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3.
Semin Ophthalmol ; 38(6): 559-564, 2023 Aug.
Article in English | MEDLINE | ID: mdl-36658742

ABSTRACT

We highlight a case of intracranial hypertension secondary to exogenous testosterone in a female-to-male transgender patient and present a systematic review of similar cases. Our review identified 19 female-to-male transgender individuals with intracranial hypertension. The mean age was 24.2 years and most common presenting symptom was headache (78.9% of patients). The most frequently associated ocular symptoms were transient visual obscurations (42.1%) and blurred vision (21.1%). Onset of symptoms occurred concurrently with exogenous testosterone therapy in 89.5% of the patients. The most common treatments were acetazolamide (89.5%), topiramate (31.6%), and alteration in hormone regimen (21.1%); four cases required surgery. These findings aid clinicians treating intracranial hypertension in patients undergoing gender affirmation therapy in a conscientious, patient-centered manner.


Subject(s)
Intracranial Hypertension , Transgender Persons , Humans , Male , Female , Young Adult , Adult , Testosterone/adverse effects , Intracranial Hypertension/chemically induced , Intracranial Hypertension/diagnosis , Acetazolamide/adverse effects , Vision Disorders/etiology
8.
Case Rep Ophthalmol ; 13(1): 116-123, 2022.
Article in English | MEDLINE | ID: mdl-35431884

ABSTRACT

This is a report of an immunocompromised 49-year-old renal transplant patient with Epstein-Barr virus (EBV)-induced necrotizing retinitis (NR). The patient with NR underwent diagnostic vitrectomy. Polymerase chain reaction (PCR) testing of the vitreous fluid was positive for EBV (25,000 IU/mL) and negative for all other organisms. The patient was treated with intravitreous ganciclovir and foscarnet. After only mild clinical improvement in retinitis and an increased quantitative EBV PCR (69,000 IU/mL), intravitreous methotrexate was added to the aforementioned intravitreous antiviral injections. After eight rounds of ganciclovir/foscarnet and three injections of methotrexate, the NR resolved, the quantitative EBV PCR decreased to 29 IU/mL, and the patient's visual acuity improved. To our knowledge, this is only the second case report to demonstrate efficacy of intravitreous methotrexate in an immunocompromised patient with EBV-induced NR. Intravitreous methotrexate combined with ganciclovir and foscarnet may be an effective treatment strategy for patients with PCR-positive EBV-induced NR that does not respond to conventional antiviral therapy.

9.
Retin Cases Brief Rep ; 15(6): 783-788, 2021 Nov 01.
Article in English | MEDLINE | ID: mdl-31306292

ABSTRACT

PURPOSE: To retrospectively report the outcomes of patients presenting to our facility with central retinal artery occlusion and receiving therapy with hyperbaric oxygen (HBO). METHODS: This was a retrospective, chart review at a single hospital center. Patients with diagnosed central retinal artery occlusion were treated with HBO twice daily for 5 days during their inpatient stay for a total of 10 HBO treatments. Main outcome was change from the documented presenting best-corrected visual acuity to discharge best-corrected visual acuity. Thirty-nine patients with central retinal artery occlusion were included in the analysis during a 30-month period. RESULTS: Twenty-eight of 39 patients (72%) had some improvement in acuity. There was a mean of 5.05 lines of improvement using a modified Snellen chart after completing their HBO treatment course. Patients treated within 12 hours of symptom onset showed the greatest improvement in their visual acuity (6.11 mean lines of improvement). Complications of therapy included middle ear barotrauma (10/39) and confinement anxiety (1/39) and did not interfere with the therapy regimen or hospital course. CONCLUSION: This retrospective case series supports the use of emergent HBO therapy as a viable treatment option for patients with central retinal artery occlusion. Hyperbaric oxygen therapy was safely administered and well tolerated.


Subject(s)
Hyperbaric Oxygenation , Retinal Artery Occlusion , Humans , Retinal Artery Occlusion/therapy , Retrospective Studies
10.
Asia Pac J Ophthalmol (Phila) ; 6(1): 37-39, 2017.
Article in English | MEDLINE | ID: mdl-28161924

ABSTRACT

PURPOSE: To compare stroke evaluations recommended by retina special-ists and neurologists for retinal artery occlusion (RAO). DESIGN: A cross-sectional survey. METHODS: An anonymous survey was emailed to members of the American Academy of Neurology Stroke Section listserv and vitreoretinal specialists registered with the American Academy of Ophthalmology. The survey was divided based on duration of symptoms before encounter: less than 12 hours, 24-48 hours, and more than 1 week. Institutional review board approval was obtained before data collection. RESULTS: Four hundred forty-eight surveys were completed (281 retinologists and 167 neurologists). Within 12 hours of RAO, most neurologists (75%) pursue a hospital-based evaluation, whereas the majority of retinologists (82%) pursue outpatient workup (P < 0.0001). Most neurologists (92%) and retinologists (98%) pursue outpatient stroke workup if symptoms have been present for more than 7 days. CONCLUSIONS: Neurologists pursue higher acuity care after RAO, whereas most retinologists order outpatient evaluations. Retina specialists should consider urgent stroke evaluation to mitigate stroke risk factors.


