Internuclear Ophthalmoplegia

A slideshow describing INO; includes a video clip of saccadic delay

Choroidal Infarction in Giant Cell Arteritis

An 80-year-old Caucasian woman presented with a 10-day history of headaches, intermittent binocular diplopia, and jaw pain. Temporal artery biopsy confirmed a diagnosis of giant cell arteritis. Examination showed characteristic large area of choroidal ischemia that is well-known to be associated with GCA. The finding of choroiodal ischemia was confirmed by fluorescein angiography and indocyanine angiography ancillary testing.EECgiantcellarteritis; EECexaminationimagingmri; kbdsysdisgiantcellarteritistemporalarteriti

MRI findings in Giant Cell Arteritis

Case 1. An 80-year-old Caucasian woman presented with a 10-day history of headaches, intermittent binocular diplopia, and jaw pain. Temporal artery biopsy confirmed a diagnosis of giant cell arteritis. MRI with contrast showed enhancement of bilateral optic nerve sheaths in addition to enhancement of the orbital fat. Case 2. A 70-year-old Caucasian man presented with a one-month history of blurred vision in both eyes that progressed to tunnel-vision, associated with jaw claudication and temporal tenderness. MRI with contrast showed enhancement of bilateral optic nerve sheaths.EECgiantcellarteritis; EECexaminationimagingmri; kbdsysdisgiantcellarteritistemporalarteriti

OCT Biomarkers in Spinocerebellar Ataxia Type-3 and Correlation With Clinical Data

Ameloblastoma is a rare, benign, highly recurrent tumor, derived from the odontogenic apparatus, which can rarely present with neuro-ophthalmologic manifestations. To our knowledge, orbital invasion has been reported in 36 cases of ameloblastoma, including five with cavernous sinus invasion. We present a rare case of a recurrent ameloblastoma presenting with signs of orbital apex syndrome due to direct invasion into the orbit and cavernous sinus

Risk factors and visual sequel of non-arteritic ischemic optic neuropathy in Saudi Arabia

Objective: To provide the demographic data, risk factors, and visual prognosis of patients from a Saudi population diagnosed with non-arteritic anterior ischemic optic neuropathy (NAION). Materials and Methods: A retrospective observational case series of 120 patients (146 eyes) with NAION from the King Khaled Eye Specialist Hospital or King Abdulaziz University Hospital from 1998 to 2015. Patients with other retinal pathology or glaucoma were excluded from the study. Additionally, a subgroup analysis was performed to compare the long-term assessment between diabetic and non-diabetic patients and its effects on NAION. Results: The mean duration of follow-up was 1.7 ± 2.4 years. The mean age of the study population was 55.0 ± 10.1 years. NAION was present in the fellow eye of 26 patients, and the median time for involvement was less than 1 year from the presentation. There was no significant difference in the best-corrected visual acuity between diabetics and non-diabetics at presentation or last visit (P = 0.868, P = 0.599, respectively). Conclusions: The majority of patients with NAION also had coexisting diabetes mellitus. Diabetes mellitus had no significant effect on NAION during the presentation, follow-up, and last visit

Delayed spontaneous closure of blue laser-induced full thickness macular hole

Purpose: To report a blue laser-induced full thickness macular hole (FTMH) with delayed spontaneous closure without surgical intervention. Observations: A 14-year old male developed full thickness macular hole after momentary exposure to a high-power handheld blue laser device. The macular hole closed spontaneously over a long period of observation. Conclusion: Despite an initial enlargement in size, small FTMH caused by blue lasers may close spontaneously over an extended period of observation. Keywords: Blue laser, Full thickness macular hole, Spontaneous closur

Internuclear Ophthalmoplegia (INO)

A 67-year-old man with a known history of heart failure and atrial fibrillation developed binocular horizontal diplopia in right gaze after cardiac catheterization. His examination showed normal afferent visual function, full ocular movement of the right eye, and slow adducting saccades in the left eye only which explain his intermittent diplopia in right gaze. He had normal vertical eye movements in addition to normal lid and pupillary examinations. Figure 1a/b : Axial MRI showing diffusion weighted imaging (DWI) hyperintensity in the left posterior pons (A) with corresponding apparent diffusion coefficient (ADC) hypointensity (B), confirming an acute ischemic stroke (lacunar infarction) Figure 2: Illustration showing the anatomy of the RIGHT medial longitudinal fasciculus (MLF).EECIN

Comparison of posterior hyaloid assessment using preoperative optical coherence tomography and intraoperative triamcinolone acetonide staining during vitrectomy

Purpose: To compare the specificity of diagnosing posterior vitreous detachment (PVD) using preoperative optical coherence tomography (OCT) versus intraoperative triamcinolone acetonide (TA) staining in patients undergoing vitrectomy. Patients and Methods: This retrospective cohort study included patients undergoing pars plana vitrectomy for diverse retinal pathologies. Intraoperatively, surgeons evaluated the posterior hyaloid status with TA staining and compared it with preoperative OCT findings. Results: One hundred six patients underwent intraoperative assessments of posterior hyaloid status, with 72% (76/106) of the eyes showing positive staining. Sixty-two patients had also undergone preoperative OCT. Of the patients diagnosed with PVD on preoperative OCT, 50% (15/30) showed positive TA staining intraoperatively. The sensitivity of preoperative OCT assessment was 83.3%, and its specificity was 65.9%. Conclusion: Preoperative OCT imaging is associated with lower sensitivity and specificity for diagnosing PVD when compared to intraoperative TA staining

Classic Pathology Findings in Giant Cell Arteritis

An 80-year-old Caucasian woman presented with a 10 day history of headaches, intermittent binocular diplopia, and jaw pain. Temporal artery biopsy confirmed a diagnosis of giant cell arteritis. Pathology findings were classic for giant cell arteritis with numerous inflammatory cells in the tunica media and tunica intima and with loss of the internal elastic lamina.EECgiantcellarteritis; kbdsysdisgiantcellarteritistemporalarteriti

Clinical characteristics of full thickness macular holes that closed without surgery.

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.Purpose: To ascertain the anatomic factors that help achieve non-surgical sealing in full thickness macular hole (FTMH). Methods: Retrospective collaborative study of FTMH that closed without surgical intervention. Results: A total of 78 patients (mean age 57.9 years) included 18 patients with blunt ocular trauma, 18 patients that received topical or intravitreal therapies and 42 patients with idiopathic FTMH. Mean±SD of the initial corrected visual acuity (VA) in logMAR improved from 0.65±0.54 to 0.34±0.45 (p<0.001) at a mean follow-up of 33.8±37.1 months. FTMH reopened in seven eyes (9.0%) after a mean of 8.6 months. Vitreomacular traction was noted in 12 eyes (15.8%), perifoveal posterior vitreous detachment in 42 (53.8%), foveal epiretinal membrane in 10 (12.8%), cystoid macular oedema (CME) in 49 (62.8%) and subretinal fluid (SRF) in 20 (25.6%). By multivariate analysis, initial VA correlated to the height (p<0.001) and narrowest diameter of the hole (p<0.001) while final VA correlated to the basal diameter (p<0.001). Time for closure of FTMH (median 2.8 months) correlated to the narrowest diameter (p<0.001) and the presence of SRF (p=0.001). Mean time for closure (in months) was 1.6 for eyes with trauma, 4.3 for eyes without trauma but with therapy for CME, 4.4 for eyes without trauma and without therapy in less than 200 μm in size and 24.7 for more than 200 μm. Conclusion: Our data suggest an observation period in new onset FTMH for non-surgical closure, in the setting of trauma, treatment of CME and size <200 μm