1
|
Chen A, Ngo AM, Repka MX, Kraus CL. Isolated ectopia lentis with partial anterior dislocation and pupillary block: a case report. BMC Ophthalmol 2024; 24:192. [PMID: 38664661 PMCID: PMC11044500 DOI: 10.1186/s12886-024-03455-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/15/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Ectopia lentis is the dislocation of the natural crystalline lens and usually presents in the setting of trauma or other systemic diseases. Herein, we describe a case of an otherwise healthy four-year-old boy with isolated ectopia lentis whose partial lens dislocation was captured on a smartphone by the patient's father several days prior. CASE PRESENTATION A four-year-old boy with no past medical, developmental, or trauma history presented with bilateral partial anterior lens dislocation with pupillary block. Initial ophthalmic evaluation two months prior was notable for uncorrected visual acuity at 20/100 OD, 20/250 OS, bilateral iridodenesis, and partially dislocated lenses inferonasally OD and inferiorly OS on slit lamp. Genetic testing found no abnormalities. Ten months later, the patient developed sudden onset of left eye pain. A dislocated lens and temporarily dilated left pupil were captured on a smartphone by the patient's father. He was evaluated 3 days later after a second episode and found to have hand motion vision OS, a fixed 8 mm left pupil with the crystalline lens subluxed into the pupil space and accompanying intraocular pressure OS of 40 mmHg. The lens was surgically removed with a limited anterior vitrectomy. Four and a half years after surgery, visual acuity was 20/125 OS with aphakic correction. The right eye eventually underwent prophylactic lensectomy and was 20/30 in aphakic correction. CONCLUSIONS This report presents a unique presentation of isolated ectopia lentis with anterior lens dislocation and pupillary block and illustrates the role of smartphone photography in assisting in the triage of eye emergencies.
Collapse
Affiliation(s)
| | - Angela M Ngo
- Georgetown University School of Medicine, Washington, DC, USA
| | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins University School Medicine, Baltimore, MD, USA
| | - Courtney L Kraus
- Wilmer Eye Institute, Johns Hopkins University School Medicine, Baltimore, MD, USA.
| |
Collapse
|
2
|
Kisilevsky E, Donaldson L, Margolin EA. Leber Hereditary Optic Neuropathy With Childhood Onset Producing Severe Unilateral Optic Neuropathy With No Relative Afferent Pupillary Defect. J Neuroophthalmol 2023; 43:e337-e339. [PMID: 36166811 DOI: 10.1097/wno.0000000000001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Eli Kisilevsky
- Department of Ophthalmology and Vision Sciences (EK, LD, EAM), University of Toronto, Toronto, Canada; and Department of Medicine (EAM), Division of Neurology, University of Toronto, Toronto, Canada
| | | | | |
Collapse
|
3
|
Wei X, Li L, Jiang L, Lu H, Huang H, Zhong D, Pan L, Wei D, Han Y, Lin H, Chen Q. Comparison of the new self-contained darkroom refractive screener versus table-top autorefractor and cycloplegia retinoscopy in detecting refractive error. BMC Ophthalmol 2023; 23:487. [PMID: 38012552 PMCID: PMC10680182 DOI: 10.1186/s12886-023-03231-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE By comparing the results of the new self-contained darkroom refractive screener (YD-SX-A) versus table-top autorefractor and cycloplegic retinoscopy, to evaluate the performance of the YD-SX-A in detecting refractive error in children and adolescents and then judge whether it can be used in refractive screening. METHODS Cross-sectional study. 1000 participants between the ages of 6 and 18 who visited the Optometry Center of the People's Hospital of Guangxi Zhuang Autonomous Region from June to December 2022 were selected. First, participants were instructed to measure their diopter with a table-top autorefractor (Topcon KR8800) and YD-SX-A in a noncycloplegic setting. After cycloplegia, they were retinoscopy by a professional optometrist. The results measured by three methods were collected respectively. To avoid deviation, only the right eye (1000 eyes) data were used in the statistical analysis. The Bland-Altman plots were used to evaluate the agreement of diopters measured by the three methods. The receiver operating characteristic (ROC) curves was used to analysis effectiveness of detecting refractive error of YD-SX-A. RESULTS The average age of participants was 10.77 ± 3.00 years, including 504 boys (50.4%) and 496 girls (49.6%). When YD-SX-A and cycloplegia retinoscopy (CR) were compared in the myopia group, there was no statistical difference in spherical equivalent (SE) (P > 0.05), but there was a statistical difference in diopter spherical (DS) and diopter cylinder (DC) (P < 0.05). Comparing the diopter results of Topcon KR8800 and CR, the difference between each test value in the myopia group was statistically significant (P < 0.05). In the hyperopia group, the comparison between YD-SX-A and CR showed no statistically significant differences in the DC (P > 0.05), but there were significant differences in the SE and DS (P < 0.05). In the astigmatism group, the SE, DS, and DC were statistically different, and the DC of YD-SX-A was lower than that of CR and Topcon KR8800. Bland-Altman plots indicated that YD-SX-A has a moderate agreement with CR and Topcon KR8800. The sensitivity and specificity of YD-SX-A for detecting myopia, hyperopia and astigmatism were 90.17% and 90.32%, 97.78% and 87.88%, 84.08% and 74.26%, respectively. CONCLUSION This study has identified that YD-SX-A has shown good performance in both agreement and effectiveness in detecting refractive error when compared with Topcon KR8800 and CR. YD-SX-A could be a useful tool for large-scale population refractive screening.
Collapse
Affiliation(s)
- Xianxian Wei
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
- Guilin Medical University, Guilin, China
| | - Lili Li
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Li Jiang
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Haiyan Lu
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Huiyao Huang
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Dedong Zhong
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Liang Pan
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Diefeng Wei
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Yun Han
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Hong Lin
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Qi Chen
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China.
| |
Collapse
|
4
|
Negi R, Raviselvan M, Yarravarapu D, Chillakala K, Durai CVR, Baskar J, Jain A, Bisht K, Bhate M, Bharadwaj SR. Effect of Light Intensity on the Relative Afferent Pupillary Defect in Unilateral Neuro-ophthalmic Pathology. Optom Vis Sci 2023; 100:614-624. [PMID: 37639694 DOI: 10.1097/opx.0000000000002061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
SIGNIFICANCE Objective pupillometry with standardized light intensities allows a comprehensive assessment of the relative afferent pupillary defect in patients with unilateral neuro-ophthalmic pathology. PURPOSE This study aimed to determine the impact of varying light intensities on the grade of relative afferent pupillary defect in unilateral neuro-ophthalmic pathology vis-à-vis healthy controls. METHODS Monocular pupillary light reflexes of 20 controls (14 to 50 years) and 31 cases (12 to 72 years) with clinically diagnosed relative afferent pupillary defect were measured thrice using 1-second-long light pulses, followed by 3 seconds of darkness, at eight light intensities (6.4 to 1200 lux) using objective pupillometry. The relative afferent pupillary defect was quantified as the ratio of the percentage change in the direct light reflexes of the left and right eyes. Its change with light intensity was described using standard exponential fits. RESULTS The median (25th to 75th interquartile range) defect score of 54.8% cases decreased from baseline values of 1.58 (1.25 to 1.87) for right eye pathology and 0.45 (0.39 to 0.55) for left eye pathology to saturation values of 1.18 (1.05 to 1.31) and 0.98 (0.95 to 1.06), respectively, at light intensities between 56.9 and 300.5 lux. Like controls (1.01 [1.00 to 1.06]), the defect scores of the remaining 45.2% cases were constant with light intensity at 1.23 (1.18 to 1.46) and 0.87 (0.86 to 0.89) for right and left eye pathologies, respectively. CONCLUSIONS Relative afferent pupillary defects may decrease with test light intensity in a significant proportion of patients with unilateral neuro-ophthalmic pathology. This highlights the importance of objective pupillometry with standardization light intensities for clinical assessment of afferent pupillary defects.
