Journal of Neuro-Ophthalmology, December 1996, Volume 16, Issue 4

Literature Reviews

Journal of Neuro- Ophthalmology 16( 4): 297- 300, 1996. © 1996 Lippincott- Raven Publishers, Philadelphia Literature Abstracts- U. S. A. Retinal Venous Sheathing and the Blood- Retinal Barrier in Multiple Sclerosis. Birch MK, Barbosa S, Blumhardt LD, O'Brien C, Harding SP. Arch Oph­thalmol 1996; 114: 34- 9 ( Jan). [ Correspondence to Dr. M. K. Birch, St. Paul's Eye Unit, Royal Liver­pool University Hospital, Prescot Street, Liverpool L7 8XP, England.] Twenty- three patients with relapsing- remitting, primary- progressive, or secondary- progressive multiple sclerosis were followed for 6 months to assess the blood- retinal barrier. Patients under­went ophthalmic examination, fluorescein angiog­raphy, and magnetic resonance imaging monthly. Six patients had retinal venous sheathing with var­ious findings on fluorescein angiography. There was no correlation between ophthalmic retinal fea­tures and multiple sclerosis subgrouping, disease course, or magnetic resonance findings. Fields of Dreamers and Dreamed- up Fields. Func­tional and Fake Perimetry. Thompson JC, Kos-morsky GS, Ellis BD. Ophthalmology 1996; 103: 117- 25 ( Jan). [ Reprint requests to Dr. G. S. Kosmorsky, Division of Ophthalmology, Cleveland Clinic Foundation, 1 Clinic Center, A- 31, Cleveland, OH 44195- 5024.] Volunteers posed as neuro- ophthalmic patients and were instructed to fake certain visual field de­fects, which were described to them. As is never surprising, the volunteers who faked visual field defects were very good at fooling both automated perimeters and technicians doing manual perime­try. Additionally, more experienced technicians were easier to fool than inexperienced ones, prob­ably because of the more methodical way in which experienced technicians tested abnormal areas as well as their meant- to- be helpful exhortations, e. g., " you may not see the light but then it will suddenly appear," when testing for a presumed scotomatous area. Lyn A. Sedwick, MD [CFocularinjury] Hypertropia and the Posterior Blowout Fracture. Mechanism and Management. Seiff SR, Good WV. Ophthalmology 1996; 103: 152- 6 ( Jan). [ Reprint requests to Dr. S. R. Seiff, University of California, San Francisco, Department of Ophthalmology, K301, 10 Kirkham St, San Francisco, CA 94143- 0730.] Ten consecutive patients, each with a blowout fracture and hypertropia on the affected side, make up this report. Presumably, infraduction was " diminished due to changes in the effective origin and insertion of the inferior rectus muscle," and such patients should be suspected of having a pos­terior blowout fracture. They may require surgical intervention if motility does not improve in 10- 14 days postaccident. Oculopalatal Myoclonus After the One- and- a- Half Syndrome With Facial Nerve Palsy. Wolin MJ, Trent RG, Lavin PJM, Cornblath WT. Ophthal­mology 1996; 103: 177- 80 ( Jan). [ Reprint requests to Dr. M. J. Wolin, Medicus, Anderson Eye & Ear Associates, PA, 1655 East Greenville St, Anderson, SC 29622- 1226.] Five patients with one- and- a- half syndrome and facial nerve palsy developed oculopalatal myoclo­nus. All had either brainstem or pontine hemor­rhage, or stroke. The exact mechanism for devel­opment of oculopalatal myoclonus in this setting is discussed. Retinopathy and Optic Neuropathy in Bone Mar­row Transplantation for Breast Cancer. Khawly J A, Rubin P, Petros W, Peters WP, Jaffe GJ. Oph­thalmology 1996; 103: 87- 95 ( Jan). [ Reprint requests to Dr. G. J. Jaffe, P. O. Box 3802, Duke University Eye Center, Durham, NC 27710.] Nine patients with breast cancer had visual symptoms after chemotherapy with carmustine, cisplatin, cyclophosphamide, and autologous bone marrow transplantation. Optic neuropathy and 298 LITERATURE ABSTRACTS retinopathy were found in five patients, retinopa­thy