Cotton-wool spots and retinal light sensitivity in diabetic retinopathy.

In 14 eyes of 14 patients with diabetic retinopathy the light sensitivity of retinal cotton-wool spots was studied by computerised perimetry, and the visual field data were accurately correlated with the corresponding morphology as seen on fundus photographs and fluorescein angiograms. In 12 of the eyes the examinations were repeated within one year in order to follow changes in retinal light sensitivity during the evolution of the lesions. Retinal cotton-wool spots were in all eyes associated with localised non-arcuate scotomata in the visual field. In four eyes the cotton-wool spots disappeared within three months of the first examination, and in two of these cases the corresponding scotomata disappeared together with the morphological lesions. In eight eyes the cotton-wool spots (and the corresponding scotomata) had not resolved one year after the first examination. The mean blood pressure showed no significant difference between the patients in whom the lesions resolved within three months and the patients in whom the lesions persisted longer.     

Neuroimaging Features of Idiopathic Intracranial Hypertension Persist After Resolution of Papilloedema

Papilloedema is a key clinical finding in the diagnosis of idiopathic intracranial hypertension (IIH). However, newly proposed criteria allow diagnosis without papilloedema only if certain neuroimaging features are present. It is currently unclear if these findings persist upon resolution of papilloedema and IIH. A retrospective chart review identified three groups of patients (six per group) who had received orbital imaging within 4 weeks of fundoscopic examination: (1) IIH patients without active papilloedema, (2) IIH patients with active papilloedema, and (3) patients with no history of IIH or papilloedema. All magnetic resonance imaging (MRI) scans were graded by a neuroradiologist who was blinded to clinical status. Neuroimaging features were compared by using the Kruskal-Wallis one-way analysis of variance. Measurements of sellar and optic nerve configuration showed a statistical trend with papilloedema status. For the control group versus the active papilloedema group, the values were 0.0597 and 0.0621, respectively. For the control group versus the resolved papilloedema group, the values were 0.0485 and 0.0512, respectively. However, globe and sellar p values for the resolved papilloedema group versus the active papilloedema group were 1.000 and 0.6023, respectively, and not significant. Sellar and globe configuration suggest that a statistical trend for persistence after papilloedema has resolved and intracranial pressure (ICP) has normalised. Careful clinical correlation and fundus examination are essential because some of these neuroimaging features can be seen in normal patients and those with resolved IIH, and their presence on MRI may not necessarily indicate active disease or elevated ICP.     

Orbital myositis, recurrence of Whipple's disease]

Whipple's disease, a chronic systemic and multi-organ disease can be associated with ophthalmological manifestations with or without CNS involvement. Myositis rarely occurs during Whipple's disease. Antibiotic treatment prevents CNS recurrence. We report here the association of an orbital pseudotumor with Whipple's disease. This myositis was discovered on a follow-up CT examination. It appeared only one year after the end of a long course of antibiotic treatment, but it resolved within a few weeks when treatment was reintroduced. Relations between these two diseases are discussed.     

Acanthamoeba keratitis after LASIK

PURPOSE: To report a case of Acanthamoeba infection following LASIK. METHODS: A 20-year-old woman developed pain, redness, decreased vision, and corneal infiltrate in the right eye 15 days after bilateral LASIK. She did not use contact lenses postoperatively. Patient examination 3 months after surgery revealed a large, central, full-thickness corneal infiltrate with multiple satellite lesions in the right eye. Corneal scrapings were taken and the flap excised, and submitted for histopathologic examination. RESULTS: Microscopic examination of smears revealed Acanthamoeba cysts and non-nutrient agar showed a significant growth of Acanthamoeba. Histopathology examination of the excised flap demonstrated numerous Acanthamoeba cysts in tissue sections. The infiltrate was treated with a combination of topical polyhexamethylene biguanide, chlorhexidine, atropine sulfate, and oral itraconazole and resolved within 2 months. CONCLUSIONS: Laser in situ keratomileusis can be complicated by Acanthamoeba infection. Microbiologic evaluation is essential for accurate early diagnosis and treatment.     

