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Show Journal of Neuro- Ophthalmology 25( 4): 255- 260, 2995. 1995 Lippincott- Raven Publishers, Philadelphia Literature Abstracts Epidemic Neuropathy in Cuba Not Associated with Mitochondrial DNA Mutations Found in Leber's Hereditary Optic Neuropathy Patients. Newman NJ, Torroni A, Brown MD, Lott MT, Fernandez MM, Wallace DG, Cuba Neuropathy Field Investigation Team. Am J Ophthalmol 1994; 118: 158- 68 ( Aug). [ Reprint requests to Dr. D. C. Wallace, Department of Genetics and Molecular Medicine, 1462 Clifton Rd. N. E., Room 403, Emory University School of Medicine, Atlanta, GA 30322.] Dr. Newman and others examined blood samples from 135 Cubans with optic neuropathy as part of the recent epidemic neuropathy and found only a handful of cases with mitochondrial DNA mutations known to be associated with Leber's disease. Ophthalmic Manifestations of Rochalimaea Species. Golnik KC, Marotto ME, Fanous MM, Heitter D, King LP, Halpern JI, Holley Jr PH. Am ] Ophthalmol 1994; 118: 145- 51 ( Aug). [ No reprint information given.] The Cat Scratch Disease- Bacillary Angiomatosis Puzzle. Grossniklaus HE. Am } Ophthalmol 1994; 118: 246- 8 ( Aug). [ No reprint information given.] Four patients are described in the first article with a clinical picture of cat scratch disease but also intraocular inflammation and neuroretinitis. The patients were successfully treated with ciprofloxacin hydrochloride or, in one case, doxycycline hy-clate. Dr. Grossniklaus reviews this and other reported ocular manifestations of Rochalimaea infection in the eye in his editorial. Skew Deviation After Vestibular Neuritis. Safran AB, Vibert D, Issoua D, Hausler R. Am ] Ophthalmol 1994; 118: 238- 45 ( Aug). [ Reprint requests to Dr. A. B. Safran, Neuro- Ophthalmology Unit, Hopital Cantonal Universitaire, 1211 Geneva 4, Switzerland.] Diplopia from skew deviation was experienced by five patients with acute vestibular neuritis. All Lyn A. Sedwick, M. D. eventually resolved their ocular symptoms with resolution of the vestibular disease. The Natural History and Results of Treatment of Superior Oblique Myokymia. Brazis PW, Miller NR, Henderer JD, Lee AG. Arch Ophthalmol 1994; 112: 1063- 67 ( Aug). [ Reprint requests to Dr. N. R. Miller, Maumenee B- 109, The Wilmer Ophthalmo-logical Institute, The Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287.] Records of all 16 patients with superior oblique myokymia seen at Wilmer Ophthalmological Institute between 1976 and 1993 were reviewed. Follow- up was available for 14 patients and ranged from 3 to 29 years. Five of seven patients who had received no therapy were still symptomatic, and one of three patients treated medically continued to do well on carbamazepine. Four patients had superior oblique tenectomy with resolution of all symptoms after surgery. The authors suggest that this disease may be more protracted and disabling than previously thought and that surgical therapy may be more efficacious when symptoms are disabling. Optic Nerve Sheath Fenestration for Progressive Ischemic Optic Neuropathy. Results in Second Series Consisting of 21 Eyes. Glaser JS, Teimory M, Schatz NJ. Arch Ophthalmol 1994; 112: 1047- 50 ( Aug). [ Reprint requests to Dr. J. S. Glaser, Bas-com Palmer Eye Institute, 900 N. W. 17th St., Miami, FL 33136.] A second series of 21 patients who underwent optic nerve sheath decompression for progressive ischemic optic neuropathy at Bascom Palmer Eye Institute is detailed. As they had found previously with 26 similar patients, in their hands surgery did not result in any significant improvement in visual outcome with most patients unchanged, two with modest improvement, and two with worsening of visual function. Based on their experience, the authors do not endorse the surgery for treatment of progressive ischemic optic neuropathy. 