Bilateral Cerebral Venous Thrombosis with a Rare Presentation in a COVID-19 Patient: A Case Report / Trombose venosa cerebral bilateral com apresentação rara em paciente com COVID-19: Relato de caso

Since the COVID-19 pandemic started, millions of peoples are involved. The presentation of the disease varies from mild respiratory symptoms and multiple organ failure to coma and death. Neurological symptoms such as headache or seizure are also coincident with COVID-19. Thromboembolic events increase in COVID-19 patients due to hypercoagulability and inflammation, particularly in severely ill patients. Thrombosis may cause venous thrombosis, pulmonary embolism, or cerebral sinus venous thrombosis (CSVT). Cerebral sinus venous thrombosis is a rare phenomenon that is usually found in critically ill patients with bad prognoses. In the present case report, we present a 40-year-old man with COVID-19 confirmed by real-time polymerase chain reaction (RT-PCR) who was admitted due to acute bilateral visual loss due to bilateral transverse sinus thrombosis. Pseudotumor cerebri disease was confirmed through high lumbar puncture. Early surgical intervention (optic nerve fenestration) was performed and, fortunately, his visual acuity improved. Cerebral sinus venous thrombosis is a rare incident in COVID-19 patients, but due to irreversible complications, an early diagnosis is fundamental. In any neurologic change in COVID-19 patients, CSVT must be considered. Also, prophylactic thrombolytic therapy should be kept in mind as the patient is admitted.

Desde o início da pandemia da COVID-19, milhões de pessoas estão envolvidas. A apresentação da doença varia desde sintomas respiratórios leves e falência de múltiplos órgãos até coma e morte. Sintomas neurológicos, como dor de cabeça ou convulsão, também coincidem com COVID-19. Os eventos tromboembólicos aumentam em pacientes com COVID-19 devido à hipercoagulabilidade e inflamação, particularmente em pacientes gravemente enfermos. A trombose pode causar trombose venosa, embolia pulmonar ou trombose venosa do seio cerebral (TVC). A trombose venosa do seio cerebral é um fenômeno raro, geralmente encontrado em pacientes gravemente enfermos e com mau prognóstico. No presente relato de caso, apresentamos um homem de 40 anos com COVID-19 confirmado por reação em cadeia da polimerase em tempo real (RT-PCR) que foi internado devido a perda visual bilateral aguda causada pela trombose bilateral do seio transverso. A doença pseudotumor cerebral foi confirmada através de punção lombar alta. Foi realizada intervenção cirúrgica precoce (fenestração do nervo óptico) e, felizmente, sua acuidade visual melhorou. A trombose venosa do seio cerebral é um incidente raro em pacientes com COVID-19, mas devido a complicações irreversíveis, um diagnóstico precoce é fundamental. Em qualquer alteração neurológica em pacientes com COVID-19, a TVCS deve ser considerada. Além disso, a terapia trombolítica profilática deve ser lembrada quando o paciente é internado.

The impact of early intervention on a child with vision loss in infancy - A parental perspective

Purpose: To assess the impact of early intervention services provided to children with visual loss and to report how parents perceive them in terms of a child’s development and the family dynamics. Methods: A qualitative descriptive study was conducted on a purposively selected sample of 15 children with severe visual impairment, availing early intervention services at a tertiary care facility in Pune, Maharashtra. Data were collected by conducting in?depth interviews of the parents with the help of a semi?structured interview topic guide. Participants were asked in detail about how and whether various components of the early intervention program (EIP) had an impact on their child. The interviews were audio?recorded, transcribed, and translated into English, and the resultant textual data were analyzed using the qualitative research software NVIVO 12 to identify themes and sub?themes under each domain. Results: A total of 15 children were included in the study, with ages ranging from 13 months to 5 years. All the children included in the study suffered from severe visual impairment in infancy (Vision 3/60 – PL). In the course of this EIP, the majority of the children showed consistent progress in various aspects of child development. According to the parents, the most beneficial components of EIP were visual stimulation exercises, an improvised teaching methodology, and counseling services. Conclusion: Almost all the parents included in the study reported a positive change in the behavior and development of the child as well as improved family dynamics after implementation of EIP

