Progressive Visual Loss An Unusual Presenting Symptom In Giant Cell Arteritis

"Arteritic anterior ischemic optic neuropathy (AAION) due to Giant cell arteritis (GCA) is a rare cause of visual loss in Asian people. However, there are a few AAION cases in Asian that have been reported. In general, patient with AAION usually presented with acute severe visual loss with disc edema and systemic presentation of GCA.

Interobserver and Intra-Observer Reliability of Eyelid Tests for Ocular Myasthenia Gravis

Background: Lid fatigability test (LFT), Cogan lid twitch (CLT), and forced eyelids closure test (FECT) are simple clinical screening tests for ocular myasthenia gravis (OMG). However, these tests are subjectively interpreted. We thus evaluated the interobserver and intra-observer reliability of each test. Methods: The 3 eyelid tests were performed in ptotic patients associated with various conditions, including OMG and others. Video clips of all tests were recorded using smartphone with built-in camera in the following order; LFT, CLT, and FECT. All video clips were distributed to 3 neuro-ophthalmologists and 3 general ophthalmologists, who were trained to evaluate the tests using a single standard instruction. After 3 months, all video clips were re-organized for the second evaluation. Interobserver and intra-observer reliability were calculated using Cohens' Kappa coefficient and Fleiss Kappa statistic. Results: The 3 eyelid tests were performed and recorded in 35 patients, which included the diagnosis of OMG, levator muscle dehiscence, partial oculomotor nerve palsy, and Horner syndrome. CLT received moderate-to-substantial interobserver reliability in neuro-ophthalmologist group (Fleiss Kappa 0.77 [95% CI 0.60-0.94] and 0.66 [95% CI 0.46-0.85] in first and second evaluation respectively), but the results varied in general ophthalmologist group (Fleiss Kappa 0.58 [95% CI 0.37-0.79] and 0.54 [95% CI 0.33-0.76] in first and second evaluation respectively). FECT and LFT received lower interobserver reliability in both groups. CLT also received moderate-to-almost perfect intra-observer reliability in neuro-ophthalmologist group (Cohen Kappa 0.55, 0.58, and 0.92), whereas FECT and LFT received lower intra-observer reliability. The intra-observer reliability varied among general ophthalmologists for all 3 eyelid tests. Conclusions: CLT is the most reliable test among the 3 eyelid tests. However, all tests should be interpreted with caution by general ophthalmologists

Giant cell arteritis mimicking orbital apex syndrome: A case report

Giant cell arteritis (GCA) is a large-vessel vasculitis in elderly Caucasian. Arteritic anterior ischemic optic neuropathy (AAION) is the most common ophthalmic manifestation. We report unilateral visual loss with complete ophthalmoplegia, mimicking orbital apex syndrome as a rare presentation of GCA

Comparison of Peripapillary Retinal Vessel Density of Optic Atrophy after Optic Neuritis and NAION

Identifying cause of unknown optic atrophy (OA) can be challenging and problematic since the optic disc pallor is the end result of various types of optic neuropathy. Optic neuritis (ON) and non-arteritic anterior ischemic optic neuropathy (NAION) are among the leading causes. The purpose of this study is to quantitatively compare the retinal vessel density between post-ON and post-NAION optic atrophy. Both conditions need different management to prevent complications in the future

Peripapillary Vessel Density Changes in Alzheimer's Type Dementia ; A Pilot Study

Alzheimer's type dementia(ATD) is a common disorder affecting elderly adult. From previous study, there's an evidence of retinal pathology in ATD. This study aims to identify ophthalmic findings including retinal thickness and retinal vascular density in ATD compared to normal subjects

Health-related quality of life of daily-life-affected benign essential blepharospasm: Multi-center observational study

Purpose To compare Thais’ health-related quality of life (HRQOL) and severity grading, efficacy and safety in daily-life-affected benign essential blepharospasm (BEB) patients at baseline and after Botulinum toxin type A (BTX-A) treatment. Design Prospective-observational study. Participants BEB patients with Jankovic rating scale (JRS) at least 3 in both severity and frequency graded from 14 institutes nationwide were included from August 2020 to June 2021. Methods Demographic data, HRQOL evaluated by the Thai version of EQ-5D-5L and NEI-VFQ-25 questionnaires, and severity grading score evaluated by Jankovic rating scale (JRS) at baseline, 1, and 3 months after the treatment were collected. The impact of the BTX-A injections and their complications were recorded. Results 184 daily-life-affected BEB patients were enrolled; 159 patients (86.4%) had complete data with a mean age of 61.40±10.09 years. About 88.05% were female, and 10.1% were newly diagnosed. Most of the patients had bilateral involvement (96.9%) and 12.6% had history of BEB-related accident. After BTX-A treatment, HRQOL improved significantly in 4 dimensions of EQ-5D-5L, except self-care. The EQ_VAS (mean±SD) was 64.54±19.27, 75.13±15.37, 73.8±15.85 (pConclusion Daily-life-affected BEB impacted HRQOL in most dimensions from both generic and visual-specific questionnaires. BTX-A treatment not only decreased disease severity, but also improved quality of life