The findings of standardized echography for choroidal folds.

Twenty-four patients (31 eyes) with choroidal folds unassociated with orbital tumors were evaluated with standardized echography. Hypermetropia was the most commonly associated finding (eight eyes); in ten eyes, no consistent abnormal findings could be established. Among the less common causes were swelling of the optic nerve proper or the perineural sheaths and thickened extraocular muscles. Standardized echography demonstrated ocular changes, orbital changes, or both, in all but two patients (two eyes) with idiopathic folds. The most frequent findings were flattening of the posterior ocular wall (18 eyes), thickening of the retinochoroid layer (12 eyes), and distention of the optic nerve sheaths (eight eyes). While fluorescein angiography is well established as the preferred method of demonstrating choroidal folds, standardized echography may now be used to delineate the often subtle associated ocular and orbital findings.

Presumed metastatic transitional cell carcinoma of the choroids.

Ocular metastases from urinary tract carcinoma are extremely rare. Three previous cases of choroidal metastases from transitional cell carcinoma from the urinary bladder have been described, as have 2 cases of orbital metastases from bladder carcinoma. This is believed to be the first reported case of choroidal metastasis from transitional cell carcinoma of the renal pelvis in a 50-year-old female patient. The tumour, despite the absence of extension beyond the pelvic wall, showed disseminated metastases that proved resistant to chemotherapy. The fluorescein angiographic and ultrasonographic findings are described and the literature is briefly reviewed.

Adenosquamous carcinoma of the lacrimal caruncle: a case report.

A 76-year-old Caucasian woman presented with a caruncle tumour, histologically diagnosed as mixed adenosquamous carcinoma. Complete excision was performed, but this necessitated removing parts of the lacrimal canaliculi. No local recurrence or distant metastasis was found after six months' follow-up, and spontaneous recanalisation of both canaliculi occurred. This tumour is believed to be a primary adenosquamous carcinoma of the caruncle and possibly the first reported case. Long term follow up is planned to detect late metastasis, but complete excision of the tumour and its favourable site should yield a good prognosis.

Effect of orally administered nadolol on the intraocular pressure in normal volunteers.

Forty six normal volunteers were randomly assigned in double-blind fashion to once daily orally administered nadolol 10, 20, 40, or 80 mg for five days. Significant and dose related intraocular pressure (IOP) reductions (range 20-40%) were demonstrated both at three hours and 24 hours post dosing (p less than 0.001, all dosages). The reductions in IOP were dose related (p less than 0.05). One subject (in the 10 mg group) failed to show a significant intraocular pressure reduction. Significant reductions in blood pressure and heart rate also were recorded at all dose levels (with the exception of diastolic pressure in the 10 mg group), though considerably less in degree than IOP reductions. Two subjects (20 mg and 80 mg groups) experienced known side effects of beta blocker therapy necessitating termination of the drug, and four others experienced mild side effects but had no difficulty completing the study. The results have prompted further investigation of the usefulness of low doses of oral nadolol as therapy in chronic simple glaucoma patients.

A comparison of 10 MHz and 20 MHz ultrasound probes in imaging the eye and orbit.

BACKGROUND: /aims: B-scan ultrasonography is an invaluable, versatile, non-invasive tool in ophthalmology. Recently, a "high frequency" contact 20 MHz probe has been introduced. B-scanning ultrasonography of orbital and ocular structures was performed with both a 10 MHz and the new 20 MHz probe, to evaluate what information was best obtained from each probe, and provide recommendations for the use of each. METHODS: Patients were selected from routine ultrasound clinics at Aberdeen Royal Infirmary between 1 January 2002 and 1 August 2002. The vitreous, retina, choroid, sclera and, in the orbit, the extraocular muscles, optic nerve, and orbital fat were assessed with both the 10 MHz and 20 MHz probes. In the laboratory, using a "point target," the characteristics of the ultrasound beam at different distances from the probe were also assessed. RESULTS: The point target showed that focus was deeper and that the lateral, and to a lesser degree the axial, resolution are sharper with the 20 MHz probe, compared with the 10 MHz probe. In patients' eyes, highly reflective structures are seen at higher resolution with the 20 MHz probe. Imaging of lower intensity reflectors such as the vitreous and particles within it are seen better with the 10 MHz probe. Increased tissue attenuation was evident with the 20 MHz probe. CONCLUSION: The 20 MHz probe has a superior resolution and can be used to better detect details at the posterior pole and in the orbit. The 10 MHz probe can be used to examine low intensity scatterers, such as the vitreous humour, that cannot be seen using a higher frequency probe.