An adult case of ophthalmoplegic migraine with the pseudo-Graefe sign

PURPOSE: An adult case of ophthalmoplegic migraine is reported. CASE: A 35-year-old man presented at our hospital with a 2-day history of double vision. He had a history of double vision following migraine which completely resolved within a week, occurring every few years since the age of 13. At the first visit, oculomotor nerve palsy with internal ophthalmoplegia was observed in his left eye. Magnetic resonance imaging and magnetic resonance angiography demonstrated no other abnormalities. After 3 months, the oculomotor nerve palsy was completely resolved, except for the pseudo-Graefe sign. RESULTS: Ophthalmoplegic migraine may be occur in adults. Therefore, a detailed history is important for examination of painful ophthalmoplegia. The Pseudo-Graefe sign observed in our case suggested the existence of recurrent oculomotor nerve palsy, which is an important indicator for ophthalmoplegic migraine.     

Sclerokeratoplasty with maintenance of the angle.

Using sclerocorneal dissection and angle-support sutures to maintain the angle and its function, we performed 14-mm sclerokeratoplasty with placement of allograft tissue in five eyes of 15 patients. One previously operated-on eye required a second sclerokeratoplasty and three eyes required secondary optical keratoplasty after opacification of the original large graft. Patients were monitored from 11 to 90 months postoperatively. At the last examination, all patients had clear grafts and visual acuity had improved since the preoperative examination. All patients had intraocular pressure maintained within normal range (less than 22 mm Hg, as measured by pneumotonometry) except for two patients in whom transient increases were resolved by tapering of corticosteroid treatment. Our results suggested that sclerokeratoplasty, using angle-support sutures, is an effective treatment for diffuse destructive corneoscleral disease that cannot be managed with a smaller graft.     

CASE REPORT Lepromatous Iridocyclitis

A 36-year-old woman with no prior medical history presented with a unilateral decrease in vision and iridocyclitis to our hospital. External examination demonstrated multifocal, firm, elevated, non-tender skin nodules on the patient's face and left hand. In addition, slit-lamp biomicroscopy revealed gray, cheesy-appearing nodules on the iris surface of the affected eye. Anterior chamber paracentesis and pars plana vitrectomy did not reveal further information. Skin nodule biopsy, however, demonstrated multiple fragmented organisms within histiocytes, consistent with leprosy. The iridocyclitis resolved after treatment with dapsone, corticosteroids, and rifampin and her vision returned to 20/20.     

Lepromatous iridocyclitis

A 36-year-old woman with no prior medical history presented with a unilateral decrease in vision and iridocyclitis to our hospital. External examination demonstrated multifocal, firm, elevated, non-tender skin nodules on the patient's face and left hand. In addition, slit-lamp biomicroscopy revealed gray, cheesy-appearing nodules on the iris surface of the affected eye. Anterior chamber paracentesis and pars plana vitrectomy did not reveal further information. Skin nodule biopsy, however, demonstrated multiple fragmented organisms within histiocytes, consistent with leprosy. The iridocyclitis resolved after treatment with dapsone, corticosteroids, and rifampin and her vision returned to 20/20.     

Buccal fat pad hemorrhage after retrobulbar injection

PURPOSE: To enable ophthalmologists to recognize and manage buccal fat pad hemorrhage occurring after retrobulbar injection. DESIGN: Interventional case report. METHODS: A 52-year-old woman with proliferative diabetic retinopathy underwent left retrobulbar injection before panretinal photocoagulation (PRP). RESULTS: Immediately after PRP, the patient complained of left cheek swelling. Ocular examination was unremarkable. Computed tomographic imaging studies confirmed the clinical diagnosis of hemorrhage within the buccal fat pad. No hemorrhage was found within the retrobulbar space. The hemorrhage resolved spontaneously without sequelae. CONCLUSION: This case widens the known spectrum of hemorrhagic complications after retrobulbar injection.     

