Pediatric primary optic nerve sheath meningioma

Kavin Vanikieti, Pisit Preechawat, Anuchit Poonyathalang Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Abstract: Primary optic nerve sheath meningioma (PONSM) is extremely rare among children. We report two cases of pediatric PONSM. The first case was a 12-year-old boy who presented with gradual visual loss of his right eye and was found to be associated with neurofibromatosis type 2. The second case was a 10-year-old boy who presented with gradual proptosis of his left eye with normal visual acuity. Severe visual loss is a common clinical manifestation of pediatric PONSM. Although the visual acuity in the second case was normal, his vision rapidly deteriorated to 20/200. In both cases, the diagnosis of PONSM was confirmed by magnetic resonance imaging, and a successful tumor growth control was achieved after stereotactic radiotherapy was implemented. Keywords: meningioma, optic nerve, children, pediatric, sheath, orbi

Isolated Horner syndrome as a rare initial presentation of nasopharyngeal carcinoma: a case report

Tanyatuth Padungkiatsagul,1 Anuchit Poonyathalang,1 Panitha Jindahra,2 Piyaphon Cheecharoen,3 Kavin Vanikieti1 1Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Background: Horner syndrome refers to a set of clinical presentations resulting from disruption of sympathetic innervation to the eye and adnexa. Classically, the clinical triad consists of ipsilateral blepharoptosis, pupillary miosis, and facial anhidrosis. Ocular sympathetic denervation may signify life-threatening causes. Timely investigation and accurate diagnosis are essential in patients with oculosympathetic denervation. Case presentation: A 33-year-old Asian man with a heavy smoking habit presented with a 3-week history of left ptosis and no other complaints. His visual acuity was 20/20 bilaterally. An ophthalmic examination was significant for mild ptosis of his left eyelid and anisocoria (smaller left pupil), which was greater in the dark. Both pupils reacted to light briskly without an afferent pupillary defect. Anhidrosis was found on the medial side of the left forehead. A 10% cocaine test was positive. At his first visit, neurologic examination was unremarkable. Comprehensive radiological investigations were scheduled for a left-sided isolated Horner syndrome. Two weeks after his first visit, he experienced a left-sided headache along with ipsilateral Horner syndrome. Neurologic examination revealed hypoesthesia in the left cranial nerve V1–3 territories. Emergent computed tomography angiography was suspected for petrous part of the left internal carotid artery (ICA) dissection. Magnetic resonance imaging demonstrated an enhancing infiltrative lesion with its epicenter at the left sphenoid bone. The lesion encased the left ICA and invaded the left Meckel cave. Rhinoscopy with incisional biopsy revealed squamous cell nasopharyngeal carcinoma. Conclusion: This case involved an unusual initial presentation of nasopharyngeal carcinoma: isolated Horner syndrome with clinical progression to adjacent structures. Infiltration involving the Meckel cave and ICA at the foramen lacerum can present as postganglionic Horner syndrome associated with trigeminal pain and hypoesthesia. These clinical findings may mimic carotid artery dissection on computed tomography angiography. Detailed magnetic resonance imaging with careful attention to the skull base should be performed. Keywords: Horner syndrome, nasopharyngeal carcinoma, trigemina

Anterior ischemic optic neuropathy due to biopsy-proven giant cell arteritis in Thai patients

Taweevat Attaseth,1 Kavin Vanikieti,1 Anuchit Poonyathalang,1 Pisit Preechawat,1 Panitha Jindahra,2 Duangkamon Wattanatranon3 1Department of Ophthalmology, 2Department of Medicine, 3Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Abstract: Giant cell arteritis is a systemic granulomatous vasculitis affecting medium to large arteries. An arteritic anterior ischemic optic neuropathy is the most common cause of permanent visual loss. Giant cell arteritis is very rare among Asians. We report six patients with biopsy-proven arteritic anterior ischemic optic neuropathy. Demographic data, clinical manifestations, laboratory findings, treatment, and visual outcome are described in detail and compared with Caucasian patients. We found no differences in any clinical features except for sex preference. Moreover, perioptic nerve sheath enhancement was observed in half of our patients. Keywords: giant cell arteritis, temporal artery biopsy, perioptic nerve sheath enhancement, choroidal ischemia, Asia

Management of the Contracted Socket

The ideal anophthalmic socket has the following characteristics: a well-positioned implant of adequate volume, normal upper and lower eyelids with good height and tone, and a lining of mucous membrane with deep superior and inferior fornices to hold the ocular prosthesis. Sockets can become scarred and contracted due to trauma, recurrent infections and inflammations, chemical or thermal injuries, implant exposures, and radiation therapy. Mild contracture leads to entropion with poor cosmesis and crusting. Moderate contracture results in shallowing of the fornices with inability to close the eyelids and often difficulty in maintaining the artificial eye. Severe contracture results in complete loss of fornices, horizontal shortening, and inability to place a prosthesis. This chapter covers the causes and prevention of socket contracture as well as surgical correction. Methods include grafting with mucous membrane, amniotic membrane, dermis fat, and skin. Fornix-deepening sutures as well as fixated conformers are also discussed

Optic Disc Classification by Deep Learning versus Expert Neuro-Ophthalmologists

Objective: To compare the diagnostic performance of an artificial intelligence deep learning system with that of expert neuro-ophthalmologists in classifying optic disc appearance. Methods: The deep learning system was previously trained and validated on 14,341 ocular fundus photographs from 19 international centers. The performance of the system was evaluated on 800 new fundus photographs (400 normal optic discs, 201 papilledema [disc edema from elevated intracranial pressure], 199 other optic disc abnormalities) and compared with that of 2 expert neuro-ophthalmologists who independently reviewed the same randomly presented images without clinical information. Area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity were calculated. Results: The system correctly classified 678 of 800 (84.7%) photographs, compared with 675 of 800 (84.4%) for Expert 1 and 641 of 800 (80.1%) for Expert 2. The system yielded areas under the receiver operating characteristic curve of 0.97 (95% confidence interval [CI] = 0.96\u20130.98), 0.96 (95% CI = 0.94\u20130.97), and 0.89 (95% CI = 0.87\u20130.92) for the detection of normal discs, papilledema, and other disc abnormalities, respectively. The accuracy, sensitivity, and specificity of the system's classification of optic discs were similar to or better than the 2 experts. Intergrader agreement at the eye level was 0.71 (95% CI = 0.67\u20130.76) between Expert 1 and Expert 2, 0.72 (95% CI = 0.68\u20130.76) between the system and Expert 1, and 0.65 (95% CI = 0.61\u20130.70) between the system and Expert 2. Interpretation: The performance of this deep learning system at classifying optic disc abnormalities was at least as good as 2 expert neuro-ophthalmologists. Future prospective studies are needed to validate this system as a diagnostic aid in relevant clinical settings. ANN NEUROL 2020;88:785\u2013795