A case of permanent vision loss due to a carotidcavernous fistula: importance of early diagnosis / Relato de caso de perda visual secundária a fístuda carótido-cavernosa: a importância de um diagnóstico adequado

ABSTRACT A 97-year-old female presented with spontaneous acute-onset palpebral hyperemia and edema of the right eye that had progressively worsen over the previous three days. These signs did not suggest possible carotid-cavernous fistula until a second examination 72 h later, during which the patient exhibited significant progression. Despite embolization, the patient exhibited sustained corneal edema, clots, and turbidity in the aqueous humor, which resulted in permanent visual loss. A greater level of clinical suspicion for possible carotid-cavernous fistula is warranted on initial presentation of palpebral hyperemia and edema to prevent possible irreversible vision loss.

RESUMO O objetivo deste relato é apresentar o caso de uma paciente de 97 anos com início agudo e espontâneo de hiperemia e edema palpebral. Estes sinais não levaram a uma suspeita diagnóstica de fístula carótido-cavernosa até um segundo momento, quando a paciente apresentou progressão importante do quadro clínico. Apesar da realização de tratamento efetivo com embolização da fístula, a paciente manteve alterações oculares como edema de córnea, coágulos e turvação no humor aquoso, e manteve perda visual definitiva.

Analysis of visual loss after non-ocular surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#Visual loss after non-ocular surgery(VLNOS)includes postoperative visual loss and perioperative visual loss after non-ocular surgery. The former accident consists of the blindness during a surgery or after a surgery, and the latter accident shows the acute visual loss in perioperative period. VLNOS can be appeared in a prone spinal surgery, cardiopulmonary bypass surgery, head and neck surgery, and facial micro-plastic injection treatment, which is a rare, extremely serious complication. VLNOS is divided into predictable and unpredictable condition. Doctors of related subjects have pay attention to VLNOS, and begin to study the possible reasons, and take positive precautions.

Does obesity affect intraocular pressure during laparoscopic surgery? / A obesidade afeta a pressão intraocular durante a cirurgia laparoscópica?

ABSTRACT Purpose: Obesity is accepted as a risk factor for postoperative visual loss due to possible perioperative elevations in intraocular pressure. This study investigated whether intraocular pressure changes differed according to the body mass index of patients undergoing laparoscopic cholecystectomy. Methods: Thirty obese and 30 non-obese patients (body mass index cutoff point, 30 kg/m2) undergoing laparoscopic cholecystectomy were enrolled. Intraocular pressure was measured at baseline (T1), after induction of anesthesia (T2), 5 min after initiation of mechanical ventilation (T3), 5 min after pneumoperitoneum inflation (T4), 5 min after the patient was placed in the head-up position (T5), 5 min after deflation with the patient in the supine position (T6), and 5 min after extubation with the patient in the 30 degrees upright position (T7). Results: The mean intraocular pressure values of the obese and non-obese groups were similar at T1 (16.60 ± 2.93 and 16.87 ± 2.85 mmHg respectively). In both groups, intraocular pressure decreased following initiation of anesthesia (T2) (p<0.001, T2 vs T1). Intraocular pressure values at T7 were significantly higher than those at T1 in the obese (20.38 ± 4.11 mmHg, p<0.001) and non-obese (20.93 ± 4.37 mmHg, p<0.01) groups. There were no significant differences between intraocular pressure values of obese and non-obese patients at any time point. Conclusions: Obesity is not correlated with intraocular pressure during short laparoscopic surgeries with the patient in the head-up position.

