1/241. Severe ocular and orbital toxicity after intracarotid etoposide phosphate and carboplatin therapy.PURPOSE: To report severe ocular and orbital toxicity after administration of intracarotid etoposide phosphate and carboplatin. METHOD: Case report. RESULTS: A 52-year-old man with glioblastoma multiforme underwent left intracarotid administration of eto poside phosphate and carboplatin inferior to the ophthalmic artery. Within 7 hours, a nonpupillary block angle-closure glaucoma developed secondary to uveal effusion in the ipsilateral eye, which was relieved by cycloplegia. Four days later, severe orbital inflammation resulted in a visual acuity of counting fingers, proptosis, optic neuropathy, and total external ophthalmoplegia in the eye. The patient's condition improved after a lateral cantholysis and administration of high-dose intravenous corticosteroids. Two weeks later, an anterior uveitis occurred in the left eye, which responded to topical corticosteroids. During a 2-month period, the patient recovered to a visual acuity of 20/70, near normal motility, and normal intraocular pressure, and the ocular and orbital inflammation resolved. Preexisting ipsilateral chemotherapy-induced maculopathy became more pronounced. CONCLUSION: Ocular and orbital toxicity after intracarotid etoposide phosphate and carboplatin therapy is infrequently reported.- - - - - - - - - - ranking = 1keywords = optic (Clic here for more details about this article) |
2/241. Macular hole formation: new data provided by optical coherence tomography.OBJECTIVE: To establish the sequence of events leading from vitreofoveal traction to full-thickness macular hole formation. methods: Both eyes of 76 patients with a full-thickness macular hole in at least 1 eye were examined by biomicroscopy and optical coherence tomography. RESULTS: Sixty-one fellow eyes had a normal macula. Optical coherence tomograms showed central detachment of the posterior hyaloid over the posterior pole in 19 cases (31%) and a perifoveal hyaloid detachment not detected on biomicroscopy in 26 cases (42%). In the 4 impending macular holes, optical coherence tomography disclosed various degrees of intrafoveal split or cyst, with adherence of the posterior hyaloid to the foveal center and convex perifoveal detachment. In the 14 stage 2 holes, eccentric opening of the roof of the hole was observed, and in the 24 stage 3 holes, the posterior hyaloid was detached from the entire posterior pole. CONCLUSIONS: In fellow eyes of eyes with macular holes posterior hyaloid detachment begins around the macula, but the hyaloid remains adherent to the foveolar center, indicating the action of anteroposterior forces. This results in an intraretinal split evolving into a cystic space, and then to the disruption of the outer retinal layer and the opening of the foveal floor, thus constituting a full-thickness macular hole.- - - - - - - - - - ranking = 6keywords = optic (Clic here for more details about this article) |
3/241. diplopia secondary to aniseikonia associated with macular disease.OBJECTIVE: To provide an explanation for diplopia and the inability to fuse in some patients with macular disease. methods: We identified 7 patients from our practices who had binocular diplopia concurrent with epiretinal membranes or vitreomacular traction. A review of the medical records of all patients was performed. In addition to complete ophthalmologic and orthoptic examinations, evaluation of aniseikonia using the Awaya New aniseikonia Tests (Handaya Co Ltd, tokyo, japan) was performed on all patients. RESULTS: All patients were referred for troublesome diplopia. Six of the patients had epiretinal membranes and 1 had vitreomacular traction. All 7 patients had aniseikonia, ranging from 5% to 18%. In 5 of the patients the image in the involved eye was larger, and in the other 2 patients it was smaller than in the fellow eye. All patients had concomitant small-angle strabismus and at least initially did not fuse when the deviation was offset with a prism. Response to optical management and retinal surgery was variable. CONCLUSIONS: aniseikonia caused by separation or compression of photoreceptors can be a contributing factor to the existence of diplopia and the inability to fuse in patients with macular disease. Concomitant small-angle strabismus and the inability to fuse with prisms may lead the clinician to the incorrect diagnosis of central disruption of fusion. Surgical intervention does not necessarily improve the aniseikonia.- - - - - - - - - - ranking = 2keywords = optic (Clic here for more details about this article) |
