Humphrey visual field analysis, visual field defects, and ophthalmic findings in patients with macro pituitary adenoma.

OBJECTIVE: To evaluate the Humphrey visual field parameters in patients with pituitary adenoma and classify the visual field defects in this patient group. METHODS: Forty primary pituitary adenoma patients underwent neuro-ophthalmological examination and Humphrey Perimetry 30-2 visual field test at Baskent University, Departments of Ophthalmology, and Neurosurgery, between 2003 and 2005. Global indices, mean+/-SD and pattern standard deviation (PSD) of pituitary adenoma patients (group 1) were taken as the test parameters and compared with age- and sex- matched controls (group 2). RESULTS: There were no significant differences between groups 1 and 2 with respect to mean age or gender distribution (p>0.05). The MD and PSD results of group 1 according to the age groups and gender were not statistically significant (p>0.05). The MD and PSD results of subjects in group 2 were within normal limits, and no special visual field defects were observed. When compared with healthy controls, the MD and PSD values of patients with hypophyseal adenomas were statistically significantly (p<0.05). In group 1, the mean adenoma size was 13.34 mm and no statistically significant correlation was found between the adenoma size and either the MD or PSD values (p>0.05). Sixteen (40%) patients had visual field defects, the specific complete bitemporal hemianopsia was found in 5 (12.5%) patients. Only in 3 patients (7.5%) the primary diagnosis was made by ophthalmologic examination. CONCLUSION: Although ophthalmologists rarely have a role in the primary diagnosis of hypophyseal adenoma, routine ophthalmologic examination is still important. To detect early visual field abnormalities, automated perimetry should be performed as a part of routine examination in patients with suspected hypophyseal adenomas.

Effect on astigmatism of the location of clear corneal incision in phacoemulsification of cataract.

PURPOSE: To investigate the refractive results of clear corneal incision performed at the steepest meridian of pre-existing corneal astigmatism. METHODS: One hundred eighty-two patients with astigmatism > 0.75 diopters (D) were evaluated. Superior, temporal, nasal, superotemporal, or superonasal clear corneal incisions were performed at the steep meridian. Refraction, visual acuity, and topography values were evaluated, and changes in surgically induced astigmatism were calculated by vector analysis using the Fourier formula. Paired t test was used to compare mean values. RESULTS: Postoperative cylinder values showed minor changes in all groups, except the nasal group. Nasal incision increased preoperative cylinder from 1.13 D to 1.83 D 6 months after surgery. Temporal and superotemporal incisions resulted only in small astigmatic changes. Conversely, superior, superonasal, and nasal incisions induced more pronounced astigmatism. CONCLUSIONS: Performing clear corneal incision for phacoemulsification of cataract at the steep meridian resulted in small changes with temporal incisions, whereas nasal incisions resulted in higher surgically induced astigmatism.

Retinal arterial macroaneurysm rupture following fundus fluorescein angiography and treatment with Nd:YAG laser membranectomy.

A 60-year-old woman with hypertension was seen for a routine examination. Her best-corrected visual acuity was 20/20 bilaterally. Intraretinal hemorrhages were found in the parafoveal region of the right eye. A fundus fluorescein angiography evaluation identified the hemorrhages as arterial macroaneurysms. The following day, the patient returned complaining of blurred vision that had developed the previous evening. Best-corrected visual acuity was counting fingers in the right eye. A subhyaloid hemorrhage approximately three optic disks in size was found in the macular region. The hemorrhage was drained with an Nd:YAG laser.

Secondary bacterial keratitis associated with shield ulcer caused by vernal conjunctivitis.

PURPOSE: To report a patient with vernal keratoconjunctivitis-induced shield ulcer superinfected with Staphylococcus aureus. METHODS: Observational case report. A 12-year-old boy who had been followed for vernal keratoconjunctivitis for 3 years was admitted to our clinic complaining of visual loss, photophobia, and a ropy discharge. On slit-lamp examination, a transversely oval shield ulcer, which was situated in the center of the superior third of the cornea, was seen in the left eye. The vernal corneal plaque area and margins were infiltrated, and hypopyon was also observed. With the diagnosis of shield ulcer with secondary bacterial keratitis and hypopyon, the patient underwent medical treatment consisting of topical fortified cefazolin (50 mg/mL) and tobramycin (14 mg/mL), lodoxamide 0.1%, prednisolone acetate 1%, cyclopentolate, and systemic cetirizine. RESULTS: After treatment, the bacterial keratitis, shield ulcer, and inflammation in the anterior chamber disappeared. CONCLUSION: Bacterial keratitis associated with shield ulcer may be rarely observed in patients with vernal keratoconjunctivitis. Prompt diagnosis and treatment may prevent permanent complications and vision loss.

Bilateral synchronous primary orbital lymphoma.

Extranodal marginal zone B-cell non-Hodgkin's lymphoma affecting bilateral orbital regions was diagnosed in an 80-year-old man. He was given chemotherapy and external beam irradiation therapy. Two months after treatment, repeat orbital magnetic resonance imaging showed dramatically improved lesions. In this case report, orbital non-Hodgkin's lymphoma and treatment options are discussed.

Oral anticoagulant therapy, endocapsular hematoma, and neodymium:YAG capsulotomy.

We present a case of endocapsular hematoma, a rare form of intraocular hemorrhage that developed in a patient with pseudophakia receiving oral anticoagulants for previous mitral valve replacement and cerebrovascular disease.