Disc Swelling Research Articles

Bilateral posterior scleritis after sequential bilateral cataract surgery: a case report

BackgroundPosterior scleritis is a rare, inflammatory ophthalmic disease, leading to severe visual impairment if untreated. Posterior scleritis occurring after surgery, unrelated to systemic inflammatory diseases, is even rarer. This report discusses a case of bilateral posterior scleritis, after cataract surgery in both the eyes, treated with high-dose steroids.Case presentationA 55-year-old man, who had undergone bilateral sequential cataract surgery one week before, presented with sudden loss of vision and ocular pain in both eyes. The patient had no systemic diseases or neurological symptoms. Serous retinal detachment of the macula with optic disc swelling was observed on fundus examination in both the eyes, and bilateral thickening of choroid and sclera was seen in ultrasonography. Under diagnosis of bilateral posterior scleritis due to the increased signal of sclera in both the eyes on magnetic resonance imaging, high-dose steroid therapy was performed. After treatment, improvement in visual acuity and retinal detachment were observed, and thereafter, it has been maintained without relapse.ConclusionsWith high-dose steroid therapy, we successfully treated a rare case of bilateral posterior scleritis following cataract surgery in both eyes. To our knowledge, this is the first report on posterior scleritis occurring after surgery, unrelated to systemic inflammatory diseases.

Role of Swept source optical coherence tomography in management of acute Vogt-Koyanagi-Harada's disease.

Purpose:To evaluate the role of swept-source optical coherence tomography (SS-OCT) in the management of acute Vogt–Koyanagi–Harada’s (VKH) disease.Methods: Retrospective analysis of SS-OCT images of acute VKH patients between January 2015 and February 2020 in a tertiary eye care hospital.Results: We studied 34 eyes of 17 patients with acute probable VKH disease. The mean age was 31.6 ± 10.4 years. Twelve patients were women. The mean follow-up was 17.1 ± 9.3 months. The mean visual acuity was 0.86 logMAR (Snellen equivalent: 6/45) at presentation and 0.18 logMAR (Snellen equivalent: 6/9) at the last follow-up. The mean subfoveal choroidal thickness (SFCT) was 784.97 microns at presentation, 431.40 microns at the first month of therapy, 453.94 microns at six months of therapy, and 405.83 microns at the last follow-up. Qualitative features noted on SS-OCT on presentation was subretinal fluid (SRF) in 29 (85%) eyes, subretinal hyperreflective dots in 34 (100%) eyes, subretinal septa in 33 (97%) eyes, RPE undulations in 21 (61.7%) eyes, posterior vitreous cells in 34 (100%) eyes, SRF around disc in 9 (26%) eyes, and disc swelling in 34 (100%) eyes. At the end of 1 year of follow-up, RPE undulations were absent in 30 eyes (88%) and disc swelling was notably absent in all 34 eyes (100%), though SRF around disc was noted in 4 eyes (11.7%) of 2 patients who had recurrences.Conclusion: SFCT, SRF around disc, RPE undulation, and disc swelling may be important indicators on SS-OCT to guide therapy and prognosticate recurrences in acute VKH.

Optic disc swelling in the paediatric population

Swelling of the optic disc may result from inflammation, infiltration, optic nerve compression or ischaemia, as well as increased intracranial pressure. It can be imitated by local structural features of the optic disc leading to pseudopapilloedema. Disease entities leading to optic disc swelling can take different courses in the paediatric population compared to the adult population. Investigations used to confirm diagnosis include optical coherence tomography (OCT), ocular ultrasound, fluorescein angiography, visual evoked potentials (VEP), and imaging studies of head and orbits.

A 10-year-old girl with red eyes and hypothyroidism

Objective: Hypothyroidism has many causes and manifestations in children. One of the causes is autoimmunity, which is known as autoimmune thyroiditis or Hashimoto thyroiditis. Pseudotumor cerebri is a rare manifestation of Hashimoto thyroiditis. Here we report a 10-year-old girl with asymptomatic papillary edema who was treated with levothyroxine and acetazolamide. Case Presentation: A 10-year-old girl suffered from left eye trauma while playing volleyball and went to an ophthalmology center due to redness in the same eye. During the examination, they noticed a bilateral optic disc swelling without ocular inflammation and the other eye examination was within normal limits. Encephalopathy may rarely occur during autoimmune thyroiditis, which is known as Hashimoto encephalopathy, and it is stated that the autoimmune disorder is not related to the thyroid dysfunction characterized by the symptoms of decreased level of consciousness and seizures. Conclusion: The diagnosis of hypothyroidism in children is usually made by examining the thyroid-stimulating hormone (TSH), and T4 in which TSH is elevated and T4 is decreased as in our patient.

