Beidseitige Stauungspapillen,einseitiger Visusverlust und Abduzensparese

A 35-year-old woman complained of headache, reduced visual acuity, restricted visual field in the right eye and blindness in the left eye. The examination of the retina showed papilledema and peripapillary hemorrhages in both eyes. Magnetic resonance imaging (MRI) revealed a sinus thrombosis. Despite modern imaging technologies sinus thrombosis is an often overlooked, life-threatening disease and needs immediate treatment in order to avoid long-term consequences. An ophthalmological examination can be pioneering as it leads to further imaging.     

Maculopathy associated with tacrolimus (FK 506)

A 63-year-old man with a history of liver transplantation presented to our clinic complaining of visual disturbance. He had been receiving tacrolimus (FK 506) for 30 months (6 mg/day for 2 years and 3 mg/day for 6 months); he reported that the visual disturbance began while taking tacrolimus. A full ophthalmologic examination and electrophysiologic and imaging studies were performed. The best corrected visual acuity was 0.1 in both eyes. There were no abnormal finding in the anterior segment, pupillary reflexes were normal and, there was no swelling in either optic disc. Although the foveal reflex was slightly decreased, fluorescein angiography revealed non-specific signs, with the exception of a window defect. A multifocal electro-retinogram revealed decreased amplitude of the central ring. A Swedish interactive threshold algorithm-standard 10-2 visual field test revealed a central scotoma. These findings suggest that tacrolimus may result in maculopathy. Therefore, careful ophthalmologic examination is necessary in the patients taking tacrolimus.     

Occipital lobe dysfunction revealed by functional brain imaging in a patient with traumatic visual field loss

We report a patient with visual field loss due to closed head trauma who was imaged with anatomic and functional brain imaging. The findings of ophthalmologic examination were normal except for a complete homonymous hemianopia on the right, an incongruous homonymous hemianopia on the left, and right oculomotor palsy. The results of anatomic brain imaging, computed tomography, and magnetic resonance imaging (MRI) were unremarkable. However, single-photon emission computed tomography (SPECT) scan revealed marked hypoperfusion of the left occipital lobe and functional MRI showed a corresponding strikingly reduced response to visual stimuli in the left occipital lobe. Therefore, this patient is thought to have had dysfunction of the left occipital lobe. Functional brain imaging techniques, such as SPECT and functional MRI, can be helpful in the localization of the responsible lesions even when conventional neuro-imagings are nondiagnostic.     

Optic disc pit combining with an optic nerve cyst — A case report

Herein, we report a case presenting with the optic disc pit and optic nerve cyst coexistence. A 54-year-old female presented to our office with progressive blurred vision for up to 3 months in her left eye. Upon examination, the best corrected visual acuity in the right eye was 20/20 and in the left eye was 20/100. Fundoscopic examination revealed a black pit at the temporal margin of left optic disc without obvious macular edema. Findings were confirmed later with optical coherence tomography (OCT) examination. Further magnetic resonance imaging (MRI) disclosed a well defined 6 mm x 6mm cystic lesion located at temporal aspect of left retro-bulbar optic nerve within the optic nerve sheath. Compression of left optic nerve was prominent. Visual evoked potential (VEP) test verified dysfunction of left optic nerve. She kept following up for 6 months. Neither maculopathy nor retinal edema occurred during this period. The visual acuity maintained 20/100 in her left eye. The size and location of optic disc pit remained as well. To sum up, in a patient with visual impairment combing with optic disc pit, further imaging surveys should be considered to exclude the possible coexistence of other optic nerve abnormalities.     

Chronic Invasive Fungal Sinusitis Presenting as Inferior Altitudinal Visual Field Defect

A young male with acute blurring of vision (6/9) complained of an inferior altitudinal field defect in right eye. Clinical ophthalmological examination was normal. Magnetic resonance imaging (MRI) of the brain revealed the expansion and mucosal thickening of right posterior ethmoid and sphenoid sinuses and opacified right maxillary sinus. Surgical intervention (transethmoidal sphenoidotomy) and histopathological examination revealed chronic invasive granulomatous fungal sinusitis. Anti-fungal therapy led to resolution of visual complaints and restoration of visual field defects.     

