Augmented trabeculectomy in paediatric glaucoma.

AIMS: To report the experience with trabeculectomy augmented with mitomycin C and 5-fluorouracil for the treatment of paediatric glaucoma. METHODS: Retrospective, interventional case series design was used. The sample included 17 children (29 eyes) with primary (19 eyes) or secondary (10 eyes) glaucoma who were treated with augmented trabeculectomy as the primary procedure between 1990 and 2002. Data were collected on age and family history, preoperative and end of follow up intraocular pressure, cup/disc ratio (evaluated by drawing), visual acuity, complications, and post-surgery treatment. RESULTS: Patient age at surgery ranged from 1 month to 8 years; most patients (n = 14, 82.3%) were aged less than 1 year (range 1 month-8 months, mean 3.95 (SD 2.56) months); three patients (17.7%) were aged 3, 5, and 8 years. The duration of follow up was 3-120 months (mean 46 months). Intraocular pressure significantly improved from 21 mm Hg to 60 mm Hg (mean 33.1 (10) mm Hg) before surgery to 6-26 mm Hg (mean 17.1 (6) mm Hg) after, (p <0.0001). There was no significant change in cup/disc ratio: 0.1-0.8 (mean 0.42 (0.26)) before and 0.1-1.0 (mean 0.511 (0.27)) after (p = 0.45). In 22 eyes (75.8%), intraocular pressure was controlled at less than 20 mm Hg and the cup/disc ratio remained stable or improved. The life table success rate for intraocular pressure control remained stable at 86% at the 12, 24, and 36 months and after 48 months decreased to 53%. There was no significant difference in the life table results between primary and secondary glaucoma. 14 eyes (48.2%) had a visual acuity better than 20/120 by the end of follow up. Repeated surgery was necessary in eight eyes (27.5%), and additional antiglaucoma treatment in 13 (44.8%). Complications included retinal detachment 1 year after surgery, choroidal detachment, and blebitis (one eye each). CONCLUSIONS: Augmented trabeculectomy with mitomycin C and 5-fluorouracil may serve as the primary procedure in a selected group of paediatric patients with glaucoma.

Pupillary block following posterior chamber intraocular lens implantation in adults.

BACKGROUND: Pupillary block rarely occurs after cataract extraction with posterior chamber intraocular lens implantation. METHODS: A series of six patients (seven eyes) treated for pupillary block after posterior chamber intraocular lens implantation between 1990 and 2001 is described; in one eye, the attack occurred after phacoemulsification. RESULTS: The interval between pupillary block development and the cataract surgery ranged from 1 day to 5 years. In all eyes, treatment consisted of neodymium-YAG laser peripheral iridotomy. In four eyes, the laser peripheral iridotomy relieved the block (one procedure in two; two to three procedures in two). One patient was also treated with YAG capsulotomy, and two patients needed additional surgical intervention. CONCLUSION: Despite the rarity of the complication of pupillary block after posterior chamber intraocular lens implantation, physicians should be aware of the sometimes difficult course of recovery after treatment.

Increased matrix metalloproteinases 1, 2, and 3 in the monkey uveoscleral outflow pathway after topical prostaglandin F(2 alpha)-isopropyl ester treatment.

OBJECTIVE: To investigate the effects of topical prostaglandin F(2 alpha)--isopropyl ester (PGF(2 alpha)-IE) administration on immunoreactivity of matrix metalloproteinases (MMPs) 1, 2, and 3 within the anterior segment tissues of monkey eyes. METHODS: Eight eyes from 4 cynomolgus monkeys were evaluated. One eye from each monkey was treated with 2 mg of PGF(2 alpha)-IE twice daily for 5 days, and intraocular pressure reduction was measured. After fixation and processing, deparaffinized sections of anterior segments were immunostained using antibodies to MMP-1 (interstitial collagenase), MMP-2 (gelatinase A), or MMP-3 (stromelysin-1). Optical density along 2 line segments overlying the iris root, ciliary muscle, and adjacent sclera and perpendicular to their long axes was measured using imaging densitometry. RESULTS: Compared with the contralateral vehicle-treated eyes, statistically significant increases in optical density scores were observed in the iris root, ciliary muscle, and adjacent sclera for all 3 MMPs (P<.01). In these tissues, MMP-1 immunoreactivity was increased by a mean +/- SD of 89% +/- 16%, 61% +/- 8%, and 66% +/- 57%, respectively; MMP-2 immunoreactivity by 129% +/- 53%, 82% +/- 27%, and 267% +/- 210%, respectively; and MMP-3 immunoreactivity by 207% +/- 84%, 83% +/- 49%, and 726% +/- 500%, respectively. CONCLUSIONS: Treatment of monkey eyes with PGF(2 alpha)-IE induces elevation of MMP-1, MMP-2, and MMP-3 in tissues of the uveoscleral outflow pathway. These increases suggest that MMPs might play an important role in the increased uveoscleral outflow observed with topical prostaglandin treatment. CLINICAL RELEVANCE: Immunoreactivity of MMPs in tissues of the monkey uveoscleral outflow pathway is increased after topical treatment with PGF(2 alpha)-IE. This response also might be involved in the intraocular pressure--lowering effect of other prostanoids used to treat glaucoma.

