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Show Journal of Nemo- Ophthalmology 17( 1): 72- 75, 1997. © 1997 Lippineoll- Raven Publishers, Philadelphia Literature Abstracts Lyn A. Sedwick, MD To the Reader: In December 1984, Dr. J. Lawton Smith asked me whether I would be interested in writing abstracts of articles from U. S. ophthalmologic periodicals that had neuro- ophthalmic appeal for what was then the Journal of Clinical N euro- ophthalmology. I had just completed fellowship with Dr. Ronald Burde, was newly established in private practice in Orlando, and thought this would be a challenging and enjoyable task. It proved to be so. Over the years, I have abstracted hundreds of articles and have greatly appreciated hearing from readers regarding the usefulness of the abstracts in your research. I have now branched out in my activities ( to wit, Eric, age 8, and Jillian, age 5), consequently I have less time and energy to focus on the abstracts; this seems to be the right time for me to pass the baton to Steve Newman, whom I trust will bring the same enthusiasm and interest to the job that I began over a decade ago. My thanks to those of you who made a point of telling me how much you enjoyed the abstracts; it made the work worthwhile.- L. A. S. Editor's Comments Covering the span of the last decade, the Abstract Section of the Journal has been under the editorial aegis of Lyn Sedwick in Orlando. She is mother and wife as well as being one of the few people who are full time neuro- ophthalmologists in private practice. Lyn has done everything an Editor- in- Chief could request without being asked. She commented critically about the value or implications of the work under discussion. Thus, she did more than abstract. This approach drew some criticism, but I believe added to the value of the section. Lyn has requested to be relieved of this responsibility. I have ruefully capitulated. The yeowoman's job that she's done requires pointed recognition in the Journal. We will all miss your contributions to the Journal and your incisive thinking. Enjoy Gerry and the kids - they grow up so fast. god speed, Ronald M. Burde, M. D. Editor- in- Chief Long- Term Results Using Adjunctive Mitomycin C in Optic Nerve Sheath Decompression for Pseudotumor Cerebri. Spoor TC, McHenry JG, Shin DH. Ophthalmology 1995; 102: 2024- 8 ( Dec). [ Reprint requests to Dr. T. C. Spoor, Kresge Eye Institute, 4717 St. Antoine, Detroit, MI 48201- 1423, U. S. A.] The authors used mitomycin C in six patients with pseudotumor cerebri undergoing optic nerve sheath decompression ( four original surgeries and two repeat). Neurosurgical cottonoids soaked in mitomycin C were placed on the optic nerve for 5 min prior to the decompression surgery. Although the authors had hoped the use of mitomycin C would decrease the need for reoperations, two of the six patients required a second nerve sheath decompression after visual deterioration ensued. The Value of Combined Serum Angiotensin- Converting Enzyme and Gallium Scan in Diagnosing Ocular Sarcoidosis. Power WJ, Neves RA, Rodriguez A, Pedroza- Seres M, Foster CS. Ophthalmology 1995; 102: 2007- 11 ( Dec). [ Reprint requests to Dr. C. S. Foster, Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114, U. S. A.] The authors tested the efficacy of gallium scan versus angiotensin converting enzyme ( ACE) measurement in the diagnosis of sarcoidosis in 22 patients with ocular inflammatory disease consistent with sarcoid. All 22 patients had biopsy- proven sarcoidosis; of these, 100% had either a positive gallium scan or ACE level. ACE was, by itself, elevated in only 73% of patients. One or the other test was abnormal in 33% of patients with other types of uveitis; however, none of the patients tested abnormally in both tests. Leber Hereditary Optic Neuropathy. Sadun AA, Sa-dun F. Authors' Reply. Kerrison JB, Miller NR, Green WR, Hirst L, Howell N. Ophthalmology 1996; 103: 201- 2 ( Jan). [ No reprint information given.] The Saduns comment on the histopathology of a patient with Leber's who died at 81 years of complications of congestive heart failure. They believe that the calcium inclusions found in the retina and optic nerve, which were thought to be caused by the mitochondrial mutations, were actually caused by some other factor, possi- 72 LITERATURE ABSTRACTS 73 bly the patient's congestive heart failure and mode of death. Their belief was formed having found no such inclusions in their histopathologic studies of Leber's. The authors of the original article reply. Clinical Features of Graves' Ophthalmopathy in an Incidence Cohort. Bartley GB, Fatourechi V, Kadrmas EF, Jacobscn SJ, Ilstrup DM, Garrity JA, Gorman CA. Am J Ophthalmol 1996; 121: 284- 90 ( Mar). [ Reprint requests to Dr. G. B. Bartley, Department of Ophthalmology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, U. S. A.