1/15. A sighting of orbital pseudotumor.A 39-year-old woman developed bilateral proptosis, photophobia, and pain with extraocular movements over the course of 5 days. Her findings initially were ocular pain and photophobia which progressed to periorbital edema and nasal discharge ultimately resulting in proptosis with vertical globe displacement and decreased visual acuity. She was diagnosed with corneal abrasion and sinusitis respectively during two initial emergency department visits. On her third visit to the emergency department within 4 days, she developed acute visual deficits. The patient was subsequently diagnosed with orbital pseudotumor after computed tomography scan revealed inflammation of orbital structures bilaterally.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
2/15. Phototherapeutic keratectomy for Schnyder's crystalline corneal dystrophy.PURPOSE: To describe the treatment of Schnyder's crystalline dystrophy (SCD) with excimer laser phototherapeutic keratectomy (PTK). methods: Chart review of three patients (four eyes) with SCD treated with PTK between March 1992 and December 1998. Pre- and posttreatment visual acuity, subjective glare, photophobia, manifest refraction, ultrasound pachymetry, hyperopic shift, and biomicroscopic findings were studied. Brightness acuity testing (BAT) was evaluated in two eyes. RESULTS: Four eyes were treated during the study period. The average best corrected visual acuity (BCVA) improved from 20/175 to 20/40 under bright conditions. All patients reported subjective improvement in glare and photophobia. No visually significant recurrence was observed during the follow-up period which ranged from seven months to three years. The mean spherical equivalent refractive shift was 3.28 diopter (D). One patient developed irregular astigmatism from an eccentric ablation. No vision threatening complications were observed. CONCLUSION: PTK can be effective at improving visual symptoms in patients with SCD. It can be a useful therapeutic alternative to lamellar or penetrating keratoplasty in these patients.- - - - - - - - - - ranking = 2keywords = visual (Clic here for more details about this article) |
3/15. Abnormal activation in the visual cortex after corneal refractive surgery for myopia: demonstration by functional magnetic resonance imaging.OBJECTIVE: To try to correlate subjective photophobic symptoms with visual pathway modifications (from the retinal image to the visual cortex) after refractive surgery by exploring brain activation on photic stimulation. DESIGN: Noncomparative case series. PARTICIPANTS: Four subjects reporting discomfort produced by luminance (glare, halos, starbursts, or a combination thereof) in one eye after laser in situ keratomileusis (LASIK) were enrolled. The contralateral myopic eye (control) had no visual impairment and had undergone LASIK without complications or had not had previous surgery. methods: Functional magnetic resonance imaging was performed during photic stimulation, delivered by an optical fiber, of the affected and unaffected eyes. RESULTS: Functional magnetic resonance imaging provided evidence that most subjective visual symptoms correlated with anatomic flap abnormalities are associated with a higher signal increase in the visual association cortices compared with a nonsymptomatic eye. CONCLUSIONS: Functional magnetic resonance imaging of the visual cortex may help in exploring the mechanisms involved in glare effects after refractive surgery.- - - - - - - - - - ranking = 5keywords = visual (Clic here for more details about this article) |
4/15. photophobia as the presenting visual symptom of chiasmal compression.Five patients with a chief visual complaint of photophobia were subsequently found to have compressive lesions of the optic chiasm. visual acuity and visual field deficits were often subtle. magnetic resonance imaging scanning revealed large suprasellar masses, including three pituitary adenomas, a craniopharyngioma, and a clivus chordoma. photophobia resolved in all patients following treatment of the tumors. A compressive lesion of the optic chiasm should be considered in patients who experience persistent photophobia unexplained by ocular abnormalities.- - - - - - - - - - ranking = 3keywords = visual (Clic here for more details about this article) |
5/15. Open-sky pupilloplasty during phakic penetrating keratoplasty to treat a fixed, dilated pupil.We report a technique in which penetrating keratoplasty is performed in conjunction with open-sky pupilloplasty in a phakic patient. The technique was used in a 27-year-old man with poor vision and severe light sensitivity in the left eye dating back to an episode of presumed herpes simplex keratouveitis 13 years previously. Examination showed a best corrected visual acuity of 20/40, a paracentral midstromal corneal scar, a fixed dilated pupil, and a clear lens. Postoperatively, the pupil was relatively round with a diameter of approximately 4.0 mm, the cosmetic result was favorable, the photophobia had resolved, and the lens and corneal transplant were clear.- - - - - - - - - - ranking = 1.3520650570461keywords = sensitivity, visual (Clic here for more details about this article) |