Collapse
Affiliation(s)
| | | | - Divyank Yarravarapu
- Centre for Technology Innovation, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | | | | | - Juhi Baskar
- Centre for Technology Innovation, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ashish Jain
- Centre for Technology Innovation, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Karan Bisht
- Centre for Technology Innovation, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Manjushree Bhate
- Jasti V. Ramanamma Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | | |
Collapse
|
5
|
Mishra A, Ashraf M, Zaka-ur-Rab S, Khan N. Retinal nerve fiber layer and ganglion cell complex thickness analysis in patients having relative afferent pupillary defect. Indian J Ophthalmol 2022; 70:4337-4342. [PMID: 36453341 PMCID: PMC9940509 DOI: 10.4103/ijo.ijo_754_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/18/2022] [Accepted: 08/03/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose To determine the retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC) thickness in patients having relative afferent pupillary defect (RAPD) measured by optical coherence tomography (OCT). Methods This cross-sectional study was conducted on 30 patients with posterior segment disease and glaucoma presenting with RAPD. The control group comprised 30 patients with the aforementioned diseases without RAPD. RAPD was graded using neutral density filters placed over the unaffected eye. Peripapillary RNFL thickness and macular GCC were measured using the Cirrus HD-OCT machine. Results There were 45 males and 15 females. There was a statistically significant (P < 0.05) difference in the mean of average RNFL thickness in patients having RAPD (64.73 ± 15.16 μm in the affected eyes) as compared to sick control (82.73 ± 11.33 μm in the affected eyes). It was further observed that there was a decrease in RNFL thickness with advancing grades of RAPD. There was a statistically significant (P < 0.05) difference in the mean of average GCC thickness in patients having RAPD (51.57 ± 14.96 μm in the affected eyes) as compared to sick control (76.36 ± 8.06 μm in the affected eyes). Conclusion Our study suggests that there is a significant reduction in RNFL thickness and GCC thickness in RAPD patients as compared to the sick control group.
Collapse
Affiliation(s)
- Aradhna Mishra
- Retina Service, Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohammad Ashraf
- Retina Service, Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Simi Zaka-ur-Rab
- Retina Service, Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Nida Khan
- Retina Service, Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| |
Collapse
|
6
|
Israr M, Zahir KK, Khattak A, Khattak IU, Gul N. Etiology of white pupillary reflex in pediatric age group. Rom J Ophthalmol 2022; 66:32-35. [PMID: 35531443 PMCID: PMC9022157 DOI: 10.22336/rjo.2022.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Leukocoria means white pupil. Normal pupil appears black in children and adults. The typical red reflex is due to retro-illumination of choroidal vessels reflected via the retina, vitreous humor, crystalline lens, aqueous humor, pupil, and cornea. If there is interference in these structures, it would result in a changed red reflex, or leukocoria. Immediate family members are highly likely to detect the first indicator and the pediatrician or general ophthalmologist is usually the first to be visited. The aim of the study was to find out the prevalence of common causes of white pupillary reflex in children, to undertake early diagnosis and treatment, and to reduce morbidity and death. This study aimed to see how common it is for children to have a white pupillary reflex when they visit a pediatric ophthalmologist. Objective: Determine the incidence of conditions that cause a white pupillary reflex in children who visited Hayatabad Medical Complex Hospital in Peshawar. Materials and methods: This study was carried out in the Ophthalmology unit of HMC Hospital Peshawar, from January 2021 to December 2021. 168 patients were enrolled in the study. We included all patients of up to 10 years and both genders with the above findings. Workup for leukocoria was done to find the exact cause that included fundoscopy, B-Scan, MRI, and CT scans. Examination under anesthesia (EUA) was carried out for uncooperative children for detailed fundus examination. Patient data was recorded and a proforma was made to collect all the necessary information. Family history was taken in detail during this study. Results: The most common cause of aberrant pupillary reflex in children aged 1 to 10 years was cataract, 79.76 percent of patients having it. Retinoblastoma (12.5%), Coats disease (3.5%), retinal detachment (2.9%) and persistent hyperplastic vitreous (PHPV) (1.1%) were other notable causes found. Conclusion: Leukocoria is a critical clinical finding, and if parents or primary care physicians notice it, the patient requires a complete follow-up examination by a pediatric ophthalmologist to determine the etiology.
Collapse
|
7
|
Ahmad S, Azarcon CP, Hubbard GB, Wells JR. Unilateral Xanthocoria and Retinal Vascular Anomalies in a 3-Year-Old Boy: Retinoblastoma or Coats Disease? J Pediatr Ophthalmol Strabismus 2022; 59:e33-e34. [PMID: 35603949 DOI: 10.3928/01913913-20220420-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors describe a challenging case of unilateral retinoblastoma in a patient referred for xanthocoria. A 3-year-old boy was referred for unilateral xanthocoria and disordered retinal vasculature, suggestive of Coats disease. Further investigation revealed diffuse subretinal tumor seeding and areas of calcification, consistent with retinoblastoma. Enucleation was performed and histopathology confirmed exophytic retinoblastoma. This case highlights that xanthocoria, although often encountered in patients with Coats disease, can sometimes be associated with retinoblastoma. As such, retinoblastoma should be considered in the differential diagnosis for children with both leukocoria and xanthocoria. [J Pediatr Ophthalmol Strabismus. 2022;59(X):e32-e34.].
Collapse
|
8
|
Kelbsch C, Stingl K, Jung R, Kempf M, Richter P, Strasser T, Peters T, Wilhelm B, Wilhelm H, Tonagel F. How lesions at different locations along the visual pathway influence pupillary reactions to chromatic stimuli. Graefes Arch Clin Exp Ophthalmol 2021; 260:1675-1685. [PMID: 34902059 PMCID: PMC9007757 DOI: 10.1007/s00417-021-05513-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To examine systematically how prechiasmal, chiasmal, and postchiasmal lesions along the visual pathway affect the respective pupillary responses to specific local monochromatic stimuli. METHODS Chromatic pupil campimetry (CPC) was performed in three patient groups (10 subjects with status after anterior ischemic optic neuropathy, 6 with chiasmal lesions, and 12 with optic tract or occipital lobe lesions (tumor, ischemia)) using red, low-intensity red, and blue local stimuli within the central 30° visual field. Affected areas - as determined by visual field defects revealed using conventional static perimetry - were compared with non-affected areas. Outcome parameters were the relative maximal constriction amplitude (relMCA) and the latency to constriction onset of the pupillary responses. RESULTS A statistically significant relMCA reduction was observed in the affected areas of postchiasmal lesions with red (p = 0.004) and low-intensity red stimulation (p = 0.001). RelMCA reduction in the affected areas seemed more pronounced for low-intensity red stimulation (46.5% mean reduction compared to non-affected areas; 36% for red stimulation), however statistically not significant. In prechiasmal lesions, a statistically significant latency prolongation could be demonstrated in the affected areas with low-intensity red stimulation (p = 0.015). CONCLUSION Our results indicate that the choice of stimulus characteristics is relevant in detecting defects in the pupillary pathway of impairment along the visual pathway, favoring red stimuli of low intensity over blue stimuli. Such knowledge opens the door for further fundamental research in pupillary pathways and is important for future clinical application of pupillography in neuro-ophthalmologic patients.
