Intraocular pressure and ocular biometric parameters changes in migraine.

BACKGROUND: The aim of this study was to assess the intraocular pressure and ocular biometric parameters in migraine patients during acute migraine attacks and compare them with painless period and healthy controls using a new optical biometer AL-Scan. METHODS: In this prospective, case-control study, the axial length, corneal curvature radius, anterior chamber depth, central corneal thickness, and pupil size of 40 migraine patients during acute migraine attacks and painless period and 40 age- and sex-matched healthy subjects were measured using a AL-Scan optical biometer (Nidek Co., Gamagori, Japan). All patients underwent a complete ophthalmic examination before the measurements. IOP and biometer measurements were taken at the same time of day (10:00-12:00) in order to minimize the effects of diurnal variation. RESULTS: There was not a statistically significant difference in intraocular pressure between the migraine patients during acute migraine attacks (15.07 mmHg), painless period (14.10 mmHg), and the controls (15,73 ± 0,81). Also, the ocular biometric parameters did not significantly vary during the acute migraine attacks. CONCLUSIONS: Further studies are needed to evaluate the etiopathologic relationship between intraocular pressure and ocular biometric parameters and acute migraine attack.

Normal-tension glaucoma and obstructive sleep apnea syndrome: a prospective study.

BACKGROUND: Today, identified risk factors for normal-tension glaucoma (NTG) include abnormal ocular blood flow, abnormal blood coagulation, systemic hypotension, ischemic vascular disorders, and autoimmune diseases. However, pathogenesis of the condition remains unclear. On the other hand, there are also a few studies suggesting that the obstructive sleep apnea syndrome (OSAS) may compromise optic nerve head perfusion and cause glaucomatous optic neuropathy by creating transient hypoxemia and increasing vascular resistance. In this study, we evaluated the possible association between OSAS and NTG. METHODS: We recruited 24 patients with NTG and 24 age and sex matched controls who were also similar for systemic risk factors such as diabetes mellitus (DM), hypertension (HT) and hypercholesterolemia. All patients and controls underwent over-night polysomnography (PSG) for the diagnosis of OSAS and calculation of Apnea-Hypopnea Index (AHI). RESULTS: Patients and controls were statistically similar in terms of age, sex, gender, smoking, systemic risk factors, neck circumference and body mass index. The subjects with AHI ≥ 20 were accepted as OSAS. Ten (41.7%) of 24 patients with NTG and 3 (12.5%) of 24 controls had OSAS (p < 0.05). CONCLUSIONS: The prevalence of OSAS was higher in patients with NTG and the difference between patient and control groups was statistically significant (p < 0.05).

''The association of normal tension glaucoma with Buerger's disease: a case report''.

BACKGROUND: To report a case of a 48-year-old man with Buerger's disease who presented with bilateral normal-tension glaucoma (NTG). CASE PRESENTATION: A 48-year-old man who had been diagnosed with Buerger's disease 12 years ago, and received bilateral below-the-knee amputations for ischemic ulcers of the lower limbs, presented at our clinic due to a sudden loss of visual acuity in the left eye. A fundus exam revealed a cup-to-disc ratio of 0.5 for the right eye and 0.8 for the left eye, arteriolar constriction in both eyes, retinal edema in the inferopapillary area, and splinter hemorrhages and soft exudate in the left eye. We diagnosed the patient as having acute nasal branch retinal artery occlusion in the left eye and bilateral NTG, as a result of the ophthalmologic examination and the other findings. CONCLUSION: Although the pathomechanism of NTG is still unknown, previous studies have suggested that patients with NTG show a higher prevalence of vasospastic disorders. We present the second report of NTG associated with Buerger's disease to be described in the literature.

Aggressive Low-Grade Optic Nerve Glioma in Adults.

Primary optic nerve gliomas are most commonly benign pilocytic astrocytomas (World Health Organization [WHO] Grade I) occurring in childhood and following an indolent course. Malignant optic gliomas occur in adulthood and follow an extremely aggressive course, with rapid infiltration of the chiasm, blindness, and death typically within months. A third category of optic glioma, occurring in adulthood, histopathologically benign (WHO Grade I-II) but following an aggressive course, has been rarely reported. The authors describe clinical and histopathologic features of clinically aggressive but histopathologically benign optic nerve gliomas of adulthood. Retrospective review of cases of biopsy-proven optic nerve glioma in the neuro-ophthalmology division of the Jules Stein Eye Institute from 1990 to 2011 was carried out. Cases following an aggressive course were selected for review of clinical, neuroradiologic, and histopathologic features. Three cases were selected for detailed study. Ages ranged from 31 to 45 years. All were initially diagnosed with optic nerve inflammation or benign neoplasm based on clinical and neuroradiologic features, but all suffered neuroradiologic extension and rapid deterioration of vision in the affected eye to no light perception over 3-8 weeks. Optic nerve biopsies were undertaken for the suspicion of malignancy. Features ranged from WHO Grade I (pilocytic astrocytoma, ganglioglioma) in two cases, to WHO Grade II in one case (diffuse astrocytoma, histopathologically benign, but associated with aggressive features such as high p53 [13-21%] and Ki-67 [40%]). The diffuse astrocytoma case subsequently developed extensive intracranial extension suspicious for malignant transformation. These findings indicate that benign optic nerve glioma in adults may be initially misdiagnosed as inflammation, be clinically aggressive, and require excision to prevent further intracranial involvement.

