The King-Devick test as a determinant of head trauma and concussion in boxers and MMA fighters.

OBJECTIVE: Sports-related concussion has received increasing attention as a cause of short- and long-term neurologic symptoms among athletes. The King-Devick (K-D) test is based on measurement of the speed of rapid number naming (reading aloud single-digit numbers from 3 test cards), and captures impairment of eye movements, attention, language, and other correlates of suboptimal brain function. We investigated the K-D test as a potential rapid sideline screening for concussion in a cohort of boxers and mixed martial arts fighters. METHODS: The K-D test was administered prefight and postfight. The Military Acute Concussion Evaluation (MACE) was administered as a more comprehensive but longer test for concussion. Differences in postfight K-D scores and changes in scores from prefight to postfight were compared for athletes with head trauma during the fight vs those without. RESULTS: Postfight K-D scores (n = 39 participants) were significantly higher (worse) for those with head trauma during the match (59.1 ± 7.4 vs 41.0 ± 6.7 seconds, p < 0.0001, Wilcoxon rank sum test). Those with loss of consciousness showed the greatest worsening from prefight to postfight. Worse postfight K-D scores (r(s) = -0.79, p = 0.0001) and greater worsening of scores (r(s) = 0.90, p < 0.0001) correlated well with postfight MACE scores. Worsening of K-D scores by ≥5 seconds was a distinguishing characteristic noted only among participants with head trauma. High levels of test-retest reliability were observed (intraclass correlation coefficient 0.97 [95% confidence interval 0.90-1.0]). CONCLUSIONS: The K-D test is an accurate and reliable method for identifying athletes with head trauma, and is a strong candidate rapid sideline screening test for concussion.

Cilioretinal artery occlusion with central retinal vein occlusion.

BACKGROUND: Combined cilioretinal artery and retinal vein occlusions are infrequently documented retinal vascular disorders of speculative origin. Occlusion of the cilioretinal artery is believed to result from either mechanical compression of the artery as a result of an increase in venous pressure or from a reduction in perfusion pressure in both the cilioretinal and retinal arteries. The ophthalmoscopic and angiographic features of this condition are reviewed. CASE REPORTS: Two cases of cilioretinal artery occlusion after central retinal vein occlusion are presented, one of which evolved to the development of iris neovascularization. DISCUSSION: The incidence of cilioretinal artery occlusions due to central retinal vein occlusions is infrequently reported in the literature. Excluding those with chronic cystoid macular edema, most patients have a favorable visual outcome. It is possible that the incidence of combined cilioretinal artery and central retinal vein occlusions is grossly underestimated.

Torpedo maculopathy.

BACKGROUND: Congenital nevi of the retinal pigment epithelium (RPE) may manifest variable degrees of pigmentation. These nevi, which are almost always asymptomatic, can be either solitary or grouped. Torpedo maculopathy is a recently described congenital RPE nevus. METHODS: A review of congenital nevi of the RPE is presented to include torpedo maculopathy. RESULTS: Torpedo maculopathy is a solitary congenital RPE nevus; it is oval, variably pigmented, and located in the temporal macula. Diagnosis of this lesion is made on the basis of its characteristic shape and location. The etiology may be related to alterations in the choroidal vasculature in the macular area during the embryologic development of the eye. Because of the benign nature of the nevus, yearly evaluations are recommended. CONCLUSIONS: Classification of congenital nevi of the RPE is still evolving. As more is learned, a better system of organizing these lesions will be developed.

Sarcoidosis and its ocular manifestations.

BACKGROUND: Sarcoidosis is a significant cause of pulmonary dysfunction and ocular morbidity. The worldwide distribution of sarcoidosis involves primarily Caucasians, however, within the United States, the disease is nearly confined to the African American population. Although genetic and environmental factors have been implicated, a definitive cause of the disease, at present, remains unknown. METHODS: A review of the epidemiology, pathogenesis, and clinical features of non-ocular and ocular sarcoidosis is presented along with current thoughts on the applicability of diagnostic studies and treatment options available for afflicted patients. RESULTS: Epithelial, non-caseating granulomas are the hallmark histological findings of sarcoidosis and can be found in virtually all body tissues. The inflammatory response is a delayed hypersensitivity (type IV) reaction with an abundance of helper T-cells (CD4+). Although pulmonary findings are most common, ocular involvement with sarcoidosis occurs in approximately 25 percent of all cases. Posterior segment inflammation occurs in upwards of 28 percent of all cases of ocular sarcoidosis and is a major cause of visual morbidity among these patients. CONCLUSIONS: Sarcoidosis should be suspected in cases of granulomatous uveitis. Laboratory studies may be corroborative but should not be considered diagnostically specific or prognostic with regard to treatment. Ocular involvement often suggests a more progressive or recalcitrant form of the disease with significant pulmonary findings that may benefit from a trial course of oral prednisone.

Idiopathic preretinal fibrosis with concurrent cystoid macular edema.

Idiopathic preretinal fibrosis is a common disorder which typically affects elderly individuals. The epiretinal membranes are of glial origin in the retina where they migrate through breaks in the internal limiting membrane to form fibroglial sheets on the surface of the retina. Although visual symptomatology is rare, the epiretinal membranes may, in some instances, grow rapidly and contract causing tractional changes to occur involving the underlying retina and retinal vessels. This paper presents a case of preretinal fibrosis with accompanying cystoid macular edema and consequent dramatically reduced vision. The diagnosis, pathophysiology and management of preretinal fibrosis are discussed.