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At least 253 records · Page 14Linked to original sources
PubMed2003

Anterior chamber depth in plateau iris syndrome and pupillary block as measured by ultrasound biomicroscopy.

PURPOSE: To quantitatively analyze the anterior chamber depth (ACD) in patients with pupillary block and plateau iris syndrome. DESIGN: Retrospective, consecutive, observational case series. METHODS: We measured the ACD in 318 eyes of 318 patients who had been diagnosed by ultrasound biomicroscopy as having either pupillary block or plateau iris syndrome. Pupillary block patients were all preiridotomy and plateau iris patients were all postiridotomy. Anterior chamber depth was measured axially from the internal corneal surface to the lens surface using the ultrasound instrument's internal measuring capability. RESULTS: The mean ACD in patients with plateau iris syndrome (n = 181) was significantly smaller than the hypothesized normal ACD (2.04 +/- 0.30 mm vs 3.0 mm, P =.0001). The mean ACD in patients with pupillary block (n = 137) was also significantly smaller than the hypothesized normal ACD (2.17 +/- 0.30 mm vs 3.0 mm, P =.0001). The mean ACD in patients with plateau iris syndrome was significantly smaller than the ACD in patients with pupillary block (2.04 +/- 0.30 mm vs 2.17 +/- 0.30 mm, P =.001). CONCLUSIONS: Review of the literature suggests that patients with plateau iris have a normal or deeper axial ACD compared with pupillary block. This study found that the ACD associated with plateau iris syndrome is shallower than normal and also shallower than in pupillary block.

Adult↗
PubMed1996

Long-term fluctuation of relative afferent pupillary defect in subjects with normal visual function.

PURPOSE: To determine whether the relative afferent pupillary defect (RAPD) remains constant over time in normal subjects. METHODS: Seventeen normal subjects were tested with infrared pupillography and automated perimetry in four sessions over 3 years. The changes in RAPD and visual field asymmetry between testing sessions were compared. RESULTS: The range of RAPD was 0.0 to 0.3 log unit, and the difference in the mean deviation between the eyes on automated static perimetry was 0 to 3 dB. Eight subjects repeatedly had an RAPD in the same eye. There was no correlation between the RAPD and the visual field asymmetry at the same visit. Changes in the magnitude of the RAPD between any two sessions were typically small (median, 0.08 log unit; 25th percentile, 0.04 log unit; 75th percentile, 0.15 log unit). CONCLUSIONS: Some normal subjects may show a persistent but small RAPD in the absence of detectable pathologic disease. Therefore, an isolated RAPD in the range of 0.3 log unit that is not associated with any other significant historical or clinical finding should probably be considered benign.

Adult↗
PubMed1997

Ultrasound biomicroscopic findings in humans with shallow anterior chamber and increased intraocular pressure after the prone provocation test.

PURPOSE: To investigate ultrasound biomicroscopic findings in human eyes with shallow anterior chamber and risk of anterior chamber angle-closure glaucoma after the prone provocation test. METHODS: A total of 32 consecutive patients (64 eyes) with bilateral shallow anterior chamber who were at risk for primary angle-closure glaucoma underwent the prone provocation test in a lit room. Before and immediately after measurement of intraocular pressure in this test, high-frequency ultrasound biomicroscopy was performed in the horizontal and vertical directions, and the chamber angle views were recorded at the 3-, 6-, 9-, and 12-o'clock positions. RESULTS: Ten eyes of six patients exhibited an increase in intraocular pressure of 8 mm Hg or more, a positive response, with the remainder showing a negative response to the test. In the eyes with a positive response to the test, the profile of the iris showed a markedly convex shape with a large space behind the posterior iris. However, the anterior chamber angle of each eye remained open, even during the high level of intraocular pressure caused by the provocation. CONCLUSIONS: The present results suggest that no angle closure occurs during the initial increase of intraocular pressure after the prone provocation test. Such an initial increase of intraocular pressure was associated with high pressure in the posterior chamber because of the relative pupillary block. A time lag was observed between the high intraocular pressure caused by the pupillary block and the occurrence of angle closure.

