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Two cases of hypoplasia of the optic nerve associated with porencephaly and one case of porencephaly without ophthalmologic signs are described. The clinicopathological correlation of the double-ring sign is presented and the possible mechanism of optic nerve hypoplasia being a secondary degeneration is discussed.
A total of 369 ophthalmological practices were asked to report the number of patients seen within one test week who drove their cars but did not satisfy minimum legal requirements for diurnal visual acuity applicable for applicants for a West German Class 3 driver's license. There were 471 such patients. From this number it can be calculated that approximately 570 000 individuals (+/- 9%) drive cars in the Federal Republic of Germany with inadequate visual acuity. An analysis of the questionnaire produced the following results: Fifty percent of these patients are less than 62 years of age. The main cause of inadequate visual acuity is age. In younger drivers refractive errors were the prime cause and in most cases correction with glasses was possible. In older drivers the loss of acuity was mainly due to opacities of the lens which for the most part could not be corrected by spectacles. Two-thirds of the drivers with inadequate visual acuity consider their vision to be "sufficient" or "good" for driving; younger drivers are more self-critical than older ones. Only 31% of these drivers stopped driving at night of their own accord. As many as two-thirds of the drivers who consider their acuity to be "insufficient" drive their cars during darkness. The authors show that the findings in patients suffering from severe loss of visual acuity must in principle also be valid for patients with minor visual impairments who still meet the minimum legal requirements. This agrees well with published statistical investigations.(ABSTRACT TRUNCATED AT 250 WORDS)
A case of cornea verticillata discovered by chance is reported; as a result of this finding, a mother and daughter were found to be heterozygous carriers of Fabry's disease. The ocular and internal symptoms as well as the biochemical analysis are discussed. Early ophthalmologic diagnosis is essential. The patient should be informed of the genetic risk.
Quality assurance for diagnostic ultrasound in ophthalmology is of growing importance and will be the subject of new standards and regulations. Methods for equipment performance testing by means of electric test signals in A- and B-mode equipment are described, both for comparative evaluation of equipment and for routine quality assurance tests. Newly developed test signal generator for checking the time scale in ultrasonic biometry of the eye are presented.
In three patients, recurrence of a large pituitary adenoma was not detectable by ophthalmological means, because the tumor recurred in an area where the optic nerve fibers had already been destroyed by the primary tumor. These cases demonstrate that unchanged visual fields do not exclude tumor regrowth, and that computer tomography is indispensable in the follow-up surgically treated pituitary adenomas.
Since it is possible to approach orbit either from outside or through the cranial cavity, orbital surgery constitutes a borderline field between ophthalmic surgery, facial and neurosurgery. With reference to characteristic cases of space-occupying orbital tumors, an attempt is made to point out limitations and surgical possibilities from the ophthalmological point of view. In this connection, Krönlein's operation, which has almost been forgotten, is described and illustrated with original pictures.
Somatopsychic disturbances encompassing both ophthalmologic as well as child-psychiatric phenomena mainly occur in ADD: Central disorders of eye motoricity (strabismus) and disorders of visual perception are encountered. Dyslexia or dysorthography often occur as secondary phenomena. The psychosomatic or psychogenic disturbances affect not only the lid mechanism but also visualization. In the lid region, nictation tics and trichotillomania of the eyebrows and eyelashes occur. Psychic impairment of vision may range from a slight amblyopia, often associated with limitation of the field of vision, to complete amaurosis. The symptomatology is described and illustrated with examples.
