Atypical Optic Neuritis After Inactivated Influenza Vaccination.

The existence of vaccine-associated optic neuritis is essentially based on the temporal relationship between the administration of a vaccine and the development of optic neuritis in patients with no other known aetiologies for infectious or non-infectious inflammation that could account for the optic neuritis. Influenza vaccine (inactivated or live attenuated) is considered to be one of vaccines that could be related to optic neuritis. The authors describe a rare case of bilateral asymmetric optic neuritis with leptomeningeal enhancement on magnetic resonance imaging (MRI) in a previously healthy young woman who received inactivated influenza vaccination 2 weeks before the onset of symptoms.

Diagnostic Considerations in Patients Presenting with Transient Vision Loss.

A complete history is essential for determining whether the underlying etiology of transient vision loss is from an ischemic or a nonischemic condition that originates in the eye or elsewhere. Ischemic transient vision loss constitutes a transient ischemic attack and requires a full work-up for ischemic stroke. If carotid artery stenosis is found, early intervention may improve the clinical outcome. This article highlights the diagnostic considerations in the evaluation of patients with transient vision loss.

The Development of Hypertrophic Inferior Olivary Nucleus in Oculopalatal Tremor.

Oculopalatal tremor is an acquired clinical condition resulting from the interruption of the dentato-rubro-olivary neuronal pathway. The signal change in inferior olivary nucleus and its hypertrophy on magnetic resonance imaging (MRI) can be observed prior to the development of symptomatic oculopalatal tremor. This is a case of the fourth cranial nerve palsy followed by oculopalatal tremor, and increased signal intensity in inferior olivary nucleus on MRI was observed in 7 months after damage to the dentate-rubro-olivary pathway and 5 months prior to the development of oscillopsia and oculopalatal tremor.

Increased Prevalence of Optic Disc Drusen after Papilloedema from Idiopathic Intracranial Hypertension: On the Possible Formation of Optic Disc Drusen.

This is a 25-year observational retrospective review of 372 consecutive participants with optic disc drusen or resolved papilloedema from idiopathic intracranial hypertension. The prevalence of optic disc drusen at 19% among eyes with resolved papilloedema was approximately 10 times higher and significantly increased (p < 0.001) as compared with the occurrence in the general population. Eyes with both resolved papilloedema and optic disc drusen had similar visual acuity and visual field outcome as compared with resolved papilloedema alone. Eyes with exposed drusen had significantly worse visual acuity and visual field outcome (p < 0.001) than buried drusen. The high prevalence of optic disc drusen after papilloedema has resolved suggests a non-coincidental relationship. Optic disc drusen formation can be a sequela of papilloedema.

Papilloedema and Increased Intracranial Pressure as a Result of Unilateral Jugular Vein Thrombosis.

Intracranial hypertension and papilloedema are known to develop secondary to cerebral sinus or bilateral jugular vein thrombosis. However, in rare cases, unilateral jugular vein thrombosis may lead to increased intracranial pressure and papilloedema with resultant headache and vision changes. We describe a 45-year-old patient with squamous cell carcinoma of the larynx that developed right jugular vein thrombosis after chemoradiation therapy with cetuximab. This was later complicated by intracranial hypertension and papilloedema. The normal cerebral venous drainage, the potential role of chemoradiation therapy on the aetiology of jugular vein thrombosis, and the mechanism of increased intracranial pressure secondary to unilateral jugular vein occlusion are discussed.

Corneal wound architecture and integrity after torsional and mixed phacoemulsification: evaluation of standard and microincisional coaxial techniques.

BACKGROUND AND OBJECTIVE: To compare the effects of torsional and mixed ultrasound on clear corneal incision architecture, wound integrity, and apposition using standard (2.75 mm) and microincisional (2.2 mm) coaxial phacoemulsification. SUBJECTS AND METHODS: Twenty human cadaver eyes (4 groups of 5 eyes) underwent simulated coaxial phacoemulsification for 45 seconds of ultrasound time (group 1 = 2.75 mm, 100% torsional; group 2 = 2.2 mm, 70% torsional; group 3 = 2.2 mm, 100% torsional; group 4 = 2.2 mm, mixed ultrasound). All phacoemulsification settings were kept constant across each group. Following phacoemulsification, intraocular pressure (IOP) was cyclically raised and lowered from 0 to 125 mm Hg. Two eyes from each group had India ink placed over the wound and were observed for leakage and for histopathologic examination. Eyes not exposed to India ink (three eyes of each group) were examined using anterior segment optical coherence tomography (OCT) and scanning electron microscopy (SEM). RESULTS: Wound leakage was evident in one eye from group 1 and no eyes from the other three groups. Histopathologic examination revealed no India ink penetration in any of the eyes studied. Anterior segment OCT showed good wound apposition in each group. SEM demonstrated partially compromised endothelium and Descemet's membrane in all eyes studied from each group. CONCLUSION: No differences in corneal wound architecture and integrity were observed. Torsional and mixed ultrasound settings do not appear to induce any adverse effects on corneal wound architecture and integrity in standard and microincisional coaxial phacoemulsification techniques.

Bilateral Vision Loss with p-ANCA Associated Lymphocytic Vasculitis.

Purpose: To describe a case of p-ANCA associated vasculitis in a patient with bilateral vision loss with no systemic symptoms or signsMethods: A descriptive review of a caseResults: We report a case of bilateral sequential vision loss in a 73-year-old woman who had no constitutional symptoms except headache and was found to have positive p-ANCA and lymphocytic infiltration on bilateral temporal artery biopsy. Despite the early administration of systemic corticosteroids, the visual outcome was unfavorable.Conclusion: It is important to consider ANCA associated vasculitides when temporal artery biopsy does not support GCA.

