Neurofibromatosis type 2: a case of ptosis

BACKGROUND

Neurofibromatosis type 2 (NF2) is a disorder usually diagnosed later in life since the features are subtle in children. The hallmark is bilateral vestibular schwannomas, which may not appear until after the second decade. Other cranial nerve schwannomas occur as well. In addition, there may be schwannomas of spinal nerve roots or peripheral nerves, as well as meningiomas, gliomas, and ependymomas. Here is described a rare case of NF2 associated with a superior rectus muscle paralysis and severe ptosis. A complex surgical procedure, which achieved satisfactory results, is also described.

CASE REPORT

A 17-year-old patient with NF2 was referred to us with diagnosis of left-eye superior rectus muscle paralysis, with a later onset of unilateral severe ptosis. Best-corrected visual acuity was 20/20 in both eyes; pupillary reflexes to light and near vision were normal, and subcapsular posterior opacity of the lens was detected. Eye motility examination confirmed a left-eye superior rectus paralysis and a severe ptosis with almost absent palpebral levator muscle function. The patient showed positive familiar history for NF (the father was affected), bilateral involvement of the acoustic nerves (schwannoma), multiple neurofibromas, and bilateral posterior subcapsular lens opacity. Magnetic resonance imaging (MRI) showed bilateral acoustic neuromas in the left temporal region close to the cavernous sinus; since neurological examination and ocular motility problems had remained stationary over time, surgical correction of ptosis and strabismus was suggested.

CONCLUSION

Palpebral ptosis has rarely been reported in NF2. In the case described, ptosis associated with rectus superior palsy was caused by expansive processes in the temporal region close to the cavernous sinus. In order to resolve ptosis and vertical diplopia, we performed a complex surgery that achieved satisfactory results.

Central serous chorioretinopathy and Helicobacter pylori

PURPOSE

This study was designed to evaluate the prevalence of Helicobacter pylori infection in patients with central serous chorioretinopathy (CSC).

METHODS

Retrospective observational case series. A group of 23 patients (22 men and 1 woman, age range 34-62 years, median age 47 years) with diagnosis of CSC, confirmed by fluorescein angiogram, and a control group of 23 consecutive patients (22 men and 1 woman, age range 41-69 years, median age 50 years) referred to our Department for retinal disease other than CSC were studied. Each patient provided peripheral venous blood samples and a stool specimen, which were analyzed at the Department of Gastroenterology and Microbiology at the same university. H. pylori infection was determined by measurement of IgG anti-bodies to H. pylori and by determination of H. pylori antigens in the stool specimens by enzyme-linked immunosorbent assay technique. Patients were defined as H. pylori infected if both tests were positive.

RESULTS

The prevalence of H. pylori infection was 78.2% (95% CI, 56%-92%) in CSC patients and 43.5% (95% CI, 23%-65%) in control subjects (p<0.03 by two-tail ed Fisher exact test). The odds ratio for CSC associated with H. pylori infection was 4.6 (95% CI 1.28-16.9).

CONCLUSIONS

The results of this study show that the prevalence of H. pylori infection seems to be significantly higher in patients with CSC than in control s. H. pylori infection may represent a risk factor in patients with CSC.

Sjögren reticular dystrophy of the retinal pigment epithelium: a case report

PURPOSE

To describe the clinical manifestations in a patient with Sjögren reticular dystrophy of the retinal pigment epithelium, and the evolution of the disease over a 20-year follow-up period.

CASE REPORT

A 45-year-old woman with Sjögren reticular dystrophy of the retinal pigment epithelium was seen for the first time in 1983; the patient underwent 20 years of annual check-ups.

RESULTS

Over the follow-up period, fundus photographs, computerized perimetry, electroretinogram, and electro-oculogram findings had either normal or slightly subnormal outcome.

CONCLUSIONS

The results confirm that this disease involves only the retinal pigment epithelium and should not be considered a central tapeto-retinal degeneration or late onset retinopathy.

Isolated optic nerve involvement in chronic myeloid leukemia

Eye involvement in chronic myeloid leukemia is well known. The signs are infiltration of the choroid, the sclera, the episclera, the conjunctiva and the optic nerve. Eye involvement is more common in acute than in chronic forms of leukemia. This paper reports a case of chronic myeloid leukemia in which optic nerve involvement was the only initial sign of the disease.