The progression of neuro-ophthalmologic signs and symptoms caused by cavernous sinus meningiomas (CSMs) was evaluated in 24 patients. Ten patients had primary involvement of the cavernous sinus by meningioma, and 14 patients had extension of a sphenoid ridge meningioma into the cavernous sinus. Eighteen patients were followed after intradural meningioma debulking. Two of these patients underwent conventional radiation therapy after surgery. The other six patients were followed without treatment. Optic neuropathy caused by extension of the CSM was the most frequently (67%) seen manifestation at the beginning of the follow-up period. Proptosis (50%), ocular motor nerve palsies (46%), and trigeminal neuropathy (33%) were also common. During a mean follow-up period of 57 months, 14 patients (58%) had no change in neurologic status, four patients (17%) had improvement in one or more parameters and six patients (25%) worsened. The patients who worsened had progression of preexisting cranial nerve palsies (two patients), developed new cranial neuropathies (three patients), or both (one patient). Patients who worsened had a significantly longer mean follow-up (76 months) than patients who remained stable or improved (47 months) (p = 0.01). Although the signs and symptoms of CSMs may worsen with time, the rate is slow and the degree is mild. These factors are important when considering treatment options.
Five million blind people in India suffer from cataract, which is a curable condition. Untreated cataract accounts for more than half of the cases of blindness in that country. Twenty percent of all cases of blindness are caused by infections, while malnutrition accounts for 27% in children. In India, ophthalmological care has been provided for many years now in eye-camps. In cataract surgery, the expression method is customary. Trachomas at all stages, infectious eye diseases, traumatic lesions, vitamin A deficiency and leprosy are also diagnosed and treated in large numbers of cases. By way of an example the authors, assistants at the First Eye Clinic of Vienna University, describe an eye-camp in Andhra Pradesh where they worked. Work of this kind can be recommended to others.
In a study of electro-ophthalmological responses of the EOG, the photopic and scotopic ERG, the OP and the VECP, in combination with fluorescein angiography and computerized perimetry, in 34 patients suffering from uveitis, chorioretinitis (lesions near the macula and at the periphery), papillitis or retrobulbar neuritis, the following results were obtained: Uveitis and chorioretinitis with lesions either near the macula or at the retinal periphery produce different responses; generally, pathologic responses of the EOG and ERG and normal VECP are obtained in cases of uveitis. Peripheral chorioretinal lesions lead to a diminution of the scotopic ERG, OP and EOG, in contrast to lesions near the macula, in which pathologically diminished amplitudes of the photopic ERG and VECP are found. In papillitis and retrobulbar neuritis, however, the most important peculiarity is the increase in latency and the decrease in amplitudes of the VECP, especially in retrobulbar neuritis.
Fifty-eight glaucoma patients (105 eyes) of an ophthalmological practice were treated with Timolol eyedrops (0.1%-0.5% once or twice daily) over a long-term period. In group 1 - without pre-treatment (12 patients) pressure was lowered by 34%. In group II, glaucoma patients who were insufficiently stabilized by conservative treatment. Timolol was added to the glaucoma medication and thus a further pressure decrease of 27% was achieved. Group III comprised 24 glaucoma patients who, although their intraocular pressure was satisfactorily controlled, had problems with their medication. After having been switched to Timolol alone they presented a further decrease in IOP of 22%. Group IV comprised those patients resistant to Timolol therapy (six patients; 10%) who showed no further reduction in IOP--neither with Timolol alone nor in combination with other glaucoma medication. Advantages and slight disadvantages of Timolol therapy were discussed. Timolol is the only local glaucoma medication without ascertainable side-effects and thus represents a gain for the therapeutic spectrum of the practitioner.
At the Department of Ophthalmology of the Univeristy of Zurich, cytostatic drugs have been used since 1962 for the treatment of various eye conditions: 16 keratoplasties, 11 cases of degenerative or proliferative eye disease, six cases of retinal vasculitis and 147 of uveitis (sympathetic ophthalmia, Behcet, chronic cyclitis, rheumatoid infantile uveitis etc. After a few rather unsatisfactory trials with methotrexate and azathioprine, a routine therapy combining cyclophosphamide and procarbazine was established. Of the 29 failures (16.1%) six were in the group of keratoplasties (37.5%!), three in cases of degenerative disease, three in the six vasculitis cases, and only 17 in the 147 cases of uveitis. The main cause of failure in corneal grafts was pre-existent vascularization, and in uveitis belated commencement of therapy. In cases where blindness threatens immunodepressors should be administered as early as possible. In the 180 cases reported here, these drugs did not produce any serious complications.
