| OCR Text |
Show Journal of Neuro- Ophthalmology 16( 2): 156- 160, 1996. © 1996 Lippincott- Raven Publishers, Philadelphia Literature Abstracts Antiphospholipid Antibody Syndrome Associated with Microscotomata. Hartnett ME, Pruett RC, DaSilva KC, Burkart PT. Am J Ophthalmol 1994; 118: 397- 8 ( Sept). [ Inquires to Dr. M. E. Hartnett, Schepens Retina Associates, 100 Charles River Plaza, Boston, MA 02114.] In 1982, a 47- year- old woman with a three- year history of recurrent relative scotoma left eye was examined. Her subsequent history is given through 1993 when partial thromboplastin time was found to be prolonged and positive antiphospholipid antibodies were detected. No other laboratory tests were abnormal, including ANA, serum protein electrophoresis, protein S and C levels, and she seemed to improve on Coumadin therapy. Bilateral, Intraconal Non- Hodgkin's Lymphoma in a Patient with Acquired Immunodeficiency Syndrome. Logani S, Logani SC, Ali BH, Goldberg RA. Am ] Ophthalmol 1994; 118: 401- 2 ( Sept). [ Inquiries to Dr. R. A. Goldberg, Jules Stein Eye Institute, 100 Stein Plaza, UCLA, Los Angeles, CA 90024- 7006.] A 35- year- old man with HIV and a complaint of blurred vision on examination was found to have bilateral proptosis with " radiologic examination" and ultrasonography demonstrating bilateral intraconal masses. Abdominal computerized tomography disclosed a mass, biopsy of which showed small cell, noncleaved, non- Hodgkin's, B- cell lymphoma. A similar 35- year- old HIV- positive man had similar orbital findings and had similar pathologic findings on fine- needle orbital biopsy. Clinical and Echographic Findings in Idiopathic Orbital Myositis. Siatkowski RM, Capo H, Byrne SF, Gendron EK, Flynn JT, Munoz M, Feuer WJ. Am J Ophthalmol 1994; 118: 343- 50 ( Sept). [ Reprint requests to Dr. R. M. Siatkowski, 900 N. W. 17th St., Miami, FL 33136.] Lyn A. Sedwick, MD Retrospective chart review of 100 patients thought to have idiopathic orbital myositis revealed 75 patients with complete data and no confounding possible diagnoses ( e. g., thyroid eye disease). In two thirds of patients, a single muscle was involved, and in about half the affected muscle functioned normally. In the other half there was about an equal distribution of paretic, restrictive, or combined paretic and restrictive myopathy. Their data suggest that early echography can show an enlarged muscle with normal function, but within days the muscle becomes paretic and later restricted. Two thirds of patients responded very well to oral corticosteroid therapy, and the authors advocate starting this therapy as soon as possible to avoid permanent restrictive changes in the muscles affected by thyroid eye disease. Comparison of Standardized Echography with Magnetic Resonance Imaging to Measure Extraocular Muscle Size. Demer JL, Kerman BM. Am J Ophthalmol 1994; 118: 351- 61 ( Sept). [ Reprint requests to Dr. J. L. Demer, Jules Stein Eye Institute, 100 Stein Plaza, UCLA, Los Angeles, CA 90024- 7002.] The authors compare the size of extraocular muscles in 20 subjects ( 39 orbits) using magnetic resonance imaging with surface coil technique and echography. Relapsing and Remitting Central Retinal Artery Occlusion. Werner MS, Latchaw R, Baker L, Wirtschafter JD. Am ] Ophthalmol 1994; 118: 393- 5 ( Sept). [ Inquiries to Dr. J. D. Wirtschafter, University of Minnesota, Box 493, 420 Delaware St. S. E., Minneapolis, MN 55455- 0501.] A 66- year- old patient with several episodes of amaurosis fugax was found to have multiple confluent cotton- wool spots below and above his cilioretinal artery with normal visual field. After LITERATURE ABSTRACTS 157 verapamil and aspirin therapy, he returned with stable visual function but worsening retinal picture. Carotid ultrasonography found a 30- 50% occlusion of the internal carotid artery. He underwent transfemoral catheterization and infusion of urokinase into the left ophthalmic artery, which was complicated by a transient expressive aphasia. Magnetic resonance imaging 24 h later showed temporal lobe edema. He did well visually, however. The authors discuss this rather unconventional