alone in three patients, and optic neuropathy in only one patient. Retinopathy is generally re­solved with good visual return; however, optic neuropathy less often resolved and, in two pa­tients, showed progression after 4 months. Of all the agents, cisplatin was associated with a higher risk of ocular toxicity when these patients were compared to a control group with similar chemo­therapy and bone marrow transplantation but without ocular toxicity. How to Handle the Pressure or Too Much of a Good Thing. Sedwick LA. Comments. Boghen D, Moster M. Surv Ophthalmol 1996; 40: 307- 11 ( Jan- Feb). [ Reprints are not available.] A case of a 28- year- old woman with pseudotu­mor cerebri is presented and discussed with em­phasis on current medical and surgical treatment strategies. Negative MRI Versus Real Disease. Weinberg DA. Comments. Kaufman DI, Siebert JD, Perni-cone JR. Surv Ophthalmol 1996; 40: 312- 9 ( Jan- Feb). [ Reprint address: Dr. D. I. Kaufman, College of Osteopathic Medicine, A217 Clinical Center, Mich­igan State University, E. Lansing, MI 48824- 1313.] A 76- year- old lady with progressive diplopia and right eye pain is presented. She had a partial right third nerve palsy with partial pupil involve­ment and was ultimately found to have a posterior communicating aneurysm on conventional arteri­ography after magnetic resonance angiography " failed" to identify an aneurysm. A good discus­sion ensues as to why magnetic resonance angiog­raphy failed and points out that, in this case, mag­netic resonance image- producing techniques were suboptimal since other projections of the initial magnetic resonance angiogram data demonstrated the lesion. Recommendations are made that one ensure that one's radiologist is aware of both the area in question and lesion suspected when order­ing magnetic resonance angiography. Spasm of the Near Reflex: A Spectrum of Anom­alies. Goldstein JH, Schneekloth BB. Surv Ophthal­mol 1996; 40: 269- 78 ( Jan- Feb). [ Reprint address: Dr. J. H. Goldstein, Department of Ophthalmology, State University of New York, Health Science Cen­ter at Brooklyn, 450 Clarkson Ave- Box # 28, Brooklyn, NY 11203.] This major review deals with this subject in its entirety and serves as a good reference for the cli­nician who is trying to sort out spasm of accom­modation versus spasm of convergence versus spasm of the entire near flex. There is a discussion regarding neuroanatomic correlates and patho­physiology, but the author notes that the clinician is often " perplexed with regard to which patients should be ' worked up'." Choroidal Neovascular Membrane Associated With Optic Nerve Head Drusen in a Child. Brown SM, Del Monte MA. Am } Ophthalmol 1996; 121: 215- 7 ( Feb). [ Inquiries to Dr. M. A. Del Monte, W. K. Kellogg Eye Center, 1000 Wall St., Ann Ar­bor, MI 48105; fax: ( 313) 936- 2340.] A 9- year- old boy had bilateral disc edema and a retinal mass in one eye. He had numerous optic nerve drusen on clinical examination, and the mass proved to be a choroidal neovascular mem­brane caused by the drusen. Ocular Signs and Symptoms Caused by Exposure to Sarin Gas. Kato T, Hamanaka T. Am } Ophthal­mol 1996; 121: 209- 10 ( Feb). [ Inquiries to Dr. T. Kato, Department of Ophthalmology, Japanese Red Cross Medical Center, 4- 1- 22 Hiroo, Shibuya-ku, Tokyo, Japan; fax: [phone].] Many individuals exposed to sarin gas ( a cholin-esterase inhibitor) during the Tokyo subway ter­rorist attacks of March 1995 were found to have miosis and conjunctival injection. Signs and symp­toms spontaneously abated in 3- 21 days and were not affected by systemic atropine treatment. Ocu­lar pain, however, was relieved with 0.5% tropic-amide, presumably for relief of ciliary spasm. Presumed Ocular and Central Nervous System Tuberculosis in a Patient With the Acquired Im­munodeficiency Syndrome. Muccioli C, Belfort Jr R. Am ] Ophthalmol 1996; 