Functional MRI examination of visual pathways in patients with unilateral optic neuritis.

The relations between brain areas involved in vision were explored in 8 patients with unilateral acute optic neuritis using functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI). In all patients monocular stimulation of affected and unaffected eye elicited significantly different activation foci in the primary visual cortex (V1), whereas the foci evoked in the middle temporal visual area (area V5) were similar in size and in delay of blood-oxygen-level-dependent response. DTI analysis documented lower white matter anisotropy values and reduced fibre reconstruction in the affected compared with the unaffected optic nerves. The preserved activation of area V5 observed in all our patients is an interesting finding that suggests the notion of a different sensitivity of the optic pathways to inflammatory changes.

Unilateral visual loss due to ischaemic injury in the right calcarine region: a functional magnetic resonance imaging and diffusion tension imaging follow-up study.

To study the functional recovery of a patient with cerebrovascular injury using combined functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI). A 24-year-old woman with left hemianopsia underwent fMRI and DTI in a 1.5-tesla machine both in the acute phase and 1 month after an ischaemic stroke involving the right calcarine cortex. Acute-phase fMRI demonstrated that peripheral left visual field stimulation did not activate the right primary visual cortex, whereas stimulation 1 month later activated the visual cortex bilaterally. Analysis of acute-phase DTI data disclosed that a reduction of fractional anisotropy in the right optic radiation had almost resolved after 1 month. Fibre direction was normal at either time point. fMRI and DTI can demonstrate functional damage and recovery in patients with neuro-ophthalmological lesions.

Long-term control of choroidal neovascularization in quiescent congenital toxoplasma retinochoroiditis with photodynamic therapy: 4-year results.

PURPOSE: To evaluate the efficacy and safety of photodynamic therapy (PDT) in the long-term control of subfoveal choroidal neovascularization (CNV) associated with toxoplasmic retinochoroiditis. METHODS: The records of 13 patients with classic subfoveal CNV associated with toxoplasmic retinochoroiditis treated with PDT were reviewed. All patients were followed up for at least 48 months. Postoperative visual acuity was defined as a gain or loss of two or more lines of best-corrected visual acuity (BCVA), respectively. Post-treatment CNV size was dichotomized into "increased" if the major CNV diameter (CMD) had increased by >or=300 microm, and as "stable/reduced" if it had decreased by >or=300 microm or had not changed by >300 microm. RESULTS: Nine patients [four males (44.4%) and five females (55.6%)] with a mean age of 20.1 +/- 4.3 years (range 14-27 years) were enrolled in the study. All had unilateral involvement. The median follow-up was 55 months (minimum 48, maximum 65 months). At the 48-month follow-up, all patients had stable/improved BCVA and a mean stable/reduced CMD (846 +/- 326.5 microm), with the BCVA having improved significantly (p < 0.0001) from 0.29 +/- 0.19 at baseline to 0.54 +/- 0.16 at 48 months. CONCLUSION: Photodynamic therapy seems to be a safe and effective approach to the long-term control of subfoveal CNV associated with toxoplasmic retinochoroiditis. Further trials are needed to validate these findings.

Retinal vasculitis associated with asymptomatic Gardnerella vaginalis infection: a new clinical entity.

PURPOSE: To report on 3 cases of retinal vasculitis associated with asymptomatic Gardnerella vaginalis (GV) infection. METHODS: Review of 3 consecutive patients who presented with central retinal vasculitis without signs or symptoms of systemic disease. The vasculitis involved the central branches of the retinal vessels bilaterally and was steroid-dependent. RESULTS: During treatment, patients developed clinically significant vaginitis, which the gynecologist considered to be exacerbated by the steroid treatment, leading to its withdrawal. All 3 vaginal specimens were positive for GV. Antibiotic susceptibility testing led to administration of oral ampicillin (2 g/day for 10 days), which resolved both the vaginal infection and the retinal vasculitis. CONCLUSIONS: Idiopathic retinal vasculitis can be triggered by several agents. In this case series, GV was associated with retinal vasculitis, which was resolved by oral ampicillin. GV infection may be one of a number of triggers of retinal vasculitis. Appropriate treatment and full resolution of ocular inflammation requires exclusion of possible underlying infections.

Vitritis in the contralateral uninjected eye following intravitreal bevacizumab (Avastin).

PURPOSE: To report a case of contralateral vitritis following intravitreal bevacizumab (Avastin, Roche Pharma). CASE SUMMARY: A 54-year-old man was treated with intravitreal bevacizumab (IB) for a choroidal neovascularization secondary to anisometropic high myopia in the right eye that did not respond to photodynamic treatment. After the second injection, he showed a moderate vitritis in the fellow un-injected eye a few hours later. RESULTS: The patient was treated with a sub-Tenon's injection of 40 mg triamcinolone (Kenacort, Squibb) and entirely recovered his vision. No further complications were observed. DISCUSSION: Although IB has a satisfactory safety profile, the possibility of unusual complications associated with the drug or the procedure itself should always be considered.

White-matter alterations and callosal abnormalities in syndromic patients with mental retardation.

The aim of this study was to evaluate the frequency of callosal abnormalities and white matter alterations in syndromic patients. The authors report on the cerebral magnetic resonance imaging (MRI) morphologic analysis of the corpus callosum and white matter in 73 normal subjects and 61 syndromic patients. The study of the corpus callosum was carried out by MRI using different morphometric methods: measurement of the dimensions of length and thickness of genu, body, and splenium; measurement of angles obtained using the sagittal plane; and application of the proportional grid of Talairach. The evaluation of the white matter was carried out by applying a subjective grading scale. Abnormalities of the corpus callosum were found in about 50% of the syndromic subjects; in half of these cases, the abnormalities were associated with white matter alterations. In five syndromic patients (8.2%), the white matter alterations were not associated with corpus callosum abnormalities. This study shows that corpus callosum abnormalities are frequent in syndromology regardless of the syndrome type.