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Show journal of Neuw- Ophtlialmology 16( 3): 227- 230, 1996. Literature Abstracts- U. S. A. Vitreous Amyloidosis in Familial Amyloidotic Polyneuropathy: Report of a Case With the Val30Met Transthyretin Mutation. Ciulla TA, To-lentino F, Morrow JF, Dryja TP. Surv Ophthalmol 1995; 40: 197- 206 ( Nov- Dec). [ Reprint address: Dr. T. P. Dryja, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114.] This companion piece to the " major review" in the same journal describes a patient with vitreous amyloid and a polyneuropathy; the patient's eyes were available at autopsy 20 years after onset of visual symptoms. Amyloid deposits were found in virtually every part of the eyes, including the sphincter muscles of the iris, which " may be the histologic correlates of the scalloped pupillary margin," the authors note. Retinal Arterial Occlusions in Young Adults. Greven CM, Slusher MM, Weaver RG. Am J Ophthalmol 1995; 120: 776- 83 ( Dec). [ Reprint requests to Dr. C. M. Greven, Wake Forest University Eye Center, Medical Center Blvd., Winston- Salem, NC 27157- 1003.] The authors studied 27 eyes of 21 patients who were < 40 years of age and who had retinal artery occlusion ( 21 patients had arteriolar occlusion, 15 had central retinal artery occlusion, and one had a ciliary retinal artery occlusion; bilateral retinal artery occlusions were seen in six patients). Cardiac valvular disease was the leading recognizable cause in four ( 19%) patients, but various factors leading to a hypercoagulable state were found in 19 ( 91%) patients. These findings suggest that historical, physical, and laboratory evaluation can detect causative factors in most of these patients. Early Progression of Ophthalmoplegia in Patients With Ischemic Oculomotor Nerve Palsies. Jacob-son DM, Broste SK. Arch Ophthalmol 1995; 113: 1535- 7 ( Dec). [ Reprint requests to Dr. D. M. Jacob- © 1996 Lippincott- Ravcn Publishers, Philadelphia Lyn A. Sedwick, MD son, Neuro- ophthalmology ( 4F), Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449.] In this study, 16 patients were evaluated within 1 week of onset of ischemic oculomotor palsy. Of these, 11 ( 69%) had progression of severity of the palsy, with a range of 3- 23 days. Progression was associated with a somewhat longer recovery period ( mean time, 7.2 weeks of nonprogressive, 11.2 weeks for progressive). Presumed Acquired Ocular Toxoplasmosis. Ron-day MJH, Luyendijk L, Baarsma GS, Bollemeijer JG, Van der Lelij A, Rothova A. Arch Ophthalmol 1995; 113: 1524- 9 ( Dec). [ Reprint requests to Dr. M. J. H. Ronday, the Netherlands Ophthalmic Research Institute, PO Box 12141, 1100 AC Amsterdam, the Netherlands.] Eight adult patients, all > 40 years of age and with focal chorioretinitis and laboratory evidence of recently acquired infection with toxoplasmosis, are described. No patient was HIV- positive or had AIDS. Effect of Levodopa and Carbidopa on Recovery of Visual Function in Patients With Nonarteritic Anterior Ischemic Optic Neuropathy of Longer Than Six Months' Duration. Johnson LN, Gould TJ, Krohel GB. Am } Ophthalmol 1996; 121: 77- 83 ( Jan). [ Reprint requests to Dr. L. N. Johnson, Neuro- Ophthalmology Unit, Mason Institute of Ophthalmology, University of Missouri- Columbia, Columbia, MO 65212.] This article deals with a possible treatment for longstanding visual loss from nonarteritic anterior ischemic optic neuropathy. The authors used levo-and carbidopa to treat a patient with a childhood amblyopia, using information from previous reports regarding its efficacy for this condition. To their surprise, the patient's fellow eye, which had suffered nonarteritic anterior ischemic optic neu- 227 228 LITERATURE ABSTRACTS ropathy, had improvement in vision from counting fingers to 20/ 200. They then did a trial with 20 patients with nonarteritic anterior ischemic optic neuropathy, 10 patients as control and 10 treated