Spectrum and Clinical Course of Visual Field Abnormalities in Ethambutol Toxicity.

Visual toxicities from ethambutol are rare but represent one of the few causes of non-glaucomatous and non-compressive bitemporal hemianopsia. The authors present a six-patient case series illustrating variable clinical presentation and reversibility of visual loss in patients treated with ethambutol for Mycobacterium avium complex, including four patients who presented with visual field defects suggestive of bitemporal hemianopsia. Two additional patients were being followed for glaucoma, developed visual field defects with ethambutol treatment, and subsequently recovered with cessation of drug. In patients being treated with ethambutol, reversible bitemporal hemianopsia was the most commonly noted presentation of ethambutol toxicity.

Perineural optic nerve enhancement on magnetic resonance imaging in giant cell arteritis.

Giant cell arteritis (GCA) may cause visually devastating optic neuropathy. In atypical cases, diagnosis of optic neuropathy can be delayed. We present 2 such atypical cases and demonstrate that contrast-enhanced orbital magnetic resonance imaging may be a valuable tool in patient evaluation and aid in the diagnosis of GCA.

Shader Lamps Virtual Patients: the physical manifestation of virtual patients.

We introduce the notion of Shader Lamps Virtual Patients (SLVP) - the combination of projector-based Shader Lamps Avatars and interactive virtual humans. This paradigm uses Shader Lamps Avatars technology to give a 3D physical presence to conversational virtual humans, improving their social interactivity and enabling them to share the physical space with the user. The paradigm scales naturally to multiple viewers, allowing for scenarios where an instructor and multiple students are involved in the training. We have developed a physical-virtual patient for medical students to conduct ophthalmic exams, in an interactive training experience. In this experience, the trainee practices multiple skills simultaneously, including using a surrogate optical instrument in front of a physical head, conversing with the patient about his fears, observing realistic head motion, and practicing patient safety. Here we present a prototype system and results from a preliminary formative evaluation of the system.

Stage IV primitive-appearing sinus and orbital rhabdomyosarcoma presenting in a 68-year-old female previously treated for breast cancer.

A 68-year-old female who had undergone treatment several years previously for breast cancer presented with diplopia and unilateral proptosis and exposure keratopathy related to biopsy-proven rhabdomyosarcoma of the sinus and orbit. Further evaluation revealed multiple metastatic lesions felt to have originated from the primary sinus and orbital tumor. Histopathologic examination showed primitive-appearing rhabdomyosarcoma with some features suggestive of the alveolar subtype. Orbital or sinus rhabdomyosarcoma is seen almost exclusively in the pediatric population, but may very rarely occur in adults. There are several genetic mutations that appear to play a role in both rhabdomyosarcoma and certain breast tumors. There is also increasing evidence that even low doses of radiation may contribute to the future development of cancer, particularly in susceptible individuals. In our patient with atypical demographics for rhabdomyosarcoma, the previous neoplasm and treatment thereof may have predisposed to the development of this rare tumor.

A Rare Ocular Presentation of Metastatic Lung Cancer: Unilateral Anterior Chamber Angle, Bilateral Choroidal, and Multiple Intracranial Metastases.

A 64-year-old man who presented with photopsia was found to have elevated intraocular pressure in one eye and optic disc swelling in the other eye. He was initially diagnosed with neurocysticercosis and later metastatic lung adenocarcinoma. The purpose of this paper is to report a rare case of bilateral glare as the first sign of diffusely metastatic cancer and to raise clinical suspicion for systemic malignancy in the presence of multiple ocular manifestations.

Retrospective analysis of translaminar, demographic, and physiologic parameters in relation to papilledema severity.

OBJECTIVE: Some case reports suggest that the translaminar pressure difference is important in cases of papilledema. The purpose of this study was to determine ocular, physiologic, and demographic factors associated with papilledema severity. DESIGN: Retrospective, blinded study. PARTICIPANTS: Patients who had undergone a diagnostic lumbar puncture and had a diagnosis of papilledema in conjunction with idiopathic intracranial hypertension between 2004 and 2012 were included in the study. One-hundred and fifty-one patients were identified in initial screening. Sixty of 151 patients met all inclusion criteria, and 120 eyes were eligible for investigation. METHODS: A retrospective review of optic nerve photographs by 2 masked experts was used to grade papilledema severity using the Modified Frisén Scale (MFS). Patients with any systemic or neurologic disease that could affect cerebrospinal fluid pressure (CSFP) were excluded. Patients on acetazolamide were excluded. Assessments within 1 MFS grade were averaged and correlated to intraocular pressure, CSFP, translaminar pressure differential, MFS, age, weight, height, and systolic and diastolic blood pressure. RESULTS: In univariate and multivariate type 3 generalized estimating equation analyses, only age (Z = -2.70; p < 0.01) and sex (Z = 2.81; p < 0.0001) were significantly correlated with MFS. CONCLUSIONS: Papilledema severity decreased with advancing age and was higher for female sex. We found no association between severity of papilledema and CSFP, intraocular pressure, blood pressure, or any other physiologic parameter. Factors other than the translaminar pressure differential may be important in determining the severity of papilledema.

A novel method for teaching key steps of strabismus surgery in the wet lab.

The surgical laboratory environment plays an important role in modern surgical education. Learning how to complete the key steps of strabismus surgery prior to actual surgery may enhance efficiency and sensitize the surgeon to potential complications. Cadaveric extraocular muscle is difficult to manipulate and specimens are not readily available; therefore, an alternative is needed to teach strabismus surgery techniques. We developed a wet lab to practice the key steps of strabismus surgery using commercially available bacon as an extraocular muscle substitute and cadaveric pig eyes for conjunctival and scleral tissue in a framework of peer teaching, expert supervision, and validated written feedback.