Internuclear Ophthalmoplegia Following COVID-19 with Abnormal Findings on Neuroimaging; A Case Report.

COVID-19 had been reported to be associated with neuro-ophthalmic complications. However, there is a shortage of evidence regarding internuclear ophthalmoplegia (INO) presentation after COVID-19 infection with related brain magnetic resonance imaging (MRI). Herein, we report a case of INO in a 69-year-old woman with presentation of diplopia following COVID-19 infection, along with her neuroimaging. We concluded that it is important to recognize the possibility of INO in patients with diplopia after COVID-19 and to consider brain MRI as an informative tool in these patients.

Massive Uveal Relapse of Retinoblastoma Presumed to Be Choroidal Tumorous Involvement: Case Series.

We report the choroidal and ciliary body invasion by retinoblastoma (RB) in a salvaged eye after complete and successful primary treatment. Case 1: A 25-month-old boy was referred due to group B RB lesions based on the International Classification of RB (ICRB; groups A-E) in the right eye (OD). His left eye (OS) was enucleated because of advanced group E RB. After 47 months of uneventful follow-up (F/U), a new lesion recurred and was treated with transpupillary thermotherapy. Four months later, a fast-growing pigmented subretinal mass was detected that was treated by brachytherapy with the apical dose of 80 Gy. Three weeks later, the lesion regressed completely, and no recurrence happened after 6 years of F/U. Case 2: A 4-month-old girl with a deletion in chromosome 13 was referred for bilateral RB. OD was enucleated because of unresponsive RB and anterior segment involvement. In OS, group B lesions had multiple recurrences after systemic chemotherapy. After a while, a single mass appeared in the nasal periphery which was controlled well with brachytherapy. Four months later, AC involvement was controlled with IAC, intravitreal, and intracameral chemotherapy, but posterior synechia and cataract appeared later. One year after the last treatment, UBM showed a ring-shaped ciliary body mass. Her parents refused enucleation again, and she received intravenous chemotherapy. Two years later, magnetic resonance imaging showed orbital and optic canal involvement with a deformed globe. In conclusion, RB recurrence can appear as local choroidal and ciliary body involvement even after a time of complete remission. The role of B-scan and UBM in early diagnosis and successful treatment is valuable.

Computed tomography scan to diagnose abducens nerve palsy cases with superior-compartment atrophy.

PURPOSE: To use orbital computed tomography (CT) to explore the proportion of superior-compartment lateral rectus muscle atrophy in abducens nerve palsy and its relationship with clinical findings. METHODS: Twenty-two patients with isolated unilateral abducens nerve palsy were enrolled. Orbital CT scans of all patients were acquired. All measurements were performed in two ways for normal and paretic lateral rectus muscles: posterior volume (mm3) and maximal cross-section area (mm2). These variables were also measured separately in the superior and inferior 40% of the muscle. Primary position esotropia and amount of abduction limitation was also recorded. RESULTS: The mean deviation was 23.4Δ ± 12.1Δ (range, 0Δ-50Δ); the mean limitation of abduction, -2.7 ± 1.3 (range, -1 to -5). Seven cases (31.8%) showed the gross morphologic characteristics of superior-compartment atrophy. In these 7 cases, the mean percentage of atrophy in posterior volume and in maximal cross-section was significantly greater in the superior compartment than the inferior compartment (P = 0.02 for both). The mean limitation of abduction in these 7 cases (-1.7 ± 0.9; range, -1 to -3) was significantly lower than in other cases (-3.1 ± 1.3, range, -1 to -5 [P = 0.02]). CONCLUSIONS: In our study cohort, a subgroup of abducens nerve palsy cases demonstrated evidence of superior portion lateral rectus atrophy on orbital CT. The superior-compartment-atrophy group had both a smaller primary gaze esotropia and a smaller abduction deficit, providing evidence that compartmental atrophy should be considered in patients with partially retained lateral rectus function.

Addition of intravitreal carboplatin with melphalan for management of vitreous seeding in retinoblastoma.

PURPOSE: To evaluate the efficacy and toxicity of intravitreal carboplatin plus melphalan for the treatment of vitreous seeds in eyes with retinoblastoma (RB). METHODS: This retrospective series at a tertiary referral center included 22 consecutive RB patients who had received intravitreal carboplatin (16 µg per 0.05 ml) combined with melphalan (30 µg in 0.03 ml) [IVi (Ca-Me)] for treatment of vitreous seeds. Tumor control and drug toxicities were recorded. RESULTS: There were 22 eyes of 22 patients, divided into primary group (n = 13) without history of previous intravitreal chemotherapy (IViC) and refractory group (n = 9) with history of previous IViC using melphalan and/or topotecan. The demographics and clinical findings of the primary and refractory groups did not differ significantly. The 6-month follow-up revealed complete vitreous seed control (77% vs. 89%, p = 0.47). Vitreous seed recurrence was detected in 1 eye of each group at 6 months. During the next 18-month follow-up period, no recurrence of seed was observed. The response to IVi (Ca-Me) was not significantly influenced by previous IViC (p = 0.70), primary systemic or intra-arterial chemotherapy (p = 0.45), or the type of regression (p = 0.35). The most common tumor treatment complications were retinal detachment (RD) (n = 2), early hypotony (n = 2) and late hypotony (n = 4, unrelated), cataract (n = 2), and severe pigment dispersion (n = 1). Enucleation was performed in 8 eyes, for total RD (n = 1), phthisis bulbi (n = 5), and extensive solid tumor recurrence (n = 2). There was no case of orbital invasion, systemic metastasis, or death. CONCLUSION: Based on this interventional case series for primary and refractory vitreous RB seeds, carboplatin plus melphalan therapy may be effective with few toxic side effects.

A new clinical scoring system for adenoid hypertrophy in children.

INTRODUCTION: Chronic nasal obstruction due to adenoid hypertrophy is a very common disorder. Although the clinical assessment of adenoid hypertrophy is essential, its real value in young children is difficult to evaluate. The purpose of this prospective study was to validate a simple clinical score to predict the severity of adenoid obstruction and to evaluate the relationship between this method of clinical scoring with radiography and nasopharyngeal endoscopy. MATERIALS AND METHODS: Ninety symptomatic children were enrolled into this study. The clinical score included difficulty of breathing during sleep, apnea, and snoring. We investigated the relationship between clinical scoring, nasal endoscopy, and radiographic findings. RESULTS: The clinical score correlated very well with endoscopic findings (P<0.000), but the correlation between the clinical score and radiologic findings (P>0.05) and endoscopic findings and imaging (P>0.05) was weak.  CONCLUSION: Clinical findings could be used to select children for adenoidectomy, especially when endoscopic examination is not available or cannot be performed.