256 LITERATURE ABSTRACTS Is Smoking a Risk Factor for NAION? Johnson LN, Botelho PJ, Kuo HC. Author's reply. Chung SM, Gay CA, McCrary III JA. Ophthalmology 1994; 101: 1322- 4 ( Aug). [ No reprint information given.] A very exacting critique of a recent article in ophthalmology linking smoking to nonarteritic ischemic optic neuropathy is given in this letter to the editor with some valid points advanced regarding control groups used. The authors of the original article ( Ophthalmology 1194; 101: 779- 82 abstracted for Journal of Neuro- ophthalmology) respond and challenge Dr. Johnson, Dr. Botelho, and Ms. Kuo to publish their own data, to which they refer in their letter as showing smoking not to be a risk factor for nonarteritic ischemic optic neuropathy. Lack of Global Vagal Propensity in Patients with Oculocardiac Reflex. Arnold RW, Gould AB, MacKenzie R, Dyer JA, Low PA. Ophthalmology 1994; 101: 1347- 52 ( Aug). [ Reprint requests to Dr. R. W. Arnold, Pediatric Ophthalmology and Strabismus, Ophthalmic Associates, 542 West Second Ave., Anchorage, AK 99501- 2242.] Six patients who experienced profound oculocardiac reflex ( 3- to 10- second asystole) during extraocular muscle surgery were studied with four vagotonic maneuvers. Only carotid sinus massage correlated with increased oculocardiac reflex, producing significantly more bradycardia in the six patients than in controls. This test might be useful in predicting patients likely to experience profound oculocardiac reflex during extraocular muscle surgery. Measuring Eye Movements in Graves' Ophthalmopathy. Mourits MP, Prummel MF, Wiersinga WM, Koornneef L. Ophthalmology 1994; 101: 1341- 6 ( Aug). [ Reprint requests to Dr. M. P. Mourits, Department of Ophthalmology, E03.136, Academic Hospital Utrecht, P. O. Box 85500, 3508 GA Utrecht, The Netherlands.] The authors used a hand perimeter to quantitate degree of eye movement in Graves' ophthalmopathy. They found this technique to produce much more precise measurements than the subject of assessments of endocrinologists or ophthalmologists. Antibodies to Botulinum Toxin. Borodic G, Pearce LB, Johnson E. Authors' Reply. Siatkowski RM, Biglan AW, Raikow RB. Ophthalmology 1994; 101: 1158- 9 ( July). [ No reprint information given.] Drs. Borodic and colleagues point out that a recently published report (" Serum Antibody Production in Botulinum A Toxin," Ophthalmology 1993; 100: 1861- 6, previously abstracted for the Journal of Neuro- ophthalmology) which showed 57% incidence of detectable antibody to botulinum A toxin in patients receiving this medication is not as important a clinical observation as would be measuring " neutralizing" antibodies, which render patients unresponsive to further treatment with botulinum A injections. Drs. Siatkowski and associates reply. Paraneoplastic Retinopathy Associated with Antiretinal Bipolar Cell Antibodies in Cutaneous Malignant Melanoma. Weinstein JM, Kelman SE, Bresnick GH, Kornguth SE. Ophthalmology 1994; 101: 1236- 43 Quly). [ Correspondence to Dr. J. M. Weinstein, Physicians Plus, 7102 Mineral Point Rd., Madison, WI 53717.] Two patients with malignant melanoma developed bilateral visual loss with findings consistent with paraneoplastic retinopathy. They were studied with electroretinography and had testing of their sera in vitro with normal cadaveric retinal tissue. These patients had an IgG antibody reactive to retinal bipolar cells, in contradistinction to the usual antiretinal cancer antibodies that react with retinal ganglion and photoreceptor cells. Painless Diplopia Caused by Extraocular Muscle Sarcoid. Patel AS, Kelman SE, Duncan GW, Ris-mondo V. Arch Ophthalmol 1994; 112: 879- 80 ( July). [ Reprint requests to Dr. A. S. Patel, Department of Ophthalmology, University of Maryland Hospital, 22 S. Greene St., Baltimore, MD 21201.] A 43- year- old black woman presented with a 3- month history of diplopia. She had bilateral duc-tion deficits and magnetic resonance imaging demonstrated enlargement of right superior, right inferior, and left medial recti, as well as lacrimal glands. Gadolinium gave diffuse enhancement of all rectus muscles. Thyroid function studies were normal as was a chest radiograph. Biopsy of the left medial rectus and lacrimal gland showed non-caseating granulomas and angiotensin- converting enzyme was elevated ( 2,700 nmol L _ 1 s_ 1 ) . She was successfully treated with oral corticosteroids. / Neuro- Ophthalmol, Vol. 