with levodopa plus carbidopa, first at a low dose and then at a higher dose. There was modest improvement in visual acuity in the treated group, but the exact improvement was measured via early treatment diabetic retinopathy study eye charts; thus, it is difficult to exactly interpret the " 5.9 letters" improvement. The authors cautiously interpret their results and recommend a larger cohort study to support or refute these findings. Clinical Study of a Large Family With Autosomal Dominant Progressive Cone Degeneration. Small KW, Gehrs K. Am ] Ophthalmol 1996; 121: 1- 12 ( Jan). [ Reprint requests to Dr. K. W. Small, Jules Stein Eye Institute, 200 Stein Plaza, UCLA, Los Angeles, CA 90095.] Seventy- three individuals from a single large family with autosomal dominant cone degeneration were studied for this report. They underwent ophthalmic examination, and some had full- field electroretinography, foveal retinography, and/ or color testing. The visual acuity in affected individuals ranged from 20/ 20 to 5/ 200; fundus findings were variable, from gross macular granularity to a normal appearance. Treatment of Migraine Headache After Ocular Surgery With Intravenous Metoclopramide Hydrochloride. MacCumber MW, Jaffe GJ, McCuen II BW. Am } Ophthalmol 1996; 121: 96- 7 ( Jan). [ Inquiries to Dr. B. W. McCuen II, Duke University Eye Center, Box 3802, Durham, NC 27710.] Two young patients ( aged 20 and 35 years) both with a history of migraine, underwent intraocular surgery and postoperatively had periocular pain and nausea ( and vomiting in one). Neither was helped by oxycodone and acetaminophen, but both responded immediately to intravenous metoclopramide hydrochloride for presumed migraine. Anaerobic and Aerobic Isolates from a Subperiosteal Orbital Abscess in a 4- Year- Old. Harris GJ, Bair RL. Arch Ophthalmol 1996; 114: 98 ( Jan). [ Correspondence to Dr. G. J. Harris, Eye Institute, 8700 W Wisconsin Ave, Milwaukee, WI 53226.] A 4- year- old child with a subperiosteal abscess with a mixed infection is described. The authors recommend conservative treatment, first with antibiotics for a subperiosteal abscess. However, such a case, with evidence of chronicity that could lead to anaerobic conditions even in very young children, should be treated aggressively and may require surgical drainage. Angiosarcoma Metastatic to the Orbit. Burnstine MA, Frueh BR, Elner VM. Arch Ophthalmol 1996; 114: 93- 6 ( Jan). [ Correspondence to Dr. V. M. Elner, The University of Michigan, W. K. Kellogg Eye Center, 1000 Wall St, Ann Arbor, MI 48105.] A 46- year- old patient with a history of breast angiosarcoma resected 2 years previously was seen for a right orbital mass that was subtotally resected and found to be an angiosarcoma. The authors believe this to be the first reported case of this malignant tumor found metastatic to the orbit. Breast Carcinoma Metastatic to the Optic Nerve. Newman NJ, Grossniklaus HE, Wojno TH. Arch Ophthalmol 1996; 114: 102 ( Jan). [ Reprints not available.] A 61- year- old woman with visual loss in one eye and a history of breast cancer is presented in this beautiful photo essay. She had circumferential enhancement of the left optic nerve only on magnetic resonance imaging. Laboratory workup and cerebrospinal fluid examination were negative, but biopsy of the nerve revealed breast carcinoma cells. Persistent Palinopsia Following Ingestion of Lysergic Acid Diethylamide ( LSD). Kawasaki A, Purvin V. Arch Ophthalmol 1996; 114: 47- 50 ( Jan). [ Reprint requests to Dr. A. Kawasaki, Midwest Eye Institute, 201 Pennsylvania Pkwy, Indianapolis, IN 46280- 1381.] Three patients reported palinopsia up to 3 years after use of lysergic acid diethylamide ( LSD). All had normal neurologic and neuro- ophthalmic examinations and two had normal magnetic resonance imaging and electroretinography as well. Possible mechanisms are given along with a discussion of hallucinogen- persisting perception