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At least 1,639 records · Page 91Linked to original sources
PubMedDate not supplied

Wavefront-guided surface ablation with prophylactic use of mitomycin C after a buttonhole laser in situ keratomileusis flap.

PURPOSE: To describe the surgical outcome of a patient who had a previous buttonhole after laser in situ keratomileusis (LASIK) and 3 months later, had wavefront-guided photorefractive keratectomy (PRK) with topical mitomycin C 0.02%. METHODS: A 38-year-old man underwent bilateral LASIK for correction of myopic astigmatism. A buttonhole in his right eye LASIK flap occurred, but the surgeon decided to proceed with ablation due to the small size of the buttonhole. After LASIK, the patient complained of monocular diplopia in his right eye with 20/30 best spectacle-corrected visual acuity. Wavefront analysis showed a large amount of higher order aberrations, especially coma. Slit-lamp examination revealed a moderate buttonhole scar. Three months after LASIK, the patient underwent wavefront-guided PRK with application of topical mitomycin C 0.02% on the stromal bed, for a duration of 2 minutes. RESULTS: One month after wavefront-guided PRK, his uncorrected visual acuity was 20/25 in the right eye, with no symptoms. Best spectacle-corrected visual acuity in the right eye was 20/15 with +0.25 -0.50 x 110 degrees. No haze or scar was seen on slit-lamp examination. Wavefront analysis showed a decrease in higher order aberrations, especially coma and spherical aberration. CONCLUSIONS: Wavefront-guided PRK with prophylactic topical mitomycin C was effective in treating a patient with visual symptoms and loss of BSCVA after a LASIK flap buttonhole. No delayed epithelial healing, side effects or complications were noted due to mitomycin C.

Adult↗
PubMed2006

Schwannoma of the oculomotor nerve.

A 63-year-old woman presented with an extremely rare oculomotor schwannoma not associated with neurofibromatosis, manifesting as a transient diplopia and ptosis. Magnetic resonance images showed a well-enhanced mass extending from the cavernous sinus to the intraorbital region. Surgical exposure confirmed the tumor originating from the oculomotor nerve in the cavernous sinus. The intraorbital cystic part of the tumor was partially resected to preserve the oculomotor function. This is the first case of oculomotor schwannoma in the cavernous sinus with intraorbital component.

Blepharoptosis↗
PubMedDate not supplied

Diabetes insipidus as a consequence of neurologic involvement in Behcet's syndrome.

OBJECTIVE: To describe a case of central diabetes insipidus that was associated with Behçet's syndrome. METHODS: We present a case report, including clinical, laboratory, and radiologic data. The pertinent literature is reviewed relative to diabetes insipidus and Behçet's syndrome, and a discussion about a possible association is presented. RESULTS: A 32-year-old man presented with diplopia and severe headaches and was found to have transverse sinus thrombosis. He reported having recurrent mouth and genital ulcers for 3 months before the current consultation. On the basis of the clinical picture, Behçet's syndrome was diagnosed. During hospitalization of the patient, polyuria and polydipsia developed, along with hypernatremia and hypotonic urine, indicative of diabetes insipidus. After desmopressin treatment was initiated, considerable improvement in clinical status and laboratory data was evident and persisted during follow-up. CONCLUSION: Behçet's syndrome, probably through vasculitic mechanisms, may result in central diabetes insipidus. This case report emphasizes that Behçet's syndrome should be considered in the differential diagnosis of diabetes insipidus.

Adult↗
PubMed1999

Neuro-ophthalmologic manifestations of Maffucci's syndrome and Ollier's disease.

Patients with Ollier's disease (multiple skeletal enchondromas) and Maffucci's syndrome (multiple enchondromas associated with subcutaneous hemangiomas) may develop skull base chondrosarcomas or low-grade astrocytomas as a delayed consequence of these disorders. We report three patients with Ollier's disease and Maffucci's syndrome who had diplopia as the initial manifestation of intracranial tumors. Since patients with Maffucci's syndrome and Ollier's disease are at risk for the delayed development of brain and systemic neoplasms, neuroophthalmologists must be aware of the need for long-term surveillance in patients affected by these conditions.

Abducens Nerve↗
PubMed1994

The surgical management of Graves' ophthalmopathy.

