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Show journal of Neuro- Ophthalmology 15( 1): 56- 60, 1995. © 1995 Raven Press, Ltd., New York Literature Abstracts Bilateral Optic Neuritis After a Bee Sting. Berrios RR, Serrano LA. Am } Ophthalmol 1994; 117: 677- 8 ( May). [ Inquiries to Dr. R. R. Berrios, Department of Ophthalmology, University of Puerto Rico School of Medicine, Box 365067, San Juan, PR 00936- 5067.] An 11- year- old boy had a bee sting in the left brow, and 1 week later lost vision in his right eye, followed 4 days later by loss of vision in his left eye. When his visual acuity was hand motions right eye and counting fingers 1 ft left eye, he was treated with intravenous corticosteroids for presumed bee sting optic neuritis and did recover vision of right eye 20/ 25 and left eye 20/ 30. Intractable Diplopia After Overcorrection of Vertical Strabismus. Simon JW, Paskowski JR. Am J Ophthalmol 1994; 117: 675- 6 ( May). [ Inquiries to Dr. J. W. Simon, Department of Ophthalmology, Albany Medical College, One Pinnacle Place, Albany, NY 12203.] Three patients with surgical correction of a hy-pertropia had postoperative diplopia from a new, opposite hypertropia. These patients presumably had a contralateral superior oblique palsy, which was unrecognized preoperatively. Nocturnal Arterial Hypotension and Its Role in Optic Nerve Head and Ocular Ischemic Disorders. Hayreh SS, Zimmerman MB, Podhajsky P, Alward WLM. Am } Ophthalmol 1994; 117: 603- 24 ( May). [ Reprint requests to Dr. S. S. Hayreh, Department of Ophthalmology, University Hospitals and Clinics, Iowa City, IA 52242.] Dr. Hayreh and coworkers examined the role of nocturnal arterial hypotension in various optic nerve disorders, including glaucoma and ischemic optic neuropathy. He monitored the patients over a 24- hour period in the hospital with a blood pressure cuff that inflated every 20 minutes and mea- Lyn A. Sedwick, M. D. sured intraocular pressures at 10: 00 am, 1: 00 pm, 4: 00 pm, 7: 00 pm, 10: 00 pm, and 7: 00 am next day. He found a positive correlation between nocturnal arterial hypotension and visual field deterioration. There are a number of interesting conclusions reached by the authors from their data. Transient Blindness After Optic Nerve Sheath Fenestration. Flynn WJ, Westfall CT, Weisman JS. Am } Ophthalmol 1994; 117: 678- 9 ( May). [ Inquiries to Dr. W. J. Flynn, Wilford Hall Medical Center/ PSSE, 2200 Berquist Dr., Suite 1, Lackland AFB, TX 78236- 5300.] A 37- year- old man with pseudotumor cerebri and 20/ 400 vision right eye underwent an optic nerve sheath decompression. Five hours postoperatively he had no light perception vision in this eye, but had a normal fundus examination. He improved to 20/ 800 after 12 hours of intravenous corticosteroids, which the authors advocate as therapy in similar cases of blindness after optic nerve sheath decompression. Binocular Field Expansion in Adults After Surgery for Esotropia. Kushner BJ. Arch Ophthalmol 1994; 112: 639- 43 ( May). [ Reprint requests to Dr. B. J. Kushner, University Station, 2880 University Ave., Madison, WI 53705.] Strabismus Surgery in Adults. Functional and Psychosocial Implications. Kelt-ner JL. Arch Ophthalmol 1994; 112: 599- 600 ( May). [ Reprint requests to Dr. J. L. Keltner, Department of Ophthalmology, University of California- Davis, Davis, CA 95616.] Dr. Kushner found that 34 of 35 patients undergoing strabismus surgery for esotropia had expansion of their binocular field of vision, regardless of response of binocularity or suppression with Ba-golini lenses or degree of amblyopia. Dr. Keltner comments on this study and notes his previously reported observation that patients with binocular visual field loss had an excess incidence of auto LITERATURE ABSTRACTS 57 accidents. Whether increasing the binocular field of vision in patients with esotropia will increase the patient's ability to function