treatment. Enterogenous Cyst of the Orbital Apex and Superior Orbital Fissure. Leventer DB, Merriam JC, De-fendini R, Behrens MM, Housepian ED, LeQuerica S, Blitzer A. Ophthalmology 1994; 101: 1614- 21 ( Sept). [ Reprint requests to Dr. J. C. Merriam, Edward S. Harkness Eye Institute, 635 West 165th St., New York, NY 10032.] This case report involves a woman who presented at age 23 with sudden retrobulbar pain and visual loss in the left eye, which was treated as optic neuritis in 1986 with oral corticosteroids. One month later, computerized tomography and magnetic resonance scanning showed a mass in the left orbital apex, and laboratory workup was negative for sarcoidosis or vasculitis. Needle biopsy was " not diagnostic," and her vision did return to near normal. Her acuity worsened within several months, and exploration of the orbit was negative for a mass. Visual function again improved on oral corticosteroids. Over the following two years, the patient had intermittent treatment with corticosteroids but became Cushingoid. Repeat imaging again demonstrated a posterior orbital mass; three years after original presentation, this was definitively biopsied and subtotally resected via a frontal craniotomy. In the year following, two more surgeries were performed via the orbit for recurrence of the tumor, and she ultimately developed ocular motility problems and optic atrophy with subnormal visual function. Pathologic diagnosis was an enterogenous cyst believed to have started intra-cranially with extension into the superior orbital fissure and orbital apex, the first reported case in this location. The entity is discussed in detail. Fixation Duress in the Pathogenesis of Upper Eyelid Retraction in Thyroid Orbitopathy. A Prospective Study. Hamed LM, Lessner AM. Ophthalmology 1994; 101: 1608- 13 ( Sept). [ Reprint requests to Dr. L. M. Hamed, Pediatric Ophthalmology Clinic, Department of Ophthalmology, University of Florida College of Medicine, Box 100284, JHM-HSC, Gainesville, FL 32610- 0284.] Six patients with thyroid eye disease and presumed " fixation duress" that caused upper lid retraction are described. Each had improved lid retraction in downgaze and significant supraduction deficit bilaterally. All had strabismus, and bilateral inferior rectus recessions were performed that improved the eyelid position. This condition is defined and discussed. Spontaneous Hemorrhage within the Rectus Muscle. Hakin KN, McNab AA, Sullivan TJ. Ophthalmology 1994; 101: 1631- 4 ( Sept). [ Correspondence to Dr. A. A. McNab, 200 Drummond St., Carlton, Melbourne, Victoria, 3053, Australia.] Three patients ( ages 31, 68, and 76) who had an acute intramuscular hemorrhage involving one rectus muscle, are presented in detail, including results of computerized tomographic and magnetic resonance scans. One patient had hypertension and another a history of intense exercise the day before the hemorrhage, but the third had no risk factor. All had no change in visual function and resolved spontaneously. This entity is discussed. Cyclodeviation in Skew Deviation. Galetta SL, Liu GT, Raps EC, Solomon D, Volpe NJ. Am J Ophthalmol 1994; 118: 509- 14 ( Oct). [ Reprint requests to Dr. S. L. Galetta, Division of Neuro- ophthalmol-ogy, Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.] Four patients are presented, with pathology at or below the level of the pons, who demonstrated a hypertropia pattern not consistent with superior oblique muscle dysfunction. They all had significant cyclotorsion. The authors discuss possible mechanisms for these findings in cases of skew. Orbital Hemorrhage Induced by Barotrauma. An-denmatten R, Piguet B, Klainguti G. Am ] Ophthal- ! Neuro- Ophthalmol, Vol. 16, No. 2, 1996 158 LITERATURE ABSTRACTS mol 1994; 118: 536- 7 ( Oct). [ Inquiries to Dr. B. Piguet, University Eye Clinic, Jules Gonin Hospital, Av. de France 15, 1004 Lausanne, Switzerland.] A 22- year- old inexperienced diver felt pain in the right orbit during a dive to 20 m. She had pro-ptosis and limited supraduction of the right eye as well as conjunctiva hemorrhages. Computerized tomographic scanning showed a