CASE SERIES OF HYPERBARIC OXYGEN THERAPY FOR CENTRAL RETINAL ARTERY OCCLUSION.

PURPOSE: To retrospectively report the outcomes of patients presenting to our facility with central retinal artery occlusion and receiving therapy with hyperbaric oxygen (HBO). METHODS: This was a retrospective, chart review at a single hospital center. Patients with diagnosed central retinal artery occlusion were treated with HBO twice daily for 5 days during their inpatient stay for a total of 10 HBO treatments. Main outcome was change from the documented presenting best-corrected visual acuity to discharge best-corrected visual acuity. Thirty-nine patients with central retinal artery occlusion were included in the analysis during a 30-month period. RESULTS: Twenty-eight of 39 patients (72%) had some improvement in acuity. There was a mean of 5.05 lines of improvement using a modified Snellen chart after completing their HBO treatment course. Patients treated within 12 hours of symptom onset showed the greatest improvement in their visual acuity (6.11 mean lines of improvement). Complications of therapy included middle ear barotrauma (10/39) and confinement anxiety (1/39) and did not interfere with the therapy regimen or hospital course. CONCLUSION: This retrospective case series supports the use of emergent HBO therapy as a viable treatment option for patients with central retinal artery occlusion. Hyperbaric oxygen therapy was safely administered and well tolerated.

Choroidal biopsy of a patient with AIDS and systemic tuberculosis: a clinicopathologic case report.

PURPOSE: To report a case of Mycobacterium tuberculosis choroidal granuloma confirmed by the presence of acid-fast bacilli seen on subretinal biopsy of the choroidal lesion. METHODS: Observational case report. A 54-year-old woman with AIDS and systemic tuberculosis reported decreased vision in the right eye for 2 months duration. RESULTS: Subretinal biopsy showed granulomatous inflammation, and acid-fast bacilli were identified on the acid-fast bacilli stain. CONCLUSION: In cases of presumed tuberculosis choroidal granuloma not initially responsive to tuberculosis therapy, biopsy of the choroidal mass can be beneficial to confirm the diagnosis and guide treatment.

Deficits in ocular and manual tracking due to episodic ataxia type 2.

Four patients with a novel mutation leading to episodic ataxia type 2 were studied in a task that required them to track target motion either with the eyes or with the index finger of the right hand. The target initially moved in a straight line and then changed direction at an unpredictable time by an unpredictable amount. On the day of testing, 3 of the patients were evaluated as normal on a neurological exam, whereas the fourth was severely ataxic. Nevertheless, all 4 showed deficits in tracking behavior with common features. Ocular tracking tended to result in hypermetric saccades at longer than normal latencies. Smooth pursuit tracking was absent in 1 patient and had lower than normal gain in the others. Deficits in manual tracking showed similarities to the deficits in ocular tracking, with hypermetric compensations for changes in target direction. The similarities in the deficits in manual and ocular tracking suggest that they are subject to similar control by the cerebellar structures.

Interactions between ocular motor and manual responses during two-dimensional tracking.

Tracking of a moving target usually involves coordinated movements of the eye and the hand. To study the extent to which one behavior influences the other, eye and hand movements were recorded during three conditions (eye alone, hand alone, and eye and hand together) where subjects tracked a target that initially moved in a straight line and then made an abrupt and unpredictable change in direction. The response latencies of the eye and hand were influenced by the presence of the other tracking modality. More specifically, the latency for the hand was decreased during concomitant ocular tracking, whereas the latency for the eye was increased during combined hand-eye tracking. Moreover, the velocity profile of the smooth pursuit component of ocular tracking was different when the hand also tracked the target. Taken together, these observations support the hypothesis that at least part of the neural substrate underlying tracking is shared by the two modalities.