Incidence Of Visual Field Defects Research Articles

Hypometabolism in the Posteromedial Temporal and Medial Occipital Cortex on Preoperative 2-Deoxy-2-(18F) Fluoro-D-Glucose Positron Emission Tomography Suggests Exacerbation of Visual Field Defects After Surgery for Temporal Lobe Epilepsy: A Retrospective Long-Term Follow-Up Study

ObjectiveSurgery is a good treatment option for drug-resistant temporal lobe epilepsy (TLE). 2-deoxy-2-(18F) fluoro-D-glucose (FDG) positron emission tomography (PET) is used to detect epileptic foci as hypometabolic lesions in presurgical evaluation. Visual field defects (VFDs) in the contralateral homonymous upper quadrant are common postoperative complications in TLE. This study aimed to quantify VFDs using pattern deviation probability plots (PDPPs) and examine the effect of hypometabolism in FDG-PET on VFDs. MethodsThis study included 40 patients. Both visual fields were assessed using the Humphrey field analyzer (HFA) preoperatively and 3 months and 2 years postoperatively. PDPPs with <0.5% confidence level counted in the contralateral homonymous upper quadrant. FDG-PET results were compared between groups with (15 patients) and without (24 patients) hypometabolism in the optic radiation. ResultsAll 40 patients were evaluated by HFA at 3 months postoperatively and 39 at 2 years postoperatively. The incidence of VFDs 3 months postoperatively was 35/40 (87.5%), and 17/40 (42.5%) patients had severe VFDs. In cases of surgery on the left temporal lobe, ipsilateral eyes appeared to be more significantly affected than contralateral eyes. VFDs were more severe in patients with FDG hypometabolism than in those without hypometabolism in posteromedial temporal and medial occipital cortex (P < 0.01); however, 85% of patients with FDG hypometabolism had a reduced VFD 2 years postoperatively. ConclusionPDPP counting is useful for quantifying VFDs. Preoperative dysfunction indicated by preoperative FDG-PET in the posteromedial temporal and medial occipital cortex could enhance VFDs early after TLE surgery.

Five years follow-up of juvenile lupus nephritis: a single-center retrospective cohort study.

We analyze the clinical manifestations and 5 years of follow-up outcomes of children with lupus nephritis (LN) and provide a reference for clinicians. The clinical data of children diagnosed with LN (n=62) from January 2012-2015 were collected and analyzed. The median age at the diagnosis was 12.0 years. The female to male ratio was 3.4:1. The most prevalent clinical features were mucocutaneous involvement and hematological involvement. Renal biopsy was performed on 38 patients. Class IV and class V were the most common findings. The lupus activity was improved markedly after 3 months treatment. The rate of survival was 98.3% in 5 years. The most common side effects of corticosteroid and other immunosuppressive agent drug treatment were corticosteroid-related hypertension and high intraocular pressure. The rate of cataracts, osteoporotic fracture, and visual field defects increased as the treatment progressed. Especially, the incidence of visual field defects in children is higher than adults. The LN children showed a good prognosis. During the follow-up process, the adverse drug reactions, such as hormone-related hypertension and ocular hypertension, especially the visual field defects caused by hydroxychloroquine, cannot be excluded. However, multicenter long term follow-up studies are essential to substantiate the current data.

The incidence of neovascular membranes and visual field defects from optic nerve head drusen in children

