Journal of Neuro-Ophthalmology, March 1996, Volume 16, Issue 1

Literature Abstracts

Journal of Neuro- Ophthalmology 16( 1): 55- 67, 1996. © 1996 Lippincott- Raven Publishers, Philadelphia Literature Abstracts- U. S. A. The Course of Visual Recovery after Optic Neu­ritis. Experience of the Optic Neuritis Treatment Trial. Beck RW, Cleary PA, Backlund JC, The Op­tic Neuritis Study Group. Ophthalmology 1994; 101: 1771- 8 ( Nov). [ Reprint requests to Dr. R. W. Beck, Jaeb Center for Health Research, Inc., 3010 East 138 Ave., Suite 13, Tampa, FL 33613.] The time course of recovery of vision in the 457 patients entered in the Optic Neuritis Treatment Trial is discussed. Only 438 completed the six-month visit and were analyzed for this study. In general, all patients, treated or not, of either sex, with or without abnormal magnetic resonance im­aging, had an excellent chance of recovery of good visual acuity, and about 90% had at least one line recovery by the day 15 appointment. Patients with very poor starting acuity ( counting fingers or worse) statistically had poorer average final acuity but still excellent ( 82%) chance of recovery to 20/ 40 or better. Value of Parasagittal Magnetic Resonance Images in Visualizing the Vascular Territories of the Cer­ebellum. Chung CS, Chaves CJ, Caplan LR. Surg Ophthalmol 1995; 39: 399- 402 ( Mar- Apr). [ Corre­spondence to Dr. C. S. Chung, Neurology, Chung-nam National University Hospital, 640 Daesa-dong, Joong- ku, Taejon, Korea 301- 040, or Dr. L. R. Caplan, Tufts- England Medical Center, 750 Washington St., Boston, MA 02111.] A 61- year- old woman sustained bilateral cerebel­lar infarctions. This case illustrates the usefulness of parasagittal magnetic resonance images, which can nicely separate the territory served by the an­terior inferior cerebellar artery, superior cerebellar artery, and posterior inferior cerebellar artery. Unilateral Disk Edema in a Young Woman. Moster ML. Comments. Slavin M, Wall M. Surv Ophthalmol 1995; 39: 409- 16 ( Mar- Apr). [ Reprint ad­dress: Dr. M. Moster, Albert Einstein Medical Cen- Lyn A. Sedwick, MD ter, Department of Neurology, Klein Professional Bldg., 5501 Old York Rd., Philadelphia, PA 19141.] A 27- year- old woman was found to have a mildly elevated optic nerve head after seeing an eye physician with complaints of " a vague abnor­mality of vision" in this eye. Visual function was normal both eyes. Her other optic nerve was not elevated, but spontaneous venous pulsations were not seen. Ultimately, she was found to have hy­drocephalus thought to be secondary to aqueduc-tal stenosis, and lumbar puncture had an opening pressure elevated to 310. She was treated with ac-etazolamide and did well. Two Brothers with Bilateral Optic Neuropathy. Hedges TR III. Comments. Sedwick LA, Newman NJ. Surv Ophthalmol 1995; 39: 417- 24 ( Mar- Apr). [ Reprints are not available.] This clinical pathologic conference concerns two brothers with Leber's disease. The differential di­agnosis is discussed, and current thoughts regard­ing Leber's, its diagnosis, and causative genetic mechanisms are well discussed. Diplopia Resolution. Novis CA, Rubin ML. Surv Ophthalmol 1995; 39: 396- 8 ( Mar- Apr). [ Reprints are not available.] This diplopia patient confounds the clinical sup­position that monocular diplopia is from pathology in the eye and binocular diplopia from pathology in the brain. He has diplopia when wearing glasses, which is induced by gaze off- center and is caused by anisophoria ( differential prism induced by glasses lenses with significant difference in power between the two eyes). 55 56 LITERATURE ABSTRACTS Results of Miillerotomy and Levator Aponeurosis Transposition for the Correction of Upper Eyelid Retraction in Graves' Disease. Ceisler EJ, Bilyk JR, Rubin PAD, Burks WR, Shore JW. Ophthalmology 1995; 102: 483- 92 ( Mar). [ Reprint requests to Dr. J. W. Shore, Ophthalmic Consultants of Boston, 50 Staniford St., 6th Floor, Boston, MA 02114.] The authors describe their results using a com­bination of miillerotomy, recession of levator apo­neurosis, and medial transposition of the lateral horn of the levator aponeurosis for upper eyelid retraction in Graves' disease. Of 72 eyelids oper­ated, 71 had good or excellent results. Quantitative Analysis of Optic Disc Cupping in Compressive Optic Neuropathy. Bianchi- Marzoli S, Rizzo JF III, Brancato R, Lessell S. Ophthalmology 1995; 102: 436- 40 ( Mar). [ Reprint requests to Dr. J. Rizzo, Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114.] The authors retrospectively examined optic nerve photographs of 29 patients with compres­sive optic neuropathies and compared the cupping to normal age- matched controls. The median cup area/ disc area was increased to 0.37 for all eyes with visual compromise versus 0.1 for control eyes, and the intereye difference in cupping in uni­lateral compressive optic neuropathy was signifi­cant ( 0.13). Their data " confirm an association be­tween compression of the afferent visual pathways and cupping of the optic nerve." Management of Visual Loss after Optic Nerve Sheath Decompression in Patients with Pseudo­tumor Cerebri. Mauriello JA Jr, Shaderowfsky P, Gizzi M, Frohman L. Ophthalmology 1995; 102: 441- 5 ( Mar). [ Reprint requests to Dr. J. A. Mauriello, Jr., Department of Ophthalmology, University of Medicine and Dentistry- New Jersey Medical School, Doctors Office Center, 90 Bergen St., New­ark, NJ 07103- 2499.] This study addresses the very difficult problem of managing a patient who shows loss of vision after an optic nerve sheath decompression for pseudotumor cerebri. Five patients are presented, none of whom had immediate repeat optic nerve sheath decompression, but four of whom were treated with lumboperitoneal shunting with stabi­lization or improvement in vision. This is an inter­esting paper, which leads to the speculation that repeat optic nerve sheath decompression may need to be evaluated more than anecdotally. Surgery for Ischemic Optic Neuropathy. Lessell S. Arch Ophthalmol 1995; 113: 273- 4 ( Mar). [ No reprint information given.] Dr. Lessell offers a concise review of the results of the Ischemic Optic Neuropathy Decompression Trial in the setting of its historical precedent. His article also includes the abstract of the full report that was published in the February 22,1995 Journal of the American Medical Association. Metastasis of Adenocarcinoma of the Lung to Op­tic Nerve