Hereditary angioedema is caused by a deficiency of the C 1 esterase inhibitor (a component of complement). It is manifested by attacks of swelling of the extremities, face, eyelids, trunk, respiratory tract or abdominal viscera. The ophthalmological significance, diagnosis, symptoms and treatment of the condition are discussed.
Patients with cranial base tumors often have impairment in visual function, either due to the pathologic process itself or as a result of surgical treatment of the lesion. We conducted a pilot study in which we performed ophthalmologic evaluations on patients before and after cranial base surgery. The results of the study were used to develop a protocol and reporting form for longitudinal assessment of visual function in these patients. Use of the protocol and reporting form for the past 2(1/2) years has shown that they are easy for physicians to use and that the results provide a representative evaluation of the patient's ability to function visually in everyday life. The authors propose implementation of the protocol and reporting form as a means of collecting data for further research into visual function in patients with cranial base tumors.
We describe a patient with Churg-Strauss syndrome (CSS) who developed bilateral chronic anterior uveitis and neuro-ophthalmologic manifestations 20 years after the onset of asthma and sinus disease. The patient was treated successfully with a combination of cyclophosphamide and prednisone, after other immunomodulatory strategies, aside from systemic prednisone, had failed.
Antiphospholipid syndrome (APS) is a hypercoagulable disorder with highly variable symptomatology including ocular manifestations. Antiphospholipid antibodies (aPL) are the serologic markers of this clinical entity. Our aim was to note the main associated ocular features of APS and elucidate which pathogenic mechanisms may participate. Retinal vascular thrombosis and different neuro-ophthalmologic manifestations, such as optic neuropathy and amaurosis fugax, may be considered as the ocular hallmarks of this syndrome. Ocular features due to aPL-induced thrombosis should be treated with anticoagulant drugs. Conversely, for the treatment of ocular features due to immunological mechanisms such as vasculitis, immunosuppressive regimes seem to be more appropriate.
Neuro-ophthalmologic complications from cataract surgery are uncommon and include central nervous system toxicity, binocular diplopia, traumatic optic neuropathy and ischemic optic neuropathy. Retrobulbar blocks may be accidentally injected into the subarachnoid space with diffusion to the brainstem. This leads to cardiovascular, respiratory, and mental status compromise. Most patients have complete recovery with adequate support. Post-operative, binocular diplopia may occur secondary to anisometropia or previously unrecognized misalignment. Periocular injection may cause paresis or fibrosis of extraocular muscles. Anterior or posterior ischemic optic neuropathy can occur in the first 6 weeks after cataract surgery with or without periocular injection. The risk to the other eye is high with subsequent contralateral cataract extraction. Post-operative vision loss associated with direct traumatic needle injury is recognized immediately. Therefore, an orbital MRI may be warranted for a patient with an optic neuropathy in the first 24 hours after cataract surgery using periocular anesthesia. If evidence of needle injury is present on neuroimaging, a trial of steroids should be considered.
The purpose of this paper is to give a brief overview on the application of multifocal stimulation techniques in ophthalmology. The use of m-sequences as a stimulus sequence allows a high-resolution topographic mapping of sensory function. Outer retinal dysfunction can readily be detected with the multifocal ERG (mfERG). When the inner retinal contribution to the mfERG response is enhanced through adapting the stimulation sequence, the sensitivity of the mfERG to detect retinal dysfunction in glaucoma can be increased. Testing of the entire visual pathway with multifocal cortical evoked visual potentials is also possible and recent studies have focused on reducing interindividual variability. The use of m-sequence stimulation in magnetic encephalography offers new ways to study visual processing without the need to apply electrodes.