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Show Journal of Neuro- Ophthalmology 14( 1): 60- 64, 1994. © 1994 Raven Press, Ltd., New York Literature Abstracts Intracranial Plasma Cell Granuloma Presenting as an Optic Neuropathy. Kodsi SR, Younge BR, Leavitt JA, Campbell RJ, Scheithauer BW. Surv Ophthalmol 1993; 38: 70- 4 ( Jul- Aug). [ Reprint requests to Dr. J. A. Leavitt, Mayo Clinic, 200 First Street S. W., Rochester, MN 55905.] A 40- year- old white man with a 3- month history of visual loss left eye was found to have a mass involving the left trigeminal nerve and left cavernous sinus shown by biopsy to be plasma cell granuloma. His vision improved after the biopsy and corticosteroids given postoperatively, and he was managed with 3- weeks- between pulses of 100 mg of prednisone X 5 days for a year with diminution and stabilization of residual tumor. The authors discuss this unusual tumor, which heretofore has been reported intracranially in only 11 cases. Lyn A. Sedwick, M. D. Vertical Diplopia. Spector RH. Surv Ophthalmol 1993; 38: 31- 62 ( Jul- Aug). [ Reprint requests to Dr. R. H. Spector, Suite 550, 980 Johnson Ferry Road, Atlanta, GA 30342.] This is a " major view" of conditions causing vertical diplopia and includes an extensive section describing the clinical evaluation of patients with this complaint. A very straightforward inclusive review. Lyn A. Sedwick, M. D. Visual Loss and a Suprasellar Mass Complicated by Pregnancy. Shutter LA, Kline LB, Fisher WS. Comments. Tang R, Bedoya EM, Harper R, Hupp SL. Surv Ophthalmol 1993; 38: 63- 9 ( Jul- Aug). [ Reprint requests to Dr. L. B. Kline, 1000 19th St. South, Birmingham, AL 35205.] A 43- year- old white female, who was 12 weeks pregnant, had a 4- week history of visual loss right eye and was found to have multiple intracranial aneurysms, one between the ophthalmic and the anterior communicating artery on the right, which was presumed to be the cause of her visual loss. The discussion centers on management of intracranial aneurysm presenting in this way with special emphasis to the effect of the workup and treatment to the 12- week- old fetus. Lyn A. Sedwick, M. D. Choroidal Nonperfusion in Giant Cell Arteritis. Quillen DA, Cantore WA, Schwartz SR, Brod RD, Sassani JW. Am J Ophthalmol 1993; 116: 171- 5 ( Aug). [ Reprint requests to Dr. W. A. Cantore, Department of Ophthalmology, Pennsylvania State University College of Medicine, Hershey, PA 17033.] A 68- year- old man is described who had a several week history of transient blotches in front of his right eye. When his visual acuity became mildly decreased, he had placoid lesions at the level of the retinal pigment epithelium right eye with marked choroidal nonperfusion of the macula. He admitted to jaw claudication but had a Westergren sedimentation rate of only 35. Temporal artery biopsy was positive for changes of giant-cell arteritis, and his vision and choroidal perfusion markedly improved after 72 hours of intravenous corticosteroid therapy. This very unusual presentation for giant- cell arteritis is discussed. Lyn A. Sedwick, M. D. The Efficacy of Optic Nerve Sheath Decompression for Anterior Ischemic Optic Neuropathy and Other Optic Neuropathies. McHenry JG, Spoor TC. Reply. Sadun AA. Am ] Ophthalmol 1993; 116: 254- 6 ( Aug). [ No reprint information given.] Drs. McHenry and Spoor share some of their experience with over 400 optic nerve sheath decompressions done for varying indications and suggest that in anterior ischemic optic neuropathy, patients who show marked accumulation of peri- LITERATURE ABSTRACTS 61 optic nerve fluid by A scans will be more likely to benefit from the procedure. Dr. Sadun makes comments in his reply. Lyn A. Sedwick, M. D. Lateral Geniculate Nucleus in Glaucoma. Chaturvedi N, Hedley- Whyte ET, Dreyer EB. Am J Ophthalmol 1993; 116: 182- 8 ( Aug). [ Reprint requests to Dr. E. B. Dreyer, Director ( act.), Glaucoma Consultation Service, Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114.] Postmortem study of the lateral geniculate nuclei of 5 patients with severe and advanced glaucoma were studied as well as 5 controls. Relative diminution of the magnocellular cell density was found in glaucoma patients. The authors suggest that screening strategies to target the magnocellular system may earlier identify glaucomatous damage. Lyn A. Sedwick, M. D. Psychosocial Aspects of Strabismus Study. Satter-field D, Keltner JL, Morrison TL. Arch Ophthalmol 1993; 111: 1100- 5 ( Aug). [ Reprint requests to Dr. J. L. Keltner, Department