Bilateral optic neuropathies with remission in two HIV-positive men.

Two patients seropositive for the human immunodeficiency virus (HIV) developed bilateral optic neuropathies. Evaluations failed to identify an infectious or neoplastic etiology. Both patients improved, one in temporal relation to treatment with azidothymidine (AZT), the other during oral steroid therapy. Optic neuropathy in HIV-positive patients does not necessarily carry a poor prognosis even when a treatable cause is not found. A role for primary HIV infection in the pathogenesis remains speculative.     

Characteristics,management, and outcome of patients with uveal melanoma treated by Iodine-125 radioactive plaque therapy in a single tertiary cancer center in Jordan

Objective

To evaluate King Hussein Cancer Center experience in using Iodine-125 COMS radioactive plaque for treatment of Uveal Melanoma in Jordan.

Control of visual symptoms in two men with birdshot retinochoroidopathy using low-dose oral corticosteroid therapy.

PURPOSE: To describe two men with birdshot retinochoroidopathy whose severe subjective visual symptoms were controlled by long-term use of low-dose oral corticosteroid therapy. METHOD: Chart review. RESULTS: Vision improved subjectively in both men after initial treatment with oral prednisone (1 mg/kg/day) and remained stable while taking 5 mg daily or less of prednisone for periods of 54 and 81 months. CONCLUSION: Some patients with birdshot retinochoroidopathy do well with no long-term therapy or only low-dose oral corticosteroids as long-term therapy.     

Retinal injury identified by overhead-mounted optical coherence tomography in two young children with infantile-onset glaucoma

PurposeTo report and characterize unexpected retinal findings identified by imaging with overhead-mounted optical coherence tomography (OCT) in 2 young children with infantile-onset glaucoma.MethodsChildren with glaucoma were imaged during clinically indicated examinations under anesthesia using overhead-mounted HRA+OCT Spectralis with Flex module (Flex-OCT, Heidelberg, Germany) from February 2017 through February 2022. Imagers prioritized scans of the peripapillary retinal nerve fiber layer (pRNFL), optic nerve head, and macula. Children imaged before age 2 years with images adequate for evaluation were included. Age at glaucoma diagnosis, glaucoma type, highest intraocular pressure (IOP), corneal diameter (CD), and axial length (AL) were recorded.ResultsA total of 41 children (71 eyes with glaucoma) were imaged before age 2 years. Macular imaging identified both inner and outer retinal thinning in 3 eyes of 2 young children (both eyes of a child with newborn primary congenital glaucoma (PCG) and 1 eye of a child with glaucoma following cataract surgery), which remained stable over time. These findings were present in 2 of 41 children (4.9%) and 3 of 71 eyes (4.2%) imaged with Flex-OCT. Neither highest IOP, CD, nor AL at imaging differentiated the 3 eyes with retinal changes from the larger group.ConclusionsThree eyes of 2 young children with refractory glaucoma of different etiologies and highly elevated IOP demonstrated areas of inner and outer retinal thinning, consistent with retinal injury from probable prior macular ischemia. Unexpected retinal pathology identified on Flex-OCT imaging in infantile-onset glaucomas highlights the need for continued study of the pathophysiology of this disease.

     

Seroprevalence and Manifestations of Ocular Toxoplasmosis in Patients with Schizophrenia

Purpose: Recent studies have linked infectious agents such as Toxoplasma gondii to schizophrenia. We investigated the seroprevalence of T. gondii and conducted ophthalmologic examinations in schizophrenia patients and controls to identify lesions suggestive of ocular toxoplasmosis.

Methods: During 2015 and 2016, 34 schizophrenia patients and 85 healthy controls underwent ophthalmologic examination and anti-T. gondii IgG and IgM antibody measurements by chemiluminescence.

Results: Schizophrenia patients had a higher prevalence of anti-T. gondii IgG positivity than controls (91.18% [95% confidence interval (CI), 77.04%–96.95%] vs. 70.59% [95% CI, 60.18%–79.21%]; p = 0.017). Anti-T. gondii IgM antibodies (acute form) were not detected in any patient. One (3%) schizophrenic patient and two (2.4%) control patients presented fundoscopic scarring.