Central Serous Chorioretinopathy Following Pulse Corticosteroid Therapy in Multiple Sclerosis

The purpose of this paper was to report a case of central serous chorioretinopathy following pulse corticosteroid therapy in multiple sclerosis. The patient was a 40-year-old female patient admitted to neurology clinic with muscle weakness and difficulty in moving. Having the diagnosis of multiple sclerosis, she was hospitalised for the treatment of the acute attack. Pulse intravenous methylprednisolone therapy was introduced and on the third day of the therapy, patient reported acute visual loss. Magnetic resonance imaging was performed to exclude optic neuritis. Complete eye examination and imaging of the fundus revealed retinal pigment epithelial detachment as the cause of the visual loss. Corticosteroids (endogenous or exogenous) are known risk factors for central serous chorioretinopathy. As retinal pigment epithelial detachment is a component of central serous chorioretinopathy, systemic corticosteroid was thought to be responsible for acute visual loss in this case. Steroid therapy was gradually tapered and acetazolamid was introduced. Her visual acuity improved but retinal pigment epithelial detachment was found to be persisting 2 years later. Although optic neuritis, the most common ocular presentation, is generally responsible for acute visual loss in multiple sclerosis, one should consider that systemic corticosteroid therapy for the acute attack may be in charge.     

The value of clinical electrophysiology in the assessment of the eye and visual system in the era of advanced imaging

Electrophysiological techniques allow clinical investigations to include a ‘dissection’ of the visual system. Using suitable electrophysiological techniques, the ‘dissection’ allows function to be ascribed to the different photoreceptors (rod and cone photoreceptors), retinal layers, retinal location or the visual pathway up to the visual cortex. Combined with advances in genetics, retinal biochemistry, visual fields and ocular imaging, it is now possible to obtain a better understanding of diseases affecting the retina and visual pathways. This paper reviews core electrophysiological principles that can complement other examination techniques, including advanced ocular imaging, and help the interpretation of other clinical data and thus, refine and guide clinical diagnosis.     

Optic Neuropathy Associated with Castleman Disease

A 44-year-old woman with Castleman disease presented with acute visual loss in the left eye. A full ophthalmologic examination and imaging were performed. Visual acuity was 20/20 in the right eye and 20/100 in the left eye. Total dyschromatopsia, a relative afferent pupillary defect, and a cecocentral scotoma were observed in the left eye. Mild disc edema, without leaking during fluorescein angiography, was also observed. Magnetic resonance imaging revealed a small cystic epidermoid-like lesion in the right prepontine and suprasellar cistern. Her visual acuity did not improve and deteriorated to 20/200 in the left eye at 22 months after the initial visual loss. Optic neuropathy may rarely be associated with Castleman disease and suggests a poor prognosis.     

Macular function and morphology in acute retinal pigment epithelitis

A 20-year-old man applied with vision loss in the left eye. Right eye examination was unremarkable. Best-corrected visual acuity (BCVA) in the left eye was 20/200. Fundus examination revealed a few yellow spots within a round-shaped macular lesion. Autofluorescence imaging showed hyperautofluorescence in the lesion. Central amplitudes in multifocal electroretinogram (mfERG) were depressed. The patient reported a rhinopharyngitis 7–10 days before the visual loss. The patient was diagnosed as acute retinal pigment epithelitis. BCVA improved gradually up to 20/20 in 4 weeks. mfERG amplitudes returned to normal. A slight pigmentary distortion was the only residual fundus finding.     

Homonymous Hemianopsia Due to Posterior Cortical Atrophy

A 63-year-old woman presented to her ophthalmologist complaining of reading difficulties for two years. Ophthalmological examination revealed a homonymous hemianopsia. Brain magnetic resonance imaging (MRI) scan was interpreted as normal, but positron emission tomography (PET) showed areas of posterior brain hypometabolism. This case highlights the high diagnostic suspicion that ophthalmologists should have regarding posterior cortical atrophy (including the visual variant of Alzheimer disease) in patients complaining of reading difficulties in the setting of a normal ophthalmic examination.     

Vision Loss from Choroidal and Pituitary Metastases Secondary to Renal Cell Carcinoma: A Case Report

A 62-year-old male with a history of metastatic clear cell renal cell carcinoma (ccRCC) presented with decreased vision to 20/50 in the left eye. Fundus examination revealed an elevated, amelanotic mass lesion in the superotemporal macula, without involvement of the central macula by subretinal fluid or tumour. Given incongruity between the fundus findings and the degree of visual impairment, visual field testing was obtained, revealing a bitemporal hemianopia. Magnetic resonance imaging demonstrated optic chiasm compression by a pituitary mass, which had previously been overlooked on computed tomography imaging. Biopsy confirmed metastatic ccRCC to the pituitary, which presented simultaneously with the presumed choroidal metastasis.     