Occam versus Hickam

A 23-year-old man presented with new onset horizontal diplopia 5 months after a left orbital floor fracture. Examination revealed bilateral abduction deficits and disc swelling. Urgent MRI and MRI showed no significant abnormalities in the CNS. Lumbar puncture revealed a minimally elevated opening pressure and significant leukocytosis. Additional CSF testing revealed probable Lyme meningitis. The patient responded to a course of oral doxycycline, with rapid resolution of his diplopia, abduction deficits, and disc edema.

Traumatic Optic Neuropathy Aggravated by Orbital Emphysema after Orbital Fracture

Purpose: To report a case of traumatic optic neuropathy aggravated by orbital emphysema after an orbital fracture.Case summary: A 19-year-old man with no specific medical history was referred for a right orbital fracture caused by blunt trauma to the supraorbital rim of the right eye. Computed tomography (CT) showed a right orbital fracture involving the inferomedial wall and inferomedial strut. The corrected visual acuity was 0.4 in the right eye (RE) and 1.0 in the left and the intraocular pressure was 15 and 18 mmHg, respectively. Restriction on downgaze, abduction, and an indefinite relative afferent pupillary defect (RAPD) were observed in the RE. Fundus exam was non-specific other than commotio retinae on the temporal side of the macula in the RE. After 12 hours post trauma, the visual acuity of the RE had decreased to light perception. Definite RAPD was observed with optic disc swelling on the fundus photo and optical coherence tomography. Orbital CT showed air shadows, which were not seen on the initial evaluation, adjacent to the optic disc. We diagnosed traumatic optic neuropathy aggravated by orbital emphysema. High-dose intravenous steroid was given for 3 days. Despite a lateral canthotomy and cantholysis to decompress the right orbit, visual acuity did not improve above counting fingers.Conclusions: Increased intraorbital pressure and congestion caused by orbital emphysema may exacerbate traumatic optic neuropathy. Therefore, close observation is required.

FACTORS ASSOCIATED WITH AN INCREASED RISK OF ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: To identify factors associated with an increased risk of adverse cardiovascular events in patients with arterial hypertension Design and method: We analyzed the results of 455 patient case files of patients with arterial hypertension included in the database in the period from January 2016 to May 2020. We made a phone call to all patients to identify new cases of adverse cardiovascular events (ischemic heart disease, stroke, transient ischemic attack, atrial fibrillation, chronic heart failure, death). 371 (81.5%) of 455 patients answered. Results: 45 adverse cardiovascular events occurred in 371 patients with arterial hypertension. Such factors as the age of the onset of hypertension, the duration of hypertension, gender, obesity, dyslipidemia, hyperuricemia, left ventricular hypertrophy, and severe retinopathy were analyzed to assess the relationship with adverse cardiovascular events. According to the Kaplan-Meier survival analysis in the presence of severe retinopathy, the risk of complications after 36 months of follow-up was 50% (p = 0.018). The hazard ratio for complications in the presence of severe retinopathy was 7.88 (CI 1.05–58.98; p = 0.044). Besides only 8 (1.75%) of 455 studied patients with arterial hypertension had severe retinopathy (retinal hemorrhage, microaneurysm, cotton wool spot, hard exudates or optic disc swelling). All 8 patients had a resistant arterial hypertension. No other evidence of interaction was found between other factors and the risk of adverse cardiovascular events. Conclusions: Severe retinopathy is more common in patients with resistant hypertension. Severe retinopathy is associated with an increased risk of adverse cardiovascular events in patients with arterial hypertension

Fundoscopy use in neurology departments and the utility of smartphone photography: a prospective prevalence and crossover diagnostic accuracy study amongst neurology inpatients.

