Transient visual blurring during a sexual intercourse in a young woman with surgically corrected myopia and unrecognized pigmentary glaucoma: A rare case report.

PURPOSE: To present a rare case of unilateral visual loss episodes occurred during sexual intercourse in a young patient affected by unrecognized pigmentary glaucoma and previously undergone myopic refractive surgery. CASE DESCRIPTION: The patient presented surgically flattened corneas and markedly asymmetric pigmentary glaucoma. CONCLUSIONS: Previous refractive surgery, sexual intercourse, and athletic lifestyle might be risk factors for acute pigment dispersion and chronic progression of pigmentary glaucoma in young myopic patients. During their ophthalmic examination prior to refractive surgery, greater attention should be paid to detect early signs of pigmentary dispersion, and awareness of these dangerous situations should be raised in affected patients.

PERG adaptation for detection of retinal ganglion cell dysfunction in glaucoma: a pilot diagnostic accuracy study.

It has been previously demonstrated that the adaptive phase changes of steady-state pattern electroretinogram (SS-PERG), recorded during 4-min presentation of patterned stimuli, are reduced in glaucoma suspects and patients compared to normal subjects. Our study aims at testing the hypothesis that adaptive changes of SS-PERG, recorded using the novel optimized Next Generation PERG (PERGx) protocol, differ between glaucoma patients and controls. In this pilot cross-sectional study, we included 28 glaucoma patients and 17 age-matched normal subjects. Both patients and controls underwent a full ophthalmologic examination, visual field testing, OCT and PERGx. The PERGx signal was sampled over 2 min (providing 1 noise and 9 signal packets) in response to alternating gratings generated on an OLED display. PERGx amplitude and phase were analyzed to quantify adaptive changes over recording time. Receiver operating characteristic (ROC) curves were used to study the diagnostic accuracy of PERGx parameters in distinguishing glaucoma patients from normal subjects. PERGx amplitude and phase data showed declining trends in both groups. PERGx amplitude slope and grand-average vector amplitude and phase were significantly different in patients compared to controls (p < 0.01), whereas phase angular dispersion was greater in patients but not significantly different between the two groups. The area under the ROC curves were 0.87 and 0.76 for PERGx amplitude slope and grand-average vector amplitude, and 0.62 and 0.87 for PERGx angular dispersion and grand-average vector phase, respectively. The PERGx paradigm resulted highly accurate in detecting the reduction of amplitude adaptive changes in glaucoma patients, presumably due to the loss of functional retinal ganglion cell autoregulation. Thus, PERG adaptation, recorded by this new protocol, might be helpful in the identification and diagnosis of early glaucomatous dysfunction.

Influence of aqueous humor convection current on IOL opacification.

BACKGROUND AND PURPOSE: The opacification of Akreos Adapt (Bausch & Lomb, Rochester; NY) intraocular lens (IOL) has been previously reported in Literature. A metabolic change in aqueous humour was considered as the main trigger factor to IOL opacification. We report our case and discuss the association with Ex-PRESS, highlighting the particular pattern of IOL opacification and its possible relation with the intraocular convective motions of the aqueous. MATERIAL AND METHODS: We analyzed our case using both digital slit lamp acquisition and OCT Visante (Zeiss, Germany) images. A literature review was conducted to evaluate our results with that previously reported. CONCLUSION: The role of a relative stationary flow was reported as suggested concurrent mechanism in IOL opacification phenomenon.

Correlation of optic nerve head tomography with visual field sensitivity in papilledema.