in real life situations, such as driving, has yet to be proven but seems likely. Epidemic Optic Neuropathy in Cuba. Sadun AA, Martone JF, Muci- Mendoza R, Reyes L, DuBois L, Silva JC, Roman G, Caballero B. Arch Ophthalmol 1994; 112: 691- 9 ( May). [ Reprint requests to Dr. A. A. Sadun, Doheny Eye Institute, 1450 San Pablo St., Los Angeles, CA 90033.] Dr. Sadun and associates describe their findings and conclusions regarding an outbreak of bilateral optic neuropathy in Cuba during 1992 and 1993. Although the exact etiology for the visual loss in these patients was not proven, most responded with visual improvement to vitamin B complex and folic acid therapy. Supplying these vitamins to the Cuban population in general has apparently halted new cases, but at great expense. Other similar outbreaks of bilateral optic neuropathy are reviewed in this nice article, which is destined to be the authoritative description of this recent interesting epidemic. Graves Ophthalmopathy. Results of Transantral Orbital Decompression Performed Primarily for Cosmetic Indications. Fatourechi V, Garrity JA, Bartley GB, Bergstralh EJ, DeSanto LW, Gorman CA. Ophthalmology 1994; W1: 938- A2 ( May). [ Reprint requests to Dr. V. Fatourechi, Mayo Clinic, 200 First St. S. W., Rochester, MN 55905.] The records of 34 patients treated at the Mayo Clinic who underwent transantral orbital decompression for cosmetic improvement were reviewed. Although most were ultimately satisfied with the result, 31 of 34 had further surgeries on the eye muscles and/ or eyelids. The authors note this procedure usually does improve proptosis and lower lid retraction but may worsen or cause diplopia and upper lid retraction, requiring further surgeries to achieve optimal results. Hertel Exophthalmometry Without Orbital Rim Contact. Kratky V, HurwitzJJ. Ophthalmology 1994; 101: 931- 7 ( May). [ Reprint requests to Dr. V. Kratky, Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada K7L 3N6.] The authors have developed a simple fixation adaptor for the Hertel exophthalmometer so that accurate measurements can be obtained in patients with absence of one or both orbital rims. The device creates two fixation points on the forehead and on the bridge of the nose, and measurements taken with it are in good agreement with those taken with orbital fixation. The history of the exophthalmometer is also reviewed briefly. Orbital Emphysema. Staging and Acute Management. Hunts JH, Patrinely JR, Holds JB, Anderson RL. Ophthalmology 1994; 101: 960- 6 ( May). [ Reprint requests to Dr. J. R. Patrinely, Baylor College of Medicine, Cullen Eye Institute, 6501 Fannin, NC- 200, Houston, TX 77030.] Eight cases of orbital emphysema are described in detail and the literature reviewed. Although previous treatments have been largely surgical ( canthotomy, cantholysis, orbitotomy), the authors achieved good results with simple needle aspiration of the air pocket( s) when required by severity of symptoms or signs. The entity is discussed and their needling technique described in detail. An elegant reference. Orbital Polymyositis and Giant Cell Myocarditis. Leib ML, Odel JG, Cooney MJ. Ophthalmology 1994; 101: 950- 4 ( May). [ Reprint requests to Dr/ M. L. Leib, Orbit and Ophthalmic Plastic Surgery, The Edward S. Harkness Eye Institute, 635 West 165th St., New York, NY 10032.] A 22- year- old woman was described with presumed orbital polymyositis, which responded to corticosteroid therapy; however, 1 month later she developed cardiogenic shock from giant cell myocarditis. She ultimately did well after cardiac transplant. This rare but twice previously reported association between orbital polymyositis and cardiac giant cell myositis is discussed. Optic Nerve Enlargement and Chronic Visual Loss. Beck AD, Newman NJ, Grossniklaus HE, Galetta SL, Kramer TR. Surv Ophthalmol 1994; 38: / Neuro- Ophthalmol, Vol. 25, No. I, 1995 58 LITERATURE