Optical coherence tomography angiography findings in optic nerve sheath meningioma

A 46-year-old female with a history of 5 months of progressive painless visual loss in the left eye was found to have an optic nerve sheath meningioma. Optical coherence tomography angiography showed a reduction in the superficial capillary plexus density consistent with her visual field defect and peripapillary retinal nerve fiber layer thinning. Moreover, abnormalities in the choriocapillaris were found in the affected eye compared to the fellow eye. Possible explanations for these findings are discussed. Further studies and a consistent number of cases are needed to correctly assess the impairment of ocular blood flow in optic nerve sheath meningioma

Intraocular Tuberculosis: A Challenging Case Mimicking Wet Age-Related Macular Degeneration

An otherwise healthy 72-year-old Chinese patient diagnosed with exudative age-related macular degeneration and decreased vision in left eye was fully investigated. The retrospective analysis of past multimodal imaging revealed bilateral severe choroidal neovascularization and choroiditis associated with a positive tuberculin skin testing and interferon-gamma release assay (QuantiFERON-TB Gold – Cellestis®, Chadstone, VIC, Australia) suggestive of latent ocular tuberculosis. The variable presentation and tests’ results interpretation represent the greatest limitations in understanding and treating intraocular TB (IOTB). This may present without any other systemic symptoms, the intraocular tissues are of limited access to biopsies and other tests, including imaging and immunological tests, are of relative value. This case highlights how variable may be the presentation of IOTB, which can be easily misdiagnosed leading to a delayed treatment and worse prognosis

Corneal involvement in Wallenberg syndrome: case report and literature review

A 47-year-old man with Wallenberg syndrome after a stroke in the territory of the left vertebrobasilar artery and posterior inferior cerebellar artery, presented a week later complaining of visual loss in the left eye. Examination showed corneal anaesthesia associated with a neurotrophic corneal epithelial defect. Corneal involvement secondary to trigeminal neuropathy in Wallenberg syndrome is not frequently reported and may lead to epithelial erosion and neurotrophic keratopathy. Clinicians should be aware that visual loss can occur from a neurogenic basis (e.g., Wallenberg syndrome) due to neurotrophic keratopathy. The use of cocaine, a potential cause of neurotrophic keratopathy, should also be suspected in the appropriate clinical scenario

Optical Coherence Tomography Angiography in Chiasmitis

A 29-year-old girl presented complaining of acute bilateral visual loss associated with mild headache and retrobulbar pain. She was diagnosed with chiasmal optic neuritis caused by multiple sclerosis. Her visual acuity and visual field defect promptly improved after steroid therapy. However optical coherence tomography angiography showed a progressive reduction of superficial capillary plexus density of the retina and optic nerve consistent with the progressive impairment of the retinal ganglionar cell layer. Contrary to chiasmal compression, in chiasmal optic neuritis, the superficial capillary plexus density reduction is diffuse and does not reflect the peculiar anatomy of the chiasm

