Optic disc elevation in Down syndrome

BACKGROUND

Optic disc elevation associated with Down syndrome is an uncommon phenomenon and raises the suspicion of an intracranial space-occupying lesion, thus necessitating the consideration of invasive and noninvasive investigations.

METHOD OF STUDY

Four patients with Down syndrome and optic disc elevation without an underlying intracranial pathology are reported. Thorough ophthalmological and neuroradiological investigations were performed on each patient. Mild hyperopia occurred in three patients and myopia in one.

CONCLUSIONS

We believe that in most Down syndrome patients with disc elevation, fluorescein angiography and/or clinical follow-up may be sufficient.

Peroxisomal bifunctional enzyme deficiency with associated retinal findings

Peroxisomal disorders include single enzyme defects and defects of peroxisomal fatty acid oxidation enzymes. Peroxisomal bifunctional enzyme complex deficiency is a recently recognized abnormality of fatty acid metabolism. We present one patient with peroxisomal bifunctional enzyme deficiency in association with a flecked retina. This clinical association has only been previously reported once. The finding of a flecked retina in an infant presenting with hypotonia, seizures, and failure to thrive is highly suggestive of peroxisomal bifunctional enzyme complex deficiency.

Bacterial keratitis after penetrating keratoplasty

Bacterial keratitis continues to be a serious problem in developing countries. The authors studied 881 patients who had undergone penetrating keratoplasty (total of 947 procedures) from January 1983 to March 1986 at the King Khaled Eye Specialist Hospital, Riyadh, Saudia Arabia. All patients were followed for at least 6 months. Clinical evidence of bacterial keratitis developed in 113 (11.9%) eyes with penetrating keratoplasties in 108 patients. The causative organisms among those patients included: Streptococcus pneumoniae, 29 (26%); Staphylococcus epidermidis, 24 (21%); Pseudomonas aeruginosa, 13 (12%); Staphylococcus aureus, 5 (4%); Hemophilus influenzae, 5 (4%); Moraxella spp, 5 (4%); alpha-hemolytic streptococcus, 5 (4%); and other bacteria, 27 (25%). In addition, postoperative epithelial defects that required hospital admission for treatment developed in 21 (2.2%) patients. Herpetic keratitis developed in three (0.3%) patients and fungal keratitis developed in 1 (0.1%). Statistically significant predisposing risk factors included: trichiasis (P less than 0.0001), epithelial defects (P less than 0.0001), soft contact lens wear (P less than 0.0001), and eroding sutures (P less than 0.0001). The authors believe that the incidence of postoperative bacterial keratitis can be minimized or avoided by appropriate selection of patients for penetrating keratoplasties as well as good preoperative and postoperative management of associated ocular conditions.