Laser trabecular sclerosis for chronic hypotony after vitreoretinal surgery.

Purpose: To perform a pilot study of laser trabecular sclerosis (LTS) for chronic ocular hypotony after vitreoretinal surgery.

Design: Prospective noncomparative case series.

Participants: Three patients with chronic hypotony after vitreoretinal procedures underwent LTS.

Anterior ischemic optic neuropathy in eyes with optic disc drusen.

Background: There have been anecdotal reports of anterior ischemic optic neuropathy (AION) occurring in eyes with optic disc drusen (ODD), but the clinical features of this condition have not been well characterized.

Objectives: To better describe the clinical features of AION associated with ODD and to compare the clinical features of this condition with those of "garden variety" nonarteritic AION.

Methods: We reviewed the medical records of 20 patients who experienced an episode of AION in an eye with ODD.

Sprint car visual loss.

A 16-year-old boy developed bilateral visual loss 24 hours after a sprint car accident. Bilateral central scotomas were demonstrated but were unexplained by a thorough eye examination and neuro-imaging. A diagnosis of commotio retinae was established by multi-focal ERG testing.

Dolichoectatic arterial compression of the anterior visual pathways: neuro-ophthalmic features and clinical course.

Aim: To characterise the clinical findings and natural history of anterior visual pathway compression by dolichoectatic intracranial vessels.

Methods: A retrospective case review of patients evaluated in an outpatient neuro-ophthalmology clinic.

Results: 10 patients with this condition were identified.

Diabetic retinopathy and diabetic macular edema: pathophysiology, screening, and novel therapies.

Diabetic retinopathy (DR) and diabetic macular edema (DME) are leading causes of blindness in the working-age population of most developed countries. The increasing number of individuals with diabetes worldwide suggests that DR and DME will continue to be major contributors to vision loss and associated functional impairment for years to come. Early detection of retinopathy in individuals with diabetes is critical in preventing visual loss, but current methods of screening fail to identify a sizable number of high-risk patients.

Idiopathic recurrent neuroretinitis: effects of long-term immunosuppression.

Objective: To determine the efficacy of long-term immunosuppressive therapy in patients with recurrent idiopathic neuroretinitis.

Methods: A retrospective review of 30 patients with recurrent idiopathic neuroretinitis identified 7 who received ongoing immunosuppression with prednisone and/or azathioprine for whom adequate follow-up information was available. We calculated the number of attacks per unit of time for each patient before and after treatment to derive mean attack rates for the group.

Novel approaches for retinal drug delivery.

Novel methods of ophthalmic drug delivery are being developed to facilitate treatment of a variety of eye diseases. Pharmaceuticals administered intravitreally are able to bypass the blood-ocular barrier to achieve constant therapeutic levels in the eye, while minimizing systemic side effects. Sustained-release intravitreal implants are being developed to enhance further the intravitreal route of administration.

Ocular perfusion abnormalities in diabetes.

Purpose: To review the role of ocular perfusion in the pathophysiology of diabetic retinopathy, one of the leading causes of irreversible blindness in the industrialized world.

Methods: We carried out a Medline search of the literature published in English or with English abstracts from 1966 to 2000 using various combinations of relevant key words.

Results: Hyperglycaemia leads to a wide variety of vascular abnormalities at the microvascular and macrovascular levels, including abnormal autoregulation.

Superior segmental optic nerve hypoplasia.

A visually asymptomatic 27-year-old man was found to have inferior altitudinal visual field defects binocularly. Ophthalmoscopy revealed superior segmental optic pallor with superior nerve fiber layer atrophy, nicely highlighted in red-free photographs. The patient's mother had insulin-dependent diabetes mellitus.

Optic perineuritis: clinical and radiographic features.

Background: Optic perineuritis is an uncommon variety of orbital inflammatory disease that is distinct from demyelinating optic neuritis.

Objective: To describe the clinical and radiographic features of idiopathic optic perineuritis, with particular emphasis on those features that help to distinguish this condition from optic neuritis.

Methods: We reviewed the medical records of 14 patients with optic perineuritis who were seen in 2 neuro-ophthalmology clinics.

Disorders of the pupil.

The pupil is one objective marker of vision and autonomic pathways. A good understanding of its anatomy and careful examination techniques are the essential tools for proper clinical diagnosis of pupillary disorders.

Papilledema and obstructive sleep apnea syndrome.