Sheath Meningioma. Arnold AC, Hepler RS, Badr MA, Lufkin RB, Anzai Y, Konrad PN, Vinters HV. Arch Ophthalmol 1995; 113: 346- 51 ( Mar). [ Reprint requests to Dr. A. C. Arnold, Jules Stein Eye Institute, 100 Stein Plaza, University of California- Los Angeles, Los Angeles, CA 90024- 7005.] The authors report a patient with a 12- year his­tory of known optic nerve sheath meningioma who developed adenocarcinoma of the lung and died of metastatic disease within two years. Al­though no change in her meningioma was appre­ciated clinically premortem, autopsy showed ade­nocarcinoma metastatic to the optic nerve sheath meningioma. This may be the first reported case of such an occurrence. The Missing Temporal Crescent. Landau K, Wich-mann W, Valavanis A. Am ] Ophthalmol 1995; 119: 345- 9 ( Mar). [ Reprint requests to Dr. K. Landau, Department of Ophthalmology, University Hospi­tal Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland; fax: [phone].] Two patients with a monoclonal temporal cres­cent field loss, plotted on the Goldmann perime­ter, are presented, each with discrete anterior oc­cipital lobe pathology. This interesting monocular cerebral- based visual field defect is discussed. / Neuro- Ophthalmol, Vol. 16, No. 1, 1996 LITERATURE ABSTRACTS 57 Melanoma- Associated Retinopathy. Singh AD, Milam AH, Shields CL, De Potter P, Shields JA. Am J Ophthalmol 1995; 119: 369- 70 ( Mar). [ Inquiries to Dr. J. A. Shields, Director, Oncology Service, Wills Eye Hospital, 900 Walnut St., Philadelphia, PA 19107; fax: [phone].] A 64- year- old man had subacute photopsia, de­creased night vision, and reduced peripheral vi­sion. Shortly thereafter, a melanoma was resected from his maxillary sinus. His electroretinogram showed a reduced b- wave amplitude under sco-topic testing conditions to a bright flash. He was followed, and his visual status remained stable. Hourglass- Shaped Visual Fields as a Sign of Bi­lateral Lateral Geniculate Myelinolysis. Donahue SP, Kardon RH, Thompson HS. Am } Ophthalmol 1995; 119: 378- 80 ( Mar). [ Inquiries to Dr. S. P. Don­ahue, Department of Ophthalmology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA 52242.] A 37- year- old patient with central pontine my­elinolysis developed visual loss and was found on examination to have 20/ 25 OD and 20/ 30 OS acuity but hourglass- shaped preserved visual field in each eye. Magnetic resonance imaging showed bi­lateral enhancing lesions in the lateral geniculate bodies. Hemifacial Spasm and Osteitis Deformans. Ing EB, Savino PJ, Bosley TM, Sergott RC, Kelepouris N. Am } Ophthalmol 1995; 119: 376- 7 ( Mar). [ Inqui­ries to Dr. P. J. Savino, Wills Eye Hospital, 900 Walnut St., Philadelphia, PA 19107.] A 73- year- old woman with Paget's disease de­veloped left hemifacial spasm believed related to marked temporal bone overgrowth, presum­ably causing stenosis of the canal of the left facial nerve. She did well after botulism injections after her hemifacial spasm progressed on pamidronate therapy. Ocular Vaso- occlusive Disease in Primary An-tiphospholipid Syndrome. Castan6n C, Amigo MC, Banales JL, Nava A, Reyes PA. Ophthalmology 1995; 102: 256- 62 ( Feb). [ Reprints requests to Dr. P. A. Reyes, Instituto Nacional de Cardiologia I. Chavez, Juan Badiano No. 1, Tlalpan, Seccion XVI Mexico, D. F., 14080 Mexico.] Seventeen patients with primary antiphospho-lipid syndrome were evaluated prospectively, only one of whom presented with visual symptoms with subsequent diagnosis. Of the 17, 15 had oc­ular disease with or without visual symptoms. Al­most all had venous tortuosity on retinal exam. Retinal hemorrhages, vascular sheathing, and op­tic nerve edema were seen less frequently. The au­thors recommend that eye examination with intra­venous fluorescein angiography be done in all pa­tients in evaluating primary antiphospholipid syndrome. Intrapapillary and Peripapillary Hemorrhage in Young Patients with Incomplete Posterior Vitre­ous Detachment. Signs of Vitreopapillary Trac­tion. Katz B, Hoyt WF. Ophthalmology 1995; 102: 349- 54 ( Feb). [ Reprint requests to Dr. B. Katz, Neuro- Ophthalmology Unit, California Pacific Medical Center, 2340 Clay St., San Francisco, CA 94115.] Eight patients ages 11 to 42 years are described, and very nice color disc photographs of six are included, which show varying degrees of hemor­rhage and disc elevation. The authors postulate that the mildly dysplastic discs seen in many of these patients may have unusual vitreous attach­ment, which, when severed, leads to the hemor­rhage and other findings seen. The Optic Neuritis Treatment Trial: Three- Year Follow- Up Results. Beck RW. Arch Ophthalmol 1995; 113: 136- 7 ( Feb). [ Correspondence to Dr. R. W. Beck, Jaeb Center for Health Research, 3010 East 138th Ave., Suite 9, Tampa, FL 33613.] As has been hinted at, at the end of three years, patients in the Optic Neuritis Treatment Trial treated with intravenous corticosteroids begin to catch up to the untreated patients in the develop­ment of multiple sclerosis ( MS). By four years, there is no statistical difference between the groups, i. e., 24.7% of those treated versus 26.9% of those not treated developed MS. / Neuro- Ophthalmol, Vol. 16, No. 1, 1996 58 LITERATURE ABSTRACTS Magnetic Resonance Imaging Findings in a Pa­tient with Nuclear Oculomotor Palsy. Pratt DV, Orengo- Nania S, Horowitz BL, Oram O. Arch Oph­thalmol 1995; 113: 141- 2 ( Feb). [ Correspondence to Dr. S. Orengo- Nania, Cullen Eye Institute, Baylor College of Medicine, 6501 Fannin, NC- 200, Hous­ton, TX 77030.] A 60- year- old patient developed acute bilateral ptosis and a bilateral superior rectus weakness as well as left infraduction and adduction deficits consistent with a left nuclear third nerve palsy. She had no other neurologic symptoms or find­ings. Her magnetic resonance scan demonstrated a small hemorrhage near the aqueduct in the region of the left third nerve nucleus, which improved coincident with clinical resolution. Abnormal Disc Vessels after Diabetic Papillopa-thy. De Ungria JM, Del Priore LV, Hart W. Arch Ophthalmol 1995; 113: 245- 6 ( Feb). [ Reprint requests to Dr. L. V. Del Priore, Box 8096, Washington Uni­versity School of Medicine, Department of Oph­thalmology and Visual Sciences, 660 S. Euclid, St. Louis, MO 63110.] This photo essay presents unilateral disc edema in a juvenile- onset diabetic man, which resolved but went through a period of dilated man which resolved