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1.
Neurol Neuroimmunol Neuroinflamm ; 6(4): e572, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31355308

RESUMO

Objective: To investigate whether visual disability which is known to accumulate by poor recovery from optic neuritis (ON) attacks can be lessened by early treatment, we investigated whether the time from symptom onset to high-dose IV methylprednisolone (IVMP) affected visual recovery. Methods: A retrospective study was performed in a consecutive cohort of patients following their first aquaporin-4 (AQP4)-IgG or myelin oligodendrocyte glycoprotein (MOG)-IgG-ON. Best-corrected visual acuity (BCVA) in ON eyes at 3 months (BCVA3mo) was correlated with time to IVMP (days). In cases of bilateral ON, 1 eye was randomly selected. Results: A total of 29 of 37 patients had ON (27 AQP4-seropositive neuromyelitis optica spectrum disorder [NMOSD] and 9 MOG-IgG-ON), 2 of whom refused treatment. Of the 27 patients included, 10 presented later than 7 days from onset. The median BCVA3mo of patients treated >7 days was 20/100 (interquartile range 20/100-20/200). Patients treated >7 days had an OR of 5.50 (95% CI 0.88-34.46, p = 0.051) of failure to regain 0.0 logMAR vision (20/20) and an OR of 10.0 (95% CI 1.39-71.9) of failure to regain 0.2 logMAR vision (20/30) (p = 0.01) compared with patients treated within 7 days. ROC analysis revealed that the optimal criterion of delay in IVMP initiation was ≤4 days, with a sensitivity and specificity of 71.4% and 76.9%, respectively. Conclusions: In this retrospective study of ON with AQP4 and MOG-IgG, even a 7-day delay in IVMP initiation was detrimental to vision. These results highlight the importance of early treatment for the long-term visual recovery in this group of patients. A prospective, multicenter study of the effects of timing of IVMP is currently underway. Classification of evidence: This study provides Class IV evidence that hyperacute treatment of AQP4 and MOG-ON with IVMP increases the chance for good visual recovery (20/20 vision) and that even a greater than 7-day delay in treatment is associated with a higher risk for poor visual recovery.

2.
J Neurol ; 2018 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-29938337

RESUMO

Optic neuritis (ON) is a common clinical manifestation in myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease. Other clinical manifestations include acute demyelinating encephalomyelitis, transverse myelitis and neuromyelitis optica spectrum disorders. Uncommon presentations of MOG-positive disease have recently been reported. ON in MOG-positive disease commonly involves the anterior portion of both optic nerves, leading to bilateral disc swelling. During the early stages of ON, in the setting of bilateral disc swelling and pain, patients may initially be suspected as pseudotumor cerebri (PTC). In this study, we report five cases presenting early in the course of MOG-IgG-related ON, which were misdiagnosed as PTC in the emergency department. MOG-IgG-positive ON requires timely treatment to prevent RNFL and vision loss secondary to the high relapse rate associated with these antibodies. Our aim is to increase the awareness of the unique findings of MOG-IgG-positive ON, which may initially mimic PTC, thereby delaying treatment.