Acetazolamide↗
PubMed1992

Pupillary constriction during forceful eyelid closure.

Pupillary constriction during forceful eyelid closure was investigated in 30 normal subjects. The right eye of each subject was filmed with an infrared-sensitive television camera in darkness before, during, and after eyelid closure. Clinically detectable constrictions were found in nine of the 30 subjects (30%). No significant correlation was found between amplitude of constriction and age of subject or baseline pupillary diameter. Forceful eyelid closure should be considered as a technique to elicit pupillary constriction in patients with a poor near response, but many subjects will have no detectable constriction using this maneuver.

Adult↗
PubMed1996

Localization of traumatic oculomotor nerve palsy to the midbrain exit site by magnetic resonance imaging.

PURPOSE: To present the magnetic resonance imaging findings for a patient with traumatic oculomotor nerve injury. METHODS: We examined a patient with a right pupil-involving oculomotor nerve palsy after severe closed head trauma. RESULTS: Magnetic resonance imaging of the brain demonstrated marked signal hypointensity on gradient-echo T2*-weighted images consistent with hemorrhage at the midbrain exit site of the right oculomotor nerve. CONCLUSIONS: Distal fascicular damage or partial rootlet avulsion is a mechanism of injury in some traumatic oculomotor nerve palsies. Gradient-echo T2*-weighted magnetic resonance imaging is the most sensitive method to detect hemorrhagic changes associated with shearing injury.

Accidents, Traffic↗
PubMed1995

Clinical assessment, optic disk measurements, and visual-evoked potential in optic nerve hypoplasia.

PURPOSE: Because there is a broad spectrum of visual dysfunction in eyes with optic nerve hypoplasia, we determined whether any clinical observations, including optic disk measurements, could predict visual outcome in eyes with hypoplastic optic nerves. METHODS: We prospectively studied the eyes of 19 children (eight consecutive and 11 randomly selected), ages 7 to 92 months, in whom a diagnosis of optic nerve hypoplasia was made by an ophthalmologist. Clinical assessment included visual acuity, pupillary responses, and nystagmus. The ratio of the horizontal disk diameter to the disk-macula distance was calculated from fundus photographs. The amplitude and latency of the flash visual-evoked potential as well as the threshold response to pattern reversal checks were recorded. RESULTS: Visual acuity was associated with pupil reactivity, nystagmus, the ratio of the horizontal disk diameter to the disk-macula distance, pattern visual-evoked potential threshold, and flash visual-evoked potential amplitude (P < .001 for all parameters). All eyes with a ratio of the horizontal disk diameter to the disk-macula distance greater than .30 had good visual acuity, and all eyes with a ratio of the horizontal disk diameter to the disk-macula distance less than .30 had poor visual acuity. No eye with a ratio of the horizontal disk diameter to the disk-macula distance less than or equal to .15 had visual acuity better than light perception. CONCLUSIONS: Visual-evoked potential and photogrammetric measurement of relative disk size can be used to approximate visual acuity in eyes with optic nerve hypoplasia. This finding could lead to a diagnostic criterion or a severity classification for optic nerve hypoplasia.

Child↗
PubMed1995

Variability of the relative afferent pupillary defect.

PURPOSE: Afferent asymmetry of visual function is detectable in both normal and pathologic conditions. With a computerized test, we assessed the variability in measuring afferent asymmetry of the pupillary light reflex, that is, the relative afferent pupillary defect. METHODS: In ten normal subjects, pupillary responses to an alternating light stimulus were recorded with computerized infrared pupillography. The relative afferent pupillary defect for each test was determined by using a new computer analysis. The 95% confidence interval of each determination of relative afferent pupillary defect was used to represent the short-term fluctuation in its measurement. To optimize the test for clinical use, we studied the influence of stimulus intensity, duration, and number on the variability of the relative afferent pupillary defect. RESULTS: When the relative afferent pupillary defect was based on only a few light alternations (stimulus pairs), there was excessive variability in its measurement (95% confidence interval > 0.5 log units). With approximately 200 stimulus pairs, the 95% confidence interval was reduced to less than 0.1 log unit (relative afferent pupillary defect +/- 0.05 log unit). Also, there was less variability when the dark interval between alternating light stimulation was less than one second. CONCLUSIONS: Computerized infrared pupillography can standardize the alternating light test and minimize the error in quantifying a relative afferent pupillary defect. A reproducible relative afferent pupillary defect measurement is desirable for defining afferent injury and following the course of disease.