Background and purposeAlthough fundoscopy is a crucial part of the neurological examination, it is challenging, under‐utilized and unreliably performed. The aim was to determine the prevalence of fundus pathology amongst neurology inpatients and the diagnostic accuracy of current fundoscopy practice compared with systematic screening with smartphone fundoscopy (SF) and portable non‐mydriatic fundus photography (NMFP).MethodsThis was a prospective cross‐sectional surveillance and diagnostic accuracy study on adult patients admitted under neurology in an Australian hospital. Inpatients were randomized to initial NMFP (RetinaVue 100, Welch Allyn) or SF (D‐EYE) followed by a crossover to the alternative modality. Images were graded by neurology doctors, using telemedicine consensus neuro‐ophthalmology NMFP grading as the reference standard. Feasibility parameters included ease, comfort and speed.ResultsOf 79 enrolled patients, 14.1% had neurologically relevant pathology (seven, disc pallor; one, hypertensive retinopathy; three, disc swelling). The neurology team performed direct ophthalmoscopy in 6.6% of cases and missed all abnormalities. SF had a sensitivity of 30%–40% compared with NMFP (45.5%); however, it had a lower rate of screening failure (1% vs. 13%, p < 0.001), a shorter examination time (1.10 vs. 2.25 min, p < 0.001) and a slightly higher patient comfort rating (9.2 vs. 8/10, p < 0.001).ConclusionOur study demonstrates a clinically significant prevalence of fundus pathology amongst neurology inpatients which was missed by current fundoscopy practices. Portable NMFP screening appears more accurate than SF, whilst both are diagnostically superior to routine fundoscopic practice, feasible and well tolerated by patients.

066 Clinical and imaging findings in MOG antibody positive patients presenting to Kings College Hospital

We identified all patients testing positive for MOG antibodies at KCH and reviewed their clinical phenotype and imaging findings. 22 patients tested positive for MOG antibodies between Jan 2015 and Aug 2019 (11 female, mean age 39 (SD 18)). The majority of patients 15/22 presented with optic neuritis, 3 patients bilateral, 2 bilateral sequential. Other presentations included LETM (2), ADEM(2), brain stem syndrome (1), lower cord/conus syndrome (1) seizures (1). Mean logMar visual acuity at nadir in patients present- ing with an optic neuritis was 0.69 (SD 0.58). Mean logMar visual acuity at recovery was logMAR 0.1 (SD 0.54), 12/15 eyes had documented optic disc swelling. MRI brain was performed in 20 patients and was normal in 10, 6 had non-specific white matter changes the remainder had inflammatory brainstem and ADEM –like changes. MRI orbits was performed in 13 patients, 4 had bilateral optic nerve involvement and 5 had longitudinally extensive optic nerve lesions. Spinal cord imaging was performed in 9 patients, 2 had a LETM, 1 multifocal signal change and the remainder normal imaging. The cervical cord was the most frequently involved region of the spinal cord. 5 patients developed relapses (all optic neuritis), 3 relapses occurred off treatment.r.raftopoulos@ucl.ac.uk

Differences in Neuropathic Pain and Radiological Features Between AQP4-ON, MOG-ON, and IDON

PurposeThe purpose of this study was to investigate pain and radiological features of different types of first-episode demyelinating optic neuritis (ON).MethodsEighty-three patients presenting with first-episode aquaporin-4 (AQP4) antibody-associated ON (AQP4-ON; n = 28), myelin oligodendrocyte glycoprotein (MOG) antibody-associated ON (MOG-ON; n = 26) and idiopathic demyelinating optic neuritis (IDON, n = 29) were included in this retrospective case-control study. We assessed optic nerve lesions on magnetic resonance imaging (MRI), acute pain associated with onset of optic neuritis and clinical characteristics of those ON patients with different serum autoantibody status.Results24 AQP4-ON patients (85.75%), 23 MOG-ON patients (88.5%) and 24 IDON patients (82.8%) suffered from ON-associated pain. MOG-ON had mostly retro-orbital pain; AQP4-ON and IDON had mostly neuropathic pain. In addition, pain was more severe in AQP4ON patients than in other ON patients. In MRI, bilateral involvement was more common in AQP4-ON than IDON (26.9 and 3.7%); radiological optic nerve head swelling was more common in MOG-ON than in AQP4-ON and IDON (68.0 vs. 23.1 vs. 25.9%). MRI lesion in peri-optic nerve sheath was more common in AQP4-ON (53.8 vs. 16.0 vs. 3.7%). In 70 patients with ON-associated pain, gadolinium enhancement of orbital optic nerve was most common in MOG-ON patients (82.4 vs. 55.0 vs. 33.3%, P = 0.018), and enhancement of optic chiasma was most common in AQP4-ON patients (40.0 vs. 5.9 vs. 6.7%, P = 0.015). Perineural and orbital enhancement was observed only in patients with MOG-ON (P < 0.001). The length of enhancement was longer in AQP4-ON patients than in MOG-ON and IDON patients.ConclusionPain is a common symptom in patients with all types of demyelinating ON. AQP4-ON is frequently associated with severe ON-associated pain and longitudinally extensive optic nerve inflammatory lesions. Intra-orbital and peri-optic inflammation were more frequently observed in patients with MOG-ON, which was closely related to optic disc swelling and retro-orbital pain provoked by eye movements.

