The efficacy of microperimetry and contrast sensitivity test in the diagnosis of optic chiasm compression due to pituitary adenomas

Introduction: The aim of the study was to determine which microperimetry and contrast sensitivity test parameters would prove the most valuable during diagnosing optic chiasm compression due to pituitary adenomas. Material and methods: A control group comprised healthy individuals (Group 1). Patients with pituitary macroadenoma were divided into two groups: Group 2 — absent optic chiasm compression; and Group 3 — present optic chiasm compression detected on contrastenhanced magnetic resonance imaging (MRI). Each group comprised 20 patients (40 eyes), i.e. a total of 60 patients (120 eyes) were examined. A complete ocular examination, intraocular pressure, microperimetry, contrast sensitivity test, kinetic Goldmann visual field, and static Octopus visual field test were performed. Results: Group 1 and 2 variables showed no statistically significant differences with respect to the mean sensitivity (MS) and mean defect (MD) in microperimetry. After dividing the microperimetry area into quadrants, a difference was shown in the mean sensitivity of the lower-nasal quadrant (MS LN) and mean defect of the lower-nasal quadrant (MD LN) between those groups. Receiver operating characteristic (ROC) curves analysis revealed that the microperimetry parameter — MS LN as well as row D and E contrast sensitivity test could be highly specific in the assessment of early damage of the optic nerve in patients suffering from pituitary adenoma. Conclusions: Microperimetry and contrast sensitivity test are non-invasive diagnostic investigations adjunctive to MRI, which facilitate detection of early chiasmal compression caused by pituitary adenomas.

Long-term remission of steroid-resistant Graves’ orbitopathy after administration of anti-thymocyte globulin

Not required for Clinical Vignette

Ocular manifestations in Sjögren’s syndrome – it never rains but it pours? Case report

Zespół Sjögrena (Sjögren’s syndrome – SS) jest przewlekłą, autoimmunologiczną chorobą układową o charakterze zapalnym. Występują w nim limfocytarne nacieki zapalne w gruczołach wydzielania zewnętrznego, co prowadzi do ich znacznej dysfunkcji i zniszczenia. Stan chorobowy najczęściej obejmuje gruczoły łzowe i ślinianki, co powoduje suchość oczu i suchość w jamie ustnej. W pracy opisano przypadek 64-letniej kobiety, która od 6 lat odczuwała dyskomfort w prawym oku. Okulista rozpoznał zaćmę początkową obu oczu, owrzodzenie rogówki oka prawego i podwinięcie powieki dolnej prawej wymagające interwencji chirurgicznej. Pomimo udanego zabiegu rzęsy zaczęły nieprawidłowo odrastać i podrażniać rogówkę. W krótkim czasie problem nieprawidłowo rosnących rzęs objął również powieki lewego oka. Rzęsy powiek obu oczu wielokrotnie usuwano mechanicznie. Na podstawie objawów, dodatniego wyniku testu Schirmera oraz obecności przeciwciał SS-A rozpoznano SS. W kolejnych latach w obu oczach pacjentki rozwinęły się keratopatia wraz z ubytkami na-błonka rogówki, zaawansowana zaćma, podwinięcie górnych powiek oraz związany z tym nieprawidłowy wzrost rzęs. Stany te wymagały intensywnego leczenia farmakologicznego oraz chirurgicznego, w tym naszycia błony owodniowej na powierzchnię oka prawego, plastyki powiek, zamknięcia punktów łzowych i operacji zaćmy. Pomimo leczenia u pacjentki występują obecnie liczne zrosty spojówkowe oraz unaczynione bielmo rogówki prawego oka. Oprócz objawów ocznych pacjentka wykazuje objawy ze strony innych narządów.Sjögren’s syndrome (SS) is a chronic, systemic, autoimmune inflammatory disease. It is characterized by inflammatory lymphocytic infiltration of exocrine glands, leading to their significant dysfunction and destruction. Lacrimal and salivary glands are commonly affected, causing dryness of the eyes and mouth. The subject of the study is a case report of a 64-year-old woman who had been suffering from discomfort in her right eye for 6 years. Early stage cataract in both eyes, corneal ulceration of the right eye, and a right lower eyelid entropion requiring surgical intervention, were diagnosed at that time. Despite successful treatment, the eyelashes began to grow improperly again and irritated the cornea. Subsequently, the problem of trichiasis also affected the eyelid of the left eye. The eyelashes of both eyes were removed mechanically many times. Sjögren’s syndrome was diagnosed on the basis of the symptoms, a positive Schirmer test and the presence of SS-A antibodies. In the following years, the patient developed keratopathy with corneal epithelial defects, advanced stage cataract, and upper eyelid entropion with associated trichiasis in both eyes. These conditions required both intensive pharmacological and surgical treatment, including an amniotic membrane transplant onto the surface of the right eye, blepharoplasty, lacrimal puncta closure and cataract surgery. Despite the treatment, the patient currently has numerous conjunctival adhesions and vascularized corneal leucoma of the right eye. In addition to the ocular symptoms, the patient has presented other systemic signs