Adult↗
PubMed1994

Pupillary block during cataract surgery.

Sudden phakic pupillary block occurred immediately upon cortical cleaving hydrodissection during cataract surgery in two patients. We believe this unique complication is related to the recent introduction of viscoelastics with properties that enhance the maintenance of the anterior chamber during capsulorhexis. We postulate that the cause of the block was a combination of O-ring capsulocortical and iridocapsular seals that tamponade hydrodissection fluid posteriorly. Additional precipitating factors were diabetes, poorly dilating pupils, and increased vitreous pressure, which may have contributed to the sudden and irreversible nature of this block. If this complication is not recognized, an aqueous misdirection syndrome may ensue, requiring pars plana vitrectomy. Immediate mechanical breakage of the pupillary and capsular block, resulting in an immediate decrease in intraocular pressure from greater than 70 mm Hg, may cause severe retinal vascular damage. These cases stress the importance of mechanical pupil dilation to prevent this serious complication of cataract surgery.

Aged↗
PubMed1993

The relationship between static perimetry and the relative afferent pupillary defect.

This study was undertaken to understand better how damage to the anterior visual pathway may affect the relationship between the visual and pupillomotor systems. The relative afferent pupillary defect and the interocular difference in visual field mean deviation (determined by the Humphrey Field Analyzer Statpac program) were correlated in 137 patients. A moderate linear correlation (r = .66) was found. In 25 patients tested by both static and kinetic perimetry, the correlation could not be significantly improved by considering field loss outside of 30 degrees. The correlation was further studied in four subcategories of diagnosis: optic neuritis (n = 36), idiopathic intracranial hypertension (n = 26), compressive optic neuropathy (n = 14), and anterior ischemic optic neuropathy (n = 7). In compressive optic neuropathy and idiopathic intracranial hypertension, the difference in mean deviation between the two eyes was associated with a larger relative afferent pupillary defect than in optic neuritis and anterior ischemic optic neuropathy. In optic neuritis, the correlation was the poorest. These results indicate that diseases of the afferent visual system may not necessarily affect visual threshold (as tested by static perimetry) and the pupillary light reflex (a suprathreshold test) in the same way.

Adolescent↗
PubMed1995

Exercise and reversed pupillary block in pigmentary glaucoma.

PURPOSE/METHODS: The effect of exercise on the iris contour was investigated with ultrasound biomicroscopy in two patients with pigmentary glaucoma. RESULTS/CONCLUSION: Ten minutes of bicycle exercise strikingly increased the iris concavity. After Nd:YAG laser iridotomy the iris remained plane after a repeated exercise test. We believe that exercise increased the ocular pulse, which augmented cyclic aqueous movements through the pupil. Combined with a reverse pupillary block, the resulting intermittent excessive iris concavity caused pigment dispersion.

Anterior Chamber↗
PubMed1990

The use of crossed polarized filters in the measurement of the relative afferent pupillary defect.

We used crossed polarized neutral density filters to quantitate relative afferent pupillary defects. To prove reproducibility, the relative afferent pupillary defects of 20 patients were measured with this technique by two independent observers. There was no statistically significant difference between the two measurements. Relative afferent pupillary defects as low as 0.03 log unit were easily measured. These filters offer a convenient and reproducible technique that is more sensitive than the use of neutral density filters.

Evaluation Studies as Topic↗