6/15. Idiopathic limbal stem cell deficiency.PURPOSE: To describe and to characterize the clinical findings and prognosis of patients with idiopathic limbal stem cell deficiency (LSCD). DESIGN: Retrospective case series. PARTICIPANTS/methods: We reviewed records from seven patients whose LSCD had been diagnosed clinically and confirmed by impression cytology and in whom the cause of LSCD was never identified. A detailed history, clinical records, and results of slit-lamp biomicroscopy, photography, vital staining, and impression cytology were evaluated. RESULTS: Six of seven patients (86%) were women, indicating a female predominance. Two patients were from the same family, whereas one other had a positive family history. Severe photophobia was noted in all patients and reduced vision in three patients. The main clinical findings included superficial vascularization, worse in the superior followed by the inferior and nasal cornea. The limbal regions showed a loss of limbal palisades of Vogt, and the adjacent peripheral cornea revealed an irregular and hazy epithelium with positive late fluorescein staining and the presence of conjunctival goblet cells by impression cytology. LSCD was bilateral in all patients but asymmetric in four. During a mean follow-up of 6.1 /- 3.8 years, the visual acuity decreased in both eyes of one patient after cataract extraction and in both eyes of two other patients without surgery. The process of conjunctivalization advanced in four patients (57%) and remained stable in three (43%) without surgical intervention. CONCLUSIONS: Idiopathic LSCD is a rare and as yet poorly recognized clinical entity, and the findings reported herein may help explore how progressive loss of limbal stem cells occurs. Correct diagnosis of idiopathic LSCD is important so that the patient will not be subjected to unnecessary surgeries, which may actually severely worsen the clinical course.- - - - - - - - - - ranking = 0.5keywords = visual (Clic here for more details about this article) |
7/15. Macular infarction after transpupillary thermotherapy for subfoveal choroidal neovascularization in age-related macular degeneration.PURPOSE: To report the complication of macular infarction after transpupillary thermotherapy (TTT) for the treatment of subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). DESIGN: Interventional case reports. methods: Among 107 consecutive patients with subfoveal CNV due to AMD, a 73-year-old woman with recurrent subfoveal classic choroidal neovascularization and a 76-year-old man with subfoveal occult choroidal neovascularization with adjacent areas of geographic retinal pigment epithelium atrophy noted a severe decrease in visual acuity and photopsias within hours of undergoing TTT. RESULTS: Both patients had marked whitening of the macula clinically and closure of the perifoveal capillaries on fluorescein angiography. Immediately after treatment their visual acuity decreased from 20/200 to 6/200 and from 20/400 to 2/200, respectively. Several months later, all exudation had resolved and their visual acuity had stabilized at 20/100 and 20/200, respectively. CONCLUSIONS: Macular infarction is a rare complication that occurred in two of 107 patients undergoing TTT for subfoveal CNV due to AMD. The presence of geographic retinal pigment epithelium atrophy or a previous laser treatment scar in the macular region may predispose patients to this complication.- - - - - - - - - - ranking = 1.5keywords = visual (Clic here for more details about this article) |
8/15. Multiple evanescent white dot syndrome and acute zonal occult outer retinopathies.BACKGROUND: Multiple evanescent white dot syndrome (MEWDS) is a rare, acute, multifocal retinitis located in the posterior pole. patients with MEWDS may report photopsia, central scotoma, or decreased vision. Prodromal viral-like symptoms may be associated with this syndrome, but its etiology remains unknown. The condition is self limiting with a favorable prognosis for visual recovery within several weeks. CASE REPORT: A young, myopic, female patient presented with painless photopsia, scotoma, and subsequent vision loss secondary to MEWDS. The clinical appearance, differential diagnosis, and management of MEWDS are discussed. DISCUSSION: Careful ophthalmoscopic and angiographic interpretation along with complete history taking are the keys to diagnosing MEWDS. Ancillary testing including electroretinogram, early receptor potential, and visual fields aid in the differential diagnosis. Once the diagnosis has been established, patient reassurance is appropriate in the management of this condition.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
9/15. Waldenstrom's macroglobulinemia-associated retinopathy.OBJECTIVE: To report the clinical, electrophysiologic, and immunopathologic findings in a patient with progressive retinal degeneration associated with Waldenstrom's macroglobulinemia. DESIGN: Case report with immunohistochemical studies. methods: A 46-year-old female with elevated serum immunoglobulin m (IgM) levels complained of photophobia and photopsias. Complete ophthalmic examinations including electrophysiologic testing and hematologic evaluations were performed over a 3-year period. Immunohistochemical studies to determine the presence of serum antiretinal antibodies were evaluated using confocal microscopy. RESULTS: Examination of the patient's fundus remained normal, although there was deterioration in her visual acuity, visual field, and electroretinogram over the follow-up period. Waldenstrom's macroglobulinemia was diagnosed by bone marrow biopsy. Indirect immunohistochemistry revealed reactivity of the patient's serum against the photoreceptor-connecting cilium. CONCLUSION: The paraneoplastic retinopathy associated with Waldenstrom's macroglobulinemia in this patient is presumed to result from antibodies of the IgM subtype reacting to proteins in the retinal photoreceptors.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
10/15. Contact lens management of aniseikonia and photophobia induced by trauma.PURPOSE: To describe a case of a contact lens fitting to relieve aniseikonia and photophobia resulting from trauma. methods: A 61-year-old man suffered a blunt injury to his left eye resulting in glaucoma and a traumatic cataract with a fixed pupil and iris defects. A vitrectomy, lensectomy, and iris repair were performed leaving him with significant anisometropia. RESULTS: The patient was fitted with a prosthetic contact lens. CONCLUSIONS: contact lenses can provide significant visual improvement in cases of aniseikonia and photophobia.- - - - - - - - - - ranking = 0.5keywords = visual (Clic here for more details about this article) |
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