Nonarteritic anterior ischemic optic neuropathy and obstructive sleep apnea.

BACKGROUND: To evaluate the obstructive sleep apnea syndrome (OSAS) in patients with nonarteritic anterior ischemic optic neuropathy (NAION). METHODS: We recruited 27 patients with NAION and 27 age-matched and sex-matched controls who also were similar for systemic risk factors such as diabetes mellitus, hypertension, and hypercholesterolemia. All patients and controls underwent overnight polysomnography for the diagnosis of OSAS and calculation of apnea-hypopnea index (AHI). RESULTS: Patients and controls were statistically similar in terms of age, sex, gender, smoking, systemic risk factors, neck circumference, and body mass index. The subjects with AHI ≥ 20 were accepted as OSAS. Fifteen of 27 patients (55.6%) with NAION and 6 of 27 controls (22.2%) had OSAS (P < 0.05). CONCLUSION: The prevalence of OSAS was higher in patients with NAION, and the difference between patient and control groups was statistically significant (P < 0.05). This result supports prior series suggesting the association between NAION and OSAS.

Combined non-penetrating deep sclerectomy with phacoemulsification versus non-penetrating deep sclerectomy alone.

PURPOSE: To compare the results of combined non-penetrating deep sclerectomy with phacoemulsification (Phaco-NPDS) to those of non-penetrating deep sclerectomy (NPDS) alone. MATERIALS AND METHODS: Fifty-two eyes with cataract and primary open angle glaucoma (POAG) or pseudoexfoliative glaucoma (PXG) were randomly assigned to either Phaco-NPDS or NPDS. Follow-up was performed at regular intervals for up to 36 months. Complete success was defined as intraocular pressure (IOP) <21 mmHg without medication and qualified success was defined as IOP <21 mmHg with medication. RESULTS: Mean IOP in the Phaco-NPDS group decreased from 23.0 ± 7.8 mmHg to 14.1 ± 2.8 mmHg and in the NPDS group from 23.5 ± 5.1 to 14.6 ± 2.2 mmHg 24 months after surgery. The decreases of IOP in the postoperative period were statistically significant in both groups (p < 0.05). There was no significant IOP difference between Phaco-NPDS and NPDS patients postoperatively (p > 0.05). The mean number of glaucoma medications decreased from 1.8 ± 1.3 to 0.15 ± 0.4 and from 1.7 ± 1.4 to 0.22 ± 0.6 in the Phaco-NPDS and NPDS groups, respectively. The decreases in the mean number of the anti-glaucoma medications at the end of the postoperative, 24-month follow-up period were found to be statistically significant for both Phaco-NPDS and NPDS groups (p < 0.05). Mean BCVA increased significantly in both groups. However, the visual outcome was significantly better for the Phaco-NPDS group (p < 0.05). The complete and qualified success rates were 65.3% and 88.4% for Phaco-NPDS patients and 73.1% and 92.3% for NPDS patients, respectively (p > 0.05). CONCLUSION: Phaco-NPDS surgery achieved excellent IOP control, while also providing immediate visual recovery. The success rate was similar to that of the NPDS procedure alone. It is advisable to consider Phaco-NPDS as a primary surgery for patients with coexisting cataract and open angle glaucoma, including PXG.

Toxic Anterior Segment Syndrome following Phacoemulsification Secondary to Overdose of Intracameral Gentamicin.

Objective. To report a case of toxic anterior segment syndrome (TASS) that was caused by inadvertent anterior chamber and cornea stromal injection with high dose gentamicin following cataract surgery. Methods. Case report. Results. We report a 72-year-old female patient who developed TASS that was caused by high dose gentamicin (20 mg/0.5 mL), which was inadvertently used during the formation of the anterior chamber and hydration of the corneal incision. Unlike previous cases, hyphema and hemorrhagic fibrinous reaction were seen in the anterior chamber. Despite treatment, bullous keratopathy developed and penetrating keratoplasty was performed. The excised corneal button was sent for histopathological examination. Conclusions. Subconjunctival gentamicin is highly toxic to the corneal endothelium and anterior chamber structures. Including it on the surgical table carries a potentially serious risk for contamination of the anterior chamber.