Managing a rare case of familial Radius Maumenee syndrome.

Idiopathic elevated episcleral venous pressure (IEEVP), also known as Radius-Maumenee syndrome, is a rare condition which can pose a diagnostic and management challenge for clinicians. Filtration surgery is often required due to medical treatment proving ineffective. We describe to our knowledge the first case of familial Radius-Maumenee syndrome in a father and son duo. Primary management using a glaucoma drainage device is an effective option in addition to being a safer alternative when compared to trabeculectomy. Patients will require rigorous monitoring in the post-operative period to reduce the risk of complications.

A complex case of haemodialysis induced increased intraocular pressure.

PURPOSE: To describe a case of intraocular pressure fluctuation during haemodialysis in a patient with previously treated proliferative diabetic retinopathy and previous unilateral angle neovascularisation. CASE DESCRIPTION: A 63-year-old male with end-stage renal disease on maintenance haemodialysis and recurrent episodes of symptomatic intraocular pressure rise during dialysis sessions. Higher intraocular pressure spikes occurred in the eye with previous angle new vessels. OUTCOME: Topical antihypertensive drops failed to control the intraocular pressure. Due to multiple co-morbidities, options of medical management were deemed unsuitable; those included intravenous mannitol, systemic acetazolamide and intravenous glucose. Furthermore, modifications of his dialysis prescription did not lead to satisfactory results. As a consequence, the patient underwent trabeculectomy with mitomycin C. Adequate control of his intraocular pressure was achieved post-operatively. CONCLUSION: Intraocular pressure fluctuations during haemodialysis are not fully understood, and management can be quite challenging to the treating ophthalmologists and nephrologists. In this case report, we discuss some of those difficulties and different treatment options.

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.

Outcomes of sulfur hexafluoride (SF6) versus perfluoroethane (C2F6) gas tamponade for non-posturing macular-hole surgery.

AIM: To compare the outcomes of non-posturing macular-hole surgery using sulfur hexafluoride (SF(6)) gas versus perfluoroethane (C(2)F(6)) for idiopathic macular hole repair. Design Interventional, comparative cohort study. METHODS: 39 eyes of 38 patients undergoing macular-hole surgery with SF(6) were compared with another consecutive group of 39 eyes (39 patients) in whom C(2)F(6) was used. All patients were operated on by a single surgeon and underwent 23G transconjunctival phakovitrectomy with no prone posturing in the postoperative period. The best-corrected Snellen's visual acuity (VA) was converted to the logarithm of minimal angle of resolution (logmar) visual acuity for analysis. Optical coherence tomography documentation of anatomical closure and complications of surgery were recorded. RESULTS: Primary hole closure was achieved in 89.75% in the C(2)F(6) group and 87.2% in the SF(6) group. Secondary closure after non-posturing redo surgery with heavy oil (Oxane-HD) was 100% in both groups. The mean preoperative VA in the C(2)F(6) group and SF(6) group was 0.81 logMAR and 0.78 respectively. 2 weeks after surgey, SF(6) was completely absorbed in all cases, and the mean VA improved to 0.5 logMAR; however, it remained 1.9 logMAR in the C(2)F(6) group. The final mean VA at 6 months was 0.44 (range 0-0.78) and 0.38 (range 0-1) in the C(2)F(6) and SF(6) group respectively. There were no instances of pupillary capture in the SF(6) group, whereas there were four in the C(2)F(6) group. CONCLUSION: Macular-hole surgery with SF(6) gas achieves similar results to C(2)F(6) and is absorbed faster, allowing quicker visual rehabilitation for the patient.

Contact lens referrals to Hull Royal Infirmary Ophthalmic A&E Unit.

PURPOSE: To investigate the quantity and severity of contact lens complications referred into Hull Royal Infirmary Ophthalmic A&E, their impact on resources and whether their management and treatment was appropriate. METHODS: A survey was conducted over a 7-month period at Hull Royal Infirmary Ophthalmic A&E Unit. In this time 100 patients were enrolled, all completed a questionnaire including information about lens type and wearing schedule, and were photographed. All were examined, and where necessary treated by the Ophthalmic A&E doctor. RESULTS: Contact lens complications accounted for 9.1% of the referrals into Ophthalmic A&E, a total of 323 appointments. Microbial keratitis was the most common diagnosis (22%), and Klebsiella and Pseudomonas the most common pathogen implicated. A case of Fusarium was also recorded. Optometrists/contact lens practitioners were the most common referral source (41%). Soft lens wearers were most common (67%), followed by silicone hydrogel wearers (28%) and least common were rigid gas permeable wearers (5%). Ten percent of the patients referred into the department were admitted. CONCLUSION: Education of the patient in their wear schedule and hygiene are still significant factors in their risk of developing contact lens complications. A closer working relationship needs to be fostered between Community Optometrists and Eye Departments to give the most appropriate management of contact lens related problems which would help alleviate undue burdens on Ophthalmic A&E.

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.