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Show LITERATURE ABSTRACTS 215 lated or in combination with the rectus muscle. Echography was felt to be particularly useful to demonstrate enlargement of the oblique muscles, which may be difficult to capture on computerized tomographic scanning. LYIl A. Sedwick, M. D. Plasmacytoma of the Orbit. Tung G, Finger PT, Klein I, Chess Q. Arch Ophthalmol 1988; 106: 1622 ( Nov). [ No reprint information given.] A patient with known multiple myeloma had an orbital mass shown on biopsy to be a plasmacytoma. He responded to radiation therapy and chemotherapy. Lyn A. Sedwick, M. D. Dysthyroid Optic Neuropathy: The Crowded Orbital Apex Syndrome. Neigel JM, Rootman J, Belkin RI, Nugent RA, Drance SM, Beattie CW, Spinelli JA. Ophthalmology 1988; 95: 1515- 21 ( Nov), [ Reprint requests to Dr. J. Rootman, Department of Ophthalmology, 2550 Willow St., Vancouver, BC, Canada V5Z 3N9.] The authors reviewed 58 patients ( 95 eyes) with dysthyroid optic neuropathy and 60 control patients ( 119 eyes) with thyroid orbitopathy without optic neuropathy, all from referral cases to the Orbital Clinic at the University of British Columbia over the last 10 years. A total of 675 patients with thyroid eye disease had been seen in this time period. The presence of optic neuropathy was ascertained by defects in visual acuity, visual field, or color vision, and/ or the presence of an afferent pupillary defect. Visual evoked response and computerized tomographic scanning of the orbits was obtained on most patients in both groups, Many results are discussed, including the authors' conclusion that computerized tomographic scan evidence of apical crowding in the orbit was pOSitively correlated with dysthyroid optic neuropathy. Although the sheer volume of patients reviewed is impressive, several variables confound interpretation of this study, including ( a) a lack of information about referred patients with thyroid eye disease who are not eligible to serve ~ s " controls" (" 60 consecutive patients With thyrOid orbitopathy but without optic neuropathy who had computerized tomographic scans"), ( b) prereferral treatment of patients with optic neuropathy in 75,9% ( with surgery, corticosteroids, radiation, or some combination), and ( c) a lack of information about the length of follow- up observation, especially in control eyes deemed to be free of optic neuropathy but with a crowded orbital apex on scanning or an abnormal visual evoked response. An even bigger hurdle to interpretation of this data is the presence of diabetes in 15.5% of the patients with optic neuropathy and only 1.7% of controls, bringing up the possible contribution of diabetic optic neuropathy. This article is certainly worth reading but suggests that further prospective work is in order to confirm the authors' impressions. Lyn A. Sedwick, M, D. Optic Disk Size in Ischemic Optic Neuropathy. Mansour AM, Shoch D, Logani S. Am JOphthalmol 1988; 106: 587- 9 ( Nov). [ Reprint requests to Dr. A. M. Mansour, Department of Ophthalmology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77550.] Using fundus photographs, the authors measured the horizontal and vertical diameter of the optic nerve in the fellow eyes of patients with nonarteritic ischemic optic neuropathy and in controls. They found a statistically significant decrease in horizontal diameter and total disk area in the eyes of patients with ischemic optic neuropathy, although the range in each group was somewhat overlapping ( perhaps some control eyes with low horizontal diameters would go on to have ischemic optic neuropathy?), Combined with previous data regarding the small cup- to- disk ratio in such eyes, these results may indicate that small, crowded disks such as these are predisposed to vascular compromise, as the authors contend. LYIl A. Sedwick, M. D, Paradoxic Pupillary Phenomena: A Review of Patients With Pupillary Constriction to Darkness. Frank JW, Kushner BJ, France TO. Arch Opht/ zalmol 1988; 106: 1564- 6 ( Nov). [ Reprint requests to Ms. J, W, Frank, Pediatric Eye Clinic, 600 Highland Ave., Madison, WI 53792.) The authors describe six patients with congenital nystagmus and four patients with strabismus and! I C/ il! Neuro- ol'hthall1lol. Vol. 9, No, 3. 1989 |
