RESUMEN
In this case report, a 33-year-old pregnant woman with migraine and visual aura complained of headache, nausea, and blurred vision. Clinically, she presented with bilateral dilated and fixed pupils, ptosis, and tearing. She was erroneously diagnosed as having a migraine attack, but after referral to an ophthalmological department she was diagnosed with bilateral acute angle closure. At one-year follow-up her visual acuity was normalized but the severe visual field defects affected her daily activities and prevented her from having a driving licence.
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Errores Diagnósticos , Glaucoma de Ángulo Cerrado , Campos Visuales , Humanos , Femenino , Adulto , Glaucoma de Ángulo Cerrado/diagnóstico , Embarazo , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/etiología , Complicaciones del Embarazo/diagnóstico , Enfermedad Aguda , Migraña con Aura/diagnósticoRESUMEN
OBJECTIVE: Congenital cytomegalovirus infection (cCMV) is a common, frequently unrecognized cause of childhood disability. The aim of the present study was to determine the symptoms that raise the suspicion of cCMV, define the neurodevelopmental outcomes, and assess their correlations. METHODS: This longitudinal observational study comprised 78 children with symptomatic cCMV who underwent neuropediatric follow-up for 4 to 17.9 years. RESULTS: Symptoms of central nervous system involvement, hearing/visual impairments, and hepatic involvement were mostly recognized. The average age of disease suspicion was 3.3 months. In terms of outcomes, 10.53% of the children developed complex minor neurological dysfunction and 23.68% developed cerebral palsy. Visual and hearing impairments occurred in 38.16% and 14.47% of patients, respectively. Intellectual disability was present in 30.26% of patients, and epilepsy in 21.05%. Microcephaly and hearing impairment was significantly associated with overall neurodevelopmental outcome. Microcephaly was also associated with poor motor outcomes, hearing impairment, and severe visual impairment. Furthermore, microcephaly and intrauterine growth restriction were significantly associated with poor cognitive outcomes. CONCLUSION: Symptoms that raised the suspicion of cCMV-especially microcephaly, hearing impairment, and intrauterine growth restriction-were important parameters that were associated with outcomes; however, their recognition was often insufficient and/or late.
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Infecciones por Citomegalovirus , Humanos , Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/congénito , Infecciones por Citomegalovirus/diagnóstico , Femenino , Masculino , Niño , Preescolar , Lactante , Adolescente , Estudios Longitudinales , Microcefalia/virología , Microcefalia/etiología , Parálisis Cerebral , Pérdida Auditiva/virología , Pérdida Auditiva/etiología , Pérdida Auditiva/diagnóstico , Discapacidad Intelectual/virología , Retardo del Crecimiento Fetal/virología , Trastornos de la Visión/virología , Trastornos de la Visión/etiología , Trastornos de la Visión/diagnóstico , Recién Nacido , Pronóstico , Citomegalovirus/patogenicidad , Estudios de SeguimientoRESUMEN
Herein, we present two cases of isolated suprasellar dissemination of glioblastoma in patients with well-controlled primary lesions. A 22-year-old woman and a 56-year-old woman developed rapid growth of suprasellar glioblastoma dissemination 26 and 17 months after initial surgery, respectively. Both patients presented with acute visual impairment (decreased acuity and visual field disturbances) but lacked severe pituitary dysfunction. During surgery for the disseminated tumors, gross total tumor resection was difficult due to intraoperative findings suggesting optic pathway invasion. Both patients developed further intracranial dissemination within several months post-surgery. The presence of solitary sellar and suprasellar dissemination may indicate a terminal stage.
