ABSTRACT
A 30-year-old woman with a phenotypic presentation of retinitis pigmentosa (RP) presented with a 5-day history of painless, acute vision loss in her right eye, with visual acuity dropping from 20/30 to hand motions. Optical coherence tomography of the right macula showed near-complete loss of the ellipsoid layer. Treatment with a prolonged course of oral prednisone resulted in a complete structural regeneration of the ellipsoid layer and improvement of visual acuity to 20/50, with eccentric fixation. Tests for infectious diseases, autoimmune disorders, and rare RP mimic syndromes (eg, Refsum disease) were negative. The patient has remained stable since. We favor a diagnosis of two separate pathologies and suggest a designation of acute zonal occult outer retinopathy (AZOOR) in RP for this previously unreported presentation.
Subject(s)
Retinitis Pigmentosa , White Dot Syndromes , Female , Humans , Adult , White Dot Syndromes/complications , White Dot Syndromes/diagnosis , Scotoma/diagnosis , Scotoma/etiology , Retinitis Pigmentosa/complications , Retinitis Pigmentosa/diagnosis , Tomography, Optical Coherence/methodsABSTRACT
OBJECTIVE: Intentional malicious laser strikes on commercial pilots are committed by individuals who target a laser into airplane cockpits during takeoff and landing. Because laser exposure to pilots is a relatively new but growing occurrence, our study investigates the ocular effect of this laser exposure in pilots. DESIGN: Retrospective chart review by a single ophthalmologist. PARTICIPANTS: All commercial airline pilots (58 male, 3 female) who experienced a laser strike while flying between April 2012 and November 2014 who presented to our clinic were included. METHODS: A retrospective chart review was performed in a retinal specialist's practice. Ocular assessment was performed within 3 days of laser exposure. A complete ophthalmic evaluation was conducted, including Early Treatment Diabetic Retinopathy Study visual acuity, colour vision, visual fields, intraocular pressure, slit-lamp examination, dilated fundus examination, colour fundus photographs, and ocular coherence tomography. RESULTS: Sixty-four laser strike incidents involving commercial pilots were included. All pilots in the study experienced some degree of immediate ocular irritation or light sensitivity. No definite cases of ocular damage were attributed to laser strikes. No pilot had any functional ocular deficits. CONCLUSIONS: Our study revealed that laser strikes on aircraft did not result in permanent visual functional or structural deficits. However, laser strikes cause immediate visual effects, including glare, flash blindness, and ocular irritation that can interfere with a pilot's visual function. Given the widespread accessibility of high-power lasers and the rapid increase in incidents, laser strikes threaten to jeopardize aviation safety unless effective preventative measures are put in place.
Subject(s)
Aerospace Medicine , Aircraft , Criminal Behavior , Eye Injuries/etiology , Lasers/adverse effects , Vision Disorders/etiology , Adult , Canada , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Clostridial gas gangrene (myonecrosis) is a rapidly progressive, life-threatening infection. The occurrence of clostridial gas gangrene in the orbit is uncommon. We present a case of gas gangrene in the orbit of a child, with Clostridium perfringens isolated from the wound. Our patient was successfully treated with extensive surgical débridement, anti-microbial therapy, and hyperbaric oxygen therapy. Hyperbaric oxygen is established as an adjuvant therapy of clostridial gas gangrene and has been shown to significantly reduce morbidity and mortality. To our knowledge, this is the first reported case of using hyperbaric oxygen therapy in the treatment of orbital gas gangrene.