ABSTRACTS 555- 66 ( May- Jun). [ Reprint address: Dr. N. J. Newman, Neuro- ophthalmology Unit, Emory Eye Center, 1327 Clifton Rd., Atlanta, GA 30322.] Four patients with anterior visual pathway sarcoidosis are presented who had unilateral or bilateral loss of vision. Neuroimaging showed enlargement of intraorbital optic nerve, posterior optic nerve, or optic nerve enhancement at the orbital apex. Three of four improved with corticosteroid or methotrexate therapy. Current strategies for diagnosis and treatment of this disease when it affects the optic nerves are discussed in this very practically oriented article. Traumatic Optic Neuropathy. Steinsapir KD, Goldberg RA. Surv Ophthalmol 1994; 38: 487- 518 ( May- Jun). [ Reprint address: Dr. K. D. Steinsapir, Jules Stein Eye Institute, UCLA School of Medicine, Health Sciences, 100 Stein Plaza, Los Angeles, CA 90024- 7006.] This major review discusses all aspects of traumatic optic neuropathy, including an extensive section on the biochemical mechanisms and pharmacology of optic nerve injury. Their treatment protocol recommends high- dose intravenous corticosteroids followed by an oral steroid taper. Optic canal decompression is advocated if vision does not improve on intravenous steroids or deteriorates after cessation of intravenous corticosteroid and start of oral steroids. The Clinonasal Line as a Reproducible Reference Guide for Optic Canal Imaging. Gossman MD, Charonis G, Moser R, Knipe R. Am J Ophthalmol 1994; 117: 815- 6 ( Jun). [ Inquiries to Dr. M. D. Gossman, Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY 40292.] The authors propose a new reference line, from the posterior clinoid to the tip of the nasal bone, to properly align patients for imaging of the optic canal on the computed tomographic scanner. This orientation may be helpful in patients with traumatic optic neuropathy, among other disorders. Horner's Syndrome After Tonsillectomy. Shissias CG, Golnik KC. Am J Ophthalmol 1994; 117: 812- 3 ( Jun). [ Inquiries to Dr. K. C. Golnik, Department of Ophthalmology, Medical University of South Carolina, 171 Ashley Ave., Charleston, SC 29425.] A 9- year- old boy sustained a preganglionic Horner's syndrome during a routine tonsillectomy. It is presumed that an anomalous, more anterior path of oculosympathetic fibers immediately behind the tonsil led to his Horner's syndrome, not surgical error. Magnetic Resonance Imaging Findings in Oculo-palatal Myoclonus. Massry GG, Chung SM. Am J Ophthalmol 1994; 117: 811- 2 ( Jun). [ Inquiries to Dr. S. M. Chung, Anheuser- Busch Eye Institute, 1755 S. Grand Blvd., St. Louis, MO 63104.] A 65- year- old man with a 1- month history of nystagmus, drooling, and trouble talking and swallowing is presented. Four months earlier he had a hemorrhagic brainstem infarction with two lesions on magnetic resonance scanning, the dorsal one extending from the medulla to midbrain. At the time of his presentation with nystagmus he was found to have increased signal intensity in the inferior olivary nucleus on magnetic resonance imaging. Tobacco Amblyopia. Mackey D, Howell N. Reply. Rizzo III JF, Lessell S. Am J Ophthalmol 1994; 117: 817- 9 ( Jun). [ No reprint information given.] A very interesting letter to the editor regarding Drs. Rizzo and Lessell's previously published paper on tobacco- alcohol amblyopia ( American Journal of Ophthalmology, 116: 84, July 1993, previous abstracted in the Journal of Neuro- ophthalmology) points out that perhaps this disease and Leber's have a similar unknown but now declining trigger factor. Drs. Rizzo and Lessell did recall their patients to test for Leber's ( negative) and suggest testing for Leber's mutation should be done in all patients with a diagnosis of tobacco- alcohol amblyopia. Antiphospholipid Antibodies in Retinal Vascular Occlusions. A Prospective Study of 75 Patients. Glacet- Bernard A, Bayani N, Chretien P, Cochard