Color Doppler Imaging in Uveitis

PURPOSE

To evaluate the vascular hemodynamic changes that can be detected with color Doppler imaging (CDI) in diagnosis, differential diagnosis and prognosis of uveitis with different etiologies including Behçet's disease.

METHODS

Four groups consisting of healthy volunteers, uveitis patients with different etiologies and Behçet's disease patients with and without ocular involvement were examined by CDI. Central retinal artery (CRA), posterior ciliary artery (PCA), ophthalmic artery (OA) and central retinal vein (CRV) flow velocities and vascular resistances were measured prospectively by a radiologist blinded to the presence and etiology of uveitis.

RESULTS

The peak systolic and end-diastolic velocities in CRA and PCA in Behçet's disease with ocular involvement were significantly lower than all other groups (p < 0.001). Peak systolic and end-diastolic velocities in CRA were lower than the control group in Behçet's disease patients without ocular involvement (p < 0.001) but there were no differences in PCA and OA flow velocity (p > 0.05). In the uveitis group, CRA and CRV flow velocities were significantly lower than in the control group (p < 0.001).

CONCLUSIONS

According to our results, uveitis in Behçet's disease is associated with significant reductions of CRA and PCA flow velocities when compared with other types of uveitis and healthy subjects. In cases without ocular involvement, CRA flow velocities were lower than the control group, but there were no real differences in the PCA and OA values. This suggests that vasculitic involvement of PCA is more specific to Behçet's disease and occurs later in the course of the disease. The results also suggest that it may be possible to detect and follow hemodynamic changes in Behçet's disease with CDI before clinical findings of ocular involvement become evident.

Interleukin-4, Interleukin-8 and E-selectin Levels in Intranasal Polyposis Patients with and without Allergy: A Comparative Study

Intranasal polyposis is a chronic inflammatory upper airway disease with unknown aetiology. Interleukin (IL)-4 and IL-8 play very significant roles in allergic events and infectious inflammation, respectively. In contrast, E-selectin is important in the initiation and organization of inflammation. In this study, levels of IL-4, IL-8 and E-selectin were measured in nasal mucosa specimens of intranasal polyposis patients with and without allergic rhinitis, and healthy controls. Healthy controls had significantly higher IL-4 levels than allergic patients and non-allergic patients; IL-4 levels were similar in allergic and non-allergic patients. Allergic and non-allergic patients had significantly higher IL-8 levels than healthy controls; IL-8 levels were comparable in allergic and non-allergic patients. E-selectin levels were similar in all groups. The infection-based theory, represented by IL-8, seems to be more likely than the allergy-based theory, represented by IL-4, for the pathogenesis of nasal polyposis.

Inflammatory pigmented paravenous retinochoroidal atrophy

PURPOSE

To describe an active inflammatory cause of pigmented paravenous retinochoroidal atrophy.

METHODS

A 54-year-old female patient presented with complaints of worsening visual acuity and poor night vision was examined. Fundus examination was performed and color fundus photographs were taken. In addition to fluorescein angiography, visual field examinations and electroretinographic tests were performed. Macular evaluation was performed with optical coherence tomography.

RESULTS

Both fundi showed circumscribed patches of retinochoroidal atrophy and pigmentation along the retinal veins. She had also marked vitreous cells with snow ball opacities and cystoid macular edema in both eyes. Fluorescein angiography confirmed the presence of a hyperfluorescence due to widespread paravenous retinal pigment epithelial defect while ICG angiography disclosed hypofluorescence in all phases. The electroretinogram showed reduced responses especially in the left eye. Visual field tests showed scotomas corresponding with areas of atrophy along the retinal veins.

CONCLUSIONS

This is a report of the findings in pigmented paravenous retinochoroidal atrophy that is a nonspecific degenerative disease and may occur in association with systemic infections or inflammation. Ocular inflammation with cystoid macular edema is an unusual manifestation of the disease.

Poor correlation between "fix-follow-maintain" monocular/binocular fixation pattern evaluation and presence of functional amblyopia

PURPOSE

To assess the reliability of visual screening with fix- follow-maintain (FFM) method in early detection of amblyopia in children who are not able to cooperate in testing with Allen Figures or Snellen E-chart.

METHODS

Followup records of 89 patients that were examined in our pediatric ophthalmology department between May 1996 and May 1999 were evaluated retrospectively. The visual acuities that were measured with FFM method at the first visit were compared with the visual acuity levels that were measured with the Snellen E-chart at later followup visits. Functional amblyopia was defined as a difference of 2 or more Snellen lines between the two eyes.

RESULTS

Amblyopia was later definitively diagnosed on the E-chart in only 17 (32.6%) of the 52 eyes that were estimated to have a significantly lower visual acuity than the fellow eye with the FFM method. Sensitivity of the FFM method in diagnosing amblyopia was found to be 53.1% and the specificity was 38.5%.