PURPOSE: To quantify the relationship between optic nerve head tomography and perimetric sensitivity in patients with papilledema. METHODS: Eight patients with variable degrees of recently diagnosed papilledema associated with idiopathic intracranial hypertension (IIH) were evaluated with confocal scanning laser ophthalmoscopy (CSLO) and automated perimetry. Patients were followed up with serial measurements over a period of 5 to 30 months (mean +/- SD, 17.1 +/- 9), while under medical treatment (acetazolamide). The tomographic parameters, volume above reference (VAR), volume above surface (VAS), effective mean height (EMH), and maximum height in contour (MxHC), were obtained by tomography, either globally or from predefined disc sectors. The perimetric indices, mean deviation (MD) and pattern SD (PSD), were evaluated. The results from patients' right eyes and the individual intereye differences in both tomographic and perimetric parameters, were statistically evaluated by nonparametric correlational (Spearman) and repeated measures (Wilcoxon) analyses. RESULTS: At baseline, all tomographic parameters were negatively correlated with MD in global (r = -0.8) and sectorial (r = -0.6) evaluations. The interocular differences in overall tomographic parameters were correlated with corresponding differences in perimetric MD (r = -0.8) and PSD (r = 0.6). During the follow-up period, volumetric disc parameters decreased (P < 0.02), whereas perimetric MD increased (P = 0.02) at comparable times. CONCLUSIONS: In patients with recently diagnosed papilledema, optic nerve head tomographic abnormalities are quantitatively correlated with visual field sensitivity losses. Therapeutic improvement of volumetric parameters may be paralleled by recovery in perimetric sensitivity. The data support the possible use of both techniques in combination to monitor the amount of papilledema and the effectiveness of treatments designed to reduce intracranial hypertension.

Ultrasonographic evaluation of optic disc swelling: comparison with CSLO in idiopathic intracranial hypertension.

PURPOSE: To determine the accuracy and reproducibility of ultrasonographic (US) readings of optic disc elevations in patients with papilledema compared with confocal scanning laser ophthalmoscope (CSLO) measurements. METHODS: One randomly selected eye of 22 patients with idiopathic intracranial hypertension (IIH) and a variable degree of optic disc swelling underwent five and three repeated measurements of disc height using high-resolution ultrasonography (Biovision unit; Quantel Medical, Clermont-Ferrand, France) and CSLO (Heidelberg Retina Tomograph [HRT]; Heidelberg Engineering, Heidelberg, Germany), respectively. The same procedure was assessed in 14 subjects with variable degrees of physiologic optic disc cupping. US and HRT measurements from each group were individually compared with each other to estimate the accuracy of US readings in both disc conditions in comparison with HRT data. RESULTS: Ultrasonographic readings were positively correlated with HRT measurements in both swollen (r = 0.62, P: = 0.002) and excavated disc (r = 0.84, P: < 0.0002). The 95% limits of agreement between the instruments were 0.24 +/- 0.59 mm (mean +/- 2 SD) and 0. 05 +/- 0.3 mm for swelling and cupping measurements, respectively. The coefficient of variation was 7.63% and 1.8% for swelling and 7. 93% and 5.91% for cupping, with US and HRT, respectively. CONCLUSIONS: The results indicate that US and CSLO readings are correlated i: both disc swelling and cupping conditions, but to a different extent because of a significant discrepancy in papilledema. US assessment can be considered highly reproducible. Combined US and HRT optic disc analysis may be recommended in papilledema evaluation as long as a better correlation can be demonstrated in further studies.

Photopic negative response of the human ERG: losses associated with glaucomatous damage.

PURPOSE: To evaluate in glaucomatous eyes the photopic electroretinogram (ERG) negative response (PhNR), a component that follows the b-wave peak and is thought to be correlated with inner retinal activity. METHODS: Eleven patients with open-angle glaucoma (OAG) and moderate field loss (Humphrey 30-2 [Humphrey Instruments, San Leandro, CA] mean deviation < or = -6 dB), eight with ocular hypertension (OHT), and eight age-matched normal subjects were tested. Optic discs of patients and control subjects were evaluated by confocal scanning laser ophthalmoscopy. ERGs were recorded to long-duration stimuli (250 msec) of photopic luminance (78 candelas [cd] /m2), presented in the macular region (12 degrees x 12 degrees field size) on a steady, adapting background. Amplitudes of the a-wave and b-wave and the PhNR were measured. Pattern reversal ERGs to 30-minute checkerboards were also recorded from patients and control subjects. RESULTS: Compared with control subjects, patients with OAG showed reduced PhNR (average reduction: 62%, P < 0.01), but normal a- and b-wave amplitudes. In patients with OHT, PhNR and a- and b-wave amplitudes did not differ from control values. In individual patients with OAG, PhNR amplitudes were correlated positively with pattern ERG amplitudes (r = 0.80; P < 0.01) and central (12 degrees) perimetric mean deviations (r = 0.68; P < 0.05) and negatively with cup-to-disc area ratios (r = -0.79; P < 0.01) and cup shape measures (r = -0.78; P < 0.01). CONCLUSIONS: Similar to that found in monkeys with experimentally induced glaucoma, the PhNR is selectively altered in human glaucoma. The correlation between PhNR losses and clinical parameter abnormalities suggests that this component depends on inner retina integrity and may be of clinical value for detecting glaucomatous damage.