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Glioblastoma , Neoplasias Hipofisarias , Silla Turca , Humanos , Femenino , Glioblastoma/cirugía , Glioblastoma/patología , Glioblastoma/diagnóstico por imagen , Persona de Mediana Edad , Silla Turca/cirugía , Silla Turca/patología , Silla Turca/diagnóstico por imagen , Adulto Joven , Neoplasias Hipofisarias/cirugía , Neoplasias Hipofisarias/patología , Neoplasias Hipofisarias/diagnóstico por imagen , Imagen por Resonancia Magnética , Neoplasias Encefálicas/cirugía , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/diagnóstico por imagen , Trastornos de la Visión/etiología , Trastornos de la Visión/cirugía , Invasividad Neoplásica , Procedimientos Neuroquirúrgicos/métodosRESUMEN
BACKGROUND AND OBJECTIVES: Recovery of vision after acute optic neuritis (AON) is critical to improving the quality of life of people with demyelinating diseases. The objective of the study was to prospectively assess the changes in visual acuity, retinal layer thickness, and cortical visual network in patients with AON to identify the predictors of permanent visual disability. METHODS: We studied a prospective cohort of 88 consecutive patients with AON with 6-month follow-up using high and low-contrast (2.5%) visual acuity, color vision, retinal thickness from optical coherence tomography, latencies and amplitudes of multifocal visual evoked potentials, mean deviation of visual fields, and diffusion-based structural (n = 53) and functional (n = 19) brain MRI to analyze the cortical visual network. The primary outcome was 2.5% low-contrast vision, and data were analyzed with mixed-effects and multivariate regression models. RESULTS: We found that after 6 months, low-contrast vision and quality of vision remained moderately impaired. The thickness of the ganglion cell layer at baseline was a predictor of low-contrast vision 6 months later (ß = 0.49 [CI 0.11-0.88], p = 0.012). The structural cortical visual network at baseline predicted low-contrast vision, the best predictors being the betweenness of the right parahippocampal cortex (ß = -036 [CI -0.66 to 0.06], p = 0.021), the node strength of the right V3 (ß = 1.72 [CI 0.29-3.15], p = 0.02), and the clustering coefficient of the left intraparietal sulcus (ß = 57.8 [CI 12.3-103.4], p = 0.015). The functional cortical visual network at baseline also predicted low-contrast vision, the best predictors being the betweenness of the left ventral occipital cortex (ß = 8.6 [CI: 4.03-13.3], p = 0.009), the node strength of the right intraparietal sulcus (ß = -2.79 [CI: -5.1-0.4], p = 0.03), and the clustering coefficient of the left superior parietal lobule (ß = 501.5 [CI 50.8-952.2], p = 0.03). DISCUSSION: The assessment of the visual pathway at baseline predicts permanent vision disability after AON, indicating that damage is produced early after disease onset and that it can be used for defining vision impairment and guiding therapy.
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Neuritis Óptica , Recuperación de la Función , Tomografía de Coherencia Óptica , Humanos , Neuritis Óptica/fisiopatología , Neuritis Óptica/diagnóstico por imagen , Masculino , Femenino , Adulto , Persona de Mediana Edad , Recuperación de la Función/fisiología , Estudios Prospectivos , Potenciales Evocados Visuales/fisiología , Vías Visuales/fisiopatología , Vías Visuales/diagnóstico por imagen , Agudeza Visual/fisiología , Estudios de Seguimiento , Imagen por Resonancia Magnética , Retina/fisiopatología , Retina/diagnóstico por imagen , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/etiología , Corteza Visual/diagnóstico por imagen , Corteza Visual/fisiopatologíaRESUMEN
Intraocular pressure is currently the only known reliable, modifiable risk factor for the development and progression of glaucoma. Other risk factors for glaucoma include increasing age, myopia, decreased central corneal thickness, and low corneal hysteresis (CH) measurements. Photoablative keratorefractive surgery including laser assisted in situ keratomileusis (LASIK) has become a common way to treat refractive error, with over 25 million procedures performed in the United States alone. Though myopic LASIK has been associated with a decrease in CH measurements, relatively little is known about the risk of LASIK on glaucoma onset and progression. Here we present an observational study of 4 consecutive relatively young and otherwise healthy glaucoma patients with a history of myopic LASIK who showed progression of paracentral visual field deficits at intraocular pressures of 12 mm Hg or less while being carefully monitored. Therefore, these patients required lower targets of intraocular pressure, in the single-digit range, to slow or halt progression. In this cohort, the average corneal hysteresis was more than 2 standard deviations below normal values. This series suggests that additional study into the association of LASIK and glaucoma is warranted, including the potential risk contribution of diminished CH. These studies may be particularly relevant as patients who underwent LASIK procedures in the early 2000s may now be at increased risk of glaucoma due to the risk factor of age.