RESUMO Objetivo: A obesidade é aceita como um fator de risco para a perda visual pós-operatória devido a possíveis elevações perioperatórias da pressão intraocular. Este estudo investigou se as alterações na pressão intraocular diferem de acordo com o índice de massa corporal dos pacientes submetidos à colecistectomia laparoscópica. Métodos: Trinta pacientes obesos e 30 não-obesos (limiar de índice de massa corporal de 30 kg/m2), submetidos à colecistectomia laparoscópica foram incluídos. A pressão intraocular foi medida no início do estudo (T1), após a indução anestésica (T2), 5 min após o início da ventilação mecânica (T3), 5 min após a insuflação do pneumoperitôneo (T4), 5 min após o posicionamento vertical da cabeça (T5), 5 min após a deflação na posição em decúbito dorsal (T6) e 5 min após a extubação com o paciente na posição vertical de 30 graus (T7). Resultados: Os valores médios da pressão intraocular dos grupos obeso e não obeso foram semelhantes no T1 (16,60 ± 2,93 e 16,87 ± 2,85 mmHg, respectivamente). Em ambos os grupos, a pressão intraocular diminuiu após o início da anestesia (T2) (p<0,001, T2 vs T1). Os valores da pressão intraocular em T7 foram significativamente maiores do que aqueles em T1 nos grupos obesos (20,38 ± 4,11 mmHg, p<0,001) e não obesos (20,93 ± 4,37 mmHg, p<0,01). Não houve diferenças significativas entre os valores de pressão intraocular de pacientes obesos e não obesos em qualquer momento. Conclusões: A obesidade não está correlacionada com a pressão intraocular durante cirurgias laparoscópicas curtas com o paciente em posição de cabeça erguida.

Eye injury after non-ocular surgery in patients underwent general anesthesia: A report of 2 cases and literature review / 吉林大学学报(医学版)

Objective: To study the pathogenesis and the risk factors of eye injury after non-ocular surgery in the patients underwent general anesthesia∗ and to provide the reference for its prevention, diagnosis and treatment. Methods: The clinical materials of two patients with eye injury after non-ocular surgery underwent general anesthesia were analyzed and the related literatures were reviewed. Results: A young woman patient underwent laparoscopic hysterectomy with general anesthesia while positioned Trendelenburg, the eyes were being closed naturally without protection, and corneal abrasion of both eyes occurred after operation. The lesion had completely resolved with no sequelae after treatment. An old man underwent cervical posterior laminoplasty with general anesthesia in prone position developed ischemic optic neuropathy (ION) after operation. The vision of the patients partly recovered after symptomatic treatment. Conclusion: Corneal abrasion is the most frequent ophthalmologic complication during general anesthesia, most of the patients have good prognosis. Postoperative visual loss (POVL) is the most severe ophthalmologic complication without effective treatment available, the delicate reasons and mechanisms are not totally clear, prevention outweighs treatment.

Curative effect of vision therapy on children with functional visual loss / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the curative effect of vision therapy on children with functional visual loss.<p>METHODS: Totally 22 children with functional vision loss were enrolled in our department between January 2018 and June 2018, including 12 males and 10 females, the mean age 7.5±0.8 years old. All patients had routine eye examinations, refraction and binocular visual function examinations. Children with or without astigmatism whose diopter spherical mirror was between±1.00D and were accompanied by astigmatism less than ±1.00D participated in personalized vision therapy. Paired <i>t</i> test was used to analyze the binocular visual function before and after vision therapy.<p>RESULTS: The average visual acuity of the 22 children were improved, but the diopters before and after vision therapy were -0.011±0.573D and -0.057 ±0.338D drespectively, without statistical significance(<i>P</i>=0.633). The average of the distant level phoria(DLP)before and after vision therapy were -3△ ±2.97△ and -1.18△ ±1.6△, which was not statistically significant(<i>P</i>=0.089). The near level phoria(NLP)were -6.27△ ±4.56△ and -2.82△ ±2.56△; the near point of convergene(NPC)were 7.73±2.15 and 3.05±0.69cm; the accommodation convergence/accommodation(AC/A)were 2.00±1.55, 3.64±0.5 before and after the training respectively(<i>P</i><0.05); The negative relative accommodation(NRA)and positive relative accommodation(PRA)before vision therapy were 1.61±0.41 and -1.98±0.71D; after training they were 2.09±0.23 and -3.89±0.71D respectively; binocular crossed-cylinder(BCC)was 0.09±0.38D, which improved to 0.39±0.13D after therapy; the average of amplitude of accommodation(AMP)were 9.55±2.54 and 11.55±1.13D; binocular accommodation facility(BAF)were 3.36±2.73 and 9.64±1.5cpm respectively before and after therapy.<p>CONCLUSION:It is necessary to perform binocular visual function examination base on the refractive examination for children with functional vision loss. Visual therapy can improve visual acuity and binocular vision function.