C, Lelong F, Coscas G. Arch Ophthalmol 1994; 112: 790- 5 ( Jun). [ Reprint requests to Dr. G. Coscas, ] Neuw- Ophthalmol, Vol. 15, No. 1, 1995 LITERATURE ABSTRACTS 59 Clinique Ophthalmologique Universitaire de Cre-teil, 40 Avenue de Verdun, Creteil, France 94010.] Seventy- five consecutive patients seen for retinal vascular occlusions were tested for antiphos-pholipid antibodies and compared with a control group. One patient had lupus anticoagulant testing, and three had positive tests for anticardiolipin antibody, but all four had other vascular risk factors, such as hypertension and hyperlipidemia. The authors conclude that routine screening for these antibodies, especially if other vascular risk factors are present, is not warranted. Endovascular Treatment of Giant Aneurysms Which Cause Visual Loss. Vargas ME, Kuper-smith MJ, Setton A, Nelson K, Berenstein A. Ophthalmology 1994; 101: 1091- 8 ( Jun). [ Reprint requests to Dr. M. J. Kupersmith, 530 First Ave., Suite 3B, New York, NY 10016.] Endovascular treatment of giant aneurysms causing anterior visual pathway compression was used in 19 of 26 consecutive patients. Detachable balloons were used in 12, with temporary complications in 4 and severe and permanent in 3; detachable electrocoils in 7 patients had only one temporary complication. Overall, vision improved in 7 patients, was unchanged in 11 and worse in 1. Seven untreated patients experienced three hemorrhages ( one death), monocular blindness and dementia ( two patients), complete homonymous hemianopia ( one patient), and total blindness ( one patient). The Pupil Photostress Test. Zabriskie NA, Kardon RH. Ophthalmology 1994; 101: 1122- 30 ( Jun). [ Reprint requests to Dr. R. H. Kardon, The University of Iowa Hospitals and Clinics, Department of Ophthalmology, 200 Hawkins Dr., Iowa City, IA 52242.] The authors performed photostress testing with infrared pupillometer readings in normal subjects and in patients with unilateral optic nerve disease. Although optic nerve disease diminished the initial stress- induced loss of light sensitivity, the poststress rate of recovery was not significantly affected. Details of their technique are included. " Recurrent" Giant Cell Arteritis. Gans M. Author's Reply. Trautmann JC. Ophthalmology 1994; 101: 971 ( Jun). [ No reprint information given.] This letter to the editor reports a case of temporal arteritis with a recurrence of the disease manifest as recurrent headaches and a rising sedimentation rate several months after stopping an initial corticosteroid course of 11 months. A repeat temporal artery biopsy confirmed reactivation of the disease. Fascicular Arrangement in Partial Oculomotor Paresis. Ksiazek SM, Slamovits TL, Rosen CE, Burde RM, Parisi F. Am J Ophthalmol 1994; 118: 97- 103 ( Jul). [ Reprint requests to Dr. T. L. Slamovits, Department of Ophthalmology, Montefiore Medical Center, 111 E. 210 St., Bronx, NY 10467.] Two patients with a partial third nerve palsy with pupil dilation and predominant inferior rectus weakness are described, each of whom had lesions in the ventral mesencephalon. The authors postulate that the exact arrangement of subnuclei fibers in the fascicular portions of the nerve led to such discrete involvement of the pupil and inferior rectus and offer a nice schematic demonstrating the supposed location of these fibers. Fisher's Syndrome, Anti- GQlb Antibody, and HLA- BBB Antigen. Suzuki T, Obara Y, Yuki N. Am J Ophthalmol 1994; 118: 119 ( Jul). [ Inquiries to Dr. T. Suzuki, Department of Ophthalmology, Dok-kyo University School of Medicine, Koshigaya Hospital, 2- 1- 50 Minamikoshigaya, Koshigaya Saitama 343, Japan.] A 57- year- old woman with a clinical presentation consistent with Fisher's syndrome was found to have IgG anti- GQlb antibody by enzyme- linked immunosorbent assay as well as HLA- BBB antigen. These immunologic findings have been previously reported in this disease