CONCLUSIONS

The use of the FFM monocular/binocular fixation pattern to determine visual acuity and the possible presence of amblyopia is so insensitive, and so unspecific, that its reliability is very low and the results of such testing are therefore virtually useless, if not medically hazardous. There is, therefore, a need to make more universally available more sophisticated tests of vision (preferential looking, VEP); where they are not available, further emphasis should be placed on Snellen equivalent vision testing as with Allen Cards, Tumbling E, HOTV Test, Lea Figures etc. so as to obtain an accurate direct visual acuity at as young an age as possible. Amblyopia treatment should not be initiated solely on the basis of FFM testing.

Effect of hormone replacement therapy on ocular hemodynamics in postmenopausal women

PURPOSE

To evaluate the effect of hormone replacement therapy on ocular hemodynamics in postmenopausal women.

METHODS

Ocular Doppler ultrasonography was performed in 20 postmenopausal women on hormone replacement therapy (HRT) and in 20 women without treatment, as the control group. Central retinal artery (CRA), posterior ciliary artery (PCA) and ophthalmic artery (OA) flow velocities and vascular resistances were measured prospectively by a radiologist blinded to the therapy. There were no associated systemic or ocular diseases or any medication history.

RESULTS

The mean age of the patients on HRT was 50.05 +/- 4.5 yrs (range 44-62). The mean age of the control group was 52.8 +/- 4.09 yrs (range 46-65). The mean duration of HRT was 1.6 +/- 1.4 yrs (range 3 months - 5 years). There were no differences between the groups in terms of flow velocities, vascular resistivities or pulsatility indices of OA, CRA and PCA (p>0.05).

CONCLUSIONS

HRT is essential in postmenopausal women for relief of vasomotor symptoms, cardioprotection and prevention of osteoporosis. Even though vaso-occlusive complications of hormone preparations have been reported, we did not observe any changes in ocular hemodynamics detectable with Doppler ultrasonography.

Bilateral sixth-nerve palsy associated with dural arteriovenous malformation

A fifty-two year old postmenopausal woman was admitted to the hospital with complaints of diplopia, headache, humming over the head, and pain over the left eye. Neurological examination showed right abducens nerve palsy. In a few days, she also developed left abducens nerve palsy and chemosis, exophthalmos, and proptosis of both eyes. There was pulsation over the left eye. Intraocular pressure was found to be elevated bilaterally. Selective carotid angiograms showed the presence of bilateral dural arteriovenous malformations (AVM) supplied by the external carotid arteries. Two months after the embolisation of the AVMs, eye movements improved. Repeat angiograms showed the absence of flow into the previously embolised AVMs.

Comparative efficacy of beta-irradiation and mitomycin-C in primary and recurrent pterygium

PURPOSE

To determine the efficacy and safety of mitomycin-C as adjunctive treatment and to compare this drug with beta irradiation with strontium-90 after surgical excision of primary and recurrent pterygia.

MATERIALS AND METHODS

The study group consisted of 193 patients with primary and recurrent pterygia who underwent surgical excision with the bare sclera technique. They were divided into two groups according to the type of adjunctive treatment. In group I, 130 patients (141 eyes, 67.8%) were treated with beta irradiation with Sr-90 doses of 1000-7000 cGy. In group II 63 patients (67 eyes, 32.2%) received topical mitomycin-C at a concentration of 0.02% four times daily for one week postoperatively. Recurrence rates, complications and efficacy of these treatments were compared with the chi-square of Fisher's exact test.

RESULTS

The recurrence rates were 6.4% in group I after a mean postoperative follow-up of 89 months and 17.9% in group II after a mean follow-up of 14.9 months. Recurrence, rates and complications were higher in group II and the difference was significant (p<0.05, p<0.001). Life-table analysis showed a success rate of 93.6% for Sr-90 and 81.9% for the mitomycin-C, the difference being significant (p<0.005).

CONCLUSIONS

Beta irradiation with Sr-90 after surgical excision was more effective than topical mitomycin-C in patients with primary and recurrent pterygium in terms of recurrence rates, and safer in terms of complications.

A case of atypical idiopathic orbital myositis mimicking neurological disease

A 24 year old patient with acute double vision and headache was admitted to our clinic. A diagnosis of orbital myositis was confirmed after magnetic resonance imaging and orbital echogram. No other clinical manifestations were observed on general examination. Since orbital myositis cases with only neurological symptoms and without typical visual impairment are not frequent, we decided to present this case.

Isolated sixth nerve palsy from pontine infarct

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

Superior oblique muscle palsy in a patient with orbital dermoid cyst

We describe the clinical and radiologic findings and surgical outcome of an orbital dermoid cyst causing a superior oblique muscle palsy in a child. Superior oblique muscle palsy in childhood is most often congenital. Less common causes are trauma, vascular lesions, neoplasms, and infections.(1,2) The most common orbital lesions in children are dermoid and epidermoid cysts.(3-5) A dermoid cyst at the region of trochlea is suspected as the cause of superior oblique muscle palsy in our case. This unusual presentation of a dermoid cyst has not been reported previously.

Amiodarone-related optic neuropathy

BACKGROUND

To evaluate a case of atypical optic neuropathy that presented with blurred vision following the use of an antiarrythmic agent.