To evaluate the incidence of visual field defects and choroidal neovascular membranes (CNVM) in a cohort of pediatric patients with optic nerve head drusen (ONHD). The medical records of children with ONHD seen at a single center from January 2012 to July 2014 were retrospectively reviewed to identify patients who had a dilated fundus examination, fundus photography, spectral domain optical coherence tomography (SD-OCT)/enhanced-depth imaging (EDI) of the optic nerve head (ONH), SITA fast 24-2 Humphrey visual field (HVF) testing, lumbar puncture, and ocular ultrasound. A masked neuro-ophthalmologist analyzed fundus photographs, OCT, and fields. Retinal nerve fiber layer (RNFL) data were compared to age-matched controls. A total of 52 children (98 eyes) were included. Mean age was 10.8±3.3years. Of these, 42 patients had visual fields (57 eyes deemed reliable), and 19 eyes had documented visual field deficits (8 were reproducible across ≥1 sitting [frequency 14%]). After correction of plotting errors (40 eyes), RNFL thickness was 111.9±17.9μm. CNVM were present in 24 of 98 eyes (24.5%), with 21 of 24 located nasally (87.5%). Neither RNFL thinning nor identification of ONHD on fundus photography correlated with the presence of visual field defects. Visual field defects due to ONHD can be reliably identified in children. In eyes of children with ONHD, RNFL protocol is frequently unreliable and may overestimate RNFL thickness. EDI scans through the ONH revealed peripapillary CNVM in nearly a quarter of the patients. Further longitudinal studies looking at the progression of CNVM and visual field deficits are warranted.

Fixed combination of latanoprost and timolol vs the individual components for primary open angle glaucoma and ocular hypertension: a systematic review and meta-analysis.

To assess the effects of the fixed combination of 0.005% latanoprost and 0.5% timolol (FCLT) vs their individual components for primary open angle glaucoma (POAG) and ocular hypertension (OHT). After searched PubMed, EMBASE, the Cochrane Library and SCI, all randomized controlled clinical trials (RCTs) and cross-over studies were included. The control groups were the mono therapy or the concomitant therapy of latanoprost and timolol. The outcomes were visual field defect, optic atrophy, mean intraocular pressure (IOP) and IOP fluctuation. The analysis was carried out in RevMan version 5.1 software. The post-intervention mean IOP of FCLT was significantly lower compared to timolol [mean difference (MD) -2.92, 95%CI -3.28 to -2.55, P<0.00001] and latanoprost (MD -1.11, 95%CI -1.51 to -0.72, P<0.00001). The post-intervention IOP fluctuation was also significantly lower compared to timolol (MD -0.88, 95%CI -1.23 to -0.53, P<0.00001) and latanoprost (MD -0.63, 95%CI -1.04 to -0.22, P=0.002). The mean IOP was higher in FCLT morning dose group than the one in unfixed combination of 0.005% latanoprost and 0.5% timolol (UFCLT) (MD 1.10, 95%CI 0.81 to 1.39, P<0.00001). Otherwise, there was no difference between FCLT evening dose group and UFCLT (MD 0.34, 95% CI -0.01 to 0.69, P=0.06). There was no statistical difference for the incidence of visual field defect and optic atrophy between FCLT and the monotherapy of components. A better IOP lowering effect has been demonstrated for FCLT compared to the mono therapy of components. The IOP lowering effect was worse for FCLT morning dose and almost same for FCLT evening dose compared to the UFCLT. We need more long-term high quality RCTs to demonstrate the outcomes of visual field defect and optic atrophy.

Analysis of the impact of anterior temporal lobectomy on visual field in temporal lobe epilepsy patients with diffusion tensor imaging

Objective Anterior temporal lobectomy（ATL） for temporal lobe epilepsy （TLE） is the most commonly performed epilepsy surgery procedure.A visual field defect（VFD） due to the injury to the optic radiation may occur after ATL.DTI technique can visualize the optic radiation （OR） noninvasively.This study aimed at evaluating the incidence of VFD after ATL and investigating whether the resection size of lateral ATL correlated with the extent of VFD.We tried to explain the impact of ATL on the OR and to investigate the anterior extending of Meyer loop with DTI technology.Method 25 patients（ 14male, 11 female） underwent ATL for treatment of epilepsy.The patients were aged from 13 to 39 years old （ mean age：22.4 yrs）.All cases were classified into three groups on the basis of the severity of VFD（ A ～ C,with group C the most severe）.All patients had preoperative and follow up clinical and MRI（ including DTI series） examinations.The clinical and MRI（DTI） outcomes of these patients were retrospectively analyzed.Results At mean follow up period of 31.3 weeks （ range, 17 - 42 weeks）, we found 22 patients become quadrantanopia due to the injury to OR after ATL.A significant reduction of fractional anisotropy was demonstrated in the OR on the side of the temporal lobectomy.The severity of VFD decreased according to the reducing of the mean resection size（group A, 31.1 mm;group B 42.5 mm;C, 50.4 mm）, P ＜0.05.There was linearship between the resection size and the FA decrease.Conclusions VFD due to the injury to the OR was not uncommon after ATL There was an association between the resection size and severity of VFD.Optic radiation showed a decreased FA value in cases after ATL.There is considerable intersubjective variance about the OR, so it is necessary to get the patient＇s DTI information about the OR before the operation ,which could help to assess the preoperative risks. Key words: Epilepsy; Anterior temporal lobectomy; Optic radiation; Visual field defect; Diffusion tensor imaging