Conclusion: The seropositivity rate was significantly higher among schizophrenia patients than among controls (p = 0.017). There was no association between the presence of fundoscopic scarring and schizophrenia (p = 1.000).     

Electrophysiological findings in two young patients with Bothnia dystrophy and a mutation in the RLBP1 gene

Purpose: To characterize the clinical phenotype, with emphasis on electrophysiology, of two children with suspected Bothnia dystrophy. Methods: Two unrelated affected patients, 10 and 11 years old, were studied. Ophthalmological examination included testing of visual acuity, fundus inspection and fundus photography, kinetic perimetry, full-field electroretinogram (ERG), and multifocal ERG. The presence of a mutation in exon 7 of the RLBP1 gene was investigated by DNA sequencing. Results: Both patients were homozygous for the Arg234Trp-causing mutation in the RLBP1 gene, but the resulting disease phenotype appeared to vary somewhat between them. Visual acuity was moderately reduced in one patient and normal in the other. Fundus inspection at this age revealed no pathology in either patient and there were no signs of retinitis punctata albescens, which has been described previously as a frequent clinical feature of Bothnia dystrophy. The result of kinetic perimetry was normal. The final rod threshold was moderately elevated. Full-field ERG demonstrated the uncommon combination of absent rod response and normal cone response after 40 minutes of dark adaptation. However, after prolonged dark adaptation (20–24 h), both the rod response and the dark adaptation threshold became normal. Multifocal ERG was performed in one of the patients (the one with normal visual acuity and normal fundus appearance) and showed a reduced cone response in the central region of the tested area. There was no improvement of the multifocal ERG result after 20–24 h of dark adaptation. Conclusion: Patients with mutations in the RLBP1 gene (Arg234Trp) may have a normal fundus appearance early in the disease course. Multifocal ERG can be used for the objective documentation of the disturbed macular function, especially when the patient's visual acuity and fundus appearance are normal. The rod response is absent in the electroretinogram; however, after prolonged dark adaptation (20–24 hours), the rods recover completely. The central cones do not seem to recover.     

Guidelines in the management of penetrating ocular trauma with emphasis on the role and timing of pars plana vitrectomy

The principles and guidelines in the management of penetrating ocular injury are detailed. In the absence of definitive clinical trial or an experimental model, the rationale for pars plana vitrectomy has been presented. In addition, our recommendations as to the appropriate role and timing of pars plana vitrectomy are included.This study was supported in part by the National Institutes of Health grant EY 02061-01.Dr. Ryan is recipient of the Louis B. Mayer Scholar Award from Research to Prevent Blindness, Inc., New York, New York.     

Pigmented free-floating vitreous cysts in two young adults. Electron microscopic observations

Pigmented free-floating vitreous cysts were observed in two young adults. In both patients, the cyst was in the visual axis; however, the size and extent of pigmentation of the cyst wall compromised the visual acuity only in case 1. In this case, the vitreous cyst was aspirated through the pars plana and studied by light and electron microscopy. Histopathologically, the cyst was lined by a heavily pigmented layer of cuboidal cells intermixed with sheets of nonpigmented cells forming papillae. Ultrastructurally, the pigmented cells contained predominantly large, mature melanosomes (0.9-2.2 micron). Scattered immature melanosomes with a scarcity of mitochondria and other cytoplasmic organelles were present. Additionally, the cells were invested by a thin polarized basement membrane and displayed apical microvilli. Numerous microvillous processes were noted under the plasmalemmae and between adjacent cells. The results of the light and ultrastructural studies provide support for the hypothesis that the cyst in case 1 originated from the pigment epithelium. The possibility of a traumatic etiology is proposed for these pigmented vitreous cysts. If significant visual impairment is present, surgical removal of the cyst through a pars plana approach can be safely performed as in our case 1.     