Venous stasis orbitopathy: a clinical and echographic study.

AIMS: A variety of acute and chronic orbitopathies may be distinguished by standardised echography. Venous stasis orbitopathy (VSO) often presents with orbital signs when secondary to cavernous sinus and middle cranial fossa disorders. In this study, the aim was to assess whether differentiation between vascular and nonvascular causes of VSO could be made on the basis of clinical and echographic features at the time of presentation. METHODS: This study comprised 37 patients with echographic features of VSO (17 patients with arteriovenous fistulae, confirmed by computed tomography imaging or angiography, and 20 patients with non-vascular diseases). Excluded were patients with orbital mass lesions detected by echography and muscle enlargement due to other causes (for example, orbital myositis). Patients with a suspected mass involving the orbital apex and echographic features of VSO were included. After full neuro-ophthalmic and ocular examination, both orbits were examined to document maximal thickness and reflectivity of four recti muscles and compared with the normal contralateral orbit with standardised A-scan (Kretz-technik 7200MA or Ophthascan) and contact B-scan (Ultrascan or Ophthascan S). RESULTS: Cumulative ocular recti muscle thickness was significantly greater in patients with arteriovenous fistulae compared with the non-fistula group (23.3 (SD 3.7) and 17.8 (2) mm, p = 0.001). Clinically, the presence of a bruit and a uniocular rise in intraocular pressure were significantly greater in the fistula group of patients. CONCLUSIONS: Standardised echography is a safe and non-invasive method of diagnosing VSO in patients presenting with signs of proptosis, ophthalmoplegia, and inflammation of the conjunctiva. Furthermore, using these standard techniques the two major causes of VSO (arteriovenous fistulae and compressive mass lesions) could be differentiated.

Ultrasonic localization of anesthetic fluid in sub-Tenon's, peribulbar, and retrobulbar techniques.

PURPOSE: To determine the distribution of anesthetic fluid during 3 regional anesthetic techniques routinely used for phacoemulsification. METHODS: Patients having routine cataract extraction by phacoemulsification were studied after informed consent had been obtained. B-scan ultrasonography was performed on the eye before administration of the anesthetic agent. Kinetic echography was used to scan the eye during administration of the anesthesia to show the needle position and location of fluid in the orbit during the injection. Ten minutes after injection, another scan was performed to outline the pattern of fluid distribution. RESULTS: In all patients, the needle and the anesthetic fluid were seen on ultrasonography, with sub-Tenon's the most easily seen. In the sub-Tenon's group, fluid tracked behind the globe in the retrobulbar space, appearing as a dark outline during the injection. The fluid around the optic nerve developed a characteristic T sign. In the retrobulbar technique, the needle was less easily identifiable and fluid localized within the cone. The fluid distributed in the intraconal fat. Identification of the peribulbar needle and fluid was also more difficult; the fluid was, however, seen in the extraconal fat. After 10 minutes, fluid was seen within the cone. CONCLUSION: B-scan ultrasonography was a suitable method of identifying the needle position and the distribution of anesthetic fluid in regional ocular anesthesia. The sub-Tenon's technique appears to be the safest method of introducing anesthetic fluid into the retrobulbar space without the potential complications of sharp-needle techniques.

Role of ultrasound biomicroscopy in managing pseudophakic pupillary block glaucoma.

We describe a case of anterior capsule adherence to the iris that occurred after phacoemulsification with in-the-bag intraocular lens (IOL) implantation. This adherence led to the development of pseudophakic pupillary block glaucoma. There were no synechias at the pupillary margin associated with the capsule-iris adherence. Ultrasound biomicroscopy, used to evaluate the anterior segment in vivo, clarified the mechanism of pseudophakic pupillary block. The pupillary block was relieved by a single laser iridotomy.

A case of eye disease due to dietary vitamin A deficiency in Glasgow.

