1/61. Preliminary report: indications of improved visual function after retinal sheet transplantation in retinitis pigmentosa patients.PURPOSE: To report indications of new visual function after retinal transplantation in two blind patients with retinitis pigmentosa. methods: Intact sheets of fetal retina (15 and 17 weeks gestational age) were transplanted subretinally (between the neurosensory retina and the retinal pigment epithelium) near the fovea in the left eye of a 23-year-old white man (Patient A) and in the left eye of a 72-year-old white woman (Patient B), both with autosomal-recessive retinitis pigmentosa. RESULTS: Postoperatively, at 6 and 5 months, respectively, both patients reported new visual sensation in the visual field corresponding to the transplant. In both patients, the visual sensation continued to be present after transplantation, at 12 and 8 months, respectively. In Patient A, a transient multifocal electroretinography (mfERG) response was observed in the transplant area 4 months postoperatively but was not detectable in Patient A at 6.0 and 9.5 months post-retinal transplantation. In Patient B, no positive mfERG responses were seen up to 5 months postoperatively. No rejection (presenting as cystoid macular edema, macular pucker, and extensive intraretinal edema with disrupted retinal pigment epithelium) to the transplanted tissue was seen up to 13 months in Patient A and 9 months in Patient B by fluorescein angiography. CONCLUSION: Transplantation of intact sheets of fetal human retina in two patients with retinitis pigmentosa was not associated with evidence of transplant rejection. Subjective improvement and an indication of objective improvement 4 months postoperatively were seen in Patient A, and subjective improvement only was seen in Patient B.- - - - - - - - - - ranking = 1keywords = white (Clic here for more details about this article) |
2/61. Central retinal vein occlusion combined with cilioretinal artery occlusion.A healthy 65-year-old man with sudden profound visual loss in his right eye presented with clinical signs of central retinal venous occlusion and retinal whitening, indicative of a cilioretinal arterial obstruction. He had been diagnosed with cilioretinal artery occlusion at a private ophthalmology clinic three days before being referred to our department. On fluorescein angiogram of the affected eye, the proximal portion of the retinal arteries filled with dye 27.3 seconds after injection, indicating a delay in retinal arterial filling. Moreover, the cilioretinal artery did not fill at that phase, but went on to fill 45.1 seconds after injection. Over 63.4 seconds after the filling of the retinal arteries, the laminar flow of the retinal venous vessels appeared. This was not until 90.7 seconds after injection. This patient was elderly, had no systemic diseases, and showed non-ischemic CRVO, prolonged retinal arterial filling on fluorescein angiography, and poor prognosis in visual acuity. His clinical course seemed to favor the pathogenetic hypothesis of a primary arterial affection.- - - - - - - - - - ranking = 0.5keywords = white (Clic here for more details about this article) |
3/61. Ocular massage in a case of central retinal artery occlusion the successful treatment of a hitherto undescribed type of embolism.BACKGROUND: The pathogenesis of central retinal artery occlusions (CRAO) varies, depending upon the underlying disease. An embolic origin of an occlusion often occurs. PATIENT AND methods: A 50-year-old man with an occlusion of the left internal carotid artery was examined because of a left central retinal artery occlusion. fluorescein angiography revealed that in no blood vessel could any circulation of blood be demonstrated. The slight vascular filling with dye mainly came from collateral circulation at the disc. RESULTS: Ocular massage was carried out. After a delay of several minutes, the vessels of the fundus became increasingly filled with blood. The patient noticed continuing recovery in the vision of his left eye. During fluorescein angiography, carried out one day later, white embolic clots appeared in the arteries of the papilla, some of them moving with the velocity of the blood flow through the retinal vessels and reaching the periphery of the retina and immediately disappearing. Others moved more slowly. This was seen repeatedly over several minutes. CONCLUSIONS: In this patient we have recorded in a fluorescein angiogram bright boluses visible in the blood of the retinal arteries. We suggest that conglomerations of blood cells can also cause an obstruction of blood flow. The observation of this kind of bright clots (boluses) visible in the blood of the retinal arteries we did not find described in the literature. In such a situation ocular massage is extremely helpful. Therefore, ocular massage should be carried out in every patient with CRAO.- - - - - - - - - - ranking = 0.5keywords = white (Clic here for more details about this article) |
4/61. Tubercular endophthalmitis simulating retinoblastoma.PURPOSE: To report a case of tubercular endophthalmitis simulating retinoblastoma. methods: Case report. An 8-year-old female presented with a history of complete loss of vision and a white pupillary reflex in the left eye of 3 month's duration. RESULTS: retinoblastoma could not be excluded on the basis of clinical examination and relevant investigational studies. In the left eye, a computed tomography (CT) scan demonstrated a large vitreous mass with foci of calcification. Enucleation in the left eye was performed, and histopathological examination revealed a chronic granulomatous endophthalmitis and acid-fast bacilli consistent with tubercular pathology. CONCLUSION: This case illustrates that tubercular endophthalmitis with leukocoria and a vitreous mass containing focal calcification may simulate retinoblastoma.- - - - - - - - - - ranking = 0.5keywords = white (Clic here for more details about this article) |