Collapse
Affiliation(s)
- Carina Kelbsch
- University Eye Hospital, Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
- Pupil Research Group at the Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Krunoslav Stingl
- University Eye Hospital, Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany.
- Pupil Research Group at the Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany.
- Center for Rare Eye Diseases, University of Tuebingen, Tuebingen, Germany.
| | - Ronja Jung
- University Eye Hospital, Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
- Pupil Research Group at the Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Melanie Kempf
- University Eye Hospital, Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
- Center for Rare Eye Diseases, University of Tuebingen, Tuebingen, Germany
| | - Paul Richter
- University Eye Hospital, Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
- Pupil Research Group at the Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Torsten Strasser
- University Eye Hospital, Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
- Pupil Research Group at the Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Tobias Peters
- Pupil Research Group at the Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Barbara Wilhelm
- Pupil Research Group at the Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Helmut Wilhelm
- University Eye Hospital, Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
- Pupil Research Group at the Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Felix Tonagel
- University Eye Hospital, Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| |
Collapse
|
9
|
Nussinovitch U, Gendelman O, Rubin S, Levy Y, Vishnevskia Dai V, Livneh A, Lidar M. Autonomic Nervous System Indices in Patients with Systemic Sclerosis without Overt Cardiac Disease. Isr Med Assoc J 2021; 23:651-656. [PMID: 34672448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Systemic sclerosis (SSc) is a connective tissue disease that may affect the heart and the autonomic nervous system (ANS). There is little knowledge regarding the degree of ANS involvement in SSc patients with unknown cardiac disease. OBJECTIVES To evaluate cardiac and pupillary autonomic functions in patients before cardiac involvement has emerged. METHODS The study comprised 19 patients with SSc and 29 healthy controls. Heart rate variability (HRV) analysis for time and frequency domains, as well as deep breathing test and Ewing maneuvers, were performed in all patients. Automated pupillometry for the evaluation of pupillary diameter and pupillary light reflex was completed in 8 SSc patients and 21 controls. RESULTS Both groups had similar characteristics, except for medications that were more commonly or solely prescribed for SSc patients. Compared with control subjects, the SSc patients had significantly lower HRV parameters of NN50 (15.8 ± 24.4 vs. 33.9 ± 33.1, P = 0.03), pNN50 (4.9 ± 7.4% vs.10.8 ± 10.8%, P = 0.03), and triangular index (11.7 ± 3.4 vs. 15.7 ± 5.8, P = 0.02). Abnormal adaptive responses in heart rate changes were recorded during deep breathing tests and Ewing maneuvers. There was no significant difference in any of the pupillometric indices or other HRV parameters within groups. CONCLUSIONS SSc patients may manifest cardiac autonomic dysfunction, while their autonomic pupillary function is seemingly spared. The role of certain medications, the significance of differential organ involvement, as well as the prognostic value of our findings should be evaluated in future studies.
Collapse
Affiliation(s)
- Udi Nussinovitch
- Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA
| | - Omer Gendelman
- Department of Rheumatology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shiri Rubin
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Levy
- Medicine E, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Viktoria Vishnevskia Dai
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Livneh
- Department of Rheumatology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Lidar
- Department of Rheumatology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
10
|
Rajendrababu S, Senthilkumar VA. Anterior Segment OCT Imaging of the Persistent Pupillary Membrane. J Pediatr Ophthalmol Strabismus 2021; 58:340. [PMID: 34180286 DOI: 10.3928/01913913-20210218-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
11
|
Abstract
This study aims to identify predictive factors associated with surgical intervention and the visual outcome of orbital cellulitis and to evaluate the treatment outcomes.A retrospective study involving 66 patients (68 eyes; 64 unilateral and 2 bilateral) diagnosed with bacterial orbital cellulitis was conducted between November 2005 and May 2019.The mean (± standard deviation) age was 42.1 (± 25.8) years (range: 15 days-86 years). Sinusitis was the most frequent predisposing factor, occurring in 25 patients (37.9%), followed by skin infection in 10 patients (15.2%), and acute dacryocystitis in 9 patients (13.6%). Subperiosteal abscesses were found in 24 eyes and orbital abscesses in 19 eyes. Surgical drainage was performed in 31 eyes. Regarding the abscess volume for surgical drainage, a cut-off of 1514 mm3 showed 71% sensitivity and 80% specificity. There was significant improvement in visual acuity (VA) and decrease in proptosis after treatment (for both, P ≤ .001). Only pre-treatment VA ≤20/200 was a significant predictor for post-treatment VA of 20/50 or worse (adjusted odds ratio: 12.0, P = .003). The presence of a relative afferent pupillary defect was the main predictor of post-treatment VA of 20/200 or worse (adjusted odds ratio: 19.0, P = .003).The most common predisposing factor for orbital cellulitis in this study was sinusitis. VA and proptosis significantly improved after treatment. We found that the abscess volume was strongly predictive of surgical intervention. Pre-treatment poor VA and the presence of relative afferent pupillary defect can predict the worst visual outcome. Hence, early detection of optic nerve dysfunction and prompt treatment could improve the visual prognosis.
Collapse
Affiliation(s)
| | | | - Nuttha Sanghan
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| |
Collapse
|
12
|
Liang T, Zhang C, Fu L, Hu M, Zhang L, Li L. Clinical and Histopathological Features of Congenital Fibrovascular Pupillary Membranes in a Chinese Case Series. J Pediatr Ophthalmol Strabismus 2021; 58:105-111. [PMID: 34038268 DOI: 10.3928/01913913-20201230-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the clinical and histopathological features of congenital fibrovascular pupillary membrane (CFPM) in Chinese patients. METHODS This retrospective study reviewed CFPM cases treated at Beijing Children's Hospital. The clinical manifestations, approaches of treatment, outcomes, and histopathological findings were collected and analyzed. RESULTS A total of 33 patients with CFPM were reviewed. All patients had unilateral eye involvement. A total of 21 eyes (63.64%) had a white membrane that partially covered the pupil and 12 eyes (36.36%) had a membrane that completely covered the pupil. Of the 12 eyes with a complete pupillary membrane, 6 (50%) had glaucoma. For eyes with a partial pupillary membrane, 11 eyes (52.38%) were followed up at the outpatient clinic without surgery and 10 eyes (47.62%) underwent membranectomy and pupilloplasty due to visual axis blockage. For the 12 eyes with a complete pupillary membrane, 6 eyes (50%) with normal intraocular pressure (IOP) received membranectomy and pupilloplasty combined with iridectomy, and 1 (16.67%) of these 6 eyes underwent a reoperation after 5 months due to a recurrent membrane. Furthermore, 6 eyes (50%) with glaucoma had membranectomy, pupilloplasty, iridectomy, and goniosynechialysis. Among these 6 eyes, 2 eyes (33.33%) underwent a reoperation due to the recurrence of a membrane and 4 eyes (66.67%) had a pale optic disc. The histopathological findings revealed that these membranes were mainly composed of fibrous tissue, lymphocytes, pigment epithelial cells, and vascular tissues. CONCLUSIONS CFPM has diverse manifestations, including a partial pupillary membrane, a complete pupillary membrane with normal IOP, and a complete pupillary membrane with glaucoma. Timely diagnosis and treatment are critical when the visual axis is blocked and/or the IOP is high. [J Pediatr Ophthalmol Strabismus. 2021;58(2):105-111.].