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Progresión de la Enfermedad , Presión Intraocular , Queratomileusis por Láser In Situ , Miopía , Tonometría Ocular , Campos Visuales , Humanos , Queratomileusis por Láser In Situ/efectos adversos , Presión Intraocular/fisiología , Campos Visuales/fisiología , Miopía/cirugía , Miopía/fisiopatología , Masculino , Femenino , Adulto , Córnea/fisiopatología , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/etiología , Trastornos de la Visión/diagnóstico , Pruebas del Campo Visual , Persona de Mediana Edad , Agudeza Visual/fisiología , Factores de Riesgo , Láseres de Excímeros/uso terapéutico , Adulto JovenRESUMEN
Langerhans cell histiocytosis (LCH) is a neoplastic disease characterized by aberrant proliferation of the mononuclear phagocyte system, predominantly affecting children under the age of 3 years. Although LCH can affect almost all organs, sinus involvement is rare. This case report documents a 9-year-old boy presented with vision impairment and intermittent headache on the right side. The CT scan and MRI examination revealed the presence of a soft mass in the right atrium of sphenoid sinus, which impacted the right optic canal. Biopsy results confirmed the presence of LCH. Considering the involvement of optic canal and vision impairment, meticulous debridement was performed followed by a 12-month standard chemotherapy. After 2 years of follow-up, the patient showed significant improvement, despite the presence of an encapsulated cyst in the right sphenoid sinus. This case highlights the importance of considering LCH when encountering an isolated soft mass accompanied by decreased vision in the sphenoid sinus. A thorough physical examination, laboratory tests, and imaging methods should be performed, with a biopsy being necessary to confirm the type of lesion and guide the appropriate treatment.
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Histiocitosis de Células de Langerhans , Seno Esfenoidal , Trastornos de la Visión , Humanos , Histiocitosis de Células de Langerhans/complicaciones , Histiocitosis de Células de Langerhans/diagnóstico por imagen , Histiocitosis de Células de Langerhans/patología , Histiocitosis de Células de Langerhans/diagnóstico , Masculino , Seno Esfenoidal/diagnóstico por imagen , Seno Esfenoidal/patología , Niño , Trastornos de la Visión/etiología , Trastornos de la Visión/patología , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To assess the functional outcomes in visual acuity, metamorphopsia, and vision-related quality of life (VR-QOL) and to evaluate prognostic factors after macular buckling (MB) surgery in eyes with high myopia and foveoschisis (FS)-associated macular detachment (MD). METHODS: Thirty-nine eyes of 39 patients with FS-associated MD who underwent MB surgery were enrolled. Measured outcomes comprised best-corrected visual acuity (BCVA), metamorphopsia, VR-QOL, axial length (AL), macular reattachment, and resolution of foveoschisis. In addition, factors affecting final BCVA and metamorphopsia were analyzed. RESULTS: At 12 months postoperatively, 36 eyes (92.31%) achieved macular reattachment, 37 eyes (94.87%) achieved complete resolution of foveoschisis, and metamorphopsia diminished in 31 eyes (79.49%). LogMAR BCVAs at baseline and months 1, 3, 6, and 12 postoperatively were 0.62 ± 0.35 (20/83), 0.65 ± 0.3 (20/89), 0.59 ± 0.31 (20/77), 0.54 ± 0.31 (20/69), and 0.46 ± 0.27 (20/57) (P < 0.001), respectively. Metamorphopsia scores by M-CHARTS were 1.36° ± 0.51°, 1.04° ± 0.51°, 0.74° ± 0.47°, 0.59° ± 0.47°, and 0.13° ± 0.29° (P < 0.001). All Visual Function Questionnaire-25 subscales demonstrated significant improvement postoperatively, with the exception of "general health" (P = 0.08) and "driving" (P = 0.111). Preoperative BCVA was an independent risk factor for postoperative BCVA at month 12 (r = 0.638, P < 0.001), and the preoperative M-score was an independent risk factor for postoperative M-score at month 12 (r = 0.187, P = 0.045). CONCLUSION: MB surgery significantly improved BCVA, metamorphopsia, and VR-QOL in patients with FS-associated MD. Preoperative BCVA and metamorphopsia score were prognostic factors for postoperative BCVA and metamorphopsia score at month 12.
