A Case of Cerebral Venous Sinus Thrombosis Presenting During Relapse of Ulcerative Colitis.

BACKGROUND Extra-intestinal manifestations of inflammatory bowel disease (IBD) include thromboembolic events that can present as deep vein thrombosis, pulmonary embolism, and cerebral venous sinus thrombosis. Cerebral venous sinus thrombosis is a rare complication of IBD that can be associated with high morbidity and mortality. This report is of a case of cerebral venous sinus thrombosis presenting in a young man during a relapse of ulcerative colitis (UC). CASE REPORT A 27-year-old man presented with seizures and focal neurological deficit during a relapse of chronic UC. He was found to have left cerebral venous sinus thrombosis complicated by left frontotemporal infarction that was treated with anticoagulation therapy. CONCLUSIONS Thromboembolic events are well documented extra-intestinal manifestation of IBD. Cerebral venous sinus thrombosis is a rare but serious complication that can be fatal. The correct diagnosis and timely management require a high degree of suspicion in patients with IBD who present with a new-onset headache, focal neurological symptoms, seizure, or altered mental status.

Laser in situ keratomileusis correction of mixed astigmatism by bitoric ablation.

PURPOSE: To evaluate the effect of bitoric ablation (cross cylinder) in 1 eye and ordinary monotoric treatment in the contralateral eye of patients with mixed astigmatism. SETTING: Instituto Oftalmológico de Alicante and University of Miguel Hernández, Alicante, Spain. METHODS: A comparative consecutive study was initiated in 30 eyes of 15 patients with mixed astigmatism. In each patient, 1 eye was treated with bitoric ablation (Group 1) and the other eye was treated with monotoric ablation (Group 2). The decision to treat with bitoric or monotoric ablation was randomized. All patients were operated on by the same surgeon (J.L.A.) and examined by the same investigators (M.J.A., M.A.H.). All completed a 6-month follow-up. Visual acuity was estimated by transforming the Snellen chart readings into logMAR equivalents. In Group 1, theoretical ablation was also performed on glass slides by making 3 ablation profiles (positive, negative, and bitoric). RESULTS: There was a statistically significant improvement in the mean uncorrected visual acuity (UCVA), the mean spherical equivalent (SE), and the mean refractive cylinder in Group 1 (P<.0001, P =.04, P<.0001, respectively) and in the mean refractive cylinder in Group 2 (P =.01). Better results were obtained in the mean incremental change in UCVA, best corrected visual acuity, SE, and refractive cylinder in Group 1. CONCLUSIONS: Treatments to correct mixed astigmatism vary in ablation profiles and depth. Bitoric ablation appears to be safer, more effective, and more tissue sparing than the standard treatment.

Changes in corneal biomechanics following different keratoplasty techniques.

PURPOSE: To evaluate corneal biomechanics with the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments, Depew, NY) after penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK). SUBJECTS AND METHODS: Sixty-three eyes of 63 patients were included in this prospective comparative study. Patients were divided into 3 groups: the first included 21 eyes of normal subjects (control group); the second included 21 eyes with PK; the third included 21 eyes with DALK. ORA was performed 2 months postoperatively for all patients. RESULTS: Both mean corneal hysteresis (CH) and mean corneal resistance factor (CRF) were significantly lower in the PK group than both the DALK group and matched controls. No statistically significant difference was found between mean CH and mean CRF between the DALK group and matched controls CONCLUSION: Corneas after PK have weaker biomechanical properties than normal corneas. DALK preserves the biomechanical strength of the corneas to almost normal values.

Delineating the extent of anterior capsulorhexis with gentian violet using capsulorhexis marker: a preliminary study of efficacy and toxicity in an animal model.

BACKGROUND: The purpose of this study was to evaluate the efficacy and safety of a new instrument to optimize the size, shape, and centration of anterior capsulorhexis. METHODS: The study was divided into two parts. The first part was done in 10 goats' eyes. A specially designed capsulorhexis marker was used. The lower edge of the instrument was stained by gentian violet and then applied to the anterior capsule to produce a circular mark of 5.5 mm. In five eyes, the gentian violet was applied to the marker using a corneal marking pen; in the remaining five eyes, the gentian violet was applied using a corneal marking pad. In the second part, the toxicity of gentian violet was tested as follows: ten albino rabbits received a gentian violet injection into the anterior chamber in one eye (experimental group) and an equal volume of balanced salt solution in the fellow eye (control group). Five rabbits were sacrificed one day after surgery and the remaining five rabbits after one week. RESULTS: In the first part, there was no difficulty in the introduction or removal of the instrument from all eyes. In the first two eyes, the circular mark was diffuse due to sliding of the marker on the surface of the anterior capsule. In the remaining eight eyes, there was a well-centered, rounded mark which was adequately stained. In the second part, there was no histopathological evidence of corneal toxicity in either group. There was loss of ganglion cells from the neurosensory retina one day after surgery in one eye from the experimental group. At one week, there was no evidence of retinal toxicity in any of the rabbits. CONCLUSION: This capsulorhexis marker can guide the surgeon to a better centration and proper sizing of anterior capsulorhexis using gentian violet staining. More refinement of the instrument is needed to be able to use it in human eyes.