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Show LlTERATlIR[ ABS'IRACrS /9/ mentary by Lois Martyn is good and m,lkes the important point that one call1lllt ,1Itogl'll1l'r l'\dude "real" dise,lst' in patients with "function,ll visual fields:' sinn' "it is nl)t lIIll'lllnnHHl for ,1 p,ltient with org,lIlil' dise,lst' tl) h,lVl' sU~1l'rimpl\sl'd manifestations of functillll,ll type, ,1Ild llI'g,1I1ic disease in children can bt' insidl'llus I~id." Hyperglycemic Acidotic Coma and Death in Kearns-Sayre Syndrome. Bachynski BN, Flynn JT, Rl)drigues 1\11\1. Rl)senthal S, Cullt'n R, Curit'SS RG. l)l'hlhtllllll l [,lS.11 14,sh;9J:JlJl-h (Mar). lReprint requests tll Jl)hn T. Fh'nn, 1\1.D., Departnwnt of Ophthalnllllt)g\', B,lS('l)m P,llml'r Eye Institult', P.O. Bo'\ llIbS,sO, 1\li,wli, FL JJllH.] This frightening p,lpt'r describes two young bo.ys with Kearns-SaY. re who \Vt're tredted with prednisone and died from hyperglycemic acidotic coma. In both patients, prednisone was prescribed to attempt to improw the skeletal myopathy. The authors postulate "multi-system interactions" in Kearns-Sayre, including inadequate insulin release and decreased renal function, that could predispose to h!'perglycemic acidotic coma, a disorder that is seen generally in elderly, debilitated patients or young people with major trauma, burns, or septicemia. A warning is sounded to use steroids sparingly in this disease and only with very close metabolic monitoring. Lilli A. Sedwick, M.D. Contralateral Decreased Visual Acuity and Extraocular Muscle Palsies Following Retrobulbar Anesthesia. Antoszyk AN, Buckley EG. Ophlhalmology 1986;93:462-5 (Apr). [Reprint requests to Edward G. Buckley, M.D., Duke University Eye Center, Box 3802, Durham, NC 27710.] Three patients who had retrobulbar anesthesia (3-6 ml of Xylocaine 2'j(, plus Marcaine a.75'ft., one with Wydase and epinephrine, and one with Wydase) are presented; each experienced sudden decreased vision and partial third nerve palsies in the contralateral, uninjected, eye. In all patients, these findings resolved completely. The authors postulate injection of the anesthetic agent in the subdural space of the optic nerve and migration into thl' contralater,ll optic nerve and perichiasmal space, where the third nerve could be affected. LYIl A. Sedwick, M.D. Botulinum Toxin for the Treatment of Dysthyroid Ocular Myopathy. Dunn Wj, Arnold AC, O'Connor PS. 0llhtJ1I11l1loloXII ] ljt>6;LJ3:470- 5 (Apr). IRt'print requests to William J. Dunn, M.D., DepJrtment of Ophthalmology, Wilford Hall USAF Medical Center, Lackland AFB, TX 78236.] Eight patients with dysthyroid ocular myopathy were treated with botulinum A toxin to attempt correction of deviations averaging 19.5 prism diopters (range 9-30 diopters); three patients had hypotropia, two esotropia, and three mixed vertical and horizontal deviation. The patients had diplopic symptoms for variable times prior to treatment (l month to 2 years, but on average 6 months), received variable number of injections (two patients one injection, three patients two injections, three patients three injections), and each injection was into the presumably restricted muscle, i.e., left medial rectus if left esotropia was the problem. Six of eight patients seemed to have negligible deviations after 6-20 months follow-up, and two had a small phoria or tropia. One could criticize these findings because of the indistinct description of "pre-op" motility (i.e., how stable was the deviation), since it is conceivable that some patients would have improved without botulinum. Nevertheless, the results and the pictures of case 2 pre- and postoperatively, showing a marked improvement in upgaze with injection of the inferior rectus, seem to support the authors' contention that there mav be a time of "int1ammatory spasm" early on in th"wid mvopathy when botulinum A can alter favorably the progress of the disease. LI/Il A. Sedwick, M.D. Temporal Arteritis: A Clinicopathologic Study. McDonnell PJ, Moore GW, Miller NR, Hutchins GM, Green WR. Op"I"l1ll1lO!l\~y 1986;93:518-30 (Apr). [Reprint requests to W. Richard Green, M.D., Eye Pathology Laboratory, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21205.] Temporal artery biopsies of 252 patients from a I Clill NCUrt.·,,/./rtll/llll/<l/. V,.I. 6. N,l. J. 1986 |