Clinical Observations on Tolosa-Hunt Syndrome

PURPOSE: The authors reviewed clinical features, response to treatment and recurrence rate of Tolosa-Hunt syndrome. METHODS: A retrospective chart review was performed on 6 patients, who fulfilled the diagnosis for Tolosa-Hunt syndrome according to the International Headache Society (IHS) classification of 2004. RESULTS: Every patient had orbital pain as a first symptom, followed by cranial nerve paresis. The third cranial nerve was most commonly involved (83.3%), followed by the sixth nerve (50%), the forth nerve (16.7%), and the first branch of the fifth cranial nerve (16.7%). Two of the patients showed multiple cranial nerve paresis (33.3%, 2 out of 6). All patients received high-dose steroid therapy for more than 5 days, and all patients had resolution of orbital pain within 72 hours of treatment. Full recovery of cranial nerve paresis occurred on average in 2.3 months (3 days to 12 months). During the 29 months of follow-up, 2 patients (33.3%) had a recurrence episode. CONCLUSIONS: Tolosa-Hunt syndrome responds well to steroid therapy, and full recovery is possible with proper treatment. The exact diagnosis and treatment of Tolosa-Hunt syndrome is important. Because Tolosa-Hunt syndrome often recurs after full recovery, the authors suggest a minimum follow-up period of 2 years.

Intravitreal Bevacizumab Injection for Macular Edema Secondary to Branch Retinal Vein Occlusion

PURPOSE: To examine the clinical effects of intravitreal bevacizumab injections for patients with macular edema secondary to branched retinal vein occlusion (BRVO). METHODS: Nineteen patients (19 eyes) diagnosed with BRVO within the three month study window, having visual acuities under 0.5 and significant macular edema within two-disc diameters of the fovea were included in the present study. The author evaluated the patients' responses to bevacizumab (1.25 mg/0.05 mL) treatment using visual acuity and central macular edema measurements. RESULTS: The mean visual acuity improved from 1.06 (+/-0.10 logMAR unit) at baseline to 0.68 (+/-0.09 logMAR unit), 0.279 (+/-0.049) at one month, 0.67 (+/-0.9 logMAR unit) at two months, 0.61 (+/-0.09 logMAR unit) at three months and 0.54 (+/-0.10 logMAR unit) at six months. The mean central macular thickness decreased from 552.9 micrometer (+/-41.0) at baseline to 290.0 micrometer (+/-36.7) at one month, 290.0 micrometer (+/-36.7) at three months and 281.3 micrometer (+/-30.1) at six months. No adverse side effects were observed following injections. CONCLUSIONS: The observed macular edema and visual acuity improvements, as well as lack of serious adverse side effects after intravitreal bevacizumab injection, demonstrated that intravitreal bevacizumab injection may be useful for treating patients with macular edema secondary to BRVO.

A Case of Intraorbital Foreign Body Removed Using A Magnet Under C-arm Fluoroscopy

PURPOSE: We report a case of an intraorbital foreign body removed in a walk-in patient using a magnet under fluoroscopy. METHODS: A patient walked into the eye clinic complaining of ocular pain caused by foreign body that pernetrated into his right lower eyelid while mowing the lawn one day before he came to the hospital. Since an orbital foreign body was observed when the patient entered the hospital, and a high-density metallic response was diagnosed within the orbit from a computerized tomogram, we performed an emergency operation to take out the foreign body within the orbit. RESULTS: We removed the metallic foreign body, which was 5 mm in size and buried in the orbital fat, in an operation using a magnet under fluoroscopy. CONCLUSIONS: This study shows that fluoroscopy and magnets are an efficient operative means of removing foreign bodies that are found within the orbital fat layer and are difficult to access.