Reduced TIGR/myocilin protein in the monkey ciliary muscle after topical prostaglandin F(2alpha) treatment.

PURPOSE: Mutations in the trabecular meshwork inducible glucocorticoid response (TIGR) gene, also known as myocilin, have recently been linked to some forms of glaucoma. Recent studies have shown that TIGR protein also is expressed in the ciliary muscle. Because uveoscleral outflow, which traverses the ciliary muscle, is increased by prostaglandins (PGs), the present study assessed whether topical PGs alter the amount of TIGR protein within the ciliary muscle. METHODS: Vehicle was topically applied to one eye, and 2 microg PGF(2alpha)-isopropyl ester (PGF(2alpha)-IE) was applied to the other eye of cynomolgus monkeys twice daily for 5 days. Pressure reductions of 5 mm Hg in the PGF(2alpha)-IE-treated eyes were confirmed. The eyes were then fixed and paraffin sections were cut from each eye. The distribution of TIGR protein in the ciliary muscle was determined by confocal scanning laser microscopy. Additional sections were immunostained with a polyclonal antibody to recombinant TIGR protein or with a polyclonal antibody to a synthetic peptide corresponding to the leucine zipper region within the TIGR protein. Staining intensity in the ciliary muscle was assessed by measuring optical density (OD) along two line segments overlying the ciliary muscle, by using a high-resolution imaging densitometer. RESULTS: TIGR protein immunoreactivity was observed in ciliary muscle fibers throughout the ciliary muscle. Extracellular TIGR immunoreactivity colocalized with collagen type IV immunoreactivity. Intracellular staining also was present. Immunoreactivity was less intense in the sections from the PGF(2alpha)-IE-treated eyes compared with the vehicle-treated eyes. This was reflected in the reduction of mean OD scores in each monkey. Overall, the reduction of mean OD scores in the treated eyes was 42.1% +/- 9.9% (P < 0.005) with the anti-recombinant TIGR antibody and 27.3% +/- 10.4% with the anti-TIGR peptide antibody (P < 0.005). CONCLUSIONS: TIGR protein immunoreactivity was present both intracellularly and extracellularly in the ciliary muscle of the cynomolgus monkey. This suggests that extracellular TIGR protein is in contact with aqueous humor in the uveoscleral outflow pathway. Moreover, IOP-lowering topical PGF(2alpha)-IE treatment decreases the amount of TIGR protein in the ciliary muscle.

Reduction of collagen type I in the ciliary muscle of inflamed monkey eyes.

PURPOSE: To investigate in monkey ciliary muscle the relationship between the extent of anterior segment inflammation and alterations of collagen type I as determined by quantitative imaging densitometry. METHODS: Anterior segment inflammation was induced in one eye of five cynomolgus monkey by cannulation of the anterior chamber, by anterior chamber injection of bovine serum albumin, or by disruption of the iris and anterior lens capsule with a needle. Increases in inflammatory cells were scored in hematoxylin and eosin-stained sections. Parallel eye sections were immunostained for collagen type I and developed using diaminobenzidine. Optical density (OD) was measured along two line segments overlying the immunostained ciliary muscle using two-dimensional imaging densitometry. To assess antibody labeling of ciliary muscle structures, additional sections were double-immunostained using antibodies to collagen type I and calponin and examined by confocal microscopy. RESULTS: In each of the inflamed eyes, hematoxylin and eosin-stained sections showed signs of chronic inflammation including lymphocytes and macrophages dispersed among ciliary muscle fibers and in the iris. Double label confocal microscopy showed collagen type I immunoreactivity in the interstitial extracellular matrix between bundles of ciliary smooth muscle fibers. Collagen type I OD scores in each of the inflamed eyes were less by 16% to 55%, compared with the contralateral control eyes. The mean of the OD scores for all inflamed eyes was 39%+/-7% less than the mean of the control eye scores (mean +/- SEM, P < 0.001). Regression analysis showed a close correlation between inflammatory cell scores in the treated eyes and the reduction of OD scores (r = 0.94, P = 0.02). CONCLUSIONS: These results indicate that the density of collagen type I in the extracellular matrix (ECM) of monkey ciliary muscle is reduced during anterior segment inflammation and support the view that reduction of ciliary muscle ECM may contribute to increased uveoscleral outflow facility during anterior segment inflammation.