121: 217- 9 ( Feb). [ Inquiries to Dr. R. Belfort, Jr., Rua Botucatu, 822, Sao Paulo, SP, 04023- 062, Brazil] / Ncuro- Ophthalmol, Vol. 16, No. 4, 1996 LITERATURE ABSTRACTS 299 A 35- year- old woman with AIDS presented with mental status change, fever, pneumonia, and leth­argy. On examination, she had bilateral vitritis and chorioretinitis. Her workup disclosed tuberculosis with central nervous system, ocular, and pulmo­nary involvement; she improved on triple- drug therapy. Reading- Evoked Visual Dimming. Manor RS, Yassur Y, Hoyt WF. Am J Ophthalmol 1996; 121: 212- 4 ( Feb). [ Inquiries to Dr. R. S. Manor, Depart­ment of Ophthalmology, Beilinson Medical Cen­ter, 49100 Petah- Tikva, Israel.] A fascinating 49- year- old monocular patient noted a five- year history of visual dimming with reading. He was found to have an intraconal tu­mor in the orbital apex that probably compressed the optic nerve when the eye was in infraduction. The Treatment of Graves' Ophthalmopathy in an Incidence Cohort. Bartley GB, Fatourechi V, Kadrmas EF, Jacobsen SJ, Ilstrup DM, Garrity JA, Gorman CA. Am J Ophthalmol 1996; 121: 200- 6 ( Feb). [ Reprint requests to Dr. G. B. Bartley, Department of Ophthalmology, Mayo Clinic, 200 First St. S. W., Rochester, MN 55905.] One hundred and twenty patients with Graves' ophthalmopathy were found in the medical diag­nostic index of the Mayo Clinic and the Rochester Epidemiology Project for the period 1976- 1990. Of these, 89 ( 74.2%) patients required no treatment or supportive measures only, six ( 5%) were treated with systemic corticosteroids, one had orbital ra­diotherapy, and 24 ( 20%) had one or more surgical procedures ( lid, strabismus, and/ or orbital decom­pression). This is reassuring information to give patients with Graves' ophthalmopathy who may ask their chance of needing medical or surgical in­tervention when seen early in the disease course. The Current Use of Botulinum Toxin Therapy in Strabismus. Rosenbaum AL. Arch Ophthalmol 1996; 114: 213- 4 ( Feb). [ Reprint requests to Dr. A. L. Rosenbaum, Jules Stein Eye Institute, 100 Stein Plaza, Los Angeles, CA 90024- 7001.] This editorial describes current and possible fu­ture indications for the use of botulinum toxin in the treatment of strabismus. The Relative Afferent Pupillary Defect and a Novel Method of Fusion Recovery With the Worth 4- Dot Test. Johnson LN. Arch Ophthalmol 1996; 114: 171- 5 ( Feb). [ Reprint requests to Dr. L. N. Johnson, Neuro- ophthalmology Unit, Mason Insti­tute of Ophthalmology, University of Missouri- Columbia, Columbia, MO 65212.] The author placed neutral density filters in front of the better eye in patients who had a relative afferent pupillary defect and found that Worth 4- dot testing improved to a fusion response with increasing neutral density filters, although tests of stereopsis did not improve. The author suggests that Worth 4- dot neutralization testing " may be a useful adjunct in the assessment of visual dysfunc­tion." Ocular Amyloidosis, With Special Reference to the Hereditary Forms With Vitreous Involvement. Sandgren O. Surv Ophthalmol 1995; 40: 173- 96 ( Nov- Dec). [ Reprint address: Dr. O. Sandgren, Depart­ment of Ophthalmology, University of Umea, S- 901 85 Umea, Sweden.] This is a major review of the subject with truly lovely color clinical photographs, including pupil­lary " scalloping." A very nice reference. Two Neuro- Ophthalmic Episodes Separated in Time and Space. Cullom Jr RD, Cullom ME. Com­ments. Kardon R, Digre K. Surv Ophthalmol 1995; 40: 217- 24 ( Nov- Dec). [ Reprint address: Dr. R. D. Cullom, Department of Ophthalmology, Naval Medical Center, 620 John Paul Jones Circle, Ports­mouth, VA 23708- 2197.] A 39- year- old woman suffered a branch retinal artery occlusion of her right eye, thought to be secondary to migraine or mitral valve prolapse. Her vision recovered to near