ECHO COLOR DOPPLER STUDY DEMONSTRATING AN HIGHER INCIDENCE OF LEFT VS RIGHT RENAL ARTERY STENOSIS IN OLD PEOPLE

INTRODUCTION AND AIMS: Renal vascular pathology is a topic of rising clinical interest and growing therapeutic application (atherosclerosis prevention, percutaneous transluminal renal artery angioplasty and stenting). The aim of this study was to confirm our previous scintigraphic data suggesting a higher incidence of left Renal Artery Stenosis (RAS) Vs the right one. METHODS: 341 nephropathic or hypertensive elderly patients (pts) (219 males, 122 females) mean age 71.7 ± 15.5 (years ± SD) were studied with B mode ultrasound (US) and color Doppler (CD). Renal function was evaluated by determining serum creatinine and glomerular filtration rate (eGFR), calculated using the CKD-EPI formula. The kidney size has been measured by m mode ultrasound. The presence of stenosis has been defined as estimated lumen reduction >50%. RESULTS: Mean serum creatinine levels 1.8 ± 0.9 mg/dl, eGFR 44.1 ± 25.7 ml/min, due to hypertensive or parenchymal renal disease Right Kidney (RK) Longitudinal Diameter (LD) 103.2 ± 12.4 mm (Normal Value -NV)-: 109 ± 12 mm) and Left Kidney (LK) LD (103 ± 12.9 mm - NV: 112 ± 12 mm); that’s to say there is a slight inversion in anatomic size between the kidneys, with a left kidney shrinking for ageing more pronounced in our whole group of nephropathic people. Over 65 years the LK becomes clearly smaller than RK (101.2 ± 13.2 Vs 102.3 ± 12.4 mm) kidney cortical thickness (NV: 16-18 mm) resulted 14.2 ± 3.3 mm on the RK Vs of 13.9 ± 3.3 mm of the LK, confirming a more evident parenchymal loss on this side 100 pts (29%) presented renal artery stenosis with lumen reduction >50%: (in these, 78% interested a single renal artery versus 22% involved both renal arteries) In the subgroups with a single RAS, 31% (24) interested the RKartery and 69% (54) the LK artery, p <0.001 ). Pts with single or bilateral RAS showed more evident reduction in renal function (39.2+21.61) in comparison to pts without any stenosis (46.3 ± 27.04, p = 0.029). We didn’t find any statistically significant functional difference, between pts with single or bilateral stenosis (eGFR 38.5 ± 20.40 and 41.6 ± 25.8 ml/ min respectively p: ns) Index Resistance (IR) presented symmetrically in nephroangiosclerotic pts without any lateral unbalancement in pts without critical RAS. CONCLUSIONS: Our study confirms a higher susceptibility of the left renal artery to develop atherosclerotic stenosis in the elderly. This probably derives from anatomic reasons (first of all the narrower emergency angle) inducing blood flow turbulence and atheroslerosis progression. Peripheral Nephrosclerosis, on the contrary, results a symmetric disease, probably for a predominance of metabolic over reologic causes in atherosclerosis development. The LK seems hence more susceptible to aging progressively loosing both size and function. In over 65 people the RK becomes the predominant one in size and functional performance

Bilateral Implantation of Multifocal Intraocular Lenses: 10-Year Follow-Up

Purpose To evaluate and compare the long-term results after bilateral implantation of different multifocal intraocular lenses (MIOLs).Methods This retrospective comparative study included 42 patients who underwent cataract surgery with bilateral MIOL implantation. Patients were divided into 5 groups: Group 1 received a refractive ReZoom NGX1 IOL (AMO), Group 2 a diffractive Acrysof ReSTOR SA60D3 IOL (Alcon), and Group 3 a diffractive Tecnis ZM900 IOL (AMO). Group 4 and Group 5 were implanted using the mix and match approach with refractive ReZoom-diffractive ReSTOR IOL and refractive ReZoom-diffractive Tecnis ZM900 IOL, respectively. Primary outcome measures were distance, near, and intermediate distance visual acuity measured 6 months (T0) and 10 years (T1) after surgery. Secondary outcomes were defocus curves, contrast sensitivity, patients' satisfaction, and spectacle independence.Results All patients achieved best-corrected distance visual acuity (BCDVA) greater than 0.11 logMAR and uncorrected distance visual acuity (UCDVA) greater than 0.14 logMAR at both time points. A decrease in contrast sensitivity was evident, particularly at high spatial frequencies; at T1, Group 4 reported statistically higher values than Group 2 at 12 cycles/degree and 18 cycles/degree and statistically higher values than Group 3 at 18 cycles/degree. Great overall satisfaction was reported even in the presence of dysphotopsia. Tecnis ZM900 IOL showed the lowest incidence of posterior capsular opacification.Conclusion MIOLs could provide adequate functional vision and patient satisfaction, despite the incidence of side effects, in carefully selected patients desiring spectacle independence