An unusual presentation of sixth nerve palsy: neurobrucellosis.

Abducens nerve palsy is generally seen in older patients with diabetes and hypertension. It is relatively rare in young and otherwise healthy patients. An extensive differential diagnosis is considered in patients younger than 50 years of age who develop a sixth nerve palsy. We report here a 25-year-old patient from Turkey who was admitted with sixth nerve palsy as a component of neurobrucellosis. She was referred to our clinic because she had double vision and restricted right eye abduction. During the ophthalmic examination, both pupils were round and reactive to light and accommodation. Extraocular movements were intact with the exception that the right eye was unable to abduct. Magnetic resonance imaging revealed no pathology. She also had a diagnosis of brucellosis and her abducens nerve palsy was a form of clinical manifestation of neurobrucellosis. We conclude that neurobrucellosis should be considered in patients with sixth cranial nerve palsy especially in areas where brucellosis is endemic.

Effect of Fasting on Corneal Biomechanical and Structural Parameters.

PURPOSE: To evaluate the effects of hunger and thirst on corneal biomechanical and structural parameters during Ramadan fasting. MATERIALS AND METHODS: Corneal biomechanical properties and intraocular pressures of 29 eyes of 29 healthy subjects were evaluated by Reichert ocular response analyzer; and structural and anatomical properties of cornea and anterior eye chamber of same eyes were scanned with Oculus Pentacam anterior segment analyzer. Each eye has been evaluated at 8 am and 4 pm both during and 1 month after Ramadan. Changes of subjects' weight were calculated and their relationship with corneal biomechanical and structural parameters was assessed. RESULTS: Intraday changes in horizontal corneal astigmatism (p = 0.02), anterior chamber volume (p = 0.01), intraocular pressure associated with the Goldmann IOPg (p = 0.02) and corneal resistance factor (CRF) (p = 0.04) were significantly different when measured during the fasting period in Ramadan and 1 month thereafter. Moreover, when we compared 8 am measurements taken during and after Ramadan, we observed significant differences for anterior chamber volume (p = 0.04) and anterior chamber angle values (p = 0.03). Similarly, for 4 pm measurements, there were significant differences for IOPg (p = 0.01) and CRF values (p = 0.00). CONCLUSIONS: Fasting lasting for more than 12 h during Ramadan creates an important window of opportunity to investigate the response of anterior chamber of eye to hunger and thirst. The current study contributes to the existing literature on the effects of dietary habits and water intake on corneal and anterior chamber properties.

Corneal viscoelastic differences between pseudoexfoliative glaucoma and primary open-angle glaucoma.

PURPOSE: The aims of this study were to assess the biomechanical properties of corneas with pseudoexfoliative glaucoma (PEXG) and to compare them with those of patients with primary open-angle glaucoma (POAG). METHODS: This prospective, comparative case series consisted of 73 eyes of 73 patients, 35 eyes with PEXG (PEXG group) and 38 eyes with POAG (POAG group). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPCC), and Goldmann-correlated intraocular pressure (IOPG) were determined by using ocular response analyzer (ORA). IOP using Goldmann applanation tonometer (GAT) and ultrasonic central corneal thickness (CCT) were also measured for each eye. Exclusion criteria included refractive error/astigmatism of >3.00 D, history of intraocular surgery, corneal disease, angle-closure glaucoma, and secondary glaucoma other than PEXG. In cases where both eyes were eligible, the right eye was preferred for analysis. The main outcome measures were CH, CRF, IOPCC, IOPG, and GAT. The results were statistically analyzed by using t test, general linear model, and the Pearson correlation test. RESULTS: The mean CH was found to be significantly lower in patients with PEXG (8.8 ± 1.4 mm Hg) than those with primary open-angle glaucoma (9.9 ± 1.2 mm Hg; P=0.0007). The mean CRF was found to be significantly lower in patients with PEXG (9.5 ± 1.8 mm Hg) than those with POAG (11.1 ± 1.3 mm Hg; P<0.0001). IOPCC was not significantly different between the groups (PEXG, 16.7 ± 2.5 mm Hg; POAG, 16.9 ± 2.4 mm Hg; P=0.72). IOPG was significantly lower in PEXG group (14.7 ± 2.7 mm Hg) compared with the POAG group (16.5 ± 2.5 mm Hg; P=0.004). GAT was significantly lower in the PEXG group (14.6 ± 2.7 mm Hg) compared with the POAG group (16.4 ± 2.8 mm Hg; P=0.007). There was no significant difference between the groups regarding mean CCT (PEXG, 546.1 ± 34.9 µ; POAG, 549.1 ± 25 µ; P=0.66) and mean age (PEXG, 70.3 ± 8.2; POAG, 67.6 ± 8.8; P=0.17). The difference between the IOPCC and the GAT was 2.1 and 0.5 mm Hg in both PEXG and POAG groups, respectively. CONCLUSIONS: Patients with PEXG had lower CH and CRF values than those with POAG. These findings require further investigation to assess the role of differing corneal biomechanical properties between the 2 groups and its association with poor prognosis among patients with PEXG.

