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Iris to lens persistent pupillary membranes.
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Pupillometry in the detection of concomitant drug use in opioid-maintained patients.
Pupillometry and ocular response measures are sensitive to a variety of acutely administered drugs and as such are useful for drug detection and fitness-for-duty applications. The utility of pupillometry to complement urine testing in methadone clinics, where there is considerable non-therapeutic drug use, has not been tested. A video-based pupillometer (FIT 2000) was evaluated in 37 opioid-maintained patients. Three times a week they provided urine samples and pupillometry measures of: initial diameter (ID) in mm; constriction amplitude (CA) in mm; constriction latency (CL) in msec; and saccadic velocity (SV) in mm/sec. Analysis of the success rates indicated that 92.9% of subjects obtained an acceptable reading, 59% on the first attempt. Low variability in pupillary parameters on drug-free days are necessary for effective identification of concomitant drug use. The variability (standard deviation) of ID (0.51 vs. 0.68), CA (0.12 vs. 0.27) and SV (7.2 vs. 11.1) increased on days when the urine was positive for abused drugs compared with drug-free urine days in subjects (n = 6). Subjects who were always drug-free (n = 4) had lower variability than those who always had urine positive for additional drugs (n = 20). These preliminary results suggest that pupillometry may be useful to verify concomitant drug use in a methadone-maintained population. Successful implementation of the methodology could reduce costly and intrusive urine testing.
Evolution of oculomotor nerve palsies.
The management of patients with isolated oculomotor nerve palsies (OMPs) who have normal pupils and no other signs of neurological disease is a controversial issue. A more precise delineation of the clinical course of isolated OMPs may help to determine whether neuroradiologic evaluation is indicated in these cases. We studied 41 patients with isolated third cranial nerve palsies, emphasizing the times of progression and resolution of the oculomotor nerve dysfunction. The average interval from onset to development of maximal ophthalmoplegia failed to differentiate between a microvascular etiology (3.3 days) or posterior communicating artery aneurysm (3 days). Of the 28 patients with diabetic or idiopathic palsies, regardless of pupillary involvement, 68% had improvement of the oculomotor paresis within 4 weeks, 96% within 8 weeks, and 100% within 12 weeks of the onset of symptoms. Our study suggests that patients with pupil-sparing OMPs should be considered for extensive neuroradiologic evaluation only if there is deterioration or failure to improve within 4 to 8 weeks.
The Miller Fisher syndrome. Review of the literature.
The triad of ataxia, areflexia and ophthalmoplegia was first described as a variant of the Guillain-Barre syndrome in 1932 by Collier. In 1956, Miller Fisher reported three patients with ataxia, areflexia, and ophthalmoplegia as a separate entity. Since then, 223 cases of Miller Fisher syndrome have been published. The male/female ratio is 2:1 with a mean age of 43.6 years at the onset of the disease. A viral infection preceded the neurological symptoms in 71.8% of cases with an average symptom-free interval of 10 days. First symptoms were diplopia (38.6%) or ataxia (20.6%). An areflexia was present in 81.6% of cases. Cranial nerves other than the oculomotor nerves were involved in 127 cases (56.9%): cranial nerves 7 (45.7%), 9 and 10 (39.9%), and 12 (13%) were involved. In 53 cases a tetraparesis occurred. An elevated protein value was present in 134 patients (64.4%); cerebrospinal fluid findings were normal in 56 patients. Eighteen patients showed a mild pleocytosis. Besides the cerebellar type of ataxia, initial disturbances of consciousness (n = 8), supranuclear oculomotor signs (n = 22), and pathology findings in electroencephalography (n = 38), computed tomography (n = 8), and magnetic resonance imaging (n = 2) were reported as evidence for a central nervous system involvement in the Miller Fisher syndrome. The prognosis of Miller Fisher syndrome was good--recovery occurred after a mean time period of 10.1 weeks. Residual symptoms were present in 74 cases (33.2%), and a recidivism of the Miller Fisher syndrome was reported in seven patients. Eight patients died. Of six patients with autopsy findings, four exhibited central nervous system lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
Hypovolemic ischemic optic neuropathy.
