Auditory and Visual Health after Ten Years of Exposure to Metal-on-Metal Hip Prostheses: A Cross-Sectional Study Follow Up

Case reports of patients with mal-functioning metal-on-metal hip replacement (MoMHR) prostheses suggest an association of elevated circulating metal levels with visual and auditory dysfunction. However, it is unknown if this is a cumulative exposure effect and the impact of prolonged low level exposure, relevant to the majority of patients with a well-functioning prosthesis, has not been studied. Twenty four male patients with a well-functioning MoMHR and an age and time since surgery matched group of 24 male patients with conventional total hip arthroplasty (THA) underwent clinical and electrophysiological assessment of their visual and auditory health at a mean of ten years after surgery. Median circulating cobalt and chromium concentrations were higher in patients after MoMHR versus those with THA (P<0.0001), but were within the Medicines and Healthcare Products Regulatory Agency (UK) investigation threshold. Subjective auditory tests including pure tone audiometric and speech discrimination findings were similar between groups (P>0.05). Objective assessments, including amplitude and signal-to-noise ratio of transient evoked and distortion product oto-acoustic emissions (TEOAE and DPOAE, respectively), were similar for all the frequencies tested (P>0.05). Auditory brainstem responses (ABR) and cortical evoked response audiometry (ACR) were also similar between groups (P>0.05). Ophthalmological evaluations, including self-reported visual function by visual functioning questionnaire, as well as binocular low contrast visual acuity and colour vision were similar between groups (P>0.05). Retinal nerve fibre layer thickness and macular volume measured by optical coherence tomography were also similar between groups (P>0.05). In the presence of moderately elevated metal levels associated with well-functioning implants, MoMHR exposure does not associate with clinically demonstrable visual or auditory dysfunction

Clinical and Radiological Findings in Patients with Traumatic Optic Neuropathy: A Case Series

Traumatic optic neuropathy is a well-recognised consequence of head trauma and frequently results in significant irreversible loss of vision. Previous reports have suggested that up to 10% of patients with craniofacial fractures have traumatic optic neuropathy. Corticosteroids and orbital decompression have previously been advocated as treatment options, although studies have previously shown no significant improvement in visual outcome with steroids and some studies have suggested that steroids may result in increased mortality. There is limited understanding of the exact pathophysiology of traumatic optic neuropathy and of the correlation between injury mechanism, anatomical location and final visual outcome

Bilateral superior rectus transposition and medial rectus recession for bilateral sixth nerve palsy

Purpose: To present the results of bilateral superior rectus transposition with medial rectus recession in a case of chronic bilateral sixth nerve palsy. Observation: Bilateral superior rectus transposition with medial rectus recession resulted in full correction of esotropia with resolution of horizontal diplopia, improvement in abduction, and regain of stereoacuity in our case. There was minimal limitation of adduction, with no abnormal vertical or torsional changes. Conclusion and importance: Bilateral superior rectus transposition with medial rectus recession appears to be a useful procedure for surgical treatment of bilateral sixth nerve palsy with minimal side effects. Given its potential for reduced risk of anterior segment ischemia (ASI), it may have especially good value in the select group of patients at risk for ASI. Studies with larger sample size and longer follow up are needed to further evaluate this procedure and elucidate the variables in surgical technique for superior rectus transposition

Ethambutol Induced Optic Neuropathy: A Case Series

Optic neuropathy is a rare but potentially sight-threatening adverse effect of the anti-tuberculous agent ethambutol. The consequences can be devastating, with early diagnosis and cessation of medication critical in preventing irreversible visual loss. Royal College of Ophthalmologists in the United Kingdom recently revised its guidelines in regards to baseline assessment prior to commencement of the medication, advising that baseline assessment must be performed by the prescriber

Tubular Aggregate Myopathy with Miosis and Rod-Cone Dysfunction

Tubular aggregate myopathy (TAM) is a rare condition primarily affecting skeletal muscles. Abnormal proteins build up in type I and II fibres forming bundles of tube-like structures called tubular aggregates. It is characterized by muscle pain, cramps, weakness and fatigability. There have been reports of pupil miosis, ophthalmoplegia and retinal degeneration in patients with TAM. Two genes have been implicated in TAM; STIM1 gene encodes a protein which acts as endoplasmic reticulum calcium sensor, and ORAI1 gene which encodes calcium release-activated calcium channel. We report a patient with miosis, rod-cone dysfunction and TAM with heterozygous Pro245Leu mutation in the ORAI1 gene

Pediatric Anisocoria - How Worried Should You Be?

Anisocoria is a common referral to the pediatric Ophthalmologist. We reviewed the clinical course of patients seen with anisocoria in the pediatric department of our eye hospital

Trochleitis Without Imaging Abnormality

Trochleitis is an uncommon inflammation of the trochlea/peritrochlear region, and there are relatively few reports to guide management in the scientific literature. Clinically, there is characteristic pain and tenderness over the trochlea and pain on vertical ductions. Orbital imaging can show localised swelling and superior oblique inflammation. We report a case of trochleitis, diagnosed clinically, with no demonstrable radiological features, successfully managed by peritrochlear injection of dexamethasone/lidocaine

Aetiology of Acute Sixth Nerve Palsies in Children

Existing literature on the aetiology of acute sixth cranial nerve palsies in children is variable with limited generalisablity given that many studies originate from tertiary neuro-ophthalmic centres. An acute sixth nerve palsy may be the presenting feature of a brain tumour, butthe spectrum of underlying aetiology in children is wide including many more benign causes. Given the potential for serious underlying pathology, and as assessment of children with acute esotropia may be difficult, many proceed to neuroimaging often requiring general anaesthesia. We aimed to determine the incidence, underlying aetiology and further management of acute sixth nerve palsy in our dedicated eye hospital