probable hemorrhage in the superior right orbit, which the authors believe to be subperiosteal. It seems it might alternatively be within the superior rectus muscle, given the motility disorder. Fortunately, it resolved spontaneously. The Ischemic Optic Neuropathy Decompression Trial. Diegel JT. Reply. Kelman SE. Arch Ophthalmol 1994; 112: 1275- 6 ( Oct). [ No reprint information given.] Another point/ counterpoint letter to the editor criticizing the economic design of the Ischemic Optic Neuropathy Decompression Trial, which in essence expects patients' private insurance to foot the bill for all visits and surgery, a decidedly non-minimalist attitude in an insurance climate of capitation and emphasis on primary care. Dr. Kelman responds that the care dictated by the trial falls within the realm of care " normally provided by neuro- ophthalmologists to patients with nonar-teritic ischemic optic neuropathy" and that data analysis is covered by the National Eye Institute funding. Nevertheless, it seems to this practicing neuro- ophthalmologist that Dr. Diegel has a point, as the number of visits and testing done on patients in the trial is significantly more than seems to be medically necessary when such patients are followed in the community. Optic Neuritis Treatment Trial Study. Coyle JT. Reply. Beck RW. Arch Ophthalmol 1994; 112: 1274- 5 ( Oct). [ No reprint information given.] For those of us wondering about the cost effectiveness of scanning patients with optic neuritis vis- a- vis treatment decisions, this letter to the editor and reply by Dr. Beck are required reading. Dr. Coyle notes previous studies showing much greater conversion to multiple sclerosis for women than men with an initial optic neuritis and contends that not separating gender and perhaps race as well in the Optic Neuritis Treatment Trial may lump instead of splitting in terms of outcomes. He also suggests forgoing the magnetic resonance scan and using the three days of high- dose intravenous corticosteroids in all medically approved patients with optic neuritis. In a vigorous reply, Dr. Beck notes that the results to date of the Optic Neuritis Treatment Trial are valid no matter how one lumps or splits the groups and that their patients' conversion to multiple sclerosis has been similar for men and women. Furthermore, the MR may be most useful in demonstrating which patients truly do not and will not have multiple sclerosis, as its predictive value has been excellent to date in the trial. Sequential Embolization and Excision of an Orbital Arteriovenous Malformation. Christie DB, Kwon YH, Choi I, Jakobiec FA, Woog JJ. Arch Ophthalmol 1994; 112: 1377- 9 ( Oct). [ Reprints not available.] An 11- year- old girl with a several- week history of right lower eyelid edema was found to have a subcutaneous pulsatile mass in this location. Color Doppler, magnetic resonance scanning, and right arteriogram demonstrated an arteriovenous malformation of the inferior orbit and the right lower eyelid. The lesion enlarged, and the patient underwent successful polyvinyl alcohol embolization followed 48 h later by resection. Treatment of Acquired Nystagmus with Botulinum Neurotoxin A. Repka MX, Savino PJ, Rei-necke RD. Arch Ophthalmol 1994; 112: 1320- 4 ( Oct). [ Reprint requests to Dr. M. X. Repka, The Johns Hopkins Hospital, 600 N. Wolfe St., Bl- 35 Wilmer, Baltimore, MD 21287- 9009.] Six patients with acquired, visual- disabling nystagmus underwent retrobulbar botulinum A injections. Five of six patients rated their improvement good or excellent, and two patients with oc-ulopalatal myoclonus had a prolonged therapeutic 7 Neuro- Ophthalmol, Vol. 16, No. 2, 1996 LITERATURE ABSTRACTS 159 response ( four to six months) compared to that of the other patients ( six weeks to four months) with diagnoses of pontine hemorrhage and multiple sclerosis. The authors feel this is a reasonable treatment alternative for those patients and recommend it be tried as an adjunct to retroequatorial rectus muscle recession for acquired nystagmus. Epithelioid Sarcoma of the Orbit. White VA, Heathcote JG, Hurwitz JJ, Freeman JL, Rootman J. Ophthalmology 