Cases reported "Optic Nerve Diseases"

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1/11. Measurement of venous outflow pressure in the central retinal vein to evaluate intraorbital pressure in Graves' ophthalmopathy: a preliminary report.

    PURPOSE. To evaluate the intraorbital pressure in patients with Graves' ophthalmopathy (GO) in relation to the intraocular pressure (IOP) and proptosis and to find out whether optic nerve compression is predictable. methods. The venous outflow pressure (VOP) in the central retinal vein was measured by the perviously described technique of oculodynamometry.1 Since the central retinal vein passes through the orbit, the VOP cannot be lower than the intraorbital pressure if outflow is to be guaranteed. The IOP was measured either in primary position or with slight chin elevation to avoid restriction of the globe. Fifty-seven patients underwent a complete ophthalmologic examination, including VOP measurements, Hertel exophthalmometry and visual fields. RESULTS. The IOP in primary position ranged between 10 and 29 mmHg and in most (n=54) cases the VOP was 0-4 mmHg higher than the IOP. These patients had neither scotomas nor visual deterioration during an observation period of up to 2 years. In those cases (n=3) where the difference between IOP and VOP was 35 mmHg, the patients developed scotomas and visual deterioration and had to be treated (high-dose steroids or orbital decompression). The elevation in VOP did not correlate with the degree of proptosis. In one unilateral case, treatment of high IOP (32 mmHg) with dorzolamide drops led to a decrease in visual acuity of two lines, inferior field depression and relative afferent pupillary defect. The difference between IOP and VOP was 10 mmHg. Stopping treatment normalized visual function, the IOP rose to its original level and the difference between IOP and VOP was 4 mmHg. CONCLUSION. The increased IOP in GO is not caused by primary glaucoma but by elevated intraorbital pressure. The difference between IOP and VOP must be <5 mmHg to guarantee normal perfusion. We interpret these findings to suggest that loss of visual acuity and visual field defects may not only be caused by optic nerve compression at the apex but also by deterioration of optic nerve head perfusion.
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ranking = 1
keywords = ophthalmopathy
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2/11. Severe Graves' ophthalmopathy in pregnancy.

    BACKGROUND: Thyroid ophthalmopathy is a rare extrathyroidal complication most commonly associated with Graves' disease. The disease course ranges from mild to severe, with severe cases resulting in major visual impairment and facial disfigurement. CASE: A 22-year-old primigravida developed severe thyroid ophthalmopathy during pregnancy, requiring high-dose steroids and surgical orbital wall decompression to restore visual acuity. CONCLUSION: Severe thyroid ophthalmopathy can occur in the euthyroid pregnant patient. Corticosteroid therapy and surgical intervention may be required during pregnancy in this clinical scenario.
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ranking = 1.4
keywords = ophthalmopathy
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3/11. Orbital decompression of dysthyroid eye disease.

    Two cases of graves ophthalmopathy (GO) are presented, both of which required orbital decompression. The indications for orbital decompression and techniques used are discussed and the advantages of inferior orbitotomy presented.
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ranking = 0.2
keywords = ophthalmopathy
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4/11. Prediction of postoperative vision in eyes with severe trauma.

    The single most important factor determining the potential for return of useful vision in severely injured eyes is the magnitude of damage incurred by the macula or optic nerve at the time of injury. Most gravely injured eyes have media opacities that prevent funduscopic examination. In such eyes, the flash visually evoked potential is the single best predictor of postoperative vision. The second most reliable predictor is the bright-flash electroretinogram. ultrasonography is an important part of the preoperative assessment of injured eyes with opaque media, but is of less value than electrophysiological testing in predicting postoperative vision in eyes with major trauma.
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ranking = 8.6630987256122E-5
keywords = grave
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5/11. early diagnosis of Graves' optic neuropathy using visual evoked responses.

    A 27 year old woman with Graves' disease developed progressive ophthalmopathy and was noted to have abnormal visual evoked responses (VER). She was treated with high dose prednisone with clinical improvement and return of the visual evoked responses to normal. On withdrawal of steroids symptoms recurred and VER again were abnormal. Orbital irradiation was given with improvement in the ophthalmopathy and VER again normalized. To our knowledge this report represents the first demonstration of improvement in VER with treatment in Graves' optic neuropathy.
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ranking = 0.4
keywords = ophthalmopathy
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6/11. Optic neuropathy of Graves' disease. A report of a perimetric follow-up.