Correlation of pattern electroretinogram with optic disc cup shape in ocular hypertension.

PURPOSE: To evaluate the correlation of pattern electroretinogram (PERG), an index of inner retinal function, with confocal scanning laser (CSLO) optic disc structural parameters in ocular hypertension (OHT). METHODS: Thirty-four patients with OHT, normal white-on-white (Humphrey 30-2) perimetry, and normal clinical optic discs were examined with PERG and CSLO disc analysis. Two groups of normal subjects (n = 38 and 18, for PERG and CSLO, respectively) and a group of 12 patients with early open-angle glaucoma (EOAG) were also tested. Pattern electroretinogram amplitudes were measured in response to sinusoidal gratings of variable spatial frequency (0.58-5.8 cycles/degree), modulated in counter-phase at 7.5 Hz. Morphometric optic disc parameters were obtained by the Heidelberg Retina Tomograph (HRT), either globally or from predefined disc sectors. In addition to standard parameters, the cup shape measure, an index of depth variation and steepness of the cup walls, was determined. RESULTS: In individual OHT patients, PERG amplitudes at 2.6 cycles/degree were negatively correlated with cup shape measures (r = -0.43, P < 0.01) obtained from analysis of the inferotemporal (IT) sector. No significant correlations were found for the other parameters. On average, the cup shape measures derived from IT sector or global analysis were significantly (P < 0.01) worse, and closer to the measures of EOAG patients, in OHT patients with abnormal PERG compared with those with normal PERGs. The cup shape measure displayed a low sensitivity (20%) and a high specificity (100%) in predicting PERG abnormalities in individual OHT patients. CONCLUSIONS: The results indicate that in OHT there is a significant although weak correlation between PERG amplitude and the shape of the optic disc cup, suggesting a parallel involvement of both function and morphology. Combined PERG and optic disc cup structural analysis is of potential diagnostic value to detect early damage to optic nerve head in individual OHT patients.

A new device for ocular surgical training on enucleated eyes.

OBJECTIVE: To develop a reliable inexpensive device for teaching ocular surgical procedures and practicing experimental techniques on enucleated eyes. DESIGN: Teaching device trial. PARTICIPANTS: Thirty enucleated porcine eyes. METHODS: A Plexiglas ocular bulb holder was secured with its base support to a polyvinylchloride pillar on a modified polystyrene trial head. MAIN OUTCOME MEASURE: The convenience and reproducibility of both laser and surgical ocular techniques performed with this new device were evaluated. RESULTS: This model allows curvilinear capsulorrhexis and phacoemulsification of porcine lenses through a corneal tunnel incision and insertion of a soft foldable acrylic intraocular lens into the capsular bag. Argon and neodymium:YAG laser iridotomy and retinal argon laser photocoagulation can also be performed with this model. CONCLUSIONS: This inexpensive device is useful for teaching both surgical and laser ocular procedures.

The spatial tuning of steady state pattern electroretinogram in multiple sclerosis.