Eye injury after non-ocular surgery in patients underwent general anesthesia:A report of 2 cases and literature review / 吉林大学学报(医学版)

Objective:To study the pathogenesis and the risk factors of eye injury after non-ocular surgery in the patients underwent general anesthesia, and to provide the reference for its prevention, diagnosis and treatment.Methods:The clinical materials of two patients with eye injury after non-ocular surgery underwent general anesthesia were analyzed and the related literatures were reviewed.Results:A young woman patient underwent laparoscopic hysterectomy with general anesthesia while positioned Trendelenburg, the eyes were being closed naturally without protection, and corneal abrasion of both eyes occurred after operation.The lesion had completely resolved with no sequelae after treatment.An old man underwent cervical posterior laminoplasty with general anesthesia in prone position developed ischemic optic neuropathy (ION) after operation.The vision of the patients partly recovered after symptomatic treatment.Conclusion:Corneal abrasion is the most frequent ophthalmologic complication during general anesthesia, most of the patients have good prognosis.Postoperative visual loss (POVL) is the most severe ophthalmologic complication without effective treatment available, the delicate reasons and mechanisms are not totally clear, prevention outweighs treatment.

Visual Loss with Ophthalmoplegia after Prone Position Spinal Surgery

PURPOSE: We report a case of acute visual loss with ophthalmoplegia after prone position spinal surgery who had blood supply dependence on collateral circulation due to occlusion of the Internal carotid artery. CASE SUMMARY: A 74-year-old man was referred to the department of ophthalmology for acute visual loss and ophthalmoplegia after lumbar spine surgery performed in prone position. On the initial visit, his right visual acuity was 0.8 and the left visual acuity was negative light perception. Intraocular pressure was normal. There was a relative afferent pupillary defect and ophthalmoplegia of all directions in the left eye. Because of the ptosis of the upper eyelid in the left eye, it was impossible to tune the eye voluntarily. The cherry red spot and pale retina were observed on the fundus examination. On brain magnetic resonance imaging angiography, we found complete obstruction of the left internal carotid artery. He had intravenous injection of 1 g methylprednisolone for 3 days, and discharged with per oral medicine. After 1 month of treatment, the ophthalmoplegia was slightly improved, but visual acuity was not recovered. CONCLUSIONS: In this case, unlike previous reports, acute visual loss and ophthalmoplegia occurred after spinal surgery the patient who had collateral circulation for ocular blood supply because of complete obstruction of the left internal carotid artery. This report highlights the importance of being aware of the anatomical variant in possible complications of external ocular compression after non-ocular surgery.

Diagnóstico y tratamiento en un caso de neurocisticercosis / Diagnosis and treatment of a neurocysticercosis case

La neurocisticercosis es una enfermedad del sistema nervioso central de origen parasitario que genera una alta morbilidad. Presentamos el caso de un paciente de 30 años de edad, negro, del sexo masculino, con historia de dolor de cabeza y disminución progresiva de la visión desde hace tres meses. Fue examinado en la Consulta de Oftalmología, donde se constató la pérdida visual y alteraciones campimétricas. En el fondo de ojo se observó papiledema bilateral. Le fue indicada tomografía computarizada de cráneo que mostró una gran lesión en la región frontal derecha y por lo cual fue transferido para el Servicio de Neurocirugía. Se decidió el tratamiento quirúrgico y se le realizó una craneotomía frontal derecha y resección de la lesión. El diagnóstico histológico confirmó una neurocisticercosis, por lo que se decidió comenzar el tratamiento con albendazol y praziquantel. El paciente evolucionó satisfactoriamente. Después de completar el tratamiento y pasados unos meses se le realizó la tomografía axial computarizada de control, donde se mostró una remisión total de la lesión(AU)