Comparison of a torsional handpiece through microincision versus standard clear corneal cataract wounds.

PURPOSE: To directly compare intraoperative and clinical parameters using a torsional handpiece through microincision and standard clear corneal cataract wounds with appropriately configured tips and sleeves. SETTING: Duke University Eye Center, Durham, North Carolina, USA. METHODS: Cataracts in both eyes of 32 patients needing bilateral surgery were extracted using the OZil torsional handpiece. Tips and sleeve selections were optimized for the incision chosen. Right eyes had cataract surgery using a standard method consisting of a 2.8 mm incision with a 0.9 mm tapered 30-degree bevel Kelman configuration tip with a Microsleeve. Left eyes had cataract surgery through a 2.2 mm microincision using a 0.9 mm miniflared 45-degree bevel Kelman configuration tip with an Ultrasleeve. Intraoperative measurements included cumulative dissipated energy (CDE) and balanced salt solution use. Clinical measurements included preoperative and 1-day postoperative central corneal thickness (CCT), preoperative and 6-month postoperative endothelial cell count (ECC), and preoperative and postoperative anterior segment optical coherence tomography (AS-OCT). RESULTS: Intraoperatively, the microincision (2.2 mm) group had less CDE use than the standard incision (2.8 mm) group (P= .001). Clinical measurements showed less ECC loss at 6 months in the microincision group (P<.05). No difference in CCT or AS-OCT findings was detected between groups. CONCLUSIONS: Phacoemulsification using the OZil torsional handpiece through a microincision with an Ultrasleeve and a 45-degree miniflared tip showed favorable clinical and intraoperative characteristics such as less total energy use and less endothelial cell loss at 6 months. Further studies are warranted to substantiate these preliminary findings.

Thermal study of longitudinal and torsional ultrasound phacoemulsification: tracking the temperature of the corneal surface, incision, and handpiece.

PURPOSE: To evaluate the change and difference in the corneal surface, incision, and handpiece temperatures during longitudinal and torsional ultrasound (US) phacoemulsification with standard incisions (2.75 mm) and microincisions (2.20 mm) and the thermal effect on wounds. SETTING: Department of Ophthalmology, Duke University, Durham, North Carolina, USA. METHODS: In this prospective study, human cadaver eyes had simulated phacoemulsification. Group 1 had a 2.75 mm incision with 100% longitudinal US; Group 2, a 2.20 mm incision with 100% longitudinal US; Group 3, a 2.75 mm incision with 100% torsional US; and Group 4, a 2.20 mm incision with 100% torsional US. During phacoemulsification, the corneal incision was evaluated by surgical microscopy and scanning electron microscopy (SEM) and images of the corneal surface, incision, and handpiece were captured with an infrared camera. RESULTS: Twelve eyes (3 each group) were evaluated. The maximum incision temperature was higher in the longitudinal groups than in the torsional groups. With the same US modality, the maximum microincision temperature was higher than the maximum standard incision temperature. After application of full power for 40 seconds, wound burn was observed in all eyes in the longitudinal groups and no eyes in the torsional groups. On SEM, there was more extensive loss of Descemet membrane in the longitudinal groups than in the torsional groups. CONCLUSION: Incision temperature was influenced by US modality and was significantly lower with torsional US than with longitudinal US. Using torsional US with smaller incisions may decrease the risk for wound burn in eyes with denser cataracts.

Refractive change after descemet stripping automated endothelial keratoplasty surgery and its correlation with graft thickness and diameter.

PURPOSE: The purpose of this study was to evaluate the refractive change after Descemet stripping automated endothelial keratoplasty (DSAEK) surgery and its correlation with graft thickness and diameter. METHODS: We retrospectively analyzed the refractive outcomes of 45 cases of DSAEK surgery that were performed at Duke University Eye Center between August 2005 and December 2006. We divided our study groups into DSAEK triple cases and pseudophakic DSAEK cases. We measured manifest refraction preoperatively and postoperatively in each group and compared the difference between the preoperative and the postoperative spherical equivalent. We evaluated the correlation of the refractive change with graft thickness and diameter. RESULTS: Forty-five DSAEK cases in 44 patients (27 women and 17 men) were evaluated and analyzed. Mean age of the patients at surgery was 67.6 years (15-81 years, SD 10.7 years). Forty cases were treated for Fuchs endothelial dystrophy and 5 for pseudophakic bullous keratopathy/bullous keratopathy. Seventeen cases were DSAEK triple cases and 28 pseudophakic DSAEK cases. In the DSAEK triple group, the mean change in refraction at an average of 4 months postoperatively was +1.15 D (range -0.02 to 2.87, SD 1.15). In the pseudophakic DSAEK group, the mean change in refraction at an average of 5 months postoperatively was +0.71 D (range -1.75 to 3.0, SD 1.11). The overall refractive change was +0.88 D (range -1.75 to 3.0, SD 1.02). Correlation of refractive change with graft diameter was modest (r = 0.29, P = 0.05), and a small correlation was found with respect to graft thickness (r = -0.16, P = 0.31). CONCLUSIONS: Our study of DSAEK grafts demonstrated a hyperopic refractive shift after DSAEK surgery. This observation should be taken into consideration when deciding on the appropriate intraocular lens power in DSAEK triple surgery and may also aid in anticipating refractive outcomes after pseudophakic DSAEK surgery. Further studies to follow these refractive changes over a longer follow-up period and to investigate the mechanism of this refractive change after DSAEK surgery are warranted.