3.
PLoS One ; 12(1): e0170847, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28125740

RESUMO

BACKGROUND: Optic neuritis (ON) in patients with anti-myelin oligodendrocyte glycoprotein (MOG)-IgG antibodies has been associated with a better clinical outcome than anti-aquaporin 4 (AQP4)- IgG ON. Average retinal nerve fiber layer thickness (RNFL) correlates with visual outcome after ON. OBJECTIVES: The aim of this study was to examine whether anti-MOG-IgG ON is associated with better average RNFL compared to anti-AQP4-IgG ON, and whether this corresponds with a better visual outcome. METHODS: A retrospective study was done in a consecutive cohort of patients following anti-AQP4-IgG and anti-MOG-IgG ON. A generalized estimating equation (GEE) models analysis was used to compare average RNFL outcomes in ON eyes of patients with MOG-IgG to AQP4-IgG-positive patients, after adjusting for the number of ON events. The final mean visual field defect and visual acuity were compared between ON eyes of MOG-IgG and AQP4-IgG-positive patients. A correlation between average RNFL and visual function was performed in all study eyes. RESULTS: Sixteen patients were analyzed; ten AQP4-IgG-positive and six MOG-IgG-positive. The six patients with MOG-IgG had ten ON events with disc edema, five of which were bilateral. In the AQP4-IgG-positive ON events, 1/10 patients had disc edema. Final average RNFL was significantly better in eyes following MOG-IgG-ON (75.33µm), compared to 63.63µm in AQP4-IgG-ON, after adjusting for the number of ON attacks (GEE, p = 0.023). Mean visual field defects were significantly smaller (GEE, p = 0.046) among MOG-IgG positive ON eyes compared to AQP-IgG positive ON eyes, but last visual acuity did not differ between the groups (GEE, p = 0.153). Among all eyes, average RNFL positively correlated with mean visual field defect (GEE, p = 0.00015) and negatively correlated with final visual acuity (GEE, p = 0.00005). CONCLUSIONS: Following ON, RNFL is better preserved in eyes of patients with MOG-IgG antibodies compared to those with AQP4-IgG antibodies, correlating with better visual outcomes.


Assuntos
Aquaporina 4/imunologia , Glicoproteína Mielina-Oligodendrócito/imunologia , Fibras Nervosas Mielinizadas/imunologia , Nervo Óptico/diagnóstico por imagem , Neurite Óptica/diagnóstico por imagem , Adulto , Aquaporina 4/genética , Autoanticorpos/biossíntese , Criança , Feminino , Expressão Gênica , Humanos , Imunoglobulina G/biossíntese , Pessoa de Meia-Idade , Glicoproteína Mielina-Oligodendrócito/genética , Fibras Nervosas Mielinizadas/patologia , Nervo Óptico/imunologia , Nervo Óptico/patologia , Neurite Óptica/imunologia , Neurite Óptica/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual , Campos Visuais
4.
Ophthalmic Res ; 52(4): 217-23, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25402842

RESUMO

BACKGROUND AND OBJECTIVE: To identify the most accurate combination of Pentacam's equivalent keratometry readings (EKR) and intraocular lens power formula when the clinical history is unavailable. PATIENTS AND METHODS: A total of 18 patients underwent cataract surgery after refractive surgery. The Pentacam 4.5- and 3.0-mm EKR were combined with the SRK II, SRK/T, Hoffer-Q, and Holladay I and II formulas. RESULTS: The smallest deviation from the predicted value was achieved by combining the 4.5 EKR with the Holladay II formula (mean arithmetic deviation, -0.2 ± 0.4 dpt). CONCLUSION: The 4.5-mm EKR + Holladay II formula can accurately calculate intraocular lens power in patients with previous refractive surgery.


Assuntos
Córnea/anatomia & histologia , Cirurgia da Córnea a Laser , Topografia da Córnea/métodos , Lentes Intraoculares , Óptica e Fotônica , Facoemulsificação , Idoso , Biometria , Feminino , Humanos , Implante de Lente Intraocular , Masculino , Pessoa de Meia-Idade , Refração Ocular/fisiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Acuidade Visual/fisiologia
5.
Ophthalmic Plast Reconstr Surg ; 30(4): e102-3, 2014 Jul-Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24819206

RESUMO

An 88-year-old woman with a blind painful OS underwent a retrobulbar alcohol injection. Nine months following the procedure, she was evaluated in the clinic for discomfort surrounding her left brow and forehead and was found to have dysesthesia in the left V1 nerve distribution. There was no evidence of orbital inflammation on history or ocular examination. An MRI of the orbits showed intraconal abnormal signal with enhancement and enophthalmos. The chronic effect of retrobulbar alcohol injection on the orbital contents may mimic orbital inflammatory disease on the MRI, but the absence of clinical correlates should allow for appropriate diagnosis.


