Volume of visual field assessed with kinetic perimetry and its application to static perimetry

John B ChristoforidisCollege of Medicine, The Ohio State University, Columbus, OH, USABackground: The purpose of this study was to quantify the volume of the kinetic visual field with a single unit that accounts for visual field area and differential luminance sensitivity.Methods: Kinetic visual field perimetry was performed with a Goldmann perimeter using I4e, I3e, I2e, and I1e targets. The visual fields of 25 normal volunteers (17 women, eight men) of mean age 33.9 ± 10.1 (range 17–64) years were obtained and digitized. Isopter areas were measured with a method devised to correct cartographic distortion due to polar projection inherent in perimetry and are expressed in steradians. The third dimension of each isopter represents sensitivity to target luminance and was calculated as log (target luminance-1). If luminance is expressed in cd/m2, the values for the third dimension are 0.5 for I4e, 1.0 for I3e, 1.5 for I2e, and 2.0 for I1e. The resulting unit is a steradian (log 103 (cd/m2)-1 which is referred to as a Goldmann. In addition, the visual fields of four patients with representative visual defect patterns were examined and compared with normal subjects.Results: Mean isopter areas for normal subjects were 3.092 ± 0.242 steradians for I4e, 2.349 ± 0.280 steradians for I3e, 1.242 ± 0.263 steradians for I2e, and 0.251 ± 0.114 steradians for the I1e target. Isopter volumes were 1.546 ± 0.121 Goldmanns for the I4e target, 1.174 ± 0.140 Goldmanns for I3e, 0.621 ± 0.131 Goldmanns for I2e, and 0.126 ± 0.057 Goldmanns for I1e. The total mean visual field volume in our study for the I target was 3.467 ± 0.371 Goldmanns.Conclusion: The volume of the island of vision may be used to quantify a visual field with a single value which contains information about both visual field extension and differential luminance sensitivity. This technique may be used to assess the progression or stability of visual field defects over time. A similar method may be applied to static perimetry.Keywords: visual field, kinetic perimetry, static perimetry, steradian, cartographic distortio

Optical coherence tomography findings of quinine poisoning

John Christoforidis, Robert Ricketts, Theodore Loizos, Susie ChangThe Ohio State University College of Medicine, Columbus, OH, USAPurpose: To report a case of acute quinine poisoning, document acute and chronic macular changes with optical coherence tomography imaging and fluorescein angiography (FA), and to review the literature on ocular toxicity of quinine.Methods: A 32-year-old white female presented to our Emergency Department after ingesting over 7.5 g of quinine. She underwent a complete ophthalmologic examination, fluorescein angiography, Stratus time-domain optical coherence tomography (OCT), and electroretinography at 72 hours and 15 months postingestion. Stratus time-domain and Cirrus spectral-domain OCT, fundus autofluorescence, and FA were obtained at 28 months postingestion.Results: Fluorescein angiography at 72 hours postingestion revealed normal filling times and vasculature. OCT showed marked thickening of the inner retina bilaterally. At 15 and 28 months follow-up, fundus photography and fluorescein angiography demonstrated optic nerve pallor, severely attenuated retinal vessels while OCT showed inner retinal atrophy. Fundus autofluorescence did not reveal any retinal pigmentary abnormalities.Conclusions: Quinine toxicity as seen by OCT reveals increased thickness with inner retinal hyperreflectivity acutely with development of significant retinal atrophy in the long-term. Fundus autofluorescence reveals an intact retinal pigment epithelial layer at 28 months. These findings suggest that quinine poisoning may produce a direct toxic effect on the inner retina in the acute phase resulting in long-term retinal atrophy.Keywords: retinal, optical coherence tomography, quinine toxicity&nbsp

A Rare Case of Traumatic Bilateral Fibular Head Fractures

Avulsion fibular head fractures are rare. There is only one reference of bilateral fibular fractures after epileptic seizure. We aim to present the mechanism and the treatment of this rare injury. We present the case of a 30-year-old woman who was hit by a car on the anteromedial side of both knees. Clinical and radiographic control showed bilateral fibular head fractures. Knee instability was not found at both knees and MRI did not show any concomitant ligament ruptures. Bone bruises of both medial condyles found in MRI explain the mechanism of this injury. The patient was treated conservatively with functional knee braces for 6 weeks allowing full range of motion, but otherwise mobilised as normal without any support. Six weeks after the trauma, there were no symptoms while the fractures sites had united completely after 6 months. One year postinjury the patient was free from symptoms