Charles Bonnet syndrome in hemianopia, following antero‐mesial temporal lobectomy for drug‐resistant epilepsy

Charles Bonnet syndrome (CBS) is a disorder characterized by the occurrence of complex visual hallucinations in patients with acquired impairment of vision and without psychiatric disorders. In spite of the high incidence of visual field defects following antero-mesial temporal lobectomy for refractory temporal lobe epilepsy, reports of CBS in patients who underwent this surgical procedure are surprisingly rare. We describe a patient operated on for drug-resistant epilepsy. As a result of left antero-mesial temporal resection, she presented right homonymous hemianopia. A few days after surgery, she started complaining of visual hallucinations, such as static or moving "Lilliputian" human figures, or countryside scenes, restricted to the hemianopic field. The patient was fully aware of their fictitious nature. These disturbances disappeared progressively over a few weeks. The incidence of CBS associated with visual field defects following epilepsy surgery might be underestimated. Patients with post-surgical CBS should be reassured that it is not an epileptic phenomenon, and that it has a benign, self-limiting, course which does not usually require treatment.

Nonarteritic anterior ischemic optic neuropathy and ‘visual field defects’ following vitrectomy: could they be related?

Visual field defects after uncomplicated vitrectomy have been reported but poorly explained. We describe two cases of nonarteritic anterior ischemic optic neuropathy (NAION) observed following vitrectomy. We also reviewed the literature for cases of post-vitrectomy visual field defects for evidence of optic nerve damage. Two patients developed optic disc edema and features of an optic neuropathy after uncomplicated vitrectomy for macular hole and epiretinal membrane. A systematic literature search was conducted to obtain prior reports of visual field defects or ischemic optic neuropathy following vitrectomy. Additional studies were identified from the bibliographies of the retrieved articles. The incidence of visual field defects following vitrectomy has varied from 1-71% across all studies. Overall, we found 160 (14.5%) cases of unexplained visual field defects following vitrectomy out of 1,104 patients. Of these, 31 eyes (19.4%) have shown some sign of optic nerve damage following vitrectomy, including pallor in 29 eyes, relative afferent pupillary defect in eight eyes, and intrapapillary hemorrhage in two eyes. NAION may develop following vitrectomy. "Visual field defects" following vitrectomy are common and many of the involved eyes demonstrate evidence of optic nerve damage, some of which may have represented NAION.

Moderate to severe obstructive sleep apnoea patients is associated with a higher incidence of visual field defect

To compare the visual fields (VFs) and optic nerve head changes between obstructive sleep apnoea (OSA) in normotensive patients and an age-matched non-OSA population. Case-control study. A total of 41 ethnic Chinese patients diagnosed with moderate to severe OSA referred from the Sleep Laboratory, ENT Department, Tuen Mun Hospital. A total of 35 age-matched non-OSA subjects recruited from the Ophthalmology Department, North District Hospital. Comprehensive ophthalmological and systemic history, complete ophthalmological examination, including central-30 computerized perimetry for all studied patients. Polysomnographic data, VF indices, optic disc changes. In the OSA arm, VF indices were significantly subnormal and the incidence of suspicious glaucomatous disc changes was four times higher than that of the control arm. None of the studied patients suffered from any form of anterior segment complications. Moderate to severe OSA is associated with a higher incidence of VF defect and glaucomatous optic nerve changes.