Assuntos
Depressores do Sistema Nervoso Central/efeitos adversos , Etanol/efeitos adversos , Órbita/efeitos dos fármacos , Pseudotumor Orbitário/induzido quimicamente , Pseudotumor Orbitário/diagnóstico , Idoso de 80 Anos ou mais , Cegueira/complicações , Depressores do Sistema Nervoso Central/administração & dosagem , Etanol/administração & dosagem , Dor Ocular/tratamento farmacológico , Feminino , Humanos , Imagem por Ressonância Magnética , Órbita/patologia
6.
AJR Am J Roentgenol ; 202(3): 608-13, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24555598

RESUMO

OBJECTIVE: MRI abnormalities have been described in patients with increased intracranial pressure (ICP), including in those with idiopathic intracranial hypertension (IIH). Spontaneous CSF-filled outpouchings of the dura (meningoceles) and secondary CSF leaks can occur from elevated ICP in patients with IIH; however, few studies have evaluated these findings. Our objective was to evaluate the frequency of spontaneous intracranial meningoceles among IIH patients and determine their association with visual outcome. MATERIALS AND METHODS: We performed a retrospective case-control study of consecutive IIH patients between 2000 and 2011 who underwent MRI that included T2-weighted imaging. Demographics, presenting symptoms, CSF opening pressure, and visual outcome were collected for the first and last evaluations. Control subjects included patients without headache or visual complaints who had normal brain MRI results. Stratified analysis was used to control for potential confounding by age, sex, race, and body mass index. RESULTS: We included 79 IIH patients and 76 control subjects. Meningoceles were found in 11% of IIH patients versus 0% of control subjects (p<0.003). Prominent Meckel caves without frank meningoceles were found in 9% of IIH patients versus 0% of control subjects (p<0.003). Among IIH patients, the presence of meningocele or prominent Meckel caves was not associated with demographics, symptoms, degree of papilledema, CSF opening pressure, visual acuity, or visual field defect severity. CONCLUSION: Meningoceles are significantly more common in IIH patients than in control subjects and can be considered an additional imaging sign for IIH. Meningoceles are not, however, associated with decreased CSF opening pressure or better visual outcome in IIH.


Assuntos
Encefalocele/epidemiologia , Encefalocele/patologia , Imagem por Ressonância Magnética/estatística & dados numéricos , Meningocele/epidemiologia , Meningocele/patologia , Pseudotumor Cerebral/epidemiologia , Pseudotumor Cerebral/patologia , Adulto , Causalidade , Comorbidade , Feminino , Georgia/epidemiologia , Humanos , Incidência , Masculino , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Adulto Jovem
7.
Neuroophthalmology ; 38(2): 82-87, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-27928280

RESUMO

Heteronymous hemianopic defects may lead to the hemifield slide phenomenon. We report one case of binasal and two of bitemporal visual field defects causing hemifield slide. Both patients with bitemporal visual field defects underwent strabismus surgery. One with adjustable sutures reported omission or duplication of a central strip of vision dependent on alignment during adjustment, but did not have long-term improvement of hemifield slide in two patients. Visual field improvement resolved hemifield in two patients, one of whom had strabismus surgery. Strabismus surgery to restore binocular visual function can be performed in hemifield slide patients. Patients with improving visual fields may have a better sensory prognosis.