Neurocysticercosis is a disease of the central nervous system of parasitic origin and high morbidity. This is the case of a 30 years-old Black male patient with a history of headache and progressive reduction of vision for three months. He was examined at the Ophthalmological Service where visual loss and campometric alterations were confirmed. The fundus oculi revealed the presence of bilateral papilledema. He was performed cranial CT that showed a large lesion in the right front region, so he was transferred to the neurosurgery service. It was decided to apply surgical treatment. He was then performed a right front craniotomy and then resection of the lesion. The histological diagnosis confirmed neurocysticercosis and he was then treated with albendazol and praziquantel. His recovery was satisfactory. Upon completing the treatment and after a few months, the axial computerized tomography for control showed total remission of lesion(AU)

Phenytoin toxicity presenting with acute visual loss and acute delirium, a case report

@#Phenytoin is a widely prescribed antiepileptic agent for both focal and generalized seizure. We report a case of a 20-year-old man with focal epilepsy presented with acute bilateral visual loss, and delirium. His random phenytoin serum concentration on admission was 43.6 mg/L, well above the recommended therapeutic range of 10-20 mg/L. Extensive investigations have ruled out other vascular or demyelinating causes. His visual symptoms completely resolved after discontinuing phenytoin for 84 hours. This case shows that acute phenytoin toxicity can result in reversible visual failure.

Post operative visual loss after cervical laminectomy in prone position / Perda visual no pós-operatório de laminectomia cervical em pronação

Abstract Postoperative visual loss is a rare and devastating complication. The estimated incidence is 0.01-1% after non ocular surgery. It has been reported after spine, cardiac and head and neck surgeries. We report a patient who was operated for cervical laminectomy in prone position and complained of loss of vision in one eye postoperatively. He was thoroughly investigated after visual loss. The case was diagnosed as central retinal artery occlusion (CRAO) of the left eye. Here we consider the potential etiological factors causing this unilateral loss of vision and try to suggest strategies to reduce the incidence of the complication in spinal surgery.

Resumo A perda visual pós-operatória é uma complicação rara e devastadora. A incidência estimada é de 0,01-1% após cirurgia não oftalmológica. Há relatos de sua ocorrência após cirurgias da coluna, cardíaca e de cabeça e pescoço. Relatamos o caso de um paciente submetido à laminectomia cervical em pronação que se queixou de perda de visão em um dos olhos no pós-operatório. O paciente foi profundamente investigado após a perda visual. O caso foi diagnosticado como oclusão da artéria central da retina (CRAO) do olho esquerdo. Aqui consideramos os potenciais fatores etiológicos que causam essa perda unilateral da visão e tentamos sugerir estratégias para reduzir a incidência dessa complicação em cirurgia de coluna vertebral.

Forensic analysis of 109 cases of traumatic visual loss / 中国法医学杂志

Objective To analyze types, mechanism and forensic identification for traumatic visual loss. Methods 109 cases of the evaluation for impairment and disability on traumatic visual loss were retrospectively analyzed, including interocular differences, anisometropia, left or right eye and the distributions of visual acuity, etc. Results The male-to-female ratio was 5.8:1, mainly 30~59 years of age. The ratio of monocular versus binocular injuries was 17.17:1. The ratio of left versus right injured eye was 1.39:1 in intentional injury cases. 115 eyes were injured, 83 of which were in low vision or blindness. 95 patients(87.16%) had large interocular differences( ≥ 3 lines). There were 9 patients with anisometropia from 2.25D to 6.00D and 23 patients with anisometropia larger than 6.00D. Conclusion Interocular differences and anisometropia are common in practice, which are not included in the expertise standard yet. Functional vision should be considered when developing the expertise standard.

