Management of intraocular pressure elevation during hemodialysis of neovascular glaucoma: a case report.

BACKGROUND: It is generally accepted that dialysis may lower plasma osmolality at a faster rate than changes in ocular osmolality. This osmotic difference causes water to migrate from the plasma into the aqueous humor, increasing intraocular pressure. Certain authors have described IOP increase in patients with narrow angles. CASE PRESENTATION: Here we report a neovascular glaucoma patient who experienced a substantial increase in IOP associated with severe eye pain and blurred vision during sessions of dialysis. The patient had been refractory to several antiglaucoma drugs and improved after intravenous administration of 20% hyperosmotic glucose solution with dialysis and pan-retinal photocoagulation. CONCLUSION: It is the first report in which intravenous glucose administration and reduction of neovascularization by argon laser pan-retinal photocoagulation successfully managed IOP increase during dialysis in neovascular glaucoma. Further clinical studies are required to confirm our results.

Supero-lateral orbitotomy for resection of spheno-orbital meningioma: a case report.

Spheno-orbital meningioma have traditionally been defined as secondary tumors of the orbit originating from the dura of the sphenoid wing bone. Nevertheless, pathologic findings reveal a distinct periorbital component as a defining feature of these lesions. These tumors are characterized by an intraosseous mass growth leading to a significant hyperostosis involving the sphenoid wing, the orbital roof, the lateral orbital wall and the middle fossa cranial base and to a thin, usually soft-tissue growth at the dura. We report here on the extension of the primary tumor into the orbital cavity and present the surgical approach performed.

Retinal detachment and convexity intracranial meningioma: an uncommon association.

CASE REPORT: A 70-years-old woman presented with a one week history of progressive loss of vision in the right eye (RE) diagnosed as retinal detachment from 7 to 1 o' clock with retinal break at the 10.30 o' clock associated. Gadolinium enhanced magnetic resonance imaging (MRI) scan of the brain and orbits with fat suppression showed a convexity meningioma. Scleral buckling with a segmental sponge, subretinal fluid drainage and cryopexy were performed with detachment repair. CONCLUSION: In our patient with retinal detachment and convexity meningioma without significant neurological symptoms, performing ocular surgery and close follow up care seemed to be the optimal treatment option.

Pterygomaxillary extension of orbital pseudotumor. Case report.

Idiopatic pseudotumor (IP) is a non-specific, non-neoplastic, inflammatory process without identifiable local or systemic causes. IP most commonly affects the orbit, comprising 5% to 8% of all orbital masses with occasional extension to other areas of the skull base. The ophthalmology literature has detailed reviews of IP as a space-occupying intraorbital lesion, but lesion involving only the skull base and sparing the orbit is exceptional. Understanding the presentation, work-up, and characteristics of the lesion is important for proper diagnosis and treatment. We report a rare case of orbital IP with extension into infratemporal fossa. Clinical and radiological findings and surgical approach are discussed.

Benign orbital pseudolymphoma. Case report.

Orbital pseudolymphomas are uncommon benign tumors composed of reactive lymphocytes. The typical clinical presentation is painless onset of ptosis, proptosis, diplopia, or eyelid swelling. Virtually any adnexal structure can be affected, but lacrimal gland, orbital soft tissue, or extraocular muscles are the usual sites of involvement. Historically, treatment has been with oral corticosteroids or localized radiotherapy. We present a case of benign orbital pseudolymphoma.

Long-term effectiveness of lumboperitoneal flow-regulated shunt system for idiopathic intracranial hypertension.

AIM: The aim of the study was to assess the efficacy of lumboperitoneal flow-regulated shunt for the treatment of idiopathic intracranial hypertension (IIH). METHODS: This was a retrospective study carried out on four patients with IIH, treated from January to December 2007 with lumboperitoneal flow-regulated shunt (OSV II Smart Valve Systems; Integra NeuroSciences). The mean follow-up period was 13 months. RESULTS: The treatment was successful in alleviating symptoms in all cases and no patient required revisions. CONCLUSIONS: In conclusion the placement of flow-regulated valves is a satisfactory treatment for those IIH patients who require surgical therapy.

Ocular manifestations of chronic graft-versus-host disease in patients treated with extracorporeal photochemotherapy.

PURPOSE: Eye involvement has long been appreciated in patients with chronic graft versus host disease (cGVHD). In particular, ocular complications are frequent and can be potentially severe in patients with steroid-refractory cGVHD, and therefore necessitate close monitoring. This prospective study was designed to describe eye manifestations of cGVHD in a large series of patients monitoring them before and after 1 year of extracorporeal photochemotherapy (ECP). ECP is a relatively new therapeutic approach based on the biological effects of psoralen 8-methoxypsoralen (8-MOP) and ultraviolet A light (UVA) on mononuclear cells collected by apheresis, and reinfused into the patient. METHODS: Only patients with steroid-refractory cGVHD under treatment with ECP, who developed cGVHD-related eye symptoms, were selected for the study. Ophthalmologic examination was repeated every 3 months. Only patients with complete recovery of the ocular manifestations and symptoms were considered responsive. RESULTS: In our study we observed eye alterations in 24 out of 140 patients (17%) with cGVHD. After 12 months of ECP, 10 out of 21 patients (48%) completely responded to the therapy. In all these cases the contribution of ECP was also essential in all the other organs subject to cGVHD. CONCLUSIONS: Further studies are necessary to clarify the role of ECP in patients with cGVHD, especially in associated eye manifestations. Although our experience is limited, it suggests that ECP could be a safe and effective therapy for steroid-refractory eye manifestations of cGVHD.