Objectives: To characterize the pathogenesis and clinical features of optic disc edema associated with obstructive sleep apnea syndrome (SAS).

Methods: A series of 4 patients with SAS and papilledema (PE) underwent complete neuro-ophthalmologic evaluation and lumbar puncture. In 1 patient, continuous 24-hour intracranial pressure (ICP) monitoring was also performed.

Extraocular muscle responses to orbital cooling (ice test) for ocular myasthenia gravis diagnosis.

Background: As a result of clinical and laboratory investigations of temperature correlates of myasthenia gravis, orbital cooling (ice test) has been developed as a reliable test for ocular myasthenia diagnosis through blepharoptosis response. The test has not been utilized in a prospective manner for myasthenia diagnosis through extraocular muscle responses.

Methods: Fifteen patients with acquired motility disorders were studied with the use of orbital cooling and other tests for myasthenia gravis.

Optic neuropathies for the neurologist.

Before embarking on expensive ancillary testing, it is crucial for the neurologist to distinguish visual loss due to optic nerve dysfunction from other causes of visual loss. This can usually be accomplished based on specific features of the history and bedside examination. Once it has been established that a patient has some form of optic neuropathy, several clinical features are helpful in determining the etiology.

Physiology, assessment, and disorders of the pupil.

Proper examination of the pupil provides an objective measure of the integrity of the pregeniculate afferent visual pathway and allows assessment of sympathetic and parasympathetic innervation to the eye. Infrared videography and pupillography are increasingly used to study the dynamic behavior of the pupil in common disorders, such as Horner's syndrome and tonic pupil.

Oculomotor nerve schwannoma associated with ophthalmoplegic migraine.

Purpose: To describe a patient with an oculomotor nerve schwannoma who had symptoms of ophthalmoplegic migraine.

Methods: Case report.

Results: A 23-year-old woman had a history of recurrent headache accompanied by transient right oculomotor palsy since age 7 years.

Hyperhomocysteinaemia in young patients with non-arteritic anterior ischaemic optic neuropathy.

Background/aim: Elevated plasma homocysteine is a newly identified vascular risk factor among patients under age 55 years with cerebrovascular, cardiovascular, or peripheral vascular disease. This study sought to evaluate retrospectively the plasma homocysteine status among healthy younger patients with ischaemic optic disc disease.

Methods: 12 non-diabetic patients who had been diagnosed with non-arteritic anterior ischaemic optic neuropathy (NAION) before the age of 50 years were identified from chart review.

Optic neuritis.

Advances in magnetic resonance (MR) orbital imaging using fat suppression techniques and contrast enhancement have increased our ability to visualize the area of inflammation in patients with optic neuritis. Our understanding of the natural history of optic neuritis continues to expand. The high risk of developing multiple sclerosis (MS) after an episode of optic neuritis has been confirmed with longitudinal studies.

Through a shade darkly.

A 43-year-old man complained of difficulty seeing in dim light (nyctalopia). A prolonged photostress test and abnormal electroretinogram confirmed retinal rather than optic nerve dysfunction. Vitamin A deficiency secondary to remote ileal-jejunal bypass was diagnosed, and his visual symptoms and signs reversed with oral vitamin A supplementation.

Unilateral optic disc edema following trabeculectomy.

Two cases of a benign form of optic disc edema after successful trabeculectomy are reported. In both patients, optic disc edema was noted 2 to 4 weeks after trabeculectomy. The edema occurred without loss of visual acuity or field.

Clinical comparison of the Alcon 20,000 Legacy and 10,000 Master phacoemulsification units.

Purpose: To determine whether the use of the Alcon 20,000 Legacy phacoemulsification unit requires less phacoemulsification time and causes fewer intraoperative complications than the Alcon 10,000 Master unit.

Setting: Private practices in Kansas City, Missouri, and Marshalltown, Iowa, USA.

Methods: This prospective study comprised 400 consecutive cases of phacoemulsification with intraocular lens (IOL) implantation performed using the Alcon 20,000 Legacy unit by a high-volume phacoemulsification surgeon (n = 200) and a moderate-volume surgeon (n = 200).

Bilateral anterior ischemic optic neuropathy following influenza vaccination.

Optic neuritis is an occasional complication of vaccination. Visual loss can be unilateral or bilateral, and most patients recover substantially without treatment. The presumptive mechanism is an immune-mediated demyelinating injury of the optic nerve.