but went through a period of dilated peri­papillary vessels before the resolution. Cutaneous Melanoma- Associated Retinopathy. Kim RY, Retsas S, Fitzke FW, Arden GB, Bird AC. Ophthalmology 1994; 101: 1837- 43 ( Nov). [ Reprint re­quests to Dr. A. C. Bird, Professional Unit, Moorfields Eye Hospital, City Rd., London, EC1V 2PD, United Kingdom.] Three patients with melanoma- associated reti­nopathy are described. All had electroretinogra-phy with a negative flash wave form. All also had negative tests for known antibodies to retinal antigen. Ophthalmic Manifestations of Vertebral Artery Dissection. Patients Seen at the Mayo Clinic from 1976 to 1992. Hicks PA, Leavitt JA, Mokri ^. Oph­thalmology 1994; 101: 1786- 92 ( Nov). [ Reprint re­quests to Dr. J. A. Leavitt, Department of Oph­thalmology, Mayo Clinic, 200 First St. SW, Roch­ester, MN 55905.] Fifty- one episodes of vertebral artery dissection in 47 patients were reviewed in regard to neuro-ophthalmic symptoms. Seventy- one percent had neck or head pain. Often lateral medullary syn­drome ( 27%) occurred. Diplopia ( 45%) and blurred vision ( 14%) were often reported by patients, and nystagmus was seen in 19 patients ( 38%). Verte­bral artery dissection was causally related to neck trauma in slightly less than half the cases and gen­erally treated conservatively with anticoagulation. Visual Morbidity in Giant Cell Arteritis. Clinical Characteristics and Prognosis for Vision. Lui GT, Glaser JS, Schatz NJ, Smith JL. Ophthalmology 1994; 101: 1779- 85 ( Nov). [ 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.] Records of 185 patients with giant cell arteritis examined between 1980 and 1993 at Bascom Palmer were reviewed. From these, 45 patients were found who had visual symptoms and a pos­itive biopsy. Arteritic ischemic optic neuropathy occurred in 88% of 63 eyes with visual events. The breakdown of exact timing of visual loss in one or both eyes and severity is delineated as is the re­sponse to treatment. In general, patients treated with intravenous corticosteroids tended to avoid further visual loss or to improve more frequently than patients treated with oral corticosteroids, but neither therapy always prevented further visual loss. Acquired Double Elevator Palsy in a Child with a Pineocytoma. Munoz M, Page LK. Am ] Ophthalmol 1994; 118: 810- 1 ( Dec). [ Inquiries to Dr. M. Munoz, Bascom Palmer Eye Institute, P. O. Box 016880, Mi­ami, FL 33101.] An 8- year- old girl with a three- year history of hypertropia and a monocular upgaze palsy and same- side ptosis was ultimately found to have a pineocytoma. When this tumor was removed, she had some improvement in her ocular findings. / Neuro- Ophthalmol, Vol. 16, No. 1, 19% LITERATURE ABSTRACTS 59 Systemic Diseases Associated with Nonarteritic Anterior Ischemic Optic Neuropathy. Hayreh SS, Joos KM, Podhajsky PA, Long CR. Am J Ophthal­mol 1994; 118: 766- 80 ( Dec). [ Reprint requests to Dr. S. S. Hayreh, Department of Ophthalmology, Uni­versity Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA 52242- 1091.] This rather lengthy paper reviews previous lit­erature reports and prospectively studies 406 pa­tients seen between 1974 and 1989 with nonar­teritic ischemic optic neuropathy for the preva­lence of systemic disease to try to determine any strong associations. The conclusion, in brief, is that nonarteritic ischemic optic neuropathy is probably multifactorial and patients with this dis­ease should have a systemic evaluation for associ­ated and possibly causative conditions, such as vasculitides, hypercholesterolemia, etc. Visual Acuity after Radiation for Orbital Rhabdo­myosarcoma. Abramson DH, Notis CM. Am J Oph­thalmol 1994; 118: 808- 9 ( Dec). [ Inquiries to Dr. D. H. Abramson, 70 E. 66th St., New York, NY 10021.] Thirty- two patients treated with radiation ther­apy for orbital rhabdomyosarcoma between 1960 and 1992 were followed up from five to eight years. The majority ( 66%) had no light perception vision with only about 20% showing 20/ 70 or bet­ter. The authors believe this rather depressing vi­sual result should be considered when making de­cisions regarding the treatment of patients with orbital rhabdomyosarcoma. A Case of Unilateral Congenitally Enlarged Ex­traocular Muscles. Dickson JS, Kraft SP, Jay V, Blaser S. Ophthalmology 1994; 101: 1902- 7 ( Dec). [ Correspondence to Dr. S. P. Kraft, Department of Ophthalmology, 555 University Ave., Toronto, Ontario, Canada M5G 1X8.] An 8- month- old girl with a vertical strabismus noted at birth was found to have poor elevation and abduction left eye as well as a left upper lid ptosis. Computerized tomographic scanning and magnetic resonance imaging showed enlarged muscle bellies of the left medial, inferior, and lat­eral rectus muscles. Thyroid testing was normal. At strabismus surgery, biopsy of an involved mus­cle showed only normal muscle tissue. The au­thors think that these findings may constitute a previously unrecognized syndrome of congenitally enlarged muscles. Central American Mesencephalopathy. Katz B. Comments. Winterkorn J, Newman SA. Surv Oph­thalmol 1994; 39: 253- 9 ( Nov- Dec). [ Reprint address: Dr. B. Katz, Department of Ophthalmology, Pa­cific Presbyterian Medical Center, 2340 Clay St., San Francisco, CA 94115.] A 31- year- old Nicaraguan man presented with posterior headaches and diplopia. His exam showed " subtle deficits of elevation and depres­sion of the left eye." Magnetic resonance imaging demonstrated a dorsal midbrain lesion, which en­hanced. The discussants include neurocysticerco-sis in the differential diagnosis, which, in fact, seemed the correct diagnosis after further workup ( cerebrospinal fluid evaluation) and appropriate therapy ( praziquantel, an anthelmintic agent, and steroids), which resulted in clinical improvement. Ocular Myasthenia: A Protean Disorder. Wein­berg DA, Lesser RL, Vollmer TL. Surv Ophthalmol 1994; 39: 169- 210 ( Nov- Dec). [ Reprint address: Dr. R. L. Lesser, 60 Temple St., Suite 4- B, New Haven, CT 06510.] This major review highlights the history of this disorder, epidemiology, usual clinical presenta­tion, and any other information one might like to have about the disease in a concise, readable form. There is an extensive section on therapeutic agents. Macular Sparing as a Perimetric Artifact. Bischoff P, Lang J, Huber A. Am J Ophthalmol 1995; 119: 72- 80 ( Jan). [ Reprint requests to Dr. P. Bischoff, De­partment of