Collapse
|
13
|
Carell EM. Case Report: Combined Ischemic Optic Neuropathy and Central Retinal Artery Occlusion after Starting Hemodialysis. Optom Vis Sci 2021; 98:212-216. [PMID: 33633019 DOI: 10.1097/opx.0000000000001655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE This case highlights ocular ischemia after hemodialysis resulting in permanent vision loss. Fifteen percent of the U.S. population suffers from chronic kidney disease. Eye care providers should recommend risk factor modifications to their patients with end-stage renal disease before hemodialysis is started to prevent loss of vision. PURPOSE The purpose of this study was to demonstrate a case of concurrent nonarteritic anterior ischemic optic neuropathy and central retinal artery occlusion in the setting of hemodialysis initiation. CASE REPORT A 68-year-old Irish man with end-stage renal disease undergoing dialysis presented, complaining of 3 weeks of progressive vision loss in his left eye. His medical history is complex and includes extensive cardiac disease, bilateral carotid stenosis, and peripheral vascular disease. His surgical history includes a right carotid endarterectomy, bilateral lower extremity amputations, and an aortic valve replacement. Clinical examination revealed light perception vision with an afferent pupillary defect in the left eye and count finger peripheral vision only in the superior temporal quadrant of his vision. The dilated fundus examination showed significant pallid disc edema and focal areas of retina whitening with attenuated peripapillary vasculature in the left eye. This edema was confirmed by optical coherence tomography and supported optic nerve and retinal infarction. A temporal artery biopsy confirmed no evidence of arteritis. CONCLUSIONS Hemodynamic disruption during dialysis in patients with end-stage renal disease and overlying anemia can result in optic nerve and retinal infarction. Patients who are predisposed to nonarteritic anterior ischemic optic neuropathy or central retinal artery occlusion should be educated on this before starting dialysis to ensure careful blood pressure monitoring.
Collapse
|
14
|
Acón D, Hamichi SE, Berrocal A, Murray TG. Leukocoria in a 2-Year-Old Patient With Atypical Optic Nerve Fiber Layer Myelination. J Pediatr Ophthalmol Strabismus 2020; 57:e56-e58. [PMID: 32816043 DOI: 10.3928/01913913-20200527-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/27/2020] [Indexed: 11/20/2022]
Abstract
Myelinated retinal nerve fiber layer is a benign retinal condition that is usually an incidental finding in a healthy patient. Visual acuity is typically not compromised, but some cases have other associated ocular conditions that can affect vision. Diagnosis in challenging atypical cases requires imaging studies to rule out other pathologies. The authors describe the case of a 2-year-old girl who presented with atypical optic nerve fiber myelination. [J Pediatr Ophthalmol Strabismus. 2020;57:e56-e58.].
Collapse
|
15
|
Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
Collapse
Affiliation(s)
- Frank A Rasulo
- Division of Anesthesiology, Intensive Care & Emergency Medicine, University of Brescia at Spedali Civili Hospital, Brescia, Italy.
| | - Tommaso Togni
- Division of Anesthesiology, Intensive Care & Emergency Medicine, University of Brescia at Spedali Civili Hospital, Brescia, Italy
| | - Stefano Romagnoli
- Department of Health Science, University of Florence, Florence, Italy
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| |
Collapse
|
16
|
Safi M, Nejad SK, O'Hara M, Shankar SP. Ectopia Lentis et Pupillae Caused by ADAMTSL4 Pathogenic Variants and an Algorithm for Work-up. J Pediatr Ophthalmol Strabismus 2019; 56:e45-e48. [PMID: 31282960 DOI: 10.3928/01913913-20190509-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/26/2019] [Indexed: 11/20/2022]
Abstract
Ectopia lentis is displacement of the lens from its original position. It can be inherited or acquired with isolated or systemic findings. The authors describe a 4-year-old girl with isolated ectopia lentis et pupillae caused by pathogenic variants in the ADAMTSL4 gene and discuss the molecular genetic work-up of individuals with ectopia lentis. [J Pediatr Ophthalmol Strabismus. 2019;56:e45-e48.].
Collapse
|
17
|
Bentata R, Chan H, Coste V, Delyfer MN, Chan G, Korobelnik JF. [Persistent pupillary membrane (Wachendorf membrane)]. J Fr Ophtalmol 2019; 42:808-810. [PMID: 31147100 DOI: 10.1016/j.jfo.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 03/13/2019] [Indexed: 11/18/2022]
Affiliation(s)
- R Bentata
- Service d'ophtalmologie, CHU de Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France.
| | - H Chan
- Service d'ophtalmologie, CHU de Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
| | - V Coste
- Service d'ophtalmologie, CHU de Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
| | - M-N Delyfer
- Service d'ophtalmologie, CHU de Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
| | - G Chan
- Service d'ophtalmologie, CHU de Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
| | - J-F Korobelnik
- Service d'ophtalmologie, CHU de Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, rue Léo-Saignat, 33000 Bordeaux, France
| |
Collapse
|
18
|
Mathis T, Hofverberg P, Caujolle JP, Hérault J, Leal C, Maschi C, Delaunay B, Baillif S, Kodjikian L, Thariat J. Occurrence of Phosphenes in Patients Undergoing Proton Beam Therapy for Ocular Tumor. Am J Ophthalmol 2018; 192:31-38. [PMID: 29753854 DOI: 10.1016/j.ajo.2018.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/06/2018] [Accepted: 05/02/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Phosphenes are frequently reported by patients irradiated in the head and neck area. The aim of the present study was to characterize and investigate potential mechanisms of proton beam therapy (PBT)-induced phosphenes in a large population of patients undergoing PBT for ocular tumors. DESIGN Prospective cohort study. METHODS Consecutive patients who underwent PBT in a single center were included. Immediately after the first session, all patients completed a questionnaire collecting information about the presence of phosphenes as well as their color, shape, and duration. Patient, tumor and treatment characteristics (dose volume histograms) were also collected. RESULTS Among the 474 patients included, 62.8% reported phosphenes during the first session of PBT. Reported colors were mainly blue-violet (70.5%) and white (14.1%). The prevalence of phosphenes was higher in younger patients (P = .003); other patient or ocular characteristics were not associated with the occurrence of phosphenes. Irradiation of the macula (P < .001) and/or optic disc (P < .001) were significantly associated with the presence of phosphenes, whereas blue-violet color was only associated with young age and irradiation of macular area (P = .04). Pupillary constriction was reported for 57.1% of patients with phosphenes vs 18.5% of patients without (P < .001). Blue-violet phosphenes (P < .001) and irradiation of macula (P = .001) were statistically associated with pupillary constriction. CONCLUSIONS The present study reported a high rate of phosphenes in patients irradiated by PBT for ocular tumor. Their blue-violet color and their association with a pupillary constriction probably indicates the stimulation of S-cones and retinal ganglion cells that reflects the activation of the afferent visual pathway.