Functional outcome of macular hole surgery with and without indocyanine green-assisted peeling of the internal limiting membrane.

To describe the impact of indocyanine green (ICG) staining of the internal limiting membrane (ILM) on the functional outcome of anatomically successful macular hole surgery by comparing consecutive patient series with and without ILM staining. Eighteen consecutive patients who had undergone ICG-assisted vitrectomy (0.05%) for idiopathic macular hole were retrospectively analysed (visual acuity, gain in lines, Goldmann perimetry) and compared with two consecutive series of patients who had undergone macular hole surgery without the use of ICG immediately before (n=22) and after (n=17) the introduction of ICG in our institution. The osmolarity of the ICG solution applied was 275 mosmol, pH was 7.5. Although there was no statistically significant difference in duration of preoperative symptoms (P>0.3) and preoperative visual acuity (P>0.5), the functional outcome in patients after ICG-assisted vitrectomy was significantly lower (P<0.001 for visual acuity). The incidence of visual field defects was 50% (9/18) in patients after ICG application. Our findings suggest potential damage to the neurosensory retina in association with the intraoperative administration of the ICG solution. Whether this is caused by toxic effects of the dye itself, mechanical trauma to the retina or other mechanisms remains unknown.

Visual field deficits in conventional anterior temporal lobectomy versus amygdalohippocampectomy. Egan RA, Shults WT, So N, Burchiel K, Kellogg JX, Salinsky M. Neurology 2000;55:1818–1822.

Visual field defects occur frequently after temporal lobe surgery for epilepsy because of the location of the optic radiations in the temporal lobe. The traditional surgery employed is anterior temporal lobectomy (ATL), often resulting in contralateral homonymous superior quadrantanopias. Another surgical procedure, amygdalohippocampectomy (AH), solely removes the epileptogenic mesial temporal lobe structures including the hippocampus, uncus, and amygdala, presumably sparing the lateral temporal lobe anatomy and, hence, the optic radiations. The objective of this study was to evaluate and identify the incidence of visual field defects after ATL versus AH. All patients had intractable seizures and mesial temporal sclerosis, small tumors localized to only the uncus, amygdala, or hippocampus, or no known pathology. Post-operative kinetic field testing using the 14e isopter on a Goldmann perimeter was performed 30 days or more after surgery. Of 29 patients examined, 14 underwent AH and 15 had ATL. Four of 14 AH patients (28%) had a visual field defect at 10 degrees from center and 11 of 14 (78%) had a visual field defect at 40 degrees. One of 15 ATL patients (7%) had a visual field defect at 10 degrees from center and 11 of 15 (73%) had a visual field defect at 40 degrees. There was no significant difference between surgery types. Although it was hoped that AH would cause fewer or no visual field defects when compared with ATL, this was not the case. The mechanism of injury from both procedures is presumably direct trauma to the optic radiations while accessing the mesial temporal lobe structures. Interestingly, all patients in the study were asymptomatic for their visual field defects.—Nancy J. Newman

Visual field defects with vigabatrin: epidemiology and therapeutic implications.