In normal subjects, the steady-state electroretinogram in response to contrast reversing gratings (PERG), is spatially band-pass tuned in amplitude, with a maximum at intermediate spatial frequencies and an attenuation at lower and higher ones. The amplitude attenuation at low spatial frequencies is believed to reflect centre-surround antagonistic interactions in the receptive fields of inner retinal neurons. The aim of this study was to evaluate the PERG spatial tuning in multiple sclerosis (MS) patients without a previous optic neuritis history. Steady- state PERGs in response to counterphase-modulated (8 Hz) sinusoidal gratings of variable spatial frequency (0.6, 1.0, 1.4, 2.2 and 4.8 c/deg), were recorded from 18 patients with definite or probable MS and no history of optic neuritis (ON-). Nine of them had no signs of subclinical optic nerve demyelination (asymptomatic) in either eye, while nine had symptoms or signs of optic pathways involvement (symptomatic) in one or both eyes. Results were compared with those obtained from 10 MS patients with a previous history of optic neuritis (ON+) in one or both eyes, as well as from 21 age-matched controls. The amplitudes and phases of the responses' 2nd harmonics were measured. Compared with the controls, asymptomatic ON- patients showed selective losses in mean PERG amplitudes at medium and high (1.0-4.8 c/deg) spatial frequencies. Symptomatic ON- patients and ON+ patients had reductions in mean PERG amplitudes, with respect to controls, involving the whole spatial frequency range, but with greater losses at medium-high (1.0-4.8 c/deg) than at lower spatial frequencies. In all patients' groups, the average PERG spatial tuning function differed significantly from that of the controls, assuming a low-pass instead of the normal band-pass shape. The PERG phase was delayed in ON+ but not in ON- patients, as compared to controls. However, the phase delay was independent of spatial frequency. In both ON- and ON+ patients, losses in PERG amplitude and spatial tuning tended to be associated with corresponding abnormalities in perimetric sensitivity, visual acuity, colour vision and transient visual evoked potential (VEP) latency. The results indicate that abnormalities of the spatial tuning of steady-state PERG can be found in MS patients without either optic neuritis or signs of subclinical optic nerve demyelination. These changes may reflect a retinal dysfunction, developing early in the course of MS, due to a loss of specific subpopulations of inner neurons, changes in lateral interactions of their receptive fields, or both.

Pattern electroretinogram and optic nerve topography in ocular hypertension.

It is known that changes in pattern electroretinogram (PERG) and optic disk morphology may both precede the onset of visual field damage in glaucomatous disease. However, the relationship between PERG and optic disk morphometry in ocular hypertension (OHT) has not yet been evaluated in detail. This study of PERG amplitude in a group of OHT patients indicates its significant correlation with various optic disk morphometric parameters, in particular, those of optic disk sectors considered at risk for early glaucomatous damage. Analysis of individual data points to the possibility that, while functional abnormalities may often precede optic disk morphologic changes, in a much lower number of cases it seems to be the other way around.

Transiently raised intraocular pressure reveals pattern electroretinogram losses in ocular hypertension.

PURPOSE: It is known that the pattern electroretinogram (PERG) of normal subjects is reduced temporarily after short-term elevation of intraocular pressure (IOP). The authors evaluated PERG changes in ocular hypertension during and after transient IOP elevation. METHODS: Steady state (8 Hz) PERGs to sinusoidal gratings (1.7 cyc/deg spatial frequency) were recorded in seven untreated patients with ocular hypertension at medium risk (maximum IOP, 22 to 25 mm Hg; cup-disk ratio, 0.6 to 0.7; normal Humphrey 30-2 visual field results; positive family history), as well as in six age-matched normal subjects. Recordings were obtained for the baseline condition during a short-term (6-minute) IOP elevation (to 30 mm Hg) by using a suction cup apparatus and during a 6-minute recovery period after removal of the apparatus. RESULTS: During IOP elevation, PERG amplitudes were reduced significantly from baseline values in normal subjects and patients. However, PERG losses were significantly greater in patients (average loss from baseline after 4 minutes of IOP elevation: 72% +/- 7.6%) compared to controls (average loss after 2 minutes of IOP elevation: 40% +/- 7.5%). In the recovery phase, mean PERG amplitude returned to baseline values in normal subjects but not in patients, whose recovery took longer. In normal subjects, PERG phase did not change either during or after IOP elevation. In patients, however, PERG phase showed a delay from baseline during and after IOP elevation (average delay after 6 minutes of recovery: -41.1 degrees +/- 13 degrees). CONCLUSIONS: Results indicate that increasing IOP with scleral suction produces greater PERG losses in eyes with ocular hypertension than in normal eyes. This suggests that the inner retina of eyes with ocular hypertension may have a heightened sensitivity to vascular or mechanical changes induced by transient IOP elevation.

