Affiliation |
Consultant, Retina and Vitreous Services, LV Prasad Eye Institute, Bhubaneswar, India Department of Ophthalmology, Government Medical College, Punjab, India Optometrist, Retina and Vitreous services, LV Prasad Eye Institute, Bhubaneswar, India Consultant, Retina and Vitreous Services, LV Prasad Eye Institute, Bhubaneswar, India |
OCR Text |
Show REFERENCES 1. Wall M. Idiopathic Intracranial Hypertension and the Idiopathic Intracranial Hypertension Treatment Trial. J Neuroophthalmol. 2013;33:1-3. 2. Micromedex Healthcare Series. Greenwood Village, CO: Thomson Reuters Healthcare Inc. Available at: http://roger.ucsd. edu:80/record=b4385157~S9. Accessed August 28, 2012. 3. Arber N, Shirin H, Fadila R, Melamed E, Pinkhas J, Sidi Y. Pseudotumor cerebri associated with leuprorelin acetate. Lancet. 1990;335:668. 4. Boot J. Pseudotumor cerebri as a side effect of leuprorelin acetate. Irish J Med Sci. 1996;165:60. 5. Fraunfelder F, Edwards R. Possible ocular adverse effects associated with leuprolide injections. JAMA. 1996;273: 773-774. 6. Digre K. Idiopathic intracranial hypertension headache. Curr Pain Headache Rep. 2002;6:217-225. 7. Biousse V, Bruce B, Newman N. Update of the pathophysiology and management of idiopathic intracranial hypertension. J Neurol Neurosurg Psychiatry. 2012;83:488-494. Pseudo-doubling of Optic Disc in a Case of Proliferative Diabetic Retinopathy True optic disc duplication with 2 independent retinal vasculatures is rare (1). Lesions reported to simulate the optic disc include colobomas and inflammatory foci (2-4). We report a case of pseudo-optic disc doubling in a patient with proliferative diabetic retinopathy (PDR). A 38-year-old man with advanced PDR and visual acuity of 20/400 in each eye was examined in our clinic. Fundus examination revealed retinal hemorrhages and fibrovascular proliferation over the optic disc and along the vascular arcades in both eyes. A disc-like structure was FIG. 1. An optic disc-like structure is present along the superotemporal vascular arcade. The media is hazy due to vitreous hemorrhage. FIG. 2. A. Fluorescein angiogram (venous phase) shows that the blood vessels emerging from the pseudo-disc are actually continuation of those arising from the true optic disc. B. Fluorescein angiogram (late phase) demonstrates leakage from new vessels overlying both the true and pseudo-optic discs. Letters to the Editor: J Neuro-Ophthalmol 2013; 33: 307-318 311 Letters to the Editor Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. present along the superotemporal arcade of the left eye, which was yellow in color with ill-defined margins (Fig. 1). Fluores-cein angiography showed that the blood vessels emerging from the pseudo-disc were actually continuation of vessels from the true optic disc and demonstrated early hyperfluor-escence (Fig. 2A) followed by late leakage (Fig. 2B). Optical coherence tomography (OCT) through the lesion showed an irregular thick hyper-reflective membrane over the retina con-tinuous with fibrovascular proliferation (Fig. 3). The subretinal yellow exudates, circular fibrovascular proliferation with new vessels emerging centrifugally gave the appearance of an optic disc. But absence of an independent vasculature on fluorescein angiography (5) and the lack of a crater-like depression on OCT con-firmed the lesion to be pseudo-optic disc. We are unaware of the previous reports of pseudo-optic disc doubling due to proliferative diabetic retinopathy. Tapas Ranjan Padhi, MS Consultant, Retina and Vitreous Services, LV Prasad Eye Institute, Bhubaneswar, India Karamjit Singh, MS Department of Ophthalmology, Government Medical College, Punjab, India Krushna Gopal Panda, B Optom Optometrist, Retina and Vitreous services, LV Prasad Eye Institute, Bhubaneswar, India Taraprasad Das, MD Soumyava Basu, MS Consultant, Retina and Vitreous Services, LV Prasad Eye Institute, Bhubaneswar, India The authors report no conflicts of interest. REFERENCES 1. Padhi TR, Samal B, Kesarwani S, Basu S, Das T. Optic disc doubling. J Neuroophthalmol. 2012;32:238-239. 2. Donoso LA, Magargal LE, Eiferman RA, Meyer D. Ocular anomalies simulating double optic discs. Can J Ophthalmol. 1981;16:85-87. 3. Barboni P, Deluigi M, De Bonis C, Monetti G, Savini G, Zanini M. Pseudodoubling of the optic disc. Arch Ophthalmol. 1998;116:1400-1401. 4. Walton DS, Dorfman MS. Pseudo-doubling of optic nerve. J Pediatr Ophthalmol Strabismus. 2009;46:382. 5. Brink JK, Larsen FE. Pseudo doubling of the optic disc. A fluorescein angiographic study of a case with coloboma. Acta Ophthalmol (Copenh). 1977;55:862-870. Isolated Horizontal Gaze Palsy With Congenital Pontine Hypoplasia We read with great interest the article by Connors et al. (1) published in the Journal on the "16 syndrome." The authors described an interesting eye movement pat-tern characterized by bilateral limitation of horizontal eye movements and bilateral facial nerve palsies that was caused by an acquired disorder of the pontine tegmen-tum. We evaluated a patient with bilateral horizontal gaze palsies due to a congenital abnormality of the central nervous system. An 11-year-old boy was referred to our clinic for evaluation of eye movements. Visual acuity was 20/20 in each eye. There was no abnormal head posture and the eyes were orthophoric in primary position. Ocular movements showed a bilateral horizontal gaze palsy with normal vertical eye movements. Horizontal movements could not be elicited with the Doll's head maneuver and horizontal saccades and pursuit movements were absent. Convergence to a near target was normal (see Supplemental Digital Content, Video, http://links.lww.com/WNO/A76). Forced duction testing was negative and the remainder of the ocular examination was unremarkable. Brain magnetic resonance imaging (MRI) revealed hypoplasia of the dorsal pons with a midsagittal cleft extending ventrally from the floor of the fourth ventricle (Fig. 1). The facial colliculi were absent and there was mild atrophy of the midbrain and medulla. FIG. 3. Optical coherence tomography of the pseudo-optic disc reveals a thick hyper-reflective epiretinal membrane (arrows). 312 Letters to the Editor: J Neuro-Ophthalmol 2013; 33: 307-318 Letters to the Editor Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. |