Pseudotumor of the orbit. Clinical, pathologic, and radiologic evaluation.

Pseudotumor, Graves' disease, and lymphoproliferative disease are the most common ophthalmologic disease entities requiring evaluation by CT and MR imaging. A history of acute onset, pain, swelling, proptosis, and response to steroids are the classical findings. The radiologic findings are categorized according to location into dacryoadenitis, myositis, and sclerouveitis, with and without associated infiltrations. The inflammatory infiltrate, which is composed of polymorphic leukocytes, lymphocytes, and plasma cells interspersed with a variable amount of fibrovascular tissue, may be diffuse or localized. The preferred radiologic method used for assessment of pseudotumor is CT. MR imaging, however, is indicated for evaluation of the Tolosa-Hunt syndrome, which is characterized by an inflammatory infiltrate in the orbital apex and cavernous sinus leading to cranial nerve involvement with ophthalmoplegia. The clinical and radiologic constellation of findings allows a definitive diagnosis in most cases.

Penicillin-resistant Streptococcus pneumoniae endophthalmitis.

PURPOSE: To report a case of trabeculectomy-associated endophthalmitis caused by penicillin-resistant Streptococcus pneumoniae. METHOD: Case report. RESULTS: The patient developed endophthalmitis 1 month after an uncomplicated trabeculectomy for primary open-angle glaucoma. Vitreous cultures grew abundant, highly penicillin-resistant S pneumoniae. Despite aggressive treatment with vitrectomy and intravitreal injections of vancomycin hydrochloride and amikacin sulfate, the patient had a poor visual outcome. CONCLUSION: Penicillin-resistant S pneumoniae can cause endophthalmitis after trabeculectomy.

Graves' disease of the orbit.

Graves' disease, the most common orbital disorder, affects approximately 0.5 % of the population of the United States. It is the underlying cause in 15% to 28% of cases of unilateral exophthalmos and in 80% of cases with bilateral exophthalmos. Also called "thyroid-associated ophthalmopathy", autoimmune thyroid disease," "endocrine exophthalmos," and "thyroid eye disease", Graves' disease presents with enlargement of the extraocular muscles, increased orbital fat volume, and venous stasis caused by increased orbital pressure. This article discusses the clinical evaluation and radiologic findings of this common orbital disorder.

Pseudotumor of the orbit.

Pseudotumor of the third most common ophthalmologic disease after Graves' disease and lymphoproliferative disease. It is usually a continuous illness, although recurrent forms do occur, especially in the pediatric age group. The radiologic evaluation consists of computed tomography and magnetic resonance imaging. The imaging findings, correlated with the clinical findings, allow a diagnosis in most cases and, hence, obviate the need for a biopsy.

Lymphoproliferative disease of the orbit.

Lymphoproliferative disease of the orbit represents a diverse group of lesions affecting various soft tissue structures within the orbital cavity. They are one of the most common disease entities encountered in orbital pathology and frequently present with proptosis or anterior tumefactive swelling in the lids, conjunctiva, and lacrimal glands. For elucidation of the underlying cause, computed tomography and magnetic resonance imaging are the optimal imaging modalities.

Rapidly progressive outer retinal necrosis caused by varicella zoster virus in a patient infected with human immunodeficiency virus.

We describe a 21-year-old immunocompromised patient with a unique type of necrotizing herpetic retinitis. The retinitis progressed with loss of vision when acyclovir or ganciclovir alone was used for treatment. Examination of a chorioretinal biopsy specimen revealed that varicella zoster virus was the causative agent. Foscarnet monotherapy also failed to prevent progression of the retinal infection. Combination antiviral therapy with ganciclovir and foscarnet appeared to delay progression of disease and helped maintain a visual acuity of 20/200 for at least 6 months after the onset of infection.

Scanning laser ophthalmoscope macular perimetry in the evaluation of submacular surgery.

PURPOSE: Submacular surgery for choroidal neovascularization (CNV) is under investigation in the treatment of age-related macular degeneration (AMD) and the presumed ocular histoplasmosis syndrome. Four case studies are presented to demonstrate scanning laser ophthalmoscope (SLO) testing in the pre- and postsurgical evaluation of visual function in patients with subfoveal CNV secondary to AMD, presumed ocular histoplasmosis syndrome, and submacular hemorrhage secondary to AMD. METHODS: Patients underwent a visual assessment pre- and 6 months postoperatively, consisting of low vision visual acuity measurement, SLO macular perimetry of dense and relative scotomas, and analysis of the preferred retinal locus for fixation (PRL) location and ability. RESULTS: Visual acuity, dense and relative scotoma size and location, and PRL location were compared; and relationships between anatomic and functional changes were observed. Decreases in scotoma size and improvement in PRL location and ability usually corresponded with improved visual acuity. Preoperative scotoma and PRL location guided retinotomy site selection. CONCLUSION: Scanning laser ophthalmoscope macular perimetry and PRL testing may be useful adjuncts in the visual assessment of submacular surgery and may advance under-standing of the effects of submacular surgery on visual function. In addition, this testing may be used to plan location of surgical interventions for macular diseases.

