Management of intracranial aneurysm causing a third cranial nerve palsy: MRA, CTA or DSA?

The management of a patient with a suspected posterior communicating artery aneurysm is discussed with emphasis on neuroimaging including magnetic resonance angiography (MRA), computed tomography angiography (CTA) and intra-arterial digital subtraction angiography (DSA). This paper underscores the advantages and disadvantages of each neuroimaging modality, and is presented in an atlas-type format.     

Coats’ disease and bilateral cataract in a child with Turner syndrome: a case report

Purpose To report the first case in which Coats’ disease was observed with infantile cataract in a girl with Turner syndrome (TS). Materials and methods We examined a 4-year-old female infant with TS who was referred with a diagnosis of leukocoria in the left eye. Results and discussion Examination under anaesthesia revealed a bilateral punctate cataract and left eye fundus showed vascular retinal abnormalities typical of Coats’ disease. Cryotherapy was performed on the telangiectatic vessels and the child was followed up for a period of 12 months. Despite cryotherapy resulting in regression of the peripheral exudates, an exudative maculopathy persisted with poor visual outcome. We suggest that Coats’ disease should be considered as a rare ocular manifestation in TS.     

Apple peel atresia in association with bilateral colobomatous malformation of the optic nerve heads, dysmorphic features, and learning disability - a new syndrome?

Apple peel atresia of the small bowel is a rare congenital cause of intestinal obstruction. This case report describes a male patient with apple peel atresia and bilateral colobomatous malformation of the optic nerve heads in association with dysmorphic features and learning disabilities. In the absence of a positive family history, we propose that this collection of clinical findings could be due to a new dominant mutation or chromosomal microdeletion.     

Effects of vertical muscle surgery on differences in the orientation of Listing’s plane in patients with superior oblique palsy

Background

Although scleral search coils are widely and accurately used for the measurement of Listing’s plane in both eyes, they require specialized equipment and are invasive. In this study, we describe a convenient and less invasive method that uses a synoptometer to analyze the differences in orientation of Listing’s plane (difLP), and the effects of vertical muscle surgery on the difLP tilt in patients with superior oblique palsy (SOP).

Methods

Seventeen patients with unilateral congenital SOP (CSOP) and four patients with unilateral acquired SOP (ASOP) who had not undergone any strabismus surgeries were examined. Cyclodeviations of 13 vertical and horizontal gaze points within 30° were measured with a synoptometer, and the difLP tilts in the yaw and pitch planes were analyzed before and after vertical muscle surgery.

Results

The difLP tilt in the CSOP patients was significantly tilted nasally (p?=?0.02) and forward on the lower side (p?=?0.001), whereas that in ASOP patients tended to tilt temporally (p?=?0.15). Ipsilateral inferior oblique recession (IOR) performed in seven CSOP patients tended to improve the difLP tilt in both the yaw (p?=?0.07) and pitch (p?=?0.09) planes, whereas contralateral inferior rectus recession (IRR) performed in three CSOP patients significantly improved the difLP tilt in the pitch plane (p?=?0.015). The mean excyclodeviations in the 13 gaze points were significantly improved with both procedures (p?<?0.0001 for both).

Conclusions

The difLP tilt in the SOP patients could be analyzed with a convenient and less invasive method using a synoptometer, and dissimilar difLP tilts were confirmed in the ASOP and CSOP patients. The results of this study suggest that both IOR and IRR are reasonable treatments for improving the difLP tilt in CSOP patients. IOR should be selected for patients with a steep preoperative difLP tilt to the nasal side, whereas IRR should be selected for patients with a gentle preoperative difLP tilt.     

Pacific's experience with Web-based instruction: bats in the belfry or Webs in the classroom?

BACKGROUND: There is a revolution underway in education that involves a shift from the traditional lecture style of information presentation toward a more active style of learning. Many educators now believe that students must actively participate in the learning process for information to be truly understood and retained. Coincident with this revolution, there is an increased understanding that the body of knowledge in most professions has become too large to retain in the brains of individuals. These concepts have opened the door to innovative, computer-based educational techniques. METHODS: Pacific University College of Optometry has used a variety of Web-based educational methodologies in selected classes. These have ranged from shifting classes totally to the Web, to using the Web for pre-class preparation. RESULTS: Initial student acceptance of Web-based courses has been good. However, an undesirable trend has emerged--the tendency for students to print out Web-presented material rather than reading from the computer screen. Other concerns with shifting material from lecture to the Web include peer and administrator acceptance of this teaching style and issues associated with evaluation of professors who no longer give stand-up lectures. CONCLUSIONS: Changes in educational theory are making their way into the Schools and Colleges of Optometry. These changes will place greater reliance on active learning, reduced student memorization, and increased use of computers as information storage and retrieval devices. This will change the fundamental way in which students are educated, and this, in turn, will change the way in which future doctors, patients, and computers interact in clinical settings.     

