Metastatic breast cancer presenting as sequential cranial nerve palsy: a case report.

INTRODUCTION: Cranial nerve palsy is a common presentation in the neuro-ophthalmology clinic and investigations are directed towards the cause. Metastatic breast cancer presenting as carcinomatous meningitis leading to sequential fourth, third and sixth nerve palsy is very rare. This is the first case to be reported to the best of our knowledge. CASE PRESENTATION: A 66-year-old Caucasian woman presented with vertical double vision for the previous 3 weeks. At 6-weeks follow up this had resolved. However, she presented with a new third and sixth cranial nerve palsy. Neuroimaging with contrast revealed carcinomatous meningitis. CONCLUSIONS: Metastatic cancer may manifest as cerebral metastases or carcinomatous meningitis. This is evident on neuroimaging with contrast and may be missed on unenhanced scans.

Long-term follow-up of zonulo-hyaloido-vitrectomy for pseudophakic malignant glaucoma.

PURPOSE: To report long-term follow-up of zonulo-hyaloido-vitrectomy (ZHV) via anterior approach for pseudophakic malignant glaucoma refractory to medical treatment. DESIGN: Noncomparative case-series. MATERIALS AND METHODS: Medical records of 9 patients who sought treatment for aqueous humor misdirection refractory to medical treatment were reviewed. All patients underwent anterior vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy (PI) via an anterior approach. Main outcome measures were preoperative and postoperative visual acuity, intraocular pressure, medications, slit-lamp examination, and fundus findings. RESULTS: 10 eyes of 9 patients (7 female, 2 male) who underwent ZHV for refractory pseudophakic malignant glaucoma between 2003 and 2010 were included in this case-series. The mean age of patients was 77.4 ± 9.0 years, mean follow-up duration 50.2 ± 27.2 months. Recurrence of malignant glaucoma was noted in 40% (four cases) after a successful ZHV on long-term follow-up. CONCLUSIONS: An anterior segment surgeon can treat malignant glaucoma refractory to medical treatment successfully by vitrectomy, hyaloido-zonulectomy, and PI. This can be done via an anterior approach and patients require long follow-up to rule out a relapse despite a successful outcome in the short term.

Stratus optical coherence tomogram III: a novel, reliable and accurate way to measure corneal thickness.

The commercially available optical coherence tomogram (Stratus OCT III) designed for posterior segment imaging can be used for central corneal thickness (CCT) measurement. The aim of the study was to determine the accuracy and reliability of CCT measurements using Stratus OCT III versus ultrasound pachymetry. CCT using Stratus OCT III (CCT oct) was taken and averaged. The focusing system had to be defocused near the maximum to relay the image of the OCT beam onto the cornea. CCT was then determined using the ultrasound pachymeter (CCT usg). Thirty white volunteers (12 male, 18 female) participated in this study. The mean CCToct was 522.33+/-34.44 microns. The mean CCTusg was 547.37+/-33.08 microns. The mean differences between CCTusg and CCToct was 25.04+/-11.67. CCT usg was found to be highly correlated with CCToct (P < 0.001) The relation can be represented by the equation. CCToct = 0.98 (CCTusg) - 13.9. The Stratus OCT III gave reliable readings of CCT and is a novel, reliable and accurate way to measure CCT.