| The authors wanted to catalogue which clinical features were present in 120 patients with Graves' ophthalmology diagnosed between 1976 and 1990 in Olmstead County, Minnesota. Of the 120 patients, 90% had Graves' hyperthyroidism, 1% had primary hyperthyroidism, and 3% had Hashimoto's thyroiditis. Most of the patients ( n = 108) had lid retraction sometime in their disease course, with lesser numbers showing exophthalmos ( n = 73), restrictive extraocular motility ( n = 51), or optic nerve dysfunction ( n = 7). Table 3 shows all the changes of thyroid eye disease seen at the time of diagnosis and gives numbers and percentages. Of neuro-ophthalmic importance, only one of the seven patients who had optic neuropathy presented with this problem, underscoring the need for vigilant follow- up examinations for patients with active thyroid eye disease. Congenital Absence of the Inferior Rectus Muscle. Muiioz M. Am .1 Ophthalmol 1996; 121: 327- 9 ( Mar.) ( Correspondence to Dr. M. Muiioz, Bascom Palmer Eye Institute, P. O. Box 016880, Miami, FL 33101, U. S. A.] A 4- year- old boy with a history of pronounced light head till and previous strabismus surgery was found to have no inferior rectus muscle at surgical exploration. Functional Magnetic Resonance Imaging in Homonymous Hemianopsia. Miki A, Nakajima T, Fujita M, Takagi M, Abe II. Am .1 Ophthalmol 1996; 121: 258- 66 ( Mar). ( Reprint requests to Dr. A. Miki, Department of Ophthalmology, Niigata University School of Medicine, 1- 757 Asahimachi- dori, Niigata 951, Japan.] The authors studied five patients with homonymous hemianopic visual field defects caused by retrochiasmal lesions with functional magnetic resonance imaging; this involves visual stimulation with a pattern generator ( checkerboard) while the patient is in the MR machine. Even if the homonymous hemianopia was not complete, asymmetric activation was clearly demonstrated on the scans, except if macular sparing was present, in which case bilateral activation of calcarine cortex was observed. Although the authors postulate a clinical application in patients who cannot perform perimetry, because of the negative results with macular sparing, it would seem that a " normal" functional MR of the calcarine cortex cannot rule out even an extensive visual field defect if the macula is spared. Subtenon's Local Anesthesia for Optic Nerve Sheath Fenestration. Rizzuto PR, Spoor TC, Ramocki JM, McHenry JG. Am .1 Ophthalmol 1996; 121: 326- 7 ( Mar). ( Correspondence to Dr. P. R. Rizzuto, Koch Eye Associates, 566 Tollgatc Rd., Warwick, RI 02886, U. S. A.| The authors report the use of subtenon's local anesthetic for optic nerve sheath fenestration rather than retrobulbar injection or general anesthetic. Unilateral Optic Neuritis Caused by Hisloplasma cap-sulatum in a Patient With the Acquired Immunodeficiency Syndrome. Yau TH, Rivera- Velazquez PM, Mark AS, Cytryn AS, Levy CS, Shmookler BM, Koi-sky MP. Am J Ophthalmol 1996; 121: 324- 6 ( Mar). ( Correspondence to Dr. M. P. Kolsky, 106 Irving St. NW, Stc. 321, Washington, DC 20010, U. S. A.| A 35- year- old man with AIDS developed an optic neuropathy, ultimately found to be secondary to Hisloplasma capsulation found in biopsy specimens of retrobulbar fat and optic nerve sheath. Fluorescein Angiography in Nonischemic Optic Disc Edema. Arnold AC, Badr MA, Hepler RS. Arch Ophthalmol 1996; 1 14: 293- 8 ( Mar). | Reprint requests to Dr. A. C. Arnold, Jules Stein Eye Institute, UCLA, 100 Stein Plaza, Los Angeles, CA 90024- 7005, U. S. A.] The authors compared 16 intravenous fluorescein angiographic studies from patients having nonischemic disc edema ( papilledema, papillitis, and edema secondary to orbital cavernous hemangioma) with their previously published information on typical nonarteritic ischemic optic neuropathy ( NAION) and young ( not older than 46) patients with nonarteritic ischemic optic neuropathies ( NAIONy). They found that both ischemic entities are frequently associated with delayed optic disc filling