Combined excision, cryotherapy, and intraoperative mitomycin C (EXCRIM) for localized intraepithelial and squamous cell carcinoma of the conjunctiva.

BACKGROUND: To report the results of patients undergoing combined excision, cryotherapy, and intraoperative mitomycin-C (EXCRIM) for primary ocular surface squamous neoplasia (OSSN) METHODS: A retrospective review of a non-comparative interventional case series. Histopathologically confirmed primary localized (less than four clock hours) OSSN treated with EXCRIM using adjuvant 0.02 % mitomycin-C (MMC) were included in the study. The main outcome measures were recurrence and complications related to MMC. RESULTS: The study enrolled 28 eyes of 28 patients with OSSN with a median age of 64.5 (range 43 to 84) years. The mean tumor size was 6.9 × 4.35 mm. There was corneal involvement in 23 of 28 (82 %). Seven patients (21 %) had delayed epithelial healing. Two of eight patients (25 %) with squamous cell carcinoma (SCC) had positive lateral margins. There were no recurrences over a mean follow-up of 49 months (range 24 to 96). CONCLUSION: The excision of OSSN combined with cryotherapy and intraoperative MMC is effective with a low recurrence rate. Long-term follow-up yielded favorable results.

Gamma-knife-based stereotactic radiosurgery for medium- and large-sized posterior uveal melanoma.

BACKGROUND: This study investigated the use of gamma-knife-based stereotactic radiosurgery (GKRS) for medium- and large-sized posterior uveal melanoma treatment. METHODS: We assessed 50 eyes from 50 consecutive patients with uveal melanoma who were treated with GKRS. All tumors met the criteria for medium- and large-sized uveal melanomas. Patients underwent a single session treatment under local anesthesia; the prescribed radiation dose at the tumor periphery was standardized to 30 Gy at the 50 % isodose field for all patients. The main outcomes were local tumor control, eye retention, and survival rates. RESULTS: The median follow-up time was 40 months (16-78 months). The baseline mean tumor diameter was 10.3 mm (7.1-15.7 mm) and the apical tumor height was 8.7 mm (4.1-16.8 mm). After treatment, the mean tumor diameter was 8.7 mm (5.5-12.0 mm) and the tumor height was 6.2 mm (0.5-11.2 mm). Changes in both tumor height and diameter were statistically significant (p < 0.001). The tumor control rate was 90 %, and the eye retention rate was 82 %. A total of nine patients (18 %) developed metastasis, and seven (14 %) died due to metastasis during follow-up. Cataracts (34 %) and radiation maculopathy (30 %) were the most frequent complications, and 14 % of patients developed neovascular glaucoma. Visual acuity (VA) decreased significantly after treatment (p < 0.0001). CONCLUSION: Treatment using low doses of GKRS, (30 Gy) is an eye-sparing outpatient option for patients with medium- or large-sized posterior uveal melanomas who are not eligible for brachytherapy or particle therapy. Complications, particularly impaired VA, should be taken into consideration.

A novel surgical technique to prevent postoperative Ahmed valve tube exposure through conjunctiva: tenon advancement and duplication.

BACKGROUND AND OBJECTIVE: To present and evaluate a novel surgical technique to prevent exposure of the Ahmed valve implant tube (New World Medical, Rancho Cucamonga, CA) through conjunctiva in congenital glaucoma called "combined short scleral tunnel technique with Tenon advancement and duplication." PATIENTS AND METHODS: Patients with failed previous congenital glaucoma surgeries were divided into two groups. In group 1, 32 eyes of 28 patients with a mean age of 8.82 +/- 5.39 years underwent classic Ahmed valve implant surgery. In group 2, 28 eyes of 24 patients with a mean age of 8.79 +/- 5.55 years underwent the novel combined short scleral tunnel with Tenon advancement and duplication technique. RESULTS: After a mean 31.68 +/- 9.25 months of follow-up, conjunctival tube exposure was seen in 3 patients (9.4%) in group 1. There was no conjunctival tube exposure in group 2 after a mean 34.96 +/- 7.93 months of follow-up. CONCLUSION: The combined short scleral tunnel with Tenon advancement and duplication technique is able to prevent conjunctival tube exposure after Ahmed valve implantation surgery in patients with congenital glaucoma.