normal, and, 7 years later, she developed right periocular discomfort and a third order neuron Horner's syndrome. The discussants conclude that the right carotid artery must be the origin of the pathology; the patient was subsequently found to have a right internal / Neuw- Ophthalmol, Vol. 16, No. 4, 1996 300 LITERATURE ABSTRACTS carotid artery dissection. She did well with antico­agulation. Ophthalmologic Findings in a Patient With Cere­bellar Ataxia, Hypogonadotropic Hypogonadism, and Chorioretinal Dystrophy. Salvador F, Garcia- Arumi, J., Corcostegui B, Minoves T, Tarrus F. Am } Ophthalmol 1995; 120: 241- 4 ( Aug). [ Reprint re­quests to Dr. F. Salvador, C/ Numancia 95- 99, Esc. A, 7°- l", 08029, Barcelona, Spain.] A patient with Boucher- Neuhauser syndrome ( spinocerebellar ataxia, chorioretinal dystrophy, and hypogonadotropic hypogonadism) is de­scribed. This syndrome is an autosomal recessive disorder. Only five families with the disorder have been reported, but none in eye literature. This 39- year- old woman complained of decreased vision for 2 years duration and was found to have an atrophic retinal pigment epithelium, choriocapil-laris, and clumps of pigment deposition. She had had delayed puberty, medication- induced menses only, and, at age 28 years, started to have balance problems. Neuro- Ophthalmic Manifestations of Meningoce-rebral Inflammation From the Limited Form of Wegener's Granulomatosis. Newman NJ, Slamo-vits TL, Friedland S, Wilson WB. Am ] Ophthalmol 1995; 120: 613- 21 ( Nov). [ No reprints are available.] Four patients aged 40- 73 years presented with ocular motor nerve palsy or palsies, or gaze palsy. Neuro- imaging showed meningeal inflammation and, in one patient, parenchymal disease, but lab­oratory testing ( antineutrophil cytoplasmic anti­bodies) was initially negative for all patients. This disease is discussed, in general, with attention to its ophthalmic and neurologic complications. Ocular Abnormalities in Neurofibromatosis 2. Ragge NK, Baser ME, Klein J, Nechiporuk A, Sainz J, Pulst SM, Riccardi VM. Am ] Ophthalmol 1995; 120: 634- 41 ( Nov). [ Reprint requests to Dr. N. K. Ragge, Western Eye Hospital, London, NW1 5YE, United Kingdom.] The authors examine patients with neurofibro­matosis 2 as well as asymptomatic gene carriers for ophthalmic manifestations of the disease. Cata­racts at a young age ( 67%) and retinal hamartomas ( 22%) were seen as well as ocular motility nerve palsy ( 12%) and optic nerve sheath meningioma ( 2%). Rapidly Progressive Optic Disk Neovasculariza­tion After Diabetic Papillopathy. Ho AC, Maguire AM, Yannuzzi LA, Fisher YL, Galetta SL, Sergott RC. Am } Ophthalmol 1995; 120: 673- 5 ( Nov). [ Inqui­ries to Dr. A. C. Ho, Retina Service, Scheie Eye Institute, 51 N. 39th St., Philadelphia, PA 19104.] Two patients, aged 37 and 18 years, with insu­lin- dependent diabetes of unspecified duration de­veloped blurred vision and were found to have bilateral disk edema and decreased acuity in one or both eyes. Intravenous fluorescein angiography was done in each patient. Both had neuro- imaging and cerebrospinal fluid testing. By 10 weeks after onset of symptoms, each patient had optic disc neovascularization and complications from same. The authors caution that these patients should be followed even after initial resolution of symptoms and disc edema. Variability of the Relative Afferent Pupillary De­fect. Kawasaki A, Moore P, Kardon RH. Am J Oph­thalmol 1995; 120: 622- 33 ( Nov). [ Reprint requests to Dr. R. H. Kardon, Department of Ophthalmology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA 52242.] The authors used normal subjects and a comput­erized binocular infrared video pupillometer, and varied light stimulus in intensity, duration, and number to determine its effect on the variability of detecting a relative afferent pupillary defect ( in­duced in these