Optic nerve diameters and perimetric thresholds in idiopathic intracranial hypertension.

AIMS/BACKGROUND: Idiopathic intracranial hypertension (IIH) is a central nervous disorder characterised by abnormally increased cerebrospinal fluid (CSF) pressure leading to optic nerve compression. An indirect estimate of increased CSF pressure can be obtained by the ultrasonographic determination of optic nerve sheaths diameters. Computerised static perimetry is regarded as the method of choice for monitoring the course of the optic neuropathy in IIH. The aims were to compare the echographic optic nerve diameters (ONDs) and the perimetric thresholds of patients with IIH with those of age-matched controls, and to examine the correlation between these two variables in individual patients with papilloedema. METHODS: Standardised A-scan echography of the mid orbital optic nerve transverse diameters and automated threshold perimetry (Humphrey 30-2) were performed in 20 patients with IIH with variable degree of papilloedema (according to the Frisén scheme) and no concomitant ocular diseases. Echographic and perimetric results were compared with those obtained from 20 age-matched controls. RESULTS: When compared with controls, patients with IIH showed a significant increase in mean ONDs and significantly reduced mean perimetric sensitivities. In individual patients with papilloedema, the transverse ONDs correlated negatively with Humphrey mean deviation values and positively with pattern standard deviation values. CONCLUSION: These results indicate that OND changes in IIH are associated with perimetric threshold losses, and suggest that IIH functional deficits may be related to the degree of distension of optic nerve sheaths as a result of an increased CSF pressure.

Pattern electroretinogram in treated ocular hypertension: a cross-sectional study after timolol maleate therapy.

To investigate pattern electroretinogram changes in treated ocular hypertension, we evaluated pattern electroretinogram recordings of 48 hypertensive eyes following an 8-month timolol maleate therapy. During treatment, 27 of 48 eyes had normalized intraocular pressures (15-18 mm Hg), while 21 retained elevated values (21-25 mm Hg). Twenty-eight eyes with untreated hypertension (22-25 mm Hg) lasting at least 8 months, as well as 32 untreated, normotensive eyes served as controls. When compared to untreated normotensive controls, timolol-treated eyes with either elevated or normalized intraocular pressures showed reductions in the mean electroretinographic amplitudes. However, these amplitude reductions were substantially greater in treated eyes with elevated pressures as compared to those with normalized ones. Untreated hypertensive controls showed pattern electroretinogram reductions, with respect to normal values, that were comparable to those of treated hypertensive eyes, but larger than those of treated normotensive ones. These results indicate that, in treated ocular hypertension, pattern electroretinogram losses tend to be associated with moderately increased intraocular pressures in the range of 21-25 mm Hg. Electroretinographic abnormalities may be, at least in part, prevented only by lowering intraocular pressure into a normal range.

Transvenous sclerotherapy of the gonadal veins for treatment of varicocele: long-term results.

Percutaneous occlusion of the spermatic vein has been performed on 136 consecutive patients with varicocele scroti during the last six years. The authors report their long-term results on the first 119 cases to have a follow-up of at least six months. Occlusion of the insufficient gonadal vein is induced by the selective transcatheter injection of sclerosing agent with local anesthesia. Their patients are always evaluated before and after the procedure by Doppler examination. A spermiogram is done before the procedure and after six months. In this series they registered only 4 recurrences with no major complications.

[Rupture of hydatid cyst with invasion of the bile ducts and acute pancreatitis]. / Invasione delle vie biliari da rottura di cisti idatidea e pancreatite acuta.

Acute pancreatitis is a rare complication of intrabiliary rupture of an hydatid cyst. The Authors report a new case and discuss its clinical, radiological and surgical findings with special emphasis to the diagnostic approach and surgical management.