on angiography ( 76% typical NAION, 62% NAIONy), whereas this finding was never seen in nonischemic conditions. Thus, intravenous fluorescein angi- ./ Natm- Ophlhtllnml. Vul. 17. Nt>. I. I')<) 7 74 LITERATURE ABSTRACTS ography may be of diagnostic value in patients for whom the etiology of the disc edema is not clear. Papilledema Following Bowtie Optic Atrophy. Ing EB, Leavitt JA, Younge BR. Arch Ophthalmol 1996; 114: 356- 7 ( Mar). [ Correspondence to Dr. J. A. Leavitt, Department of Ophthalmology, Mayo Clinic, West 7, 200 First St. SW, Rochester, MN 55905, U. S. A.] This exquisite photo essay shows a disc with previous bowtie optic atrophy from a sellar/ suprasellar astrocytoma that caused a temporal hemianopia. The disc then experienced papilledema from hydrocephalus. This " sparing" of the atrophic disc portion is striking. Are Systemic Corticosteroids Useful in the Management of Orbital Pseudotumor? Mombaerts I, Schlinge-mann RO, Goldschmeding R, Koornneef L. Ophthalmology 1996; 103: 521- 8 ( Mar). [ Reprint requests to Dr. I. Mombaerts, Orbital Center, Department of Ophthalmology A2- 118, Academisch Medisch Centrum, Meiberg-dreef 9, 1105 AZ Amsterdam Zuidoost, The Netherlands.] This interesting paper takes the position that corticosteroid therapy is not the most effective therapy in long-term control or cure of presumed orbital pseudotumor. Of 32 patients, 27 were primarily treated with corticosteroids and had a 37% cure rate and a 4 1% recurrence rate; 22% showed no response to therapy. Conversely, the 13 patients with optic neuropathy from orbital pseudotumor enjoyed a 92% total reversal of visual loss on corticosteroid therapy. This paper outlines reasonable treatment alternatives to corticosteroids. Magnetic Resonance Imaging in Patients With Unexplained Optic Neuropathy. Golnik KC, Hund III PW, Stroman GA, Stewart WC. Ophthalmology 1996; 103: 515- 20 ( Mar). [ Correspondence to Dr. K. C. Golnik, Outpatient Eye Surgery Center, The Cincinnati Eye Institute, 10494 Montgomery Rd., Cincinnati, OH 45242, U. S. A.] The authors investigated 20 patients with unexplained optic neuropathy with 20 age- matched controls. The distance found between the neuropathic optic nerve and internal carotid artery on MRI was significantly less than the contralateral optic nerve or the control group. The authors speculate that " the intimate relation between the optic nerve and adjacent ICA may be important in the development of unexplained optic neuropathy." Ophthalmologic Findings in Leber Hereditary Optic Neuropathy, With Special Reference to mtDNA Mutations. Nikoskelainen EK, Huoponen K, Juvonen V, Lamminen T, Nummelin K, Savontaus ML. Ophthalmology 1996; 103: 504- 14 ( Mar). [ Reprint requests to Dr. E. Nikoskelainen, Department of Ophthalmology, University of Turku ( TYKS), FIN- 20520 Turku, Finland.] Twenty- one pedigrees of Leber's ( presumably all from Finland) are reported, with several different known mutations and several families with no detected mutation. Some individuals harbored more than one Leber's mutation, which surprisingly did not seem to adversely affect visual outcome. The authors exhaustively discuss their own data, especially in regard to disease course and outcome. Calcific Retinal Emboli and Collateral Shunting in a Woman With Rheumatic Heart Disease. Winterkorn JMS, Ptachewich Y. Arch Ophthalmol 1995; 113: 1464- 5 ( Nov). [ Correspondence to Dr. J. M. S. Winterkorn, Neuro- ophthalmology, 900 Northern Blvd, Suite 210, Great Neck, NY 11021.] This stunning photo essay displays > 25- year- old bilateral calcific retinal artery emboli with shunt vessels around the blockage in a patient with rheumatic heart disease and valve replacement. Management of Diplopia Limited to Down Gaze. Kushner BJ. Arch Ophthalmol 1995; 113: 426- 30 ( Nov). [ Reprint requests to Dr. B. J. Kushner, Department of Ophthalmology and Visual Sciences, University of Wisconsin- Madison, 2880 University Ave, Madison, WI 53705- 3631.] Dr. Kushner reports his experience with 51 patients symptomatic in downgaze only for incomitant, vertical strabisumus. The causes for this include previous surgery for restrictive motitlity from thyroid eye disease, entrapment from a blowout fracture, and others. Optical management, e. g., slab- off bifocals or changing the position or type of reading correction, worked in 20 patients, surgery worked in 21, and a combination of optical and surgery was effective in 10 