Vertical implantable collamer lens (ICL) rotation for the management of high vault due to lens oversizing.

PURPOSE: To describe the good outcome of implantable collamer lens (ICL) rotation to reduce post-operative vault. METHODS: Retrospective analysis of case report. A 43-year-old woman had V4c EVO + myopic non-toric ICL implantation and post-operatively she presented with anisocoria and high vault. She underwent surgery to rotate the ICL 90 degrees to a vertical orientation. RESULTS: We achieved a reduction in the vault from 1020 to 486 µm after vertical ICL rotation. Satisfactory refractive outcome and optimal vault were achieved and maintained during the period of follow-up. CONCLUSION: Optimal ICL sizing is important as too high vault/clearance is associated with problems such as angle closure glaucoma, pupil dilatation and anisocoria and too low vault/clearance to increased risk of cataract formation. Non-toric ICL rotation can be a simple surgical technique to deal with oversized lenses thus avoiding ICL exchange.

Midriasis benigna episódica. Experiencia en una consulta monográfica de neuro-oftalmología de un hospital terciario / Benign episodic mydriasis. Experience in a specialist neuro-ophthalmology clinic of a tertiary hospital

Introducción: Las anisocorias son un motivo de consulta relativamente frecuente en unidades de neuro-oftalmología (UNO). Suponen un reto diagnóstico por la variedad de procesos que pueden ocasionarla. En ausencia de síntomas acompañantes, suelen estar ocasionadas por procesos benignos. La midriasis benigna episódica (MBE) es una causa aislada de asimetría pupilar intermitente, de fisiopatología no esclarecida y predominio en mujeres jóvenes migrañosas. Sujetos, material y métodos: Describimos las características epidemiológicas y clínicas de los pacientes con MBE valorados en una UNO de un hospital terciario. Resultados: Un total de 7 pacientes fueron diagnosticadas de MBE. Todas eran mujeres, con edad media de 33 ± 10 años. Los motivos de consulta fueron asimetría pupilar (n = 5) y visión borrosa (n = 2) de presentación fundamentalmente unilateral (n = 6). La duración fue variable, desde minutos hasta 48 h. Cuatro pacientes (57%) presentaban como antecedente migraña sin aura. En estas, los episodios eran recidivantes (75%), de minutos de duración (75%) y asociaban visión borrosa (50%). Los estudios de neuroimagen (resonancia magnética cerebral) fueron normales. Discusión: La midriasis benigna episódica se presenta predominantemente en mujeres jóvenes. Se asocia al antecedente de migraña y hace plantear si se trata de un síntoma acompañante de la migraña, un aura migrañosa o de migraña oftalmopléjica. De predominio unilateral, puede sin embargo existir alternancia del ojo afectado o ser bilateral de forma simultánea, lo que nos hace cuestionarnos la idoneidad del término. En ausencia de síntomas acompañantes y en episodios de corta duración, no consideramos necesaria la realización de pruebas de imagen

Introduction: Anisocorias are a relatively frequent reason for consultation in neuro-ophthalmology units. They remain a diagnostic challenge for specialists as they may be due to several etiological factors. In the absence of other accompanying symptoms, anisocorias are usually due to benign processes. Benign episodic mydriasis (BEM) is an isolated cause of intermittent pupil asymmetry, in which the pathophysiology is still not fully understood, and is predominant in young women with migraine. Subjects, material and methods: We describe the epidemiological and clinical characteristics of patients with BEM, assessed in a neuro-ophthalmology unit in a tertiary hospital. Results: A total of 7 patients were diagnosed with BEM, all of them females, with a mean age of 33 ± 10 yrs. The patients presented with pupil asymmetry (n = 5) and blurred vision (n = 2), and 6 of the 7 patients had unilateral involvement. The duration of impairment varied from a few minutes to 48 hrs. Four patients (57%) had a clinical history of migraine without aura. The episodes in these 4 patients were recurrent (75%), often lasted for a few minutes (75%), and had associated blurred vision (50%). The neuroimaging studies were normal. Discussion: BEM appears predominantly in young women. It is frequently related to a previous history of migraine, and the specialist must consider if it is a concomitant symptom of common migraine, migraine with aura, or ophthalmoplegic migraine. Although BEM has unilateral predominance, there may be alternation of the affected eye or even bilateral impairment during the same episode, which makes us question the adequacy of the term to describe the process. Imaging tests are not recommended in the absence of other accompanying symptoms, or in short-term episodes

The localizing value of asymmetry in pupillary size in severe head injury: relation to lesion type and location.

Reliable Assessment of the probability that a head injury patient harbors a surgical intracranial lesion is critical to both triage and treatment. The authors analyzed data from 608 patients with severe head injuries (Glasgow Coma Scale score, < or = 8) in the Traumatic Coma Data Bank to assess the reliability of pupillary asymmetry in predicting the presence and location of an intracranial mass lesion. Of 210 patients with pupillary asymmetry of > or = 1 mm, 63 (30%) had intracranial mass lesions, 52 (25%) of which were extra-axial in location, 38 (73%) of these located ipsilateral to the larger pupil. Of 51 patients with asymmetry of > or = 3 mm, 22 (43%) had intracranial mass lesions, 18 (35%) of which were extra-axial in location, 14 (64%) of these located ipsilateral to the larger pupil. For both asymmetry categories, strong interactions were found with age and mechanism of injury, the highest incidence of extra-axial lesions occurring in older patients injured other than as occupants of motor vehicles. The authors developed regression equations that provide a graphic means to predict the presence of an intracranial hematoma using data on pupillary asymmetry, age, and mechanism of injury. This predictive model, interpreted in a hospital- and patient-specific fashion, should be of significant use in directing triage, activating diagnostic and therapeutic resources, and evaluating the utility of exploratory trephination.