Collapse
Affiliation(s)
- Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France; UMR-CNRS 5510 Matéis, Villeurbane, France.
| | - Petter Hofverberg
- Department of Radiation Therapy, Proton Therapy Center, Centre Antoine Lacassagne, Nice, France
| | | | - Joël Hérault
- Department of Radiation Therapy, Proton Therapy Center, Centre Antoine Lacassagne, Nice, France
| | - Cécilia Leal
- Department of Ophthalmology, Pasteur II Hospital, Nice, France
| | - Celia Maschi
- Department of Ophthalmology, Pasteur II Hospital, Nice, France
| | - Benoit Delaunay
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France; UMR-CNRS 5510 Matéis, Villeurbane, France
| | - Juliette Thariat
- Department of Radiation Therapy, Centre François Baclesse - ARCHADE, Unicaen - Normandie University, Caen, France
| |
Collapse
|
19
|
Besada E, Frauens BJ, Makhlouf R, Shechtman D, Rodman J, Demeritt M, Hardigan P. More sensitive correlation of afferent pupillary defect with ganglion cell complex. J Optom 2018; 11:75-85. [PMID: 28676353 PMCID: PMC5904827 DOI: 10.1016/j.optom.2017.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 02/14/2017] [Accepted: 02/21/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE This study investigated the correlation between the relative afferent pupillary defect (RAPD) and retinal nerve fiber layer thickness (RNFLT) in optic neuropathy. METHODS RAPD assessment was performed using a log unit neutral density filter bar. Spectral domain optical coherence tomography RTVue-100 (Optovue) was used to examine the subjects. The optic nerve head pattern (ONH) was subdivided and identified for the purpose of the study into circumpapillary RNFLT (cpRNFLT) and peripheral circumpapillary RNFLT (pcpRNFLT). The cpRNFLT, pcpRNFLT and ganglion cell complex (GCC) parameters were analyzed. RESULTS Eighteen females and twenty three males with asymmetric optic neuropathy and a RAPD participated. Thirty-three subjects had glaucoma and eight had optic neuropathy other than glaucoma. Significant correlations (p<0.02) were obtained for the RAPD and the percentage difference loss of the GCC and RNFLT parameters. The grouped mean percentage difference loss for RNFLT was significantly different from that of the GCC (p<0.001). At a 0.6log unit RAPD, the average mean percentage difference loss was 23% for the CRNFLT, 15% for the GCC, 12% for the global loss volume percentage and 6% for the focal loss volume percentage (FLV%). CONCLUSIONS Significant correlations between RNFLT loss for cpRNFLT, pcpRNFLT and GCC parameters with RAPD were observed. Approximately a 35% higher sensitivity was obtained using GCC compared to CRNFL parameters. The expected change in GCC average for every 0.3log unit increment was approximately 8.49μm. The FLV% corresponded more sensitively to a RAPD but appeared to be influenced by disease severity.
Collapse
Affiliation(s)
- Eulogio Besada
- Nova Southeastern University College of Optometry, United States.
| | - Barry J Frauens
- Nova Southeastern University College of Optometry, United States
| | - Rim Makhlouf
- Nova Southeastern University College of Optometry, United States
| | - Diana Shechtman
- Nova Southeastern University College of Optometry, United States
| | - Julie Rodman
- Nova Southeastern University College of Optometry, United States
| | - Marlon Demeritt
- Nova Southeastern University College of Optometry, United States
| | | |
Collapse
|
20
|
Abstract
In autism spectrum disorder (ASD), atypical integration of visual depth cues may be due to flattened perceptual priors or selective fusion. The current study attempts to disentangle these explanations by psychophysically assessing within-modality integration of ordinal (occlusion) and metric (disparity) depth cues while accounting for sensitivity to stereoscopic information. Participants included 22 individuals with ASD and 23 typically developing matched controls. Although adults with ASD were found to have significantly poorer stereoacuity, they were still able to automatically integrate conflicting depth cues, lending support to the idea that priors are intact in ASD. However, dissimilarities in response speed variability between the ASD and TD groups suggests that there may be differences in the perceptual decision-making aspect of the task.
Collapse
Affiliation(s)
- Danielle Smith
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Danielle Ropar
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Harriet A Allen
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK.
| |
Collapse
|
21
|
Bang SP, Joo CK, Jun JH. Reverse pupillary block after implantation of a scleral-sutured posterior chamber intraocular lens: a retrospective, open study. BMC Ophthalmol 2017; 17:35. [PMID: 28356143 PMCID: PMC5372338 DOI: 10.1186/s12886-017-0427-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/20/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To report the clinical features of patients with reverse pupillary block (RPB) after scleral-sutured posterior chamber intraocular lens (PC IOL) implantation and biometric changes after laser peripheral iridotomy (LPI). METHODS Eight patients attending our hospital's ophthalmology outpatient clinic, who developed RPB after implantation of a scleral-sutured PC IOL due to subluxation of the crystalline lens or IOL, were investigated in this retrospective, observational study. RESULTS Preoperative evaluations showed angle pigmentation in all cases and iridodonesis in 2 cases. Two subjects had used an α1A-adrenoceptor antagonist for benign prostatic hyperplasia. Pars plana or anterior partial vitrectomy was performed in all cases. All eyes showed an extremely deep anterior chamber, a concave iris configuration, and contact between the IOL optic and the iris at the pupillary margin. Pupil capture was detected in 2 cases. The mean (± SD) anterior chamber angle (ACA) was 89.91 ± 10.06°, and the anterior chamber depth (ACD) was 4.42 ± 0.16 mm before LPI. After LPI, the iris immediately became flat with a decreased ACA (51.70 ± 2.59°; P = 0.018) and ACD (4.14 ± 0.15 mm; P = 0.012). After LPI, the intraocular pressure decreased from 19.75 ± 3.77 mmHg to 15.63 ± 4.30 mmHg (P = 0.011), and the spherical equivalent decreased from -0.643 ± 0.385 D to - 0.875 ± 0.505 D (P = 0.016). CONCLUSION Concomitant vitrectomy, angle pigmentation, and iridodonesis may be risk factors for RPB after scleral-sutured PC IOL implantation. LPI is effective for relieving the RPB.
Collapse
Affiliation(s)
- Seung Pil Bang
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, #56, Dalseong-ro, Jung-gu, 41931 Daegu South Korea
| | - Choun-Ki Joo
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jong Hwa Jun
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, #56, Dalseong-ro, Jung-gu, 41931 Daegu South Korea
| |
Collapse
|
22
|
Ibrahim S, Raijmakers AJW. [A child with an abnormality in the pupil]. Ned Tijdschr Geneeskd 2017; 161:D1707. [PMID: 29125077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 19-year-old female had been treated conservatively for a pupillary abnormality in early childhood. At the age of 4, slit-lamp examination had shown a persistent pupillary membrane in the right eye. Now she presented with a visual acuity of 1/300 in the right eye.
Collapse
Affiliation(s)
- S Ibrahim
- Alrijne Ziekenhuis, afd. Oogheelkunde, Leiderdorp
| | | |
Collapse
|
23
|
Yeung HH. Large Pupils in Infancy. . .Suspected Aniridia. Multisystemic smooth muscle dysfunction syndrome secondary to an ACTA2 mutation. J Pediatr Ophthalmol Strabismus 2016; 53:7-8. [PMID: 26835993 DOI: 10.3928/01913913-20151211-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
24
|
Hansen MS, Ostri C. [White pupil in an infant]. Ugeskr Laeger 2015; 177:V06150519. [PMID: 26573940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A whitish pupillary reflex (leukocoria) indicates abnormal reflection from intraocular pathology. In a child, leukocoria may be a sign of serious and even life-threatening eye disease (retinoblastoma), but the most common cause is congenital cataract. Both diagnoses require immediate referral to an ophthalmologist. Leukocoria is best detected by evaluating the reflex from the pupil with a handheld ophthalmoscope. We here present a case story of an infant with leukocoria that proved to be caused by unilateral congenital cataract.