patients. A very practical reference to help these distressed ( and distressing) patients. Radiotherapy for Thyroid Orbitopathy. Effects on Extraocular Muscle Balance. Wilson WB, Prochoda M. Arch Ophthalmol 1995; 113: 1420- 5 ( Nov). [ Reprint ./ Nciiro- Ophllialmol, Vol. 17, No. I, 1997 LITERATURE ABSTRACTS 75 requests to Dr. W. B. Wilson, 850 E Harvard Ave, Suite 355, Denver, CO 80210.] Thirty- three patients with a motility disorder secondary to thyroid eye disease had radiation therapy in an effort to control or improve ocular motility. Although there was statistically improved ductions after radiation therapy, this therapy, nevertheless, was associated with te ultimate need for eye muscle surgery in 67% of patients. The authors conclude from theirs and other studies in the literature that " the usefulness of radiotherapy was limited when it was used alone to treat diplopia." Benign Episodic Unilateral Mydriasis. Clinical Characteristics. Jacobson DM. Ophthalmology 1995; 102: 1623- 7 ( Nov). [ Reprint requests to Dr. D. M. Jacob-son, Marshfield Clinic, 1000 N. Oak Ave, Marshfield, WI 54449,] The author retrospectively reviews information of 24 patients ( seven examined by himself with episodic unilateral mydriasis. This disorder is most often found in women and associate4d with a history of migraine. Its recognition is important as it is a benign process and does not require neuroimaging or other diagnostic studies. Comparative Study of Brain Magnetic Resonance Imaging Findings in Patients with Los- Tension Glaucoma and Control Subjects. Ong K, Farinelli A, Billson F, Houang M, Stern M. Ophthalmology 1995; 102: 1632- 8 ( Nov). [ Reprint requests to Dr. A. Farinelli, Glaucoma Unit, Sydney Eye Hospital, Macquarie St, Sydney NSW 2000, Australia.] Ten patients with los- tension glaucoma and 10 age-mathced controls had cerebral magnetic resonance imaging. Based on the thickness of the corpus callosum and number of white matter lesions in each group, the authors conclude that low- tension glaucoma is an " accelerated form of aging of the nervous system." Cotton- Wool Spots and the Early Diagnosis of Giant Cell Arteritis. Melberg NS, Grand MG, Dieckert JP, Barney NP, Blumenkranz MS, Boone DE, Folk JC, Stransky TJ. Ophthalmology 1995; 102: 1611- 4 ( Nov). [ Reprint requests to Dr. M. G. Grand, One Barnes Hospital Plaza, Suite 17413, East Pavilion, St. Louis MO 63110.] Seven patients ( aged 58- 79 years) with mild visual symptoms and cotton- wool spots on fundus examination were found to have temporal arteritis ( biopsy- proven in six patients and diagnosis of polymyalgia rheumatica in the seventh patient, with a sedimentation rate of 95). No patient had a frank ische3mic optic neuropathy, and only one had an arteriolar occlusion. This is a fascinating article of special importance to general and retinal ophthalmologists for information on early diagnosis and treatment of temporal arteritis. Focal Narrowing of Retinal Arterioles in Optic Nerve Atrophy. Papastathopoulos K, Jonas JB. Ophthalmology 1995; 102: 1706- 1 1 ( Nov). [ Reprints requests to Dr. J. B. Jonas, University Eye Hospital, Schwabachanlage 6, D- 91054 Erlange, Germany.] The authors examined color stereo disc photographs of patients with primary open- angle glaucoma ( 114), pseu-doexfoliation glaucoma ( 41), normal- pressure glaucoma ( 54), ocular hypertension ( 45), anterior ischemic optic neuropathy ( 20), descending optic atrophy ( 60), and controls for focal retinal vessel narrowing. Focal narrowing was correlated with age but was seen in eyes with glaucoma or nonglaucomatous optic nerve damage; this suggests that " focal narrowing of the retinal arteries is part of a panoply of changes hcarterislic of any optic nerve damage . . . [ and] indicates that focal vessel narrowing is not specific for glaucoma and . . . does not play a major role in the pathogenesis of this disease." Protracted Postraumatic Optic Disc Swelling. Brod-sky MC, Wald KJ, Chen S, Weiter JJ. Ophthalmology 1995; 102: 1628- 31 ( Nov). [ Reprint requests to Dr. M. C. Brodsky, 800 Marshall St, Little Rock, AR 72202- 3591.] Three patients had blunt ocular trauma and prolonged disc edema lasting from 2 to 6 months. In two patients, there was associated choroidal ruptures; all had a reson-ably good final visual outcome. Possible mechanisms for the edema are discussed. Nice color disc photographs are included. ./ Nniro- Ophtlwlmol, Vol. 17, No. I, 1997 |