Exploration of visual memory by functional MRI

PURPOSE: The aim of our study was to evidence the location of the cortical area triggered by visual memory tasks by he mean of functional magnetic resonance imaging examination (fMRI). METHODS: Twelve healthy volunteers underwent fMRI examination on a 1.5 Tesla magnet with echoplanar imaging sequence during figurative and non-figurative memory tasks. An area was considered to be activated if at least 10 contiguous voxels activation was noted. Activated areas were defined for both tasks and the brain mapping was realized according to Talairach atlas. RESULTS: For all examinations a bilateral activity was evidenced (area 17 and 18). In addition, a frontal activation was also noted in 83% of the cases for both tasks. However, frontal activation was bilateral in 9/10 cases for the figurative task and 6/10 cases for the non-figurative task. CONCLUSION: FMRI was able to evidence activation of cerebral areas during visual memory tasks in all our study cases. Frontal activation was not discriminative of figurative or non figurative memory. This might be probably explain by inappropriate non-figurative tests. FMRI should allow a better knowledge of memory mechanisms as well as an enhancement of functional cerebral mapping before surgery.     

Aspergillosis presenting as an optic neuritis

A 59-year-old woman was referred to our clinic with sudden visual loss in her right eye after she was treated with 40 mg/day of oral prednisolone for 2 weeks under the diagnosis of idiopathic optic neuritis. At that time, computerized tomography (CT) of the brain showed no evidence of optic nerve or brain pathology. However, there was progressive diminution of right visual acuity associated with a limitation of adduction and abduction in the right eye. On magnetic resonance imaging and repeated CT, a malignant lesion was suggested, and was confirmed as an Aspergillus fungus colony by histopathologic examination. Postoperatively, she was treated with intravenous administration of amphotericin B for 13 weeks. However, her condition continued to deteriorate. She developed ptosis and total ophthalmoplegia in the right eye and blindness in both eyes. After discharge, she was given itraconazole for 20 weeks. She has shown no recovery of visual acuity or extraocular motion during a two-year follow-up period. The clinical features of our case suggest that early diagnosis in a case of aspergilloma presenting with visual loss is difficult and that a high index of suspicion, repeated radiological examination and adequate biopsy may be required for diagnosis.     

Bilateral central scotoma with preservation of central vision in 2 patients following caesarian section under spinal anesthesia

Two female patients are described with acute bilateral central scotomata with preservation of central vision following spinal anesthesia. Both patients had a temporary drop in systemic blood pressure and underwent caesarian section with moderate blood loss.In order to explain the visual field defects extensive ophthalmological examination and CT-scanning with nuclear magnetic resonance imaging were performed. The hypothetical explanation for the visual field defects is transient macular ischemia.     

Transient homonymous hemianopia and positive visual phenomena in nonketotic hyperglycemic patients

PURPOSE: To report a case of a transient homonymous hemianopia in a patient with nonketotic hyperglycemia with negative magnetic resonance imaging (MRI) scans. DESIGN: Case report. METHOD: A 72-year-old woman with diabetes mellitus was referred to the neuro-ophthalmology service with hyperglycemia and multiple visual complaints. RESULTS: The patient was found to have a dense left homonymous hemianopia on examination. An MRI scan of the brain was negative for a lesion affecting the visual pathways. Resolution of the homonymous hemianopia and the patient's symptoms came with normalization of her blood glucose levels. CONCLUSION: Nonketotic hyperglycemia is an important diagnostic consideration in patients who present with homonymous visual field defects but have negative neuroimaging studies.     

Acquired unilateral scotoma

A 54-year-old white man presented with a “blind spot” temporally in his left eye. Best-corrected visual acuity in the affected eye was 20/20, and Humphrey visual field revealed an enlarged blind spot. Funduscopic examination revealed subtle peripapillary pigmentary changes corresponding to a well-demarcated peripapillary region of hyperautofluorescence and hypoautofluorescence on fundus autofluorescence. Outer retinal degenerative changes were detected on spectral-domain optical coherence tomography. A diagnosis of acute zonal occult outer retinopathy was made based on clinical history and imaging studies.     

Perioperative posterior ischemic optic neuropathy as a rare complication of blepharoplasty

PURPOSE: To report a case of visual loss to light perception in the right eye after upper and lower eyelid blepharoplasty. DESIGN: Case report. METHOD: A 46-year-old man was referred 3 days after combined bilateral upper and lower lid blepharoplasty with visual acuity of light perception in the right eye. The fundus examination, fluorescein angiography and magnetic resonance imaging of the orbit were normal. Ocular motility was full in all directions of gaze. RESULT: The diagnosis of optic nerve damage was initially based on the relative afferent pupillary defect. The diagnosis of a perioperative posterior ischemic optic neuropathy was based on the Goldmann visual field examination and the subsequent optic atrophy. Central visual acuity, color vision as well as the visual field improved markedly within 3 months. CONCLUSION: Blindness is a rare but feared complication of blepharoplasty and is reported to occur in about 0.04% of cases. Although intraorbital hemorrhage is thought to be the leading cause for optic nerve damage in most of the patients with this devastating condition, we present a case with perioperative posterior ischemic optic neuropathy leading to visual loss after blepharoplasty. The mechanism leading to optic nerve damage in this patient may include compromised small arteries perfusing the optic disk due to direct mechanical compression and a probable vasoconstrictive activity of the anesthetic agent.     