CASE

Record of the patient was reviewed to determine the etiology of his optic neuropathy.

OBSERVATIONS

Ophthalmological examination revealed unilateral optic disc edema with relatively well-preserved visual acuity. In routine tests, results of complete blood count, erythrocyte sedimentation rate, liver and kidney function tests, chest x-ray, Goldmann visual field examination, and brain computed tomography scan were normal. Orbital ultrasonography revealed optic disc edema with prominent optic nerve head and without orbital pathology.

CONCLUSIONS

Systemic history and drug intake should be investigated in every patient with optic disc edema. Discontinuation of the medication can prevent further optic nerve damage or involvement of the other eye.

Microstrabismus in monozygotic twins

PURPOSE

To report microesotropia in twins as a unique example of the role of heredity in primary microstrabismus.

METHODS

Clinical records of the examinations of monozygotic twins with primary microstrabismus were reviewed.

RESULT

Microstrabismus with different clinical findings was present in monozygotic twins. The family history and personal history of the patients were not significant.

CONCLUSION

Microstrabismus can be seen as primary ocular motility problem without previous infantile esotropia or anisometropia. Genetic factors as well as intrauterine environment and developmental factors may affect sensorimotor development of the infant and cause ocular motility problems. Both twins should be examined for ocular motility disorders even in the absence of complaints.

Surgical treatment in nystagmus

PURPOSE

To evaluate the effect of symmetric recession surgery on all four horizontal rectus muscles in the treatment of patients with congenital motor nystagmus and sensory nystagmus secondary to albinism, dyschromatopsia and degenerative myopia.

METHODS

Prospectively, four patients with a diagnosis of congenital motor nystagmus and eight patients with sensory nystagmus were operated on. The amount of recession was determined according to the ocular alignment of the patients. Electronystagmographic recordings were conducted in every patient pre-operatively and post-operatively, as well as an ophthalmological examination.

RESULTS

Mean age of the patients at the time of the first visit was 6.7 +/- 4.2 years (range 9 months to 14 years) and mean age at the time of operation was 8.3 +/- 2.7 years (range 6-14 years). In 8 cases an equal amount of weakening of the four horizontal recti was done, whereas in 2 cases more recession on the lateral recti due to exotropia and in 2 cases more recession on the medial recti due to esotropia was performed. Mean follow-up time was 15.8 months (min. 6 months, max. 28 months). Improvement in visual function was achieved in 7 patients. Amplitude decreased in 9 patients. One patient had a decrease in visual acuity due to progression of her primary macular degeneration. Improvement in head posture was seen in 3 patients and there was no change in the head posture in 2 patients. One patient acquired head posture after surgery. Restriction of motility was seen in none of the patients after surgery in spite of large amounts of recession. Recession of horizontal recti decreased nystagmus amplitude and frequency in 81.8% of patients. Improvement in visual function, measured as an increase in visual acuity in terms of Snellen lines, was achieved in 63.6% of patients.

CONCLUSION

Symmetric recession of the horizontal rectus muscles is shown to be a successful procedure to perform in nystagmus patients, resulting in an increase in visual acuity and a decrease in nystagmus amplitude and frequency. It is a reliable alternative to the Kestenbaum operation and is easier to perform surgically.

Diagnosis of ocular involvement in Behçet's disease: value of spectral and color Doppler sonography

OBJECTIVE

The purpose of this study was to determine the value of duplex and color Doppler sonography in the detection of ocular involvement in Behçet's disease.

SUBJECTS AND METHODS

Duplex and color Doppler sonography was done in 21 patients with Behçet's disease and ocular involvement and in 22 patients with Behçet's disease but without ocular involvement. Twenty health volunteers also were examined as a control group. Flow velocities in the central retinal artery, posterior ciliary arteries, and ophthalmic artery were measured in the patients with Behçet's disease.

RESULTS

In patients with Behçet's disease and ocular involvement, peak systolic velocities in the central retinal, posterior ciliary, and ophthalmic arteries were 7.3 +/- 2.3, 12.8 +/- 3.1, and 35.8 +/- 7.2 cm/sec, respectively. In patients with Behçet's disease but without ocular involvement, these values were 10.0 +/- 1.9, 17.3 +/- 3.4, and 33.5 +/- 4.0 cm/sec, respectively. In control subjects, the respective calculated values were 12.3 +/- 1.0, 16.5 +/- 1.6, and 35.8 +/- 4.4 cm/sec. For the central retinal and posterior ciliary arteries, peak systolic and diastolic velocities were significantly lower in patients with Behçet's disease and ocular involvement than in control subjects and patients with Behçet's disease but without ocular involvement (p < .001). Peak systolic and diastolic velocities in the central retinal artery were significantly lower in patients with Behçet's disease but without ocular involvement than in the control group (p < .001); however, no difference was observed for the posterior ciliary artery. Flow velocities in the ophthalmic artery were not significantly different among groups.

CONCLUSION

These findings suggest that duplex and color Doppler sonography may be helpful in the diagnosis of ocular involvement in patients with Behçet's disease.