Ophthalmology, Kantonsspital, CH- 9007 St. Gallen, Switzerland; fax: [phone].] Fifteen patients with known hemianopic visual field defects were examined with a scanning laser ophthalmoscope to produce " microperimetry." Of these, 12 patients showed macular sparing of 1- 5°, both on Goldmann visual field studies and with microperimetry, but with frequent fixation shifts / Neuro- Ophthalmol, Vol. 16, No. 1, 1996 60 LITERATURE ABSTRACTS documented by the laser ophthalmoscope toward the seeing hemiretina. The authors believe macu­lar sparing to be a perimetric artifact. Measurement of the Subarachnoid Pressure of the Optic Nerve in Human Subjects. Liu D, Michon J. Am J Ophthalmol 1995; 119: 81- 5 ( Jan). [ Reprint re­quests to Dr. D. Liu, USC School of Medicine, Doheny Eye Institute, 1450 San Pablo St., Los An­geles, CA 90033- 4684.] Subarachnoid pressure was measured in the op­tic nerve of 16 eyes before previously scheduled enucleation or evisceration. The mean pressure was 8.5 mm Hg but increased 1- 2 mm in Trende­lenburg position. Ophthalmic Manifestations of Rathke's Cleft Cysts. Rao GP, Blyth CPJ, Jeffreys RV. Am J Oph­thalmol 1995; 119: 86- 91 ( Jan). [ Reprint requests to C. P. J. Blyth, F. R. C. Ophth., Department of Ophthalmology, University Hospital of Wales, Heath Park, Cardiff, CF4 4XW, United Kingdom; fax: [phone].] Eleven patients who had surgery for symptom­atic Rathke's cleft cysts were identified from records review, eight of whom had initial visual symptomatology. Reduced acuity, visual field de­fect, and/ or optic atrophy were found in nine of 11. Six patients had increase in visual function post­operatively. Although these lesions may mimic craniopharyngioma, it may be important to try to distinguish them preoperatively as a conservative surgical approach is usually curative for these cysts. Automated Perimetry and Malingerers. Can the Humphrey Be Outwitted? Stewart JFG. Ophthal­mology 1995; 102: 27- 32 ( Jan). [ Reprint requests to J. F. G. Stewart, MB, ChB, Department of Oph­thalmology, Western Infirmary, Dumbarton Rd., Glasgow Gil 6NT, Scotland.] The authors purported to ascertain whether or not malingerers can be uncovered by the Hum­phrey's machine but actually challenged unsophis­ticated volunteers to feign a superior right relative visual field defect both eyes, which they were able to do. Anyone who has seen a malingerer referred with a " screwy" automated field ( usually an amoeba- shaped one) knows that this machine of­fers no help in ferreting out feigned visual loss. Diagnosis and Clinical Characteristics of Ocular Lyme Borreliosis. Karma A, Seppala I, Mikkila H, Kaakkola S, Viljanen M, Tarkkanen A. Am ] Oph­thalmol 1995; 119: 127- 35 ( Feb). [ Reprint requests to Dr. A. Karma, Department of Ophthalmology, University of Helsinki, SF- 00290 Helsinki, Finland; fax: [phone].] The authors, from Helsinki, Finland, report their experience with ten patients with ocular manifes­tations of Lyme disease. Not all were seropositive to the ELISA test. Four patients had a neuroret-initis, and three of these had an associated optic neuropathy. Clinical Features and Treatment of Seven Patients with Carcinoid Tumor Metastatic to the Eye and Orbit. Fan JT, Buettner H, Bartley GB, Boiling JP. Am J Ophthalmol 1995; 119: 211- 8 ( Feb). [ Reprint re­quests to Dr. H. Buettner, Department of Ophthal­mology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905; fax: [phone].] Seven patients with carcinoid tumors metastatic to the eye and orbit were found in Mayo Clinic patient files between 1974 and 1992. Patients with metastases to the choroid had the best long- term survival after appropriate therapy. All reported similar cases are discussed, and the entity and its treatment in general described. The Incredible Shrinking Brain. Levy MH, Hart WM Jr, Sonstein FM, Ballinger WE Jr. Comments. Sadun A. Surv Ophthalmol 1995; 39: 315- 22 ( Jan- Feb). [ Reprint address: Dr. M. H. Levy, Sarasota Retina Institute, 3400 Bee Ridge Road, Sarasota, FL 34239- 7223.] A 65- year- old woman had stuttering loss of vi­sual acuity and visual field over eight years. She demonstrated cerebral atrophy over time, espe­cially of the parietal lobes, and brain biopsy dem­onstrated findings of both Alzheimer's disease and / Neuro- Ophthalmol, Vol. 16, No. 1, 1996 LITERATURE ABSTRACTS 61 amyloid angiopathy. The case is nicely discussed by Dr. Sadun. Automated Perimetry Detects Visual Field Loss before Manual Goldmann Perimetry. Katz J, Tielsch JM, Quigley HA, Sommer A. Ophthalmol­ogy 1995; 102: 21- 6 ( Jan). [ Reprint requests to J. Katz, ScD, Johns Hopkins School of Hygiene and Public Health, 615 N. Wolfe St., Room 5515, Balti­more, MD 21205- 2103.] This study is extracted from the Glaucoma Screening study, which enrolled 1,207 eyes from 813 patients with intraocular pressures greater than 21 on at least two occasions who started with no abnormalities on Goldmann perimetry. They were followed from 1981 to 1992 with yearly visual field examinations with Goldmann perimetry, in­cluding a detailed protocol of kinetic and static testing and automated Humphrey visual field test­ing with the C- 30- 2 program from 1984 onward. Of the 106 eyes from 91 patients that developed glau­comatous visual field loss on Goldmann testing, 40 had evidence of such visual field loss one year ear­lier on automated visual field testing. Given that the retesting interval is one year in this study, it may not be fair to conclude that Goldmann perim­etry would/ could not have found the defect sooner that one year later; however, it does seem fair to conclude that good automated perimetry is more sensitive than good Goldmann studies in detecting early visual field loss in glaucoma. Disk Edema in an Overweight Woman. Wolin MJ, Brannon WL. Comments. Kay MD, Hupp SL. Surv Ophthalmol 1995; 39: 307- 14 ( Jan- Feb). [ Reprint ad­dress: Dr. M. Wolin, Anderson Eye and Ear Asso­ciates, 1655 East Greenville St., Anderson, SC 29622- 1226.] A 46- year- old obese woman complained of headaches and intermittent blurred vision. The unusual pattern of hemorrhagic papilledema asso­ciated with multiple dot hemorrhages in the retinal periphery led the discussants to the correct diag­nosis ( as did the computerized tomographic scan showing cerebral edema) of hypoventilation. This interesting cause of, or condition related to, pseu­dotumor cerebri in morbidly obese patients is described. Congenital Orbital