4/241. Clinical features of Goldmann-Favre syndrome.A 21-year-old woman complained of progressive loss of visual acuity. She had also had night blindness since she was ten years old. At the eye examination, the vitreous was found to be degenerated in both eyes. The fundus findings were a large retinoschisis in the right macula, edema resembling retinoschisis in the left macula and annular degenerative changes in the midperiphery. ERG and dark adaption were abnormal. This vitreoretinal degeneration was diagnosed as Goldmann-Favre syndrome.- - - - - - - - - - ranking = 0.030889917073949keywords = edema (Clic here for more details about this article) |
5/241. Fetal alcohol syndrome.BACKGROUND: Fetal alcohol syndrome (FAS) describes the systemic and ocular anomalies resulting from the teratogenic effect of maternal alcohol abuse during pregnancy. It is a leading cause of preventable birth defects in the U.S. case reports: Two case reports illustrate the characteristic findings in FAS. These include growth retardation, cognitive impairment, and facial dysmorphism. Ocular signs are prevalent, including small palpebral fissure, microcornea, strabismus, myopia, astigmatism, and optic nerve hypoplasia. DISCUSSION: Fetal alcohol exposure can lead to a wide spectrum of systemic defects and vision deficits. The increasing frequency of drinking among pregnant women in recent years should call more public attention to this detrimental yet preventable syndrome. CONCLUSION: The high frequency of ocular manifestations aids in making a diagnosis of FAS, which can be challenging. eye-care professionals can play an important role in patient management and the educational process.- - - - - - - - - - ranking = 1keywords = optic (Clic here for more details about this article) |
6/241. Conradi-Hunermann syndrome with ocular anomalies.We report a Japanese girl with the Conradi-Hunermann form of chondrodysplasia punctata and anterior segment malformations characteristic of Axenfeld-Rieger syndrome. The patient also had cataracts and unilateral optic atrophy. A possible role for homeobox-containing genes in the etiology of this type of chondrodysplasia punctata is suggested as an explanation for the coincidence of these two syndromes.- - - - - - - - - - ranking = 1keywords = optic (Clic here for more details about this article) |
7/241. Ocular toxicity of systemic medications: a case series.BACKGROUND: There are many visually threatening conditions that may result from long-term use of systemic medications. Many of these adverse side effects can be greatly reduced or prevented with close monitoring of patients. In view of current knowledge, updated clinical guidelines for appropriate monitoring of ocular toxicity from systemic medications need to be developed for the eye care practitioner. CASE review: There have been many reports of ocular toxicity from isoniazid, thioridazine, steroids, and amiodarone therapy. Clinical cases illustrating possible adverse ocular side effects are presented, which include INH-induced optic neuropathy, phenothiazine-induced retinopathy, steroid-induced glaucoma, and vortex epitheliopathy secondary to amiodarone. CONCLUSION: Optometrists should be aware of the potential for ocular side effects from systemic medications. eye care guidelines for monitoring ocular side effects from thioridazine, INH, steroids, and amiodarone use are suggested.- - - - - - - - - - ranking = 1keywords = optic (Clic here for more details about this article) |