5/61. Exudative retinal detachment and scleritis in polyarteritis.A 64-year-old white man, treated with systemic corticosteroids for five years, developed polyarteritis. He then developed a severe scleritis with an exudative retinal detachment in the right eye, which became blind and painful and was enucleated 23 months after onset of the scleritis. Histopathologic examination of the enucleated eye revealed granulomatous scleritis, chronic nongranulomatous uveitis, exudative retinal detachment, and perivasculitis of intrascleral, iris, ciliary body, and retinal blood vessels. Systemic findings were minimal and limited to elevated sedimentation rate, weight loss, mild anemia, and microscopic hematuria. Respiratory disease, severe kidney disease, hypertension, and arthritis were notably absent. A muscle biopsy established the diagnosis.- - - - - - - - - - ranking = 0.5keywords = white (Clic here for more details about this article) |
6/61. blindness after liver transplant.A 58-year-old woman developed a generalized seizure 12 days after undergoing liver transplantation and awakened with persistent hand motions vision binocularly. cyclosporine levels were normal and blood pressure was only mildly elevated. The ophthalmic and neurologic examinations were otherwise normal. brain MRI revealed bilateral parieto-occipital white matter signal abnormalities consistent with vasogenic edema. The cyclosporine was abruptly replaced with tacrolimus and the patient recovered normal vision within 48 hours. A subsequent brain MRI taken 30 days later showed that the patient had reverted to normal. This is an example of posterior leukoencephalopathy owing to cyclosporine toxicity. It points out that visual loss may be an isolated or most prominent clinical manifestation, cyclosporine and blood pressure levels may be normal, deficits are reversible if cyclosporine is promptly discontinued, and tacrolimus, a similar immunosuppressive agent, may be a safe substitute.- - - - - - - - - - ranking = 0.5keywords = white (Clic here for more details about this article) |
7/61. Phakic implantation of a black intraocular lens in a blind eye with leukocoria.A 54-year-old woman with leukocoria from a white cataract requested evaluation for the undesired cosmetic appearance of her blind right eye. The eye was hypotonous from chronic total retinal detachment, and the lens appeared loose and partially resorbed. A solid, black poly(methyl methacrylate) intraocular prosthesis was placed in the phakic posterior chamber and sutured into the ciliary sulcus, leaving the lens undisturbed. The patient achieved excellent cosmesis and a significant improvement in self-image.- - - - - - - - - - ranking = 0.5keywords = white (Clic here for more details about this article) |
8/61. Posterior ischemic optic neuropathy after hemodialysis.PURPOSE: To report a case of visual loss from posterior ischemic optic neuropathy (PION) after hemodialysis. DESIGN: Observational case report. methods: Neuro-ophthalmic examination, neuro-imaging including computed tomography (CT) scan, magnetic resonance imaging (MRI) of the head and orbits, and magnetic resonance angiography (MRA) of the neck and cerebral vasculature, as well as electrophysiologic testing including electroretinogram (ERG) and visually evoked response (VER) were performed. RESULTS: Acute onset of painless bilateral no light perception vision with absent pupillary response to light and normal funduscopic examination occurred shortly after completion of hemodialysis. Computed tomography scan and MRA results were normal. magnetic resonance imaging scan showed small vessel ischemic white matter changes. Electroretinogram results were normal and the VER was unrecordable. CONCLUSIONS: Visual loss after hemodialysis is a rare complication and is associated with anemia and hypotensive events. The visual loss is usually a result of anterior ischemic optic neuropathy. We were unable to find another instance in the literature of visual loss after hemodialysis resulting from PION.- - - - - - - - - - ranking = 0.5keywords = white (Clic here for more details about this article) |
9/61. Familial optic atrophy with white matter changes.We report two brothers who suffer from infantile onset optic atrophy and blindness. MRI of the brain demonstrated periventricular white matter changes in both children. Neurological and developmental examination are normal. Extensive laboratory investigations rule out metabolic disorders that can be associated with optic atrophy. No mutations associated with Leber hereditary optic neuropathy (LHON) were found and sequencing of the mitochondrially encoded complex 1 subunits was normal. We suggest that this family represents either an atypical variant of LHON with a yet undescribed mtDNA mutation or a new syndrome.- - - - - - - - - - ranking = 2.5keywords = white (Clic here for more details about this article) |
10/61. Cortical visual impairment following bacterial meningitis: magnetic resonance imaging and visual evoked potentials findings in two cases.Cortical visual impairment (CVI) following bacterial meningitis is a very uncommon complication. Two children with CVI following bacterial meningitis are reported. Bacterial agents were haemophilus influenzae type b in one and meningococci in the other child. Both children showed only insufficient recovery from CVI, mental retardation and residual neurological symptoms. Flash visual evoked potentials (VEP) showed preserved cortical response at onset of CVI. Re-evaluations several months later showed significantly reduced amplitudes, but normal latencies for P100. Thus, flash VEP does not allow prediction of visual outcome. MRI results have not been reported before. MRI at onset of diagnosis showed occipital parenchymal irregularities with enlarged sulci and subarachnoid spaces. Follow up MRI 15 months after onset of CVI in one patient showed marked atrophy of the occipital cortex, hyperintensities of the cortical white matter and no visible optic radiation. The MRI findings indicate hypoxic-ischaemic lesions in the border zone between the distribution of the great cerebral arteries.- - - - - - - - - - ranking = 0.5keywords = white (Clic here for more details about this article) |
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