Cysts Associated with the Common Sheath of Superior Rectus and Levator Palpebrae Superioris Muscles. Rose GE, O'Don-nell BA. Ophthalmology 1995; 102: 135- 8 ( Jan). [ Re­print requests to G. E. Rose, FRCS, Consultant Ophthalmologist, Adnexal and Orbital Service, Moorfields Eye Hospital, City Rd., London EClV 2PD, United Kingdom.] Four patients aged 14 months to 39 years pre­sented with ptosis, proptosis, or upper eyelid swelling and were found at surgery to have a con­genital orbital cyst. These cysts, which were inti­mately associated with the common sheath of the superior rectus and levator muscles, had a lining that resembled conjunctiva. Serum Antibodies Reactive with Eye Muscle Membrane Antigens Are Detected in Patients with Nonspecific Orbital Inflammation. Atabay C, Tyutyunikov A, Scalise D, Stolarski C, Hayes MB, Kennerdell JS, Wall J. Ophthalmology 1995; 102: 145- 53 ( Jan). [ Reprint requests to Dr. J. R. Wall, Allegheny General Hospital, 320 East North Ave., Pittsburgh, PA 15212- 4772.] Eight patients with pseudotumor of the orbit were examined for the presence of antibodies to eye muscle and thyroid protein. Most had antibod­ies to eye muscles and one to thyroid microsomal antigen but without evidence of thyroid gland dis­ease and a nontypical picture for thyroid eye disease. Disease Relapse in Patients with Ocular Manifes­tations of Wegener Granulomatosis. Power WJ, Rodriguez A, Neves RA, Lane L, Foster CS. Oph­thalmology 1995; 102: 154- 60 ( Jan). [ Reprint requests to Dr. C. S. Foster, Massachusetts Eye and Ear In­firmary, 243 Charles St., Boston, MA 02114.] Eight patients without systemic manifestations of Wegener's but with ocular disease presented to Massachusetts Eye and Ear Infirmary for workup. Seven of eight had a positive conjunctival or scleral biopsy, and all had increased anti- neutrophil cyto­plasmic antigen ( ANCA) levels. All were treated with cyclophosphamide, sometimes with pred­nisone as well, for at least nine months after clin­ical remission. ANCA levels became normal in five patients, four of whom remained in remission. All / Neuro- Ophthalmol, Vol. 16, No. 1, 1996 62 LITERATURE ABSTRACTS patients with persistently elevated ANCA levels had relapse; thus, this clinical test may be an ex­cellent way to predict which patients with ocular disease require prolonged therapy. Von Hippel- Lindau Disease Manifesting as a Chi­asmal Syndrome. Baker LJ, Galetta SL, Curtis M, Maguire A, Judy K. Surv Ophthalmol 1995; 39: 302- 6 ( Jan- Feb). [ Reprint address: Dr. S. L. Galetta, Uni­versity of Pennsylvania Hospital, Department of Neurology, 3400 Spruce St., Philadelphia, PA 19104.] A 21- year- old woman presented with a two- year history of difficulty reading with her left eye. She had 20/ 40 visual acuity left eye with left optic atro­phy and subtle bitemporal visual field defects. Magnetic resonance scanning disclosed a suprasel­lar lesion thought most consistent with meningio­ma. Pathology of this mass revealed hemangio-blastoma and subsequent investigation revealed further lesions both in the CNS and retinae. Central Retinal Artery Occlusion: The Presenting Sign in Radiation Retinopathy. Noble KG. Arch Ophthalmol 1994; 112: 1409- 10 ( Nov). [ Reprint re­quests to Dr. K. G. Noble, Department of Oph­thalmology, New York University Medical Center, 550 First Ave., New York, NY 10016.] A 42- year- old woman developed a central retinal artery occlusion and, on examination, also had dot and blot hemorrhages in the other eye. Fluorescein angiography disclosed marked delay in choroidal filling in the eye with the central retinal artery oc­clusion. She had had radiation therapy for thyroid eye disease 15 months previously, and an exten­sive workup for coagulopathy and carotid occlu­sive disease was negative. It is presumed her arte­rial occlusion resulted from radiation- induced obliterative arteritis. Acquired Ptosis in the Young and Middle- Aged Adult Population. Kersten RC, de Conciliis C, Kulwin DR. Ophthalmology 1995; 102: 924- 8 ( June). [ Reprint requests to Dr. R. C. Kersten, The Barrett Center, PO Box 670670, Cincinnati, OH 45267- 0670.] Patients with acquired ptosis, aged 15- 50 years and seen between April of 1986 and May of 1994 at the Department of Ophthalmology at the Univer­sity of Cincinnati College of Medicine, make up this report group. In 50 patients, contact lens use or contact lens use combined with some other fac­tor was the underlying cause of the ptosis, which was often asymmetrical or truly unilateral. Some nice clinical photographs are included. Homonymous Field Defect as the First Manifes­tation of Creutzfeldt- Jakob Disease. Vargas ME, Kupersmith MJ, Savino PJ, Petito F, Frohman LP, Warren FA. Am J Ophthalmol 1995; 119: 497- 504 ( Apr). [ Reprint requests to Dr. M. J. Kupersmith, 530 First Avenue, 3B, New York, NY 10016.] Three patients ultimately found to have Creutzfeldt- Jakob disease presented with isolated homonymous visual field defects. All had normal magnetic resonance imaging scans and one patient had a normal electroencephalogram early in the illness. This is an interesting presentation of this disease, which is discussed. Unsatisfactory Treatment of Acquired Nystagmus With Retrobulbar Injection of Botulinum Toxin. Tomsak RL, Remler BF, Averbuch- Heller L, Chan-dran M, Leigh RJ. Am J Ophthalmol 1995; 119: 489- 96 ( Apr). [ Reprint requests to Dr. R. J. Leigh, Depart­ment of Neurology, University Hospitals, 2074 Ab-ington Road, Cleveland, OH 44106.] Three patients with visually disabling acquired pendular nystagmus were treated with unilateral retrobulbar injections of botulism toxin, 10, 12.5, or 25 U. None appreciated an overall improvement in the condition because of the development of ptosis, diplopia, or pain from filamentary keratitis. Flea Collar Aniscoria. Apt L. Reply. Flach AJ, Donahue ME. Arch Ophthalmol 1995; 113: 403- 4 ( Apr). [ Correspondence to Dr. L. Apt, Jules Stein Eye Institute, UCLA School of Medicine, 100 Stein Plaza, Box 957000, Los Angeles, CA 90095- 7000.] Another case of pupil abnormality secondary to handling of a flea collar is cited by Dr. Apt, and the reply by Drs. Flach and Donahue underscores the / Neuro- Ophthalmol, Vol. 16, No. 1, 1996 LITERATURE ABSTRACTS 63 difficulty with these cases insofar as the presumed offending chemical, an anticholinesterase pesti­cide, has extremely poor corneal absorption. The Incidence of Atonic Pupil Following Cataract