Topical prostaglandin F2alpha treatment reduces collagen types I, III, and IV in the monkey uveoscleral outflow pathway.

BACKGROUND: Topical prostaglandin F2alpha isopropyl ester increases uveoscleral outflow in monkeys and humans. OBJECTIVE: To investigate the effects of prostaglandin F2alpha isopropyl ester with topical administration on collagen types I, III, and IV within the anterior segment tissue of monkey eyes. METHODS: Eight eyes of 4 cynomolgus monkeys were evaluated. One eye of each monkey was treated with 2 microg of prostaglandin F2alpha isopropyl ester twice daily for 5 days, and intraocular pressure reduction was confirmed. These eyes were fixed in methacarn, and paraffin sections were immunostained using antibodies to collagen types I, II, or IV. To measure staining intensity, optical density (OD) was determined using 2-dimensional imaging densitometry. Mean OD scores along line segments placed over the ciliary muscle were determined. RESULTS: Mean+/-SD OD scores for collagen types I, III, and IV were less in the ciliary muscle of prostaglandin-treated eyes than in vehicle-treated eyes by 52%+/-7%, 45%+/-6%, and 45%+/-5%, respectively. In the sclera adjacent to the ciliary body, mean OD scores for collagen types I and III were less in prostaglandin-treated eyes, by 43%+/-32% and 45%+/-13%, respectively. The scleral stroma was minimally immunoreactive for collagen type IV. All differences were significant by the paired Student t test (P<.05). CONCLUSIONS: This study shows reduced collagen types I, III, and IV immunoreactivity in the ciliary muscle and adjacent sclera following topical prostaglandin F2alpha isopropyl ester treatment. These reductions may contribute to the increased uveoscleral outflow observed with topical prostaglandin treatment. CLINICAL RELEVANCE: The cellular mechanism by which certain prostaglandins lower intraocular pressure is not known. The present study provides immunohistochemical data demonstrating that intraocular pressure reduction that occurs with topical prostaglandin F2alpha is associated with a reduction of collagens within the uveoscleral outflow pathway.

Matrix metalloproteinase-1 localization in the normal human uveoscleral outflow pathway.

PURPOSE: To determine the distribution of matrix metalloproteinase-1 (MMP-1) in the uveoscleral outflow pathway and other anterior segment tissues of normal human eyes. METHODS: Normal human eyes were fixed in methacarn and sectioned and immunostained using a specific polyclonal antibody to MMP-1. Immunoreactivity was visualized using diaminobenzidine. To compare the staining intensity in various tissues, the mean optical density within the ciliary body, mid-iris stroma, iris root, uveal trabecular meshwork, cornea, and sclera was determined using imaging densitometry. To determine the cellular distribution of MMP-1 in ciliary muscle, additional sections were double-immunostained using antibodies to MMP-1 and calponin. These sections were examined by confocal laser scanning microscopy. Specificity of the antibody to MMP-1 in ocular tissues was confirmed by western blot analysis with uveal tract homogenates. RESULTS: Moderate-to-strong MMP-1 immunoreactivity was observed in ciliary muscle, iris, sclera, corneal endothelium, and ciliary nonpigmented epithelium. Lighter immunoreactivity was observed in corneal epithelium, blood vessels, trabecular meshwork, Schlemm's canal, and associated collector channels. Confocal microscopy showed that ciliary muscle MMP-1 was primarily inside ciliary muscle cells. Densitometry showed that net optical density was approximately fivefold greater in ciliary muscle, iris root, and sclera than in trabecular meshwork. CONCLUSIONS: MMP-1 was prominently identified in regions of the anterior segment of normal human eyes associated with the uveoscleral outflow pathway and in the iris, corneal endothelium, and ciliary nonpigmented epithelium. These data support the hypothesis that MMP-1 activity is involved in regulating uveoscleral outflow facility.