1994; 101: 1680- 7 ( Oct). [ Correspondence to Dr. V. White, Department of Pathology, Vancouver General Hospital, 910 West 10th Ave., Vancouver, BC V5Z 4E3, Canada.] Two patients, ages 17 and 34 years, are presented with a subacute temporal orbital mass, in each of whom it was pathologically identified as epithelioid sarcoma. One patient died of her disease within 2V2 years. The authors discuss this tumor and note that these are the first cases reported with primary orbital involvement. Congenital Optic Disk Anomalies. Brodsky MC. Surv Ophthalmol 1994; 39: 89- 112 ( Sept- Oct). [ Reprint requests to Dr. M. Brodsky, Arkansas Children's Hospital, 800 Marshall St., Little Rock, AR 72202.] This major review is replete with excellent color optic disc photographs. Good magnetic resonance studies of associated anomalies are also included. This is a very nice reference. Intraocular Lymphoma Presenting as Retinal Vasculitis. Brown SM, Jampol LM, Cantrill HL. Surv Ophthalmol 1994; 39: 133- 40 ( Sept- Oct). [ Reprint requests to Dr. L. M. Jampol, 645 N. Michigan Ave. # 440, Chicago, IL 60611.] Two young men are presented with findings of retinal vasculitis ( arterial and venous sheathing, hemorrhage, branch arterial occlusion) who ultimately developed central nervous system symptoms and were found on brain biopsy to have T- cell lymphoma. The authors review the literature in regard to marker- specific intraocular lymphoma and its retinal findings. They conclude that lymphoma needs to be considered in the differential diagnosis of any patient with unexplained retinal vasculitis. Is All Nondefinable Optic Atrophy Leber's Hereditary Optic Neuropathy? Swartz N, Savino PJ. Surg Ophthalmol 1994; 39: 146- 50 ( Sept- Oct). [ Reprint requests to Dr. P. J. Savino, Neuro- Ophthal-mology Service, Wills Eye Hospital, 900 Walnut St., Philadelphia, PA 19107.] A 19- year- old woman, with progressive visual loss dating to age 3, is discussed. She was found to have the Wallace mutation at base pair 11778 ( mitochondrial DNA). The authors discuss our expanding knowledge about and definition of Leber's hereditary optic neuropathy and suggest it may be appropriate to test for this disease in both men and women with unexplained optic neuropathy. Echinococcus Cysts of the Orbit and Substernum. Mohammad AEA, Ray CJ, Karcioglu ZA. Am } Ophthalmol 1994; 118: 676- 8 ( Nov). [ Inquiries to Dr. Z. A. Karcioglu, Department of Ophthalmology, Tulane University Medical Center, 1430 Tulane Ave., Rm. 5016, New Orleans, LA 70112- 2699.] A 15- year- old girl with " progressive right pro-ptosis" was found to have a cystic mass of the anterior, medial right orbit. This was removed, and pathologic diagnosis was an Echinococcus cyst. Inferior Rectus Muscle Overaction after Cataract Extraction. Munoz M. Am J Ophthalmol 1994; 118: 664- 6 ( Nov). [ Inquiries to Dr. M. Munoz, Bascom Palmer Eye Institute, 900 N. W. 17th St., Miami, FL 33136.] Two patients are described with inferior rectus muscle overaction following cataract surgery. The author postulates that the local anesthetic agent may have induced a degeneration of some muscle fibers in the inferior rectus muscle, which ultimately resulted in overaction when these fibers regenerated. / Neuw- Ophthalmol, Vol. 16, No. 2, 1996 160 LITERATURE ABSTRACTS Central Retinal Artery Occlusion: The Presenting Sign in Radiation Retinopathy. Noble KG. Arch Ophthalmol 1994; 112: 1409- 10 ( Nov). [ Reprint requests to Dr. K. G. Noble, Department of Ophthalmology, New York University Medical Center, 550 First Ave., New York, NY 10016.] A 42- year- old woman developed a central retinal artery occlusion and, on examination, also had dot and blot hemorrhages in the other eye. Fluorescein angiography disclosed marked delay in choroidal filling in the eye with the central retinal artery occlusion. She had had radiation therapy for thyroid eye disease 15 months previously, and an extensive workup for coagulopathy and carotid occlusive disease was negative. It is presumed her arterial occlusion resulted from radiation- induced obliterative arteritis. J Neuro- Ophthalmol, Vol. 16, No. 2, 1996 |