Two ophthalmic presentations of chronic myeloid leukaemia.

Chronic myeloid leukaemia (CML) is a myeloproliferative neoplasm that accounts for 15% of newly diagnosed cases of leukaemia in adults [1]. In the developed world, 50% of patients are asymptomatic at diagnosis with the disease picked up on routine examination and blood testing. At presentation, 90%–95% of patients have chronic phase CML during which signs and symptoms typically result from anaemia and splenomegaly [2]. Ophthalmic presentations of CML are uncommon, nonetheless clinicians should be alert to CML presenting with eye signs and the pathophysiology that underpins these findings. The first case (Figure 1) is of a 53-year-old man who reported 10 days of bilateral blurred vision and palpitations on exercise. He had no significant past medical history. His visual acuities were 6/7.5 right and 6/12 left. Fundus examination revealed peripheral perivascular sheathing and florid bilateral Roth spots (Figure 1A,B). He had cystoid macular oedema and leukaemic infiltrates, confirmed on optical coherence tomography. His white blood count (WBC) was 391.4 × 109/l, haemoglobin 83 g/l and platelets 200 × 109/l. The second case (Figure 2) is of a 17-year-old man who described a 10-month history of headaches and lethargy. He had no significant past medical history. He was tachycardic (heart rate 120/min), and the ophthalmic examination revealed visual acuities of 6/6 in both eyes, bilateral optic disc swelling with corresponding blind spot enlargement on visual field testing and tortuous congested retinal vessels. His WBC was 645.8 × 109/l, haemoglobin 72 g/l and platelets 589 × 109/l, and a CT head was reported as showing no intracranial pathology. In both cases, the peripheral blood film was consistent with CML, and cytogenetic analysis of the bone marrow aspirate detected the Philadelphia chromosome. The patients received oral hydroxycarbamide and underwent leukapheresis. They were treated with nilotinib and imatinib respectively, resulting in haematological remission and improvement of their eye signs at 4 and 6 weeks, respectively (Figures 1C,D and 2C,D). The fundus findings illustrate two pathophysiological responses to CML. The first case depicts decompensated leukaemic retinopathy. Hyperviscosity and endothelial dysfunction leads to vessel rupture, intra-retinal haemorrhage and fibrin-platelet plugging at the site of rupture (ie Roth Spots), as well as perivascular sheathing and cystoid macular oedema. The second case demonstrates a hyperdynamic retinal circulation and optic disc swelling, which are likely to be an adaptive (and fully compensated) local circulatory response to the patient's chronic anaemia. The detection of Roth spots or optic disc swelling should lead to systemic work-up of the patient. Clinicians are alerted to the fact that these findings may be indicative of leukaemic disease requiring prompt, potentially lifesaving, treatment. The authors acknowledge the patients who allowed us to present their cases. The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. The report adhered to the ethical principles outlined in the Declaration of Helsinki as amended in 2013.

Congenital Optic Nerve Anomalies with Optical Disc Swelling

Pseudopapilledema is an abnormal elevation of the optic disc due to congenital reasons without increased intracranial pressure. The main causes of congenital optic disc swelling are optic disc drusen, myelinated retinal nerve fibers, hyaloid artery remnants, and congenital optic disc pigmentation. In the differential diagnosis of these conditions, papilledema should be firstly considered and ruled out. In pseudopapilledema, the disc swelling is localized only on the disc. There is no peripapillary nerve fiber layer edema, bleeding, and exudation due to venous congestion. The disc appears normal yellow in color and the optic cupping is small or absent. There may be abnormal vascular vessels on the optic disc. These diseases are generally asymptomatic. However, it is necessary to follow up in terms of complications that may accompany, albeit rarely. In this review, congenital optic disc anomalies with optic disc swelling including optic disc drusen, myelinated retinal nerve fiber, hyaloid artery remnants, and congenital optic disc pigmentation will be discussed.

