The Microbiome of Temporal Arteries

Objective: A role for microorganisms in giant cell arteritis (GCA) has long been suspected. We describe the microbiomes of temporal arteries from patients with GCA and controls. Methods: Temporal artery biopsies from patients suspected to have GCA were collected under aseptic conditions and snap-frozen. Fluorescence in situ hybridization (FISH) and long-read 16S rRNA-gene sequencing was used to examine microbiomes of temporal arteries. Taxonomic classification of bacterial sequences was performed to the genus level and relative abundances were calculated. Microbiome differential abundances were analyzed by principal coordinate analysis (PCoA) with comparative Unifrac distances and predicted functional profiling using PICRUSt. Results : Forty-seven patients, including 9 with biopsy-positive GCA, 15 with biopsy-negative GCA and 23 controls without GCA, were enrolled. FISH for bacterial DNA revealed signal in the arterial media. Beta, but not alpha, diversity differed between GCA and control temporal arteries (P = 0.042). Importantly, there were no significant differences between biopsy-positive and biopsy-negative GCA (P > 0.99). The largest differential abundances seen between GCA and non-GCA temporal arteries included Proteobacteria (P), Bifidobacterium (g), Parasutterella (g) and Granulicatella (g) [Log 2-fold change > 4]. Conclusion: Temporal arteries are not sterile, but rather are inhabited by a community of bacteria. We have demonstrated that there are microbiomic differences between GCA and non-GCA temporal arteries, but not between biopsy-positive and biopsy-negative GCA

Development and validation of a computerized expert system for evaluation of automated visual fields from the Ischemic Optic Neuropathy Decompression Trial

BACKGROUND: The objective of this report is to describe the methods used to develop and validate a computerized system to analyze Humphrey visual fields obtained from patients with non-arteritic anterior ischemic optic neuropathy (NAION) and enrolled in the Ischemic Optic Neuropathy Decompression Trial (IONDT). The IONDT was a multicenter study that included randomized and non-randomized patients with newly diagnosed NAION in the study eye. At baseline, randomized eyes had visual acuity of 20/64 or worse and non-randomized eyes had visual acuity of better than 20/64 or were associated with patients refusing randomization. Visual fields were measured before treatment using the Humphrey Field Analyzer with the 24-2 program, foveal threshold, and size III stimulus. METHODS: We used visual fields from 189 non-IONDT eyes with NAION to develop the computerized classification system. Six neuro-ophthalmologists ("expert panel") described definitions for visual field patterns defects using 19 visual fields representing a range of pattern defect types. The expert panel then used 120 visual fields, classified using these definitions, to refine the rules, generating revised definitions for 13 visual field pattern defects and 3 levels of severity. These definitions were incorporated into a rule-based computerized classification system run on Excel(® )software. The computerized classification system was used to categorize visual field defects for an additional 95 NAION visual fields, and the expert panel was asked to independently classify the new fields and subsequently whether they agreed with the computer classification. To account for test variability over time, we derived an adjustment factor from the pooled short term fluctuation. We examined change in defects with and without adjustment in visual fields of study participants who demonstrated a visual acuity decrease within 30 days of NAION onset (progressive NAION). RESULTS: Despite an agreed upon set of rules, there was not good agreement among the expert panel when their independent visual classifications were compared. A majority did concur with the computer classification for 91 of 95 visual fields. Remaining classification discrepancies could not be resolved without modifying existing definitions. Without using the adjustment factor, visual fields of 63.6% (14/22) patients with progressive NAION and no central defect, and all (7/7) patients with a paracentral defect, worsened within 30 days of NAION onset. After applying the adjustment factor, the visual fields of the same patients with no initial central defect and 5/7 of the patients with a paracentral defect were seen to worsen. CONCLUSION: The IONDT developed a rule-based computerized system that consistently defines pattern and severity of visual fields of NAION patients for use in a research setting

Treatment Options: Surgical

Mechanism of Papilledema: elevation of ICP; creates an increase in hydrodynamic force, force is brought to bear at the lamina cribrosa, lamina cribrosa is an anatomically critical area, combination of ischemia and mechanical compression, interuption of axoplasmic transport, Macro/micro-vesicular elements and mitochondria get stuck when making the 900 turn at the lamina, clinical appearance of papilledema result

Would You Believe Normal Tension Glaucoma?

ScotomaA 40-year old female with a right superonasal scotoma.VA: Best-corrected, 20/15 OUMRI; CTOptic canal stenosisSurgeryAttache

Familial Ophthalmoplegia-Plus Syndrome With Corneal Endothelial Disorder

We report two brothers, both of whom have chronic, progressive external ophthalmoplegia (CPEO) with hypogonadism, mild rod cone dysfunction, primary testicular failure, and neural deafness

Hydrocephalus - An Overview

Hydrocephalus is an abnormal accumulation of cere-brospinal fluid (CSF) within the cerebral ventricles. It maybe divided into disorders that are viewed as either hydro-dynamic or hydrostatic. A hydrodynamic disorder is one in which abnormalities in the movement of the CSF are considered pathologic, and hydrostatic disorders are those where the CSF is considered to be at rest, but not necessarily without producing pathologic effects, most typically secondary to raised pressure

Central Ocular Neuromyotonia

Delay in muscle relaxation after voluntary contraction, which originates from a peripheral nerve, has been termed "neuromyotonia" to distinguish it from myotonia which originates from spontaneous contraction of muscle

Double Double, Toil and Trouble

DiplopiaA 58-year old male with a progressive arm and leg weakness associated with a rippling phenomenon when tapped.VA: 20/15 OU; Variable esotropiaMyoedema; Myotonic dystroph

The Genetic Aspects of Neurofibromatosis Type I

Neurofibromatosis type I (NF-I) is a common disorder affecting approximately one in every 3,500 - 4,000 people. Although, the dominant mutant allele seems to be fully penetrant, the clinical expressivity is highly variable, ranging from insignificant caf6-au-lait spots to malignant neurofibrosarcomas. Approximately one-half ofthe patients are born with NF-I will suffer serious medical and social complications. NF-I is a heterogeneous disease with numerous manifestations. Heterogeneity has both clinical and etiologic levels. Clinical heterogeneity has two elements, one of these simply reflects a variation (that is degree ortype of expression), and one that may at least potentially reflect distinct entities