Severe diabetic papillopathy mimicking non-arteritic anterior ischemic optic neuropathy (NAION) in a young patient.

With the pathophysiology not clearly understood and fewer than 130 cases having been reported in the literature, diabetic papillopathy presents a special challenge to the ophthalmologist. We report a case of a young patient with more than 12 years of type 1 diabetes mellitus (T1DM) on insulin with poor compliance to treatment who presented with sudden bilateral loss of vision. Ocular examination, fluorescence angiography (FA) and systemic signs were conclusive of diabetic papillopathy. His fasting blood sugar level was high and serum glycosylated haemoglobin (HbA1c) indicated a long term fluctuating blood glucose control. His vision initially improved with treatment, but later deteriorated with tight glycemic control.

Challenges in diagnosis and management of pseudoptosis secondary to asymmetrical skin creases.

INTRODUCTION: Asymmetrical eyelid skin crease may be mistaken for ptosis due to apparent narrowing of the palpebral fissure in the eye without the skin crease. This study describes a series of patients who were mistakenly referred for ptosis operation as a result of absent skin crease. METHODS: Retrospective case review. RESULTS: A total of 8 patients (5 males and 3 females) were referred by the general ophthalmologists because of suspected ptosis. Although skin creases asymmetry was noted by the general ophthalmologists, the apparent narrowing of the palpebral fissure was thought to be caused by ptosis. However, measurement of the palpebral fissures in both eyes were normal. Creation of a symmetrical skin crease in the affected eye correct the appearent palpebral fissure narrowing. This could be achieved by either surgical or non-surgical means (tape or glue). CONCLUSION: Patients with asymmetrical skin crease of the upper eyelid can give rise to apparent differences in palpebral apertures which may be mistaken for ptosis. The treatment of choice is to create symmetrical skin crease in the eye with absent skin crease to correct the pseudoptosis. Recognition of this condition is important to avoid unnecessary ptosis surgery.

Orbital myxoma--an unusual cause of inferoorbital mass.

UNLABELLED: To describe a case of isolated infraorbital mass which had been present for the past 9 years in a young woman. Despite the size, the mass was successfully excised in total. METHOD: Case report. RESULT: Histologically, the tumour was found to be an isolated orbital myxoma. CONCLUSION: Isolated orbital myxoma is an exceedingly rare tumour of the orbit. The case shows the lesion could be excised in its entirety with good cosmetic result.

The use of preserved bovine pericardium for emergency temporizing graft in corneal perforation.

Corneal perforation is an ocular emergency that requires early intervention to avoid permanent visual loss from endophthalmitis or irreversible structural changes. Although tectonic keratoplasty is the best choice for patching a large perforation, a donor cornea is not always immediately available. Consequently, an alternative material is required while awaiting a donor cornea. We report the use of preserved bovine pericardium as a temporizing graft to maintain the ocular integrity in two patients with corneal perforation.

Chromosome 13q deletion with Cornelia de Lange syndrome phenotype.

A 3-year-old girl with facial dysmorphic features suggestive of Cornelia de Lange syndrome was seen in the ophthalmology unit for a right leukocoria. The leukocoria was found to be caused by a large retinoblastoma and the right eye was enucleated. Chromosomal analysis revealed partial chromosome 13q deletion involving band 14 which is associated with a high risk of retinoblastoma. This case shows that patient with chromosome 13q deletion syndrome cannot be diagnosed based on dysmorphic features only. Chromosomal analysis is warranted in all infants with facial dysmorphism suggestive of Cornelia de Lange syndrome so that those with chromosome 13q deletion can be referred early for early detection of retinoblastoma.

Treatment of aberrant facial nerve regeneration with botulinum toxin A.

PURPOSE: To assess the effect and efficacy of botulinum toxin type A (BTX-A) at reducing and maintaining eyelid synkinesia in aberrant facial nerve regeneration, while concurrently observing for the presence of side effects to differing treatment doses. METHODS: A prospective interventional study of five patients with eyelid synkinesia resulting from aberrant regeneration of the facial nerve. Patients were treated with injections of either 120, 80 or 40 units of BTX-A (Dysport) into the orbicularis oculi. Objective and subjective reduction in synkinesia, maintenance of response and presence of side effects were recorded. RESULTS: All five patients had improvement of the synkinesia with BTX-A treatment. Lower doses were found to be as effective as higher doses. Mean duration of abolished synkinesia was three months. Two patients developed a ptosis which resolved spontaneously. None of the patients treated with the lowest dose of 40 units developed a ptosis. CONCLUSION: Low-dose BTX-A has a lower incidence of ptosis and is effective in the treatment of aberrant facial nerve regeneration.

Uveitis and erythema nodosum in inflammatory bowel disease: clinical features and the role of HLA genes.

BACKGROUND & AIMS: There are few systematic studies on the natural history or immunogenetic associations of erythema nodosum (EN) or ocular inflammation in inflammatory bowel disease (IBD), but they are reportedly more common in patients with other extraintestinal manifestations (EIMs), particularly arthritis. Immunogenetic associations have previously been described in IBD arthritis and in EN associated with sarcoidosis. This study examined the clinical features and HLA-B, DR, and tumor necrosis factor alpha (TNF-alpha) associations of ocular inflammation and EN and their clinical and immunogenetic relationship to arthritis in IBD. METHODS: Details of EN and ocular inflammation were gathered by case-note review and questionnaire in 976 ulcerative colitis patients and 483 Crohn's patients. Sequence-specific PCR typing for polymorphisms in HLA-B, DR, and TNF-alpha was performed in 39 EN and 40 ocular patients. Results were compared with 490 IBD controls without EIMs, 38 patients with type 1 and 31 with type 2 peripheral arthritis, and 16 AS patients. RESULTS: EN and ocular inflammation were more common in women, were associated with IBD relapse, and recurred in approximately 30% of patients. They occurred more commonly with arthritis and AS than expected by chance. Ocular inflammation was strongly associated with HLA-B*27, B*58, and HLA-DRB1*0103. There is a weak association between EN and HLA-B*15 but a strong association with the -1031 TNF-alpha. CONCLUSIONS: EN, uveitis, and arthritis associated with IBD occur together commonly. They are associated with genes in the HLA region, and linkage disequilibrium between these genes may account for the clinical picture of overlapping but independent clinical manifestations.

Refractive changes following Nd:YAG capsulotomy.

PURPOSE: To investigate the effect of Nd:YAG capsulotomy on refractive changes and the need for a post-capsulotomy refraction. METHODS: Forty-two eyes with uncomplicated phacoemulsification and implant (AMO@Phacoflex II) were included. Autorefraction and subjective refraction were performed to get the best visual acuity before and after Nd:YAG capsulotomy. RESULTS: The spherical equivalent before the Nd:YAG capsulotomy was -0.61 +/- 0.90 and after the capsulotomy, -0.57 +/- 0.84. Using the paired Student's t-test there was no significant difference in the refraction following Nd:YAG capsulotomy. CONCLUSION: Routine refraction following Nd:YAG capsulotomy in patients who have had uncomplicated phacoemulsification using AMO@Phacoflex II intraocular lenses is not necessary.