BACKGROUND: Ischemic optic neuropathy refers to an acute event of ischemia, or decreased blood flow, to the optic nerve resulting in varying degrees of vision loss and visual field defects. Typically this disease affects the elderly population who experience systemic diseases that compromise the blood flow efficiency of the optic nerve head (e.g., giant-cell arteritis, hypertension, diabetes, etc.). However, cases of blood loss to the optic nerve, secondary to traumatic injuries or surgeries, have also been shown to result in ischemic optic neuropathy, regardless of age. It seems that in these cases, the resulting anemia and hypotension play contributing roles in the development of ischemic optic neuropathy. METHODS: A 41-year-old black man came to us with optic nerve head pallor O.S., count-fingers vision O.S., positive afferent pupillary defect O.S., and a central scotoma O.S. after being hospitalized and treated for a stab wound to his left neck that severed his left carotid artery at the bifurcation. RESULTS: This patient had been seen in the Optometry Clinic two years before the stab-wound incident. At that time, he had 20/20 vision in his left eye and no remarkable neurological deficits. His ocular presentation after the traumatic hypovolemic event was probably a direct result of the hypoperfusion to the left optic nerve head. This patient was diagnosed with a hypovolemic, or blood loss-related, ischemic optic neuropathy (O.S.). CONCLUSIONS: Patients who experience large amounts of blood loss due to trauma, surgery, internal bleeding, etc. and report vision loss should be screened for possible optic nerve ischemia. As eye care providers, when we are presented with patients who have optic nerve head atrophy, we should inquire about events that may have precipitated blood loss, potentially triggering ischemic optic neuropathy.
[Nd: YAG laser therapy for persistent pupillary membranes].
PURPOSE: To evaluate the clinical effects and surgical techniques of Neodymium-yttrium, aluminum, garnet(Nd: YAG) laser therapy for persistent pupillary membranes. METHODS: Twenty-five patients (26 eyes) with persistent pupillary membranes were suffered to resection membranes. The energy of laser was adjusted according to the thickness and density of the membranes. The laser with the best cutting effects and lowest energy was selected to resection. All patients were followed up for 3 - 6 months after the operation. RESULTS: All patients were cured after one laser therapy. The corrected visual acuities were improved in different degrees. Three eyes were 0.6 - 0.7 (11.5%), 5 eyes were 0.8-0.9 (19.2%) and 18 eyes were > or = 1. 0 (69.2%). No complication was observed. CONCLUSION: The laser therapy for persistent pupillary membrane is an easy, safe and effective method only if the laser energy is appropriately selected, the focus is accurate and the operation is dexterity.
Pigmentary dispersion syndrome and pigmentary glaucoma: a new mechanism concept, a new treatment, and a new technique.
Reverse pupillary block is introduced as a new cataract-implant complication and as the principle mechanism in pigmentary dispersion syndrome (PDS) and pigmentary glaucoma (PG), causing posterior iris bowing and zonular rubbing. This mechanism was investigated by performing laser iridotomy on six patients. Following surgery, the iris moved forward completely and permanently to the planar position. A new technique, locating the iridotomy by transillumination, reduced the laser energy needed for iridotomy. Laser iridotomy located with transillumination is recommended as the treatment for iris-zonular rubbing in PDS and PG caused by reverse pupillary block.
[Pupillary dysfunctions in diabetic patients].
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[Acute enterovirus uveitis in infants].
