1/17. Single isolated cotton-wool spots.The presence of isolated cotton-wool spots in normal fundi may indicate serious systemic disease. In this presentation 4 patients were examined for blurred vision or scotomas with sudden onset. Two of them were pregnant. Funduscopic examination revealed soft-appearing white spots in the temporal arcades in 3 patients and in the papillomacular bundle in 1 patient. Due to the lack of other fundus lesions 3 of the patients were initially treated for toxoplasmosis. The patients were seronegative for typical viral (hiv), antinuclear antibodies, bacterial infections, or toxoplasmosis. Blood pressures, glycosylated hemoglobin and blood counts were in the normal range. At the follow-up examinations subjective symptoms had improved and the spots disappeared or were smaller and showed more distinct borders, and no new lesions were detected. These cases suggest that isolated cotton-wool spots may occur without serious systemic disease in otherwise healthy subjects and the spots may be misinterpreted as acute inflammatory retinochoroidal lesions.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/17. Visual field defect associated with laser in situ keratomileusis.PURPOSE: To report a case of visual field defect associated with laser in situ keratomileusis. methods: Case report. A 28-year-old woman with high myopia (-10D) and a family history of normal tension glaucoma underwent bilateral laser in situ keratomileusis keratorefractive surgery. Preoperatively, both eyes had normal intraocular pressure and visual field. RESULTS: At the first postoperative visit 1 day after apparently uncomplicated laser in situ keratomileusis, the patient reported a scotoma in the right eye. At 3-month follow-up, visual fields revealed the patient had developed a near-superior altitudinal visual field defect in the right eye. The defect did not progress over 1 year of follow-up examinations. CONCLUSION: Increased intraocular pressure associated with the microkeratome vacuum ring used during laser in situ keratomileusis may have precipitated optic nerve head ischemia and visual field defect.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
3/17. Measurement of venous outflow pressure in the central retinal vein to evaluate intraorbital pressure in Graves' ophthalmopathy: a preliminary report.PURPOSE. To evaluate the intraorbital pressure in patients with Graves' ophthalmopathy (GO) in relation to the intraocular pressure (IOP) and proptosis and to find out whether optic nerve compression is predictable. methods. The venous outflow pressure (VOP) in the central retinal vein was measured by the perviously described technique of oculodynamometry.1 Since the central retinal vein passes through the orbit, the VOP cannot be lower than the intraorbital pressure if outflow is to be guaranteed. The IOP was measured either in primary position or with slight chin elevation to avoid restriction of the globe. Fifty-seven patients underwent a complete ophthalmologic examination, including VOP measurements, Hertel exophthalmometry and visual fields. RESULTS. The IOP in primary position ranged between 10 and 29 mmHg and in most (n=54) cases the VOP was 0-4 mmHg higher than the IOP. These patients had neither scotomas nor visual deterioration during an observation period of up to 2 years. In those cases (n=3) where the difference between IOP and VOP was 35 mmHg, the patients developed scotomas and visual deterioration and had to be treated (high-dose steroids or orbital decompression). The elevation in VOP did not correlate with the degree of proptosis. In one unilateral case, treatment of high IOP (32 mmHg) with dorzolamide drops led to a decrease in visual acuity of two lines, inferior field depression and relative afferent pupillary defect. The difference between IOP and VOP was 10 mmHg. Stopping treatment normalized visual function, the IOP rose to its original level and the difference between IOP and VOP was 4 mmHg. CONCLUSION. The increased IOP in GO is not caused by primary glaucoma but by elevated intraorbital pressure. The difference between IOP and VOP must be <5 mmHg to guarantee normal perfusion. We interpret these findings to suggest that loss of visual acuity and visual field defects may not only be caused by optic nerve compression at the apex but also by deterioration of optic nerve head perfusion.- - - - - - - - - - ranking = 13keywords = pressure (Clic here for more details about this article) |
4/17. Valsalva maculopathy.The Valsalva manoeuvre comprises forcible exhalation against the closed glottis, thereby creating a sudden increase in the intrathoracic or intra-abdominal pressure. A simultaneous rapid rise in intraocular venous pressure may result in the spontaneous rupture of perifoveal capillaries, leading to a characteristic clinical picture of a preretinal haemorrhage in an otherwise healthy eye. The haemorrhage typically occurs at the macula and in the vast majority of cases resolves without compromising visual acuity. Valsalva maculopathy is an isolated and self-limited event. A case of Valsalva maculopathy in a young healthy male attributable to an incontrovertible Valsalva stress associated with weightlifting is presented.