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Show LITERATURE ABSTRACTS 117 Ophthalmology 1986;93:1373-82 (Nov). [Reprint requests to Dr. G. C. Brown, 910 E. Willow Grove Ave., Wyndmoor, PA 19118.] These authors selected eight patients with acute combined obstruction of retinal and choroidal circulation, the equivalent of an ophthalmic artery obstruction, from a larger group of 150 patients with "a fundus picture compatible with acute central retinal artery occlusion" seen at Wills Eye Hospital between 1972 and 1985. The patients all had acute, total visual loss and retinal opacification in the posterior pole and one or more of other fundus characteristics suggestive of choroidal infarction either observable directly, by fluorescein angiogram, or by electroretinography. Most patients had identifiable embolic sources, and two patients had bilateral, simultaneous visual loss. This paper nicely outlines what one expects to see in such obstructions but offers no treatment options for these patients, whose visual prognosis is "generally grim." Lyn A. Sedwick, M.D. Superior Oblique Paralysis. von Noorden GK, Murray E, Wong SY. Arch Ophthalmol 1986;104: 1771-6 (Dec). [Reprint requests to Dr. von Noorden, Ophthalmology Service, Texas Children's Hospital, Box 20269, Houston, TX 77225.] Two hundred seventy consecutive patients with superior oblique palsy were examined by the authors between 1973 and 1984. Congenital palsies made up 39% of the total but were rarely bilateral, whereas traumatic palsies made up 30% of the total and were bilateral 20% of the time. Idiopathic (23%) and other (3%) causes completed the spectrum. No patients with "pure cyclotropia" without associated hypertropia were included, although three cases were seen and believed to be secondary to superior oblique palsy. Some of the idiopathic cases were probably congenital, but for inclusion in the congenital group, a history of, or photographic documentation of, head tilt was required. The authors found that diplopia was more frequently seen in patients with acquired palsies (57 vs. 21 %), and image tilt was exclusively a complaint of those with acquired palsies (23%). Tests that are helpful in detecting bilateral superior oblique palsy are discussed, but none are believed to be 100% accurate. Details of the selection of ap-propriate surgical treatment are discussed. The authors' patients experienced excellent surgical results, with an average of 1.45 surgerical procedures per operated patient. This review study has no surprises, just well-presented information regarding the causes of, signs and symptoms of, and surgical correction of unilateral and bilateral superior oblique palsy. Lyn A. Sedwick, M.D. Ocular Adnexal Monoclonal Lymphoid Tumors with a Favorable Prognosis. Jakobiec FA, Iwamoto T, Patell M, Knowles OM II. Ophthalmology 1986;93:1547-57 (Dec). [Reprint requests to Frederick A. Jakobiec, M.D., Manhattan Eye, Ear & Throat Hospital, 210 East 64th Street, New York, NY 10021.] Over a 5-year period (1977-1982), 14 patients with monoclonal B-Iymphocytic tumors of the orbit or conjunctiva were identified from a larger group of 51 patients with all types of ocular and adnexal lymphoid tumors. Following local radiation therapy to the orbit (2,000-3,000 rads total), long-term follow-up (average 7.5 years) disclosed only two patients with nonocular recurrent lymphoid tumors. There is lengthy histopathologic discussion of these tumors, and in summary, they are moderately to well differentiated. The authors recommend minimal radiation therapy for these lesions (1,800-2,000 rads), which will need light and electron microscopy for identification, and predict that these patients have little chance of developing nonocular lymphoid tumors on followup. Lyn A. Sedwick, M.D. Ptosis Associated with Botulinum Toxin Treatment of Strabismus and Blepharospasm. Burns eL, Gammon JA, Gemmill Me. Ophthalmology 1986;93:1621-7 (Dec). [Reprint requests to J. Allen Gammon, M.D., King Khaled Eye Specialist Hospital, P.O. Box 7191, Riyadh, Saudi Arabia 11462.] In a group of 44 patients treated with botulinum