Vogt-Koyanagi-Harada Disease Presenting as Unilateral Neuroretinits

A 42-year-old female presented with unilateral visual loss associated with systemic symptoms of fever and headache. Although initial ophthalmic examination revealed a unilateral neuroretinitis, investigation for infectious and non-infectious causes of neuroretinitis were negative. At our examination, retinal imaging (suggestive of bilateral involvement) along with the results of lumbar puncture (pleocytosis) and clinical findings was consistent with a diagnosis of Vogt-Koyanagi-Harada disease. The patient was treated with intravenous steroids with prompt resolution of her symptoms. Vogt-Koyanagi-Harada disease may present atypically and should be considered in the differential diagnosis of neuroretinitis.     

放射状视神经切开术治疗视网膜中央静脉 阻塞的初步观察

目的观察放射状视神经切开术（RON）治疗视网膜中央静脉阻塞（CRVO）的临床效果。方法回顾分析 5例经平坦部玻璃体途径行RON治疗的CRVO患者的临床资料。其中，2例患者手术前确诊为CRVO，手术前后分别进行视力、眼底照相、荧光素眼底血管造影（FFA）、彩色超声多谱勒（CDI）血流扫描、电脑视野及光相干断层扫描（OCT）等检查；3例患者因玻璃体积血接受手术治疗，手术中确诊为CRVO所致。5例均有明显黄斑水肿。对比观察患者手术前后视力、眼底检查及手术后眼底照相和OCT检查结果。手术后随访12个月。结果除1例患者视力下降外，其余4例患者视力均有不同程度提高。 眼底照相和（或）FFA、OCT检查显示手术后1个月时黄斑水肿均明显消退，手术后2个月时眼底出血基本吸收， 1例行视野检查者显示手术后视野改善。1例手术后出现玻璃体积血，2例手术中穿刺视盘时出血。结论RON可有助于CRVO患者改善患眼黄斑水肿，减少眼底出血，防止新生血管形成，并能一定程度地提高视力，对治疗CRVO具有一定可行性及临床价值。但尚需要较大规模、多中心的随机临床对照观察来进一步研究证实。(中华眼底病杂志,2005,21:6-9)     

Focal laser ablation of retinal angiomatous proliferation

PURPOSE: To evaluate the feasibility of focal laser ablation of retinal angiomatous proliferation (RAP) identified with clinical examination and high-speed indocyanine green (ICG) imaging in patients with age-related macular degeneration. METHODS: In this retrospective, interventional case series, 16 consecutive eyes of 15 patients with macular degeneration and leakage from a stage I or II RAP lesion were identified. RAP lesions were identified using clinical examination and high-speed ICG imaging. High-speed ICG imaging was used to identify the intraretinal component of the lesion. RAP lesions were treated with a 100- to 200-mum green or yellow wavelength laser spot that was applied to completely ablate the intraretinal component of the lesion. In eyes with stage II lesions, the subretinal component of the lesion was not treated. Early Treatment of Diabetic Retinopathy Study visual acuity, optical coherence tomography retinal thickness, angiographic leakage, and progression of the angiomatous process shown by ICG imaging were evaluated preoperatively and postoperatively. RESULTS: Sixteen eyes underwent successful ablation of the RAP lesions with an average of 1.9 treatment sessions. At a mean follow-up of 15.5 months, 94% of eyes had stable or improved visual acuity. Only 6% of eyes had a loss of >or=3 lines of visual acuity. The average visual acuity at the last follow-up was 20/45 in the stage I lesion group and 20/160 in the stage II lesion group. Of the patients, 87.5% had a reduction in retinal edema and subretinal fluid, with 69% of patients having complete resolution of retinal edema and subretinal fluid; 14% of patients had progression to retinal choroidal anastomoses. No treatment complications were encountered. CONCLUSION: Focal laser photocoagulation of RAP lesions appears to be feasible. This treatment appears to be a safe method of managing the leakage from RAP. Treatment of solely the intraretinal component of the lesion may be adequate to control leakage. Treatment may allow the angiomatous process to be arrested, resulting in stabilization of visual acuity. Visual acuity results appear to be better for patients with early stage lesions.