A 22 year old Caucasian girl living in Glasgow presented with eye disease due to Vitamin A deficiency. There was no evidence of liver disease or malabsorption and the vitamin deficiency was found to be due to her bizarre dietary habit.

Ophthalmopathy in early thyrotoxicosis--relationship to thyroid receptor antibodies and effects of treatment.

A prospective study of 25 newly diagnosed thyrotoxic patients was undertaken to determine the incidence and severity of ophthalmopathy in the early stages of the disease. A quantitative analysis of the ocular muscle changes was made using B scan ultrasonography, and the effects of treatment for the thyroid disease on the course of the eye changes was assessed. Although the majority (75%) of patients showed only mild clinical signs of ophthalmopathy (Werner Class 3 or less), 92% had ultrasonographic evidence of ocular muscle enlargement. Clinical involvement of the extraocular muscles was seen in 12% of the cases. There was an inverse correlation between the serum level of thyroid stimulating hormone receptor antibody (TR Ab) and the size of the extraocular muscles. Recovery of the euthyroid state with treatment was accompanied by a decrease in orbital infiltration in some cases, both clinically (reduced amplitude of intraocular pressure rise on elevation of the globe) and by ultrasonography, but the improvement was not statistically significant.

Increasing the size of a small peripheral iridotomy widens the anterior chamber angle: an ultrasound biomicroscopy study.

PURPOSE: A peripheral iridotomy (PI) is the treatment of choice for pupillary block. In this study we investigated the effect of enlarging the size of a small PI on the anterior chamber angle in patients with angle closure using ultrasound biomicroscopy (UBM). PATIENTS AND METHODS: Patients who had been treated with laser peripheral iridotomy for angle closure and were identified to have a small patent PI (< 100 microm) with still appositionally closed anterior chamber angle were selected prospectively. The anterior chamber angle was assessed using UBM. The angle opening distance 500 microm from the scleral spur (AOD500) as well as the anterior and posterior chamber depth (ACD and PCD) 1000 microm from the scleral spur was measured. In addition, the ACD/PCD ratio was calculated. Afterwards, the PI was enlarged using an Nd: YAG laser and the UBM measurements were repeated as described above. RESULTS: Six eyes of six patients were examined. After the enlargement of the PI the average AOD500 increased from 109 microm (+/- 36) to 147 microm (+/- 40) (p < 0.05). The ACD/PCD ratio increased from 0.36 (+/- 0.065) to 0.67 (+/- 0.185) (p < 0.05). CONCLUSION: Patients with a small PI and appositionally closed anterior chamber angle should have a repeated laser treatment. The ACD/PCD ratio, measured 1000 microm from the sclerl spur, is a new method to describe the features and changes of the anterior chamber angle taking into account the configuration of the iris and the posterior chamber depth.

Ultrasound biomicroscopy in deep sclerectomy.

PURPOSE: To evaluate by ultrasound biomicroscopy (UBM) the anatomical characteristics and the intraocular pressure (IOP) lowering mechanisms of deep sclerectomy after long-term follow-up. METHODS: In all, 22 eyes of 21 consecutive patients who had deep sclerectomy were examined by UBM. Several UBM variables were prospectively evaluated, including the presence and maximum length and height of the intrascleral space, the minimum thickness of residual trabeculo-Descemet membrane (TDM), the presence and type of subconjunctival filtering bleb, and the presence of other possible drainage sites, for example suprachoroidal. Surgical success was considered to be achieved when the IOP was <22 mmHg and the IOP was lowered by more than 20% without the use of any medication. The possible association between UBM variables and the surgical outcome was determined. RESULTS: The mean time between surgery and the UBM examination was 12.0+/-5.3 months. The mean IOP decreased significantly from a preoperative value of 23.7+/-4.0 to 16.0+/-3.9 mmHg at the time of UBM (P<0.01). There was a poor correlation between the level of IOP at the time of UBM and the length of intrascleral space (r2=0.0016), the height of the intrascleral space (r2=0.136), or the thickness of remaining TDM (r2=0.0009). The presence and type of filtering bleb were not associated with the success. CONCLUSIONS: In patients undergoing deep sclerectomy, UBM examination after long-term follow-up showed the presence of an intrascleral space and a filtering bleb in most patients. The surgical outcome was not associated with the UBM variables of the surgical area.