Collapse
|
25
|
John JS. Pupillometry: Cutting Edge Biometrics for Early Intervention in Increased Intracranial Pressure. J Contin Educ Nurs 2015; 46:431-2. [PMID: 26430859 DOI: 10.3928/00220124-20150918-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The pupillometer, a cutting-edge biometric device, is a valuable assessment tool that can aid in the early detection and prompt treatment of neurological abnormalities. Pupil assessment is a critical component of the neurological examination, and manual pupil assessment leaves much room for error. Automated pupillometry improves the quality and reliability of pupillary and neurological assessments, ultimately improving patient outcomes.
Collapse
|
26
|
Gavriş M, Horge I, Avram E, Belicioiu R, Olteanu IA, Kedves H. PERSISTENT PUPILLARY MEMBRANE OR ACCESSORY IRIS MEMBRANE? Rom J Ophthalmol 2015; 59:184-187. [PMID: 26978889 PMCID: PMC5712966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2015] [Indexed: 06/05/2023] Open
Abstract
Frequently, in literature and curent practice, accessory iris membrane (AIM) and persistant pupillary membrane (PPM) are confused. Both AIM and PPM are congenital iris anomalies in which fine or thick iris strands arrise form the collarette and obscure the pupil. AIM, which is also called iris duplication, closely resembles the normal iris tissue in color and thickness and presents a virtual second pseudopupil aperture in the centre while PPM even in its extreme forms presents as a translucent or opaque membranous structure that extends across the pupil and has no pseudopupil. Mydriatiscs, laser treatment or surgery is used to clear the visual axis and optimize visual development. Surgical intervention is reserved for large, dense AIMs and PPMs. Our patient, a 29 year old male, has come with bilateral dense AIM, bilateral compound hyperopic astigmatism, BCVA OD = 0.6, BCVA OS = 0.4, IOP OU = 17 mmHg. To improve the visual acuity of the patient we decided to do a bilateral membranectomy, restoring in this way transparency of the visual axis. After surgery, the visual acuity improved to BCVA OD= 0.8, BCVA OS=0.8.
Collapse
Affiliation(s)
- Monica Gavriş
- Laser Optisan Clinic, Cluj-Napoca, Romania
- Cluj-Napoca Military Hospital, Cluj-Napoca, Romania
| | - Ioan Horge
- Cluj-Napoca Military Hospital, Cluj-Napoca, Romania
| | | | | | | | | |
Collapse
|
27
|
Couceiro R, Fonseca A, Campos F. Toddler with retinal defects. . .psychomotor regression. Sandhoff disease. J Pediatr Ophthalmol Strabismus 2015; 52:138-9, 176. [PMID: 26020229 DOI: 10.3928/01913913-20150427-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
28
|
Takkar B, Chandra P, Kumar K, Vanathi M. Toxic granulomatous anterior uveitis in live intracameral cysticercosis masquerading as leukocoria. Can J Ophthalmol 2015; 49:e140-1. [PMID: 25433748 DOI: 10.1016/j.jcjo.2014.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 08/13/2014] [Accepted: 08/19/2014] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - Kiran Kumar
- Cornea & Ocular Surface Services, Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Murugesan Vanathi
- Cornea & Ocular Surface Services, Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| |
Collapse
|
29
|
Pellegrini M, Shields CL, Arepalli S, Shields JA. Posterior tunica vasculosa lentis and "brittle star" of persistent fetal vasculature. J Pediatr Ophthalmol Strabismus 2014; 51 Online:e69-71. [PMID: 25405659 DOI: 10.3928/01913913-20141111-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 10/23/2014] [Indexed: 11/20/2022]
Abstract
A 17-month-old girl referred for a suspected ciliary body medulloepithelioma was found to have persistent fetal vasculature. Fluorescein angiography showed perfused hyaloid artery posterior tunica vasculosa lentis with brittle star appearance and nonperfused anterior pupillary membrane. Ultrasound biomicroscopy confirmed absence of iris or ciliary body solid tumor.
Collapse
|
30
|
Ko ML, Chen YY, Ouyang Y, Huang TW, Tsuen BS, Jeng WD, Chiou JC, Ou-Yang M. Design and analysis of wearable pupillometer for autonomic neuropathy of diabetic patients. Appl Opt 2014; 53:H27-H34. [PMID: 25322428 DOI: 10.1364/ao.53.000h27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 06/28/2014] [Indexed: 06/04/2023]
Abstract
Diabetes is a familiar disease in modern society. In the early stage of diabetes, symptoms are unobvious, but they usually induce diabetic autonomic neuropathy or, worse, cardiovascular autonomic neuropathy. Pupillometers are effective instruments for observing human pupils. This article presents a novel wearable pupillometer design, without external light artifacts, and an embedded algorithm with blinking elimination, which investigates autonomic neuropathy through recording pupil dynamics triggered by an external sensitive invisible light source. The pupillometer is experimented on 36 healthy subjects and 10 diabetic patients under four different colors (white, red, green, and blue) as well as two different light intensities: 50 and 500 mcd. Ten parameters derived from pupil diameter, pupil response time, and pupil response speed will be evaluated for the healthy subjects and diabetic patients. The results show that three in four parameters related to pupil diameters, one in four related to light intensities, and one in two related to pupil response speed could have significant differences (p<0.05) between healthy subjects and diabetic patients. These parameters obtain over 85% sensitivity, 83% specificity, and 88% accuracy. The pupillometer is proven reliable, effective, portable, and inexpensive for diagnosing diabetes in an early stage.
Collapse
|
31
|
Ogata NG. Concern for "crazy pupils" began in infancy. J Pediatr Ophthalmol Strabismus 2014; 51:266, 306. [PMID: 25291155 DOI: 10.3928/01913913-20140819-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
32
|
Abstract
PURPOSE OF REVIEW This article presents an overview of the common and various kinds of pupillary disorders that can be encountered in an outpatient setting. RECENT FINDINGS The dorsal midbrain is a site where lesions may produce either an afferent or an efferent pupillary defect. The classic pupillary syndrome secondary to a dorsal midbrain lesion is bilateral light-near dissociation. Another recognized deficit is bilateral mydriasis. Recent reports have documented unilateral mydriasis, unilateral light-near dissociation, and a relative afferent pupillary defect without visual loss in association with lesions of the dorsal midbrain. These are rare syndromes. SUMMARY Careful history and examination can often identify and localize the pupillary disorder, as well as guide appropriate evaluation.
Collapse
|
33
|
Affiliation(s)
- Najim Lahrouchi
- Department of Ophthalmology, VU University Medical Center, Amsterdam, the Netherlands
| | - Machteld I Bosscha
- Department of Ophthalmology, VU University Medical Center, Amsterdam, the Netherlands
| | - Annette C Moll
- Department of Ophthalmology, VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
34
|
Al Zubidi N, Ling JD, Lee AG. Atonic pupils secondary to presumed systemic vasopressor-related ischemia. Can J Ophthalmol 2014; 48:e123-4. [PMID: 24093203 DOI: 10.1016/j.jcjo.2013.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 03/03/2013] [Accepted: 03/12/2013] [Indexed: 11/19/2022]
|
35
|
Affiliation(s)
- Amy Eapen
- Beaubien Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Lalitha Sivaswamy
- Beaubien Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan.
| |
Collapse
|
36
|
Meys VEWH, Koehler PJ. [Alert patients with mydriasis and fixed pupils]. Ned Tijdschr Geneeskd 2014; 157:A6581. [PMID: 24690486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Mydriasis is a rare phenomenon in non-comatose patients, usually caused by toxic agents or oculomotor neuropathy. We describe two patients who presented with mydriasis at the outpatient clinic. The first patient was a 46-year-old woman with mydriasis, headache, ptosis, ophthalmoplegia and transient ataxia after an influenza vaccination. The second was a 47-year-old woman with mydriasis, ophthalmoplegia, ptosis and ataxia after she had used doxycycline for an upper respiratory tract infection. In both patients, GQ1b-antibodies were detected and both were diagnosed with Miller Fisher syndrome. The second patient was treated with immunoglobulins, the other patient improved spontaneously. Miller Fisher syndrome is characterised by a triad of ophthalmoplegia, ataxia and areflexia. An infection or vaccination may give rise to an auto-immune response with GQ1b-antibodies directed against gangliosides in peripheral nerve tissue. The Miller Fisher syndrome has a good prognosis with spontaneous recovery ensuing in most patients. Treatment with immunoglobulins is required in some patients.