Subject(s)
Neurologists/statistics & numerical data , Ophthalmologists/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Referral and Consultation/statistics & numerical data , Retinal Artery Occlusion/complications , Stroke/prevention & control , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Risk Factors , United States
11.
Surv Ophthalmol ; 61(3): 357-62, 2016.
Article in English | MEDLINE | ID: mdl-26453797

ABSTRACT

A 24-year-old woman with systemic lupus erythematosus presented with a 1-year history of painless vision loss in the right eye. Examination was notable for a bitemporal hemianopia. Brain imaging revealed multiple contrast enhancing dural masses, including one along the planum sphenoidale. She underwent excisional biopsy for a presumed diagnosis of multiple meningiomas. Five years later, she developed worsening vision in the left eye, hypesthesia in the V1 distribution, and oculomotor nerve palsy. Repeat imaging showed an enhancing mass in the cavernous sinus and orbital apex. Biopsy demonstrated a lymphoplasmacyte rich infiltrate in dense extracellular material. She was diagnosed with lupus-induced hypertrophic pachymeningitis and started on immunosuppressive therapy. On further worsening of symptoms, her initial biopsy was reexamined and revealed a kappa light chain restricted B-cell and plasmacyte population. This led to the final diagnosis of central nervous system extranodal marginal zone lymphoma.


Subject(s)
Central Nervous System Neoplasms/diagnosis , Lymphoma, B-Cell, Marginal Zone/diagnosis , Biomarkers, Tumor/metabolism , Central Nervous System Neoplasms/metabolism , Diagnosis, Differential , Female , Humans , Lupus Vasculitis, Central Nervous System/diagnosis , Lymphoma, B-Cell, Marginal Zone/metabolism , Magnetic Resonance Imaging , Meningeal Neoplasms/diagnosis , Meningioma/diagnosis , Meningitis/diagnosis , Vision Disorders/diagnosis , Young Adult
12.
J Neuroophthalmol ; 35(2): 134-8, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25602744

ABSTRACT

BACKGROUND: To determine if Type 2 diabetes mellitus (DM) is protective against giant cell arteritis (GCA) and to estimate the incidence of GCA diagnosis from Medicare claims. METHODS: Medicare 5% claims files from 1991 to 2011 were used to identify beneficiaries diagnosed with DM, but not GCA, within a 3-year ascertainment period. Propensity score matching was used to define a control group of nondiabetics with comparable demographic covariates. Competing risk regression was then used to assess the impact of DM diagnosis on GCA diagnosis. To allow for a 3-year ascertainment period, the analysis sample was limited to beneficiaries older than 68 years at baseline. RESULTS: A total of 151,041 beneficiaries diagnosed with DM were matched to an equal number of controls. Mean study follow-up was 67.75 months. GCA was diagnosed among 1116 beneficiaries with DM (0.73%) vs 465 (0.30%) controls. The risk of receiving a GCA diagnosis among patients with DM was increased by 100% (subhazard ratio, 2.00; 95% confidence interval, 1.78-2.25). The annual incidence of GCA diagnosis among claims for US Medicare beneficiaries older than 68 years old was 93 in 100,000. CONCLUSIONS: A DM diagnosis is not protective against a GCA diagnosis in the Medicare population. Our data suggest that a DM diagnosis increases the risk of GCA diagnosis within 5.7 years for Medicare beneficiaries older than 68 years.


Subject(s)
Diabetes Mellitus/epidemiology , Giant Cell Arteritis/epidemiology , Diabetes Mellitus/diagnosis , Female , Giant Cell Arteritis/diagnosis , Humans , Male , Medicare/statistics & numerical data , Retrospective Studies , United States/epidemiology
13.
J Neuroophthalmol ; 34(3): 218-22, 2014 Sep.
Article in English | MEDLINE | ID: mdl-24213568

ABSTRACT

BACKGROUND: Prone is the preferred patient position for fluoroscopic-guided lumbar puncture (LP). Normative data for cerebrospinal fluid (CSF) opening pressure (OP) exist for lateral decubitus (LD) positioning only and have not been defined for the prone position. This study compares CSF OP values in the prone and LD positions and examines the effect of body mass index (BMI) on OP. METHODS: Patients undergoing diagnostic or therapeutic fluoroscopic-guided LP were recruited prospectively at 2 tertiary care centers from 2009 to 2012. Following prone fluoroscopic-guided LP, patients were rolled to the LD position for repeat CSF OP measurement. In addition to comparing the mean OP in each position, the relationships between OP, body position, and BMI were also explored. RESULTS: Fifty-two patients were enrolled. A mean OP difference of 1.2 cm H2O was observed (prone: 26.5 cm H2O; LD: 27.7 cm H2O; P = 0.07). No correlation between CSF OP and BMI was seen in either position. CONCLUSIONS: No statistically or clinically significant difference between prone and LD OP was identified. BMI does not appear to affect CSF OP measurement in either position.


Subject(s)
Cerebrospinal Fluid Pressure , Papilledema/diagnosis , Patient Positioning , Posture , Pseudotumor Cerebri/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Cohort Studies , Diazepam/administration & dosage , Female , Fluoroscopy , Humans , Hypnotics and Sedatives/administration & dosage , Male , Middle Aged , Prone Position , Spinal Puncture , Young Adult
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