Surgery. Halpern BL, Pavilack MA, Gallagher SP. Arch Ophthalmol 1995; 113: 448- 50 ( Apr). [ Reprint re­quests to Dr. B. L. Halpern, Eye Specialists of Lan­caster, 1532 Lititz Pike, Lancaster, PA 17601.] A retrospective review of 1,283 consecutive cases of cataract surgery with posterior chamber lens implantation between 1991 and 1993 was done to identify cases of postoperative atonic pupil. Of these 1,283 eyes, 25 ( roughly 2%) developed these pupil findings. The exact mechanism for the devel­opment of atonic pupil in these circumstances is unknown. Optic Nerve Ischemia: Optic Nerve Sheath De­compression Alone or With Optic Nerve Decom­pression. Beale JP Jr. Reply. Wax MB, Barrett DA, Hart JR WM, Custer PL. Arch Ophthalmol 1995; 113: 406- 7 ( Apr). [ Correspondence to Dr. J. P. Beale, Jr, 801 California Street, San Francisco, CA 94108.] In this letter to the editor, Dr. Beale reports his experience with optic nerve decompression using a partial- thickness scleral window and a dural win­dow, as opposed to simple optic nerve sheath de­compression, in patients with normal- pressure glaucoma. The authors whose article he critiques reply and note that more such studies are needed to determine the possible efficacy of this proce­dure. Orbital Metastasis From a Urachal Tumor. Gior­dano GG, Shetlar DJ. Arch Ophthalmol 1995; 113: 413- 5 ( Apr). [ Reprint requests to Dr. D. J. Shetlar, Department of Ophthalmology and Pathology, 8000 Medical Center East, Vanderbilt University Medical Center, Nashville, TN 37232.] A 28- year- old woman with an unusual primary tumor in the urachal remnant above the bladder developed an orbital metastasis. The authors be­lieve that this is the first reported case of orbital metastasis from a mucinous adenocarcinoma of this primary site. Short- Wavelength Automated Perimetry in Neuro- Ophthalmologic Disorders. Keltner JL, Johnson CA. Arch Ophthalmol 1995; 113: 475- 81 ( Apr). [ Reprint requests to Dr. J. L. Keltner, De­partment of Ophthalmology, University of Califor­nia- Davis, 1603 Alhambra Boulevard, Sacramento, CA 95816.] The authors used short- wavelength automated perimetry ( SWAP) in patients with a variety of neuro- ophthalmic diseases. In some, SWAP ap­peared more sensitive than standard automated perimetry, but not in others. Reasons for this are discussed. Visual Disturbance Secondary to Clomiphene Ci­trate. Purvin VA. Arch Ophthalmol 1995; 113: 482- 4 ( Apr). [ Reprint requests to Dr. V. A. Purvin, Mid­west Eye Institute, 1800 N. Capital Avenue, Indi­anapolis, IN 46202.] Three patients treated with clomiphene ( Clo-mid) for 4- 15 months had lingering side effects, including palinopsia, shimmering, and photopho­bia. It may be useful to query patients with these complaints about previous use of infertility drugs as these effects continued in the patients even years later. Congenital Fibrosis of the Vertically Acting Ex­traocular Muscles. A New Group of Dominantly Inherited Ocular Fibrosis With Radiologic Find­ings. Gillies WE, Harris AJ, Brooks AMV, Rivers MR, Wolfe RJB. Ophthalmology 1995; 102: 607- 12 ( Apr). [ Reprint requests to Dr. W. E. Gillies, 82 Collins Street, Melbourne 3000, Victoria, Austra­lia.] The authors describe a previously unreported type of dominantly inherited congenital fibrosis af­fecting vertical rectus muscles. Associated features include ptosis, superficial interpalpebral keratitis, and in some, an abnormal shape of the globe itself. Nice computerized tomographic and color clinical photographs are included. Orbital Infarction Syndrome After Surgery for In­tracranial Aneurysms. Zimmerman CF, Van Pat­ten PD, Golnik KC, Kopitnik TA Jr, Anand R. Oph- ! Neuro- Ophthalmol, Vol. 16, No. 1, 1996 64 LITERATURE ABSTRACTS thalmology 1995; 102: 594- 8 ( Apr). [ Reprint requests to Dr. C. F. Zimmerman, Department of Ophthal­mology, University of Texas Southwestern Medi­cal Center, 5323 Harry Hines Boulevard, Dallas, TX 75235- 9057.] The authors report six patients with presumed unilateral orbital infarction after intracranial sur­gery for aneurysm. In all, the visual result was poor. This syndrome may be multifactorial and its occurrence may be reduced by perioperative pre­cautions such as control of intracranial pressure, stability of systolic blood pressure, and volume control, as well as by avoiding pressure on the globe by craniotomy flaps or operative positioning equipment. Optic Disk Swelling and Abducens Palsies Asso­ciated With OKT3. Strominger MB, Liu GT, Schatz NJ. Am } Ophthalmol 1995; 119: 664- 5 ( May). [ Inqui­ries to Dr. M. B. Strominger, Department of Oph­thalmology, University of Nebraska Medical Cen­ter, 600 S. 42nd Street, Box 982045, Omaha, NE 68198- 2045.] An 18- year- old woman was being treated for re­nal transplant rejection with intravenous OKT3 for 10 days and developed horizontal diplopia and headaches. Her examination showed deficits of ab­duction, good visual function, and papilledema. Magnetic resonance imaging was normal, and lumbar puncture had an opening pressure of 430 with 154 monocytes and all cultures negative. Her signs and symptoms gradually resolved after her OKT3 was completed. The authors believe the OKT3 therapy led to an aseptic meningitis with meningeal inflammation and increased intracranial pressure. Acute Postpartum Horner's Syndrome due to Epi­dural Anesthesia. Jeret JS, Mazurek AA. Arch Oph­thalmol 1995; 113: 560 ( May). [ Reprint requests to Dr. J. S. Jeret, Mercy Medical Center, 1000 N. Vil­lage Avenue, Rockville Centre, NY 11570.] A 28- year- old woman had a complaint of blurred vision in the left eye and left posterolateral neck pain 1 h after vaginal delivery with an epidural anesthetic. Examination demonstrated a 3- mm an-isocoria, with the left pupil smaller, and a variable left ptosis. Computerized tomography of the brain, lumbar puncture, and magnetic resonance imaging of the cervical spine were unremarkable. The authors believe that this case of probable post­partum Horner's, which resolved over 24 h, was caused by sympathetic denervation to at least the fourth thoracic level secondary to the epidural an­esthetic. Sarcoidosis Involving the Optic Nerve and Hypo­thalamus. Westlake WH, Heath JD, Spalton DJ. Arch Ophthalmol 1995; 113: 669- 70 ( May). [ Corre­spondence to Dr. D. J. Spalton, The Medical Eye Unit, St. Thomas' Hospital, Lambeth Palace Road, London, England SE1 7EH.] This photo essay involves a 20- year- old woman with