disorder ( flashbacks), a diagnosis with criteria that describe palinopsia and its effect on the individual. / Nt'iiw- Ojilitlmliiiul, Vol. 16, No. 3, 1996 LITERATURE ABSTRACTS 229 Literature Abstracts- Europe Ultrasonographic Investigation of Optic Neuritis. Dees C, Buimer R, Dick AD, Atta HR. Eye 1995; 9: 488- 94. [ Correspondence to Dr. H. R. Atta, Eye Clinic, Aberdeen Royal Infirmary, Foresthill Aberdeen AB9 2ZB, Scotland.] The hallmarks of idiopathic optic neuritis ( also called retrobulbar neuritis) are acute loss of visual acuity and colour vision, pain on eye- movements, visual field defects, and a relative afferent pupillary defect. Swelling of the optic disc is a frequent finding. Standardised echography was performed to assess thickening of the optic nerve and/ or its sheath as well as cerebrospinal fluid dynamics in enlarged optic nerves by applying the 30- degree test. Correlations between the echographic findings and the severity of initial visual loss and rate of visual recovery were made. Inclusion criteria were typical clinical presentation, age below 55 years, and presentation less than 14 days following onset of visual loss. Twenty- seven patients were included in the study, of whom 74% had swelling of the affected optic nerve on standardised A- scan ultrasound. In these patients the average diameter of the affected nerves was 3.6 mm compared with 2.82 mm for unaffected nerves. Of the patients with a swollen optic nerve, 41% had a positive 30- degree test; 33% of those with a swollen nerve had a negative 30- degree test; and 26% had no swelling on echography. Echographi-cally normal optic nerves were associated with limited visual loss ( better than 6/ 60) and recovery to 6/ 9 or better, whereas echographically detectable swollen nerves were associated with visual loss to less than 6/ 60 in 55% of cases. All cases with an initial loss of vision of 6/ 60 or worse had echo-graphically detectable swelling of the optic nerve compared with the unaffected eye. The authors recommend standardised echography as a useful tool in the diagnosis of optic neuritis that may also play a predicting role as to the visual outcome. Eclamptogenic Gerstmann's Syndrome in Combination with Cortical Agnosia and Cortical Diplo- H. Esriel Killer, MD pia. Kasmann B, Ruprecht KW. German } Opthalmol 1995; 4: 234- 8. [ Correspondence to Dr. B. Kasmann, Department of Ophthalmology, and Eye Hospital, University of Saarland, Oscar- Orth- Strasse 1, D- 66421 Homburg/ Saar, Germany.] Eclampsia ( hypertension, edema, and proteinuria) is a severe complication in pregnancy that may lead to seizures or brain hemorrhage. Gerstmann's syndrome is a combination of left- right confusion, finger agnosia, and agraphia with acalculia. A 28- year- old otherwise healthy primipara suffered from headaches during her 20th week of pregnancy followed by a continuous rise in blood pressure. In the 30th week of gestation, eclampsia was diagnosed after she suffered a grand mal seizure. The patient underwent a caesarean section and delivered a preterm boy. She was referred to the neurological intensive care unit, where she remained under artificial respiration for 3 days. After regaining consciousness, she had a complete loss of vision in both eyes that lasted 10 days, followed by slow improvement of visual acuity up to 20/ 200 in both eyes after one year. Only then did she start to complain about monocular and binocular double vision, described by the patient as reduplication of images. Orthoptic assessment revealed orthophoria. For several months the patient also experienced palinopsia. Due to ischemic infarction of the left angular gyrus, the patient also suffered from severe Gerstmann's syndrome with finger agnosia, profound disorientation for left and right, nonaphasic alexia, agraphia, and acalculia. Spontaneous Recovery Rates for Unilateral Sixth- Nerve Palsies. King AJ, Stacey E, Stephenson G, Trimble