Evaluation and management of 2 ferocactus spines in the orbit.

A 49-year-old woman, who had fallen face first in a cactus 1 week earlier, presented with a small, mobile, noninflamed subcutaneous nodule at the rim of her right lateral orbit with no other functional deficits. A CT scan was obtained, which revealed a 4-cm intraorbital tubular-shaped foreign body resembling a large cactus spine. A second preoperative CT scan, obtained for an intraoperative guidance system, demonstrated a second cactus spine, which was initially not seen on the first CT scan.

Effect of EPI-743 on the clinical course of the mitochondrial disease Leber hereditary optic neuropathy.

Objective: To evaluate the safety and efficacy of a new therapeutic agent, EPI-743, in Leber hereditary optic neuropathy (LHON) using standard clinical, anatomic, and functional visual outcome measures.

Design: Open-label clinical trial.

Setting: University medical center.

Competency checklists for strabismus surgery and retinopathy of prematurity examination.

Purpose: To evaluate two checklist tools that are designed to guide, document, and assess resident training in strabismus surgery and examination of infants at risk for retinopathy of prematurity (ROP).

Methods: A panel of staff surgeons from several teaching institutions evaluated the checklists and provided constructive feedback. All former residents who had been trained via the use of these checklist tools were asked to take self-assessment surveys on competency in strabismus surgery and ROP examination.

Gaze-evoked amaurosis produced by intraorbital buckshot pellet.

Objective: To report the first case of gaze-evoked amaurosis secondary to an intraocular foreign body and to highlight the characteristic clinical findings of patients with this symptom.

Design: Case report and review of the literature.

Methods: Case review, clinical history, electrophysiologic testing, and follow-up.

The ice test versus the rest test in myasthenia gravis.

Objective: To compare the ice test with the rest test in subjects with myasthenic and nonmyasthenic ptosis.

Design: Randomized, noninterventional trial.

Participants: (1) Ten subjects with ptosis from previously undiagnosed myasthenia gravis.

Low diagnostic yield with second biopsies in suspected giant cell arteritis.

Objectives: The clinical diagnosis of giant cell arteritis may be confirmed with a biopsy of the superficial temporal artery. Because of "skip lesions," a histologic diagnosis of giant cell arteritis may be missed with a unilateral biopsy. The authors report a study that investigates whether a biopsy of the contralateral superficial temporal artery provides any additional information for confirmation of a diagnosis of giant cell arteritis.

Unilateral lid retraction during pregnancy.

A 32-year-old woman noted left lid retraction during pregnancy. Examination revealed unilateral enophthalmos without symptoms of diplopia or sinus disease. Orbital imaging showed characteristic features of the silent sinus syndrome, which were confirmed intraoperatively.

Progressive visual loss and ophthalmoplegia.

A 51-year-old woman with hyperthyroidism presented with a 4-week history of bilateral progressive visual loss despite treatment with oral prednisone. Her visual function improved after bilateral orbital decompression. The indications for and advantages and disadvantages of radiation therapy and orbital decompression in TAO are discussed.

Chiasmopathy?

A 57-year-old man presented with progressive visual loss in both eyes, bitemporal field defect, and a history of poor nutrition, alcohol abuse, and excessive cigar smoking. Magnetic resonance imaging was normal. The visual acuity and field defect improved with supplementation with vitamins and reduction of alcohol and tobacco consumption.

Not so slowly progressive visual loss.

A 51-year-old man presented with bilateral progressive visual loss during a 2-month period. Visual acuity was 20/60 in both eyes with bilateral constricted visual fields. Funduscopy revealed bilateral disk pallor and arteriolar attenuation.

Refractive changes during 72-hour exposure to high altitude after refractive surgery.

Purpose: The authors prospectively analyzed refractive and pachymetric parameters during exposure to high altitude after radial keratotomy (RK) and photorefractive keratectomy (PRK).

Methods: The authors measured manifest and cycloplegic refraction, keratometry, computed video keratography, and central and peripheral pachymetry in six subjects who have undergone RK (11 eyes), six who have undergone PRK (12 eyes), and nine with myopia (17 eyes) at sea level and on three consecutive days at 14,100 feet. All measurements were repeated 1 week after subjects returned to sea level.