Congenital retinal macrovessels: description of three cases and review of the literature.

BACKGROUND: Congenital retinal macrovessels are large aberrant branches of retinal arteries or veins that cross the macula. We present three patients with a unilateral congenital retinal macrovessel and we conduct a review of the literature. PATIENTS AND METHODS: A 22-year-old man complaining of chronic headache as well as two other men, 18 and 23 years old, respectively, during a routine ophthalmological examination, were found with a unilateral congenital retinal macrovessel each. A thorough ophthalmological examination was performed, including colour fundus photography in all three patients and fluorescein angiography in two of the patients. We followed them up for five years. THERAPY AND OUTCOME: Investigation revealed a unilateral venous congenital retinal macrovessel in all patients. Clinical findings and visual acuity remained unchanged throughout the entire follow-up period. No complications were recorded. CONCLUSIONS: Congenital retinal macrovessels are rare and they tend to remain stable. Visual acuity is preserved in most cases. Complications occur only occasionally and have been described in the literature. Differential diagnosis from other arteriovenous malformations affecting multiple organs is necessary.

Isolated lateral rectus myositis as a manifestation of idiopathic orbital inflammation.

BACKGROUND: We report the case of of a patient with isolated, acute, monolateral and monomuscular lateral rectus myositis as a manifestation of a localized, nonspecific, idiopathic orbital inflammation. HISTORY AND SIGNS: A 25-year-old man presented to our clinic with a painful right eye and associated double vision on right gaze due to a limitation of abduction. Conjunctival hyperemia was observed in the area of the right lateral muscle insertion. A slight axial proptosis of the right eye was evident. On axial CT scans a fusiform enlargement of the right lateral rectus muscle including a thickened anterior tendon at its insertion was recorded. A thorough systemic and laboratory investigation showed neither any further abnormal findings nor any systemic disease. THERAPY AND OUTCOME: A monocular, monomuscular myositis as a clinical manifestation of idiopathic orbital inflammation was diagnosed by the clinical findings and imaging with orbital CT/MRI scans. By appropriate treatment with oral steroids slowly tapered over weeks, symptoms and signs showed full remission without any complications. Clinical improvement was observed within a few days after the beginning of steroid administration. CONCLUSIONS: Isolated lateral rectus myositis can be a manifestation of idiopathic orbital inflammation. Diagnosis is made by the clinical presentation and imaging with orbital MRI/CT-scans. Other local or systemic inflammatory, endocrine or neoplastic diseases must be ruled out.

Severe bilateral hypertensive retinopathy and optic neuropathy in a patient with pheochromocytoma.

BACKGROUND: We present a case of severe bilateral hypertensive retinopathy and optic neuropathy due to pheochromocytoma. HISTORY AND SIGNS: A 31-year-old woman presented with severe bilateral visual acuity loss associated with headaches and photophobia. Ophthalmoscopy showed bilateral optic disc edema, soft exudates, macular star, flame-shaped hemorrhages and arterial narrowing. The situation was more severe in the right eye. Fluorescein angiography confirmed the diagnosis of hypertensive retinopathy. Arterial blood pressure was 220/145 mmHg. A thorough systemic control revealed a right adrenal gland mass. Catecholamine secretion was normal. After ablation, the tumor proved to be a pheochromocytoma, and immunohistochemistry showed dopamine secretion. THERAPY AND OUTCOME: Postoperative evolution was uncomplicated. Antihypertensive treatment lasted only a few months. Visual acuity was restored and the retinal alterations disappeared 8 months after surgery. CONCLUSIONS: Severe hypertensive retinopathy with optic neuropathy may be a consequence of malignant hypertension due to a pheochromocytoma. It is reversible after ablation of the tumor. Early diagnosis is of vital importance and relies on hormonal investigation and immunohistochemistry.

Twenty-four-hour efficacy of the brimonidine/timolol fixed combination versus therapy with the unfixed components.

PURPOSE: To evaluate the 24-h intraocular pressure (IOP) control of brimonidine/timolol fixed combination (BTFC) versusthe unfixed combination of its individual components, each dosed twice daily, in patients with primary open-angle glaucoma or ocular hypertension. METHODS: An observer-masked, randomized, crossover, active-controlled, two-centre comparison. Following a 6-week medicine-free period, patients were randomized to BTFC or to the unfixed combination of brimonidine and timolol for 3 months. Patients then were crossed over to the opposite treatment for another 3 months. At the end of the medicine-free period, and each treatment period, patients underwent 24-h IOP measurements at 0600, 1000, 1400, 1800, 2200, and 0200 hours. RESULTS: Twenty-eight patients completed this study. Both BTFC and the unfixed components showed a significant IOP reduction from untreated baseline (P<0.0001), and were statistically equal when compared directly, for each individual time point and for the 24-h IOP curve (P>0.05). The mean 24-h IOP was 24.6+/-1.9 for baseline, 19.2+/-1.9 for BTFC, and 19.2+/-1.6 mmHg for the unfixed components (P=1.0). Four patients were discontinued due to side effects. The most common ocular adverse event was ocular hyperaemia (n=3 with BTFC and n=5 with the unfixed components, P=0.7) and systemic adverse events were rare. CONCLUSION: This study suggests that both BTFC and the unfixed components of brimonidine and timolol provide a significant 24-h IOP reduction from untreated baseline, and statistically equal control when compared directly, at each time point and for the 24-h pressure curve.

Clinical findings in patients with topical anaesthetic abuse keratitis: a report of five cases.

PURPOSE: The purpose of this study is to describe the clinical findings in five patients with topical anaesthetic abuse. PATIENTS: Five patients presented in the emergency department with persistent corneal epithelial defects associated with a ring infiltrate in the corneal stroma, without any referred history of ocular trauma or ocular application of any corrosive or alkali substance. The patients were hospitalised and a thorough ocular examination was accomplished. Systemic evaluation and psychiatric consultation were also done. RESULTS: A detailed history in all our patients revealed topical anaesthetic abuse keratitis. The topical anaesthetic was deliberately taken from the pharmacy without medical prescription. In all our patients a psychiatric disease and/or drug abuse was disclosed after psychiatric examination. The hallmark of topical anaesthetic abuse keratitis was a persistent corneal epithelial defect and a complete or incomplete ring infiltration of the corneal stroma in all cases. Functional and anatomic results after the appropriate treatment were not favourable in the majority of the cases, leading in some of them to blindness. CONCLUSIONS: Although topical anaesthetic abuse keratitis is rare, it should be considered in the differential diagnosis when we see a patient with a persistent corneal epithelial defect together with a ring infiltration on the corneal stroma. Psychiatric diseases and/or systemic drug abuse are usually associated with this toxic keratopathy. The psychiatric diseases that accompany this toxic keratopathy may also lead to death or to severe handicap as a result of suicide attempts by the patients. Psychiatric consultation and therapy are imperative in the management of such patients.