and may help to differentiate this disorder from other neurologic diseases. High- Dose Methylprednisolone and Acetazol-amide for Visual Loss in Pseudotumor Cerebri. Liu GT, Glaser JS, Schatz NJ. Am } Ophthalmol 1994; / Neuro- Ophtlmlmol, Vol. 15, No. 1, 1995 60 LITERATURE ABSTRACTS 118: 88- 96 ( Jul). [ Reprint requests to Dr. G. T. Liu, Division of Neuro- ophthalmology, Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.] Four patients with severe acute visual loss from pseudotumor cerebri were treated with 5 days of high- dose intravenous methylprednisolone therapy, 1,000 mg per day, and three had remarkable improvement in vision which persisted upon tapering of oral corticosteroids over several weeks. The fourth had no improvement with corticosteroid therapy and underwent optic nerve sheath decompression, again without improvement. The authors suggest this therapy for patients with acute severe visual loss in the setting of pseudotumor cerebri. Primary Oculomotor Nerve Synkinesis Caused by an Extracavernous Intradural Aneurysm. Varma R, Miller NR. Am J Ophthalmol 1994; 118: 83- 7 ( Jul). [ Reprint requests to Dr. N. R. Miller, Wilmer Oph-thalmological Institute, Maumenee B- 109, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287.] A 64- year- old lady with painless diplopia and ptosis with symptoms gradually worsening over 2 years was found to have a partial right third nerve palsy with evidence of aberrant regeneration. She improved following surgery on a partially clotted aneurysm that was located at the junction of the internal carotid and posterior communicating artery. Ophthalmoplegia Associated with AIDS. Hedges III TR. Comments. Katz B, Slavin ML. Surv Ophthalmol 1994; 39: 43- 51 ( Jul- Aug). [ Reprints are not available.] A 34- year- old man with acquired immune deficiency syndrome was hospitalized with pulmonary symptoms and developed a decline in mental status coincident with a dorsal midbrain syndrome. Magnetic resonance imaging showed no mass but decreased white matter intensity of Tl images in the right parietal lobe, which had increased signal on T2- weighted images. The discussants thoroughly delve into the neuro- ophthalmic possibilities and decide he likely harbors a midbrain encephalitis, probably viral and of the herpetic family. Survival Factors in Rhino- Orbital- Cerebral Mucormycosis. Yohai RA, Bullock JD, Aziz AA, Markert RJ. Surv Ophthalmol 1994; 39: 3- 22 ( Jul- Aug). [ Reprint address: Dr. J. D. Bullock, Professor and Chairman, Department of Ophthalmology, Wright State University School of Medicine, 500 Lincoln Park Boulevard, Suite 104, Dayton, OH 45429- 3489.] This is a terrific reference on this subject complete with representative clinical cases, color clinical photographs, magnetic resonance and computed tomographic scans, and numerous useful tables. This article seems to be custom- made for the beleaguered physician who needs to know quickly how likely it is the patient he is examining has mucormycosis ( Table 2: Conditions Associated with Rhino- Orbital- Cerebral Mucormycosis and Table 3: Signs and Symptoms Present Within 72 Hours of Onset) and the chance of survival, a statistic present in almost every table. Combined Central Retinal Vein Occlusion and Cilioretinal Artery Occlusion Associated with Prolonged Retinal Arterial Filling. Berler DK. Reply. Keyser BJ, Duker JS, Brown GC, Sergott RC, Bosley TM. Am } Ophthalmol 1994; 118: 265 ( Aug). [ No reprint information given.] Dr. Berler points out that the cases of combined central retinal vein occlusion with cilioretinal artery occlusion and prolonged retinal arterial filling reported by Dr. Keyser and colleagues { American Journal of Ophthalmology 117: 308 March 1994, previously abstracted in the journal of Neuro-ophthalmology) had exactly the findings of papil-lophlebitis and may respond to corticosteroid therapy. / Neuro- Ophthalmol, Vol. 15, No. I, 1995 |