Diurnal Fluctuation of Ocular Perfusion Pressure in the Fellow Eyes of Branch Retinal Vein Occlusion

PURPOSE: To investigate diurnal change in blood pressure (BP), intraocular pressure (IOP), and ocular perfusion pressure (OPP) in patients with unilateral branch retinal vein occlusion (BRVO) and compare the results with healthy controls. METHODS: We conducted a prospective case-control study which included 50 patients with unilateral BRVO and 50 age-matched volunteers as controls. Each participant underwent a comprehensive ophthalmic examination including optical coherence tomography (OCT). BP and IOP were evaluated 4 times daily at 8 AM, 10 AM, 2 PM and 6 PM. The mean and fluctuation of BP, IOP, mean arterial pressure (MAP), mean OPP (MOPP), and diastolic OPP (DOPP) were compared between fellow eyes of BRVO patients and normal control eyes. RESULTS: The average retinal nerve fiber layer (RNFL) thickness was significantly reduced in the fellow eyes of BRVO patients compared to control eyes (p < 0.001). Mean IOP and IOP fluctuation did not differ, but BP fluctuation (systolic BP fluctuation, p = 0.045; diastolic BP fluctuation, p = 0.037) and MAP fluctuation (p = 0.011) were greater in the fellow eyes of BRVO patients compared to normal eyes. The mean MOPP and DOPP did not differ between groups, however, the fluctuation of MOPP (p < 0.001) and DOPP (p < 0.001) were significantly increased in the fellow eyes of BRVO patients. The mean and fluctuation of BP, MAP, MOPP and DOPP were associated with reduced average RNFL thickness in the fellow eyes of BRVO patients. CONCLUSIONS: These results suggest the fellow eyes of unilateral BRVO patients may be at risk of developing glaucomatous damage.

Dopa-responsive Dystonia Misdiagnosed as Cerebral Plasy: A Case Report / 대한정형외과학회잡지

Dopa-responsive dystonia (DRD) is a slowly progressive dystonia with childhood onset and is characterized by marked diurnal fluctuation of symptoms, dramatic response to levodopa treatment and concurrent signs of parkinsonism. We report a 16-year-old girl diagnosed as DRD. Around the age of 11, gait disturbance was developed with equinocavovarus deformity of both feet. The plantar fasciotomy, triple arthrodesis and posterior tibialis tendon transfer for left foot with the diagnosis of cerebral palsy were done. She complained of a persistent dystonia of all extremities after operation and was successfully treated with low-dose levodopa after a diagnosis of DRD. For the accurate diagnosis and prevention of unnecessary operation, trial of levodopa is warranted in patients suspected with cerebral palsy with similar symptoms of DRD.