injections, 39 for strabismus and five for blepharospasm, some degree of ptosis was encountered in 53% of injections, with 21% resulting in visually J Clin Neuro-ophthalmol, Vol. 7, No.2, 1987 U8 LITERATURE ABSTRACTS disabling ptosis. Ptosis resolved in every case, with a mean duration of -3 months in patients with severe ptosis. There was no relation between the development of ptosis and patient age, amount of botulinum given, or muscle injected. The authors caution that a previously operated muscle "may carry an increased risk for severe ptosis" but do not present data to substantiate this. It seems that ptosis is an important risk with the use of botulinum injected into extraocular muscles, in contradistinction to the apparently minimal risk when botulinum is used for blepharospasm. Lyn A. Sedwick, M.D. Ocular Neuromyotonia After Radiation Therapy. Lessell 5, Lessell 1M, Rizzo JF III. Am J Ophthalmol 1986;102:766-70 (Dec). [Reprint requests to Simmons Lessell' M.D., 243 Charles St., Boston, MA 02114.] These authors describe four patients with ocular neuromyotonia after radiation therapy, two with radiation to the sella and suprasellar space and two at the base of the brain. They all complained of episodic diplopia, horizontal or vertical, and only one had a clearly abnormal result of motility examination between episodes. The authors conclude that radiation therapy is the most common cause of ocular neuromyotonia and reviewed the literature, including the paper by Shults et al. earlier abstracted for the Journal of Clinical Neuro-opltthalmology (Arch OphthalmolI986;104:1028). Lyn A. Sedwick, M.D. Congenital Generalized Multicentric Myofibromatosis with Orbital Involvement. Nasr AM, Blodi FC, Lindahl 5, Jinkins J. Am J Ophthalmol 1986;102:779-87 (Dec). [Reprint requests to Amin M. Nasr, M.D., Division of Oculoplastic Surgery, Kind Khaled Eye Specialist Hospital, P.O. Box 7191, Ridyadh, Saudi Arabia 11462.] A 5-month-old child of first cousins was born with tumor masses on one buttock and over the right eye, which pathologically were believed to be leiomyoma. He developed proptosis of the left eye from an inferior and posterior mass, which wa",. F:,;thG~0fi(~;31.!y verined as a myofibroma with JClin Neuro-ophthalmol. Vol. 7, No 2. 1987 sections reviewed by the Armed Forces Institute of Pathology. The authors discuss this disease and the rare involvement of the orbit. Lyn A. Sedwick, M.D. Ophthalmic Manifestations of Narcolepsy. Norman ME, Dyer JA. Am J Opltthalmol 1987;103: 81-6 Gan). [Reprint requests to John A. Dyer, M.D., Mayo Clinic, 200 First St. S.W., Rochester, MN 55905.] Records of 755 patients with narcolepsy at the Mayo Clinic were reviewed retrospectively, and 405 patients were identified who had not been previously diagnosed or treated. Of these 405, 55 (14%) had the diagnosis made by an ophthalmologist, common symptoms being excessive daytime somnolence, driving-related somnolence, blurred vision, sleep precipitated by reading, poor nocturnal sleep, and diplopia. Two case reports are given, the major complaint being diplopia with reading or with driving. Both patients had abnormal pupillography consistent with "inattentiveness" or "a disorder of arousal." This interesting paper predicts that ophthalmologists may be in a position to diagnose this disease with careful history-taking and examination. Lyn A. Sedwick, M.D. Exophytic Suprasellar Glioma: A Rare Cause of Chiasmatic Compression. Coppeto JR, Monteiro MLR, Uphoff DF. Arch Ophtltalmol 1987;105:28 Gan). [No reprint information given.] A 15-year-old boy with bilateral visual loss and superotemporal visual field cuts was found to have a suprasellar mass that compressed the chiasm and right optic nerve. The tumor, a pilocytic astrocytoma, was near-totally resected, and the boy's visual acuity and visual fields normalized. The authors contrast this exophytic glioma with its compressive optic neuropathy to glioma arising from the optic nerves or chiasm, and emphasize that surgical removal is indicated when neuroradiologic maneuvers suggest an exophytic lesion. Lyn A. Sedwick, M.D. |