Indocyanine green angiographic findings in nonproliferative diabetic retinopathy.

PURPOSE: To report angiographic findings of nonproliferative diabetic retinopathy patients by means of indocyanine green angiography. METHODS: Forty-two eyes (42 patients) with nonproliferative diabetic retinopathy were evaluated by indocyanine green angiography in addition to fluorescein angiography. Angiographic findings with the two imaging techniques were compared with the red-free fundus appearance. RESULTS: Among the 42 eyes, five (12%) had the appearance on indocyanine green angiography of lobular spotty hyperfluorescent and hypofluorescent areas ("salt and pepper" appearance) in the very late phase. Twenty eyes (48%) presented with diffuse late-phase hyperfluorescence on indocyanine green angiography, corresponding to areas of retinal capillary nonperfusion on fluorescein angiography, and retinal edema. A total of 3,564 microaneurysms were divided into three types: 58 (1.6%) appeared mainly on the fluorescein angiography and very faintly on the indocyanine green angiography, 3,029 (85%) appeared on the fluorescein angiography and the indocyanine green angiography, and 477 (13.4%) were uniquely hyperfluorescent on the indocyanine green angiography. CONCLUSIONS: Indocyanine green angiography in patients with nonproliferative diabetic retinopathy disclosed microvascular findings that were in addition to those shown on fluorescein angiography. These angiographic changes were not observed on fluorescein angiography because of imaging limitations. Indocyanine green angiography may be a useful adjunct to fluorescein angiography in the evaluation of chorioretinal vascular changes in nonproliferative diabetic retinopathy.

Long-term follow-up of perfluorocarbon liquid in the anterior chamber.

BACKGROUND: Perfluorocarbon liquids are used as a vitreous substitute in the operative management of several ophthalmologic conditions. We examined the effects of residual perfluorocarbon droplets in the anterior chamber in patients after retinal detachment surgery. METHODS: The study group consisted of seven patients (seven eyes) aged 28-74 years in whom droplets of perfluorocarbon appeared in the anterior chamber subsequent to retinal detachment surgery involving scleral buckling, perfluorodecalin injection, and perfluorocarbon liquid-silicone oil exchange. Mean follow-up was 9.4 months. RESULTS: From 1 -15 droplets of perfluorocarbon liquid were found in the anterior chamber. There were no corneal complications or inflammatory reactions or blood vessel invasion into the corneal stroma. Some of the droplets appeared to be encapsulated in a membrane-like material. Perfluorocarbon liquid and silicone oil had to be removed in three patients at 20, 12, and 4 months postoperatively because of an increase in intraocular pressure due to blockage of the inferior iridectomy by a droplet of perfluorocarbon, emulsification of the silicone oil, or residual perfluorocarbon liquid on the retina (one patient each). Increased intraocular pressure in a fourth patient was successfully treated pharmacologically. CONCLUSION: Based on our experience, residual perfluorocarbon liquid droplets in the anterior chamber are well tolerated and do not induce corneal damage or ocular inflammation. These patients should be closely followed, however, and the liquid removed if complications develop.

The effect of tear substitute and silicone oil on re-epithelisation of the cornea.

PURPOSE: An animal model study was conducted to compare the effects of recurrent applications of an artificial cellulosic tear substitute and silicone oil on corneal reepithelisation. METHODS: A controlled wound was inflicted to the corneas of two groups of rabbits; one group was treated with tear substitute (5 eyes), while the other group received silicone oil (5 eyes). The left eye served as the control in both groups (10 eyes). The rate of re-epithelisation was measured at intervals of 6 h until complete wound closure was observed. After complete wound closure, the rabbits were killed and histological examinations were performed. RESULTS: The wounds of eyes treated with tear substitute closed at a statistically significant faster rate (at 24, 44, 80 h; p < 0.05) than those treated with silicone oil or the untreated eyes. At 48 h after re-epithelisation, the eyes treated with tear substitute presented a normal epithelium while the untreated and silicone-treated eyes presented an abnormally structured epithelium. CONCLUSION: This study demonstrates a favourable effect of tear substitute on corneal re-epithelisation in an animal model, in terms of both rate of re-epithelisation and histological aspects of the new epithelium.