Acute optic neuropathy in Behçet disease

PURPOSE: To report a patient with Behcet disease presenting with acute optic neuropathy. METHODS: A 47-year-old man was admitted to the authors' clinic owing to sudden visual loss in the left eye. Ophthalmologic and systemic examinations were performed. RESULTS: Visual acuity was 4/10 in the left eye. Fundus examination demonstrated swollen optic disc with blurred margins. There was relative afferent pupil defect in the same eye. Mega-dose corticosteroid treatment was started with the diagnosis of acute optic neuropathy. Ocular findings resolved within 2 weeks. CONCLUSIONS: Beh?et disease rarely presents with acute optic neuropathy.     

A Case of Accidental Macular Injury by Nd: YAG Laser and Subsequent 6 Year Follow-Up

Here, we report the case of a patient who sustained Nd: YAG laser macular injury with subsequent 6 year follow-up evaluation. A 23-year-old female was accidentally exposed to a Q-switched Nd: YAG laser without protective goggles. Upon initial evaluation, the best-corrected visual acuity of her affected eye was 20/100 OD. Fundoscopic examination revealed a macular laser burn and vitreous hemorrhage. Corticosteroids, in the form of 60 mg prednisolone, were administered orally with a 10 mg per week taper. Nineteen days following exposure, fundoscopic examination revealed a distinct epiretinal membrane which resolved within six months. The best-corrected visual acuity of the affected eye remained 20/100 OD. This clinical course is similar to those of previously reported cases including vitreous hemorrhage and subsequent epiretinal membrane formation. However, visual acuity did not recover despite spontaneous regression of the epiretinal membrane and at 6 year follow-up, there was neither choroidal neovascularization nor macular hole formation.     

Corneal densitometry evaluation in archipelago keratitis

To report a case of archipelago keratitis and its improvement as evaluated by corneal densitometry. A review of the patient’s record and relevant literature. A 57-year-old man presented with blurred vision associated with photophobia and halos around lights. Slit-lamp examination revealed multiple confluent, nummular subepithelial infiltrates. The infiltrates were unresponsive to topical nonsteroidal anti-inflammatory drops. The treatment was changed to topical steroids and oral acyclovir and a diagnosis of archipelago keratitis was made. The patient showed quick response to the treatment and the infiltrates disappeared within 5 weeks. However, no clear changes were observed initially by slit-lamp but corneal densitometry allowed us to evaluate improvement as the density value decreased from 96.5 to 38.6. After 10 days of treatment all the symptoms were resolved. Archipelago keratitis responded well to topical steroids and oral acyclovir. We describe the use of corneal densitometry complementary to slit-lamp examination in the clinical observation of archipelago keratitis.     

Sclerosing inflammatory pseudotumor of the eye

We report the clinical course and pathologic findings in a case of intraocular sclerosing inflammatory pseudotumor in a 21-year-old man. The patient initially had a unilateral right interstitial keratitis, scleritis, uveitis, ciliary body mass, and retinal detachment. Scleral and vitreous biopsy specimens revealed an inflammatory process. The eye was eventually enucleated despite therapy with high doses of prednisone and ciprofloxacin hydrochloride. Histologic examination of the globe showed nongranulomatous, acute (neutrophils) and chronic (lymphocytes and histiocytes) inflammation with proliferation of fibrous tissue within the vitreous cavity, uvea, sclera, and contiguous orbital fibroadipose tissue. The contralateral eye later developed a similar mass that resolved following aggressive and prolonged immunosuppressive therapy with retention of 20/16 visual acuity.     

External ophthalmomyiasis manifesting with keratouveitis

Purpose To report a case of external ophthalmomyiasis manifesting with keratouveitis. Case report A 77-year-old man, presented with keratouveitis secondary to external ophthalmomyiasis. Slit-lamp examination of the affected eye disclosed subepithelial linear opacities, stromal keratitis, and anterior uveitis. There were also some moving maggots identified as Oestrus ovis larvae. Following removal of the maggots and instillation of tobramycin, the symptoms completely resolved within 2 days and visual acuity improved. Conclusions Although external ophthalmomyiasis usually manifests with ocular surface involvement, this uncommon condition must be considered in the differential diagnosis of keratouveitis, especially in rural areas.     