subjects by dimming the light stim­ulus to one eye and later to the other). They found that the variability in measurements decreased with repetitive stimulus tests and that at 100 stim­ulus pairs, the 95% confidence level was < 0.1 log unit. Although they propose that such testing will have clinical effectiveness, it is hard to see how a several- min- long test of pupillary function with very sophisticated equipment will ever be cost-effective in the community. / Neuro- Ophthalmol, Vol. 16, No. 4, 1996 Journal of Neuro- Ophthalmology 16( 4): 301, 1996. © 1996 Lippincott- Raven Publishers, Philadelphia Literature Abstracts- Europe Vasospasm- A Risk Factor for Nonarteritic Ante­rior Ischemic Optic Neuropathy? Kaiser HJ, Flam-mer J, Messerli J. N'euro- ophthalmology 1996; 16: 5- 10 ( February). [ Reprint requests to Dr. J. Flammer, University Eye Clinic, P. O. Box CH- 4012 Basel, Switzerland.] Nonarteritic anterior ischemic optic neuropathy ( AION) is a disease of elderly patients with known risk factors such as disc at risk and cardiovascular disease. This paper reports five patients aged 12 to 44 with AION ( swelling of the optic disc, loss of central vision, visual field defect). All patients are reported to have capillary spasm detected with fin­gernail capillary- microscopy. Treatment consisted of the administration of an calcium antagonist, dipyramidole, beta blockers, or mineralocorti-coids. Visual acuity and visual field improved drastically in all patients. This paper raises inter­esting questions concerning a possible relationship between vasospasm and AION. The main ques­tion, however, is whether these patients represent a homogeneous group- the " normal" laboratory parameters are not specifically listed. Farbdopplersonographie der Temporalarterien- eine neue Methode zur Diagnostik der Arteriitis temporalis. Kraft HE, Moller DE, Volker L, Schmidt WA. Klin Monatsbl Augenheilk 1996; 208: 93- 5 ( February). [ Reprint requests to Dr. med. H. Kraft, Augenklinik, Klinikum Buch, Karowstrasse 11, D- 13125, Berlin, Germany.] Temporal artery biopsy is the golden standard to diagnose temporal arteritis. To move away from invasive diagnostics, the authors performed color Doppler sonography in 10 patients with temporal arteritis, 8 patients with polymyalgia rheumatica, H. Esriel Killer, MD and 23 controls. The parameters measured the size of the lumen and wall as well as blood flow veloc­ity. Color Doppler sonography of the superficial temporal artery showed a characteristic hypo-echoic halo around the perfused lumen of a ste-nosed or occluded artery. Neither patients with polymyalgia rheumatica nor controls showed this hypoechoic halo, which disappeared 10 to 14 days after glucocorticoid treatment. The authors con­clude that color Doppler sonography is a simple, quick, and noninvasive method to diagnose tem­poral arteritis. Fourth Nerve Palsy in Migraine. Wong AMF, Sharpe JA. N'euro- ophthalmology 1996; 16: 51- 4. [ Re­print requests to Dr. J. A. Sharpe, Division of Neu­rology, The Toronto Hospital, EC 5- 042, 399 Bathurst Street, Toronto, Ontario Canada M5T 2S8.] Transient third nerve palsy in children due to migraine is a well- known entity called ophthal­moplegic migraine. A 15- year- old Caucasian boy pre­sented with recurrent oblique diplopia. He had a 7- year history of common migraine. Since age 13, each migraine attack had been associated with oblique diplopia that increased in downgaze. Physical examination, cranial CT and MRI studies, and magnetic resonance angiography ( MRA), as well as laboratory work- up, were normal. Admin­istration of Fiorinal, propranolol, Cafergot, and sumatriptan failed to prevent the headaches as well as the diplopia. The authors suggest that re­current fourth nerve palsy associated with mi­graine may be included in the differential diagno­sis of fourth nerve palsy. 301 [CFocularinjury]