of Ophthalmology, University of California at Davis, Davis, CA 95616- 8650.] The authors identified 98 adults and teenagers with childhood strabismus, which was uncorrected or incompletely corrected from the records at the University of California at Davis between 1976 and 1989. Of these, 77 were locatable; and surveys were mailed to them with a 56% response rate. They found significant psychosocial problems perceived by the patient even in adulthood referable to their strabismus. Lyn A. Sedwick, M. D. Invasive Squamous Cell Carcinoma Arising from Asymptomatic Choristomatous Cysts of the Orbit. Holds JB, Anderson RL, Mamalis N, Kincaid MC, Font RL. Ophthalmology 1993; 100: 1244- 52 ( Aug). [ Reprint requests to Dr. J. B. Holds, Bethesda Eye Institute, 3655 Vista Ave., St. Louis, MO 63110.] Two patients with symptoms of a rapidly enlarging orbital mass were found by surgical excision to have epidermoid cysts with malignment transformation and essentially were cured with radical excision, although one died of a pulmonary embolus two months postoperatively. The literature about this unusual tumor in head and orbit is reviewed. Lyn A. Sedwick, M. D. Toxoplasmosis Neuroretinitis. Fish RH, Hoskins JC, Kline LB. Ophthalmology 1993; 100: 1177- 82 ( Aug). [ Reprint requests to Dr. R. H. Fish, Vit-reoretinal Consultants, 1200 Binz, Suite 1290, Houston, TX 77004.] Patient records from 1978 to 1989 were reviewed to identify patients with toxoplasmosis with involvement of the optic nerve and a clinical picture of neuroretinitis. Patients were 9 to 38 years old, and two had peripheral chorioretinal scars consistent with toxoplasmosis. All had serologic testing indicative of significant exposure to toxoplasmosis. Four of five were treated with antibiotics and corticosteroids. Two patients had recurrence of neuroretinitis 19 months to 5 1/ 2 years later. This study suggests that patients with neuroretinitis, especially if recurrent, should be tested and treated for toxoplasmosis. Lyn A. Sedwick, M. D. Paresis of the Abducens Nerve After Trivial Head Injury. Chrousos GA, Dipaolo F, Kattah JC, Laws ER Jr. Am } Ophthalmol 1993; 116: 387- 8 ( Sept). [ Inquiries to Dr. G. A. Chrousos, Center for Sight, Georgetown University, 3800 Reservoir Rd. N. W., Washington, DC 20007.] A 17- year- old boy developed a chronic left sixth nerve palsy following minor head trauma. Magnetic resonance scanning done 1 year later disclosed a left cavernous sinus mass found to be schwannoma. The authors repeat the caveat that patients who develop an ocular motor nerve palsy following relatively minor head trauma should be screened for an intracranial mass lesion. Lyn A. Sedwick, M. D. J Neuro- Ophthalmol, Vol. 14, No. 1, 1994 62 LITERATURE ABSTRACTS Spontaneous Orbital Hemorrhage in a Child with Autoimmune Hepatitis. Sires BS, Goodrich SD, Holds JB. Am ] Ophthalmol 1993; 116: 384- 5 ( Sept). [ Inquires to Dr. B. S. Sires, 1755 S. Grand Blvd., St. Louis, MO 63104.] A 13- year- old boy had a spontaneous orbital hemorrhage based on clinical and computerized tomographic characteristics. He had autoimmune hepatitis with a secondary anemia ( hematocrit 29.8) and prolonged prothrombin time and partial thromboplastin time, which are presumably the etiology of the hemorrhage. Lyn A. Sedwick, M. D. Optic Nerve Sheath Decompression for Glaucomatous Optic Neuropathy with Normal Intraocular Pressure. Wax MB, Barrett DA, Hart WM Jr., Custer PL. Arch Ophthalmol 1993; 111: 1219- 28 ( Sept). [ Reprint requests to Dr. M. B. Wax, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110.] Seven eyes of six patients with normal pressure glaucoma were treated with optic nerve sheath decompression. Two eyes had initial significant improvement in visual field but 18 months later deteriorated. The other four eyes had no improvement or deterioration during follow- up ( range: 3 to 18 months). Given the unusual and somewhat unpredictable nature of this disease, it is hard to interpret these results. Lyn A. Sedwick, M. D. Looking Behind the Eyes. The Proper Use of Modern Imaging. Trobe JD, Gebarski SS. Arch Ophthalmol 1993; 111: 1185- 6 ( Sept). [ Reprint requests to Dr. J. D. Trobe, Kellogg Eye Center, 1000 Wall St., Ann Arbor, MI 48104.] Drs. Trobe and Gebarski make some trenchant remarks regarding the use of neuroimaging by ophthalmologists. One main point is that a scan that cannot be directed to a particular area of brain or orbit based on clinical presentation or expected disease process is likely not only to be negative but