decreased visual acuity in the right eye and secondary amenorrhea. A magnetic resonance scan and disc photos demonstrate sarcoidosis in­volving the optic nerve, hypothalamus, and pitu­itary stalk. Persisting Temporal Arteritis. Wolin MJ, Kent AD. Ophthalmology 1995; 102: 701 ( May). [ No reprint information given.] This letter to the editor discusses a patient who had reactivation of temporal arteritis 4 years after initial diagnosis ( with biopsy) and 2 years after ces­sation of corticosteroid therapy. Unfortunately, she experienced biopsy- proven anterior ischemic optic neuropathy as part of her disease reactiva­tion. Proptosis as the Initial Presentation of Fungal Si­nusitis in Immunocompetent Patients. Heier JS, Gardner TA, Hawes MJ, McGuire KA, Walton WT, Stock J. Ophthalmology 1995; 102: 713- 7 ( May). [ Re­print requests to Dr. J. S. Heier, Fitzsimons Army Medical Center, Ophthalmology Service, Aurora, CO 80045- 5001.] Four patients who were not immunocompro­mised had fungal sinusitis with proptosis. All did well with antifungal therapy. Diagnostic Criteria for Graves' Ophthalmopathy. Bartley GB, Gorman CA. Am } Ophthalmol 1995; 119: / Neuro- Ophthalmol, Vol. 16, No. 1, 1996 LITERATURE ABSTRACTS 65 792- 5 ( June). [ Reprint requests to Dr. G. B. Bart-ley, Department of Ophthalmology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905.] The authors discuss previous diagnostic criteria for thyroid ophthalmopathy and propose their own. Their " bow- tie"- shaped diagnostic scheme involves either eyelid retraction or thyroid dys­function as a required feature with at least one other feature ( optic nerve dysfunction or extraoc­ular muscle involvement, for example) necessary to make the diagnosis clinically. Horner's Syndrome in Subadventitial Carotid Ar­tery Dissection and the Role of Magnetic Reso­nance Angiography. Brown J Jr, Danielson R, Donahue SP, Thompson HS. Am ] Ophthalmol 1995; 119; 811- 3 ( June). [ Inquiries to Dr. J. Brown, Jr., Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, IA 52240.] A 47- year- old man with a postganglionic Horner's syndrome and right facial pain had a neg­ative arteriogram but a positive magnetic reso­nance angiogram for a presumed subadventitial dissection of the right internal carotid artery. Metastatic Tumors to the Pituitary. Aaberg TM Jr, Kay M, Sternau L. Am J Ophthalmol 1995; 119: 779- 85 ( June). [ No reprints available.] Three patients with tumors metastatic to the pi­tuitary are described. Two had oculomotor nerve involvement as well as visual loss. Other recent similar cases in the literature are reviewed. Tonic Pupil and Orbital Glial- Neural Hamartoma in Infancy. Brooks- Kayal AR, Liu GT, Menacker SJ, Heher KL, Katowitz JA, Bilaniuk LT. Am } Oph­thalmol 1995; 119: 809- 11 ( June). [ Inquiries to Dr. G. T. Liu, Division of Neuro- Ophthalmology, De­partment of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.] A 3V2- month- old girl with a history of anisocoria since birth was pharmacologically shown to have an Adie's pupil. Magnetic resonance imaging dem­onstrated a retrobulbar mass on the involved side, which was surgically found to be a benign glial neural hamartoma. Confrontation Visual Field Loss as a Function of Decibel Sensitivity Loss on Automated Static Pe­rimetry. Implications on the Accuracy of Confron­tation Visual Field Testing. Shahinfar S, Johnson LN, Madsen RW. Ophthalmology 1995; 102: 872- 7 ( June). [ Reprint requests to Dr. L. N. Johnson, Neuro- Ophthalmology Unit, Mason Institute of Ophthalmology, University of Missouri- Colum­bia, Columbia, MO 65212.] A comparison between confrontation visual field and automated visual field on 72 consecutive neuro- ophthalmic patients was made. The sensi­tivity of confrontation visual field testing ( done by having the patient identify " which of the examin­er's fingers wiggled") varied; it was 51% for arcu­ate scotomas, 67% for field constriction, 78% for altitudinal scotomas, and 90% for hemianopias. Identification of the abnormal visual field quadrant was lower ( 38%). The authors conclude that con­frontation visual field is " relatively insensitive un­less a moderate to dense defect is present" but, when the confrontation visual field is abnormal, there is a high specificity ( 97%) and predictive value ( 96%). Macular Changes in Pseudotumor Cerebri Before and After Optic Nerve Sheath Fenestration. Carter SR, Seiff SR. Ophthalmology 1995; 102: 937- 41 ( June). [ Reprint requests to Dr. S. R. Seiff, Department of Ophthalmology K301, University of California- San Francisco, 10 Kirkham Street, San Francisco, CA 94143- 0730.] Seven patients who underwent unilateral optic nerve sheath decompression were studied in re­gard to pre- and postoperative macular changes. Macular exudates resolved with surgery, but cho­roidal striae, pigment mottling, and subretinal scars ( from presumed choroidal vascular mem­brane) did not. The continued presence of these latter three macular findings postoperatively is not an indication of surgery failure. Visual Loss After Neurosurgical Repair of Para-clinoid Aneurysms. Rizzo JF III. Ophthalmology J Neuro- Ophthalmol, Vol. 16, No. 1, 1996 66 LITERATURE ABSTRACTS 1995; 102: 905- 10 ( June). [ Correspondence to Dr. J. F. Rizzo III, Massachusetts Eye and Ear Infir­mary, 243 Charles Street, Boston, MA 02114.] Three patients who had paraclinoid aneurysm surgery subsequently, within several days, lost vision in the ipsilateral eye. One had a tightly swollen orbit and probable ophthalmic artery oc­clusion, but the other two appeared to have a ret­robulbar optic neuropathy. In one, intravenous corticosteroids may have contributed to partial re­turn of vision. Possible reasons are discussed for this unanticipated complication of aneurysm sur­gery. Extraocular Muscles: Basic and Clinical Aspects of Structure and Function. Porter JD, Baker RS, Ra-gusa RJ, Brueckner JK. Surv Ophthalmol 1995; 39: 451- 84 ( May- June). [ Reprint requests to Dr. R. S. Baker, Department of Ophthalmology, E304 Ken­tucky Clinic, University of Kentucky Medical Cen­ter, Lexington, KY 40536- 0284.] This rather dry but exhaustive major review of this topic might have benefited from more illustra­tions. Optic Disk Edema With Cotton- Wool Spots. Wall M. Comments. Breen L, Winterkorn J. Surv Oph­thalmol 1995; 39: 502- 8 ( May- June). [ Reprints not available.] A 43- year- old hypertensive man presented with subacute visual loss in