[Measurement of the erythrocyte galactokinase activity in patients with presenile and senile idiopathic cataract. Preliminary study]

The activity of galactokinase in red blood cells, has been assayed in 17 patients with idiopathic senile and presenile cataract and in 12 age-matched subjects with perfectly transparent lenses. 3 of the idiopathic cataract patients (17.6%) showed low erythrocytes GK activity, while nobody in the control group showed reduced GK activity. Although preliminary, our results seem to support the possibility that a chronic disorder of galactose metabolism may be involved in the pathogenesis of the idiopathic senile and presenile cataract.

[Hydrogen peroxide in the aqueous humor and cataract formation in human diabetes]

Hydrogen peroxide in the aqueous humor was measured in cataractous eyes from normal subjects and in cataractous eyes from diabetic subjects. The level of H2O2 in the aqueous humor was significantly higher in diabetes than in the idiopathic forms. It is likely that in the eye, impaired enzymic defenses lead to the accumulation of reactive species of O2, such as H2O2, which induces lipid peroxidation. This mechanism may be involved, as a direct consequence of retinal damage, in the pathogenesis of cataract in diabetes.

[Possible role of altered levels of plasma docosahexaenoic acid in the pathogenesis of retinitis pigmentosa. Preliminary results]

Plasma samples obtained from Retinitis Pigmentosa (R.P.) patients and controls were assayed for docosahexaenoic acid (DXA), the major fatty acid in photoreceptor cells, in order to evaluate the possibility that abnormalities in PUFA metabolism could be involved in R.P. pathogenesis. Our preliminary results show levels of plasma DXA in dominantly inherited R.P. lower than in the recessive forms and controls.

The decrease of free epsilon-amino groups in senile and diabetic cataracts

Free epsilon-amino groups in soluble and insoluble proteins were measured in clear human lenses and in diabetic and nondiabetic senile cataractous lenses. The free epsilon-amino group content of soluble and insoluble proteins was significantly lower in diabetic cataracts than in clear lenses and nondiabetic senile cataracts. Our results seem to demonstrate that nonenzymatic glycosylation of lens proteins could play a role in the pathogenesis of diabetic cataract.

[Lipid peroxidation and cataract formation in experimental diabetes]

To investigate the role of lipid peroxidation in diabetic cataractogenesis, malondialdehyde, a breakdown product of lipid peroxidation, was measured in lenses with incipient opacities and in retinas from diabetic rats and in clear lenses and in retinas from normal rats. The malondialdehyde mean values obtained in the transparent and cataractous lenses showed non-significant differences, while non-diabetic rat retinas had a significantly lower mean level of malondialdehyde compared with diabetic rat retinas (p less than 0.01). This indicates that, in streptozotocin-induced diabetic rats, lipid peroxidation is apparently not involved in the development of cataract, but it is quite probably involved in retinal damage. The retina, richer in polyunsaturated fatty acids than other ocular structures, is the elective site of lipid peroxidation and from this membrane peroxidation products might probably diffuse and damage other ocular tissues.

Galactose-1-P-uridyl transferase activity in patients with congenital and infantile cataract

The activity of red blood cell galactose-1-P-uridyl transferase in 22 patients with congenital and infantile cataract and in 18 age-matched controls was investigated. All control subjects examined showed normal enzymatic levels, while 31.8% of patients with congenital and infantile cataract presented a statistically significant reduced enzymatic activity (mean--2 SD in controls). Twenty-four parents of children with congenital and infantile cataract were also examined. Four parents were affected by congenital cataract and the other 20 showed transparent lenses. The parents were compared with a group of 20 age-matched control subjects examined previously. There was no difference in the average enzymatic activities between the groups. The results suggest that a chronic disorder of galactose metabolism may be involved in the development of congenital and infantile cataract.

[Lupus-like connectivitis with severe hemorrhagic retinitis in a patient with total IgA deficiency]

Clinical report of a 23-year-old woman with total IgA-deficit, who had suffered for 2 years from a connective tissue disease similar to lupus erythematosus, with severe hemorrhagic retinitis but without any renal involvement.

Behçet's disease: an unusual case with bilateral obliterating retinal panarteritis and ischemic optic atrophy

Report of an unusual case of Behçet's disease with bilateral obliterating retinal panarteritis and ischemic optic atrophy. The rarity of the primary optic nerve involvement and chiefly the exceptional full acute bilateral occlusion of the retinal arteries are emphasized. This ophthalmoscopic picture is further clinical evidence for the major importance of the vascular involvement in the pathogenesis of Behçet's disease.

Gyrate atrophy of choroid associated with hyperornithinaemia: report of the first case in Italy

The first case in Italy and the youngest case in the world of gyrate atrophy of the choroid associated with hyperornithinaemia is reported. A therapeutical attempt has been made and the possibility of following the evolution of the ocular lesion is very interesting.