Masquerade versus masquerade

This is an atypical uniocular presentation of systemic diffuse large B-cell lymphoma. An 80-year-old Caucasian female presented with acute left visual loss, anorexia, headache, and jaw pain with disk swelling. Systemic steroids for giant cell arteritis were started despite negative temporal artery biopsy. Later, an inferior exudative retinal detachment developed. Lytic skull lesions were eventually seen on magnetic resonance imaging. Diffuse large B-cell lymphoma was diagnosed postmortem. This is the second documented case of unilateral serous retinal detachment with no uveitis/pseudouveitis or choroidal infiltrate due to lymphoma. It demonstrates pitfalls of pattern recognition when pieces of the jigsaw do not fit.

Malignant hypertension in a child - What lies beneath?

We report a case of a 7-year-old girl presenting to the Neuro-Ophthalmology OPD with only complaints of chronic headache who was found to have malignant (grade 4) hypertensive retinopathy. Visual acuity was 20/400 in the right eye and 20/80 in the left eye. Blood pressure was 220/120 mm Hg. The patient was not a known hypertensive. Fundoscopy revealed bilateral optic disc swelling, macular stars, and serous retinal detachment in both eyes. The patient was urgently referred to pediatrician for detailed evaluation and systemic control of hypertension. This emphasizes the need for checking blood pressure in children presenting with chronic headache.

Clinical course of asymptomatic patients with papilledema from idiopathic intracranial hypertension

ObjectifOn définit l'hypertension intracrânienne idiopathique (HII) comme une élévation de la pression intracrânienne (PIC) en présence d'un volume normal de liquide céphalorachidien et en l'absence d'une cause identifiable. Les patients ressentent souvent des symptômes typiques d'une élévation de la PIC (p. ex., des céphalées); cela dit, il existe un sous-groupe de patients dont la PIC est élevée et qui présentent un œdème du disque optique, sans aucun autre symptôme connexe. La littérature médicale compte peu d'articles sur ce type de patients. Nous avions donc pour objectif, par l'entremise de la présente étude, de déterminer les caractéristiques cliniques initiales de ces patients asymptomatiques, de même que leurs résultats visuels pendant le suivi. MéthodesNous avons réalisé une revue rétrospective de l'ensemble des patients qui ont été adressés au service de neuro-ophtalmologie du Baylor College of Medicine en vue de l’évaluation d'un œdème papillaire entre janvier 2012 et juin 2020. Les dossiers médicaux de 139 patients consécutifs qui présentaient un œdème papillaire ont ainsi été passés en revue. Les patients qui répondaient aux critères d'inclusion (diagnostic d'HII, œdème bilatéral du disque optique et absence de symptômes d'une élévation de la PIC) ont été inclus dans notre analyse. RésultatsSur les 139 dossiers examinés, 5 patients répondaient aux critères d'inclusion. Il s'agissait de 5 femmes dont l’âge moyen se chiffrait à 25,2 ans (fourchette : 13 à 48 ans). Leur indice de masse corporelle moyen s’élevait à 36,3 kg/m2 (fourchette : 31,5 à 40 kg/m2), et la durée moyenne du suivi était de 3 ans (fourchette : 12 mois à 5 ans). ConclusionLes résultats démontrent que chez les patients dont l'HII est asymptomatique, l’évolution peut être variable et, malgré l'absence initiale de symptômes, avoir des effets oculaires non négligeables. Au fil du temps, l'affection peut devenir symptomatique ou entraîner un œdème continu ou une pâleur persistante du disque optique, même si le patient prend un médicament en vue d'abaisser sa PIC. Il s'agit, que l'on sache, de la toute première étude rétrospective à se pencher sur l’évolution clinique de l’œdème papillaire secondaire à l'HII chez des sujets asymptomatiques.

