1/10. Conservative management of documented neuroretinitis in cat scratch disease associated with bartonella henselae infection.BACKGROUND: bartonella henselae has been identified as the causative agent of the neuroretinitis associated with cat scratch disease (CSD). Immunofluorescent antibody tests with good sensitivity and specificity are available to aid in diagnosis. Despite diagnostic advances, optimal management remains controversial. We present a case of documented B. henselae macular neuroretinitis managed without antibiotics and discuss antibiotic use in this condition. methods: We examined a young woman with macular neuroretinitis and established a diagnosis of CSD. Management consisted of a review of the literature, followed by educating her about the condition and close observation. We documented the course of her disease. RESULTS: We diagnosed neuroretinitis associated with B. henselae infection based on immunofluorescent antibody titres and clinical presentation. Our patient's neuroretinitis resolved promptly without antibiotic therapy. CONCLUSIONS: Macular neuroretinitis in CSD can be satisfactorily diagnosed with the use of fluorescent antibodies in the appropriate clinical setting. Optimal treatment for the disease has not been established and observation combined with patient education remains an appropriate option. The self-limited nature of the disease implies that treatment studies not using controls must be interpreted with great caution. Adverse drug reactions and other iatrogenic complications can be reduced by limiting antibiotic use in settings where a meaningful treatment benefit has not been established.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/10. hydroxychloroquine and chloroquine retinopathy: screening for drug toxicity.PURPOSE: To report hydroxychloroquine and chloroquine retinopathy and consider screening for drug toxicity. DESIGN: Retrospective observational case series. methods: review of clinical records, visual fields, fundus photographs, and fluorescein angiography of six patients from a retina referral practice. RESULTS: All cases arose because of failure by physicians to avoid dosing above published safe levels. Five cases developed despite accepted ophthalmologic patterns of screening for toxicity. All cases developed parafoveal retinal pigment epithelial atrophic changes and paracentral scotomas to threshold visual field testing. CONCLUSIONS: New cases of hydroxychloroquine and chloroquine toxicity continue to develop in a screening environment. Increased ophthalmologic attention to dosing, awareness of location and nature of early visual field defects, and traditional attention to presence or absence of maculopathy can reduce the incidence of this avoidable condition.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/10. Iatrogenic ring scotoma after laser in situ keratomileusis.A 37-year-old ophthalmologist had bilateral simultaneous laser in situ keratomileusis (LASIK) for moderate myopia with astigmatism using the Alcon Summit LADARVision laser; an ablation zone of 5.5 mm was used. Five months after surgery, the uncorrected visual acuity was 20/20 and 20/25 but despite regular corneal topographies, the patient experienced prominent ghost images under photopic and scotopic conditions. To elucidate the nature of the problem, automated static perimetry was performed, which revealed a significant depression between 10 degrees and 30 degrees compared with a baseline study obtained 3 years earlier. The patient started brimonidine 0.2% 1 drop in both eyes every morning, which caused 1.5 to 2.0 mm of pupillary miosis (tonic pupil size 3.0 to 4.0 mm in dim light) and eradicated the ghost images. Repeat perimetry showed significant improvement in all indices. The mechanism of improvement is unclear but may be due to elimination of light scatter from the transition zone between the ablated and unablated cornea. The issue of perimetric changes after refractive surgery deserves more attention; postoperative testing may be indicated for patients in whom the ablation zone diameter is close to the mesopic or scotopic pupil size to provide an accurate lifetime baseline visual field.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/10. Acute macular neuroretinopathy.Acute macular neuroretinopathy is an infrequently encountered condition in which there is a sudden mild central vision loss, photopsia and red-brown wedge-shaped lesions in the macular region with corresponding scotomata in the central visual fields. The condition may be associated with the use of oral contraceptives or with a recent febrile illness. It is self-limiting and non-recurrent. The clinical features of a patient with acute macular neuroretinopathy are described and the nature of the vascular aetiology is discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/10. Peculiar arcuate scotoma in pathologic myopia--optical coherence tomography to detect peripapillary neural tissue loss over the disc crescent.BACKGROUND: Optical coherence tomography (OCT) was used to detect peripapillary neural tissue loss (PPNTL) over the disc crescent in pathologic myopia. The retinal neural tissue loss located inside the disc crescent in pathologic myopia is a newly recognized fundus lesion. methods: review of ten eyes of ten patients with peripapillary yellowish-white retinal lesions who underwent OCT for evaluation of the nature of PPNTL in pathologic myopia. OCT, fluorescein angiography, automated visual fields, axial length measurement with ultrasound A scan, and ultrasound B scan were performed. RESULTS: Ten eyes of ten patients were identified during a 14-year period to have findings characteristic of PPNTL. The mean age of the patients was 46 years. They were followed up for an average of 9 years. The mean spherical equivalent correction was -10.50 diopters (D) (range -6.0--16.0 D). The mean axial length was 28.6 mm (range 26.30-31.50 mm). In each case, OCT showed a complete retinal discontinuity in the PPNTL lesion. Automated visual field examination showed corresponding arcuate scotoma. During the follow-up period, the inner retina layer of the retinal defect margin was elevated by posterior hyaloid and partial retinal detachment developed in one eye. CONCLUSIONS: PPNTL in pathologic myopia is a relatively asymptomatic, yellowish-white peripapillary retinal discontinuity. Recognition of this lesion is important because the visual field defect may mimic glaucomatous changes owing to the loss of nerve fiber layer. Progressive partial retinal detachment may ensue as one of the complications of the peripapillary lesion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/10. An unusual application of prisms for field enhancement.This case report describes an unusual procedure to alleviate the problem of walking for a patient who has a modified "doughnut" field or ring scotoma. The technique uses prisms for field enhancement to increase the peripheral field awareness for the purpose of mobility. The unconventional placement of the prisms on the carrier lens contributes to the unusual nature of this case.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/10. angioid streaks associated with abetalipoproteinemia.angioid streaks were observed in a 31-year-old man with abetalipoproteinemia. angioid streaks have now been described in hereditary spherocytosis, beta thalassemia, alpha thalassemia, sickle cell anemia, and acanthocytosis secondary to abetalipoproteinemia and hypobetalipoproteinemia. The nature of the association of angioid streaks and structural defects of hemoglobin and the red blood cell is not understood.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/10. Functional evaluation in Harada's disease. A case report.A 21-year-old woman suffering from Harada's disease was carefully evaluated during a three year follow-up study. In the acute stage of the disease the electroretinographic changes were found to parallel the clinical course. The functional parameters indicate that the retinal involvement is localized in the layers which generate the electroretinogram. Some attempts to explain the discrepancy between the decreased positive amplitude of the electroretinogram and the normal sensory threshold findings give credence to the concept that such paradoxical behaviour can be explained by the focalized nature of the retinal involvement.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/10. "Release hallucinations" as the major symptom of posterior cerebral artery occlusion: a report of 2 cases.Visual hallucinations were the presenting symptoms in 2 patients with probable infarcts in the territory of a posterior cerebral artery. They occurred in areas of paracentral scotomas, right in Patient 1 and left in Patient 2. In Patient 1 they were formed, prolonged, and not apparently related to past experience. In Patient 2 they were at first paroxysmal and unformed, with more prolonged metamorphopsia; later there appeared to be palinoptic formed images, possibly postictal in nature. Such hallucinations appear to be of a "release" type, and may be more common than is generally appreciated in patients with posterior cerebral artery occlusion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/10. Migraine with visual aura and photosensitive epileptic seizures.A relationship between epilepsy and migraine has long been postulated, but the nature of this interaction is still debated. We observed this association in a 23-year old man with a history of migraine with visual aura who had seizures at age 15 years while watching television. Waking EEG was normal, but sleep recordings demonstrated posterior spike-waves during sleep. During intermittent photic stimulation (IPS), a photoparoxysmal response occurred, maximum in occipital areas. brain magnetic resonance imaging scan was normal. seizures did not recur after 4-year treatment with valproate. He is currently seizure-free, but continues to have rare migraine with visual aura. The role of spreading depression or of a putative dopaminergic failure in occipital cortex is discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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