8.
Can J Ophthalmol ; 48(6): 494-9, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24314410

RESUMO

OBJECTIVE: To investigate the use of peripapillary optical coherence tomography for monitoring optic neuropathy in pediatric craniopharyngioma. DESIGN: Retrospective, consecutive-cohort, single-centre chart analysis. PARTICIPANTS: Twenty children with craniopharyngioma treated at a pediatric medical centre from 1999 to 2011. METHODS: The medical files were reviewed for demographics and optic nerve function. Findings for visual acuity and visual fields were analyzed against repeated optical coherence tomography (OCT) measurements of peripapillary nerve fibre layer thickness (using either time-domain Stratus OCT or spectral-domain Cirrus OCT). RESULTS: Average age at diagnosis was 6.5 ± 3.88 years. The most common presenting symptom was headache; only 1 child complained of visual loss. Mean best corrected visual acuity (logMAR) was 0.036 ± 0.06 in the 17 healthy eyes and 1.05 ± 1.45 in the 23 eyes with optic neuropathy. Positive signs included relative afferent pupillary defect (8/20), visual acuity loss (7/20), temporal visual field loss (bilateral 4/15, unilateral 4/15), papilledema (3/20), and unilateral/bilateral optic disc pallor (14/20). RNFL thickness was significantly lower in eyes with optic neuropathy than in healthy eyes (65 ± 22 µm vs 86.2 ± 29 µm; p = 0.000) and correlated with visual acuity (r = -0.43 to -0.17, p = 0.0001) and presence or absence of a visual field defect (mean difference, 26.1 ± 5.8 µm, p = 0.003). Ten children showed no change in RNFL thickness over time (mean 18 ± 14.2 months). CONCLUSIONS: A thinner RNFL on ocular coherence tomography is correlated with poorer visual acuity and visual field loss. Ocular coherence tomography may serve as an objective method to quantify axonal loss caused by craniopharyngioma. Further investigation is needed to determine its use for evaluating progressive axonal loss over time.


Assuntos
Craniofaringioma/diagnóstico , Fibras Nervosas/patologia , Doenças do Nervo Óptico/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos , Campos Visuais , Criança , Estudos de Coortes , Craniofaringioma/tratamento farmacológico , Feminino , Humanos , Masculino , Neoplasias Hipofisárias/tratamento farmacológico , Estudos Retrospectivos , Escotoma/diagnóstico , Acuidade Visual/fisiologia , Testes de Campo Visual
9.
J Neuroophthalmol ; 33(4): 330-7, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24042170

RESUMO

INTRODUCTION: Idiopathic intracranial hypertension (IIH) is increasingly recognized as a cause of spontaneous cerebrospinal fluid (CSF) leak in the otolarnygological and neurosurgical literature. The diagnosis of IIH in patients with spontaneous CSF leaks typically is made a few weeks after surgical repair of the leak when symptoms and signs of elevated intracranial pressure (ICP) appear. METHODS: Case reports and literature review. Two young obese women developed spontaneous CSF rhinorrhea related to an empty sella in one and a cribriform plate encephalocele in the other. Both patients underwent surgical repair of the CSF leak. A few weeks later, they developed chronic headaches and bilateral papilledema. Lumbar punctures showed elevated CSF opening pressures with normal CSF contents, with temporary improvement of headaches. A man with a 3-year history of untreated IIH developed spontaneous CSF rhinorrhea. He experienced improvement of his headaches and papilledema after a CSF shunting procedure, and the rhinorrhea resolved after endoscopic repair of the leak. RESULTS: These cases and the literature review confirm a definite association between IIH and spontaneous CSF leak based on: 1) similar demographics; 2) increased ICP in some patients with spontaneous CSF leak after leak repair; 3) higher rate of leak recurrence in patients with raised ICP; 4) patients with intracranial hypertension secondary to tumors may develop CSF leak, confirming that raised ICP from other causes than IIH can cause CSF leak. CONCLUSIONS: CSF leak occasionally may keep IIH patients symptom-free; however, classic symptoms and signs of intracranial hypertension may develop after a CSF leak is repaired, exposing these patients to a high risk of recurrence of the leak unless an ICP-lowering intervention is performed.


Assuntos
Rinorreia de Líquido Cefalorraquidiano/etiologia , Hipertensão Intracraniana/complicações , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Vazamento de Líquido Cefalorraquidiano , Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Feminino , Humanos , Hipertensão Intracraniana/diagnóstico , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Obesidade , Radiografia , Tomógrafos Computadorizados
10.
Neurol Clin Pract ; 3(2): 168-170, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23914325

RESUMO

A 28-year-old African American woman developed periocular pain worsening with eye movement and decreased vision in her left eye. A diagnosis of left optic neuropathy was made based on the findings of decreased vision in the left eye, a left relative afferent pupillary defect, and mild optic disc hyperemia in the left eye (figure 1), with normal retinae and maculae bilaterally. Automated perimetry showed a small central scotoma in the left eye. The pain with eye movements suggested an inflammatory mechanism (i.e., optic neuritis). Her neurologic examination was normal. MRI of the brain showed 2 small T2 hyperintense lesions in the right inferior frontal lobe and left periatrial white matter. The lesions did not enhance. Angiotensin converting enzyme level was slightly elevated. A chest CT was negative for pulmonary sarcoidosis. She did not receive steroids, and her visual function improved spontaneously over a few weeks. She had no neurologic symptoms and the diagnosis of clinically isolated syndrome was made. The patient declined treatment with an immunomodulatory agent.