Clinical characteristics and clinical course of myelin oligodendrocyte glycoprotein antibody-seropositive pediatric optic neuritis

PurposeTo investigate the ophthalmic and neurological features of myelin oligodendrocyte glycoprotein antibody seropositive optic neuritis (MOG-ON) in pediatric patients. MethodsWe analyzed the clinical data and orbital magnetic resonance images of patients aged below 15 years, diagnosed with MOG-ON at our institution (n = 40). ResultsThe mean age at first ON onset was 7.7 ± 3.1 years, and 26 (65.0%) patients were girls. Twenty-three patients (57.5%) experienced bilateral ON, and ten (25.0%) had recurrent ON. Pain on eye movement was present in 30.6% of the eyes. In the acute stage, optic disk swelling and peripapillary hemorrhage was found in 82.6% and 15.2% of the eyes, respectively. In the chronic stage, optic atrophy was noted in 91.5% of the eyes. Although mean visual acuity (VA) at nadir was 1.72 ± 0.66 logMAR, all patients experienced visual improvement of ≥0.3 logMAR, and the mean final VA was 0.05 ± 0.14 logMAR. Twenty-one patients (52.5%) had other demyelinating diseases during the disease course (ON plus group), while 18 patients (45.0%) had experienced ON without other demyelinating disease (isolated ON group). Pain (19.4% vs. 38.5%, p = 0.098) and perineural enhancement (3.3% vs. 21.7%, p = 0.036) were less frequently observed in ON plus group. ConclusionsPediatric MOG-ON has distinct clinical features, such as infrequent pain and perineural enhancement. Although optic atrophy is commonly observed, visual function is retained in most patients. A multidisciplinary approach and long-term follow-up are required for pediatric MOG-ON, since CNS involvement is more common than ON recurrence.

REMARKABLE RESULT TOWARDS RETINOPATHY ASSOCIATED AUTOIMMUNE HEMOLYTIC ANEMIA

Introduction: To present the clinical findings of Autoimmune hemolytic anemia (AIHA) Retinopathy and its rapid resolutions following treatment with steroid. &#x0D; Case report: A 14-year-old female patient presented with decreased vision in the left eye. There was history of AIHA. Visual acuity was 1/60 in LE and 6/6 in RE. There was conjunctival pallor, and the other anterior segment were unremarkable. Fundus examination of left eye revealed flame shaped and dot blot hemorrhage, roth’s spots, optic disc swelling, venous turtuosity, and elevated macula. There were afferent pupil defect, red green deficiency, and contrast sensitivity decline. Hematological evaluation revealed anemia. A MRI Head and Orbital examination were unremarkable.&#x0D; Discussion: This patient was assessed with LE Anemic retinopathy due to AIHA. The patient’s visual acuity improved as the retinopathy resolved after 1 month of oral steroid therapy.&#x0D; Conclusion: Anemia may play a role in the occurrence of retinopathy. The diagnosis of retinopathy can be made by linking ophthalmic fndings with positive serological test. Accurate comprehensive examination can establish the systemic diagnosis, and control of systemic parameters will improve retinopathy, reverse vision loss, and avoid permanent blindness

Хронічний нейробореліоз із синдромом церебральної псевдопухлини (клінічне спостереження, обговорення)

У статті описується клінічний випадок хронічного нейробореліозу із синдромом церебральної псевдопухлини в пацієнтки 30 років, яка звернулася зі скаргами на головокружіння, двоїння в очах, зниження гостроти зору на обидва ока, відчуття «туману перед очима», постійний головний біль (7–8 балів за візуальною аналоговою шкалою), порушення сну. За 5–6 місяців до початку захворювання, протягом літнього періоду, неодноразово були укуси кліщів із почервонінням шкіри, за медичною допомогою не зверталася. Хворіє упродовж останніх 1,5 місяця, коли без видимих причин з’явився головний біль, 1 місяць тому почала відмічати зниження зору, двоїння в очах. У неврологічному статусі: ураження лівого відвідного нерва. МРТ головного мозку — симптом порожнього турецького сідла, сплющення заднього полюса склер, звивистість зорових нервів. Окуліст: гострота зору правого ока — 0,3, лівого ока — 0,8, набряк диска зорового нерва обох очей. Аналіз ліквору: тиск 300 мм вод.ст. (при люмбальній пункції в положенні лежачи), загальний білок — 0,198 г/л, цитоз — 5 в 1 мкл (лімфоцити), протибореліозні IgG — 38,15 од/мл, IgM — 5,61 од/мл. Відразу після люмбальної пункції пацієнтка відмітила значне зменшення головного болю та двоїння в очах. Індекс лікворно-сироваткових протибореліозних IgG — 1,2. Установлений діагноз: хронічний нейробореліоз із синдромом церебральної псевдопухлини, з ураженням лівого відвідного нерва та зоровими порушеннями. Лікування: цефтріаксон, реосорбілакт, цитиколін, ацетазоламід, мелатонін, фенібут. Від повторних люмбальних пункцій пацієнтка відмовилась. За час стаціонарного лікування стан хворої покращився: зменшилися головні болі (до 3–4 балів за візуальною аналоговою шкалою), зникло двоїння в очах, відновилися в повному обсязі рухи лівого очного яблука, зменшився набряк дисків зорових нервів. Пацієнтка через 3 місяці телефоном повідомила про відсутність будь-яких скарг, окрім зниження зору. Таким чином, у пацієнтів із синдромом церебральної псевдопухлини серед потенційних етіологічних чинників захворювання необхідно виключати в тому числі і хворобу Лайма.