Collapse
|
37
|
Abdolvahabi A, Taylor BW, Holden RL, Shaw EV, Kentsis A, Rodriguez-Galindo C, Mukai S, Shaw BF. Colorimetric and longitudinal analysis of leukocoria in recreational photographs of children with retinoblastoma. PLoS One 2013; 8:e76677. [PMID: 24204654 PMCID: PMC3813630 DOI: 10.1371/journal.pone.0076677] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 09/02/2013] [Indexed: 11/18/2022] Open
Abstract
Retinoblastoma is the most common primary intraocular tumor in children. The first sign that is often reported by parents is the appearance of recurrent leukocoria (i.e., "white eye") in recreational photographs. A quantitative definition or scale of leukocoria--as it appears during recreational photography--has not been established, and the amount of clinical information contained in a leukocoric image (collected by a parent) remains unknown. Moreover, the hypothesis that photographic leukocoria can be a sign of early stage retinoblastoma has not been tested for even a single patient. This study used commercially available software (Adobe Photoshop®) and standard color space conversion algorithms (operable in Microsoft Excel®) to quantify leukocoria in actual "baby pictures" of 9 children with retinoblastoma (that were collected by parents during recreational activities i.e., in nonclinical settings). One particular patient with bilateral retinoblastoma ("Patient Zero") was photographed >7, 000 times by his parents (who are authors of this study) over three years: from birth, through diagnosis, treatment, and remission. This large set of photographs allowed us to determine the longitudinal and lateral frequency of leukocoria throughout the patient's life. This study establishes: (i) that leukocoria can emerge at a low frequency in early-stage retinoblastoma and increase in frequency during disease progression, but decrease upon disease regression, (ii) that Hue, Saturation and Value (i.e., HSV color space) are suitable metrics for quantifying the intensity of retinoblastoma-linked leukocoria; (iii) that different sets of intraocular retinoblastoma tumors can produce distinct leukocoric reflections; and (iv) the Saturation-Value plane of HSV color space represents a convenient scale for quantifying and classifying pupillary reflections as they appear during recreational photography.
Collapse
Affiliation(s)
- Alireza Abdolvahabi
- Department of Chemistry and Biochemistry, Baylor University, Waco, Texas, United States of America
| | - Brandon W. Taylor
- Department of Chemistry and Biochemistry, Baylor University, Waco, Texas, United States of America
| | - Rebecca L. Holden
- Department of Chemistry and Biochemistry, Baylor University, Waco, Texas, United States of America
| | - Elizabeth V. Shaw
- Department of Chemistry and Biochemistry, Baylor University, Waco, Texas, United States of America
| | - Alex Kentsis
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Carlos Rodriguez-Galindo
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Shizuo Mukai
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
- Retina Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
| | - Bryan F. Shaw
- Department of Chemistry and Biochemistry, Baylor University, Waco, Texas, United States of America
| |
Collapse
|
38
|
Tenen A, Roberts K, Sack J, Hodge C. Assessment of midperipheral anterior chamber depth in patient with posterior chamber phakic intraocular lens. J Cataract Refract Surg 2013; 39:1611-4. [PMID: 23972892 DOI: 10.1016/j.jcrs.2013.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/02/2013] [Accepted: 05/02/2013] [Indexed: 11/20/2022]
Abstract
UNLABELLED We describe a patient who required surgical explantation of a phakic intraocular lens (pIOL) as a result of mechanical angle closure despite the absence of standard preoperative risk factors. An assessment of the patient's records suggested peripheral anterior chamber depth (ACD) values considerably shallower than the central ACD measurement. Subsequently, the midperipheral values of all patients having pIOL implantation at our practice were reviewed to provide potential baseline measurements for comparison against the values of the explanted pIOL eyes. Assessment of midperipheral anterior chamber anatomy may be advantageous in the evaluation of patients for pIOL surgery. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
Collapse
Affiliation(s)
- Abigail Tenen
- From the Vision Eye Institute (Tenen, Roberts, Hodge), Monash University (Tenen), Royal Victoria Eye and Ear Hospital (Sack), Melbourne, and Sydney Medical School (Hodge), University of Sydney, Sydney, Australia.
| | | | | | | |
Collapse
|
39
|
Patel N, Salchow DJ, Materin M. Differentials and approach to leukocoria. Conn Med 2013; 77:133-140. [PMID: 23589950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Leukocoria is an important clinical examination finding as it can be a sign of significant intraocular pathology, with the most common being retinoblastoma and congenital cataracts. The Brückner test is a quick, easy, and inexpensive way to assess the red reflex. When leukocoria is suspected, prompt referral to an ophthalmologist is necessary for further evaluation.
Collapse
|
40
|
Nowak W, Zarowska A, Hachoł A, Pieniazek M, Misiuk-Hojło M. [An assessment of the usefulness of the POLWROCHROM pupillometer to study the pupil light reflex to chromatic stimuli taking into account the intrinsically photosensitive retinal ganglion cells activity]. Klin Oczna 2013; 115:130-134. [PMID: 24059029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE The pupillary light reflex is a useful diagnostic tool used to assess the function of the eye and the visual system. The increased interest in testing the pupillary light reflex is the discovery that the intrinsically photosensitive retinal ganglion cells are involved in the reflex physiology. The aim of this study was to evaluate the usefulness of POLWROCHROM pupillometer, developed at the Wroclaw University of Technology, to study the pupillary light reflex to chromatic stimuli taking into account the photosensitive retinal ganglion cells activity. MATERIAL AND METHODS The pupillary light reflex to 10 sec. light pulse were recorded. In the experiment, a long wavelength (640 nm bandwidth) red light and a short wavelength (470 nm bandwidth) blue light were used at 2 different light luminance levels (10 cd/m2 and 100 cd/m2). RESULTS The greatest pupil response is obtained for short wavelength (blue) light at a high luminance level, whereas the markedly lower pupil response was obtained for long (red) wavelength light at a low luminance level. CONCLUSIONS The observed sensitivity of the pupillary light reflex response to color and intensity of the light stimulus was similar to known from literature the results of in vitro photosensitive retinal ganglion cells electrophysiological activity study. The described system and measurement technique can provide a new tool in testing the pupillary light reflex to chromatic stimuli enabling the assessment of photosensitive retinal ganglion cells activity and identification of pupillary light reflex components derived from photoreceptors and ganglion cells, and therefore may become a clinical pupil test which allows differentiation between disorders affecting photoreceptors and those affecting retinal ganglion cells.
Collapse
Affiliation(s)
- Wioletta Nowak
- Instytut Inzynierii Biomedycznej i Pomiarowej Politechniki Wrocławskiej.
| | | | | | | | | |
Collapse
|
41
|
Lahrouchi N, Bosscha MI, Moll AC. [A boy with leukocoria]. Ned Tijdschr Geneeskd 2013; 157:A5003. [PMID: 23328009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 1.5-year-old boy was referred to the Dutch Retinoblastoma Center with leukocoria, a white pupillary reflex. Fundoscopy revealed a white retinal tumor and ultrasonography showed a calcified mass. The patient underwent enucleation of the left eye. Histopathological examination of the retinal tumor confirmed the diagnosis 'retinoblastoma'. Leukocoria is a cardinal sign of retinoblastoma.