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Miopía Degenerativa , Calidad de Vida , Desprendimiento de Retina , Retinosquisis , Curvatura de la Esclerótica , Trastornos de la Visión , Agudeza Visual , Humanos , Agudeza Visual/fisiología , Masculino , Femenino , Persona de Mediana Edad , Desprendimiento de Retina/cirugía , Desprendimiento de Retina/fisiopatología , Desprendimiento de Retina/diagnóstico , Desprendimiento de Retina/etiología , Miopía Degenerativa/complicaciones , Miopía Degenerativa/fisiopatología , Miopía Degenerativa/cirugía , Curvatura de la Esclerótica/métodos , Retinosquisis/cirugía , Retinosquisis/fisiopatología , Retinosquisis/diagnóstico , Anciano , Estudios Retrospectivos , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/etiología , Adulto , Estudios de Seguimiento , Tomografía de Coherencia Óptica/métodos , Resultado del TratamientoRESUMEN
We describe the case of a 73-year-old woman presenting with headaches, confusion, and vision disturbances. Brain MRI showed a large T2-hyperintense lesion in the right temporo-occipital region with vasogenic edema and leptomeningeal enhancement. A leptomeningeal biopsy was performed, which led to a definitive diagnosis.
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Confusión , Trastornos de la Visión , Anciano , Femenino , Humanos , Edema Encefálico/diagnóstico por imagen , Confusión/etiología , Imagen por Resonancia Magnética , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/diagnóstico por imagen , Trastornos de la Visión/etiología , Trastornos de la Visión/diagnóstico , Campos Visuales/fisiología , Sustancia Blanca/patología , Sustancia Blanca/diagnóstico por imagenRESUMEN
Visual impairment due to ophthalmological diseases significantly affects functional activity in everyday life, since good eyesight is crucial in daily activities. Data from 837 respondents were studied, allowing for analysis of such medical and demographic indicators as age, gender, level of education, visual acuity arterial hypertension and diabetes mellitus. To measure functional status, the main activities in daily life (ADL) and instrumental activities in daily life (IADL) were evaluated using a modified version of the Katz scale and the IADL OARS scale. Statistical methods of Mantel-Hansel Chi-squared analysis were used to assess differences in the prevalence of functional blindness and visual deficit. The study showed that medical and demographic factors have a relatively smaller impact on vision deficiency compared to functional blindness, with age being a significant factor in both cases. Among the medical and demographic factors, the age of patients, as well as diabetes mellitus, significantly increase the development of visual deficiency and functional blindness. Functional blindness, in comparison with visual deficiency, causes more significant restrictions on activities in everyday life and instrumental activities in everyday life, and also causes dependence on help from others.
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Actividades Cotidianas , Trastornos de la Visión , Humanos , Femenino , Masculino , Anciano , Trastornos de la Visión/epidemiología , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/etiología , Agudeza Visual , Ceguera/epidemiología , Ceguera/etiología , Ceguera/fisiopatología , Persona de Mediana Edad , Federación de Rusia/epidemiología , Anciano de 80 o más Años , Factores de EdadRESUMEN
INTRODUCTION: Sepsis is associated with neurocognitive impairment among preterm neonates but less is known about term neonates with sepsis. This systematic review and meta-analysis aims to provide an update of neurocognitive outcomes including cognitive delay, visual impairment, auditory impairment, and cerebral palsy, among neonates with sepsis. METHODS: We performed a systematic review of PubMed, Embase, CENTRAL and Web of Science for eligible studies published between January 2011 and March 2023. We included case-control, cohort studies and cross-sectional studies. Case reports and articles not in English language were excluded. Using the adjusted estimates, we performed random effects model meta-analysis to evaluate the risk of developing neurocognitive impairment among neonates with sepsis. RESULTS: Of 7,909 studies, 24 studies (n = 121,645) were included. Majority of studies were conducted in the United States (n = 7, 29.2%), and all studies were performed among neonates. 17 (70.8%) studies provided follow-up till 30 months. Sepsis was associated with increased risk of cognitive delay [adjusted odds ratio, aOR 1.14 (95% CI: 1.01-1.28)], visual impairment [aOR 2.57 (95%CI: 1.14- 5.82)], hearing impairment [aOR 1.70 (95% CI: 1.02-2.81)] and cerebral palsy [aOR 2.48 (95% CI: 1.03-5.99)]. CONCLUSION: Neonates surviving sepsis are at a higher risk of poorer neurodevelopment. Current evidence is limited by significant heterogeneity across studies, lack of data related to long-term neurodevelopmental outcomes and term infants.