晶状体摘出联合玻璃体切除治疗外伤性晶状体脱位

目的 分析晶状体摘出联合玻璃体切除治疗外伤性晶状体脱位的治疗过程和术后效果.方法 闭合性眼球外伤所致的晶状体脱位24例(24眼)行晶状体摘出联合玻璃体切除手术治疗,同时悬吊植入人工晶状体,玻璃体腔内填充C3F8气体.结果 术后随访8个月.观察期内无角膜失代偿和严重眼内炎性反应.7例1～2个月内出现不同程度的眼压增高,调整药物治疗后,3例眼压控制,其余4例因被发现房角损害而再行小梁切除手术治疗,术后眼压控制良好.3例术后1个月发生视网膜脱离,再次行玻璃体切除手术治疗,术中发现均为锯齿缘损害,给予眼内激光光凝和填充硅油治疗,观察期内视网膜平伏.结论 联合手术治疗外伤性晶状体脱位的手术效果根据晶状体脱位程度和眼内组织损伤的程度而定,外伤本身导致的远期并发症将影响联合手术的效果.     

Isolated abscess of extraocular muscle in two young boys: Clinical and imaging features

PURPOSE: To report two cases of a cystic isolated extraocular muscle abscess in a young boy. METHOD: Case report. RESULTS: Two cases of young boys with a cystic isolated extraocular muscle abscess are described. Each presented as an inflammatory lesion in the orbit that had been stable for approximately three weeks. Neurodiagnostic imaging of the two cases revealed a cystic lesion in close proximity to an extraocular muscle. An ultrasound-guided aspiration of each lesion revealed material that, when cultured, grew Staphylococcus aureus . Both patients recovered with appropriate antibiotic therapy. No other systemic illness could be identified in either case. CONCLUSION: These cases illustrate that an isolated abscess involving an extraocular muscle may present like an inflammatory cyst even without any evidence of systemic illness. When evaluating and managing such lesions, the authors recommend the use of ultrasound-guided aspiration to avoid complications arising from delay in diagnosis and inappropriate treatment.     

Ocular findings among young men: a 12‐year prevalence study of military service in Poland

Purpose: To determine the prevalence of ocular diseases among young men and to assess the main ocular causes reflecting discharge from military service in Poland. Methods: A retrospective review of the medical records of 105 017 men undergoing a preliminary examination for military service during the period 1993–2004. Sample size for the study was calculated with 99% confidence within an error margin of 5%. All of the study participants were White men of European origin, most of whom live or lived in Poland. Data regarding the vision status were assessed in 1938 eyes of 969 participants. Two groups were distinguished based on the age of the participants: group I aged 18–24 years, and group II aged 25–34 years. Results: Presented visual impairment [visual acuity (VA) < 20/40)] followed by colour vision defects were the most common ocular disorders, accounting for 13.2%. There were statistically significant differences in uncorrected VA as well as in the rates of particular refractive errors in between the age groups (p < 0.05). The prevalence of glaucoma and ocular hypertension was significantly higher in older participants. Six hundred and sixty‐seven (68.8%) participants examined medically in the study period were accepted for military service. However, 302 (31.2%) failed their examination and were temporarily or permanently discharged from duty. Fifty‐two of them (17.2%) were discharged because of various ocular disorders. The most common causes were high refractive errors, which accounted for 38.5% of all the ocular discharges, followed by chronic and recurrent diseases of the posterior segment of the eye, which accounted for 19.2%. Conclusion: The prevalence of ocular disorders among young men in an unselected military population was closer to the results obtained in other population‐based studies comprising both men and women in the same age group. High refractive errors followed by chronic and recurrent diseases of the posterior segment of the eye are important causes of medical discharges from military service in Poland.     

眼外伤手术患者医院感染危险因素及防控策略

目的分析眼外伤手术患者医院感染的相关因素。方法回顾性分析2009年1月至2012年12月眼外伤实施手术的6513例中,发生医院感染的52例作为病例组,随机按照1：1比例选择同期未发乍医院感染的眼外伤病例作为对照组。并将曲组可能影响医院感染的因素资料进行单因素及多因素分析。结果单因素分析结果显示,年龄、致伤原因、外伤至于术间隔时间及侵入性操作等因素存病例组和对照组的分布差异有统计学意义。多因素分析结果显示,年龄小于14岁或超过60岁、植物性眼外伤、外伤至手术间隔3d以上或对患荷实施了侵入性操作,均可能成为眼外伤发生医院感染的危险因素。结论眼外伤患者医院感染因素复杂,应依据患者不同的危险因素,制定有针对性的措施,可有效预防医院感染的发生。     

A pilot study on the differences in wavefront aberrations between two ethnic groups of young generally myopic subjects