11.
Can J Ophthalmol ; 46(4): 358-9, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21816257

RESUMO

One of the most important steps during Descemet stripping automated endothelial keratoplasty (DSAEK) is attaching the donor Descemet lenticule to the host's cornea. This is usually carried out by injecting air into the anterior chamber with a syringe and needle. We present an alternative technique using an air fluid exchange system connected to an anterior chamber maintainer used in 22 cases in our institute. This technique has proven to be simple and fast, thus facilitating the successful performance of DSAEK surgery.


Assuntos
Acetatos , Ar , Câmara Anterior/cirurgia , Doenças da Córnea/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Minerais , Cloreto de Sódio , Combinação de Medicamentos , Epitélio Posterior/metabolismo , Humanos , Aderências Teciduais , Doadores de Tecidos
12.
Clin Ther ; 32(2): 347-56, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20206792

RESUMO

BACKGROUND: Folic acid supplementation in patients with folic acid deficiency has been associated with increased clearance of phenytoin to its cytochrome P450 (CYP) 2C9-mediated metabolite, 5-(4'-hydroxyphenyl)-5-phenylhydantoin. OBJECTIVE: The aim of this study was to determine whether folic acid supplementation increases the dosage requirement of the CYP2C9 substrate warfarin, and the formation clearance of the CYP2C9-mediated product, (S)-7-hydroxywarfarin. METHODS: Patients aged >or=18 years with folic acid deficiency who were receiving long-term treatment with a stable dosage of warfarin were studied prospectively, before and 30 to 60 days after the initiation of supplementation with folic acid. Warfarin dosage and international normalized ratio (INR) were documented, and the formation clearance of (S)- and (R)-7-hydroxywarfarin and the oral clearance of (S)- and (R)-warfarin were determined. RESULTS: Twenty-four white patients (14 males; mean (SD) age, 55.0 [19.7] years; body mass index, 30.64 [6.8] kg/m(2)) were enrolled. Treatment with folic acid was associated with a significantly increased mean (SD) formation clearance of (S)-7-hydroxywarfarin (1.096 [0.816] vs 1.608 [1.302] mL/min; P = 0.048). Before folic acid supplementation, the mean (SD) warfarin dosage was 5.98 (2.12) mg/d, and the INR was 2.51 (0.55). During supplementation, the warfarin dosage was 6.17 (2.31) mg/d and the INR was 2.63 (0.65) (both, P = NS vs before supplementation). CONCLUSIONS: Folic acid supplementation was associated with significantly increased formation clearance of (S)-7-hydroxywarfarin. Changes in warfarin dosage requirements and INR were nonsignificant.


Assuntos
Anticoagulantes/farmacocinética , Coagulação Sanguínea/efeitos dos fármacos , Suplementos Nutricionais , Ácido Fólico/farmacologia , Complexo Vitamínico B/farmacologia , Varfarina/farmacocinética , Administração Oral , Adulto , Idoso , Anticoagulantes/administração & dosagem , Hidrocarboneto de Aril Hidroxilases/genética , Hidrocarboneto de Aril Hidroxilases/metabolismo , Biotransformação , Citocromo P-450 CYP2C9 , Interações de Medicamentos , Feminino , Ácido Fólico/administração & dosagem , Genótipo , Humanos , Coeficiente Internacional Normatizado , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Fenótipo , Polimorfismo Genético , Estudos Prospectivos , Complexo Vitamínico B/administração & dosagem , Varfarina/administração & dosagem , Varfarina/análogos & derivados
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