The underlying cause of Graves' ophthalmopathy is unknown and therefore all treatment is palliative rather than preventive. The proximate cause of the retrobulbar swelling is an accumulation of glycosaminoglycans with subsequent water binding. Treatment, in a general sense, either attempts to shrink swollen tissues or to expand orbital volume. Expanding the orbital volume by decompression can be accomplished by many different techniques. Removal of bone is central to this theme. Another type of "decompression" removes orbital fat without any bone removal. This review highlights results of decompression by the antral-ethmoidal (transantral and anterior), transfrontal, endoscopic, and orbital defatting techniques. Diplopia can be a major source of morbidity. From a surgical perspective recessions are the most frequently performed procedure. The results of adjustable versus nonadjustable sutures are compared in one report. Various methods of performing eyelid surgery including a technique to harvest hard palate mucosa are also briefly discussed.

Diplopia↗
PubMed1999

Acquired Pseudo-Brown's syndrome immediately following Ahmed valve glaucoma implant.

A 76-year-old woman noted vertical and horizontal diplopia one day following placement of an Ahmed valve in the superonasal quadrant of her left eye. She was unable to elevate her left eye, especially in adduction. She refused implant removal and strabismus surgery alone failed to satisfactorily resolve her problem. On forced duction testing, the implant became wedged between the globe and orbit superonasally. Subsequent repositioning of the valve resulted in resolution of her motility problem. Implant-orbital disproportion can produce a pseudo-Brown's syndrome. Surgeons are encouraged to perform forced duction testing at the time of glaucoma implant placement to detect and prevent this complication.

Aged↗
PubMedDate not supplied

[Two myopathy cases].

INTRODUCTION: Early diagnosis and therapeutic measures of frequent pathologies like hyperthyroidism made their neurological complications less frequent. In spite of well known, these neurological complications are some times forgotten. CLINICAL CASES: We describe two myopathy cases, which presentation was namely fatigue. The inespecificity of this complaint create aetiology and syndromatic diagnosis difficulties, and therapeutic decision. In first case, the symptoms were very gradual, what is usual in older patients, and became extremely incapacitate, depending on others for every daily activity. In the second case, a young patient with diplopia suggested myasthenia. Both cases were diagnosed with hyperthyroidism and a quick improvement occurred with proper medication. Based in these cases, a thyrotoxic myopathy brief comment is made, as in spite of being frequent, these cases presented diagnosis difficulties.

Adolescent↗
PubMed1999

[Fronto-naso-ethmoido-sphenoido-maxillo-orbital mucocele with ophthalmologic presentation].

PURPOSE: We present a case of a large mucocele pressing the orbit forward and compared our findings with those reported by others. CASE REPORT: A 23-year-old woman was examined for an inflammatory tumor of the internal canthus. She had a 6/10 vision loss of the left eye, diplopia, and non-axial exophthalmos. CT scan and magnetic resonance imaging evidenced a huge sinus mucocele behind the orbit. Surgery using the paralateronasal approach was performed. Pathology confirmed the diagnosis of mucocele. DISCUSSION: Ophthalmic complications of mucoceles result from tumor growth leading to compressive optic neuropathy or even compression of the chiasma. A sinus mucocele should be suspected upon indirect clinical signs and lead to neuroradiological explorations. Magnetic resonance imaging reveals iso- or high signals on T1-weighted sequences and high signal on T2-weighted sequences. MRI evidences intracranial or orbital extension. CT scan reveal the degree of bone erosion. Prognosis is favorable after surgical treatment. It is important to correctly diagnose mucocele on the basis of clinical and neuroradiological findings in order to propose early surgery and prevent permanent visual loss by compressive optic neuropathy.

Adult↗
PubMed1999

Ophthalmoplegia associated with the anti-Ri antibody.

Anti-Ri antibodies most often occur in patients with breast cancer and typically are associated with the paraneoplastic syndrome of opsoclonus-myoclonus-ataxia. This study reports a patient with diplopia and ophthalmoplegia. She had anti-Ri antibodies, and despite an exhaustive search for malignancy at presentation, breast cancer was not detected for six months.

Antigens, Neoplasm↗
PubMed1999

[A case of relapsing polychondritis with oculobulbar symptoms and successful treatment of respiratory failure with BiPAP].