possibly negative/ inadequate. Also, magnetic resonance is superior to computed tomography for most studies with some notable exceptions. They also point out that studies done for ( 1) periocular pain or ( 2) unexplained visual loss ( without other clinical features pointing to a unilateral optic nerve disease, etc.) are very unlikely to be revealing of pathology. This is a nice editorial, which seems to this practicing neuro- ophthalmologist to be absolutely on the money. Lyn A. Sedwick, M. D. Intraocular Lymphoma. Clinical and Histopathologic Diagnosis. Whitcup SM, de Smet MD, Rubin BI, Palestine AG, Martin DF, Burnier M Jr, Chan C- C, Nussenblatt RB. Ophthalmology 1993; 100: 1399^ 06 ( Sept). [ Reprint requests to Dr. S. M. Whitcup, National Eye Institute, Bldg 10 Rm ION 202, Bethesda, MD 20892.] Twelve cases diagnosed at the National Eye Institute between 1984 and 1992 were retrospectively reviewed. Pathologic diagnosis of large B- cell lymphoma was made with vitreous biopsy ( 10), cerebrospinal fluid analysis ( 1), and enucleation specimen ( 1). Mean time to diagnosis from onset of symptoms was 21.4 months. Three patients had more than one vitreous biopsy until diagnosis was confirmed, and cerebrospinal fluid similarly had multiple samplings until diagnosis in three patients. Seven of twelve patients had neuroimaging ( CT or MR) either initially or subsequently, which demonstrated central nervous system lesions consistent with lymphoma. The recommendations from this paper regarding a diagnostic approach in patients suspected of having intraocular lymphoma is magnetic resonance imaging with or without gadolinium and lumbar puncture, noting that at least 10 ml of cerebrospinal fluid should be sent for immediate and careful processing for cy-topathological examination. An excellent current reference on this disease. Lyn A. Sedwick, M. D. Occult Retinal and Choroidal Vascular Disease. The Value of Timed and Directed Fluorescein Angiography. Rizzo JF III. Ophthalmology 1993; 100: 1407- 16 ( Sept). [ Reprint requests to Dr. T. F. Rizzo III, 243 Charles St., Boston, MA 02114.] Eight very interesting patients with transient and/ or permanent visual loss are presented, aged / Neuro- Ophthalmol, Vol. 14, No. 1, 1994 LITERATURE ABSTRACTS 63 23 to 62, in whom fundus examination was normal, but directed intravenous fluorescein angiography ( IVFA) disclosed either retinal or choroidal vascular abnormalities. In most, the IVFA abnormality might have been easily missed without careful timing of the angiogram and attention directed to the area of anticipated abnormality, for example, to correspond to a scotoma on visual field testing. Beautiful fundus photographs and IVFA frames are included in this interesting and informative paper. Lyn A. Sedwick, M. D. Myasthenia Gravis by Another Name: An Elusive Imposter. Blanton CL, Sawyer RA. Comments by Frohman LP, Warren FA. Surv Ophthalmol 1993; 38: 219- 26 ( Sept- Oct). [ Reprint requests to Dr. C. L. Blanton, Department of Ophthalmology, Naval Hospital San Diego, San Diego, CA 92134- 5000.] This clinical pathologic conference involves a 64- year- old man, taking a number of systemic medications, who presented with a several- month history of profound weakness. His ocular findings, for which he was asymptomatic, included extreme difficulty maintaining upgaze and orbicularis weakness. Tensilon testing did not improve upgaze or orbicularis strength. The discussants thoroughly catalogue the resultant differential diagnosis. He ultimately was diagnosed with procaina-mide- induced myasthenic syndrome and improved with the substitution of another antiarrhythmic drug. Lyn A. Sedwick, M. D. The " Pseudo- CSF" Signal of Orbital Optic Glioma on Magnetic Resonance Imaging: A Signature of Neurofibromatosis. Brodsky MC. Surv Ophthalmol 1993; 38: 213- 8 ( Sept- Oct). [ Reprint requests to Dr. M. C. Brodsky, Arkansas Children's Hospital, 800 Marshall, Little Rock, AR 72202.] A 5l/ 2- year- old boy with a 6- month history of progressive left proptosis was examined by the author. His family history was strongly consistent with neurofibromatosis, and the patient had multiple cafe au lait spots, axillary freckles, and a plex-iform neurofibroma overlying the left lumbar region. He had mildly diminished visual acuity left eye but was normal in the right. Magnetic resonance imaging demonstrated bilateral optic nerve abnormalities consistent with orbital optic nerve glioma, and the characteristics of the magnetic resonance appearance are shown in several