A comparison of the effect of hyaluronic acid versus gentamicin on corneal epithelial healing.

PURPOSE: An animal model study was conducted to compare the efficacy of recurrent topical applications of hyaluronic acid and gentamicin ointment for the treatment of noninfected, mechanical corneal erosions. METHODS: An artificial, controlled wound of identical size and depth was inflicted to the corneas of three groups of rabbit eyes in order to measure their healing rates. One group was treated with hyaluronic acid (10 eyes) while the second group received gentamicin ointment (10 eyes). The third group remained untreated and served as the control (10 eyes). The rate of re-epithelisation was measured at 8-h intervals until complete re-epithelisation was observed. After complete wound closure, the rabbits were killed, and comparative histological examinations were performed. RESULTS: Rabbit eyes treated with hyaluronic acid showed a significantly enhanced rate of epithelial defect closure compared with untreated eyes and a similar rate to that achieved with gentamicin ointment. In the eyes treated with hyaluronic acid a normal, multilayered epithelium was observed 48 h after complete healing, whereas the gentamicin-treated eyes showed an imperfectly layered epithelium, with irregularity of the cuboidal cells. CONCLUSION: While both hyaluronic acid and gentamicin enhance corneal epithelial healing at comparable rates, our study suggests that hyaluronic acid may have a more favourable effect on the structure of the healing epithelium, and can offer an alternative mode of therapy for non-infectious corneal erosions.

Three-dimensional measurements of central serous chorioretinopathy using a scanning laser tomograph.

PURPOSE: To evaluate the topographic three-dimensional mapping of retinal elevation in central serous chorioretinopathy using the Heidelberg Retina Tomograph and to correlate the measured parameters with the fluorescein angiographic findings. METHODS: Seventy-six consecutive patients with central serous chorioretinopathy (63 men, 13 women), between 26 and 54 years of age, were examined to identify areas of neurosensory retinal detachment and fluorescein leakage. In areas of retinal detachment, the parameters measured were the area, volume, maximal height, and diameters of the retinal elevation, which were statistically analyzed, and the correlations between these parameters were evaluated. RESULTS: Mean +/- SD area of elevation was 9.6 +/- 5.22 mm2 (range, 2.7 to 21.5 mm2); mean volume was 1.16 +/- 1.3 mm3 (range, 0.11 to 4.73 mm3); mean maximal height was 238 +/- 108 microns (range, 97 to 450 microns); mean x-axis was 3.4 +/- 1.1 mm (range, 1.6 to 5.6 mm); and mean y-axis was 3.03 +/- 0.98 mm (range, 1.6 to 4.7 mm). Most of the retinal elevations were oval (the x-axis longer than the y-axis); the maximal height was in the geometric center in the smaller blebs and below the geometric center in the larger blebs. There were statistically significant correlations between area, volume, and height of the sensory elevation. No correlation was found between the location and the shape of leakage on fluorescein angiography and the Heidelberg Retina Tomograph measurements. CONCLUSIONS: Confocal laser tomography is potentially useful as a noninvasive diagnostic technique for quantitative measurements of the neurosensory retinal detachment in central serous chorioretinopathy.

Three-dimensional measurements of idiopathic macular holes using a scanning laser tomograph.

PURPOSE: The diagnosis of macular holes is difficult. Confocal laser tomographic analysis of the retina permits the precise measurements of the macular surface. The authors used this technique to study the macular area of patients with full-thickness macular holes. The purposes of these studies is to perform three-dimensional measurements of the macular holes and their rims and to search for a correlation between these parameters. METHODS: Thirty-one eyes with idiopathic full-thickness macular holes underwent scanning of their affected macular area using the Heidelberg retinal tomograph (HRT). The authors evaluated the following parameters: area of the hole and its elevated rim, the maximal depth of the hole, and the maximal elevation of the rim at 12, 3, 6, and 9 o'clock. RESULTS: The average hole area was 0.33 mm2, and the rim area average was 2.99 mm2. The average area of the rim was found to be 9.06 times larger than that of the hole (P < 0.001). The depth of the hole averaged 144 microns. CONCLUSIONS: The area of the rim is usually bigger than that of the hole and in direct correlation to it. Also, the bigger the hole area, the greater its depth. The average height in each of the four quadrants (12, 3, 6, and 9 o'clock) correlates to the other quadrant heights (P < 0.001).