Chemotherapy Related Optic Neuritis

In children, most cases of optic neuritis are immune-related. Less frequently, it may also be due to demyelinating disorders. Other secondary causes such as infection of adjacent structures or infiltration are even rarer. The occurrence of optic neuritis in children on chemotherapy also has not being extensively reported. We report a case of bilateral optic neuritis in a young girl with subacute visual loss after receiving systemic chemotherapy for embryonal ovarian carcinoma.

Management of patients with macula - on retinal detachment in the retinal department of a tertiary hospital in Spain / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To analyze the management of patients with macula- on retinal detachment who received surgical treatment in our department. Placing special emphasis on the time elapsed between diagnosis and surgery, we sought to establish whether a relationship exists between time to surgery and loss of visual acuity.·METHODS: A retrospective study in which the medical records of 77 patients with macula-on retinal detachment who underwent surgery in Hospital Universitario Fundación Jiménez Díaz were reviewed.·RESULTS:A total of 77 patients, 72 were included in the study. The primary anatomic success rate was 94. 44%(68/72), and the success rate in all patients after either 1 or 2 interventions was 98. 61% ( 71/72 ) . The mean time before surgery was 5. 3 ± 2. 26d. Seven patients ( 9. 72%) lost two or more lines of vision. A statistically significant relationship was found between loss of visual acuity and patient age ( P = 0. 001 ) . Our findings also suggest a possible link between the need for further surgical intervention to reattach the retina and decline in visual acuity test ( P= 0. 045 ) . We failed to find a statistically significant relationship between loss of visual acuity and days until surgery ( P= 0. 100 ) or type of surgery ( P=0. 578) or status of the crystalline lens (P=0. 413).·CONCLUSION: It is important that each hospital study how this type of retinal detachment is being managed in order to optimize the use of available resources and guarantee the most favorable anatomic and functional outcomes possible.

Heidenhain variant of Creutzfeldt–Jakob disease in a patient who had bovine bioprosthetic valve implantation.

Creutzfeldt–Jakob disease (CJD) is a rare neurodegenerative disorder characterized by rapidly progressing dementia, general neurologic deterioration, and death. When the leading symptoms are visual disturbances, it is termed as the Heidenhain variant of CJD (HvCJD). CJD was reported following prion‑contaminated pericardium transplants but never after bovine bioprosthetic cardiac valve. In this case report, we describe HvCJD in a patient who had a bovine bioprosthetic cardiac valve implant. An 82‑year‑old‑woman was referred to neuro‑ophthalmology clinic for unexplained visual loss that started 1 month previously. Medical history included aortic valve replacement with bovine bioprosthetic valve. On examination, best‑corrected visual acuity was 20/120 in the right eye and 20/200 in the left eye; otherwise, the eye examination was normal. Humphrey visual fields revealed complete right homonymous hemianopsia. Magnetic resonance imaging (MRI) demonstrated nonspecific white matter changes. A week later, she was hospitalized due to memory impairment; repeated MRI and total body computed tomography scan showed no significant findings. Electroencephalography recordings and extremely elevated cerebrospinal fluid tau protein were compatible with CJD. The patient died 3 weeks later; autopsy was not performed. The patient had HvCJD. Ophthalmologists being first to see these patients should be aware of this diagnosis. Contaminated bovine bioprosthetic valve might be another source for prion disease. Further research is required to establish this issue.