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Sepsis Neonatal , Humanos , Recién Nacido , Sepsis Neonatal/complicaciones , Parálisis Cerebral/complicaciones , Trastornos de la Visión/etiologíaRESUMEN
BACKGROUND/OBJECTIVES: Stroke damage to the primary visual cortex induces large, homonymous visual field defects that impair daily living. Here, we asked if vision-related quality of life (VR-QoL) is impacted by time since stroke. SUBJECTS/METHODS: We conducted a retrospective meta-analysis of 95 occipital stroke patients (female/male = 26/69, 27-78 years old, 0.5-373.5 months poststroke) in whom VR-QoL was estimated using the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ) and its 10-item neuro-ophthalmic supplement (Neuro10). Visual deficit severity was represented by the perimetric mean deviation (PMD) calculated from 24-2 Humphrey visual fields. Data were compared with published cohorts of visually intact controls. The relationship between VR-QoL and time poststroke was assessed across participants, adjusting for deficit severity and age with a multiple linear regression analysis. RESULTS: Occipital stroke patients had significantly lower NEI-VFQ and Neuro10 composite scores than controls. All subscale scores describing specific aspects of visual ability and functioning were impaired except for ocular pain and general health, which did not differ significantly from controls. Surprisingly, visual deficit severity was not correlated with either composite score, both of which increased with time poststroke, even when adjusting for PMD and age. CONCLUSIONS: VR-QoL appears to improve with time postoccipital stroke, irrespective of visual deficit size or patient age at insult. This may reflect the natural development of compensatory strategies and lifestyle adjustments. Thus, future studies examining the impact of rehabilitation on daily living in this patient population should consider the possibility that their VR-QoL may change gradually over time, even without therapeutic intervention.
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Calidad de Vida , Accidente Cerebrovascular , Humanos , Femenino , Persona de Mediana Edad , Masculino , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/complicaciones , Anciano , Adulto , Estudios Retrospectivos , Trastornos de la Visión/fisiopatología , Trastornos de la Visión/etiología , Lóbulo Occipital/fisiopatología , Campos Visuales/fisiologíaAsunto(s)
Trombosis Intracraneal , Trombosis de la Vena , Humanos , Trombosis Intracraneal/complicaciones , Trombosis Intracraneal/diagnóstico por imagen , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico , Trastornos de la Visión/etiología , OftalmólogosAsunto(s)
Hidrocefalia , Tercer Ventrículo , Ventriculostomía , Humanos , Ventriculostomía/métodos , Ventriculostomía/efectos adversos , Hidrocefalia/cirugía , Tercer Ventrículo/cirugía , Masculino , Neuroendoscopía/métodos , Trastornos de la Visión/etiología , Femenino , Complicaciones Posoperatorias/etiología , AdultoAsunto(s)
Catarata , Demencia Vascular , Humanos , Catarata/complicaciones , Demencia Vascular/etiología , Demencia Vascular/prevención & control , Demencia Vascular/epidemiología , Factores de Riesgo , Femenino , Masculino , Anciano , Trastornos de la Visión/etiología , Anciano de 80 o más Años , Persona de Mediana EdadRESUMEN
Neuro-ophthalmic evaluation is a crucial component of the diagnostic and prognostic assessment of pituitary disease and compressive chiasmopathy, and can inform the timing of vision-restoring tumour resection surgery. The most common disease affecting the pituitary with neuro-ophthalmic implications are pituitary adenomas. Neuro-ophthalmic manifestations include decreased vision, abnormal colour vision and impaired visual field or diplopia. The recognition of these syndromes is critical to achieve early diagnosis and treatment and to improve prognosis. The pattern of vision loss in chiasmal compression is determined by the anatomical relationship between the pituitary lesion and optic chiasm, and potential visual field defects include bitemporal deficits, junctional scotomas, monocular cecocentral defects, and incongruous homonymous hemianopias. Rarer neuro-ophthalmic manifestations of pituitary disease include ophthalmoplegia, nystagmus, and obstructive hydrocephalus. There is growing evidence that demonstrates the strong diagnostic utility of optical coherence tomography (OCT) parameters in detecting the presence of compressive chiasmopathy, as well as the prognostic ability to predict the rate and degree of visual recovery following decompression surgery. Long-term neuro-ophthalmic monitoring is critical for detecting delayed vision loss following resection surgery, which may represent tumour recurrence or secondary complications.
