A Case of Complete Visual Recovery From No Light Perception After Resection of Pituitary Adenoma

PURPOSE: We report a case of a patient with no preoperative light perception who achieved complete visual recovery after transsphenoidal resection of a pituitary adenoma. CASE SUMMARY: A 53-year-old man with a history of pituitary adenomectomy visited our clinic complaining of decreased vision of 7 weeks ducation. His best-corrected visual acuity was 1.2 in his right eye, and he had no light perception (NLP) in his left eye. Light reflex was absent in the left eye, and no consistent wave was detected in the left eye on flash visual evoked potential (FVEP). A pituitary adenoma 3x3.5 cm in diameter was found following magnetic resonance imaging (MRI), and was removed using a transsphenoidal approach and gamma knife radiosurgery. Six weeks postoperatively, his best corrected visual acuity improved to 1.0 in the left eye. CONCLUSIONS: Prompt management should be initiated in patients with no light perception vision, due to compressive optic neuropathy.

Long-term Outcome of Nasolacrimal Duct Obstruction Treated with Nasolacrimal Polyurethane Stents (Song's Stent)

PURPOSE: This study was carried out to evaluate and investigate the long-term outcome of placement of 25 plastic nasolacrimal stents (Song's stents) without fluoroscopic guidance for the treatment of obstructed nasolacrimal ducts. METHODS: The medical records of 25 patients who had had Song's polyurethane stents placed between 1997 and 2003 were reviewed. The patients included 17 women and 8 men who ranged in age from 22 to 79 years (mean, 57.9 years). The mean follow-up period was 54 months. RESULTS: The overall technical success in this study was 92% (23 of 25 eyes), with a 91% (21 of 23 eyes) short-term success rate. Of the 21 stents deployed, at the end of this study, 20 stents (95%) had been occluded. The median duration of stent patency was 38 months. The interquartile range of stent patency (75%~25%) were 26 and 50 months, respectively. CONCLUSIONS: Although nasolacrimal stenting with Song's stents is a relatively simple and safe procedure and is a useful alternative in elderly patients or patients in poor general condition, nasolacrimal stenting with Song's stents does not meet the requirement of long-term efficacy for epiphora resolution.

Periosteal Fixation in Bilateral Total Third Nerve Palsy

PURPOSE: We present a new technique of anchoring the eyeball to the nasal periosteum with supramaximal recession of the lateral rectus muscle in one eye for exotropia management in bilateral total third nerve palsy combined with trochlear nerve palsy. CASE SUMMARY: A 38-year-old man presented with drooping of both upper lids and exodeviation of the left eye with a history of intraventricular hemorrhage 9 months previously. We noted bilateral ptosis, dilated pupils, right fixing eye, left face turn, and left exotropia over 100 prism diopters (PD) in the primary position with an inability to move both eyes together except abduction. He was diagnosed with bilateral total third nerve palsy and trochlear nerve palsy. We fixated the left globe (sclera anterior to the insertion of the medial rectus muscle) to the nasal periosteum including the medial palpebral ligament using a nonabsorbable suture. A large recession of the left lateral rectus muscle (14 mm) was also performed. Ocular alignment in the primary position was exotropia of 25PD and cosmetically satisfactory after 6 months of follow-up. CONCLUSION: Supramaximal recession of the lateral rectus muscle and periosteal fixation using nonabsorbable suture is an effective technique for the management of exotropia secondary to total third nerve palsy.

Two Cases of Oculocerebrorenal Syndrome in Two Brothers Diagnosed after Congenital Cataract Surgery

PURPOSE: We report two cases of brothers diagnosed with oculocerebrorenal syndrome after binocular congenital cataract surgery. METHODS: Two brothers who had undergone surgeries for congenital cataracts showed growth retardation, proteinuria, and generalized tonic seizures. The patients were referred to the pediatrics department and evaluated for systemic diseases and genetic counseling. RESULTS: Two brothers had renal tubular dysfunction characterized by hypercalciuria and hyperphosphaturia. The older brother had multiple microcalcifications on both kidneys, and ischemic injury with general dysfunction of the brain. Genetic analysis of brothers and their mother showed a new mutation of P799L in the region of the chromosome Xq25-26.1 locus. The two brothers were diagnosed with oculocerebrorenal syndrome of Lowe (OCRL). CONCLUSIONS: In cases of patients with congenital cataracts, the evaluation of systemic disease including genetic abnormality should be considered whenever systemic symptoms such as growth retardation, proteinuria or seizure are found.