A comparative population‐based cross‐sectional study design was used to examine the prevalence of wavefront patterns in two different ethnic groups, and the relationship of these patterns with ocular biometrics and gender. The Shin–Nippon SRW5000 open field autorefractor, the Wavefront Analysis Supported Customized Ablation (WASCA) wavefront analyser and the IOLMaster were used to determine wavefront aberrations, mean spherical equivalent (SE) refractive error and axial length (AL). Seventy‐four eyes from 74 young healthy subjects (44 British Asians, 30 Caucasians; 36 men, 38 women; mean age 22.51 ± 3.89 years) with mean SE averaging ?1.90 ± 2.76 D (range ?10.88 to +2.19 D) were examined. Relationships between ethnicity, gender, AL and SE, against the wavefront high‐order root mean square, and aberration components up to the fifth order, were assessed by using multiple regression and correlation analysis. AL on its own accounted for 4.7% of the variance in trefoil component (F_1,72 = 4.602; p = 0.035), 13.7% of coma component (F_1,72 = 12.536; p = 0.001), 6.1% of trefoil component (F_1,72 = 5.705; p = 0.020) and 9.8% of coefficient (F_1,72 = 8.908; p = 0.004). A significant model emerged (F_2,71 = 6.164; p = 0.003) for ethnicity and axial length, accounting for 12.4% of variance in primary spherical aberration with ethnicity accounting for 8.4% of that variance. For Caucasian subjects, a significant correlation was found between axial length and (Pearson’s correlation coefficient ?0.500; p = 0.005) and (Pearson’s correlation coefficient ?0.423; p = 0.020). For British Asian subjects, AL was only correlated with coefficient (Pearson’s correlation coefficient ?0.358; p = 0.017). Ethnicity is a factor to be considered in the variability of wavefront aberration, particularly spherical aberration. Relationship between AL and wavefront aberrations seems to vary between ethnicities. If higher order aberrations play a role in the emmetropization process, this may be different for different populations.     

晶状体玻璃体切除术后带虹膜隔人工晶状体缝线固定术临床观察

目的 评价眼外伤晶状体玻璃体切除术后无虹膜者植入带虹膜隔人工晶状体缝线固定术的手术的临床疗效.方法 对13例(13眼)晶状体玻璃体切除术后伴无虹膜及瞳孔极度散大者,行二期带虹膜隔人工晶状体缝线固定术,术后随访3～24个月.结果 术后畏光症状均减轻或消失.术后3个月时矫正视力＜0.1者1眼,0.1 ～0.3者5眼,0.4 ～0.6者4眼,＞0.6者3眼.术后有5例眼压升高,4眼控制,1眼行引流阀植入术好转.结论 带虹膜隔人工晶状体植入术是治疗无虹膜合并无晶状眼的有效方法,但术后并发症不容忽视.     

Chorioretinal dysplasia in young subjects with Wagner's hereditary vitreoretinal degeneration

Six young patients from three pedigrees with Wagner's disease were submitted to fluorescein angiography of the peripheral fundus. All eyes showed aberrant areas, characterized by: 1. localization principally in equatorial region of temporal half of the fundus. 2. whitish appearance of neuroretina with sharp demarcations. 3. absence of retinal vasculature. 4. marked atrophy of choriocapillaris and retinal pigment epithelium. 5. abnormal deflections of retinal vessels at the posterior margin of these areas. Arguments are presented in support of the hypothesis that these areas were dysplastic and not degenerative. The difference with lattice degeneration, another wellknown finding in Wagner's disease, is that retinal vasculature never developed in the dysplastic peripheral areas. It is probable that hypoplasia of the choroid has led to a too inferior structure of the overlying retina to permit development of retinal vessels. The frequent occurrence of retinal breaks in young patients with Wagner's disease, especially in the temporal periphery, seems to be a consequence of the poor condition of the retina in these dysplastic areas caused by the inferior development of both retinal and choroidal vasculature.     

Cytomegalovirus retinitis in a young homosexual male with acquired immunodeficiency

A case is reported of histopathologically documented CMV retinitis. It is part of a recently appreciated syndrome in young homosexual men, in which cellular immune deficiency has been documented and in which CMV infection may play a role. This case demonstrates that CMV retinitis is not excluded by negative CMV serology or cultures.