Optical coherence tomography assessed retinal nerve fiber layer thickness in patients with Alzheimer’s disease: a meta-analysis

AIM: To investigate the difference of retinal nerve fiber layer (RNFL) thickness between Alzheimer’s disease patients and normal people, so as to provide clue for the early diagnosis of Alzheimer’s disease. METHODS: The articles on the association of RNFL thickness and Alzheimer’s disease were retrieved by searching international and national databases. The qualified articles were assessed by meta analysis with Stata11.0 software. The results were pooled using weighted mean difference (WMD) with a corresponding 95% confidence interval (CI). RESULTS: Totally 7 studies enrolled 324 eyes were included in the meta-analysis. The results of meta analysis showed that in AD patients, there was a significant average RNFL thickness reduction compared with the control group [WMD=-17.561, 95%CI: (-23.971, -11.151)]. There were significant differences in superior, inferior, nasal and temporal RNFL thickness between the two groups. WMD with a 95%CI were [-18.829, 95%CI:(-25.915, -11.743); P<0.05], [-25.775, 95%CI:(-34.304, -17.247); P<0.05], [-16.877, 95%CI: (-29.141, -4.613); P<0.001] and [-14.565, 95%CI:(-28.002, -1.128); P<0.001] respectively. Begg’s test and Egger’s test did not show significant difference, funnel plot was basically symmetrical, indicating that there was no publication bias existed. CONCLUSION: There are significant differences in the RNFL thickness in all quadrants between the two groups. RNFL thickness is reduced in AD patients compared with the control group.     

Optical coherence tomography assessed retinal nerve fiber layer thickness in patients with Alzheimer’s disease: a meta-analysis

AIM: To investigate the difference of retinal nerve fiber layer (RNFL) thickness between Alzheimer’s disease patients and normal people, so as to provide clue for the early diagnosis of Alzheimer’s disease. METHODS: The articles on the association of RNFL thickness and Alzheimer’s disease were retrieved by searching international and national databases. The qualified articles were assessed by meta analysis with Stata11.0 software. The results were pooled using weighted mean difference (WMD) with a corresponding 95% confidence interval (CI). RESULTS: Totally 7 studies enrolled 324 eyes were included in the meta-analysis. The results of meta analysis showed that in AD patients, there was a significant average RNFL thickness reduction compared with the control group [WMD=-17.561, 95%CI: (-23.971, -11.151)]. There were significant differences in superior, inferior, nasal and temporal RNFL thickness between the two groups. WMD with a 95%CI were [-18.829, 95%CI:(-25.915, -11.743); P<0.05], [-25.775, 95%CI:(-34.304, -17.247); P<0.05], [-16.877, 95%CI: (-29.141, -4.613); P<0.001] and [-14.565, 95%CI:(-28.002, -1.128); P<0.001] respectively. Begg’s test and Egger’s test did not show significant difference, funnel plot was basically symmetrical, indicating that there was no publication bias existed. CONCLUSION: There are significant differences in the RNFL thickness in all quadrants between the two groups. RNFL thickness is reduced in AD patients compared with the control group.     

Essential fatty acids in the treatment of dry eye syndrome: A myth or reality?

Dry eye is a common condition that can severely impair the quality of life. Systemic and topical omega-3 fatty acids and omega-6 fatty acids have been used as treatment for patients with dry eye disease and showed promising results. Further multicenter randomized controlled trials are required in order to establish a standardized protocol for the treatment of dry eye syndrome with those essential fatty acids.     

Spontaneous choroidal detachment and ‘red-eyed shunt syndrome’: two clinical entities with the same cause?

The files of four cases of spontaneous choroidal detachment were reviewed in order to demonstrate a low pressure arteriovenous (A-V) fistula as the cause. The clinical course and symptoms were compared with those described in the red-eyed shunt syndrome. In one patient an A-V fistula was demonstrated by carotidography, while in another patient CT findings supported a similar aetiology. In two out of four cases the initial clinical diagnosis was a solid subretinal mass. In all cases echography demonstrated a choroidal detachment which spontaneously disappeared. A prolonged course, bilateral involvement with changing side recurrences are the characteristics of this disease.     

