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BACKGROUND: An association between idiopathic intracranial hypertension (IIH) and anemia has been speculated from previous case reports and case series. Retrospective studies to date have not used matched case controls to compare standardized complete blood count (CBC) values for the presence of anemia. METHODS: At our tertiary care facility, 50 patients with IIH were matched with 50 case-control patients to compare CBC values from laboratory affiliates with standardized ranges. RESULTS: No significant difference was found for any CBC parameters for IIH vs control patients. For female IIH and control patients as well as male IIH patients, values for red blood cell count, hemoglobin (HGB), and hematocrit (HCT) tended to trend on the lower end of "normal" range, whereas this was not seen in male control patients. CONCLUSIONS: In this retrospective, matched case-control study, no significant association was found between IIH and anemia when comparing standardized CBC values. In accordance with previous studies, the prevalence of anemia may be relatively higher in the IIH population due to a prominent demographic overlap of females of child-bearing age.
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Anemia/complicaciones , Presión Intracraneal/fisiología , Seudotumor Cerebral/etiología , Adulto , Anemia/sangre , Anemia/epidemiología , Biomarcadores/sangre , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Hematócrito , Humanos , Masculino , Prevalencia , Seudotumor Cerebral/epidemiología , Seudotumor Cerebral/fisiopatología , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
There is growing evidence of thyroid eye disease association with nutritional deficiencies including selenium and vitamin D. We conducted a retrospective chart review of all patients with clinical diagnosis of TED seen at our clinic from 2016 to 2017. Thirty-five patients met inclusion criteria and had serum 25-hydroxyvitamin D levels available, and 19 had selenium levels available. 7/35 (20%) patients had vitamin D deficiency, and 11 (31%) had vitamin D insufficiency, but none had selenium deficiency. Although both selenium and vitamin D supplementation have been recommended for TED, further investigation is necessary to justify supplementation for patients with TED.
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Exoftalmia/etiología , Hidrogeles/efectos adversos , Oftalmoplejía/etiología , Desprendimiento de Retina/cirugía , Curvatura de la Esclerótica/efectos adversos , Anciano de 80 o más Años , Exoftalmia/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Oftalmoplejía/diagnóstico , Curvatura de la Esclerótica/métodos , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
A 50-year-old man presented with a 4-month history of right-sided trigeminal neuropathy in the V1 and V2 distribution, right sixth nerve palsy and Horner syndrome. Magnetic resonance imaging (MRI) showed enhancement and thickening along the right ophthalmic nerve and supraorbital nerve and fullness at the right cavernous sinus extending to Meckel's cave. Evaluation for a primary tumour was negative. Cavernous sinus biopsy showed infiltrating poorly differentiated carcinoma; the patient underwent radiation therapy. To our knowledge this is the only case of poorly differentiated carcinoma involving the supraorbital nerve presenting with trigeminal neuropathy and Horner syndrome in the English ophthalmic literature.
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PURPOSE: To determine informative clinical and magnetic resonance imaging (MRI) characteristics of patients with symptomatic adult acquired, comitant esotropia due to decompensated esophoria. DESIGN: Retrospective, interventional case series. METHODS: Setting: Institutional. STUDY POPULATION: Patients with decompensated esophoria who developed acute acquired comitant esotropia. OBSERVATION PROCEDURES: Ophthalmic examination, stereopsis, and strabismus measurements at distance and near using prism cover tests in diagnostic gaze positions were performed. Patients underwent high-resolution surface coil MRI of extraocular muscles with target fixation, and MRI of the brain. Strabismus surgery was performed under topical anesthesia with adjustable sutures wherever possible. Paired t testing was used to evaluate postoperative changes with 0.05 considered significant. MAIN OUTCOME MEASURE: Clinical and MRI characteristics, and surgical outcome of patients with decompensated esophoria. RESULTS: Eight cases were identified involving subjects of mean age 29 ± 9.4 (range: 20-48) years having gradually progressive intermittent horizontal, binocular diplopia for 10 months to 3 years. Mean preoperative esotropia was 31 ± 12 Δ at distance and 29 ± 12 Δ at near, although this was intermittent in 5 patients who exhibited enhanced fusional divergence. Neurologic evaluation and MRI of brain, orbits, and extraocular muscles were unremarkable in all cases. Orthotropia was successfully restored in all by standard or enhanced doses of bimedial rectus muscle recession surgery, improving mean stereoacuity from 535 to 68 arc seconds, although 5 patients exhibited 2-14 Δ asymptomatic residual esophoria. CONCLUSION: Decompensated esophoria is a benign clinical entity causing acute, acquired, comitant esotropia treatable with enhanced medial rectus recession.