15, No. 4, 1995 LITERATURE ABSTRACTS 257 Ischemic Optic Neuropathy After Lumbar Spine Surgery. Katz DM, Trobe JD, Cornblath WT, Kline LB. Arch Ophthalmol 1994; 112: 925- 31 ( July). [ Reprint requests to Dr. J. D. Trobe, W. K. Kellogg Eye Center, 1000 Wall St., Ann Arbor, MI 48105.] Four patients are described who developed ischemic optic neuropathy in one or both eyes after lumbar spine surgery, during which blood pressure was purposefully kept low to control bleeding. Blood loss was estimated at 2 liters in 3 patients, 2 of whom had transfusions with blood products. The authors review and catalogue the literature of similar cases ( ischemic optic neuropathy after nonophthalmic surgery) and conclude that hypotension, planned or not, and/ or blood loss are major risk factors for the development of postoperative ischemic optic neuropathy. Color Doppler Hemodynamics of Giant Cell Arteritis. Ho AC, Sergott RC, Regillo CD, Savino PJ, Lieb WE, Flaharty PM, Bosley TM. Arch Ophthalmol 1994; 112: 938- 45 ( July). [ Reprint requests to Dr. R. C. Sergott, Department of Neuro- ophthal-mology, Wills Eye Hospital, 900 Walnut St., Philadelphia, PA 19107.] Twenty- two consecutive patients with biopsy-proven giant cell arteritis were studied with color Doppler, with results reported for ophthalmic artery, central retinal artery, and short posterior ciliary arteries. An abnormal ophthalmic artery flow with high peak velocity associated with turbulent flow suggestive of focal stenosis seems to be unique to patients with giant cell arteritis compared to normals and other patients with nonar-teritic ischemic optic neuropathy. Visual Field Profile of Optic Neuritis. One- Year Follow- Up in the Optic Neuritis Treatment Trial. Keltner JL, Johnson CA, Spurr JO, Beck RW, for the Optic Neuritis Study Group. Arch Ophthalmol 1994; 112: 946- 53 ( July). [ Reprint requests to Dr. J. L. Keltner, Department of Ophthalmology, University of California- Davis, Davis, CA 95616.] A total of 6,536 visual fields from the 448 patients in the Optic Neuritis Treatment Trial during the first year of follow- up were analyzed for this report. Both affected and fellow eyes were tested on Humphrey Visual Field Analyzer machines. Many interesting observations emerge from the data, perhaps the most predictable being that the majority of affected eyes regained a normal visual field with time. More remarkable is the number of fellow eyes with field defects ( nearly 70% at entry) and the number of chiasmal and postchiasmal field defects uncovered on at least one field during the testing period ( 13.2%). Antiphospholipid Antibody Syndrome Associated with Microscotomata. Hartnett ME, Pruett RC, DaSilva KC, Burkart PT. Am J Ophthalmol 1994; 118: 397- 8 ( Sept). [ Inquiries 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 } Ophthalmol 1994; 118: 343- 50 ( Sept). [ Reprint requests to Dr. R. M. Siatkowski, 900 N. W. 17th St., Miami, FL 33136.] Retrospective chart review of 100 patients thought to have idiopathic orbital myositis revealed 75 patients with complete data and no con- / Neuro- Ophthalmol, Vol. 15, No. 4, 1995 258 LITERATURE ABSTRACTS founding 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 J 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 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). [ Correspondences to Dr. A. A. McNab, 200 Drummond St., Carlton, Melbourne, Victoria, 3053, Australia.] / Neuro- Ophthalmol, Vol. 15, No. 4, 1995 LITERATURE ABSTRACTS 259 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 factors. 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 Neurophthalmology, 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 J Ophthalmol 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 under- / Neuro- Ophthalmol, Vol. 15, No. 4, 1995 260 LITERATURE ABSTRACTS went 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 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. Surv Ophthalmol 1994; 39: 146- 50 ( Sept- Oct). [ Reprint requests to Dr. P. J. Savino, Neurophthalmology 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. / Neum- Ophthalmol, Vol. IS, No. 4, 1995 |