Unilateral postoperative visual loss in a patient undergoing hip arthroscopy in the supine position: a case report / 대한마취과학회지

Micro-emboli have been reported to occur commonly during arthroscopic surgery, which is frequently performed as an orthopedic surgical procedure. We here report a patient who experienced unilateral postoperative visual loss after a hip arthroscopy using irrigation fluid in the supine position without any evidence of external compression to either eye throughout the surgical procedure. Retinal fundoscopy suggested that the patient had central retinal artery occlusion, one of the causes of the postoperative visual loss. This case suggests that arthroscopic surgery may pose a substantial risk for paradoxical air embolism, such as central retinal artery occlusion, and suggests the need to prevent the entry of micro-air bubbles during such a type of surgery.

Analysis of Pediatric Patients Referred for Decreased Vision of Unknown Origin

PURPOSE: To identify causes of conditions presenting with low vision without distinct abnormities in pediatric patients and to determine the appropriate diagnostic approach for those conditions. METHODS: We retrospectively reviewed medical records of pediatric patients with amblyopia, suspicious amblyopia or visual impairment of unknown origin referred by primary care providers. Patients were classified into 2 groups, amblyopia and visual impairment of unclear origin. In this study, we reviewed and analyzed the visual impairment of unclear origin. RESULTS: Of 152 patients, 94 patients were classified as amblyopia and 58 patients were classified as visual impairment of unclear origin. Among those with visual impairment of unclear origin, 26 patients (44.8%) were classified as functional visual loss, 23 patients (39.7%) as normal corrected visual acuity, 8 patients (13.8%) as organic disease and 1 (1.7%) patient could not be classified. Fundus examination revealed abnormal findings in all patients classified as organic disease. Six patients had optic atrophy and 2 had abnormalities on the macula. Ten patients had an orbital magnetic resonance imaging (MRI) scan. Only 1 of 10 MRI scans showed causative abnormality, however, the patient showed an optic atrophy on fundus examination before the MRI scan. CONCLUSIONS: Clinicians need to consider a high prevalence of functional visual loss and possibility of occult organic disorders when they evaluate pediatric patients presenting with decreased vision without distinct abnormities. MRI scan is recommended for only selected cases, when optic atrophy is not present.

Bilateral Compressive Optic Neuropathy Secondary to Tuberculum Sella Meningioma in Pregnancy

A 37-year-old primigravida in her second trimester presented with bilateral painless progressive visual loss. Her vision was hand motion in both eyes. Both pupils were dilated with sluggish reaction to light. Both fundus appeared myopic with bilateral optic atrophy. Magnetic resonance imaging (MRI) of the brain revealed a suprasellar mass with optic chiasm compression and bilateral optic nerve atrophy. As the mass has compromised her vision, a semiemergency craniotomy and excision of tumour was performed. Histopathological examination confirmed the diagnosis of low grade meningothelial meningioma. Both mother and foetus were well after the surgery. However, post-operatively her vision remained poor due to optic nerve atrophy.

The Clinical Features and the Prognosis of Functional Visual Loss in Children

PURPOSE: To evaluate the clinical characteristics and prognoses of children with functional visual loss. METHODS: Retrospective medical record review was performed in 53 patients 4 to 16 years of age diagnosed with functional visual loss between April 2006 and February 2014. We investigated the clinical features and results of clinical tests and the final status of the patients. RESULTS: Twenty male (37.8%) and 33 female (62.2%) patients were included in the study. The mean age was 9.69 ± 2.76 years. The incidence was highest between 8 to 12 years. The mean best corrected visual acuity at baseline was 0.43 ± 0.23, and 88.7% of patients had mild to moderate visual loss. The symptoms were bilateral in 96.2% of patients, and the difference of corrected visual acuity between two eyes was 1 line or less on Snellen chart in 94.1% of bilateral cases. The symptoms were resolved by 1.8 ± 1.0 months in 59.5% of patients and resolved by the final follow-up visit in 51 (96.2%). However, the symptoms persisted through the final follow-up in 2 patients. CONCLUSIONS: Most children with functional visual loss have bilateral and mild to moderate visual loss. The prognosis of functional visual loss in children was excellent. Most patients recovered from the disease with reassurance supportive care without psychiatric treatment, although a few patients had persistent symptoms.