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Diplopía/etiología , Esotropía/etiología , Adulto , Encéfalo/diagnóstico por imagen , Diplopía/diagnóstico , Diplopía/fisiopatología , Esotropía/diagnóstico por imagen , Esotropía/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Músculos Oculomotores/diagnóstico por imagen , Músculos Oculomotores/cirugía , Procedimientos Quirúrgicos Oftalmológicos/métodos , Estudios Retrospectivos , Visión Binocular/fisiología , Adulto JovenAsunto(s)
Presión Sanguínea/fisiología , Hipertensión/complicaciones , Disco Óptico/patología , Papiledema/etiología , Agudeza Visual , Adulto , Encéfalo/diagnóstico por imagen , Resultado Fatal , Humanos , Hipertensión/fisiopatología , Imagen por Resonancia Magnética , Masculino , Papiledema/diagnósticoAsunto(s)
Isquemia Encefálica/diagnóstico , Encéfalo/patología , Movimientos Oculares/fisiología , Lupus Eritematoso Sistémico/complicaciones , Imagen por Resonancia Magnética/métodos , Trastornos de la Motilidad Ocular/etiología , Adulto , Isquemia Encefálica/complicaciones , Diagnóstico Diferencial , Humanos , Lupus Eritematoso Sistémico/diagnóstico , Masculino , Trastornos de la Motilidad Ocular/diagnóstico , Trastornos de la Motilidad Ocular/fisiopatología , SíndromeAsunto(s)
Neoplasias del Sistema Nervioso Central/complicaciones , Cadenas kappa de Inmunoglobulina/líquido cefalorraquídeo , Linfoma de Células B/complicaciones , Paraproteinemias/complicaciones , Neoplasias del Sistema Nervioso Central/líquido cefalorraquídeo , Neoplasias del Sistema Nervioso Central/diagnóstico por imagen , Neoplasias del Sistema Nervioso Central/radioterapia , Humanos , Inmunofenotipificación , Linfoma de Células B/líquido cefalorraquídeo , Linfoma de Células B/diagnóstico por imagen , Linfoma de Células B/radioterapia , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Paraproteinemias/líquido cefalorraquídeo , Paraproteinemias/diagnóstico por imagen , Paraproteinemias/radioterapia , Radioterapia , Tomografía Computarizada por Rayos X , Agudeza Visual/fisiologíaRESUMEN
A 62-year-old female who was legally blind secondary to retinitis pigmentosa (RP) developed new positive visual phenomena (PVP) ("visual storms") following implantation of the Argus II Retinal Prosthesis System (Second Sight Medical Products, Sylmar, CA). The potential mechanisms for the exacerbating PVP or hallucinatory release phenomena are proposed. Clinicians should be aware of these visual phenomena in patients with RP and the potential for worsening of or de novo development of PVP in patients considering the Argus II implant. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:1022-1025.].
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Implantación de Prótesis/métodos , Retina/cirugía , Retinitis Pigmentosa/complicaciones , Baja Visión/cirugía , Agudeza Visual , Prótesis Visuales , Electrorretinografía , Femenino , Humanos , Persona de Mediana Edad , Oftalmoscopía , Diseño de Prótesis , Retina/diagnóstico por imagen , Retinitis Pigmentosa/diagnóstico , Retinitis Pigmentosa/cirugía , Baja Visión/etiología , Baja Visión/fisiopatologíaRESUMEN
Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common form of ischemic optic neuropathy and the second most common optic neuropathy. Patients are generally over the age of 50 years with vasculopathic risk factors (eg, diabetes mellitus, hypertension, and obstructive sleep apnea). The exact mechanism of NAION is not fully understood. In addition, several treatment options have been proposed. This article summarizes the current literature on the diagnosis, treatment, and management of NAION.
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PURPOSE OF REVIEW: We provide a summary of the epidemiology, clinical findings, management and outcomes of ethambutol-induced optic neuropathy (EON). Ethambutol-induced optic neuropathy is a well-known, potentially irreversible, blinding but largely preventable disease. Clinicians should be aware of the importance of patient and physician education as well as timely and appropriate screening. RECENT FINDINGS: Two of the largest epidemiologic studies investigating EON to date showed the prevalence of EON in all patients taking ethambutol to be between 0.7 and 1.29%, a value consistent with previous reports of patients taking the doses recommended by the World Health Organization (WHO). Several studies evaluated the utility of optical coherence tomography (OCT) in screening for EON. These showed decreased retinal nerve fiber layer (RNFL) thickness in patients with clinically significant EON, but mixed results in their ability to detect such changes in patients taking ethambutol without visual symptoms. SUMMARY: Ethambutol-induced optic neuropathy is a well-known and devastating complication of ethambutol therapy. It may occur in approximately 1% of patients taking ethambutol at the WHO recommended doses, though the risk increases substantially with increased dose. All patients on ethambutol should receive regular screening by an ophthalmologist including formal visual field testing. Visual evoked potentials and OCT may be helpful for EON screening, but more research is needed to clarify their clinical usefulness. Patients who develop signs or symptoms of EON should be referred to the ethambutol-prescribing physician immediately for discontinuation or a reduction in ethambutol dosing.
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Antituberculosos/efectos adversos , Etambutol/efectos adversos , Enfermedades del Nervio Óptico/inducido químicamente , Potenciales Evocados Visuales , Humanos , Fibras Nerviosas/patología , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/epidemiología , Prevalencia , Células Ganglionares de la Retina/patología , Tomografía de Coherencia Óptica/métodos , Pruebas del Campo VisualRESUMEN
A 10-year-old boy with bilateral colobomatous cavitary disc anomalies presented with a 3-month history of vision loss in his right eye. MRI of the head and orbit revealed bilateral tubular cystic enlargement of the optic nerve/optic sheath complex with thickening of the optic nerves without inflammation or neoplasm, suggestive of bilateral optic nerve meningocele. An optic nerve sheath fenestration was performed OD, and he experienced an improvement and stabilization of vision in his right eye during a 1-year follow-up period. The authors recommend that surgical decompression, particularly optic nerve sheath fenestration, should be considered in cases with progressive vision loss due to optic nerve meningocele.