8/241. Electron immunocytochemical analysis of posterior hyaloid associated with diabetic macular edema.BACKGROUND: Tangential traction in the macula from a thickened posterior hyaloid of the vitreous has been implicated as a cause of diffuse diabetic macular edema. vitrectomy with peeling of the posterior hyaloid has been shown to reduce retinovascular leakage and improve vision in select patients. We report a clinicopathologic correlation using electron microscopy and electron immunocytochemistry to characterize the membrane infiltrating the posterior hyaloid in two such patients. methods: Two patients presented with vision loss associated with diffuse diabetic macular edema and an attached, thickened, and taut posterior hyaloid. The patients underwent vitrectomy with peeling of the posterior hyaloid. The premacular posterior hyaloid specimens then were analyzed by electron microscopy with immunocytochemical staining for cytokeratin and glial fibrillary acidic protein. RESULTS: Both posterior hyaloid specimens contained collagen and a large cellular component. Immunogold labeling showed cells positive for glial fibrillary acidic protein or cytokeratin. With double labeling, no cells expressed both proteins simultaneously. Clinically, both patients had vision improvement and macular edema resolution after surgery. CONCLUSIONS: The thickened, taut posterior hyaloid observed in our patients with diabetic macular edema contained cells of glial and epithelial origin. This cellular infiltration may contribute to abnormal vitreomacular adherence and could play a role in the pathogenesis of macular edema in some patients with diabetes.- - - - - - - - - - ranking = 0.27800925366554keywords = edema (Clic here for more details about this article) |
9/241. Orbital drainage from cerebral arteriovenous malformations.OBJECTIVE: To describe the neuro-ophthalmic findings in patients with orbital drainage from cerebral arteriovenous malformations (AVMs). methods: We reviewed the records of 100 consecutive adult patients with cerebral AVMs who presented to our institution during a 4-year period. All patients with orbital drainage were identified, and their neuro-ophthalmic evaluations were reviewed. RESULTS: Three patients (3%) were identified with orbital drainage from a cerebral AVM. The first patient presented with typical chiasmal syndrome (reduced visual acuity, bitemporal hemianopia, and optic atrophy). magnetic resonance imaging demonstrated a large left temporal and parietal lobe AVM with compression of the chiasm between a large pituitary gland and a markedly enlarged carotid artery. The second patient presented with headaches and postural monocular transient visual obscurations. Examination revealed normal visual function with minimal orbital congestion and asymmetrical disc edema, which was worse in the left eye. magnetic resonance imaging revealed a large right parietal and occipital lobe AVM without mass effect or hemorrhage and an enlarged left superior ophthalmic vein. The third patient had no visual symptoms and a normal neuro-ophthalmic examination; a right parietal lobe AVM was discovered during an examination for the cause of headaches. CONCLUSION: Orbital drainage from cerebral AVMs is rare. Manifestations may include anterior visual pathway compression, dilated conjunctival veins, orbital congestion, and asymmetrical disc swelling.- - - - - - - - - - ranking = 1.0308899170739keywords = optic, edema (Clic here for more details about this article) |
10/241. diagnosis of vitreoretinal adhesions in macular disease with optical coherence tomography.PURPOSE: To compare the relative incidence of vitreoretinal adhesions associated with partial vitreous separation within the macula diagnosed with optical coherence tomography (OCT) with that of those diagnosed with biomicroscopy. methods: The authors obtained linear cross-sectional retinal images using OCT in patients with selected macular diseases. Additional studies included biomicroscopy, fundus photography, fluorescein angiography, and B-scan ultrasonography. RESULTS: Optical coherence tomography was performed on 132 eyes of 119 patients. Vitreoretinal adhesions within the macula were identified using OCT in 39 eyes (30%) with the following diagnoses: idiopathic epiretinal membrane (n = 13), diabetic retinopathy (n = 7), idiopathic macular hole (n = 7), cystoid macular edema (n = 7), and vitreomacular traction syndrome (n = 5). Biomicroscopy identified vitreoretinal adhesions in only 11 eyes (8%). Two distinct vitreoretinal adhesion patterns were identified with OCT, each associated with partial separation of the posterior hyaloid face: focal (n = 25) and multifocal (n = 14). CONCLUSIONS: Optical coherence tomography is more sensitive than biomicroscopy in identifying vitreoretinal adhesions associated with macular disease.- - - - - - - - - - ranking = 5.0308899170739keywords = optic, edema (Clic here for more details about this article) |
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