Vigabatrin is an antiepileptic drug (AED) that acts as a selective irreversible inhibitor of gamma-aminobutyric acid (GABA) transaminase. In 1997, 3 cases of severe symptomatic and persistent visual field constriction associated with vigabatrin treatment were described. During 1997 to 1998, similar concentric visual field constrictions were described in patients with drug-resistant epilepsy who were receiving vigabatrin concurrently with other AEDs. However, a study of patients treated with vigabatrin monotherapy alone showed that there was a causal relationship between vigabatrin treatment and the specific bilateral concentric visual field constriction. The Marketing Authorisation Holders survey (involving 335 vigabatrin recipients aged >14 years) indicated that 31% of patients [95% confidence interval (CI) 26 to 36%] had a visual field defect attributable to vigabatrin, compared with a 0% incidence of visual field defects (upper 95% CI 3%) in an unexposed control group. Other studies in adults have given similar overall prevalences, with a total of 169 of 528 patients diagnosed with vigabatrin-associated field defects (32%, 95% CI 28 to 36%). Male gender seems to be associated with an increase in the relative risk of visual field loss of approximately 2-fold. The pattern of defect is typically a bilateral, absolute concentric constriction of the visual field, the severity of which varies from mild to severe. Data gathered so far suggest that the cumulative incidence increases rapidly during the first 2 years of treatment and within the first 2 kg of vigabatrin intake, stabilising at 3 years and after a total vigabatrin dose of 3 kg. The prevalence of vigabatrin-associated field defects seems to be lower in children, but there are also methodological problems and greater variability in the assessment of visual fields in children. There is particular concern that the increased risk of the visual field defects will outweigh the benefit of the drug in patients who could be controlled with other AEDs. Vigabatrin should currently be used only in combination with other AEDs for patients with resistant partial epilepsy when all other appropriate drug combinations have proved inadequate or have not been tolerated. Regular visual field testing should be performed before the start of treatment and at regular intervals during treatment. Patients with pre-existent visual field defects due to other causes should not be treated with vigabatrin. Currently, the benefits of treating infantile spasms with vigabatrin monotherapy seem to outweigh the risks, but further prospective studies and follow-up of children receiving treatment are needed to evaluate the place of vigabatrin in this indication.

Visual field defects and other ophthalmological disturbances associated with vigabatrin.

Vigabatrin has been an important anticonvulsant drug for over 10 years with a reputation for high efficacy and excellent tolerability. However, since 1997, there have been over 25 reports in the literature of visual field defects attributable to the use of this agent. Most are case reports and many have only been reported as abstracts or posters or as letters or short communications. Only a small number of papers give details of patient characteristics. Typically, case reports detail ophthalmological tests such as visual acuity, funduscopic examination, integrity of colour vision, and the nature of the field cut. Many also include various electrophysiological tests which were performed in an attempt to further describe the nature of the visual changes. In order to shed light on the mechanism underlying these visual field changes, many investigators also tested various electrophysiological parameters. However, because electrophysiological testing requires considerable expertise on the part of the technician, this could be a source of variability in results and may also pose a challenge with data interpretation. The magnitude of the problem is difficult to assess. The manufacturer's estimate of incidence of visual field defects with vigabatrin was approximately 0.1%, but incidences estimated in the literature range from 6 to 30%. Since the majority of the published data are in case report form, proof of causation is also very difficult. Two papers that used proper scientific methodology to investigate this condition suggest that vigabatrin causes these changes; however, there needs to be further studies with larger populations to answer this question definitively. There is a lack of data on the dose-response characteristics of vigabatrin and the development of visual field defects. The only available data are reports of trends that implicate duration of therapy or cumulative dose. Perhaps the most important area to elucidate is whether or not the visual field defects are reversible. Data are scare on this subject, but we can hope that data will emerge as follow-up periods become more substantial. There is a need for more complete information regarding several aspects of the mechanistic basis of visual field defects associated with vigabatrin that will allow rational clinical decision making. The treatment choices, both pharmacological and nonpharmacological, for patients with refractory epilepsy have grown substantially in the last few years. Thus, it is doubtful that the clinical positioning of vigabatrin is likely to change in the future from that of a very valuable 'niche drug', with emphasis on paediatric usage.

