Hyperbaric Oxygen Therapy Combined with Immunosuppression for Acute Macular Neuroretinopathy in Systemic Lupus Erythematosus.

PURPOSE: To describe the use of hyperbaric oxygen therapy (HBOT) in conjunction with immunosuppression for acute macular neuroretinopathy (AMN) in systemic lupus erythematosus (SLE). METHODS: Two known cases of SLE presented to us with blurred vision and paracentral scotomas due to AMN. Both cases reported worsening of their conditions despite the initiation of high-dose steroid therapy. HBOT was added on as a treatment modality to address vaso-occlusive ischemic injury. RESULTS: Both patients underwent a total of twelve cycles of HBOT. Functional and anatomical improvements were noted immediately after the initiation of therapy and were maintained over more than one year of follow-up. No significant retinal thinning was noted on optical coherence tomography on disease resolution, as has been noted previously. Visual field scotoma showed a complete resolution. CONCLUSION: Our cases suggest that HBOT may have a role in aiding functional and anatomical recovery in AMN associated with SLE.

Effectiveness of Low Vision Rehabilitation Using Microperimetric Acoustic Biofeedback Training in Patients with Central Scotoma.

PURPOSE: To evaluate the efficacy of visual rehabilitation with microperimeter biofeedback in patients with central scotoma. MATERIALS AND METHODS: 35 consecutive patients with central scotoma (17 age-related macular degeneration (AMD), 14 Stargardt disease, and 4 cone dystrophy) were included in the study. Visual acuity, reading performance by Minnesota Low Vision Reading Test (MNREAD), quality of life by 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), and fixation analysis by MAIA microperimeter were evaluated before and 1 month after training. The rehabilitation program consisted of 10 training sessions of 10 minutes. RESULTS: The median best-corrected visual acuity (BCVA) was 0.80 logMAR (range 0.3 to 1.3 logMAR). Fifty-nine percent of patients with AMD developed a preferred retinal locus (PRL) nasal to the fovea, and 64% of the patients with Stargardt disease preferred a PRL superior to the fovea. The PRL location in 3 of 4 cone dystrophy patients was nasal to the fovea. The mean PRL distance from the fovea was 7.57 ± 3.61 degrees. Fixation stability improved with P1 values of 22.34 ± 11.81 versus 32.05 ± 18.79 (p = .003) and 95% bivariate contour ellipse area (BCEA) values of 41.6 versus 23.6 (p = .018) before and after training, respectively. There was a significant difference in reading acuity between before and after training (p = 0.008). The overall score and near activities score of NEI VFQ-25 were found to be increased at the end of the rehabilitation (p < 0.001). CONCLUSION: Rehabilitation with acoustic biofeedback in patients with central scotoma looks like a useful technique for improving fixation stability, reading performance and quality of life.

Biofeedback fixation training method for improving eccentric vision in patients with loss of foveal function secondary to different maculopathies.

PURPOSE: Fixation stability (FS) of the preferred retinal locus (PRL) may be improved by biofeedback fixation training (BFT) with microperimetry. Such training can be done on the patient's PRL or in different retinal loci with better functional characteristics. We studied both options and compared the outcomes. METHODS: Sixty-seven consecutive patients with bilateral central vision loss, poor FS and visual acuity (VA) lower than 0.3 LogMAR were recruited for BFT with microperimeter. Patients were assigned into 2 groups. In group A, BFT was performed on the patient's spontaneous PRL. In group B, PRL was located between 2 adjacent loci with the highest light sensitivity and the lowest distance from the fovea. Two sets of 12 weekly BFT sessions were performed. Primary outcomes were: FS, VA and reading speed. RESULTS: Outcomes were statistically significantly better in group B. Mean percentage of FS at therapy end improved from 32 to 35% for group A and from 40 to 55% in group B. Mean VA improved from 1 to 0.86 in group A and from 1 to 0.84 in group B. Reading speed (wpm) improved from 56 to 58 in group A and from 63 to 89 in group B. CONCLUSIONS: This study describes a reliable methodology of improving eccentric fixation stability using BFT in microperimetry, when the fixation training locus is individualized as the retinal area with best functional characteristics. Further studies are needed to validate its value in a larger scale of patients, at different stages of the disease, and its persistence over time.