Vitrectomy for cystoid macular oedema with attached posterior hyaloid membrane in patients with diabetes

AIM: To report the success of vitrectomy in eliminating cystoid macular oedema and improving vision in three eyes of two patients with diabetic cystoid macular oedema. In all of the eyes there was no ophthalmoscopic evidence of traction from a posterior hyaloid membrane or from proliferative tissue. METHODS: Pars plana vitrectomy was performed on three eyes of two patients with diabetic cystoid macular oedema who did not show traction upon examination with a slit lamp biomicroscope and a scanning laser ophthalmoscope. RESULTS: Cystoid changes disappeared 1, 3, and 5 days, postoperatively, and diffuse macular oedema resolved within 2 weeks. The visual acuity was improved and maintained. CONCLUSION: Vitrectomy can be effective in some patients with diabetic cystoid macular oedema even in patients who lack evidence of traction by ophthalmoscopy.     

Disseminated bilateral chorioretinitis due to Histoplasma capsulatum in a patient with the acquired immunodeficiency syndrome

A 31-year-old white male homosexual was healthy until March 1984, when he developed Pneumocystis carinii pneumonia, which resolved with treatment. In April 1984 he developed fever, followed by hepatosplenomegaly, headaches, blurred vision, pancytopenia and pulmonary infiltrates. On June 11, intracytoplasmic yeast were noted within leukocytes on a peripheral blood smear, and amphotericin B was started. The patient developed progressive respiratory and renal insufficiency and died on June 13, 1984. Autopsy histopathology demonstrated disseminated histoplasmosis and Histoplasma capsulatum was cultured from numerous tissues. Ocular histopathologic examination using special fungal stains and electron microscopy revealed numerous budding yeasts characteristic of Histoplasma capsulatum in the choroid, retina and central retinal vein. Their identification as H. capsulatum was confirmed by immunofluorescent staining.     

Postoperative Mycobacterium abscessus nodular conjunctivitis

Non-tuberculous or 'atypical' mycobacteria are unusual causes of ocular or periocular infection. We report a case of postoperative Mycobacterium abscessus infection of the conjunctiva. A 71-year-old gentleman developed nodular conjunctival injection and irritation 6 weeks after cataract surgery. After failure of topical therapy with antibiotics, steroids and lubricants, a biopsy was taken. Histological examination revealed non-caseating granulomas within which were clusters of acid-fast bacilli, subsequently identified as M. abscessus . The patient received a total of 16 weeks of oral antimycobacterial treatment and the conjunctivitis completely resolved. A suspected recurrence was successfully treated with topical ciprofloxacin and at final follow up 15 months later there was no evidence of infection. To the best of our knowledge this is the first report of non-tuberculous mycobacterial infection of the conjunctiva occuring after cataract surgery.     

Clostridium sordellii endophthalmitis after suture removal from a corneal transplant

PURPOSE: To report a case of endophthalmitis caused by Clostridium sordellii. METHODS: A 33-year-old man sustained a penetrating injury of the right eye that resulted in several ocular surgical procedures including pars plana vitrectomy, scleral buckling, scleral-sutured posterior chamber intraocular lens, and penetrating keratoplasty. More than 4 years after the penetrating injury he presented for examination with pain, photophobia, redness, decreased vision, and floaters in the right eye. Vitreous culture grew Clostridium sordellii. RESULTS: Following intravitreal injection of antibiotics, the patient's vision improved from 3/200 to 20/80 (baseline visual acuity) within 2 days. All signs of inflammation resolved without recurrence. CONCLUSIONS: Clostridium sordellii endophthalmitis may have a more benign course than the fulminant endophthalmitis typically seen with other Clostridium species.     

The primary care optometric evaluation of the traumatic brain injury patient.

Traumatic brain injury can cause an assortment of visual problems for the patient. These problems, unless resolved, can hinder a patient's rehabilitative progress. This article discusses the characteristic visual deficits found after traumatic brain injury. It also explains how minor modifications made to a routine comprehensive optometric examination can tailor an examination to the head trauma patient.     

Resolution of an apparent choroidal melanoma

A 67-year-old white woman had a lesion that clinically, echographically, and angiographically appeared to be consistent with choroidal melanoma. At follow-up examination 2 months later, the lesion had clinically completely resolved. A limited choroidal hemorrhage simulating a choroidal melanoma is postulated.