Eight-and-a-half syndrome: a rare potentially life-threatening disease.

Purpose: To report a case of eight-and-a-half syndrome presenting with a conjugate horizontal gaze palsy, an ipsilateral internuclear ophthalmoplegia, and an ipsilateral lower motor neuron-like facial palsy. Methods: A 56-year-old male who came in for limitation of extraocular muscle motion - wherein the only remaining movement is abduction of the left eye - and right-sided facial weakness. Magnetic resonance imaging revealed a well-defined lesion resembling a cavernoma, at the level of the ponto-medullary junction. Results: Eight-and-a-half syndrome results from a lesion affecting the paramedian pontine reticular formation, the median longitudinal fasciculus, and the facial nerve fascicle on one side. In this case, a cavernoma at the level of the ponto-medullary junction was compressing the important pontine structures. Conclusion: Although eight-and-a-half syndrome is most commonly caused by an infarction or demyelination, in rare instances, a space-occupying lesion at the level of the pons can be the etiology. It is of utmost importance to recognize the features of this disease entity to be able to exhaust the proper diagnostic exams, localize the lesion and determine the proper treatment regimen catered to each patient.

Wavefront-guided epithelial laser in situ keratomileusis with mitomycin-C for myopia and myopic astigmatism: flap-on versus flap-off technique.

PURPOSE: To compare the postoperative pain, visual recovery, and outcomes of flap-on and flap-off epithelial laser in situ keratomileusis (epi-LASIK) with mitomycin-C (MMC). SETTING: Asian Eye Institute, Makati, Philippines. DESIGN: Case-control study. METHODS: Patients with myopia up to 9.00 diopters had wavefront-guided epi-LASIK with MMC. After randomization, the epithelium was removed in 1 eye (flap off) and repositioned in the other eye (flap on). Questionnaires were used to evaluate postoperative pain and visual recovery in each eye during the first postoperative week. Visual results, refractive outcomes, contrast sensitivity, and higher-order aberrations (HOAs) were compared and analyzed. RESULTS: The study evaluated 48 eyes. The mean pain scores were lower and better vision was perceived in the flap-off group during the first postoperative week. One year postoperatively, the mean uncorrected distance visual acuity was -0.088 logMAR in the flap-on group and -0.036 logMAR in the flap-off group (P = .918). The spherical equivalent was within ± 0.50 D in 92% of eyes in both groups (P > .05). Forty-six percent in the flap-on group and 38% in the flap-off group gained 1 line of corrected distance visual acuity (P = .915). Contrast sensitivity tests under daytime and nighttime conditions were comparable. There was no statistically significant difference in the mean change in HOAs between groups. CONCLUSIONS: Wavefront-guided epi-LASIK with MMC was effective, safe, and predictable in treating myopia and myopic astigmatism. Eyes that had flap-off epi-LASIK had less pain and faster visual recovery. Visual results, refractive outcomes, contrast sensitivity, and HOAs were comparable between groups. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Glare in a Case of a Craniopharyngioma.

Glare is commonly encountered in patients with corneal disease, uveitis, or retinal problems. Rarely, it may be a presenting manifestation of more sinister conditions such as chiasmal lesions. We present the case of a 42-year-old male who complained of glare for 2-3 months. There was neither headache nor blurring of vision. His neuro-ophthalmological examination was within normal limits except for slight decrease in colour contrast of the upper temporal dots of the red-dot perimetry chart. Automated visual fields showed a central scotoma on the right eye and a temporal-inferior field defect on the left. He underwent neuro-imaging, which revealed a suprasellar cystic mass, most likely a craniopharyngioma. Referral to the neurosurgeon was made who performed supraorbital keyhole surgery. Intraoperative findings showed a cystic mass stuck bilaterally on the optic nerves, carotids, and optic chiasm with the pituitary stalk deviated to the right side. Histopathology report revealed a craniopharyngioma, adamantinomatous variant. One month post excision, the patient showed improvement in his visual functions.