    Endocrine ophthalmopathy is one of the most common space occupying lesions of the orbit. The optic nerve can be involved to varying degrees in the disease. Marked optic neuropathy may be found in cases with normal visual acuity and normal optic nerve head. Perimetry is, therefore, recommended to diagnose or rule out a neuropathy. A case report will demonstrate that a quick screening perimetry with the Octopus program 07 allows a diagnosis and follow-up of the neuropathy. It is helpful in deciding on therapeutic measures and permits a safe monitoring of the therapeutic effect during the treatment period. The case further demonstrates a very quick recovery of the visual field following radiotherapy.
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ranking = 0.2
keywords = ophthalmopathy
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7/11. optic nerve involvement in Graves' ophthalmopathy: a case report and review.

    Optic neuropathy in Graves' disease is an uncommon, but potentially treatable cause of disabling visual loss. optic nerve damage is probably secondary to compression by swollen extraocular muscles at the apex of the orbit. The visual loss is usually bilateral and insidiously progressive, although accelerated visual loss, fluctuations in vision, and features mimicking orbital cellulitis may occur. Ocular congestive symptoms and proptosis have no direct relationship to the severity of visual loss. early diagnosis is facilitated by orbital CT scanning. Oral corticosteroids and radiotherapy, alone or in combination, are the primary modalities of medical treatment. Surgical decompression of the orbit can be used where medical approaches have failed.
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ranking = 0.8
keywords = ophthalmopathy
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8/11. Von Recklinghausen's disease with a malignant meningeal, cerebral and optic nerve tumour and bilateral vagal schwannomas. Possible mesenchymal histogenesis on light and electron microscopy.

    The clinical, histopathologic and fine structural features of multiple unusual tumours detected in a 20-year-old patient with von Recklinghausen's disease, who died within a year of onset of symptoms of a rapidly expanding intracranial tumour, are described. The tumour was found to involve the falx cerebri, the basal leptomeninges and dura mater, both olfactory and optic nerves, both frontal lobes, the right temporal lobe and middle cerebral peduncle, both middle cerebellar peduncles, and with a metastasis in a cervical node. On light and electron microscopy this tumour appeared to be a fibroblastic meningeal sarcoma with giant cells, mitotic figures, a rich reticulin matrix throughout, and tumour cells full of rough ER but without any glial filaments. Also very unusual was the involvement of both vagus nerves in their cervical and intrathoracic portions, by a schwannomatous benign tumour and with a non-chromaffin paraganglioma at its termination in the oesophagus. One of the few cutaneous "neurofibromas" was also schwannian, containing tumour cells with a basement membrane on electron microscopy. Most, if not all, of these tumours appeared mesenchymal in origin, more aggressive in behaviour and carrying a graver prognosis in von Recklinghausen's disease.
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ranking = 8.6630987256122E-5
keywords = grave
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9/11. Dysthyroid optic neuropathy. Clinical profile and rationale for management.

    Dysthyroid optic neuropathy (DON) was diagnosed in 36 eyes of 21 patients with progressive visual loss and congestive ophthalmopathy. Systemic features in the patients with DON did not differ from those reported for Graves' disease patients except that patients with DON were older (mean age, 61 years) and did not show female preponderance. Congestive symptoms always preceded visual loss, which was gradual in onset and bilateral in most patients but acute and asymmetrical in several. Presenting acuities were poorer than 20/60 in 50% of cases; central scotomas, sometimes combined with inferior depression, were the predominant field defects. Congestive signs were of moderate intensity without severe proptosis or exposure keratopathy. Bilateral and symmetrical ductional restriction was the most common motility disturbance. Oral corticosteroids were effective in restoring visual function in ten of 21 eyes treated. Many steroid-unresponsive eyes were improved promptly by supervoltage orbital irradiation or surgical decompression. In general, therapeutic intervention appeared to hasten recovery and improve visual outcome.
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ranking = 0.2
keywords = ophthalmopathy
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10/11. Late onset dysthyroid optic neuropathy.

    We report three rare occurrences of late onset dysthyroid optic neuropathy. We reviewed each case in detail and found that these middle-aged patients developed onset of optic neuropathy 7 to 12 years following stabilization of clinically significant, stable ophthalmopathy. There was no corresponding reactivation of orbital inflammatory symptoms or signs. Characteristic of a Graves' ophthalmopathy, the vision was responsive to either corticosteroid or surgical decompression, or to a combination thereof. None of the patients had diabetes, hypertensive, or cardiovascular disease. We hypothesize that in these unique cases possible mechanical vascular factors may have induced decompensation of optic nerve function in otherwise stable disease.
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ranking = 0.4
keywords = ophthalmopathy
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