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Quiasma Óptico , Humanos , Quiasma Óptico/patología , Enfermedades de la Hipófisis/diagnóstico , Enfermedades de la Hipófisis/terapia , Tomografía de Coherencia Óptica , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/etiología , Trastornos de la Visión/fisiopatología , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/terapia , Neoplasias Hipofisarias/complicaciones , Campos Visuales/fisiologíaRESUMEN
PURPOSE OF REVIEW: To review the literature on visual dysfunction in dementia with Lewy bodies (DLB), including its mechanisms and clinical implications. RECENT FINDINGS: Recent studies have explored novel aspects of visual dysfunction in DLB, including visual texture agnosia, mental rotation of 3-dimensional drawn objects, and reading fragmented letters. Recent studies have shown parietal and occipital hypoperfusion correlating with impaired visuoconstruction performance. While visual dysfunction in clinically manifest DLB is well recognized, recent work has focused on prodromal or mild cognitive impairment (MCI) due to Lewy body pathology with mixed results. Advances in retinal imaging have recently led to the identification of abnormalities such as parafoveal thinning in DLB. Patients with DLB experience impairment in color perception, form and object identification, space and motion perception, visuoconstruction tasks, and illusions in association with visual cortex and network dysfunction. These symptoms are associated with visual hallucinations, driving impairment, falls, and other negative outcomes.
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Enfermedad por Cuerpos de Lewy , Trastornos de la Visión , Humanos , Enfermedad por Cuerpos de Lewy/fisiopatología , Enfermedad por Cuerpos de Lewy/complicaciones , Trastornos de la Visión/etiología , Trastornos de la Visión/fisiopatología , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/etiología , Percepción Visual/fisiologíaRESUMEN
An epiretinal membrane (ERM) is a frequently occurring disease affecting the macula, which can be associated with visual impairment and metamorphopsia, depending on the severity and location. A distinction is made between an idiopathic form caused by age-related changes of the vitreous body and a secondary form associated with diseases of the posterior segment. The development of fibrocellular epiretinal membranes formed by dedifferentiation of intraretinal and extraretinal cells at the level of the vitreomacular interface plays a major role in the pathogenesis. The diagnostics and indications for surgical treatment of ERM are based on the visual acuity, evidence of metamorphopsia, ophthalmoscopic findings and optical coherence tomography (OCT) of the macula. In addition to the possibility of observation of the course where benign spontaneous courses are not uncommon, pars plana vitrectomy (PPV) with peeling of the ERM and internal limiting membrane (ILM) to prevent recurrences is the treatment of choice in symptomatic patients. The prognosis after surgical treatment is very good. In approximately two thirds of the cases, an improvement in visual acuity and/or a reduction of metamorphopsia can be achieved, with a number of predictive, primarily OCT-based factors enabling a prediction of the functional prognosis. Comprehensive patient education regarding the generally long duration of postoperative rehabilitation and the possibility of persistent symptoms or visual deterioration despite successful membrane removal is essential.
