Ophthalmoplegic migraine.

A 5-year-old girl developed severe periocular pain lasting 4 days. As the pain subsided, a right oculomotor palsy developed which slowly resolved without aberrant regeneration over a 2 1/2-month period. A classic history and normal high-resolution CT scan were essential in making the diagnosis of ophthalmoplegic migraine. This is a rare disorder classically requiring normal cerebral angiography for diagnosis. With the advent of high-resolution CT scanning, angiography may no longer be indicated in the typical case.

Congruous and incongruous sectoral visual field defects with lesions of the lateral geniculate nucleus.

Quantitative perimetric studies in two women, each 52 years of age, with involvement of the lateral geniculate nucleus (caused by a small arteriovenous malformation in one and by an astrocytoma in the other) disclosed a striking wedge-shaped horizontal sectoranopia that was perfectly congruous in one case and incongruous in the other. Selective interruption of the dual blood supply to the lateral geniculate nucleus (with the anterior choroidal artery supplying the anterior hilus, together with the anterior and lateral nucleus and the lateral choroidal artery supplying the remainder of the nucleus) may result in a congruous visual field defect with steeply sloping borders because such a lesion must respect the anatomic boundaries produced by this vascular supply. Partial infiltration or involvement of the lateral geniculate nucleus (where uncrossed retinal projections terminate in one group of laminae, while crossed retinal projections terminate in another) provides a logical explanation for the occurrence of incongruous visual field defects. This unusual horizontal wedge-shaped defect should suggest lateral geniculate nucleus involvement, especially in the absence of trauma.

Autosomal dominant preretinal vascular loops.

Preretinal vascular loops are a congenital malformation usually occurring in otherwise normal fundi. These anomalies consist of vessels, most commonly arteries, that spiral into the vitreous and return to the otherwise normal retinal vascular system. The authors present two members of a family with preretinal vascular loops and two members with other vascular anomalies. The inheritance pattern in this group is autosomal dominant.

Achromatopsia. Clinical diagnosis and treatment.

Six cases of classic achromatopsia are presented. The methods of practical clinical diagnosis are discussed, including paradoxical pupillary constriction in darkness, the easily performed Sloan achromatopsia test, and electrophysiologic studies which are useful in young children. The visual and cosmetic benefits of heavily tinted contact lenses in such patients are stressed.

The Marcus Gunn pupil in incomplete optic tract hemianopias.

Three patients with optic tract lesions, incomplete homonymous hemianopias, and good vision in both eyes are presented. All three had a Marcus Gunn pupil in the eye with temporal field loss (eye contralateral to the tract lesion). This pupillary sign may serve to differentiate acute optic tract from acute geniculostriate lesions when the characteristic infrageniculate optic atrophy has not had time to develop.

Vitrectomy technique for removal of retained lens material.

A posteriorly dislocated lens or non-encapsulated lens material in the vitreous cavity may be difficult to remove. The pars plana vitrectomy instrumentation and technique provide new methods to remove this material, including use of the cutting-aspiration system of the instrument with or without use of a second instrument to mechanically crush firm lens material. Also, the vitrectomy instrument can be used to mobilize a dislocated lens or lens nucleus and position it in the anterior chamber prior to removal through a limbus incision. These methods provide considerable flexibility and usually permit the surgeon to achieve the objectives of lens removal, vitrectomy, and treatment of any retinal complications under optimum control during one operation. We have used these methods to successfully treat ten consecutive cases.

Evaluation of possible microwave-induced lens changes in the United States Air Force.

An Air Force examination team performed ophthalmologic examinations on 817 subjects in a double blind fashion. The subjects included 477 workers in the microwave radiation field and 340 control subjects with no known history of occupational exposure to microwave radiation. The intent of the study was to determine if a significant difference existed between the two groups for the presence of three lenticular findings equated with early cataract formation. No significant difference was found. Thus, this study does not support the contention that microwave exposure in the military environment is causing human cataracts at levels permitted by U.S. Safety Standards.