A 66-year-old man developed diplopia, ptosis, dysphagia, and acute respiratory failure. The initial diagnosis was myasthenia gravis and prednisolone had been administrated for three years. Because of recurrent upper respiratory infections, prednisolone was tapered off. Two months later, auricular chondritis, arthritis, and conjunctivitis appeared. He was diagnosed as having relapsing polychondritis on the basis of histological findings of the ear lobe biopsy. Reinstituted prednisolone had the effect on the auricular chondritis, arthritis, and conjunctivitis, but no effect on dysphagia, hoarseness, and respiratory failure caused by the deformity of the pharynx and airway. Tracheal collapse usually causes rapid death, so early tracheostomy and the use of endotracheal prostheses have been recommended in patients with airway obstruction from relapsing polychondritis, but such surgical management can only partially open up the large airways and has no effect on smaller airways. In this case tracheostomy and endoluminal stent placement have helped improve the patient's respiratory failure, but have had little effect on its aggravation at night in the supine position. The use of BiPAP after surgical management can be an effective treatment for airway involvement in relapsing polychondritis probably because it keeps the narrowed airways from collapsing, especially at night.

Acute Disease↗
PubMed2000

Botulinum toxin treatment versus conservative management in acute traumatic sixth nerve palsy or paresis.

PURPOSE: Botulinum toxin (BTX), injected into the ipsilateral medial rectus muscle, has been advocated for the management of acute traumatic sixth nerve palsy or paresis. We conducted a multicenter, nonrandomized, data collection study to evaluate recovery rates of patients treated with either conservative measures or BTX. METHODS: All members of the American Association for Pediatric Ophthalmology and Strabismus and the North American Neuro-Ophthalmology Society were invited to enroll patients with acute traumatic sixth nerve palsy or paresis during a 2-year period (between March 1996 and February 1998). The BTX group was defined as patients who received a BTX injection within 3 months of injury. Recovery at 6 months from injury was defined as absence of diplopia in the primary position and a distance esotropia of no more than 10 PD in the primary position. Nonrecovered patients with less than 6 months of follow-up (n = 15) were excluded. RESULTS: Eighty-four eligible patients were enrolled by 46 investigators. Sixty-two patients (74%) were treated conservatively and 22 (26%) with BTX. Sixty-two patients (74%) had unilateral palsy, and 22 (26%) had bilateral palsy. Recovery rates were similar between BTX and conservatively treated patients (overall: 73% vs 71%, P = 1.0; unilateral: 81% vs 83%, P = 1.0; bilateral: 50% vs 38%, P = 0.66, respectively). CONCLUSIONS: In this prospective multicenter study of acute traumatic sixth nerve palsy or paresis, patients treated with either BTX or conservative measures had similar high recovery rates.

Abducens Nerve Injury↗
PubMed2000

Isolated bilateral abducens nerve palsy in primary sphenoidal sinus non-Hodgkin lymphoma.

Isolated bilateral abducens nerve palsy is a rare complication of intracavernous tumors. A middle-aged man complaining of chronic horizontal diplopia was found to have bilateral abducens palsy as an initial manifestation of a massive non-Hodgkin lymphoma, originating from the sphenoidal sinus. This case is unique in two respects: the initial clinical presentation of isolated bilateral abducens involvement and the nature of the tumor, since only two cases of sphenoidal sinus lymphoma have been reported.

Abducens Nerve Diseases↗
PubMed2000

[Treatment of superior oblique paresis after posterior segment surgery].

PURPOSE: The purpose of this study is to report our experience in the treatment of patients with paresis of the superior oblique after posterior segment surgery. PATIENTS: and method: Between 1997 and 1998, we cared for four cases at the ophthalmology department of the Casablanca University Hospital. All four patients were men (mean age 44 years, range 31-67 years) with vertical diplopia. Our management scheme was based on prismotherapy and intensive motor and sensory orthoptic rehabilitation. RESULTS: A satisfactory clinical course was achieved in 3 patients after a mean 20 rehabilitation sessions. In the last case with a cyclotorsion, surgery was required after failure of medical treatment. CONCLUSION: Our therapeutic scheme appears to be effective only in case of deficient verticality.