Clinical Profile of Unilateral Disc Edema: A Cross-sectional Study

Background and Aim: Optic disc swelling is due to arrest or obstruction of axoplasmic flow at the lamina cribrosa.It may be due to various pathological conditions like ischemia, infiltration, inflammation, compression, metabolic andtoxic damage. In this study, the clinical profile of each case of unilateral disc edema was analysed in relation to age ofpresentation, gender, systemic association, risk factor and prognosis.Material and Methods: The present study was done in the department of ophthalmology, medical college and hospital.The patients with the unilateral disc edema were included in the study. Visual acuity was measured using Snellen’s acuitychart and converted to logmar for the purpose of statistical analysis. Intraocular pressure was recorded. Colour visionwas recorded using ishihara chart. Routine blood investigations were done. Radiological imaging was done.Results: Females are affected more commonly compared to males in the study group. The commonest cause for unilateraldisc edema is nonarteritic AION and the next common cause is optic neuritis. Compressive disc edema, inflammatory discedema and neuroretinitis are the other conditions causing unilateral disc edema. In this study 60 % of the persons showeddisc pallor on follow up and 40 % of person showed normal fundus. 66.67 % of patients of NAION had disc pallor onfollow up. MRI BRAIN in NAION showed small vessel ischemic changes in 6.67% of persons which indicates the ischemicchange were also noted in brain.Conclusion: If a patient with unilateral disc swelling presents to neuroophthalmology clinic, NA-AION and ON shouldbe considered first in the differential diagnosis. Other causes of disc edema should not be missed.

Ocular morbidity among adult patients with chronic leukemia presenting to tertiary hospitals in Jos, North-Central Nigeria

Background Chronic leukemia is the most common leukemia subtype seen among adults in Jos, Nigeria, with few reported isolated cases of ocular morbidity. There are no published comprehensive data on adult leukemic ophthalmopathy from this region. Aim The aim of this study was to determine the prevalence, pattern, and causes of visual impairment (VI) among adult patients with chronic leukemia in Jos, North-Central Nigeria. Patients and methods The study included adult patients diagnosed with either chronic myeloid leukemia or chronic lymphocytic leukemia, confirmed by bone marrow biopsy, in two tertiary hospitals in Jos, North-Central Nigeria, between January 2016 and June 2017. Visual acuity was assessed and categorized using the International Classification of Diseases. Detailed ocular examination was carried out and causes of vision loss were noted. Results A total of 104 eyes of 52 patients were examined within the study period. The mean age of the patients was 45±17.7 years, and 35 (67.3%) patients were males. The majority (63.4%) of the participants had chronic myeloid leukemia. Ocular disorders were present in 32 (61.5%) of all patients, and 10 (19.2%) patients were visually impaired. Of these, nine (90.0%) had moderate VI due to refractive errors, cataract, glaucoma, and disk swelling; and one (10.0%) person was bilaterally blind from exudative retinal detachment and vitreous hemorrhage. Only 27% of all causes of VI were leukemia specific and included disk swelling, exudative retinal detachment, and vitreous hemorrhage. Conclusion Although ocular disorders were frequent among adults with chronic leukemia in Jos, the magnitude of vision loss from chronic leukemia-specific ocular disorders was low.