The complications of perfluoropropane gas use in complex retinal detachments.

BACKGROUND: Perfluoropropane (C3F8) is a valuable adjunct in the management of complex rhegmatogenous retinal detachments, and it has become the most commonly used perfluorocarbon gas. However, there have been few large reports about its complications. This retrospective study was undertaken to evaluate the complications of the use of perfluoropropane gas. METHODS: Perfluoropropane gas was used in the repair of a complex retinal detachment in 157 consecutive eyes. Only eyes that had a follow-up of 6 months or greater were included. Any eyes that had undergone previous vitrectomy and vitreous substitution with gas or silicone oil were excluded. RESULTS: Gas-induced lens opacities developed in 26 (67%) phakic eyes; transient increased intraocular pressure developed postoperatively in 50 (32%) eyes; a transient fibrinous, pupillary membrane developed in 20 (13%) eyes; and a flat anterior chamber developed in 10 (6%) eyes. CONCLUSIONS: Scleral buckle placement and increased gas concentration were found to be risk factors for the development of increased intraocular pressure. Proliferative diabetic retinopathy was associated with a higher development of lens opacities and pupillary membranes. No major complications were associated with the use of C3F8.

Retinal detachments in incontinentia pigmenti.

We report on retinal detachments in six eyes of four patients with incontinentia pigmenti. These nonrhegmatogenous traction retinal detachments are characterized by extensive preretinal and vitreous fibrous organization that pull the retina anteriorly behind the lens. The clinical course and fundus appearance of the retinal detachments, beginning with the avascular peripheral retina and leading to traction retinal detachment, are similar to those of cicatricial retinopathy of prematurity. Vitreous surgery was performed on three eyes (two patients), with partial reattachment of a total retinal detachment in one eye and complete reattachment of a partial retinal detachment in a second eye. These cases represent the first successful surgical interventions reported for retinal detachment in incontinentia pigmenti.

Neuro-ophthalmological findings in closed head trauma.

Visual abnormalities following closed head trauma are common and can affect any part of the visual pathway. We reviewed 181 consecutive patients referred with visual complaints following closed head trauma. A motor vehicle accident was the most common etiology of trauma in 57% of cases, direct trauma to the head in 15%, and injuries sustained from a fall in 13%. Sixty-three percent of patients lost consciousness and 26% suffered a skull fracture. Thirty-five percent of all patients had visual field defects with functional (tunnel) fields the most common. Over 88% of eyes had 20/20 or better visual acuity. Thirty-three percent of patients suffered a cranial nerve palsy, with 75% resolving without intervention. The severity of head injury was directly related to the lack of proper seat belt and helmet use. Most visual complaints were improved with a simple refraction. Most binocular diplopia cleared with time, with only 15 cases requiring surgical correction.

Intracanalicular lipoma.

We present a patient with unilateral progressive painless loss of vision leading to optic atrophy and blindness. High-resolution computed tomography and magnetic resonance imaging demonstrated adipose tissue extending from the anterior portion of an enlarged optic canal posteriorly to involve the ipsilateral optic chiasm. To our knowledge, this is the first reported case of an intracanalicular lipoma.

Macular changes after retinal detachment surgery.

We studied 175 eyes of 175 patients who had successful repair of primary rhegmatogenous retinal detachment. Patients were randomly assigned to be treated with cryotherapy and episcleral sponges or with diathermy, scleral dissection, and encircling silicone bands. Fundus photography and fluorescein angiography were performed six weeks after successful reattachment surgery. Macular complications were discovered in 48 (27%) of the 175 eyes. The most frequent changes were cystoid macular edema in 28 (16%) and preretinal macular membrane in 13 eyes (8%). No significant differences in the incidence of cystoid macular edema were observed between diathermy and cryotherapy. Macular detachment, increased duration of macular detachment, cryotherapy, and pseudophakia were identified as risk factors for certain macular complications.

The measurement and definition of ptosis.

Measurements of 242 ptotic and normal eyelids were recorded clinically and compared with algebraically derived measurements from projected 35 mm photographs. Accuracy to 1.5 mm or better was obtained in 84% of clinical as compared with photographic measurements. The following definition is suggested: ptosis is present when the upper eyelid is less than 2 mm from midpupil. Reduction of the upper field of vision to 30 degrees or less is present in 97% of eyes with ptosis so defined. Asymmetric ptosis is present in the lower of the two upper eyelids when there is 2 mm or more asymmetry between the levels of the upper eyelids, even if both eyelids are 2 mm or more from midpupil. Although ptosis is best defined in terms of the midpupil to upper lid distance, the diagnosis of ptosis rests with the examining physician based on the clinical evaluation of the patient.