Hemangioma circunscrito de coroides tratado con terapia fotodinámica / Circumscribed choroidal hemangioma treated with photodynamic therapy

Caso clínico: Varón de 45 años, que acude por escotoma de ojo izquierdo de 2 meses de evolución.Las exploraciones complementarias demuestran untumor yuxtapapilar de 7 mm x 3,4 mm que es diagnosticadocomo hemangioma circunscrito de coroides.Se decide tratarlo con terapia fotodinámica. Tras 4sesiones y 17 meses de seguimiento el paciente permaneceasintomático, su agudeza visual se mantieney la lesión presenta aspecto fibrótico sin exudación.Discusión: La terapia fotodinámica es una de lasmejores opciones terapéuticas en esta patología por el mínimo daño que causa sobre la retina (AU)

Clinical case: A 45-year-old male referred with a scotoma in the left eye of 2 months’ evolution. A peripapillary tumor was found, with a basal diameter of 7 mm and thickness 3.4 mm. It was diagnosed as a circumscribed choroidal hemangioma. It was decided to treat the patient using photodynamic therapy. After 4 sessions and 17 months follow-up, the patient remained asymptomatic and visual acuity was stable. There was evidence of subretinal fibrosis and no subretinal fluid was found. Discussion: Photodynamic therapy is a good option for the treatment of circumscribed choroidal hemangioma given the minimal damage is causes to the adjacent retina. (Arch Soc Esp Oftalmol 2008; 83: 553-558)

Monocular scotomata and spinal manipulation: the step phenomenon.

OBJECTIVE: To discuss a case history wherein microvascular spasm of the optic nerve was treated by spinal manipulation. CLINICAL FEATURES: A 62-yr-old man developed a scotoma in the vision of the right eye during chiropractic treatment. INTERVENTION AND OUTCOME: Spinal manipulation treatment was continued with total resolution of the scotoma. The rate of recovery of the scotoma was mapped using computerized static perimetry. These measurements showed that significant recovery occurred at each spinal manipulation treatment, producing a stepped graph. CONCLUSION: The use of computerized static perimetry to measure the cerebral effects of spinal manipulation has increased knowledge of how chiropractic works. The further recovery of vision with each spinal adjustment suggests that more treatment may be better than less treatment in the chiropractic management of such cases.

Automated static perimetry in chiropractic.

OBJECTIVE: To demonstrate the value of quantitative static perimetry, in research and practice of spinal manipulation therapy, by reference to the recovery of uniocular loss of vision. CLINICAL FEATURES: A 44-yr-old housewife presented with nonspecific bilateral visual field loss. This visual disability disappeared immediate to pan-spinal manipulation under anesthetic. Later, on review, the presence of a uniocular visual defect was detected by quantitative static perimetry. Further examination revealed no pathology in the eye or brain to explain its occurrence, suggesting that it was due to microischemia of the optic nerve. INTERVENTION AND OUTCOME: The uniocular scotoma recovered immediate to further spinal manipulation under anesthetic, only to recur on two further occasions, each time to disappear immediate to spinal treatment. CONCLUSIONS: This case history demonstrates that spinal manipulation may dissipate microvascular spasm in the brain: even in branches of the carotid arterial system, which is not directly related to the spine. The author feels that the underlying pathology was interictal migraine, which is now known to produce prolonged hypertonic changes in the cerebral microcirculation; and he suggests that spinal manipulation is a treatment to be considered for interictal migraine.

A double-blind, placebo-controlled trial of fish oil concentrate (MaxEpa) in stroke patients.

The feeding of large amounts of fish or fish oils to healthy volunteers has been shown to reduce plasma triglycerides and platelet aggregation, and prolong the skin bleeding time. To determine whether a commercially available marine oil (MaxEpa) would have similar effect in stroke patients, we performed a double-blind, placebo-controlled study in 11 patients (7 men, 4 women) with completed stroke (7) or transient ischemic attacks (TIA's) (4). Ten 1 ml opaque capsules containing either MaxEpa or olive oil were given daily for 6 weeks, and then the patients were crossed-over. Aspirin was avoided during the trial. The data were analyzed by paired-sample t-tests. A significant reduction was found in serum triglycerides, but total serum cholesterol and HDL cholesterol were unaffected. The bleeding time was modestly prolonged after 3 weeks of treatment, but the differences between MaxEpa and olive oil treatments were not significant at 6 weeks. Aside from an increase in collagen-stimulated malondialdehyde formation no other statistically significant changes in hemostatic factors were observed. We conclude that the ingestion of up to 10 MaxEpa capsules daily for 6 weeks has little influence on such established risk factors as cholesterol concentration and platelet function in patients with stroke or TIA's.