the left eye and had bilateral disc edema, peripapillary hemorrhages, and cot­ton- wool spots. He was found to have increased blood pressure ( 260/ 170) and was treated for this with a concomitant increase in vision. This case is well- discussed, as usual, by the Clinical Pathologic Conference consultants. Microvasculature of the Human Optic Nerve. Onda E, Cioffi GA, Bacon DR, Van Buskirk EM. Am ] Ophthalmol 1995; 120: 92- 102 ( July). [ Reprint re­quests to Dr. G. A. Cioffi, Devers Eye Institute/ Good Samaritan Hospital and Medical Center, 1040 NW 22nd Avenue, Suite 200, Portland, OR 97210.] The authors injected methyl methacrylate through the central retinal artery and through the short posterior ciliary arteries in human eye bank eyes. They found that the main arterial supply to the anterior optic nerve is from the short posterior ciliary arteries. Superior Oblique Luxation and Trochlear Lux­ation as New Concepts in Superior Oblique Mus­cle Weakening Surgery. Mombaerts I, Koornneef L, Everhard- Halm YS, Hughes DS, Maillette de Buy Wenniger- Prick LJJ. Am J Ophthalmol 1995; 120: 83- 91 ( July). [ Reprint requests to Dr. I. Mom­baerts, Orbital Center, Department of Ophthal­mology A2- 118, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ Amsterdam Zuidoost, The Netherlands.] The authors describe a new technique for use in patients with acquired Brown's syndrome and su­perior oblique overaction that actually incises the trochlea to release the superior oblique tendon or incises the periosteum under the trochlea to dis­place it. Eight of nine patients ( total, 11 eyes) op­erated had improvement in subjective and objec­tive parameters postoperatively. Diabetic Papillopathy. Patient Characteristics and Fundus Findings. Regillo CD, Brown GC, Savino PJ, Byrnes GA, Benson WE, Tasman WS, Sergott RC. Arch Ophthalmol 1995; 113: 889- 95 ( July). [ Re­print requests to Dr. G. C. Brown, Retinovitreous Associates, 910 E. Willow Grove Avenue, Wynd-mor, PA 19118.] All diabetic patients with " benign transient disc swelling" seen from 1986 to 1992 at Wills Eye Hos­pital were included in this retrospective study. Twenty- seven eyes of 19 patients were included. Mean age was 50 ( range, 19- 79). Disc swelling was hyperemic and generally resolved in 3.7 months. It is nice to have an updated reference on this impor­tant topic. Fixation Switch Diplopia. Kushner BJ. Arch Oph-ihalmol 1995; 113: 896- 9 ( July). [ Correspondence to Dr. B. J. Kushner, 2880 University Avenue, Mad­ison, WI 53705- 3631.] Adults with a history of strabismus since child­hood may experience diplopia if something hap- } Neuro- Ophthalmol, Vol. 16, No. 1, 1996 LITERATURE ABSTRACTS 67 pens to switch fixation to the previously nonpre-ferred eye. Dr. B. Kushner argues that usually a workable optical solution is possible, such as cor­recting even a small amount of myopia in the pre­ferred eye. Cyclodeviation in Skew Deviation. Slavin ML. Author Reply. Galetta SL, Liu GT, Raps EC, Sol- Europe Isolated Unilateral Internuclear Ophthalmoplegia Following Head Injury. Strauss C, Ganslandt O, Huk WJ, Jonas JB. Neuro Ophthalmol 1995; 15: 15- 9. Although internuclear ophthalmoplegia ( INO) is most frequently caused by demyelinating disease, vascular events to the brain stem can produce the same clinical picture. This paper describes two cases of unilateral traumatic INO. In both cases the head injury was minor. Small pontomesencephalic paramedian contusion marks could be detected in the magnetic resonance image. Concommitant brain stem injury was excluded with brain stem auditory evoked potentials. In addition to double vision, one patient complained of unilateral hear­ing loss due to hematotypanon. Both patients re­ported anteriograde amnesia. Duane's Syndrome With Trigeminal Nerve In­volvement. Tiel- Wilck K, Wilck B, Lempert T. Neuro Ophthalmol 1995; 15: 93- 6. [ Reprint requests to Dr. Klaus Tiel- Wilck, Department of Neurology, University Klinikum Rudolf Virchow, Augusten-burger Platz 1, 13353 Berlin, Germany.] The authors report a 43- year- old woman with type 1 Duane syndrome, according to the classifi­cation of Huber, and ipsilateral sensory dysfunc­tion of the trigeminal nerve. There was a history of recurrent conjunctivitis of the left eye and fluctu­ating paresthesia of the left face. History for facial herpes zoster was negative. Neurological examina­tion revealed hypesthesia and dysesthesia of all three branches of the left trigeminal nerve. Touch­ing of the left face produced an unpleasant electri-omon D, Volpe NJ. Am J Ophthalmol 1995; 119: 815- 6 ( June). [ No reprint information given.] This letter to the editor comments on a previous paper regarding cyclodeviation in skew. Dr. Slavin argues that one of the reported cases had cyclotor-sion secondary to a separate midbrain lesion, and the authors reply to his letter. H. Esriel Killer, MD cal sensation. Intraoral sensation was normal; the corneal reflex on the left eye, however, was dimin­ished. Although the association of Duane syn­drome with other congenital malformations ( e. g., congenital nystagmus and ocular, ear, skin, and musculoskeletal malformations) is described in the literature, the association with trigeminal nerve in­volvement has not been previously reported. Hy­poplasia of the caudal spinal trigeminal tract is the proposed underlying pathology. Achromatopsia as a Symptom of Multiple Sclero­sis. Muller T, Buttner T, Kuhn W, Przuntek H. Neuro Ophthalmol 1994; 14: 277- 8. [ Reprint requests to Dr. Th. Muller, Department of Neurology, St. Josef- Hospital, University of Bochum, Gudrund-str. 56, 44791 Bochum, Germany.] A 31- year- old woman suffered from transient at­tacks ( up to four times a week for 3 months) of cerebral achromatopsia before she was diagnosed with multiple sclerosis. There was no history of migraine. The patient described the change of color perception as like a " switch to black and white on a color TV." Magnetic resonance scan of the brain showed multiple well- demarcated le­sions in the periventricular white matter. In­creased 7- globulins, positive oligoclonal IgG bands, and elevation of cells were found in the cerebrospinal fluid. The authors believe that the achromatopsia in this case is of central origin ( due to glial scarring or capillary compression by edem­atous demyelinating focus), since all optic nerve parameters, including VER, were normal. / Neuro- Ophthalmol, Vol. 16, No. 1, 1996