The incidence of pseudotumor cerebri. Population studies in Iowa and Louisiana.

We surveyed all neurologists, ophthalmologists, and neurosurgeons in Iowa, eastern Nebraska, and Louisiana over one year to determine the annual incidence of pseudotumor cerebri in residents of Iowa and Louisiana. The results were similar for both states. In Iowa, the annual incidence in the general population was 0.9 per 100,000 persons. When obesity was considered, this increased the incidence to 13/100,000 persons in Iowa and 14.85/100,000 persons in Louisiana for women 20 to 44 years of age who were 10% or more over ideal weight. Furthermore, the incidence became 19.3/100,000 for women in the same age range when they were 20% or more over ideal weight. The female-to-male ratio was 8:1, and the mean weight was 38% above ideal weight for height. Pseudotumor cerebri is a relatively common neurologic illness and may be an important preventable cause of blindness in obese young women.

Postoperative inflammation in a patient with multiple sclerosis.

We report a 51-year old white woman with a history of relapsing episodes of multiple sclerosis (MS) who developed acute anterior uveitis 11 days after having uneventful phacoemulsification with posterior chamber intraocular lens implantation. Topical corticosteroids relieved the pain and inflammation within hours. A week after the episode of anterior uveitis, the patient had a severe systemic relapse of MS. Acute inflammation in MS patients during the postoperative period may be noninfectious and could be a prodrome for a relapse of MS.

Glistenings in the AcrySof intraocular lens: pilot study.

PURPOSE: To evaluate the prevalence, severity, and visual significance of glistenings seen in the AcrySof intraocular lens (IOL) and determine whether a large in-depth study of this lens is warranted. SETTING: John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Patients who had the AcrySof IOL implanted at 1 institution over the past 4 years were serially selected. Forty-two eyes that had phacoemulsification with implantation of the AcrySof IOL were evaluated. The examination consisted of visual acuity, glare, contrast sensitivity, and dilated fundus and dilated slitlamp evaluations. Glistenings in the IOL were graded at the slitlamp from trace to 4+. RESULTS: All 42 IOLs had some degree of lenticular glistenings. The glistenings were graded as trace in 27 IOLs (64%), 1+ in 5 (12%), 2+ in 5 (12%), 3+ in 3 (7%), and 4+ in 2 (5%). The Snellen acuity in eyes with severe glistenings (> or = 2+) was one-half line lower than in eyes with mild glistenings (+) (P =.01). In all eyes, the Brightness Acuity Tester score was a little more than one-half line lower than the Snellen acuity, and the difference was 1 full line in eyes with glistenings graded above 2+. Fourteen of 15 IOLs (93%) with glistenings graded greater than trace had been in the eye for more than 1 year. There was no evidence that contrast sensitivity was affected by the glistenings. CONCLUSIONS: Glistenings occurred frequently in AcrySof IOLs, with most cases mild. A larger study of this lens is needed to determine whether severe presentations affect visual function and to understand how glistenings change over time.

Capsular bag distension with an acrylic intraocular lens.

PURPOSE: To describe the postoperative capsular bag distension that occurs with in-the-bag implantation of the soft acrylic (AcrySof) intraocular lens (IOL). SETTING: Jules Stein Eye Institute, University of California, Los Angeles. METHODS: Nine eyes in nine patients had uncomplicated continuous curvilinear capsulorhexis, phacoemulsification, and in-the-bag implantation of the AcrySof lens. Comprehensive ophthalmic examinations were performed 1 day and 1 and 6 weeks postoperatively. Patients had neodymium:YAG laser posterior capsulotomy; refractions were done before and after the capsulotomy. RESULTS: Comprehensive ophthalmic examination revealed variable degrees of anterior chamber shallowing, anterior displacement of the IOL within the bag, and distension of the posterior capsule away from the IOL. Unexpected postoperative myopic correction was seen in all patients. Postcapsulotomy mean spherical equivalent refractive shift was +3.6 diopters (D) with a shift of at least +4.0 D in four of nine eyes. CONCLUSIONS: Capsular bag distension is a previously described postoperative complication that we observed in association with the AcrySof IOL.

Visual significance of glistenings seen in the AcrySof intraocular lens.

PURPOSE: To investigate the visual significance of "glistenings" in acrylic intraocular lenses (IOLS). SETTING: John Moran Eye Center, University of Utah, Salt Lake City. METHODS: Seventeen patients who had phacoemulsification with implantation of the AcrySof acrylic IOL were evaluated by slitlamp examination and visual acuity, contrast sensitivity, and glare testing. Ten patients had a silicone posterior chamber IOL in the opposite eye and had testing with similar visual parameters for comparison. Glistenings noted in the acrylic IOLs were graded at the slitlamp. Laboratory analysis of five acrylic IOLs was also done to reproduce the glistenings noted clinically. RESULTS: All 17 patients with the acrylic IOLs had some lenticular glistenings, ranging from trace to 2+. Statistical analysis of visual acuity, contrast sensitivity, and glare testing revealed a statistically significant difference between the acrylic and the silicone IOLs only in contrast sensitivity. Laboratory analysis of the acrylic IOLs showed similar glistenings from 48 to 72 hours after they were placed in balanced salt solution. CONCLUSIONS: A patients who received AcrySof IOLs that came in the AcryPak had some degree of glistenings. There was also a significant decrease in contrast sensitivity compared with that of fellow eyes with silicone IOLs. The glistenings are likely caused by water vacuoles that form within the lens after hydration within the eyes. Further studies are necessary to assess the exact cause of these glistenings.

Safety and tolerance of ocular administration of recombinant alpha interferon.

The safety, tolerance, and levels of drug in the nasal cavity produced by an ocular formulation of interferon were determined at four dosages in a placebo-controlled, double-masked trial. Interferon given by the ocular route was generally well tolerated, although a dose-related occurrence of subjective symptoms was detected.

Amaurosis fugax associated with antiphospholipid antibodies.

In more than 50% of amaurosis fugax patients under 45 years of age no cause for the episodes of visual loss is identifiable. We have encountered 6 young adults (4 women and 2 men) with episodes of amaurosis fugax associated with elevated levels of antiphospholipid antibodies. Splinter hemorrhages of the nail beds were present in most patients. Treatment with antiplatelet medications and anticoagulants appeared to reduce the frequency of episodes and might prevent central retinal artery occlusions or stroke.

Clinical features associated with mutations in the chromosome 1 open-angle glaucoma gene (GLC1A)

BACKGROUND: A substantial proportion of cases of glaucoma have a genetic basis. Mutations causing glaucoma have been identified in the chromosome 1 open-angle glaucoma gene (GLC1A), which encodes a 57-kd protein known as myocilin. The normal role of this protein and the mechanism by which mutations cause glaucoma are not known. METHODS: We screened 716 patients with primary open-angle glaucoma and 596 control subjects for sequence changes in the GLC1A gene. RESULTS: We identified 16 sequence variations that met the criteria for a probable disease-causing mutation because they altered the predicted amino acid sequence and they were found in one or more patients with glaucoma, in less than 1 percent of the control subjects. These 16 mutations were found in 33 patients (4.6 percent). Six of the mutations were found in more than 1 subject (total, 99). Clinical features associated with these six mutations included an age at diagnosis ranging from 8 to 77 years and maximal recorded intraocular pressures ranging from 12 to 77 mm Hg. CONCLUSIONS: A variety of mutations in the GLC1A gene are associated with glaucoma. The spectrum of disease can range from juvenile glaucoma to typical late-onset primary open-angle glaucoma.