Effect of partial posterior vitreous detachment on retinal nerve fiber layer thickness as measured by optical coherence tomography.

OBJECTIVE: To evaluate the effect of partially attached posterior vitreous detachments (pPVDs) at the optic disc on retinal nerve fiber layer (RNFL) thickness as measured by optical coherence tomography. METHODS: A retrospective study was conducted using stored Stratus optical coherence tomography III scans of patients with suspected glaucoma from January 2003 to September 2006 at the Montefiore Medical Center, Bronx, New York. All scans were evaluated for vitreous attachments at the disc and were divided into control (without pPVD) and pPVD groups. The RNFL thickness was compared using the fast RNFL protocol. Patients were defined as glaucoma suspects based on clinical findings of either glaucomatous-appearing optic discs or elevated intraocular pressure. All study patients had normal Humphrey visual fields. RESULTS: A total of 110 eyes from 110 patients were included; 59 were in the pPVD group and 51 were controls. Partial PVD was found in 40% of the glaucoma suspects. The mean RNFL thickness of eyes with pPVD was significantly broader than that of controls (101.6 microm vs 95.6 microm, respectively; P < .001). The average RNFL thickness of each quadrant was greater in the pPVD group than in the control group, with statistically significant differences in superior and inferior quadrants (P < .001 and P = .001, respectively). CONCLUSIONS: More than one-third of this population of glaucoma suspects had a pPVD, indicating that this is a common phenomenon. The results suggest that RNFL thicknesses are greater in patients with pPVD than in controls. This may indicate a limitation of using RNFL thickness as a criterion for evaluating glaucomatous damage in patients with pPVD.

The neuroradiological findings in a case of Revesz syndrome.

Revesz syndrome is a variant of dyskeratosis congenita characterized by aplastic anemia, retinopathy, and central nervous system abnormalities. We describe a 3-year-old boy in whom the spectrum of neuroimaging findings, including intracranial calcifications, cerebellar hypoplasia and unusual brain lesions were found by biopsy to be gliosis despite their enhancement and progression. In patients with dyskeratosis-related syndromes, non-neoplastic parenchymal brain lesions occur and gliosis should be considered in the differential diagnosis for progressive enhancing brain lesions. Should this finding be confirmed consistently in additional cases, brain biopsy could potentially be avoided.

Rates of strabismus surgery in the United States: implications for manpower needs in pediatric ophthalmology.

PURPOSE: To investigate rates of strabismus surgery and population projections in the United States and to consider whether a sufficient number of pediatric ophthalmologists are being trained to meet future needs. METHODS: Review of online data from Series 13 reports from the National Center for Health Statistics for the period 1965 to 1996, including reports from the National Hospital Discharge Survey and the National Survey of Ambulatory Surgery. Population data were obtained from the U.S. Census Bureau. RESULTS: The current rate of strabismus surgery for children under 15 years of age is 80 per 100,000 persons in the United States. This rate would generate an additional 389 strabismus cases annually, based on the predicted growth of the pediatric population. On average, today's pediatric ophthalmologist performs about 114 strabismus procedures annually. CONCLUSIONS: If the current rates and trends remain stable over the coming years, it is not likely that there will be a shortage of pediatric ophthalmologists in the United States.