Non-retinovascular leakage in diabetic maculopathy.

BACKGROUND: Diabetic macular oedema is the leading cause of vision deterioration in diabetic retinopathy. Extracellular fluid within the retina, which distorts the retinal architecture, was assumed to be strictly of retinal vasculature origin. However, there is some experimental evidence supporting clinical observations suggesting a possible role of the retinal pigment epithelium (RPE). An unusual form of diabetic maculopathy is presented in which the RPE and the subretinal space play the main role. METHODS: Fluorescein angiograms of 1850 non-proliferative diabetic retinopathy (NPDR) patients were examined. Nineteen eyes (14 patients, 1% of NPDR patients) met the criteria-mainly having minimal diabetic retinopathy with only a few microaneurysms and no clinically significant macular oedema (CSMO). Early phase angiograms were compared with late phase angiograms. RESULTS: It was found that in all 19 eyes the area of diffuse RPE late phase leakage was spread around the macular area. No cystic changes or cystoid macular oedema were present in any of the eyes and the visual acuity was 6/10 or better in all the eyes. CONCLUSIONS: Possible changes occur in the RPE that may be responsible for the late leakage in NPDR patients-namely, diabetic retinal pigment epitheliopathy. These changes are associated with a breakdown of the outer blood-retinal barrier, consisting of leakage through RPE cells. No focal or diffuse leakage across the RPE has been reported in the literature related to the fluorescein angiograms in diffuse diabetic maculopathy.

Intraocular intrusion of sutures after retinal detachment buckling surgery.

BACKGROUND: Intraocular intrusion of tight encircling silicone band is a major complication of retinal detachment surgery leading to subretinal and vitreous hemorrhage, retinal detachment, and phthisis bulbi. Intrusion of the sutures into the eye has only been reported as an adjunct to buckle intrusion. METHODS: Seven patients (9 eyes) are presented in whom intrusion of sutures occurred as a late complication of retinal detachment surgery using the extrascleral buckling technique. Their complications and treatments are discussed. RESULTS: Eleven anchoring sutures were observed under the retina and two sutures penetrated into vitreous cavity. In five eyes (55.5%), small subretinal or vitreous hemorrhages were noted and in one of them perforation with total detachment occurred. In four eyes, no complications were detected. In four eyes, the silicone band was cut and left in place and the hemorrhages were spontaneously absorbed. The perforated eye underwent replacement of the silicone band with a wide silicone sponge, followed by vitrectomy and silicone oil injection. CONCLUSIONS: Intrusion of sutures into the eye can rarely be seen years after retinal detachment surgery and usually do not require surgical intervention. When hemorrhage occurs, cutting of the silicone band only, with no attempt to remove the band or the sutures, is recommended.

Toxic effects of systemic retinoids on meibomian glands.

Systemic use of retinoids is common in the treatment of various dermatological disorders. Blepharitis and conjunctivitis have been reported in 20-45% of the patients following systemic treatment with 13-cis-retinoic acid. Our purpose was to study the histopathological changes in the eyelids caused by long-term systemic treatment of female New Zealand rabbits with isotretinoin (2 mg/kg) and etretinate (2 mg/kg). The histopathological evaluation showed degenerative changes in the meibomian gland acini, leading to cell necrosis and a decrease in the basaloid cells lining the acini walls. No evidence of acute or chronic inflammatory reaction was noted.

Spontaneous thrombosis of a traumatic cavernous sinus fistula.

Post-traumatic thrombosis of cavernous sinus and orbital veins has been reported in conjunction with carotid-cavernous sinus fistula (CCSF). CCSF are abnormal communications between the carotid artery and the cavernous sinus. Spontaneous thrombosis of a CCSF is a rare event mainly seen in the indirect (dural) type of fistula. We report on a patient with a possible post-traumatic CSSF which underwent partial spontaneous thrombosis and presented with an extreme degree of proptosis.

Deformed optic chiasm and colloid cyst in a patient with visual disturbances.

Colloid cysts of the third ventricle are rare intracranial lesions which comprise 0.5 to 1% of all intracranial tumors. We describe a patient with a third ventricle colloid cyst who presented with non specific visual deterioration.