scan pictures and discussed in detail. Lyn A. Sedwick, M. D. Optic Nerve Sheath Decompression for Visual Loss in Patients With Acquired Immunodeficiency Syndrome and Cryptococcal Meningitis With Papilledema. Garrity JA, Herman DC, Imes R, Fries P, Hughes CF, Campbell RJ. Am } Ophthalmol 1993; 116: 472- 8 ( Oct). [ Reprint requests to Dr. J. A. Garrity, Mayo Clinic, 200 First St. S. W., Rochester, MN 55905.] Two patients with AIDS and cryptococcal meningitis with increased cerebrospinal fluid ( CSF) pressure and papilledema are presented. Both were treated with optic nerve sheath decompression. Mild decreased acuity in one or both eyes and visual field defects were present preopera-tively. In one patient, visual function improved postoperatively in only one eye and in the other in both eyes. It seems reasonable to offer this procedure if increased CSF pressure seems to be the main reason for visual loss and no cryptococcal or other organisms remain on CSF examination and CSF pressure remains elevated. Lyn A. Sedwick, M. D. The Visual- Evoked Response in Infants With Central Visual Impairment. Granet DB, Hertle RW, Quinn GE, Breton ME. Am ] Ophthalmol 1993; 116: 437- 43 ( Oct). [ Reprint requests to Dr. R. W. Hertle, Children's Hospital of Philadelphia, One Children's Center, Philadelphia, PA 19104.] The authors retrospectively identified 10 infants with central nervous system diseases who initially had clinically very poor visual function and underwent VER testing. All 10 were subsequently retested with VER and also clinically evaluated. They found that an initially absent VER ( 5 patients) did not predict absent vision later ( 9 of 10 patients had improved visual function at follow- up, 6 to normal or near- normal levels for their age). The / Neuw- Ophthalmol, Vol 14, No. 1, 1994 64 LITERATURE ABSTRACTS authors compare their results and review other similar studies in the literature. Lyn A. Sedwick, M. D. Remitting Sixth Nerve Palsy in Skull Base Tumors. Volpe NJ, Lessell S. Arch Ophthalmol 1993; 111: 1391- 5 ( Oct). [ Reprint requests to Dr. S. Lessell, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114.] The authors report seven patients, aged 7 to 61, with a remitting sixth nerve palsy but a skull base tumor, most with chordoma or chondrosarcoma. All patients recovered completely at least once, and several had recurrent sixth nerve palsy. An interesting report. Lyn A. Sedwick, M. D. Visual Fields in Optic Neuritis. Pollock SC. Reply. Keltner JL, Johnson C, Spurr J, Beck RW. Arch Ophthalmol 1993; 111: 1315- 7 ( Oct). [ Letter to the editor, no reprint information given.] Dr. Pollack critiques the conclusions of Dr. Keltner and colleagues regarding the visual field results from the Optic Neuritis Treatment Trial ( Keltner JL, Johnson CA, Spurr JO, Beck RW, Optic Neuritis Study Group. Baseline visual field profile of optic neuritis: the experience of the Optic Neuritis Treatment Trial. Arch Ophthalmol 1993; 111: 231- 234.) and makes several points regarding previously reported visual field patterns in optic neuritis and the relative drawbacks of automated visual field testing versus Goldmann perimetry. He notes that automated visual fields may not be the visual field of choice for patients with optic neuritis and deplores the apparent implication from Dr. Kelt-ner's analysis that because visual field testing in patients with optic neuritis has limited usefulness in distinguishing this from other optic neuropathies, it may then, in fact, be unnecessary. Dr. Keltner and colleagues respond and defend their conclusions. They note that automated visual fields are the current " gold standard" in most ophthalmic offices; and thus, patterns found with automated visual fields are most applicable to current practice. This rather hot debate makes interesting reading. Lyn A. Sedwick, M. D. Hydraulic Orbital Injection Injuries. Holds JB, Pa-trinely JR, Zimmerman PL, Anderson RL. Ophthalmology 1993; 100: 1475- 82 ( Oct). [ Reprint requests to Dr. J. B. Holds, The Eye Institute of St. Louis University School of Medicine, 1755 S. Grand Blvd., St. Louis, MO 63104.] The authors report four cases of foreign material accidentally injected into the orbit under high pressure. A useful flow diagram on page 1480 gives explicit advice about what to do, depending on the exact clinical and radiologic presentation- antibiotics, corticosteroids, surgery. This is a nice reference for managing this unusual type of orbital injury. Lyn A. Sedwick, M. D. / Neuro- Ophthalmol, Vol. 14, No. 1, 1994 |