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/17. Cilio-retinal arterial circulation in central retinal vein occlusion.The hypothesis that an occlusion of the central retinal artery is an essential prerequisite for haemorrhage formation after central retinal vein obstruction has been investigated by examining the fundus changes in patients with a cilio-retinal arterial circulation; the findings are at variance with the 'combined occlusion hypothesis'. Comparisons were made between the pathological features in two retinal capillary beds with independent sources of arterial supply--namely, the central retinal and cilio-retinal arteries--but with an obstructed venous drainage channel common to both--namely, the central retinal vein. The importance of intraluminal pressure changes (as distinct from perfusion changes) in the causation of haemorrhages and oedema after venous occlusion is stressed, and the role of arterial disease in the pathogenesis of venous occlusions is distinguished from its role in determining the sequelae of such occlusions.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/17. Ocular ichemia syndrome - a malignant course of giant cell arteritis.PURPOSE: To call attention to a malignant course of ocular ischemic syndrome in patients with giant cell arteritis (GCA). methods/PATIENT: A 84-year-old woman developed severe headache for about 3 (1/2) months prior to myocardial infarction and visual disturbances. RESULTS: An anterior ischemic optic neuropathy (AION) in the right eye with a distinct reduction in visual acuity was found. The retina revealed several cotton-wool spots in both eyes. Serologic examinations showed inflammatory signs. Despite treatment with prednisolone, eye pressure decreased to 2 mm Hg in the right eye and 4 mm Hg in the left eye in a few days. An ischemic iritis developed in the right eye. visual acuity worsened to detection of hand motions in the right eye and to 0.1 in the left eye. Approximately 8 (1/2) months after her initial headache, a biopsy was carried out. The patient was treated continuously with corticosteroids. histology of the superficial temporal artery indicated inflammatory cells in the vessel wall. - The patients daughter developed symptoms of GCA at the age of 54 years. CONCLUSION: An ocular ischemic syndrome points to a malignant course of the disease. A cardiac infarction can develop in GCA. A biopsy of the temporal artery can reveal inflammatory changes even after 8 (1/2) months.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/17. Bilateral central scotoma with preservation of central vision in 2 patients following caesarean section under spinal anesthesia.Two female patients are described with acute bilateral central scotomata with preservation of central vision following spinal anesthesia. Both patients had a temporary drop in systemic blood pressure and underwent caesarean section with moderate blood loss. In order to explain the visual field defects extensive ophthalmological examination and CT-scanning with nuclear magnetic resonance imaging were performed. The hypothetical explanation for the visual field defects is transient macular ischemia.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/17. Asymmetric papilledema and visual loss in pseudotumour cerebri.We report the case of a 26 year old obese woman who presented with intermittent headaches and blurred vision in her left eye (OS) and on clinical examination had an enlarged visual field blind spot OS with OS disc edema. After an extensive neurologic work up including two nondiagnostic lumbar punctures, a clinical diagnosis of OS anterior ischemic optic neuropathy was made. Gradual progression of visual field loss OS prompted reassessment of the diagnosis and intracranial pressure was confirmed to be markedly elevated by usage of a subarachnoid monitoring bolt, thus establishing the diagnosis of pseudotumour cerebri. An optic nerve sheath fenestration was performed OS with subsequent reversal of the progressive visual field loss.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/17. glaucoma: the value of a diurnal curve and Goldmann visual field.A 35-year-old man was treated with maximum medical therapy for open-angle glaucoma. A diurnal curve revealed that the pressure was not controlled as might have been thought by a single reading. Reference is also made to the value of Goldmann visual field testing, since in this patient visual field defects were discovered with normal, healthy-appearing optic discs. A careful regimen including precise visual field testing and the plotting of the diurnal curve is most important in evaluating ocular hypertension and glaucoma.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/17. Retinal vascular changes after treatment with hyperbaric oxygen.A healthy 44-year-old man, who accompanied patients with multiple sclerosis as an attendant into a pressure chamber for hyperbaric oxygen treatment at 203 kPa (2 atm) absolute pressure, used a spare 100% oxygen mask himself for one hour on two occasions, and later noticed a field defect in his left eye. The vasoconstrictive, and consequent possible ischaemic, effects of hyperbaric oxygen are discussed, and the sensitivity of the retinal vasculature to hyperbaric oxygen is emphasized.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
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