia and its effective treatment with tarsorrhaphies. methods: case reports. A 2-month-old infant presented with bilateral corneal erosions and complete corneal anesthesia. Her sister presented at age 3 years with a corneal ulcer and corneal hypoesthesia (sensation markedly decreased). The father and paternal grandmother of the siblings also had corneal hypoesthesia. RESULTS: Further investigation of the infant revealed bilateral hearing loss, swallowing difficulties, and decreased sensation in the trigeminal nerve distribution. A diagnosis of congenital trigeminal anesthesia was made. The corneal erosions of the patient resolved with bilateral two-thirds width tarsorrhaphies. The girl continues to do well now at 10 years of age with ocular lubrication and superficial corneal scar removal. Her older sister initially required antibiotic ointment for her corneal ulcer but now requires only ocular lubrication for congenital trigeminal anesthesia. CONCLUSION: This study describes the earliest reported use of tarsorrhaphies in an infant with congenital trigeminal anesthesia. The presence of this condition in her sister and relatives makes it one of the few reports of congenital trigeminal anesthesia in more than two generations. Early recognition of this condition is essential in the preservation of useful vision. ( info) |
7/182. Chiasmopathy? A 57-year-old man presented with progressive visual loss in both eyes, bitemporal field defect, and a history of poor nutrition, alcohol abuse, and excessive cigar smoking. magnetic resonance imaging was normal. The visual acuity and field defect improved with supplementation with vitamins and reduction of alcohol and tobacco consumption. A diagnosis of toxic optic neuropathy was made. The authors discuss the differential diagnosis of bitemporal/pseudobitemporal field defects and the diagnosis and treatment of toxic optic neuropathy. ( info) |
8/182. Good visual function in posterior microphthalmos. Posterior microphthalmos is a rare condition in which the anterior segment is normal in size and configuration, but the posterior segment is reduced in size; this results in axial hyperopia and retinal folding. patients have decreased vision that is caused by posterior segment abnormalities, high refractive error, and amblyopia. We present a case of posterior microphthalmos in which retinal function was relatively intact and visual loss was believed to be primarily caused by refractive error and amblyopia. After treatment, the child's visual acuity and school performance improved. This case emphasizes the need for careful examination, refraction, and follow-up for these children because their visual potential may be reasonably good. ( info) |
9/182. A erimetric technique believed to test receptive field properties: sequential evaluation glaucoma and other conditions. We used a technique to simplify and speed up a perimetric test (Westheimer function). Through sequential testing, the technique was successfully used to evaluate pathologic findings and partially to evaluate treatment regimens in three subjects. One patient had an onset of kinetic field changes and Westheimer function alteration with primary open-angle glaucoma. Temporary remissions of alterations in the Westheimer function and kinetic visual field loss occurred in patients with glaucoma and tobacco-alcohol (complicated) amblyopia. Using these techniques it is possible to localize an anomaly in the outer retinal layer, the inner retinal layer, and central to the optic nerve head. We divided the inner and outer retinal layers on a vascular support basis. ( info) |
10/182. Visual rehabilitation in a child with diffuse choroidal hemangioma by using aggressive amblyopia therapy with low-dose external beam irradiation. Diffuse choroidal hemangioma is a congenital vascular hamartoma often associated with hemangiomatous lesions of the brain, orbit, and periocular skin (nevus flammeus) in the sturge-weber syndrome. Visual loss from diffuse choroidal hemangioma may result from chronic serous retinal detachments causing retinal pigment epithelial, photoreceptor or cystoid degeneration, and glaucomatous optic atrophy. Low-dose external beam irradiation has successfully resolved exudative retinal detachment and caused shrinkage of the choroidal hemangioma.(1-3) Visual loss in sturge-weber syndrome with diffuse choroidal hemangioma often begins during amblyogenic years. Visual rehabilitation may thus require not only therapeutic intervention to address organic disease but also amblyopia therapy. Though many of the previously reported cases address treatment of the diffuse choroidal hemangioma with laser or radiotherapy, none advocate or emphasize treatment of nonorganic amblyopia associated with this condition. We report the case of a child with sturge-weber syndrome and unilateral diffuse submacular choroidal hemangioma who developed an exudative retinal detachment that responded to the combination of low-dose external beam irradiation and aggressive amblyopia therapy. ( info) |