Effect of infusion air pressure on visual field defects after macular hole surgery

PURPOSE: A defect in the visual field is one of the serious complications of macular hole surgery. We investigated the relationship between the occurrence of visual field defect and the location of infusion cannula and air pressure during fluid–air exchange. METHODS: We studied 100 eyes from 90 patients with macular holes. All patients underwent preoperative and postoperative visual field testing. Vitreous surgery was performed in a standard three-port fashion, with surgically induced posterior vitreous detachment, fluid–air exchange, and sulfur hexafluoride gas injection. We analyzed differences in surgical methods in three groups. In group A, the infusion cannula was placed inferotemporally, and the air pressure was set at 50 mm Hg. In group B, the infusion cannula was placed inferonasally, and the air pressure was set at 50 mm Hg. In group C, the infusion cannula was placed inferotemporally, and the air pressure was set at 30 mm Hg. RESULTS: Eighteen eyes (18%) showed visual field defects after vitrectomy. The defect was always located contralateral to the infusion cannula. There was no statistically significant difference in the incidence of visual field defects in groups A and B. Decreased air pressure reduced the occurrence of visual field defects significantly (24% in group A versus 4% in group C, P = .011). CONCLUSIONS: The location of the visual field defect correlated with the location of the infusion cannula. The incidence of this visual field defect was influenced strongly by the infusion air pressure. The visual field defect may be caused by the mechanical damage of air infusion.

Prevention of visual field defects after macular hole surgery

BACKGROUND/AIMThe pathogenesis of visual field loss associated with macular hole surgery is uncertain but a number of explanations have been proposed, the most convincing of which is the effect of...

Interim report on the incidence of visual field defects in patients on long term vigabatrin therapy.

The incidence was determined of visual field defects in patients in the Prescription-Event Monitoring (PEM) study, treated for > or =6 months with the antiepileptic drug vigabatrin. Questionnaires were sent to the general practitioners of the 7228 patients in the PEM study, treated with vigabatrin for > or =6 months, to ascertain whether any serious adverse events, including changes in vision, had occurred. Ophthalmologists were asked to give the results of the perimetry tests and their opinion of the cause of the visual field defect for those patients referred to them. 6793 (94%) of the 7228 questionnaires were returned. 5090 (75%) contained clinical data. 328 patients were deceased. Seventy seven cases identified from the 4762 surviving patients, are being followed up with ophthalmologists. To date, 2 weeks after posting, 12 cases of visual field defect have been confirmed by formal perimetry tests. Ten of these 12 were considered to be probably or possibly related to vigabatrin use, giving an incidence of 2.0 per 1000 patients compared with 0.4 per 1000 patients in the original PEM cohort. These interim results show a substantial increase in the incidence of visual field defects associated with long term use of vigabatrin and demonstrate that PEM can be used to assess long latency adverse events.

Interim report on the incidence of visual field defects in patients on long term vigabatrin therapy

Interim report on the incidence of visual field defects in patients on long term vigabatrin therapy

Visual fields in patients with posterior GPi pallidotomy.

The objective of this study was to describe the incidence and types of visual field defects after posterior globus pallidus internus (GPi) pallidotomy for Parkinson's disease. The creation of the pallidotomy lesion carries a risk of damaging neighboring structures such as the optic tract. The reported frequency of visual field defects in patients after pallidotomy varies from 0 to 40%. Goldmann visual field testing was performed on 40 patients who underwent microelectrode-guided posterior GPi pallidotomy. The optic tract was identified during the procedure by listening during microelectrode recording for the evoked responses to light flashes and by assessing stimulation-induced subjective responses. After the first 18 patients, lesioning thresholds were increased from 0.5 to > or =1.0 mA so that the lesion was placed more distant from the optic tract. The location of individual lesions was determined on postsurgical MRI. Three patients (7.5%) had visual field defects likely related to the pallidotomy. These were contralateral homonymous superior quadrantanopias, associated in two patients with small paracentral scotomas. The incidence of visual field defects with the early technique was 11% (2/18) and decreased to 4.5% (1/22) after thresholds for lesioning were increased. Except for the location of the lesion relative to the optic tract (more ventral, adjacent to or extending into the optic tract), no other variable correlated with a post-pallidotomy visual field defect. Microelectrode-guided GPi pallidotomy is a relatively safe procedure as regards visual function even when the optic tract is used as a guide for lesion placement.