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Show Literature Abstracts Foundation, 1355 San Pablo St., Los Angeles, CA 90033. CT was used to assess 98 orbits of 49 patients with dysthyroid ophthalmopathy. Seventy orbits had no evidence of optic neuropathy, 10 had evidence of optic neuropathy, and 16 developed optic neuropathy in an unspecified period of follow-up. The authors found a positive correlation between the muscle volume of the orbit and the absolute orbital volume with the presence or development of optic neuropathy. They conclude that there may be prognostic significance of CT of the orbits in patients with dysthyroid ophthalmopathy. Some questions which immediately come to mind about this study include: (1) How were the patients selected, i.e., is this truly a "random" sampling of all dysthyroid ophthalmopathy patients or was the pattern of referral likely to be weighted in favor of those patients with optic neuropathy? (2) How long was the period of follow-up? (3) At what point in the disease was CT obtained and were scans ever repeated? Since dysthyroid ophthalmopathy is a clinical diagnosis, CT scanning of the orbits of most patients must be considered only when decompression surgery is contemplated, to confirm the size and patency of the surrounding sinuses. Given that such surgery is not without risk, it is unlikely to become popular as "prophylactic" therapy for patients who have no evidence of optic neuropathy regardless of muscle volume or orbital volume. Lyn A. Sedwick, M.D. • • • 18. Reference: McCord, C. D., Jr.: Current trends in orbital decompression. Ophthalmology 92: 21-33, 1985. Reprints: C. D. McCord, Jr., M. D., 1938 Peachtree Rd., N.W., Suite 103, Atlanta, GA 30309. McCord sent questionnaires to 192 members of the American Society of Ophthalmic Plastic and Reconstructive Surgery and the Orbital Society. Seventy-five responses were received. These were tabulated to compare various decompression techniques and their results in the treatment of thyroid ophthalmopathy. Just over 60% of surgeries were done to relieve proptosis and 39% were for compressive optic neuropathy. Most surgeons favored antralethmoidal decompression, either translid/fornix or transantral. Many specific breakdowns of data were made, some useful and some less so, but the overall message seemed to be that antral-ethmoidal decompression is the most effective way to relieve compressive optic neuropathy, but it probably causes the most postoperative motility worsening. A comparable questionnaire sent to neuro-ophthalmologists might produce a quite different set of surgical indications but probably a similar experience with results. Lyn A. Sedwick, M.D. • • • 204 19. Reference: Scott, A. B., Kennedy, R. A., and Stubbs, H. A.: Botulinum A toxin injection as a treatment for blepharospasm. Arch. Ophthalmol. 103: 347-350, 1985. Reprints: A. B. Scott, M.D., Smith-Kettlewell Institute of Visual Sciences, 2200 Webster St., San Francisco, CA 94115. Scott et al. report the cases of 39 patients with blepharospasm who were treated with botulinum A toxin injection in the lid and brow. Followup ranged from 6 to 24 months. They found that the interval between treatments was dependent on dose injected. Complications (ptosis, dryness, and tearing) were increased two- to ninefold in patients who had had previous surgery (blepharoplasty, neurectomy, or orbicularis stripping). The mean time to re-emergence of symptoms requiring retreatment was 9.9 weeks. There seems little doubt that botulinum is a safe and effective treatment for blepharospasm. Many helpful hints about actual sites of injection, doses, and timing before retreatment are contained in this article. One puzzling table (no. 2) is probably missing a > sign next to the lower 20 dose, and, overall, the presentation of data errs on the side of "lumping" rather than "splitting." Nevertheless, tight criticism of this expedited publication is not in order, as it is obviouslv one of a number that will come from Dr. Scott as' his work on blepharospasm proceeds. Lyn A. Sedwick, M.D. • • • 20. Reference: Brown, G. c., and Shields, J. A.: Tumors of the optic nerve head. Sum Ophthalmol. 29: 239-264, 1985. Reprints: G. C. Brown, M.D., 910 East Willow Grove Avenue, Wyndmoor, PA 19118. Brown and Shields have written an extensive re. Vlew (155 references) of primary and secondary optic nerve head tumors. Each tumor is discussed accordi~~ to clinical features, associated systemic abnormahties, fluorescein angiographic findings, histopathology, and management. Black and white photographs of each entity are included and, in some cases (e.g., metastatic optic nerve head tumors), color photographs might have been more instructive. Although not an exciting subject, this review is exhausllve and the fluorescein angiogram findings in particular may be helpful to the clinician who is asked to distinguish these lesions. Lyn A. Sedwick, M.D. • • • Journal of Clinical Neuro-ophthalmology |