Adult↗
PubMed2000

Carotid cavernous fistula associated with persistent primitive trigeminal artery.

A patient with diplopia had a carotid cavernous fistula associated with a persistent primitive trigeminal artery that was seen with angiography. Balloon occlusion of the carotid cavernous fistula resulted in flow stasis of the persistent primitive trigeminal artery and resolution of the symptoms. Persistent primitive trigeminal artery may be associated with a carotid cavernous fistula.

Aged↗
PubMed2000

Isolated sixth nerve palsy from pontine infarct.

Isolated sixth nerve palsy associated with pontine infarct is very rare due to close anatomic organization of the structures. A 62-year-old woman, who complained of diplopia, had a diagnosis of sixth nerve palsy. Ophthalmological examination revealed 30 PD left esotropia in primary position with limited abduction of the left eye. Neurologic examination was normal. MR showed a lacunar infarct in the pons consistent with a fascicular lesion. Cerebral angiography was normal. Pontine infarcts causing fascicular lesions should be kept in mind in isolated sixth nerve palsies.

Abducens Nerve Diseases↗
PubMed2001

Outcome of inferior oblique recession with or without vertical rectus recession for unilateral superior oblique paresis.

PURPOSE: To determine the effectiveness of a standard fixed 10 mm inferior oblique (IO) recession with or without vertical rectus recession in visually mature patients with unilateral superior oblique paresis (SOP) and mild to moderate IO overaction. METHODS: The records of 24 patients over 12 years of age who had 10 mm IO recession for SOP, for IO overaction of +1 to +3 (out of maximum +4), with 6+ months of followup were reviewed. Criteria required for a "successful" outcome included: 1. hyperdeviation of 5delta or less in primary position; 2. elimination of any compensatory abnormal head posture; and 3. elimination of diplopia in the central 30 degrees of the binocular visual field. RESULTS: In 16 cases of IO recession alone, 88% were "successful" and in 8 cases who had in addition either contralateral inferior rectus recession or ipsilateral superior rectus recession, 75% were "successful". IO 10 mm recession alone led to an average reduction of 9.1 PD of hypertropia in primary position. CONCLUSION: A standard ungraded 10 mm recession of the IO alone or in combination with vertical rectus muscle recession is an effective weakening procedure with a high success rate for patients with unilateral SOP with mild to moderate IO overaction. In occasional cases of undercorrection, a subsequent IO myectomy is very feasible and effective.

Adolescent↗
PubMed2001

[Orbital metastasis in malignant melanoma].

We report the case of a 60-year-old man presenting bilateral progressive proptosis with diplopia, weight loss, tachycardia, nervosity, and stomach pain. These signs seemed at first to favor a diagnosis of Graves'ophthalmopathy. Thyroid tests were negative and the initial orbital CT scan was considered normal. A new radiological investigation 4 months later in our hospital revealed typical hypertrophy of the extraocular muscles compatible with orbital metastasis. The systemic investigations demonstrated a pulmonary tumor, multiple hepatic lesions, and several pigmented nodules of gastric mucosa. The pathology of pulmonary and gastric specimens confirmed the diagnosis of malignant melanoma. The primary lesion remains unknown. The authors discuss the differential diagnoses of orbital metastasis and the radiological characteristics of orbital metastasis in malignant melanoma.

Diagnosis, Differential↗
PubMedDate not supplied

Chorioretinitis sclopetaria from BB ex memoria.

Chorioretinitis sclopetaria presents a characteristic pattern of choroidal and retinal changes caused by a high velocity projectile passing into the orbit, in close proximity to the globe. While it is unlikely that a patient should completely forget the trauma causing such damage, preserved or compensated visual function may blur the patient's memory of these events over time. Characteristic physical findings help to clarify the antecedent history. Despite the lack of an acknowledged history of ocular trauma or surgery, in our case, the characteristic ocular findings discovered at presentation allowed for recognition of the underlying etiology. Because of good visual function, the patient had completely forgotten about the trauma that occurred 12 years earlier. Strabismus surgery was performed for treatment of the presenting symptomatic diplopia. The pathognomonic findings in chorioretinitis sclopetaria are invaluable in correctly diagnosing this condition, especially when a history of ocular trauma is unavailable.

Adult↗