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Membrana Epirretinal , Tomografía de Coherencia Óptica , Vitrectomía , Humanos , Membrana Epirretinal/cirugía , Membrana Epirretinal/diagnóstico , Membrana Epirretinal/patología , Vitrectomía/métodos , Trastornos de la Visión/etiología , Trastornos de la Visión/cirugía , Trastornos de la Visión/diagnóstico , Agudeza Visual/fisiologíaRESUMEN
BACKGROUND/AIM: To investigate the treatment outcomes and determinants of prognosis in patients experiencing visual acuity (VA) deterioration due to inflammatory isolated sphenoid sinus disease (ISSD) who underwent endonasal endoscopic surgery (EES). PATIENTS AND METHODS: Thirteen patients with 14 lesions treated with EES between March 2010 and April 2022 were included. Evaluation included improvements in VA using the logarithm of the minimum angle of resolution (LogMAR) scale, resolution rates of associated symptoms, and identification of factors predicting VA recovery. A literature review was conducted to assess the outcomes for ISSD-related VA impairments. RESULTS: The most common etiology is mycetoma (n=5), followed by an equal representation of mucocele and sphenoiditis (n=4). The mean interval from symptom onset to intervention was 4.7 months, with an average follow-up duration of 14.4 months. Seven eyes exhibited preoperative VA of 2.1 LogMAR or worse, with diplopia/ptosis (n=8) and headache (n=5) being the predominant co-occurring symptoms. After surgery, all ancillary symptoms improved, with an overall VA recovery rate of 87.5% (improvement more than 0.2 logMAR units). Mucocele exhibited the best improvements, whereas sphenoiditis showed the least progress (p=0.021). Poor baseline VA (p=0.026) and combined diplopia/ptosis (p=0.029) were identified as negative prognostic factors for VA recovery. CONCLUSION: Our findings suggest a favorable prognosis for VA recovery following EES in patients with inflammatory ISSDs, with response variations based on disease entity. However, further research is needed to personalize therapeutic strategies for enhanced outcomes.
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Agudeza Visual , Humanos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Anciano , Resultado del Tratamiento , Seno Esfenoidal/cirugía , Sinusitis del Esfenoides/complicaciones , Sinusitis del Esfenoides/cirugía , Sinusitis del Esfenoides/fisiopatología , Endoscopía/métodos , Pronóstico , Adulto Joven , Inflamación , Trastornos de la Visión/etiología , Trastornos de la Visión/fisiopatologíaRESUMEN
BACKGROUND AND PURPOSE: Neuromyelitis optica spectrum disorder is a demyelinating and inflammatory affliction that often leads to visual disturbance. Various imaging techniques, including free-water imaging, have been used to determine neuroinflammation and degeneration. Therefore, this study aimed at determining multimodal imaging differences between patients with neuromyelitis optica spectrum disorder, especially those with visual disturbance, and healthy controls. MATERIALS AND METHODS: Eighty-five neuromyelitis optica spectrum disorder patients and 89 age- and sex-matched healthy controls underwent 3-T magnetic resonance imaging (MRI). We analyzed adjusted brain-predicted age difference, voxel-based morphometry, and free-water-corrected diffusion tensor imaging (DTI) by tract-based spatial statistics in each patient group (MRI-positive/negative neuromyelitis optica spectrum disorder patients with or without a history of visual disturbance) compared with the healthy control group. RESULTS: MRI-positive neuromyelitis optica spectrum disorder patients exhibited reduced volumes of the bilateral thalamus. Tract-based spatial statistics showed diffuse white matter abnormalities in all DTI metrics in MRI-positive neuromyelitis optica spectrum disorder patients with a history of visual disturbance. In MRI-negative neuromyelitis optica spectrum disorder patients with a history of visual disturbance, voxel-based morphometry showed volume reduction of bilateral thalami and optic radiations, and tract-based spatial statistics revealed significantly lower free-water-corrected fractional anisotropy and higher mean diffusivity in the posterior dominant distributions, including the optic nerve radiation. CONCLUSION: Free-water-corrected DTI and voxel-based morphometry analyses may reflect symptoms of visual disturbance in neuromyelitis optica spectrum disorder.