Enterovirus uveitis (EU) is a new infant eye disease that was first detected and identified in Russia in 1980-1981. Three subtypes of human echoviruses (EV19K, EV11A, and EV11/B) caused 5 nosocomial outbreaks of EU in different Siberian cities and towns in 1980-1989, by affecting more than 750 children mainly below one year of age. Sporadic and focal EU cases (more than 200) were also retrospectively diagnosed in other regions of Russia and in different countries of the former Soviet Union. There were following clinical manifestations: common symptoms of the infection; acute uveitis (rapid focal iridic destruction, pupillary deformities, formation of membranes in the anterior chamber of the eye); and in 15-30% of cases severe complications, cataract, glaucoma, vision impairments. Uveitis strains EV19 and EV11 caused significant uveitis in primates after inoculation into the anterior chamber of the eye, as well as sepsis-like fatal disease with liver necrosis after venous infection. The uveitis strains are phylogenetically and pathogenetically close for primates to strains EV19 and EV11 isolated from young children with sepsis-like disease. The contents of this review have been published in the Reviews in Medical Virology, 2004, vol. 14, p. 241-254.
[Quantitation of the relative afferent pupillary defect for evaluating the patient's condition with rhegmatogenous retinal detachment].
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[Effect of complex treatment of retinitis pigmentosa on the results of pupillography].
Presented are the results of a 3 years long observation of the pupillary reaction in patients with pigmentary retinal dystrophy who have been subjected to a complex treatment. The authors discovered a consistency between the changes in the visual field and the amplitude of the pupillary reaction.
Management of bilateral ectopia lentis et pupillae syndrome.
A 52-year-old patient presented with signs clinically consistent with ectopia lentis et pupillae syndrome. The patient was treated successfully with vitrectomy, dislocated lens removal using perfluorocarbon liquid and phacofragmentation in the vitreous cavity, pupil reconstruction, and scleral-fixated intraocular lens implantation in both eyes. Despite the fact that the surgery was successful in technical terms, the final visual outcome was not as good as expected. This was caused by the optic nerve atrophy resulting from long-lasting glaucoma. Nevertheless, the described surgical techniques may be considered an effective method of treatment in cases of ectopia lentis et pupillae syndrome.
The usefulness of a new method of testing for a relative afferent pupillary defect in patients with ocular hypertension and glaucoma.
PURPOSE: To evaluate the validity of different methods of relative afferent pupillary defect (RAPD) detection and assess the usefulness of detecting an RAPD in glaucoma patients. METHODS: For this prospective observational study, we enrolled 70 of 153 consecutive glaucoma patients coming for examination. Exclusion criteria were cloudy corneas, recent surgery, fixed pupils, and other diseases producing RAPDs. Inclusion criteria were any type of glaucoma and absence of any exclusion criterion. Patients were examined for an RAPD by the swinging flashlight method (SFM), a magnifier-assisted swinging flashlight method (MAM), and automated pupillography. The SFM and MAM results were compared with those obtained by pupillography. Receiver operating characteristic curves and the area under the curve (AUC) were determined. Correlations of other optic disc and visual field indices of glaucoma damage with RAPD were determined. RESULTS: We confirmed RAPDs in 39 (56%) of the subjects by pupillography, finding a sensitivity of 41% and 84% and a specificity of 90% and 76% for SFM and MAM, respectively. The AUC was 0.86 for MAM and 0.61 for SFM. The correlations (r) between RAPD with intereye differences in the optic disc and visual field indices of glaucoma damage were moderate. CONCLUSIONS: A modified swinging flashlight test with magnification increases the sensitivity of the test in detecting an RAPD. Because the detection of an RAPD may precede apparent optic disc and visual field damage, looking for an RAPD may be an important part of the assessment of patients with glaucoma.
[A case of bilateral pupillary membrane].
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The computerized pupil.
An IBM-compatible computer graphics software program has been developed which simulates pupillary function. A light pen, electronically interfaced with the computer, simulates a pen light and, when it is placed on the computer image of the pupil, causes pupillary constriction; when it is withdrawn, the pupils redilate. A variety of abnormal pupillary responses are depicted. Anatomical diagrams and questions concerning various simulated pupillary conditions further enhances the educational experience. Medical students, residents in ophthalmology and the neurosciences, optometrists, nurses, ophthalmic assistants, and other health care professionals can utilize this program to learn a wide range of pupillary abnormalities in an interactive environment.
The effects of buprenorphine in methadone-dependent volunteers.
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