Angiolymphoid hyperplasia with eosinophilia of the eyelid and orbit: the Western cousin of Kimura’s disease?

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon disease most frequently occurring in the head and neck region. It occurs in all races. In spite of a clear distinction between ALHE and Kimura’s disease on histological grounds for almost 20 years now, confusion and misdiagnosis still exist to date. Three Spanish patients presented to our institution over a 6 year period with mass lesions in the superior orbit, medial orbito-nasal wall and eyelid, respectively. All patients were of Caucasian extraction and were diagnosed with epithelioid haemangioma on histological tissue analysis. We report on the history and management of these patients which resulted in good functional and cosmetic outcome with no subsequent evidence of disease recurrence.     

Comparison of the meibomian gland dysfunction in patients with chronic ocular graft-versus-host disease and Sjögren’s syndrome

AIM: To investigate the abnormalities in the meibomian gland in patients with dry eye disease (DED) associated with chronic ocular graft-versus-host disease (coGVHD) in comparison with Sjögren’s syndrome (SS), a major form of aqueous deficient DED and meibomian gland dysfunction (MGD), a common cause of evaporative DED. METHODS: A total 135 eyes of 135 subjects included in this study: patients with DED associated with coGVHD (n=30), patients with SS (n=35), patients with MGD (n=35), and normal controls (n=35). All participants completed the Ocular Surface Disease Index (OSDI) questionnaire, ocular surface examination [Schirmer test, tear film breakup time (TFBUT), and ocular surface staining], and meibomian gland assessment [meiboscore (gland dropout detected on meibography using infrared camera of the Keratograph 5M), meibum expressibility score (MES), meibum quality score (MQS), lid margin abnormality]. In addition, correlations of meibomian gland characteristics with ocular surface parameters as well as disease severity score were investigated in coGVHD group. RESULTS: The coGVHD group showed significantly higher meiboscore, MES, and MQS than the other 3 groups (all P<0.05). In the coGVHD group, parameters of meibomian gland showed a significant correlation each other and those of ocular surface. The correlation between meibomian gland parameters and severity score of coGVHD was also established (meiboscore, r=0.62; MES, r=0.47; MQS, r=0.47; lid margin abnormality score, r=0.55; all P<0.05). CONCLUSION: Patients with DED associated with coGVHD show poorer gland morphology and worse gland function than other types of DED. In addition, meibomian gland damage is not only associated with ocular surface damage but also disease severity of coGVHD.     

Salvage of the retinal ganglion cells in transition phase in Alzheimer’s disease with topical coenzyme Q10: is it possible?

Graefe's Archive for Clinical and Experimental Ophthalmology - The evaluation of the short-term effect of topically applied coenzyme Q10 (CoQ10) on retina and choroid in Alzheimer’s...     

Penetrating trauma associated with findings of multiple evanescent white dot syndrome in the second eye: coincidence or an atypical case of sympathetic ophthalmia?

PURPOSE: To report a case of sympathetic ophthalmia (SO) resembling multiple evanescent white dot syndrome (MEWDS). METHODS: Retrospective chart review. RESULTS: A 17-year-old girl with a ruptured globe in the right eye underwent prompt primary repair and vitrectomy, scleral buckling, and silicone oil infusion 3 weeks later. Eight weeks after injury, she presented with visual loss in the left eye. Fundus examination in the left eye disclosed optic disk swelling and well-circumscribed, 100 to 500 microm diameter gray-white lesions at the level of the retinal pigment epithelium (RPE) posterior to the equator, sparing the fovea. On fluorescein angiography, the lesions appeared as areas of blocked choroidal fluorescence in the arterial phase and were associated with dye leakage in a wreathlike pattern during venous filling. Dye leakage occurred at the optic disk. Visual field testing showed depressed central sensitivity and an enlarged blind spot in the left eye. The patient was treated with prednisone and underwent diagnostic enucleation of the right eye. Histopathology showed rare choroidal granulomata and pigment phagocytosis. Vision improved to 20/20 in the left eye, and the window defects persisted. Visual field testing 6 months later was normal. One month after discontinuing prednisone, new areas of RPE hypopigmentation developed. Two weeks later, choroidal inflammation recurred and periphlebitis developed. CONCLUSION: This case indicates that SO can mimic MEWDS.