Crystalline retinopathy: Unifying pathogenic pathways of disease.

Crystalline retinopathies may be associated with different etiologies including genetic, toxic, degenerative, idiopathic, and iatrogenic causes. We outline the various types of crystalline retinopathies and summarize their associated etiologies, pathogenesis, clinical presentations, multimodal imaging findings, and management strategies.

Therapeutic Effect of Anti-VEGF for Age-Related Macular Degeneration in the Untreated Fellow Eye.

Intravitreal injections of antivascular endothelial growth factor (anti-VEGF) agents have been reported to occasionally produce a therapeutic effect in the uninjected fellow eye. Here, three patients with bilateral neovascular age-related macular degeneration are presented. In all three patients, unilateral anti-VEGF injection resulted in bilateral reduction of macular thickness as measured by spectral domain optical coherence tomography.

Pharmacotherapy of Myopic Choroidal Neovascularization.

BACKGROUND: Myopic choroidal neovascularization (CNV) is a common cause of central visual loss in patients with high myopia, and the most common form of CNV in younger individuals. Pharmacologic therapy is the current mainstay of treatment of these patients. METHODS: Review of pharmacological treatment options for myopic CNV, which primarily involves intravitreal administration of anti-vascular endothelial growth factor (anti-VEGF) agents. RESULTS: At this time, anti-VEGF therapy agents are the first-line therapy in these patients. Comparative trials have not identified any major differences in treatment outcomes between aflibercept, bevacizumab, and ranibizumab. Only ranibizumab is approved for this indication in the US. Best visual outcomes are associated with younger age, smaller lesion size, and absence of chorioretinal atrophy. CONCLUSION: Anti-VEGF therapy is generally very effective in the treatment of myopic CNV.

Spontaneous intracranial hypotension syndrome accompanied by bilateral hearing loss and venous engorgement in the internal acoustic canal and positional change of audiography.

Hearing loss, tinnitus, and vertigo are very common complaints in otolaryngology practice. Here, we describe spontaneous intracranial hypotension (SIH) as a curable reason of hearing loss, tinnitus, and vertigo. A 29-year-old woman presented to the emergency room with nausea, dizziness, vertigo, instability, hearing loss, tinnitus, and neck and back pain. Cranial computed tomography, magnetic resonance imaging (MRI), and lumbar puncture were performed. The patient stated that the hearing loss and tinnitus became worse after effort or standing for prolonged times. Therefore, we performed audiogram in sitting and standing positions. The tinnitus severity index was used to evaluate tinnitus. Lumbar puncture revealed no cerebrospinal fluid, and cerebrospinal fluid could be obtained by aspiration. Cranial MRI showed dural thickness and venous engorgement in the internal acoustic canals bilaterally. Audiography showed worse hearing capacity in standing position than in sitting position and revealed especially low-frequency hearing loss bilaterally. The patient's tinnitus severity index was 48 of 60. The patient was diagnosed as having SIH and treated with autologous blood punch. Cranial MRI and audiogram were normal after the treatment. The patient had no tinnitus after the treatment. Spontaneous intracranial hypotension, which may cause Ménière syndrome-like symptoms, is a curable reason of hearing loss, tinnitus, and vertigo. In addition, the fluctuation of the hearing loss with positional changes supports the use of positional audiometry when evaluating hearing loss-related SIH. Venous engorgement in the internal acoustic canal may be related to the symptoms.

Severe visual loss after ear surgery.

Sigmoid sinus thrombosis was once one of the most common intracranial complications of otitis media, but this has become less common since the advent of antibiotics. The frequency of sigmoid sinus hypoplasia reported in the literature is about 17%. Considering the possibility of postoperative intracranial hypertension, sigmoid sinus and jugular bulb surgeries were contraindicated in this case.We present a case with sigmoid sinus thrombosis of the sinus due to compression flowing surgical injury. This is a unique case, which presents with contralateral sigmoid sinus hypoplasia. Eventually, the patient presented to us with otitic hydrocephalus, increased intracranial pressure, papilledema, oculomotor and abducens nerve palsy, and severe right-side visual loss are prominent features.