Collapse
|
42
|
Affiliation(s)
- Dermot Murphy
- Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
| | - Hugh Bishop
- Bristol Royal Hospital for Children, Bristol, UK
| | | |
Collapse
|
43
|
Yotharak P, Aui-Aree N. Correlation between clinical grading and quantification by neutral density filter of relative afferent pupillary defect (RAPD). J Med Assoc Thai 2012; 95 Suppl 4:S92-S95. [PMID: 22696859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To investigate the correlation between clinical grading in plus scale and quantified relative afferent pupillary defect (RAPD) using the neutral density filter bar. MATERIAL AND METHOD This was a prospective analytical cross sectional study. Sixty-nine patients of any ocular disease with relative afferent pupillary defects were prospectively examined. The RAPD was graded twice in each patient by the clinical grading plus scale (grade 1+ to 4+) and then by using a neutral density filter (NDF) bar Patients with an abnormal pupil or had been dilated with medication were excluded. Both clinical grading of RAPD and quantified RAPD by the NDF bar were performed by the same physician. All patients were tested by the same technique. Statistical analysis was done to compare the results of both methods. RESULTS The RAPD grading by the clinicalplus scale correlated significantly with the grading by the neutral density filter bar (p < 0.05). The four clinical grades had corresponding values in the neutral density log unit: grade 1+ < or = 0.6 log unit (94.7%), grade 2+ = 0.6-0.9 log unit (85%), grade 3+ = 1.2-1.5 log unit (88.3%), grade 4+ > or = 1.8 log unit (84.6%). CONCLUSION The results of the two methods of grading RAPD using the plus scale and the neutral density filter bar are comparable. Each grade had a corresponding value in log units. In a clinical setting where neutral density filter bars are not available, the authors can grade RAPD using the plus scale.
Collapse
Affiliation(s)
- Parida Yotharak
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | | |
Collapse
|
44
|
Helmy A, Kirkpatrick PJ, Seeley HM, Corteen E, Menon DK, Hutchinson PJ. Fixed, dilated pupils following traumatic brain injury: historical perspectives, causes and ophthalmological sequelae. Acta Neurochir Suppl 2012; 114:295-299. [PMID: 22327711 DOI: 10.1007/978-3-7091-0956-4_57] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Pupillary abnormalities are commonly seen in patients presenting with severe traumatic brain injury (TBI). The objectives of this study were to determine the underlying condition responsible, the natural history of recovery of third nerve palsy and the ultimate clinical outcome in 60 patients admitted to a regional neurosurgical centre with a diagnosis of TBI and unilateral or bilateral fixed, dilated pupils (FDP). In approximately three-quarters of cases, some form of road traffic incident was the mechanism of injury. In patients presenting with a unilateral FDP, the CT-defined condition was most commonly diffuse brain injury (49%) with no obvious lateralising condition. In 34% of cases CT demonstrated a lateralising condition ipsilateral to the side of the FDP and in 9% cases the FDP was contralateral to the side of the CT abnormality. Of those patients who survived an FDP, 72% were left with some form of ophthalmological deficit. Most patients with bilateral FDP did not survive (88%); however, of those who did survive, none was left in a persistent vegetative state or with any ophthalmological sequelae. A FDP is a grave prognostic sign following TBI commonly resulting in long term ophthalmological sequelae; however, a favourable outcome is still attainable.
Collapse
Affiliation(s)
- Adel Helmy
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | | | | | | | | | | |
Collapse
|
45
|
Chinta S, Gupta A, Sachdeva V, Kekunnaya R. Persistent pupillary membrane, strabismus, and optic nerve hypoplasia in Donnai-Barrow syndrome. J AAPOS 2011; 15:604-5. [PMID: 22153411 DOI: 10.1016/j.jaapos.2011.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 07/13/2011] [Accepted: 07/18/2011] [Indexed: 11/19/2022]
Abstract
We report a case of Donnai-Barrow syndrome in a 2-year-old boy who presented with exotropia and prominent eyes since birth. Ocular findings included high myopia, persistent pupillary membrane, and optic nerve hypoplasia. Facial manifestations included broad nasal bridge, hypertelorism, and downward-slanting of palpebral fissures. The patient had associated omphalocele, sensorineural hearing loss, and developmental delay. Magnetic resonance imaging revealed agenesis of the corpus callosum. To our knowledge, this is the first reported association of persistent pupillary membrane, strabismus, and optic nerve hypoplasia in a patient with Donnai-Barrow syndrome.
Collapse
|
46
|
|
47
|
Russell HC, Agarwal PK, Somner JEA, Bowman RJC, Dutton GN. Off-axis digital flash photography: a common cause of artefact leukocoria in children. J Pediatr Ophthalmol Strabismus 2011; 48 Online:e1-3. [PMID: 20055333 DOI: 10.3928/01913913-20091218-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 07/27/2009] [Indexed: 11/20/2022]
Abstract
Leukocoria, a presenting sign in several significant pediatric ocular conditions, can be artefactually produced by off-axis flash photography in healthy eyes. The authors demonstrate the conditions needed to produce this phenomenon, which is more commonly seen in children due to their larger-sized pupils, photogenicity, and frequent off-axis shots.
Collapse
|
48
|
|
49
|
Karasu A, Civelek E, Aras Y, Sabanci PA, Cansever T, Yanar H, Sağlam G, Imer M, Hepgül KT, Taviloğlu K, Canbolat A. Analyses of clinical prognostic factors in operated traumatic acute subdural hematomas. ULUS TRAVMA ACIL CER 2010; 16:233-236. [PMID: 20517749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Traumatic acute subdural hematoma is the most lethal of all head injuries. METHODS In this study, 113 patients with the diagnosis of posttraumatic acute subdural hematoma, who were operated between 1998 and 2006, were reviewed retrospectively. Statistical analysis was performed to detect any effects of the variables of age, Glasgow Coma Scale (GCS) score on admission, time interval between the trauma and operation, and abnormality in the pupil reaction on the disease mortality and morbidity. RESULTS Results obtained in the study are discussed and compared with the related current literature. The overall mortality in 113 patients was 56.6%. CONCLUSION According to the results, the most important determinants of the prognosis are GCS score of the patient on admission, abnormality in pupil reaction, timing of the operation, and the patient's age.
Collapse
Affiliation(s)
- Aykut Karasu
- Departments of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Varghese A, Thomas S. Orbital apex syndrome secondary to mucormycosis after a tooth extraction in an immunocompetent patient. Ear Nose Throat J 2010; 89:E24-E26. [PMID: 20397133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Mucormycosis is rare in immunocompetent patients. We describe an unusual case of orbital apex syndrome secondary to mucormycosis that occurred in an immunocompetent 64-year-old man following multiple tooth extractions. We found no frank involvement of the maxillary sinus, which is the usual pathway of spread for this fungal infection. Therefore, we suggest two possible alternate pathways from the oral mucosa to the orbital apex: one via the anterosuperior and posterosuperior alveolar vessels and one via the infraorbital branch of the maxillary artery.
Collapse
Affiliation(s)
- Ashish Varghese
- Department of ENT, Christian Medical College & Hospital, Ludhiana-141 008, Punjab, India.
| | | |
Collapse
|