RB. Eye 1995; 9: 476- 8. [ Correspondence to Dr. Mr A. King, Leicester Royal Infirmary, Leicester LE2 7LX, UK, England.] Sixth- nerve palsies are the most frequent type of oculomotor palsy. Many series have investigated the underlying cause. Most cases, however, re- / Neuro- Ophtlmlmol, Vol. 16, No. 3, 1996 230 LITERATURE ABSTRACTS main of unknown aetiology. Far less, however, has been published about the cases that undergo spontaneous resolution and the time course of their recovery. Based on the dates of 213 unilateral isolated sixth- nerve palsies ( traumatic cases were excluded), their rate and time course of recovery were studied. The findings were that 78.4% underwent spontaneous recovery, 16.4% failed to recover, and 5.2% were lost to follow- up. All those who recovered did so by 52 weeks: 46.7% by 8 weeks, 84.4% by 16 weeks, and 94% by 24 weeks. None of the recovered palsies subsequently recurred over the total follow- up of 180 months. None of the recovered palsies was associated with serious underlying disease. In the nonrecovered groups, 20% had serious underlying pathology. Compared with previous studies, the recovery rates in this prospective study are substantially higher. The authors explain this as attributable to different entry criteria. Acquired Esotropia as Presenting Sign of Cranio- Cervical Junction Anomalies. Ahmet Akman, Vol-kan Dayanir, Ali Sefik Sanac, and Ttilay Kansu. Neuro- Ophthalmology 1995; 15: 311- 4. [ Reprint address: Dr. Tiilay Kansu, Department of Neurology, Hacettepe University Hospital, 06100 Hacettepe, Ankara, Turkey.] This paper represents two cases of acquired esotropia in a 13- year- old girl and a 35- year- old man due to Arnold Chiari cranio- cervical junction anomalies. Computed tomography ( CT) scan in both patients were reported normal. Downbeat nystagmus was present in both cases. The paper stresses the necessity for magnetic resonance imaging ( MRI) studies in patients with acquired eso-tropic and pathologic nystagmus in spite of normal CT scans. Compensatory Elevation of Complex II Activity in Leber's Hereditary Optic Neuropathy. May- Yung Yen, Hsin- Chen Lee, Jorn- Hon Liu, and Yau- Huei Wei. Br ] Ophthalmol 1996; 80: 78- 81. [ Reprint address: Dr. May- Yung Yen, Department of Ophthalmology, Taipei, Veterans General Hospital, National Yang- Ming University, Taipei, 11217, Taiwan, ROC] The pathophysiology leading to loss of vision in Leber's hereditary optic neuropathy ( LHON) is thought to be a defect of mitochondrial enzyme activity. Assays for activities of NADH- cyto-chrome c reductase ( complex I + complex III), succinate- cytochrome c reductase ( complex II + complex III), and cytochrome c oxidase ( complex IV) on blood cell mitochondria of seven LHON patients and 15 normal controls were studied. Activities of succinate- cytochrome c reductase in LHON patients was significantly elevated compared with that of the control group; this was interpreted to be a compensatory effect for defects of the respiratory function of mitochondria. Third Nerve Palsy as the Sole Manifestation of Midbrain Ischemia. Frank Thomke, Barbara Tet-tenborn, and Hanns C. Hopf. Neuro- Ophlhalmologi/ 1995; 15: 327- 35. [ Reprint address: Dr. Frank Thomke, Neurologische Universitatsklinik, Lan-genbeckstr. 1, D- 55101 Mainz/ Germany.] Ischemic damage to the third cranial nerve in the elderly population, especially among diabetics, is frequent. Third nerve palsy as an isolated manifestation of midbrain ischemia, however, is quite rare. This article reports 40 patients who had risk factors for cerebrovascular disease and who developed isolated third nerve palsy. The pupil was spared in 30 patients. Magnetic resonance imaging ( MRI) and electrophysiological examination ( mas-seter- reflex and electro- oculography) demonstrated a midbrain lesion. Computed tomography ( CT) scanning missed the diagnosis in 27 patients! / Nmro- Ophllmlmol, Vol. 16, No. 3, 1996 |